Thursday, May 22, 2014

Incivility and Compassion Fatigue ...

Life is not so short but that there is always time
for courtesy.

Ralph Waldo Emerson

Hi everyone!

This morning I read an excellent article on incivility, published by the Ontario Medical Association Physician Health Program this spring. As I read it, I was reminded that uncivil behaviour can be an important early warning sign of compassion fatigue. When our nerve endings are frayed through secondary trauma exposure and burnout, we can find it difficult to rub up against others without creating sparks.

Reflecting on this article, I was reminded of many situations where I'd witnessed helping professionals treating colleagues, students, co-workers or patients/clients and families in ways that Miss Manners would find appalling. (And I was surprised at how clearly some of those uncivil memories were etched in my mind.)

I remembered a family physician who threw a stack of charts on the floor of the nurses station because he couldn't find a needed lab result and an ophthamologist who berated a nurse in full view of patients, visitors and staff because she couldn't find a functioning ophthalmoscope. I also remembered students  shamed during departmental grand rounds for daring to offer a different viewpoint from the traditional and a social worker who made caustic, belittling remarks to a female patient who had chosen to return home with an abusive husband. And then there was the cardiologist who arrived on the ward to see his patients during the nurses' shift-change report. Instead of asking for help, he sat within 3 feet of the nurses' meeting, with his feet propped on the table, singing loudly until someone left the report to accompany him on his rounds.

Unfortunately, I was also forced to remember my own reactive rudeness with an emergency nurse who called thirty minutes before the end of an exhausting 12 hour day shift to say that she was transferring a patient with a possible heart attack to our coronary care unit before the end of the shift. (Meaning that I would have to stay overtime to admit and settle the patient while the night nurses received shift-change report from my partner.) I was not a happy camper but I needn't have been quite so terse and irritated in expressing that unhappiness.

Civility is defined by the US Institute for Civility in Government in this way:

Civility is about more than just politeness, although politeness is a necessary first step. It is about disagreeing without disrespect, seeking common ground as a starting point for dialogue about differences, listening past one's preconceptions, and teaching others to do the same.
 Civility is the hard work of staying present even with those with whom we have deep-rooted and fierce disagreements. It is political in the sense that it is a necessary prerequisite for civic action. But it is political, too, in the sense that it is about negotiating interpersonal power such that everyone's voice is heard and nobody's is ignored.
Civility is claiming and caring for one's identity, needs and beliefs without degrading someone else's in the process.

Incivility, on the other hand, is a stressor causing both the recipients and witnesses to experience distress, anxiety, and depression and contributing to the development of psychosomatic illness, burnout and compassion fatigue in the workplace. People on the receiving end of incivility frequently feel either an immediate or a slow-burning desire to retaliate, leading to widespread conflict in and attrition from organizations.

We human beings need civil behaviour in order to build healthy communities and safe workplaces. It is a necessary prerequisite for psychological safety both in relationships and in working environments. A culture of unhappiness and under-performance will grow very quickly when incivility is allowed to take root.

So, how do we go about creating a civil workplace or community? Basically, it's a matter of good self-care and following the Golden Rule, "Do unto others as you would have them do unto you."

1.  Pay attention to your feelings and patterns of behaviour. If you're normally kind and compassionate in your dealings with others and you find yourself increasingly irritated by situations or acting out your feelings rather than talking them out, it may be time to take a break or to schedule an appointment with your trauma or grief counsellor.
2.  Practice exquisite self care and self compassion. As they say in the 12 step programs, don't get too hungry, angry, lonely or tired (HALT). When your personal needs are unmet, you are more likely to overreact to situations or act out your feelings. 
3.  Use the civil language you were taught in childhood - please, thank you, you're welcome, would you mind, excuse me, I'm sorry. Avoid obscenities, degrading or harsh language and sarcasm.
4.  Be a good steward of the environment. Clean up after yourself. Make the next pot of coffee when you take the last cup. Arrange for repairs if you break something. Replace supplies you use. Offer to pick up supplies for others when you go to a supply room or to another department. Return things you borrow. 
5.  Show respect for others. Learn people's names. Recognize others' contributions and don't take credit if the credit doesn't belong to you. Respect deadlines. Show up for meetings or to help other colleagues at the agreed-upon time. Acknowledge requests and give a time frame for your response. Recognize difficult periods in your co-workers' lives. If you've finished your work, offer to help others. 
6.  Avoid invading people's personal space.  Keep music, phone conversations and strong odours to yourself. Knock and await permission to enter. Try not to interrupt others when they're talking or working. Don't come to work with a contagious illness. Share the air at meetings.
7.  Praise in public, admonish in private. 
8.  Avoid gossip and contentious topics of conversation. ie religion, politics and sex.
9.  Be sensitive to cultural differences. Ask questions and learn more if you lack awareness. 
10.  If, in spite of your best efforts, you become aware that you have been uncivil with someone, be sure to  apologize, authentically, to the person involved to rebuild the interpersonal bridge between you.      

Friday, May 9, 2014

"Turn to the Sun" for Mother's Day ...

Hi everyone!

There's nothing better than having a positive purpose when it comes to building compassion fatigue resilience and Vancouver's Suzy Coulter has one.

In 2005, Suzy, a community nurse in the Downtown Eastside, volunteered for four months in Kismu, a city in Kenya with one of the highest HIV prevalence rates in that country. Conditions in the hospital where she worked were sketchy at best and, on returning home, she decided to raise money to help change those circumstances through establishing the Turn to the Sun project. She decided to raise and sell sunflower seedlings after meeting a Kenyan woman living with AIDS whose income generating activity included growing sunflowers for seeds. Chickens were fed the seeds and the income from selling the chickens and eggs helped support her family.

Every year since, Suzy and her friends have held sales of sunflower plants on Mother's Day weekend and donate the money to the Stephen Lewis Foundation which distributes it to grassroots projects focusing on direct care and programs for HIV/AIDS affected families.

I heard Suzy interviewed on CBC this afternoon and loved her energy, the name of her project and the great work they're doing.  If you'd like to support her and her work, why not attend one of the sales this weekend and buy a plant (or 6) for your Mom? Or even decide to join Suzy's happy band of volunteers?

Sunflower plants and a limited supply of Turn to the Sun T-shirts will be sold at:

Saturday, May 10 (10-3)
East Vancouver - 2133 7th Avenue, Vancouver
(Live music at 11:30)

Saturday, May 10 (9-1)
Chilliwack - Gwynn Vaughan Park
(Corner of Hope River Road and Williams Rd North)

Saturday, May 17 (12-3)
Sunshine Coast - 1163 Cedar Grove Rd, Roberts Creek

If your weekend's full and you just can't get there, at least take a look at the great website at:

Happy Mother's Day!!

Tuesday, May 6, 2014

The ABCD's of Compassion Fatigue ...

Hi everyone!

Despite having spent a number of years teaching compassion fatigue workshops, I'm always surprised to discover how many people believe that compassion fatigue is "a form of burnout" to be "cured" with relaxing bubble baths and hikes in the woods. So, in today's post, I'd like to spend a little time going back to the ABCD's, the basics of compassion fatigue:

A definition:  
Compassion fatigue is exactly what the words say it is:  fatigued compassion. It is the symptoms of posttraumatic stress, diminishing empathy and emotional disengagement that arise from helpers' exposure to others' suffering and trauma.
CF occurs when primary traumatic stress (the trauma we experience directly in our own lives) converges with secondary traumatic stress (the trauma we experience indirectly through knowing about trauma and suffering in others' lives) in the presence of burnout (the chronic stress of perceived workplace demands exceeding perceived resources).
Compassion fatigue is essentially a trauma issue, a normal and expectable response to caring for others in pain. It is a condition of people who care deeply about the suffering of others and who work hard to alleviate it. (You don't find compassion fatigue in people who don't care.)
Compassion fatigue lies at the far end of the stress continuum. If left unattended, can lead to physical and mental illnesses including clinical depression.
 Beware of these warning signs:
The warning signs of compassion fatigue include, but are not limited to:
  • loss of sense of humour 
  • emotional numbness
  • incivility / emotional reactivity (compulsive or impulsive reactions to perceived threats) 
  • difficulty relaxing 
  • difficulty separating work from personal life
  • lowered frustration tolerance / increased outbursts of anger or rage
  • dread of working with certain individuals
  • negative changes in worldview - tendency to see the world as an unsafe place and others as "victims" or "predators"
  • ineffective or self-destructive self-soothing behaviours (eg overuse of alcohol or other drugs, compulsive spending/exercising/eating etc)
  • hypervigilance (constantly scanning the environment, looking for danger to self or others)
  • decreased feelings of work competence
  • diminished sense of purpose/enjoyment in career
  • diminished functioning in nonprofessional areas of life (eg marriage, parenting etc)
  • silencing response (consciously or unconsciously preventing others from sharing painful information with you because you just can't bear to hear it anymore)
  • feeling depressed
  • loss of hope 
  Any one of these warning signs could indicate the presence of compassion fatigue.
Create coping skills:
Because compassion fatigue is a trauma issue, healing and resilience-building must focus on helping us cope with the intersection of primary traumatic stress, secondary traumatic stress and burnout, at home (family caregivers) and in our workplaces (helping professionals and volunteers). Empowering compassion fatigue resiliency skills can be developed in each of the following areas:
  • Self-regulation:  learning to intentionally control the activity and intensity of our fight/flight/freeze response while engaged in daily living.
  • Intentionality:  learning to respond intentionally (vs reacting compulsively or impulsively), in keeping with our personal values and beliefs, in response to perceived threats.
  • Maturing perceptions:  learning to shift the degree of perceived threat we see in the working environment.
  • Connection and support:  developing an environment or network where we feel supported, heard and cared about by colleagues.
  • Self-care and revitalization: becoming stronger and more mature so we are not diminished by witnessing and absorbing the pain of those for whom we care.

 Do something about CF resilience:
If you recognize yourself in these descriptions of compassion fatigue, NOW might be the time to do something about it. Why not JOIN US for the following workshop in Vancouver, BC to discover more and to build your own resilience plan:
  • Caring On Empty: Creative Tools for CF Resilience (For helping professionals and volunteers):  June 16th and Nov 8th, 2014 
 You can email me for a brochure and registration form at