Burnout in Health Care Providers;

Strategies

Burnout, compassion fatigue, chronic work stress, vicarious trauma, PTSD(Post Traumatic Stress Disorder), demoralization, moral distress, moral injury, moral compromise are less stigmatizing terms than Adjustment Disorder with depression and/or anxiety.

“Do not ask what the world needs. Ask what makes you come alive and go and do it. What the world needs is people who have come alive.” –Howard Thurman

SIGNS OF BURNOUT

1) Exhaustion

2) Mental/emotional detachment from one’s job which has become less rewarding

3) Poorer work performance; “This isn’t me”. Patients and error stats concur.

4) Cynical, irritable &judgmental trending

5) Erosion of the soul in people with ideals and commitment

6) Low personal autonomy/personal agency with high job stress

7) Not necessarily individual failure so much as social &occupational injustice begging political solutions

“What are the pebbles in your shoes?”​

​​​​MORAL DISTRESS; arises when you are prevented from doing what you believe to be the right thing. This may be caused by resource scarcity, increased workload and interpersonal intrusion while making electronic records, issues of conscience (Assisted Dying), iatrogenic suffering (showers for burn patients), being at risk of harm from patients, having to enact someone else’s decision with which you disagree often in a setting of role confusion, disrespect, bullying, hard heartedness and lack of interdisciplinary team work. (E.g. Aggressive treatment continues when hopes are not shared, unsafe discharge planned, lack of clinical supervision). Moral distress, injury and compromise can contribute to BURNOUT.

RESILIENCE; is a life force that promotes regeneration and renewal. It is an ability to confront adversity while still finding hope and purpose; restoring joy to one’s practice. Moral resilience seeks meaning in the midst of threats to integrity and dissonance with one’s moral sensitivities and reasoning. Responses may include partnering empowerment, adapting, reprioritizing, a change of setting, communal whistle-blowing and/or conscientious objection. “Walking your own talk; being true to oneself.”

“It is one of the most beautiful compensations of this life that no one can sincerely try to help another without helping themselves.”-Ralph Waldo Emerson

SELF-CARE STRATEGIES

1) Engage with others rather than isolate yourself. Laughter and camaraderie improve mood.

“The people live in the shelter of each other.”-Irish Proverb

2) Gather together to harness one voice. Present systemic concerns to a participatory leadership.

An Elder once said, “A bundle of sticks is not easily broken. I want you to live like this, bundled together.”

3) Take care not to re-live, not to re-traumatize your selves during incident debriefs. Rather focus on;

a) What do we need right now?

b) What did we do right?

c) What needs to change?

“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed it’s the only thing that ever has.” -Margaret Mead

4) Seek support through a family physician, nurse practitioner, crisis line, emergency department, confidential free Workplace counselling (online and phone support), Professional College Well-being Programs, Mental Health Teams and Faith Communities. Screening tools exist for Burnout/Depression.

https://www.youtube.com/watch?v=eKnKePBY_00 Dr Michael Myers Physician Mental Health- applicable for all HCPs’

The Good Men Project

Heads Up Guys depression resource https://headsupguys.org

5) Guard boundaries to preserve clear roles and safety for both you and your patients (see mnemonic on last page). Make peace that some patients will choose to suffer more than you can understand.

6) Medications may be a life preserver

7) Moderate Exercise- 30 mins. 5X week, walk outdoors at breaks-walk to work, to shop, take the stairs. Can you limit your sleeping and sitting to only “23 and 1/2 hours: What is the single best thing we can do for our health?” (You tube)

8) Consider the invitation of a pet (dog) to help with exercise, belonging and relaxation

9) Decrease screen time and scrolling within social media. Keep a journal, reading (paper) novels increases compassion

10) Listen to family, colleagues and friends’ concerns, especially use of substances -authorize reciprocal check-in’s

11) Consider splitting household tasks and childcare equally with a partner

12) Improve sleep hygiene https://www.anxietycanada.com/articles/making-sleep-count-active-steps/ (free) Consider a sleep disorder clinic to mitigate the disruption of shift work

13) Increase omega 3 fatty acids in diet and supplements

14) Decrease intake of alcohol, stimulants and sugar.

15) Community centres offer crafts, Tai Chi, dancing, choirs, new hobbies, fitness classes.

16) Spiritual Care Practitioners are also available to staff to facilitate health through mindful meditation, soothing music, soundscapes, devotions, prayers and reading sacred texts.

17) Sacred Spaces and gardens on site are available to all staff, patients, family and friends. “Sign in and sign out” on either side of work which you may more easily leave behind.

18) Music as therapy; “Music washes away the dust of everyday life.”-Art Blakely

19) Practice kind, positive self talk. Be your own best friend. Cognitive Behavioral Therapy (CBT). See below for my own examples.

20) Free Mindfulness apps for being present in relaxation. Nurture your soul by contemplating gratitude; “of those who have loved you into being.” (Mr Rogers)

https://anxietycanada.com. (offers free MINDSHIFT, CBT and My Anxiety Plan (MAP) online courses)

https://insighttimer.com/meditation-app. (First level is free)

“If you’re in the coal mine and your canary dies, you don’t take deep breaths and do resiliency modules on line. You get out of the coal mine.” -Dr Pamela Wible

BEYOND BURNOUT-Depression (PHQ-9 self-assessment tool)

Sleep disturbance

Loss of interest

Guilty ruminating

Energy low

Concentration/Attention poor

Appetite/weight change

Agitation or slowing​​​​​

Hopelessness

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CBT-Cognitive Behavioural Therapy is based on neurochemical links between emotions, thoughts and actions. I remember the precise moment in 1984 when I was no longer a victim of depression. CBT is a lifelong commitment to taking responsibility to think, act and feel positively, compassionately and fairly towards myself. I usually find it easier to be kind towards others. We have the innate skills to be disciplined in reversing the golden rule. The inner critic becomes the empathic encourager. By our wounds we are more understanding of the struggles of others! The persecuted complainer becomes grateful for their blessings. List them! Make it a mantra! Reason replaces distorted hyperbole with fair and kind pronouncements. I will rally again! Thankfully no one is unapproachably perfect, especially ourselves! In the face of a failure we exercise proportion reminding ourselves of other successes. In the last week I managed my anger admirably! One burst in a week is progress! Worry and fear are dethroned the high cost analysis of energy loss when evidence for fears is scarce or there is nothing purposeful to be done worrying. Practice positive coaching; I did, I can, I will! When overwhelmed with emotions, distract yourself with activities that bathe the brain in positive neurochemistry such as exercise (20 mins a day), listening to music, reaching out to a lonely friend, reading a book, writing on a blog, volunteering in your community. Do not over or under eat, avoid drinking alcohol and take care to protect your sleep. Sometimes medications are necessary to break negative circuitry. Trusting us and ours to hope, health, happiness and harmony.

• https://readmedium.com/when-things-go-wrong-for-patients-and-caregivers-abce2030385d?source=friends_link&sk=66ddc0017b32ccdf3e00df28da4a8252
• https://readmedium.com/how-professional-boundaries-keep-us-safe-a8d8588ffb51?source=friends_link&sk=3e114655be8c452945b205b2e6ec8b1c

A favourite patient who is about to be discharged asks to be “friends” on Face Book.

A patient gives you a generous “free sample” of a product they market. Do you accept?

You are having romantic dreams about a patient you are caring for and look forward to your next visit.

Mnemonic for PROFESSIONAL BOUNDARIES; “BE TESTED”

Boundaries= Best practice requires self-awareness and objectivity

Expectations of clear roles= Put pt’s best interests before your own needs

Transparency= Could you tell someone? Including your college? Avoid isolating yourself from colleagues.

Exceptions= Altering standard tx plans or regular (office) hours is a red flag

Self-disclosure = Can lead to role reversal; burdensome for patients

Trust= You hold a position of power

Exploitation= What are you gaining? Potential long term consequences?

Document= Could you write it down? Where? What is your rationale for this being in the patient’s or former patient’s long term best interests