All Courses › Forums › Course Discussion Forums › Burnout: How to Hold Out the Light Without Burning Out › Week 3 Discussion Thread
March 27, 2020 at 4:11 pm #5799
Greetings and welcome to the week 3 discussion thread. I so appreciate the collaborative learning that is going on. Obviously, this topic hit at the right time. After much discussion with my wife who is a retired Nurse Practitioner, considerable pray and meditation, and listening to the latest news updates, I decided to continue our self -isolation. This means pulling back on my PRN work as a chaplain. We are both past 70 years of age, and both have several underlying medical conditions that make us vulnerable to infection. This was a very hard decision for me. It is humbling and creates a feeling like guilt to run up against a limit. But it feels like the right thing to do, right now. If it was just me involved, I would probably have made a different decision.
We here at Oates are working hard to provide a safe, respectful place for folks to debrief at our Oates Institute Facebook Group. Further, we are working on some podcasts that include interviews offering tips for self care and other care. And we are recruiting some thought and practitioner leaders for our June online symposium: Trauma Informed Spiritual Care. Dianne writes that she wishes we could have better connection. To that end, I am very happy to set up an Adobe Connect session so we can join each other live for conversation, music, dance, prayer, etc. I was thinking about this Friday, Saturday or Sunday. Please let me know what you think. All you would need to participate is a computer with a webcam and an internet. If you would like to do this, please send me an email at [email protected] with best dates and times.
I hope you are benefiting from the resources. Please know that I have researched hundreds of articles and videos that might be helpful in starting our conversation. Moreover, as always, we welcome your sharing of resources you have found helpful.
Rick @ Oates
March 27, 2020 at 6:45 pm #5800
Rick, I completely support your decision and I know it came with mixed emotions. It is certainly a wise one. These are indeed challenging times.
Unfortunately, with the very strict policies that my employers have put in place regarding the use of social media (and the almost daily reminders that they are monitoring our activities), I don’t think it would be wise for me to participate on that platform. The strange thing is that I’ve been seeing many healthcare professionals all over the country expressing concern that they have been muzzled by their respective health systems. That’s been a reality in a number of places, for a number of years now. This pandemic has highlighted the issue of health systems controlling information that could hit their ratings and potentially cause loss of income/earnings due to bad publicity. HIPAA has been a good excuse to not disclose or allow to be disclosed information that could influence policy changes or highlight some glaring issues in resource management and disaster planning in health systems here and all across the world.
I’ll comment on the readings on tomorrow.
Please do everything you can to stay safe. Prayers for all.
March 28, 2020 at 9:56 am #5805
Reflections on week three readings.
Standing behind frontline workers. This a a well thought out article by people in the middle of the crisis. Their insights are helpful. However, There to do list while excellent requires funding from local to federal governments at a time when budgets are already stretched. Where is all the funding going to come from–taxes. But many people aren’t working. My take away is how can I best support the people I work with who are facing challenges on many levels: keeping up with patient care, maintaining their role in their family, possible financial struggles.
Vicarious Trauma reflection. It is good to be reminded that burn out is not the only term/condition facing people in health care. Work weariness is like onions/ogres. There are layers. Compassion fatigue may be the first layer or sandwiched between layers of vicarious trauma. Left untreated will most like lead to deeper layers of burnout. As stated in other articles, possible solutions seem to be early (self) diagnosis, self care beyond lip service, colleague support in the form of formal and informal conversations/debriefings, and rituals. In regards to health care workers self care, I find for myself and trying to encourage others, it is helpful to take baby steps in one or two areas rather than make sweeping new year resolution- like goals.
I can drink more water, I can walk at lunch time, I can take deep breaths, etc.
March 28, 2020 at 11:28 pm #5808
The list of definitions was helpful, esp. being able to see the extra strain nurses and doctors feel to bring healing to the physical and not always having the luxury that chaplains have to help people process their grief and emotions, but they feel it and carry it. They bring the bad news that despite that doing all they could, the person died any way. This quote from the shame section was poignant. “Given that we (doctors) do not accept the idea of the good-enough doctor, that physicians are always striving for and expecting perfection, every Doctor feels that he or she falls short to some degree. Perhaps shame and self-blame are built into the system because of an unrealistic and pervasive expectation of perfection.”
This is an important reminder for us chaplains to come along side our very human care givers when we can, especially after traumas. I’m curious in what ways you all might come along side colleagues to support them, debrief formally or informally esp. for those folks in difficult units (AIDS, NICU, PICU, ICU’s in general, ED…)
March 29, 2020 at 5:15 am #5809
When I first started to do therapy during my younger days, it took me quite a while to get used to how to keep my mouth shut on handling the issue of confidentiality of my clients. On another dimension is how and what not to reveal about you and your colleagues to the media. Paul, I understand what you’re saying.
Beckman et al’s article on ‘How to Stand Behind Frontline Health Care Workers Fighting Coronavirus’ is alarming as they write, “… 50% of people exposed to confirmed COVID-19 cases were health care personnel.” Is this rate a guestimation? I certainly empathize with people who are working on the frontline. Some of the health care personnel in my country who were on the frontline have recently died of coronavirus infection too. My question is, are the government and health facilities doing enough on their part to ensure the safety of these personnel?
March 29, 2020 at 9:11 am #5810
I feel like what jumped off the pages at me was self-care. This past week patients laid with covers up to their nose only peeping out with their eyes from fear that caregivers entering the room would make them sick. Our governor used the term “pollinator.” People understood that term fearing clinical staff would not used good hand hygiene and contaminate them. Patients also did not understand the Covid19 patients are in a locked unit, not dispersed throughout the hospital, staff would not see a C19 patient and then see other patients. Education has been so helpful in alleviating anxiety. There are physicians who are concerned for their own health and it shows. There were staffing changes in the spiritual care department where I work which have brought another unseen stress. Fast change is not normal to my system, nor do I imagine that it is normal to any one. I like gradual change and adaptation. This current health care crisis did not allow for this natural process to change. The country changed whether we were buying in to the system or not. No one assessed the country to see where we were in the change cycle. Practicing self-care is vital to remaining healthy. I find people are exploring new options to cope with this current change. I am encouraging patients to read, FaceTime, make phone calls, work crossword and puzzle booklets, participate in therapy, write down one good thing per day, etc.
My heart felt very heavy this week. In the midst of codes and normal hospital life and death situations there is this ominous unknown factor of what the “peak” will look like for us. Here in Kentucky, it has a been reported that because the governor began a rigorous scale back in public interaction, the “peak” will be more flat. Staff seem to be very appreciative of chaplain support. We have passed a “Tending to the Spirit” out each week. Staff have responded very well to that physical written word or prayer and support. Staff have asked for Blessings of hands. This simple ritual done without touching brings empowerment to them in the midst of chaos. If nothing else it brings a moment to refocus on their own breathe and gift of hands. I have been provided the opportunity to begin to reach out with Bluejeans this week. This avenue of Telehealth will be new to me. I am grateful for the opportunity since part of my population need to debrief their emotions without family support.
I appreciate Wally’s terms of onions and ogres. He processed the terms which were laid out well. Thank you, Wally. Like Peter a new layer of quiet has been added to my office work. Where once as chaplains we processed together, the stress is too fragile to process much right now. So the quiet has come about. We were able to find a day to eat together and another day to join in dessert together which allowed us as chaplains to lay aside our roles just to be together. We were appropriately spaced. I feel like in our office is also a plant that we as staff created together sometime ago that is a physical representation of hope. We put together a ritual of grief in the plant with rocks and shells buried in the pot. It is also surrounded by those objects. Those were a joint process of grieving past and creating future. If find this current situation creates opportunity to think out of the box to trust the power of ritual and what we hold in core values as true to look with hope that everything comes to pass, even burn out. After the forest fire, there is new growth, new life, new journey. This has been a well-timed and needed group for me. Thank you all so very much! Laura
March 29, 2020 at 9:23 am #5812
Sometimes Wally, coming along side is simply that. I sit in a chair and listen. I hear concerns. Sometimes there is no opportunity for me to say anything, because the nurse or physician needs to process and release. Just that simple presence gives the clinical staff the ability to unload the moment. I try to thank and debrief deaths with staff, especially in codes. I already mentioned our “Tending to the Spirit” and blessing of hands. I also review with young staff how they care for themselves as they leave and return home because their primary concern is not taking anything in their home which would harm their loved ones, especially the babies. I affirm their care and their hearts. They also need our smiles and encouragement. The common word we use is support, which is an umbrella of tools.
March 29, 2020 at 10:30 am #5813
As I mentioned, our first death from COVID-19, in my county occurred in our hospital. It was on a Saturday, and I was not in. My weekend coverage was not called. When I got in on the Monday following, my staff told me how things played out, and one said she would have loved for me to have been with them. (They will call back-up help for patients/families, but not for themselves. I suspect it’s because they know me and have formed a relationship with me and others are pretty much strangers).
Anyhow, I took the time to express my gratitude to them (I included our new Intensive Care Medical Director as well), for the work they did and how much appreciative we all are for the sacrifice and their courageous efforts in working hard to save that patients. Aside from direct referrals, I’ve spent my days checking in on staff on all my floors, asking how they are coping, listening to stories of what home has become – with kids home from college, grade school, etc. and the multiple stressors that the disruption has caused. I’ve done a lot of listening as staff expressed fears – for their safety as they go out to shop in scrubs, after work (having learned of folks being attacked in some places – not here). I’ve offered comfort to folks who have no opportunities to grieve because funeral gatherings are forbidden.
I plan on doing that for my staff for as long as this lasts. I know a lot of them very well. I know their stories and, in some cases, I know their families. That gives me an added advantage of not being “some Chaplain fellow”. I’m one of them and we can share without barriers.
March 29, 2020 at 10:47 am #5814
I also like the focus on self-care, in the articles, as many of you have pointed out.
One thing that stood out for me is the interconnection of all the terms used; burn-out, compassion-fatigue, vicarious trauma. I began thinking, as I read, that in some ways, I can identify with subsets of each of those.
I recalled years ago when my first CPE Supervisor took some time away from hospital work. (Of all things, he took on a parish as a full-time pastor for a few years). At first, I thought it strange. He explained at the time, that he need a break; he was becoming burned out. After some years in parish ministry, he went back into CPE Supervision and did that until he retired. Parish ministry gave him the respite, as well as the rejuvenation he needed.
I guess what I’m saying was he took note of what was going on within him and that was his way of practicing self-care. It seemed to work out well for him. For me, the lesson was to pay attention and not feel guilt when we have to make decisions, etc. that might be in the best interest of our health and well-being. I’ve gotten to the stage in my life that I firmly believe pastoral care can be done anywhere. It does not have to be in an acute care setting/hospital. It can be as informal as a word of encouragement to the salesperson at the car dealership as I’m having a vehicle serviced or purchasing one.
March 29, 2020 at 2:51 pm #5820
Laura, I certainly agree with you that to be healthy, you need to practice self-care. How far can we go to help others when we ourselves need to be taken care of?
You also mentioned about grieving. We see the recent death-toll of COVID-19 cases have already gone up by the thousands in so many countries. Not only they will be sadly missed, but many of their loved ones, friends and colleagues aren’t able to bid their farewell, even if they want to. Our mutual support during wake and presence at funeral are significant rituals in the grieving process, which often takes time.
Paul, yes, pastoral care can be done anywhere, and that’s exactly what I’m doing. Like my other countrymen and women who are unable to leave home, I’m now doing therapy at home through the use of video calls. With the help of a few colleagues from my counseling center, we are providing counseling on our hotline 24/7.
March 29, 2020 at 5:10 pm #5821
As I write these words, I am sitting on my deck enjoying the beautiful weather and feeling guilty or shameful or whatever word you want to put on it. As you know, from a prior post, I choose to pull back on my PRN work as a chaplain. I was scheduled to be on site right now making rounds and trying to provide support to those who are working so hard to treat this awful virus. For the sake of complete transparency, let me say that I was a colleague of Laura’s. I know first hand what a wonderful job she and the other chaplains there are doing. But, I know that with several chaplains out, the load is even more challenging. It doesn’t seem enough to say, I am sending prayers and positive energy your way. I so miss rounding and listening and talking with some of my favorite heros there.
With that said, I would like to share from one of my favorite leadership books titled “Resonate Leadership by Richard Boyatzis and Annie McKee. And I am quoting fromt he front cover of the book. “The authors marshal decades of multi-disciplinary research and hands on consulting work to provide a practical framework for how leaders can create and sustain resonate leadership with their teams, relationships, and their organizations. They argue that today’s leaders face unprecedented challenges that result from a vicious cycle of stress and sacrifice, with little or no recovery time to build on”. (Sound familiar) (And this was written way before this current crisis.) Furthermore, I know the processes suggested are as much needed with nurses, doctors, chaplains, etc. as well. “Throughout the book, they illustrate the ways that three key elements – mindfulness, hope and compassion – are essential to enabling renewal and sustaining resonance.”
Certainly, these three elements have been illustrated here in many practical ways. I would suggest that mindfulness occurs as we utilize all of our emotional intelligence: self-awareness, self-management, self-management of emotions, and social awareness. It is doing what I have heard that each of you have or are doing. It is a matter of connecting authentically with them, listening deeply to them, to the point that we can read and understand others subtle messages, EVEN THEIR UNFORMED HOPES. As spiritual caregivers or coaches we can help others reflect, practice, dream, release, and rely on supportive relationships.
Hope is something we are all familiar with from our religious and spiritual traditions, right? But let me add a bit to that from this little book. “Hope acts as a magnet – an “attractor” in the terminology of complexity theory. Like other positive emotions such as excitement, amusement, elation, and happiness, hope has a positive impact on our brains and homones.” In my own words, dreaming and hoping is a way we join with the Universal Love to see good things happening.
You have shared incidents when you have been compassionate toward others. Compassion is simply empathy and caring in action. The book is full of exercises that those who experience the vicious cycle of sacrifice and stress.
I used two scripture passages today from the lectionary for my Facebook live meditation: Ezekiel 37 and John 11, In both stories there were at least four elements; great loss, grieving and worrying about when help would come; the arrival of the Breath of the Spirit and the Spirits use of those standing around to help.
May you who still serve on the front lines feel the moving of the Breath of God as you help bring back hope and life to what feels like a valley of dry bones.
Rick @ Oates
March 29, 2020 at 6:18 pm #5824
I like the rest of you am struggling with all of this and trying to do self care the best I can. Here in hospice we are doing most of our work by telephone. Mainly talking and supporting care givers as most of the patients are not able to talk on the phone very well due to illness, dementia or are very hard of hearing. We are able to make visits, however only when the person is truly at the end of life. As I talk with care givers they are feeling very isolated with the decrease of visits, not only from the team but from family and friends as well.
We don’t have any COVID 19 patients in hospice yet however I do have a story in that a patient in a hospital in the state of Washington wanted to go home on hospice had the virus and could not find any to transport this person home. Many were saying to risky to transport in the community. I don’t know the outcome as it is not our hospice.
I am also having my own hard time with the isolation. Living alone with little or no face contact is tough. I have been doing face time, skype, zoom, etc… which helps. I am such an extrovert this is hard. Trying to stay active and engaged is the best way I know not to get to discouraged.
March 29, 2020 at 6:40 pm #5826
I couldn’t agree with you more. Pastoral care happens in a variety of places. It sometimes happens in the line at the grocery store. All the workers are working so hard to make sure we all have the food we need during this time. When I went shopping last week I was so struck how much employees were doing. I decided to start thanking them. One of them turned around and said thank you for noticing. A lot of customers are just fed up with the things we are out of, like it’s our fault. We can only stock what is brought in. The person said truly grateful for your kind word.
March 29, 2020 at 6:44 pm #5827
This link is Piglet being present to pooh after a bad day.
March 29, 2020 at 6:46 pm #5828
This group as been a welcome bright spot for me as well. It truly has come at the right time. Not only do I feel connect, I am also learning how so many of you care not only for yourselves but the folks you work with. It has given me some helpful ways that I care for my hospice team when we are so isolated. There are times when the team doesn’t see each other very often even before this virus, now we don’t see each at all as we are doing all meetings even our team meeting by phone. I am being challenged how to care with the distance.
March 29, 2020 at 6:47 pm #5829
Love the Pooh quote and picture, sometimes I think as chaplains that what we do, sit quietly with.
March 29, 2020 at 6:49 pm #5830
Thank you all for the reminders to be present to our staff, to sit with them, to acknowledge their pain and offer a genuine How are you? I heard someone use the question, “How’s your soul?”
Rick, I resonate with your statement you shared about hope being a magnet. The calmer we are the more calm we can bring and the Spirit will draw it out of others.
Peace Be still.
March 29, 2020 at 8:04 pm #5831
Love the Pooh and Piglet piece. Rick, you enjoy that sunshine and the outdoors! It feeds your soul. No guilt. This is a brave new world. I felt the lectionary brought great hope in the midst of the unknown. Peace to you! Laura
March 30, 2020 at 12:59 pm #5832
I’m a huge Winnie the Pooh fanatic. Loved it!
Thanks for sharing that with us Wally!
March 31, 2020 at 5:02 am #5836
Wally, thanks for bringing in the story of Pooh and Piglet which resonates well in one of my cases.
I had a client on an emergency case. As she entered the counseling room, I greeted her and invited her to take a seat. She sat down but there was no verbal response. So I said whether she could hear me and told her that if she was the person who called, I was to be her counselor, ready to lend a listening ear. No response either… She put her head down (Meanwhile, she was in tears).
10 minutes had passed. I said, “Speak to me whenever you’re ready, I’ll be here for you.” Then silence again. (By then, she had used up more than a dozen tissues soaked with tears).
It was about half an hour later when she looked at me and said, “Thank you for waiting.” (I was willing to “waste time” with her, just sitting there “waiting” for her to speak, without doing anything else but praying quietly for this client). Then, we started to converse for more than half an hour till the session ended.
I was just like the Piglet at the beginning of the counseling session, willing to just be present with Pooh…
March 31, 2020 at 2:10 pm #5838
It has been a rich discussion and I thank you. Now that we have arrived at the end of our third week, I invite you share your closing remarks. In order to complete the course, link on the evaluation link below, complete and return. This has been a timely discussion and time of sharing ideas, and supporting each other in these uncharted waters. I have learned a lot. Thank you. And I hope you have.
During these uncertain and challenging times, we are trying to think of ways to support spiritual care givers other than our regular scheduled seminars. As mention before, we created a special Oates Institute Group on Facebook for persons to debrief, share ideas for self-care and other care, and support each other. Please join us there and share with others who might be interested.
Our June symposium: Trauma Informed Spiritual Care presenters have offered to do some 30 minutes presentations and Q & A. over the next few weeks on topics related to the C virus pandemic either on Facebook Live or Adobe Connect. What do you think about this idea?
We are also reaching out to ACPE and the Chaplaincy Innovation Lab to co-sponsor some of these events.
Certainly, we can tweak our upcoming 3 week collaborative learning seminars. Are there particular topics that you think would be helpful?
Appreciate you all and the work you are or will be doing.
Rick @ Oates
March 31, 2020 at 3:24 pm #5841
As we come to a closure of this three-week seminar, I want to express my sincere gratitude to Rick and everyone in the class for your wonderful sharing especially in dealing with self-care. I certainly have benefited a great deal by participating and interacting with you. It has been a pleasure spending time with you, despite the outbreak of COVID-19 which has been affecting all of us.
To each and everyone of you, “terima kasih” (accepting your love/care in Malay language, literally). That’s how we say thank you.
Take care and farewell!
March 31, 2020 at 10:00 pm #5848
I’ve always been enriched by the seminars. I have fond memories of any with whom I’ve participated over the years. Thank you Rick for your guidance. As has already been noted, this was such a timely seminar. I was disappointed when it had to be rescheduled from last month, but God had a purpose and now we know why.
It’s always a special treat to have folks from other countries sharing and Peter, I thank you so much for your being with us and opening our eyes to other perspectives across the shores. The invaluable sharing and insights and personal stories will remain with me for a very long time.
My prayer for all is that God will continue to encourage and equip you all “for such a time as this”. The story of Esther seems so appropriate in these challenging times. Please take the best care of yourselves.
April 1, 2020 at 6:20 am #5849
Grace and Peace to you all.
Thank you for the encouragement, support and insights.
Here is a free coupon for some well deserved self care.
*Take a deep breath… take another…just one more….
April 2, 2020 at 5:15 pm #5858
I resonated with this week’s readings for several reasons. First, as I am currently interacting with hospice nurses in and out of my in-laws’ home as they help him in the process of his transitioning, I see the nurses and their varying levels of concern with the COVID-19 virus. I often wonder how I can better support them as they go out on the frontlines every day into different people’s homes, not knowing who or what they will encounter. Bringing this topic to the fore of our thoughts is important and was an important reinforcement for me as I’ve already been pondering these things.
Also particularly insightful for me this week was the reading on, “Vicarious Trauma in Clinicians: Fostering Resilience and Preventing Burnout.” It was especially interesting for me as I reflected on its applicability and transferability into my particular realm of chaplaincy in the corporate world.
I thought it interesting that OSHA (Occupational Hazard and Safety Administration) considers vicarious trauma to be a psychological hazard for mental health clinicians, and I wondered about the implications of mental health in the corporate world as well. The article stated:
Studies have shown that integrating work safety and wellness programs is more effective in reducing chronic conditions.<sup>7</sup> Wellness and self-care practices reduce individual risk-related factors while work safety reduces work-related risk factors. Examples of wellness programs are smoking cessation, weight control, healthy nutrition, physical activity, flu vaccination, meditation, and mindfulness.
In my mind, this lends additional credence to the necessity of chaplains like my self working within the business community to bring about holistic interventions to reduce stress and bur out.
April 2, 2020 at 5:35 pm #5859
@Laura, very insightful observation:
Fast change is not normal to my system, nor do I imagine that it is normal to any one. I like gradual change and adaptation. This current health care crisis did not allow for this natural process to change. The country changed whether we were buying in to the system or not. No one assessed the country to see where we were in the change cycle.
I see this happening everywhere except, unfortunately, where it needs to happen, which is among the general population. They seem to be *very slow* in their change with regards to what needs to be done to social distance, etc.
April 2, 2020 at 5:38 pm #5860
Thanks to all for your insight and wisdom. Not having been in an online learning setting in a while, it was difficult for me to keep up due to life circumstances, but I do look forward to future experiences and I’m thankful for this one! Blessings!
April 2, 2020 at 6:33 pm #5861
Peace for you and your family with so many sacred moments. Laura
April 4, 2020 at 6:07 pm #5867
Not sure if folks are still posting. I really enjoyed this class. I was challenged by the posts of everyone and gain some good ways to care for not only myself but others.
I wish all of you peace in this scary time and may you all stay healthy. I find the words of John ODohohue so peaceful now.
Receive this blessing.
Now is the Time to free the heart, Let all intentions and worries stop, Free the joy inside the self, Awaken to the wonder fo your life.
Open your eyes and see the friends whose hearts recognize your face as kin, Those whose kindness watchful and near, Encourages you to live everything here.
See the gifts the years have given, Things your effort could never earn,The health to enjoy who you want to be and the mind to mirror mystery.
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