PROVIDING OPTIMAL CARE TO STAFF, PATIENTS AND SELF: … Proceedings/c… · PROVIDING OPTIMAL CARE TO STAFF, PATIENTS AND SELF: COPING AND PREVENTION STRATEGIES Claudia J. Combs -Wise,

PROVIDING OPTIMAL CARE TO STAFF, PATIENTS AND SELF:

COPING AND PREVENTIONSTRATEGIES

Claudia J. Combs-Wise, ACSW, LMSW, PLLCPsychotherapist, EAGALA Equine Assisted Mental Health Specialist,

Field Instructor; Adjunct Faculty the University of Michigan School of Social WorkMichigan State University School of Social Work

Laurel Hilliker, PhD, C. P., University of Michigan-Flint

Program Manager of MPH and LEO Lecturer III

Trauma and the Brainhttps://vimeo.com/126501517 by NHA Lankshirehttp://bessel.kajabi.com/fe/71133-the-body-keeps-the-score?r=yDr. Bessel Van Der Kolk uses recent scientific advances to show how trauma literally reshapes both body and brain,

compromising sufferers capacities for pleasure, engagement, self-control, and trust.

He explores innovative treatments from neurofeedback and meditation to sports, drama, and yoga that offer new paths to

recovery by activating the brain’s natural neuroplasticity.

Signs/Triggers of Compassion Fatigue 1) Exhaustion2) Reduced ability to feel sympathy and empathy3) Anger and irritability4) Increased use of alcohol and drugs5) Dread of working with certain clients/patients6) Diminished sense of joy of career7) Disruption to world view, heightened anxiety or irrational fears8) Intrusive imagery or dissociation9) Hypersensitivity or insensitivity to emotional material10) Difficulty separating work life from personal life11) Absenteeism - missing work, taking many sick days12) Impaired ability to make decisions and care for clients/patients13) Problems with intimacy and in personal relationships14) Poor client care and low completetion rates of clinical and adminstrative duties

Resources: Professional Burnout… Jason M. Newell and Gordon A. MacNeil (pg. 59), p.45 in Rank, Zaparanick, Gentry reading

Suicide Risk Factors and Citationshttp://www.sprc.org/about-suicide/risk- protective-factorshttp://veterinarynews.dvm360.com/farewell-dr-sophia-yin

Veterinarians are four times more likely than the average person to commit suicide and twice as likely as other healthcare professionals.

https://www.avma.org/news/javmanews/pages/150401d.aspxMore than one in six veterinarians might have contemplated suicide since graduation.

The survey results, based on answers from more than 10,000 practicing veterinarians—most (69 percent) of whom are in small animal practice—revealed the following:

• 6.8 percent of males and 10.9 percent of females in the profession have serious psychological distress compared with 3.5 percent and 4.4 percent of U.S. male and female adults.

• 24.5 percent of males and 36.7 percent of females in veterinary medicine have experienced depressive episodes since veterinary school, which is about 1 1/2 times the prevalence in U.S. adults overall throughout their lifetime.

• 14.4 percent of males and 19.1 percent of females who are veterinarians have considered suicide since graduation. This is three times the U.S. national mean.

• 1.1 percent of males and 1.4 percent of females in the veterinary profession have attempted suicide since veterinary school.

Self-Assessment ScalesPatient Health Questionnaire-9: Depression

http://www.cqaimh.org/pdf/tool_phq9.pdf

Generalized Anxiety Disorder (GAD)-7: Anxietyhttp://choosenwt.com/wp-content/uploads/2014/05/Generalized-Anxiety-Disorder-GAD-7-Screening-Rev-2013.pdf

PHQ-9

1)PHQ-9 is a multipurpose instrument for screening, diagnosing, monitoring and measuring the severity of depression. (Resource: http://www.cqaimh.org/pdf/tool_phq9.pdf)

2) There are numerous depression disorders. However, the common feature of all of depression disorders is the presence of sad, empty, or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual’s capacity to function. What differs among them are issues of duration, timing, or presumed etiology (Resource: Diagnostic and Statistical Manual of Mental Health Disorders)

Resource: http://www.cqaimh.org/pdf/tool_phq9.pdf-

GAD-7Anxiety Information

1) Generalized Anxiety Disorder (GAD) is “excessive anxiety and worry (apprehensive expectation) about a number of events or activities...The individual finds it difficult to control the worry and to keep worrisome thoughts from interfering with attention to tasks at hand.” (Resource: Diagnostic and Statistical Manual of Mental Health Disorders)

2)GAD-7 is used to assess the severity of anxietyhttp://choosenwt.com/wp-content/uploads/2014/05/Generalized-Anxiety-Disorder-

GAD-7-Screening-Rev-2013.pdf

Self-Care Tools1)Block Breathing2)Mindfulness Meditation3)Calm.com4) Journaling5)Exercise6)Progressive Muscle Relaxation7)Your Safe Place - Guided Imagery 8)Hobbies9)Recreational Activities10)Other Self-Care Tools

Block BreathingBlock breathing was designed to regulate breathing to reduce traumatic stress and recharge

your body with living, flowing breath energy.Breath of Relief: Turning Compassion Fatigue into Flow by Karl LaRowe, MA, LCSW.

Retrieved fromhttps://books.google.com/books?id=GI3JaeBm0HcC&pg=PA86&lpg=PA86&dq=block

+breathing+for+compassion+fatigue&source=bl&ots=0zKoDqGqxm&sig=8Rz3qGAhw9OVx3-kANcr98bfx00&hl=en&sa=X&ved=0ahUKEwjF9OHHodnPAhUI_IMKHW1KCVEQ6AEIHDAA#v=onepage&q=block%20breathing%20for%20compassion%20fatigue&f=false

Mindfulness Meditationhttp://academicdepartments.musc.edu/ohp/employee-wellness/stress-

management/BASIC-MINDFULNESS-SCRIPT-for-blog.pdf

Mindfulness is the basic human ability to be fully present, aware of where we are and what we’re doing, and not overly reactive or overwhelmed by what’s going on around us (Resource: http://www.mindful.org/what-is-mindfulness/)<

Meditation “involves taking the time to pay attention to where we are and what’s going on, and that starts with being aware of our body” (http://www.mindful.org/what-is-mindfulness/).

Mindfulness Meditation is a technique of meditation in which distracting thoughts and feelings are not ignored but are rather acknowledged and observed nonjudgmentally as they arise to create a detachment from them and gain insight and awareness (Resource: http://medical-dictionary.thefreedictionary.com/mindfulness+meditation)

RelaxationCalm.com Exercise

Calm Application on Iphone and Android

Journaling1) Clarify your thoughts and feelings.2) Know yourself better.3) Reduce stress.4) Solve problems more effectively.5) Resolve disagreements with others.

http://psychcentral.com/lib/the-health-benefits-of-journaling/

Exercise1)Exercise.com2)Fitnessblender.com

Information on the benefits of exercise

Progressive Muscle RelaxationA script on progressive muscle relaxation

http://chs.utep.edu/wellness/wp-content/uploads/sites/8/2015/01/Progressive_Muscle_Relaxation.pdf

Information

Your Safe Place - A Guided Imagery Exercisehttp://www.unifiedcommunities.com/ucs/Visualizing-a-Safe-Place.pdf

https://www.youtube.com/watch?v=pPBxNLpOLNU

Hobbieshttps://www.bustle.com/articles/164878-11-hobbies-that-can-reduce-stress-besides-

yoga-because-we-all-need-to-unwind-sometimes1)Gardening2)Listening to Music3)Reading4)Knitting5)Dancing6)Coloring7)Playing Video Games8)Baking

Recreational Activities1)Drawing2)Painting 3)Sculpting4)Cooking5)Outdoor Activities such as hiking or camping6)Home and Family and Pets

Resources: Jason M. Newell and Gordon A. MacNeil page 62.

Other Self-Care Activities1)Utilizing Coffee and Lunch Breaks2)Setting Realisitic Goals with Regards to Work 3)Getting Adequate Sleep and Rest 4)Maintaining Positive Connections with Friends and Family5)Balanced nutrition

Resources: Jason M. Newell and Gordon A. MacNeil (page 62)

Peer Support (Hope Rounds)1)Support System2)Self-Care3)Professional and Ethical Practice

Resources: Crossroads Hospice Hope Rounds is monthly roundtable gatherings within the workplace consisting of one’s professional peers with the objective of

providing employees a “safe place” to listen, share and reflect upon experiences as a professional caregiver.

Hope Rounds mission is “[t]o provide an in-house, peer driven support system for all staff while remaining dedicated to increasing self-awareness, self-reflection and compassionate professional support to one another.”

Hope Rounds vision is “a confidential, open dialogue that shares the hospice heart.”

Note: Hope Rounds was designed for hospice workers. However, Hope Rounds can be used as a model/guideline in creating your own workplace peer support group.

Office Structure/Supports1)A Safe Room2)Team-Building Activities3)Recreational Activities4)Building Rapport with your Patients5)Utilizing Instruments such as the Maslach Burnout Inventory and the Professional

Quality of Life (ProQL) in work settings to monitor conditions of office.

Resources: Jason M. Newell and Gordon A. MacNeil page 63.

Veterinary Social Work Models1)UT-Knoxville School of Social Work and Veterinary Program

-A proposal inspired by UT-Knoxville is to work with social workers to build support groups, workshops on prevention skills and grief counseling for individual veterinarians1)Ohio State University School of Social Work and Veterinary Program

Other Resources1)Professional Counseling2)24-Hour Hotline

List the hotlines.

Suicide Hotline

Q&A