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  Compassionate Care for Hospital Staff

(© Traumatology Institute Dr. Anna B. Baranowsky, 2003)

OUR UNDERSTANDING

Caring is a quality embodied by individuals and a philosophy endorsed by a larger collective. In the best of scenarios caregivers offer skilled services with confidence and compassion, services that can make the difference between life and death. However, when care providers are impacted by conditions leading to extreme stress like those resulting from the epidemic battles with Severe Acute Respiratory Syndrome (SARS); emergency response to mass casualty or terrorist acts it becomes increasingly difficult to offer a consistent level of care. Fatigue, stress, fear, confusion, frustration, anger, burnout and compassion fatigue are only a sample of some of the responses following exposure to conditions of extreme stress. When the strain gets too intense previously dedicated staff may question their work choices and even choose to leave their jobs or change occupations. Complicating the stress that critical events place on hospital staff are systemic issues such as financial burdens that may lead to closing programs or terminating positions. Other systemic problems include communication, consistency of care, scheduling deficits, and other pressures that increase the possibility of employee dissatisfaction and staff turnover.

The most recent years have seen a significantly increased degree of strain on front line staff across hospitals settings. Reduced government funding has not only forced hospitals to increase their dependence on private donors but has also resulted in having to “do more with less’. Forced mergers and amalgamations of hospitals may provide significant savings but in the interim have, in many cases, caused increased costs and workloads. As a result, many responsibilities, previously assigned to one level of hospital worker, have been redistributed to remaining staff, often resulting in overload. Because of funding restrictions, individuals now accountable for completing more or new work can feel that they are not adequately compensated for their new levels of responsibility.

Clearly, this situation has been further compromised by the introduction of the stress of dealing with the critical events, communicable disease outbreaks, mass casualty events and other critical incidents. Front line workers have come to suffer, more than before, from Compassion Fatigue. Compassion Fatigue is a combination of burnout, primary traumatic stress and secondary traumatic stress. The Compassion Fatigued care provider feels overwhelmed as a direct result of their caring work. Front-line service providers are the first to recognize the real costs to their care giving work. Yet, without their continued efforts no level of hospital operations can continue to succeed.

Employees who previously might have felt challenged by their demanding jobs may now feel that they are performing in a ‘war zone’, risking personal safety. In this traumatic situation many are questioning whether this risk is worth it. Front line staff in medical facilities (RNs, health care professionals and service support staff), are usually compassionate, caring people who have chosen careers allowing them to ‘live’ their personal ‘missions’ at work. Because these people often define themselves by their care giving roles, Compassion Fatigue ‘hurts’ them more than it does other workers and interferes most significantly not only with their personal satisfaction but also with their job effectiveness. We know from the current research that the closer one is to serious illness, injury or trauma the more vulnerable one is the experiencing Compassion Fatigue (Weiss, et. al, 1995; Dunning & Silva, 1980; Durham, McCammon & Allison, 1985). In addition, a personal history of exposure to trauma further exacerbates this vulnerability (Hyman, 2001; Ghahramanlou & Brodbeck, 2000). With statistics indicating estimated lifetime exposure rates to trauma at 70% (NCPTSD, 2002) and the development of post-traumatic responses at up to 25% (Kessler, et. al., 1995; Kulka, et. al., 1990) this is not something easily screened out. However, there are programs that are showing promise in dealing with the complex issues arising from work in the front line (Gentry & Baranowsky, 2002).

In the rewarding field of hospital work, front line workers can become overtaxed and burdened as a direct result of their care giving. In this high-demand field, supervisors, managers, human resource and support staff may feel the effects of this care giving work both directly and secondarily.

An excellent example of this is outlined in a 2001 report which suggests that working in the health care field has a direct impact on wellness. The Canadian Institute for Health Information (CIHI) produced a recent report “Canada’s Health Care Providers” that illustrates this point (November 2001).

Key points include:

  • In 2000, health care workers were one-and-a-half times more likely to miss work as a result of disability or illness than workers from other sectors.
  • 7.2% of health care workers missed work each week stating health issues as the reason for absenteeism. This number is 2.4% larger than that of other workers (4.8% absenteeism per week for health reasons).
  • In 2000, workers from the health care industry took an average of 11.8 days each as a result of disability or illness. This compares to 6.7 days for those in other occupations.
  • The report recognizes that the equivalent time of 13,700 full-time employees could be saved if average absenteeism reduced to that of other occupations.
  • In addition, Statistics Canada (1999) reports that those in the health care professions report lower feelings of satisfaction than those in other fields (85% health care workers compared to 90% in non-health care fields report feeling satisfied or very satisfied).

In another Canadian study, (www.nursesunion.mb.ca/report/burnout.htm) nurses from the province of Manitoba reported multiple physical and emotional symptoms including:

Approximately,

  • 47% reported experiencing three or more burnout symptoms
  • 55% suffer from feelings of exhaustion
  • 25% suffer from symptoms of depression
  • 60% report sleep disruptions or disorders
  • 26% report work related injuries
  • 23% report stomach ailments
  • 55% suffer from headaches

There are significant rewards to work in hospital settings. There are also significant pressures including Compassion Fatigue. Making self-care a commitment at both the individual and organizational level brings hope to individuals who have dedicated themselves to helping others. If sustainability is the goal, then the key may be taking steps to reinforce wellness and resiliency. This may make the difference between Compassion Fatigue and Compassion Exhilaration!

Caring for health care professionals makes good sense on many levels including: personal, professional, organizational, productivity and economic functioning.

Hospitals are in an excellent position to lead the way in developing and be seen to be promoting a broadly based Compassion Care Program for employees. Hospital management can adopt new processes allowing them to aid their staff to overcome current difficulties and be proactive in preparation for future demands expected with the arrival of the next crisis. A resilient staff can draw from reserves built during less demanding times or from new skills developed after critical events. Hospitals require programs that will meet the short and longer-term needs of individual employees while at the same time recognizing the, broader, systemic issues which must be addressed. These broader systemic issues include matters such as:

  • Communication
  • Structure
  • Management
  • Inter-campus consistency
  • Employee retention
  • Program closure
  • Compensation (including rewards and recognition)
  • Work refusal

These issues must be addressed with due consideration to the current organizational culture as well as a healthy workplace model outlined as a long-term goal.

Skill Building Approaches

These approaches will focus on the skill development required to run the Core Compassion Care Program. Skills established at this stage will involve education of staff at various levels as well as Employee Assistance Providers who may be involved in interventions and thus require understanding of the Compassion Care Program. Most courses and materials can be provided through our online training portal at www.ticlearn.com

Core Compassion Care Program

Below are the components required for application of the Compassion Care Program.

  1. E.A.R. Field Trauma Model (T.I. Exclusive)
    • This program can be implemented by educating E.A.P. representatives to initiate or by exclusive service provision through the Traumatology Institute.
  2. Communication Enhancement - Clearing the Lines (T.I. Exclusive)
    • Training in the “Feel Heard & Understood” skill set
    • Communication Drills – moving from reactivity to responding
  3. Peer Support Network (T.I. Exclusive)
    • Identify Volunteers & Team Leaders
    • Train 10/100 staff members
  4. Community & Workplace Evaluation Kit (T.I. Exclusive)
    • This program can be implemented by educating E.A.P. representatives to initiate or by exclusive service provision through the Traumatology Institute.
  5. Compassion Fatigue Resiliency and Recovery Models (T.I. Exclusive)
    • Prevention Programs for Secondary Traumatic Stress & Burnout
    • Accelerated Recovery Programs & PATHWAYS (T.I. Exclusive)
    • Individual and group intervention models
    • Management & Executive briefing
    • Small Group Consultation - 1 and 2-day Retreat Models
  6. Team Building & System Building Strategies (T.I. Exclusive)
    • Management & Executive briefing
    • Small Group Consultation
    • Individual and group intervention models
  7. Community Memorials
    • Individual and group intervention models
    • Memorials can take the form of prayer circles, erecting monuments, taking down walls, singing together, burying or burning symbols. There are many forms and few absolute rules.
  8. Compassion Fatigue & Traumatic Stress: When more is needed
    • E.A.P. Counseling & Debriefing
    • More extensive work required?
      • Trauma Therapy (T.I. Exclusive) based on Trauma Practice (2010)
        • Implemented through TI or education of E.A.P. Representatives.
      • Accelerated Recovery Program for Compassion Fatigue (T.I. Exclusive)
        • Implemented through TI or education of E.A.P. Representatives.