This month we are sharing an earlier Thought Leaders interview with Patricia Smith about compassion fatigue, given the significant impact COVID-19 continues to have on caregivers across the spectrum, from hospital staff to family caregivers. We are reminded of Patricia’s interview and wanted to share it at a time when it could be so helpful to so many.

Patricia graciously agreed to us re-running her 2017 feature article, and was kind enough to write a new introduction. Many thanks to Patricia for her continued contributions to the field and in caregiver communities! Now, let’s hear from Patricia about compassion fatigue in today’s caregiver climate.

As I write this addition to the 2017 interview on compassion fatigue and caregivers, our world is in the grips of COVID-19. This pandemic has created worldwide confusion, anger, pain and suffering. My work over the past 20 years has been focused on caregivers in all of the helping professions, and family caregivers, as well. Now, with the trauma created by the virus, I consider all of us caregivers. Who hasn’t run errands for their elderly parents? Who hasn’t shopped and delivered the groceries to their elderly, ill or disabled neighbors? Who hasn’t sewn masks to be given out to their community members? Who hasn’t worked diligently in lockdown to prepare nutritious meals for themselves and their family members? Who hasn’t advocated what’s right and life-affirming on Facebook, Twitter and other social media? These, and many more actions and behaviors, define care-giving. It is more important than ever that each one of us begin our healing process. As difficult as that is in the eye of the hurricane, it is imperative if we hope to return to a healthy level of wellness, happiness and good health. Find time in each day for authentic self-care. Take a walk in nature, paint a picture, meditate, practice yoga, listen to music that stirs your soul, bake a cake and give half to someone who is weathering the storm alone, plant a vegetable garden, or sit in silence and be thankful for the good that remains in your life. All of these strategies define and promote healing.

Stay safe. Patricia

2017 Thought Leaders Interview with Patricia Smith on Compassion Fatigue

Magellan: Thank you for taking the time to participate in our virtual interview. Can you share with our readers some background regarding your interest and leadership in the area of compassion fatigue and burnout in the mental health and wellness field?

Patricia Smith: I first learned about compassion fatigue as the training and development manager at Humane Society Silicon Valley. After many years as a journalist, I decided I wanted to work with animals. Within the first two weeks in my new job, the executive director asked me to create a shelter-wide compassion fatigue training. I had never heard the term, and the only information I could find was the academic work of Dr. Charles Figley, who was then the director of the Traumatology Institute at Florida State University. I contacted Dr. Figley and he brought me through the process of understanding exactly what compassion fatigue is and how to address the symptoms. At that same time, I took the Professional Quality of Life Self-Test (https://www.proqol.org/ProQol_Test.html) created by Dr. Beth Hudnall Stamm, who also became a mentor. The test revealed that I suffered from very high levels of compassion fatigue. This started me on a journey that has lasted the past 20 years. After several years on my own personal healing journey, I created the Compassion Fatigue Awareness Project in hopes of helping others in the helping professions to understand compassion fatigue and how high levels can devastate a caregiver’s life. The scope of my work has grown beyond anything I could have imagined.

Magellan: You have done a great deal of work looking at aspects of compassion fatigue and burnout. What have you learned over the course of this work, and what recommendations would you make to peers to support their own wellness and to avoid compassion fatigue?

Patricia Smith: My own work has dovetailed with the amazing work being accomplished by professionals such as psychiatrists and psychologists in the field of traumatology and neuroscience. Powerful new information has come about from studies of the effect of trauma on our Wounded Warriors. Post-traumatic stress disorder is now a common phrase and the understanding of trauma on the human body, mind and spirit is widespread. These studies have branched out to include brain studies and how traumatic events impact our brains – and, more important, what we can do about it.

If, indeed, a caregiver suffers a high level of compassion fatigue, which is a secondary traumatic stress syndrome, the best path to take for healing is authentic, sustainable self care. The practices that promote wellness encompass the Standards of Self-Care: nutritious food, exercise, restful sleep, highly functional relationships and replacing toxic habits (smoking, alcohol, drugs, overeating, pornography, etc.) with healthy, life-affirming habits.

Magellan: Your studies/work around compassion fatigue and personal wellness are of particular interest to our readers, given their work in peer support. How can we influence modifiable lifestyle behaviors to improve individual well-being and battle compassion fatigue?

Patricia Smith: Re-wiring our brains to successfully improve the quality of our own lives takes work – lots of work. Healing is an inside job. We must go back in time to heal the wounds we have endured throughout our lives; one of the main causes of compassion fatigue is holding unresolved pain and suffering within. This takes a toll emotionally, but is well-worth the journey. The work involved in healing our wounds is nothing compared to the time, energy and emotional pain it takes to hold them at bay. Everything that has ever happened to us lives within. Pushing down the memories or ignoring them constantly elevates levels of compassion fatigue. Every time we experience additional trauma in our lives, which today is perpetrated everywhere – Facebook, TV news, newspapers— the new trauma hooks into the trauma that already exists. This pattern continues day after day in the helping professions and, eventually, a caregiver will become paralyzed with compassion fatigue. Businesses and organizations can do their part in helping caregivers to modify their lifestyles by educating their employees about compassion fatigue and putting healthy alternatives into place. This could include an edict wherein no business (emails, texts, phone calls) is conducted on weekends or evenings, encouraging mandatory vacations, providing healthy food alternatives in the cafeteria or vending machines, creating walking or biking groups, and other positive encouragement to promote wellness.

Patricia Smith is a certified compassion fatigue specialist with 20 years of training experience. As founder of the Compassion Fatigue Awareness Project©, she writes, speaks and facilitates trainings nationwide in service of those who care for others. She has presented to caregivers in numerous helping professions including social work, health care, law enforcement, chaplain services, suicide prevention and education, among many others. She has authored several books and training materials for caregivers, including the award-winning To Weep for a Stranger: Compassion Fatigue in Caregiving. She served as the caregiving expert for Spry magazine for several years. In September 2016, she presented a TEDx talk on the subject. Additionally, she was the 2012 and 2013 recipient of a writing fellowship at the Helen R. Whiteley Center, in Friday Harbor, Washington, a scholarly research center sponsored by the University of Washington in Seattle.

This is an excerpt from the Magellan Healthcare eMpowered for Wellness September newsletter. To read the full article, go here.

As the pandemic grows, healthcare workers are experiencing a new level of stress and fear. Since our first piece about healthcare workers and mental health, the toll that COVID-19 cases have taken on them has become more difficult than any could have imagined.

First, let us again say thank you to all of you, from EMTs who answer the first calls to the doctors and nurses who tend to the sickest. Your selflessness and heroism is inspiring.

We’ve set up a counseling hotline for healthcare workers and first responders at 1-800-327-7451 (TTY 711). Your call will be answered by our licensed mental health clinicians. Our team is trained and ready to listen and help during this difficult time.

There are so many things that are out of our control. We are dependent on others to address many aspects of the big picture, but there are things outlined below that we can do for ourselves and those close to us. No single recommendation is enough by itself, but when taken together, they may help.

Talk about it

Acknowledge your anxiety, fear and grief, and talk about it.

Many of our colleagues and friends say that leaning on fellow healthcare workers is very difficult. Everyone’s heart beats a little bit faster when they greet a COVID-19-positive patient, so how can we ask them to support one another? Yet this is what we do as a medical community daily. Peer support is key.

• If a compassion fatigue group isn’t available at your workplace, work with your employer to put one together.
• If a group option isn’t available, talk to your co-workers about what you are seeing and how it is affecting you. You’ll be surprised at how many share your feelings but have been afraid to say anything. Hospital workers have talked about how a quick meeting at the beginning of their shift, during a break or at other times—to talk, pray, or have a moment of silence—has helped them tremendously.¹
• Many hospital systems have been deploying their psychiatric workforce as volunteers to help colleagues who need it.² Ask your employer if this is available.
• If you don’t want to talk about it at work, find a former co-worker or friend from school or training to talk to, or contact Magellan Healthcare at the phone number above.
• Finally, if you are at a point where your feelings impact your ability to perform or feel comfortable in your role, talk to your supervisor or your organization’s human resources group about your employee assistance programs. Monitor your physical and mental symptoms. You may reach a position that you need to be treated by a behavioral health professional. If that happens, contact one as soon as possible.

Make your voice heard

Some healthcare workers are feeling betrayed by their employers and others.² Whether it’s lack of PPE, feeling unappreciated or being expected to work excessive hours, these feelings can make an already untenable situation worse. While there is much you cannot control, don’t let that stop you from advocating for yourself and others.

• Ask for more PPE or the protocols for how it is allocated. Understanding why things are happening can help people accept them and enable you and your colleagues to offer suggestions from the front lines.
• If you are frustrated about things that you see, think about how you would make them better. Make a list and discuss them with coworkers to come up with solutions. Once things slow down, you’ll have strong suggestions for improving your work environment.

Maintain focus

• Remember why you became a healthcare worker. Maybe you watched a family member battle an illness, or you felt a calling to help people. Think about that during these times.
• Remind yourself that what you are doing is noble. The cognitive impact of recognizing the value you offer will help you serve your patients in a positive way.
• Consistent with your training and dedication, keep your focus on the patient in front of you, on protecting yourself to the best of your abilities and extending those protections to the home setting when you are off work.
• When you are off work, turn your focus to what is happening in the moment.

Take care of yourself

• We acknowledge that recommending meditation or focusing on breathing in the midst of chaos and fear may not seem helpful for some. Think about how you breathe when you are stressed. Some of us hold our breath without realizing it; others breathe very shallowly. We don’t realize it until we get around to taking a real breath.
• As you work around people with COVID-19, you might be afraid to breathe deeply. If you can, try to go to a place where you feel comfortable doing so, and take a few deep, slow breaths. Something as simple as this can release stress and clear your mind.
• Exercising may feel like a lofty goal as well. Try to find 10 minutes for a brisk walk, or a quick set of jumping jacks, sit-ups and push-ups.
• If you don’t have time or energy to cook, find easy-to-eat fresh foods like bananas, oranges and carrots.
• To help you relax and get to sleep, try apps like Headspace, Calm and Balance. AMA members can access these for free.
• Finally, if you are on medications for a pre-existing behavioral health condition, don’t stop taking them, and contact your provider if your symptoms are getting worse.

For more information and tips, visit www.MagellanHealthcare.com/COVID-19.

The COVID-19 global pandemic is taking a physical, mental and emotional toll on doctors, nurses, healthcare workers and caregivers. The long work hours and limited resources are causing overwork, exhaustion and in some cases, compassion fatigue. Not to mention balancing your work with the concerns for your own family and loved ones.

What is compassion fatigue?

Compassion fatigue is a state of chronic physical and mental distress and exhaustion. People with this fatigue often describe a negative shift in their world view and a preoccupation with the illness of others. They may experience stress and burnout, affecting their ability to be effective in their jobs and relate to their loved ones and friends.

Tips for preventing compassion fatigue:

• Make self-care a priority. Despite your workload, do your best to practice healthy habits. Focus on making sure you are staying hydrated, sleeping as much as possible, eating nutritious meals and getting exercise when you can. Follow the COVID-19 CDC guidelines on keeping yourself and your family’s risk low.
• Boost your emotional resilience. Deep breathing, meditation, being grateful and allowing yourself some down time are ways to keep your life in balance, so you are better able to handle stress, setbacks and crises.
• Get social support. Reaching out over the phone or through a text message to supportive loved ones, friends and colleagues can be a calming influence and shift your perspective on what you are dealing with every day.
• Be proud of your profession. Your work is important. You are caring for people during the first-ever pandemic caused by a coronavirus and giving them hope and strength.
• Seek professional help. If you are experiencing distress and/or symptoms of burnout, take advantage of your healthcare and employee assistance benefits and meet with a behavioral health professional who can help.

We wholeheartedly thank you for all you are doing to care for others and combat this outbreak.

For more information and tips, visit MagellanHealthcare.com/COVID-19.