Compassion Fatigue Solutions

Hi dear reader,
(This is a photo of a beaver-chewed log taken by the shores of a frozen lake in the Laurentians)
I am back from a week off where I had a chance to read novels, do some spring cleaning and watch my increasingly independent children take a ski lift by themselves (gasp). It was a sun-filled week, which was great. The break was much needed for my whole family, I think.

I have been reading and thinking exclusively in French for the past few weeks, preparing for a two day visit with oncology staff at the CHUM (Centre Hospitalier de l'Université de Montréal) so I now have to put my English hat back on to write this post. I have come across some interesting French resources on Compassion Fatigue (que je mettrai bientôt sur mon site web).

One English resource was a series of podcasts produced by the CMA (Canadian Medical Association) called "Healthy Practices: A podcast on physician health" hosted by psychiatrist Dr Mamta Gautam. Follow this link to hear the podcasts.

This week, I will also be visiting a group of nurses who work in Correctional facilities near Kingston to offer them a much deserved half day on self care.

It's officially Spring! Time to dust off your rusty bike, rollerblades or snow shoes if you live up North and get out and get moving. We live in a crazy country really, (the snowiest in the world, I found out this morning, and the second coldest) so let's celebrate the arrival of Spring by making a renewed commitment to taking care of our bodies and souls.

This is a picture of a garden shed, as you can see.

Well, this garden shed is about the same size (or slightly bigger) than the Washago train station. I kid you not! I was there today, on my way back from a training session with Corrections Canada in a beautiful ymca camp. I wish I had my camera. If someone has a photo of the actual train station, send it my way please.

My dad earned his pilot’s licence before the start of World War 2 and, when I was a kid, he would often tell me stories about his flying days. When he enlisted he became an instructor and spent thousands of hours in the back seat of a Harvard aircraft “teaching young hopefuls to fly”.

After a student learned the basics of safe flying, it was necessary for them to know where the dangers were highest… how to recognize a potential problem and how to correct for it before it was too late.

Night flying meant learning to fly with instruments, not their eyes, and not just relying on their own sense of well-being. This is the core of the message that he taught me which would surface many years later when I became his caregiver during his journey through dementia. “Flying by the seat of your pants” became a wonderful metaphor - an image of how I needed to care for myself in order to continue to give quality care to him.

The lesson that I remember from him was that flying an airplane by instruments is very different from flying by our human senses. When we can see clearly, our eyes and our inner ear, which measures our sense of balance, reinforce and correct each other to ensure that we maintain proper orientation to the world around us. We can control ourselves by our senses or as the pilots say “Fly by the seat of our pants”. The pilot knows the sensation of what a safely operating airplane feels like.

At night there’s an additional challenge. The pilot’s eyes don’t give reliable information so the pilot is left with their sense of balance. Our amazing human bodies have limits of what can be detected. Although sudden or large changes are easy to recognize, one of our body’s weaknesses is identifying very gradual change. A pilot who tries to fly by the seat of his or her pants at night can’t detect if the airplane is very slowly going into a spin or a dive. Their body’s motion detector in their inner ear can’t be reoriented because their eyes can’t see in the dark. Their body might tell them “You’re level, you’re OK” but they are not…. dangerously not OK. Only the instruments can give them the feedback that tells them “Your feelings, your sensations, are getting confused. The instruments are correct. Make changes now for your safety and the safety of those with you.”

So what’s “Flying by the Seat of your Pants” got to do with being a caregiver for someone living with dementia? Caregiving means taking on additional challenges. Although we can see the changes in the person living with dementia for whom we are caring… the good days, the bad days, the losses in their capabilities… what we miss are the changes in ourselves, the constantly increasing changes in the demands on us as caregivers. It sneaks up on us. “I’m OK. I’m handling this fine” is such a common reaction… and usually it’s not true. Like the pilots, our bodies don’t detect those little changes that accumulate and our bodies and minds are not good at telling us that we’re not taking good enough care of ourselves… that we’re actually headed into a fatal dive. We tell ourselves that we’re doing fine when in reality we should be asking others for help.

So what’s the key to safety of the caregiver? How do we observe the necessary warnings so that we can ensure that we don’t do damage to ourselves by “Caregiving by the seat of our pants”? The answer is our “Instruments”. What are those external measurements telling us that we need to pay attention… information that doesn’t agree with how we feel but will help us change from a dangerous spin? There are many. Our friends telling us that “You’re looking tired” or “We’ve missed you” or “I’m concerned about your level of stress” are messages that we need to heed. Checklists for measuring Caregiver Burnout are another. The Alzheimer Society, the Victorian Order of Nurses, and several other groups have them. But don’t just measure yourself alone. Have a friend who understands the demands of dementia, knows you and will be honest with you, help you through the checklist. Listen to their opinions about how they think you are doing. If you become a damaged caregiver, then your setbacks limit the quality of care that you are able to give. Taking care of yourself means taking better care of the one living with dementia.

And if you catch yourself saying “No, really, I’m doing fine”, then you’re probably flying by the seat of your pants. It’s a good time to believe your instruments, change how you are taking care of your own needs, and stop your undetected fatal dive.

Jack Henderson, a former caregiver.
Been there… done that. And I also needed several family and friends to tell me “Listen Jack, you’re NOT doing OK. We know the signs. You’re headed for burnout. Take better care of yourself.”

©Jack Henderson, 2009 Feb 26

Benoit Duguay is a professor at the ESG Business School in Montreal. He is an expert in consumer trends and a critique of overspending and overconsumption. Dr Duguay writes French and english blogs on consumer trends. The French blog is called "Causerie sur la consommation" and is updated regularly. The English blog is a little less information packed but has some interesting reflections nonetheless. It's worth a visit.

One of my good friends celebrated his 40th birthday last night. I was deep in conversation with a guest at the party, when I mentioned something that had happened in 1989 and he said to me "Um, I was three in 89, I don't really remember that event" which made me gasp and take a little step backwards. 1989? Wasn't that yesterday? Time just mercilessly keeps on moving forward doesn't it. Here's a special hello to all of you out there who think 1989 was two years ago.

This week, I am running the two day train the trainer and then going to run a one day retreat for a group of mental health professionals who work in a psychiatric setting. Sunday I am going north to present in a prison. I really enjoy the variety among the trades that I meet, it makes this work so live and interesting.

Bonne semaine à vous tous et toutes

I apologise for the longish silence but I have been busy writing up a report for an agency. I can now return to posting weekly as is my goal.

I invite you to visit the Compassion Fatigue Awareness Project: www.compassionfatigue.org and browse through the resources available. The web site has, in particular, good resources for animal care workers (click on Resources to find links and articles.)

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On Managers and Compassion Fatigue

Supervisors and managers who work in the helping fields end up in a tough spot: Most of the management staff I have met over the years are extremely concerned about the wellbeing of their employees and feel stuck between their staff's needs (for a reduced workload, for policies that allow for more flexibility in the schedule, for concrete actions that recognise the reality of compassion fatigue in the workplace) and the need to ensure that service delivery continues and that client needs are met.

I have lost count of the times I have had a manager, almost in tears, come to me at the end of a workshop and say: "How do we, the managers, juggle it all? How do we care for our staff without burning out ourselves?"

The answer, of course, isn't simple, but there are some strategies that can help. This was my motivation in bringing Dr Pat Fisher to present a two day course for Managers in Kingston in May. I will be carrying out an interview with Pat Fisher in the weeks to come, so come back if you are curious to know more. And if you live near Kingston, do consider enrolling for the course. It will be an extremely valuable two day workshop specifically designed for managers and supervisors.

Now, in terms of what I'm up to today, I'm going to play badminton with kids this afternoon, and then I will likely not be able to resist watching part of the Oscars before falling asleep (those long boring speeches where everyone thanks their lawyer, stylist and publicist, yawn. Why not take this opportunity to advocate for a charitable cause? Maybe one of the winners will do just that tonight and surprise us).

Next week is the Train the Trainer workshop which I am very much looking forward to as it's an opportunity to work for two days with a small group of dedicated helpers from highly varied backgrounds. This time around, there are psychologists, family doctors, nurses, social workers and counsellors from a wide range of agencies such as hospitals, veterans affairs, public health, children's services and other community agencies. If you are interested in this training programme, please note that the June session is already half full.

Hope you have a good week!

This is a quick one as I am about to jump on a train for Brampton, Ontario. I have been asked to go run a series of focus groups for a very forward-thinking large community agency who wish to prepare their managers and supervisors to respond appropriately to staff presenting with concerns surrounding compassion fatigue. I am really looking forward to hearing their thoughts and concerns about this important issue. Then it's Montreal for dinner with my siblings and nieces (always a wonderful treat) and a workshop to the National Parole Board. Then back on the train for a pitstop at home to kiss hubby and kids and change clothes and off to Toronto for a workshop with special needs educational assistants. I will be very happy to sleep in my own bed by the end of the week.

I have had the very rare opportunity to spend part of the weekend completely on my own, sans children and sans partner (they were away visiting relatives) which is very nice but also very odd, for those of you who have had children I'm sure you can relate? So this is what I did with my free time: I went to play badminton with a friend, went for a very long walk around our town, and went to see the movie Slumdog Millionaire last night (very disturbing first part but the rest is very good and worth staying through the difficult stuff, I thought) and then out for wings and beer until the ungodly hour of, gasp 11:30pm. Crazy night out on the town...

I also came across a fun blog for those of you interested in cooking with a crockpot and thereby saving on energy costs and lowering your grocery bills: take a look at www.crockpot365.blogspot.com
Freelance writer Stephanie decided to spend a year cooking with her crockpot and you can find her amusing reflections and recipes on this site.

Ok, off to the races. Wishing you a healthy week.

Photo by Sakurai Midori - Autumn Fruit and Vegetables Japan from wikimedia commons

On the lovely topic of food:

One of my very first memories is watching my Inuit babysitter roll and fry her daily bannock when I was 2 or 3 years old. I can still conjure up the smell and taste of that hot bread now. Fresh deep fried bannock tastes like nothing else you'll ever try, it's just one of those things. You likely have foods like that too from somewhere in your past?

I have always been passionate about food. I'm not sure why, though I recall that when I was young my mother and my aunt used to love planning meals together, poring over recipes and trying new and unusual things. I remember one hilarious day when my mom and I bought one of each of the new tropical fruit that had just arrived in the grocery stores. This was in the early 1980s and we had never seen these strange things before nor did we know how to tell whether they were ripe (they weren't - we ended up feeling like we had fur growing on our tongues and racing for water but laughing our heads off.)

My mother was also always a strong believer in healthy eating and tried to the best of her ability to offer us fresh produce. I am not sure how she managed that during the years that we lived in a place where the ship came only once or twice a year with our groceries but she soldiered on: she made home made yogurt, sprouted beans, granola...

Anyhow, this rather lengthy introduction is to talk about a fascinating radio show I heard on Thursday. If you speak French, you can skip the rest of this post and simply go to www.radio-canada.ca/radio/christiane and look for Christiane Charette's January 29th interview with Dr Richard Béliveau.

Dr Béliveau is a biochemist who works as a research scientist at two Montreal Universities. He is an expert in cancer prevention and is also a gifted communicator who aims to bring his lab findings to our dinner tables.
He has written three books on cancer prevention and nutrition:
Foods to Fight Cancer, Cooking with Foods that Fight Cancer and his most recently released Eating Well, Living Well: Everyday Preventive Medicine which will be available in English in the Fall of 2009. He also writes a weekly column in the Journal de Montréal which you can read online:

Here are some findings:

-Reaching your healthy weight reduces your chance of developing diabetes by 90%
-26% of Canadian children and teens are overweight
-Excess abdominal fat is linked to certain types of cancers (the rates are staggering: 75% of colon cancers are nutrition related).

Dr Béliveau recommends five key strategies to improve your health and reduce the risk of cancer

1) Quit smoking
2) Exercise at least 30 minutes per day
3) Aim to reach and keep your healthy weight
4) Eat a large amount of fruit and vegetables each day
5) Eliminate junk food

Key foods to add to your diet:

-Any vegetable from the cabbage family: broccoli, cauliflower, cabbage...
-Garlic and onions
-Soy products (soybeans, tofu)
-Turmeric (1 tsp per day)
-Green Tea
-Berries
-Omega 3 fatty foods (salmon, walnuts, flax seeds)
-Tomatoes
-Citrus fruit
-1 glass of red wine per day
-Two squares of 70% dark chocolate per day

Of course you know all that already, right? But are you walking the walk?

My children were thrilled when I announced that from now on, desert would have to be chocolate!