Video 1 How to manage compassion fatigue in caregiving
As you watch1, use this interpretation of the word ‘caregiver’ and think about the following questions. Make some notes about your thoughts.What is compassion fatigue?What sorts of symptoms do those who have compassion fatigue experience?In her talk, Patricia uses an established definition of compassion fatigue:A state experienced by those helping people or animals in distress; it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic stress for the helper.(Figley, cited in Tedx, 2017, 04:40)You may be struggling with the fact that Figley’s definition refers to helping animals as well as people. However, despite this anomaly, Patricia’s talk has much relevance for anyone with responsibility, in their personal life and/or their working life, for the wellbeing of others. Most notably, caring too much can be damaging. When caregivers focus on others without practising self-care, and don’t receive appropriate support from those around them or working with them, destructive behaviours can surface. Apathy, isolation, bottled-up emotions and substance abuse head a long list of symptoms associated with compassion fatigue.Part BNow watch the second instalment of Patricia’s TEDx talk below, from 8:29 to the end of the video.
Video 1 How to manage compassion fatigue in caregiving
Make notes in response to the following questions:What are the causes of compassion fatigue?What can be done to alleviate the symptoms of compassion fatigue?While the effects of compassion fatigue can cause pain and suffering, learning to recognise and manage its symptoms is the first step towards healing. With the right support and management, caregivers can achieve their goals, carry out their roles, stay well and live fulfilled lives. A key and very important message in this short exploration of compassion fatigue is that those with responsibilities for others in health and social care not only need to know how to deal with stress in those they manage and/or care for, but also need to be aware of their own individual signs of compassion fatigue.2.1 Individual responsesPatricia (in the video in the previous section) talks about resilience in individuals’ responses to stress; different people are affected by stress and anxiety in different ways and are resilient or able to cope with these feelings to differing extents. This suggests that any consideration of stress should be contextualised within the specifics of the individual. This is what you will do in the next activity, by measuring your own levels of stress and assessing your resilience.You might wonder how abstract things like stress levels and resilience can be quantified accurately. To complete this part of the activity, you will be using a ‘stress scale’ developed by psychiatrists Thomas Holmes and Richard Rahe. Holmes and Rahe surveyed a large sample of participants to help determine the stress impact of certain major life events. In 1967, they developed the Social Readjustment Rating Scale (SRRS) – more commonly known as the Holmes and Rahe Stress Scale – a list of 43 of what they deemed to be life’s most stressful events, each with a score to indicate the level of impact. The most stressful event on this scale has a score of 100, while the least stressful event has a score of 11. In the following activity, you will go through the inventory for yourself to get an idea of the level of stress that you may have encountered. Activity 3 Stress and resilienceAllow about 1 hour 15 minutesPart AUse an internet search engine (e.g. Google or Bing) to locate an online version of the Holmes and Rahe inventory (Holmes and Rahe, 1967), and use it to measure your stress levels.Simply go through each of the events that have happened to you in the last year and add up the score for each one. If you experienced the same event more than once, add the score again for each extra occurrence of the event to improve the accuracy of your score. For guidance, see the Holmes and Rahe Stress Scale information on the Mind Tools website. Once you have completed this, make a note of your results.Answers will vary, because all our circumstances are different. For illustrative purposes two colleagues completed the Holmes and Rahe inventory. Colleague A had a score of 136, the change with the ‘most weight’ (i.e. item closest to the top of the list) was ‘Death of a close family member’, which is a stressful event. Given that these colleagues completed the inventory during the COVID-19 global pandemic it was not surprising that both had a ‘change in work hours or conditions’ and ‘change in number of family get together’. Colleague B scored 145 and noted ‘Marital separation’ was a significant stress for them. Both had scores in the ‘low’ stress range, even during the COVID-19 pandemic, with total scores below 150. Scores up to this threshold of 150 are still indicative of potential challenges that might require further support or assistance from others, even if this is informal from friends and family members.There is advice for those using the inventory who wish to quantify their chances of experiencing stress. For example:if a person has fewer than 150 life change units they have a low risk of illness.150–299 life change units equates to a moderate risk of illness.over 300 life change units means a person has a high risk of illness. (The Mind Tools Content Team, no date)As you will have found, measuring stress is not a science and people vary in their responses to the same situation. In helping others to develop their resilience, we should lead by example by being self-aware and emotionally intelligent in our relationships with others. Others’ wellbeing can be supported by adopting an honest, open manner and acknowledging the very personal way we all deal with stress and anxiety.Part BHow resilient are you? Complete the simple resilience test we have devised. Select the tick box next to any of the following statements that you feel apply to you. Completing the resilience test should give you a very rough estimate of how well you cope – being dependent, of course, on the honesty of your responses!
Resilience test
Part A and Part B are both based on surveys, and while it is interesting to do them, you will appreciate that there is a subjective element in both and they may produce conflicting results leading to further questions! For example, you may have scored high in the first survey and high in the second, indicating that even though you may have had a number of major life events that are considered stressful, you perceive yourself as being resilient. This brings into question Holmes and Rahe’s estimates of your chances of suffering from stress and stress-related illness.Whatever the differences between people – as discussed in the sections of the reading you read in Activity 1 – anyone can suffer from stress and anxiety because of personal and organisational factors. You will now look at these factors in Sections 3 and 4.3 Personal causes of stressIn this section you will be invited to complete four activities to encourage you to explore the personal causes of stress, as these apply to the ‘industry’ of health and social care, drawing on a case study. Specifically, the activities ‘It wasn’t like this before’, ‘Finding a way forward’, ‘The manager’s lot’ and ‘Time management’ primarily as these apply to the case study of Lakshmi and Angelique.The stress that people are experiencing in their own lives can impact on them and their behaviour in a work situation. For the next few activities, you will be engaging with a case study about a woman called Lakshmi and her return to work following the death of her mother. Box 1 Stress in the workplace: a health and social care case studyLakshmi lives and works in Leicester and has been an Occupational Therapist for her local NHS Trust for 15 years. She has always enjoyed her job, gets on well with other team members and has a really good relationship with her manager, Angelique. She is married, has a teenage son and lives a short drive from the office. Her family lives nearby. Sadly, her mother died from cancer in 2019, only six months after her initial diagnosis. Following the death, Lakshmi took two weeks off work. Upon her return she had her back-to-work interview, during which Angelique suggested a phased return, but Lakshmi felt this was not needed. However, soon after she found that her usual love of work had changed. The first activity involves listening to audio clips that feature Lakshmi and her manager, Angelique. They talk about what happened before and during the time when Lakshmi’s mother was dying, her subsequent death and the effect that this had on both Lakshmi’s feelings about work and her performance at work.Activity 4 It wasn’t like this beforeAllow about 30 minutesPart AListen to the following two audio clips, during which Lakshmi and Angelique independently reflect on the situation from their own perspectives.
Audio 1 Lakshmi’s perspective
LakshmiIt was strange but I didn’t feel that shocked when my mother died; since her diagnosis six months ago we had all seen it coming. The Macmillan nurses were brilliant and helped us face reality with courage. My mother’s faith helped us both too. It was also touching that the neighbours and everyone at the temple were so supportive. It was comfort to me to know that my mother would be missed by other people in the community.What was a shock to me was how I felt when I went back to work after my two weeks compassionate leave; my memory of the last six months were all black and white, as if the colour had been washed out of the world. I have always loved work – the feeling I could ‘make a difference’ helped me to get out of bed in the morning. I have found my work cathartic too, and it was a comfort to immerse myself in work during my mother’s final months. But when I got back to work everything was just so exhausting. I didn’t know what was going on – I began to fall behind not long after starting back and never seemed to have the energy to catch up again. When more work came I began to feel overwhelmed. Normally, I would have gone to Angelique right away but I just didn’t feeling normal and she didn’t want to be seen as a failure at work.
Audio 2 Angelique’s perspective
AngeliqueWhen Lakshmi’s mother died, I thought that she had coped with her bereavement in a calm and emotionally mature manner. I really admired her for that however, about six months later, I just didn’t know what to make of Lakshmi and couldn’t understand what was going on. She used to be a manager’s dream – always bubbly and bright, a keen team member, and always as sharp as a knife when it came to her caseload. Now she seemed to be permanently sullen and irritable, uncharacteristically cynical in meetings and, at serious risk of losing her grip on her caseload. I had always been close to Lakshmi but felt like we were losing the relationship we once had. What do you think could be causing Lakshmi’s behaviour? Make a list of possible causes. High levels of stress, such as that caused by bereavement, can lead to burnout, a sense of loss of control, disengagement from work and, ultimately, ill health. Lakshmi had experienced the trauma of losing her mother and had also lost the sense of fulfilment from, and engagement with, work, which she used to enjoy. Employees who have a sense of engagement in what they do find that, instead of experiencing work as stressful and demanding, they look on it as a positive challenge which, in turn, enhances their wellbeing, involvement and efficacy. When they lose that engagement, they often go down an energy-depleting path which can quickly lead to a drop in performance, fatigue and even burnout (Seemann and Seemann, 2013; Strauss, Parker and O’Shea, 2017).Part BNow listen to Lakshmi talking about how her stress built up at work.
Audio 3 Lakshmi’s build-up of stress
LakshmiI felt so ashamed. I had promised to do a presentation on a project I had done to the team and had been given a month to work on the presentation. I’m not a procrastinator and it wasn’t that I didn’t want to; rather, I simple never seemed to have the energy to sit down and start. My heart just was not in it.When it came to the week of the presentation, I hadn’t done it. Although I felt I was letting down Angelique. I kept thinking what did it matter anyway? The whole place just felt really negative these days; people didn’t seem to look out for each other anymore; everyone was so stressed trying to hold on to their jobs; Angelique was never around for us anymore. I just wanted to run away and hide.As you listen, think about the following questions:Have you ever experienced feelings similar to Lakshmi’s?Have you seen someone else go through similar emotions?In such situations, what do you think helps the person concerned?Such situations need to be handled sensitively; caring leaders and managers can draw on both management and leadership skills to develop a style of management that builds on their personal awareness to support staff, while simultaneously acknowledging their humanity and dealing sensitively with strong feelings. This kind of approach can play an important part in retaining staff, keeping morale high and enabling people to deal with the inevitable pressures of work in health and social care. As the case study of Lakshmi and Angelique continues, you will see the importance of a caring approach to management.3.1 Caring management of stressThe audio clips in the next activity feature Lakshmi’s and Angelique’s accounts of how Angelique approached the situation to support Lakshmi.Activity 5 Finding a way forwardAllow about 45 minutesPart AListen to the following audio clip, where Angelique talks about how she thought of a possible way to help Lakshmi.
Audio 4 How Angelique tries to help Lakshmi
AngeliqueI recognised that Lakshmi was struggling with her workload and that she didn’t seem to be as organised as she used to be before her mother’s death, so I arranged a meeting to discuss the situation. I wondered if Lakshmi might benefit from developing her time-management skills. I first began to use the technique when I was studying and working, and had been amazed by the way it put me back in charge of my life at a time when I was under considerable stress. The great thing was that the idea of a work–life balance was built into planning and I thought this would help Lakshmi, but wasn’t sure how to broach the subject as Lakshmi was so prickly at the moment.What do you think of Angelique’s approach to Lakshmi’s behaviour?The build-up of stress in Lakshmi’s life meant she was managing her time badly, resulting in more anxiety for her and potentially putting recipients of care at risk as well. Angelique was drawing on her own experience and personal awareness of the benefits of good time management to help improve the situation. Although she could not control the wider circumstances of Lakshmi’s stress, she felt she could help Lakshmi develop her personal sense of control, or her ‘power-from-within’ (Wong, 2003). In choosing to identify a practical tool that might support Lakshmi, Angelique was leading by example. You may well disagree with Angelique’s approach and feel that she should have focused much more on providing Lakshmi with emotional support. In the next part of the activity, you will hear how Lakshmi reacted to Angelique’s suggestion.Part BListen to the following audio clip from Lakshmi and then reflect on the questions below.
Audio 5 Lakshmi’s feelings about the meeting
Lakshmi I dreaded the meeting that Angelique had arranged for days. I also felt she was getting at me and could feel myself getting angrier and angrier just before I went in. It was so strange how my feeling changes when I got in there – I had been feeling that Angelique had seemed so distant and out of reach recently but the way she spoke to me showed that she really cared and that she was trying to find a way to help me cope and manage my time. It felt like she was there for me. It was then that the floodgates opened. I could not stop crying and I told her all about my husband’s redundancy, my son’s problems at school, my constant feeling of panic, and how isolated I felt at work when I used to love it. I told Angelique how I felt totally inadequate when I had to go home at the end of the day to support my family and she was always staying late, and never seemed to stop. I just didn’t have the energy for that.What do you think about Lakshmi’s responses and what she said?How effective do you think Angelique’s solution of personal time management was in practice?What else might Angelique have done?Clearly, there was more going on in Lakshmi’s life than Angelique had realised.Lakshmi’s transition after the death of her mother was being frustrated by other stressful factors in her life. There is a danger that, in their concern to support particular individuals, managers and leaders may either overlook or even try to downplay any associated stress factors in the wider context that may be relevant. In terms of caring management, this can be seen as lack of contextual awareness. Talking to Lakshmi about her time-management skills and giving her a practical tool certainly looks like the actions of a caring and proactive manager, but Lakshmi’s outburst focused on her personal emotions, feelings and problems.As you have seen, people who feel engaged at work generally experience a greater sense of wellbeing and are therefore more able to cope with stress. While Lakshmi had personal problems outside work that were making her feel less able to cope in work, she also revealed to Angelique that something had changed in the workplace recently, which undermined the comfort she used to feel there. So, if Lakshmi felt happier at work, it could have helped her to cope better with what was going on in the rest of her life.There are many different ways of dealing with stress and you may have come up with a different solution to help Lakshmi. It is also important for the manager, however, to consider their own stress. The next section deals with this issue.3.2 What about the caring manager’s stress?As you have seen, everybody in health and social care is under increasing pressure, and even well-intentioned managers like Angelique can struggle to meet human needs as well as organisational needs. You will explore this further in the next activity.Activity 6 The manager’s lotListen to the following audio clip, where Angelique talks about her experience managing and supporting Lakshmi in this situation.