References - A Last Post for 2011 ...

Hi everyone! I hope you're enjoying the holidays. Over the past few weeks I've had requests for compassion fatigue references from three graduate students in three different fields (nursing, social work and journalism) so I've decided to share the resources with you, as well.

The most comprehensive bibliography I know is that of Beth Hudnall Stamm on her ProQOL.org website. This 1,034 article list was last updated at the end of November 2010.

Some more recent studies I would add are:


1.  Saint-Louis, Nicole (2010) A narrative intervention with oncology professionals: Stress & burnout reduction through an interdisciplinary group process. Social work doctoral thesis - University of Pennsylvania.

2.  Beck, CT  (2011)  Secondary traumatic stress in nurses:  A systematic review.  Archives of Psychiatric Nursing, 25: 1-10.

3.  Boyle, Deborah (2011)  Countering compassion fatigue: A requisite nursing agenda.  The Online Journal of Issues in Nursing, Vol 16 (1).

4.  Chavez, Marc (2011)  Predictors of compassion fatigue and compassion satisfaction ratings among healthcare workers in critical and non-critical units.  Paper and poster presented April 2011 at the 2nd Annual Nursing Research Day in Boise ID.

5.  Day, Jennifer and Ruth A Anderson (2011)  Compassion fatigue: an application of the concept to informal caregivers of family members with dementia.  Nursing Research & Practice, Article ID 408024, 10 pages.

6.  De Oliveria, GS et al  (2011)  High incidence of burnout in academic chairpersons of anesthesiology: Should we be taking better care of our leaders?  Anesthesiology, 114: 181-193.

 7.  Dworznik, Gretchen  (2011) Factors contributing to PTSD and compassion fatigue in television news workers.  International Journal of Business, Humanities and Technology, Volume 1, No 1, July 2011.

8.  Hyman, SA et al  (2011) Risk of burnout in perioperative clinicians, Anesthesiology, 114: 194-204.

9.  Levy, Hannah et al  (2011)  Deployment stressors and outcomes among air force chaplains.  Journal of Traumatic Stress,  Vol 24(3) 342-346.

10.  Sabo, Brenda (2011)  Reflecting on the concept of compassion fatigue in nursing care.  The Online Journal of Issues in Nursing,  Vol 16 (1).

11.  Slocum-Gori, Suzanne et al  (2011)  Understanding compassion satisfaction, compassion fatigue and burnout: A survey of the hospice palliative care workforce.  Palliative Medicine (online), December 16, 2011. pmj.sagepub.com.

12.  State Bar of Wisconsin  (2011)  The Toll of Trauma.  Wisconsin Lawyer, Vol 84 (12) December 2011.

13.  Ward-Griffin C et al (2011)  Compassion fatigue within double duty caregiving: nurse-daughters caring for elderly parents.  Online Journal of Issues in Nursing, Vol. 16(1), manuscript 4.


As is so often the case, the lack of consistent definitions for compassion fatigue, burnout, vicarious trauma and secondary traumatic stress leads to an ongoing lack of clarity in the field. For a good history of the evolution of the term, Compassion Fatigue, see Chris Marchand's excellent article, Compassion Fatigue: A History of the Concept. 


I hope this list will help ease the research journey for interested students returning to write Compassion Fatigue projects in the winter semester. Good luck!   

Holiday Wishes ...

The holidays are times steeped in poignancy for caregivers of all sorts. Whether you are a hospice volunteer, a community health nurse, a family court judge, a clergyperson, an addiction counsellor or a family carepartner you will be confronted with the many holiday joys and sorrows of the people for whom you care.

Empathizing with your care recipients will affect you, both positively and negatively, as you go about your work and as you return home to your families. Knowing this, I send you heartfelt wishes for all that you need in order to replenish, restore and refresh your wellness this holiday season. In the words of an ancient Celtic prayer -

May we all have:

Grace for our needs

Strength for our weakness

Light for our blindness

Love for our loneliness

Words for our deafness

Joy for our weariness

Peace for our anxiousness

Wonder for our dullness

Hope for our hopelessness and

Health for our brokenness.

This year, I will be spending Christmas Eve with my family in Vancouver and then taking the 6:30 am (!) ferry to Vancouver Island on Christmas morning to share stockings, carol-singing, turkey and trimmings and, best of all, laughter and good conversation with my dear goddaughter and her family. I will be on holiday until January 3rd and, until then, wish you and yours every blessing of this bright and hopeful season!

Blessing for the Longest Night ...

Those of you who have attended my workshops will know of my love for the notion of blessing. Blessings, according to Celtic teacher and poet, John O'Donohue, are circles of light drawn around people to protect, heal and strengthen.

In the past, I have shared with you some blessings written by John O'Donohue. Today I would like to offer you a Solstice blessing from the writings of United Methodist minister, Jan L. Richardson. May it be a gift to all who live "long nights" during the holiday season.

Blessing for the Longest Night

All throughout these months

as the shadows

have lengthened,

this blessing has been

gathering itself,

making ready,

preparing for

this night.

It has practiced

walking in the dark, 

travelling with

its eyes closed,

feeling its way

by memory

by touch

by the pull of the moon

even as it wanes.

So believe me 

when I  tell you

this blessing will

reach you

even if you

have not light enough

to read it;

it will find you even though you cannot 

see it coming.

You will know

the moment of its 

arriving

by your release

of the breath

you have held so long;

a loosening of the clenching

in your hands,

of the clutch around your heart;

a thinning

of the darkness

that had drawn itself

around you.

This blessing

does not mean

to take the night away

but it knows 

its hidden roads,

knows the resting spots

along the path,

knows what it means to travel

in the company 

of a friend.

So when

this blessing comes,

take its hand.

Get up

Set out on the road

you cannot see.

This is the night

when you can trust

that every direction

you go,

you will be walking

toward the dawn.

Copyright - Jan L. Richardson

An Antidote for the Christmas Blues ...

Are you feeling exhausted, depleted, and just a little bah-humbuggy?

Tired of adding lists and shopping malls to an already overfull life?

Hearing your voice sounding more irritated than joyful?

Caring so much for others that you've lost the larger picture?

Then, make yourself a nice hot drink, curl up in your favourite chair and watch this wonderful video clip, borrowed from one of Barbara Stahura's latest posts. By the time you're done, I guarantee that your perspective will have shifted and that your nervous system will have begun to calm. (The clip's best viewed in a full screen format.)

And, if you have a little more time - time to spend with your journal or just thinking quietly in your chair - you might want to consider completing one or more of these sentences -


1.  The ordinary things for which I'm grateful this holiday season are ...

2.  The miracles of life that make my heart sing are ...

3.  The things that truly matter this holiday season include ...

4.  The experiences that have made me smile this week are ...

5.  The things for which I'm hopeful are ...


May this video, the sentence stems, and the thoughts and feelings that spring from them, chase away some of the humbugs and bring you "a really good day".


(This lovely film was made by filmmaker, Louie Swartzberg, with music by Gary Malkin and narration from Brother David Steindl-Rast.)

Holiday Energy ...

One of the best ways to keep up a good, steady level of energy through the holiday season (and to keep your weight in check) is to remember to eat healthy foods at regular intervals throughout the day, watching your intake of sweets, fat, salt and alcohol.

But with all the wonderful holiday baking and all the gourmet meals around, what's a person to do? ( The intentions are so strong but the body is oh, so weak ....!)

Well, recently I came across a holiday eating challenge on Ruth Buczynski's website, NICABM (National Institute for Clinical Application of Behavioural Medicine), that I think is well worth considering.  Based on the research of Dr Brian Wansink, PhD,  The Power of Three Challenge encourages us to change 3 mindless habits of eating for a period of 10 days and then see what a difference it makes in our lives. (He is convinced that we will want to continue, thus creating newer, healthier habits.)


Dr Wansink bases his challenge on the research laid out in his fascinating book, Mindless Eating: Why We Eat More Than We Think. He believes that we have a Mindless Margin of caloric intake where we can increase or decrease our calories by about 300 per day without noticing much difference in our feelings of satisfaction. Over time, however, our bodies can tell the difference as we begin to gain or lose weight and to stabilize our energy.


Here is the list of suggested changes.  Why not choose the three you would like to work on ( or one, if you do better at changing one thing at a time) and give yourself an energy boost and a rest from weight gain this holiday season? (As always, check with your physician before making changes in a prescribed diet.)


1.  Eat in a well lit room. You eat less when you can see what you're eating.

2.  Keep the bones.  We have a better sense of how much we've eaten when we can see the evidence. This could mean keeping empty beer bottles lined up on the table or hot wing bones on a side plate.

3.  Use the 1/2 Rule.  Aim for 1/2 as much protein and carbohydrates while doubting your servings of vegetables and fruit.

4.  Fill your plate, but keep it small.  When you use a smaller plate or bowl, this will naturally reduce portion size.

5.  Come up for air.  Try to slow down your pace at the table so you can rely on your body's internal cues. Then follow them - stop eating when you start to feel full rather than when your plate is clean or when you're over-stuffed.

6.  Downsize rather than supersize.  Try ordering a size down from what you would normally order.

7.  Pre-plate your food rather than serving it family style.  It's easier to make more healthful serving choices when you make decisions before you start.

8.  Pass on second helpings.

9.  Use taller, narrower glasses rather than shorter, wider ones.  You'll end up pouring less, but you probably won't notice the difference.

10.  Prepare healthy snacks for when you're on the go (try carrying along an apple or a small bag of carrots).

11.  Minimize variety in your snacks.  You'll be surprised to find ourself getting bored with the same old cheese curls, and you'll end up eating less.

12.  Put your apples on display.  Show off healthy foods in a prominent, well-lit area of your eating space, and banish unhealthy foods to the back corner of your cabinets.

13.  Keep chips out of reach.  When you have to seek out junk food consciously, it gives you a chance to think twice before indulging.

14.  Turn off the TV.  When distracted, we tend to consume more calories inadvertently.

15.  Eat meals with people who eat more healthfully than you do.  Studies have shown that we're influenced by the food choices the people around us are making.

16.  Keep unhealthy but tempting food in aluminum foil or opaque containers - out of sight is out of mind.

17.  Using smaller eating utensils and serving spoons. It's an easy way to slow down how quickly we eat and get back in synch with internal cues.

18.  Here's one for the whole family:  rename healthy foods to make them sound more appealing.  You might turn down a carrot-beet smoothie, but would you refuse a rainforest cocktail?

If you have other ideas to share, we would be happy to hear them!





  

A New Look ...

Hi everyone! Welcome to Caregiver Wellness Workshops' new look on the world.

Anyone who follows Caregiver Wellness regularly will have noticed that I have posted a new blog format pretty well every day this week - and, in some cases, even three or four times a day - as I've experimented with new templates for the site.

It's always a big decision to alter the familiar.  And that decision then leads to many questions. Does one change the layout or just the colours? Which colours are welcoming, which are peaceful, which are too intrusive or frenetic?  Which fonts are easiest to read? Which headers match the existing photos and which tend to clash? (I had decided on a lovely golden colour until I realized that it clashed with almost every photo on the site! And then there were the constraints wrought by the preselected options chosen by the Blogger folks - which were not always my cup of tea.).

All that said, I'm happy with the new look - it's familiar, and clean and clear, and bright and peaceful, and shouldn't be jarring to the tired eyes of helpers who are drawn to the site. So, enjoy!

Holiday Planning Near the End of Life ...

Whether you celebrate Christmas, Hanukkah or the Solstice, spending the winter holidays with a loved one who is dying feels poignant, fragile and precious.

The last Christmas I shared with my husband was probably the most beautiful ever - partly because of the thought we put into its planning and partly because we became willing to let go of the outcome once the planning was done. Here are a few of the things we learned:

1. Plan in advance but be flexible and hold your expectations lightly, remembering that there's a good chance that the plans will change.

2. Begin your planning with the person who is ill. Have a conversation about:

* his or her hopes and dreams for the holidays

* the themes that underlie those hopes and dreams - time with family, spiritual observances, gift giving, eating special foods, hearing traditional music

* what plans are realistic given their energy and abilities.

And don't forget to consider the same issues for yourself (and other family members living in the home) and share your thoughts with your loved one.

3. Have a conversation with extended family and friends once you know which activities matter most to you and your loved one and which will fit within your physical and emotional limits. Tell them about your limitations and about how you want/need to alter the celebrations this year. Make space to hear their responses with empathy and care. (Imposed change usually brings grief with all its sadness, anger, and efforts to control the uncontrollable.)

If the changes will be extensive, be sure to reassure people that they are still important to you and that it is the illness that is causing the constriction of activities and connection. For example, you might want to say something like:

* We'd love to have you here for the holiday meal but we don't have the energy to host it this year. If it's a particularly good day we might be able to join you for half an hour at someone else's house.

* We'd love to see you but we're moving into a time of quiet visits now. People who want to see Sam can come and sit with him for 5-10 minutes without speaking. On better days he may say something to someone but mostly its time for quiet visits now. If you're comfortable with that, you're welcome to come.

* We love you and wish we could see you but the time has come for us to protect our energy - the illness takes so much that the usual holiday visits aren't possible now.

4. Simplify rather than abandoning your traditions, for traditions are the glue that holds families together during hard times.

If your particular hopes and dreams are no longer possible, look at the important themes and values you identified in your initial conversations and use them as a guide for your new plans.

Going to the Midnight Service with family and friends on Christmas Eve and having our goddaughter and her family with us for Christmas dinner were the two traditions that were most important for my husband and me to maintain. Neither was possible in its usual form so we simplified and had a quiet, Christmas Eve service by candlelight at home in the livingroom on Christmas Eve and we all worked together to create a long, slow Christmas dinner on Christmas Day, so Derrick could go back to bed for a rest between each course.

It wasn't a perfect holiday but it turned out to be perfect in its imperfection, leaving us with cherished, loving, candlelit memories that will last forever. I hope the same will be true for all of you who face the end of life this year.