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The cornerstone of compassion lies in self-care. If we want to provide optimal care towards someone else we should provide the same care to ourselves. If we do not practice self-care how are we supposed to care for another person?
Self-care is something that I practice often, because something so simple goes a long way. I believe it goes along with balance as well. Leading a balanced lifestyle ensures that all areas of your life are being cared for allowing that care to be distributed towards others.

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"The cost of caring" for others emotional and physical pain.
The thought of accepting that such repercussions can come from caring and working for others is a testament to the complexity of human emotion and interaction. The ripple effect of "the job" and having to earn a living permeates into the initial intentions. When we see outcomes that we are not expecting and feel that we have failed others and ourselves, I think that the next best human emotion is numbness and rejection of the feeling. IT is easier not to care, when caring is exhausting and detrimental to our health. Howe ver, Mathieu informs us that not caring still has its repercussions for the healthcare provider. What is the proper balance? Will we be able to find it? Will "strategies" be able to derail this formidable foe to altruism and community?

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The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet” (Remen, 1996)

This article could not have come at a better time. It summarized the feelings I was having towards my work. Mutual feelings that were also being felt by my coworkers. There seemed no solution but to keep pushing forward. I am glad to be able to share this article with them. Pouring into others we often forget to pour into ourselves. If we are not being poured into. what then can we pour into others?

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Compassion Fatigue:Dr. Bony Dent thanks for this article which is very useful for a physical therapist to be aware of what is “compassion fatigue” and what are its signs and symptoms. I have personally faced such challenges as a compassionate physical therapist and I recall one incidence when I was rehabilitating a patient with multiple stroke who was dependent, aphasic and her only daughter who was an organ transplant surgeon knew the importance of physical therapy for her mother. The goal of the daughter and not exactly the patient was that the mother should be at least able to manage to do her ADL with assistance and myself out of compassion for the patient and the interest of the daughter would just spend extra time and physical effort to reach the goal. In this situation, I had reached a state where I faced certain health issues and had almost all the signs and symptoms of compassion fatigue. At this point I am able to correlate that it’s called  compassion fatigue and these are the check point that I should be aware of before I reach to that extreme of exhaustion.

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Compassion Fatigue:Dr. Bony Dent thanks for this article which is very useful for a physical therapist to be aware of what is “compassion fatigue” and what are its signs and symptoms. I have personally faced such challenges as a compassionate physical therapist and I recall one incidence when I was rehabilitating a patient with multiple stroke who was dependent, aphasic and her only daughter who was an organ transplant surgeon knew the importance of physical therapy for her mother. The goal of the daughter and not exactly the patient was that the mother should be at least able to manage to do her ADL with assistance and myself out of compassion for the patient and the interest of the daughter would just spend extra time and physical effort to reach the goal. In this situation, I had reached a state where I faced certain health issues and had almost all the signs and symptoms of compassion fatigue. At this point I am able to correlate that it’s called  compassion fatigue and these are the check point that I should be aware of before I reach to that extreme of exhaustion.

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 “Compassion fatigue” is not a familiar word to me, but the experience is…. (Mamata)

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 “Compassion fatigue” is not a familiar word to me, but the experience is…. (Mamata)

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Being an empath, I am very familiar with the overwhelming feeling and exhaustion when I see one in pain and suffering. The symptoms just continued and intensified after stepping into healthcare profession. It took me a while to realize that compassion is not a limitless resource and one needs to replenish before exhausting it.

This article just increased the awareness and reinforced the need for self-care.. Because running on empty does not serve the purpose..

“Be gentle with yourself. You are a child of the universe, no less than the trees and the stars. In the noisy confusion of life, keep peace in your soul.” ~Max Ehrmann

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“Healing is holistic” thoughts from Video-Sarathy

In integrating spirituality in medical care, Physician performs spiritual assesment briefly to identify spiritual needs of patients related to medical care and refer them towards spiritual care team where chaplains/pastoral counsellor perform comprehensive spiritual assessments and focus on addressing their spiritual needs by prayers or emotional support since they are core person of spiritual care team.

Sometimes social worker can handle simple spiritual needs by addressing them or contacting local faith community or local clergy to set up appointment as in following up after hospital discharge. Healing should be enabled in all aspects of individual like physical, mental and social aspects of human, that’s why healing is holistic as per Dr.Koenig. So overall this involves many steps as identifying spiritual needs, address them and follow up in community and creating comfortable atmosphere for patients and family to discuss. When addressing spirituality as a whole personal care, chaplains are not alone so different perspective is important in dealing with people.

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1-    Identify patient spiritual needs related to medical illness.

2-    Address patient spiritual needs.

3-    Follow up to be sure the spiritual needs have been adequately addressed.

4-    Create an atmosphere where patients feel comfortable talking  about the spiritual needs.

5-    Address the whole person needs.

Koenig: Spirituality in Patient Care: Introduction and Overview: Video #5 Spiritual Care.

Amr Abdelaziz.

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My reading on compassion fatigue brought to mind a story shared by a Navy Veteran to me during a very stressful time in my day.  His story brought perspective and appreciation for those who have served our nation.
This gentleman was heading to the Mediterranean during WWII.  The vessel he was on was sunk near the horn of Africa.  He and some of his shipmates were able to survive on a life raft for 3 days before being rescued by another Navy vessel.  Shortly after boarding that ship, It was sunk... this time 7 days on  the life raft.  They rationed water 7 ounces a day and had little if any food.
My minor stress over issues surrounding me seemed trivial comparatively.  When I get into a treatment or general "funk" I think of stories like his that a fair number of those I serve have experienced.  These serve as motivation when low.  It is nice to know that I am not the only caregiver that has challenges with motivation, empathy and at times sympathy.

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The healing ministry of Jesus and Compassion Fatigue (Ogwu Susan)

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The healing ministry of Jesus and Compassion Fatigue (Ogwu Susan)

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The article on compassion fatigue (CF) is a timely reminder that we are humans, we are just like our patients that can fall sick and most of our sickness may be deeply rooted in spiritual needs. Compassion fatigue is a gradual and cumulative process and so is healing from its effects. Relying only on the degrees earned in the health profession is not sufficient to protect us from the processes that leads to CF, which tends to develop from the interplay of daily activities of our life and the demands of our profession.

Thus initially taking care of our self, is of priority before extending care. Addressing our spirituality daily can be a very important approach to help us cope because our spirituality is our very core that gives us meaning in life. This can help us put in place the strategies that can combat this phenomenon that is sure to happen to all helpers or care givers. The healing ministry of Jesus points us to the fact that the concept of healing is established by God and we do not have to bear the burden of providing care alone, we can partner with Jesus in our profession. We need to trust God to fulfil this great calling of care because we are not the solution to our patient’s problem but stewards. We need to connect adequately to our spirituality and satisfy our spiritual needs to be able to find meaning in this calling of care giving and provide meaningful work of care.

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Goals of the spiritual care team from the video - Kalai.

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Goals of the spiritual care team from the video - Kalai.

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Goals of spiritual care team:

1.    Identify spiritual need of the patient

2.    Address the spiritual needs

3.    Follow up to the make sure the addressed spiritual needs are adequate

4.    Create comfortable atmosphere for the patient to communicate with the healthcare professional.

5.    Support team members – coordination among the spiritual care team to provide appropriate care.

6.    Whole person medical care including spiritual care.

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We are not superman or superwoman we are human. We are all in this human experience together, which means we will struggle at times and need support from others.

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"Putting it all together" by Sophia Brown

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"Putting it all together" by Sophia Brown

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After reading the article "compassion fatigue" by I realized how often and how easy it is for "caregivers" to simply stop caring because in essence there are many factors, trials and tribulations and a healthcare providers life that will distract them from what they have chosen to and should do whether it is emotional, spiritual, physical or social. There are times that there seems to be absolutely no way out .....but then I am reminded after reading the following quote how blessed we really are; From E G White in "the ministry of healing" pg. 72." Whatever your anxieties and trials, spread out your case before the Lord. Your spirit will be braced for endurance. The way will be open for you to disentangle yourself from embarassment and difficulty. The weaker and more helpless you know yourself to be, the stronger will you become in his strength. The heavier your burdens, the more blessed the rest in casting them upon your burden bearer"." I can definitely do all things through Christ who strengtheneth me "Phillipians 4: 13

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"Those who would communicate the beauty of the truth in Christ have a tough job, for the mists of ugly Western imperialism, war, violence, greed and gluttony are thick indeed".

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The readings this week from Sire were very interesting.  I never heard of Eastern Pantheistic Monism.  This reading gave me a whole new perspective on Eastern Religions.  Karma which even westerns talk about is "you reap what you sow" but stricter.  "If you have "sinned\', there is no God to cancel the debt and to forgive.  Confession is of no avail.  The sin must and will be worked out."  How different this is from Christianity which talks about a loving God who sent His Son Jesus to die for our sins.  All we have to do is ask for forgiveness.  How much simpler it is to ask for forgiveness than to work to make sure the sin is taken care of.   Also it leaves the stress of thinking "Did I do enough to take care of the wrong I did?"  Something to think about. pg 156

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"An authentically empowered person is one who is so strong, so empowered, that the idea of using force against another is not a part of his or her consciousness. No understanding of evolution is adequate that does not have at its core that we are on a journey toward authentic power, and that authentic empowerment is the goal of our evolutionary process and the purpose of our being. We are evolving from a species that pursues external power into a species that pursues authentic power. We are leaving behind exploration of the physical world as our sole means of evolution. This means of evolution, and the consciousness that results from an awareness that is limited to the five-sensory modality, are no longer adequate to what we must become." - Gary Zukav

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Compassion fatigue is an  emotional exhaustion and a pronounced change in the helper’s ability to feel empathy for their patients, their loved ones and their co-workers. It is an occupational hazard, which means that almost everyone who cares about their patients/clients will eventually develop a certain amount of it, to varying degrees of severity. Developing compassion fatigue is a gradual, cumulative process and so is healing from its effects. A few people can be fully restored by taking a holiday or going for a massage but most of us need to make life changes and put our own health and wellness at the top of the priority list. A  a Compassion Fatigue Prevention Toolkit consists of Self Care, Stress reduction strategies &Counselling.

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(Mette Coleman)
The article on compassion fatigue in health care professionals "Running on Empty" by Francoise Mathieu, was insightful, relevant, and just what the doctor ordered. I went to tendacademy.ca and took the PROQOL (Professional Quality of Life Screening). I was surprised to find that I scored very low on the burnout and secondary traumatic stress categories, but higher on the compassion fatigue category. My compassion fatigue score was below 40 and it indicated that I may "find problems with my job or derive satisfaction from activities other than my job." This confirmed my suspicion and
what at times feels likes "burn out" is perhaps a sign that I need to change my job. I derive great satisfaction from my DScPT studies and it is ironically perhaps why I may not "burn-out" as my studies deepen my clinical interest. Seeing patients part time and teaching would be ideal and is my dream/goal.

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(Gail)
It was interesting that there is a syndrome/name for what we used to call burnout. It was good to hear a compassionate discussion of the caregiver's symptoms and what may have caused it, what kind of counseling might help with it. Burnout somehow seemed to imply a fault with the caregiver. Thank you for giving us a better way to look at this!

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Interesting and contrasting comments on language from this week’s James W. Sire readings. He writes on page 155 in Chapter 7 (Eastern Pantheistic Monism): “Reality is one; language requires duality, several dualities in fact; ergo, language cannot convey the truth about reality”.

He also comments on page 200 of Chapter 8 when discussing conceptual relativism in New Age worldview: “It is not that reality is really different but that our Western language system with its overlay of cultural conceptions does not allow us to see otherwise. (Benjamin Whorf): ‘The structure of the language one habitually uses influences the manner in which one understands his environment. The picture of the universe shifts from tongue to tongue’.” He continues on page 204 with a quote from R.D. Laing: “Now, in a sense, it’s his distinctions that are making him unhappy. Sometimes I think a great deal of people’s suffering wouldn’t exist if they didn’t have names for it”.

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This week's reading about compassion fatigue made me realize how often and how easy it is for someone to no longer feel the compassion for others or feel aloof. A particular way of dealing with it would be developing a new hobby for example, running, yoga or reading books or learning a new instrument. These hobbies keep your mind occupied in fruitful things and helps you overcome your feelings of depression or lack of empathy towards others. A new hobby can boost your self confidence and the way you perceive yourself and others. And when one can be passionate about a particular thing, the mind automatically senses it and makes one feel better about it.

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(Pugi Narasimhan) Interesting read from one of the article I Came across on Compassion Fatigue

"We are taught in medicine to be brave and to be strong, but there should also be a time and place for emotional expression, and perhaps even for crying. Doctors, nurses and other members of the healthcare team must be steady sources of support for patient. But when the patient encounter is over, at the end of the day, the doctor or nurse or social worker or clerk needs to be able to process everything they have seen and experienced. We need to support people who work with the sickest of the sick,"¹

1.           Najjar et al. Compassion Fatigue: A Review of the Research to Date and Relevance to Cancer-care Providers. Journal of Health Psychology, 2009; 14 (2): 267 DOI: 10.1177/1359105308100211

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Jesus from an Indian perspective (Ashwin)

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Jesus from an Indian perspective (Ashwin)

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This week's readings on Eastern worldviews and the healing ministry of Jesus, led me to contemplate on what He means to millions of people who do not practice or profess allegiance to the Christian faith. When we look outside the boundaries of personal faith and religion, the Lords / Masters or Gods (Jesus the Christ, The Buddha or Lord Krishna), however we wish to glorify and celebrate them, espoused and embodied the values of spirituality, seeking, love and being what they preached. Even if this article's thoughts might be slightly different from many denominations of Christianity, it provides an interesting perspective from a land of billion people and several religions!
http://www.bbc.co.uk/religion/religions/hinduism/beliefs/jesus_1.shtml

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This week’s reading reminded me about a colleague I had when I was working in India. When I joined the hospital, I kept hearing stories about how great that person was. How involved She would get with her patients and how invested she was in their successful recovery. She was constantly being made an example of how we should behave with our patients.

However, as time went on, I had begun to notice a change in her. She no longer had the same fire or drive she once had. I never understood what happened. Since I was not every close to her I could not ask. After reading the signs and symptoms this week, I now realize that she was showing the signs and symptoms of compassion fatigue.

This is becoming serious issue. With more and more medical personnel becoming spiritually aware and interacting with patients on a spiritual level, they should all be taught to recognize the signs and symptoms. If not in themselves, at least in their colleagues.

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This weeks reading on Compassion Fatigue in Health Professionals was an article that as a practice owner makes me want to look into addressing in my staff to help prevent or be able to step in and intervene with when we see signs of it in our providers. It has been described by Figley, 1982 as the "Cost of caring" for others in emotional and physical pain. This is something that is very real many settings we see this in our practice from time and never really had a name except to say that they were getting burned out. Our answer in the past has been to take some tie off go on vacation or build time in the schedule to get caught up. I can see that there is much more to this in that it can be a situation that that may not be enough. At Physical Therapist we see people at there worst and our goal is to provide the pathway for our patients to achieve there goals and maximize there function. This can be very challenging and with increased work load I can see and have felt how this can have a toll on us as providers. As Health care providers practicing Whole person Health we can become overwhelmed meeting the needs of others and lose sight that in order to be able to give 100% to the patients we treat we must take time to take care of ourselves as well. As a practice Owner I find it my responsibility to find an out let for my staff to be able to find work/life balance. To be able to understand what CF is and the signs of it as well as a plan to address it before it progresses. I understand that working part time is one of the answers or seen as a way to prevent CF I also find that for many this is not a realistic option. I Do feel that when a practice runs short staffed for a period of time more load is put on the provider. As an owner it is vital to maintain a full staff would be one answer to keep the work load manageable. This article has intregeged me to explore deeper ways to maintain a healthy balanced work environment.

Brian Verville

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"The mountains may depart,
And the hills be removed;
But My loving-kindness shall not depart from thee,
Neither shall My covenant of peace be removed,
Saith Jehovah that hath mercy on thee."
Isaiah 54:10, A.R.V.
What a promise that Jesus gave us. I think as we administer to patients, this is one of the promises that we need t claim asking God"s loving kindness to be with us as we are working with patients. Am sure claiming God's promises will help us to prevent compassion fatigue and enhance our love and kindness towards the human race at large. When we involve God in our daily duties with our patients, we will find God in every patient we meet and we will ALWAYS have an encouraging message from God to share with our patients. This will make us look forward to go back to our work and be able to ease our minds even on hectic situaation

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This week's readings brought to my mind the question of whether Jesus ever experienced compassion fatigue. In his ministry on earth, He was constantly surrounded by suffering and pain. And unlike us, He could more than merely sympathize, He could feel the pain as if it were happening to Him. So did He ever have compassion fatigue? I know Jesus often took time away from people, in solitude, to spend time with God but was part of that the "burnout" of compassion? I think not. Isaiah 40:28 says that God does not get tired or weary. And He takes on all our burdens. However, there are habits from His life we can apply to our own to counter compassion fatigue. One of the most important points is that we need to take time to address our own needs, spiritually, physically, emotionally, by spending time away from attending others and alone time with God.

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Compassion fatigue is one of the risks associated with working in a medical profession. I would posit that it is analogous to some of the physical overuse injuries one can attribute to working in different areas of the medical field. For example, physical therapists can develop physical overuse injuries (of the joints of the hand, back injuries, pain from standing for long periods) and compassion fatigue could be seen as a mental/spiritual overuse injury. Things that help me lessen compassion fatigue are to take time off with family, further my education (board certification, fellowship, continuing education, returning to school for DScPT degree) and pro bono work. Additionally my religious and spiritual practices also renew me and promote better work-life balance, helping me to better care for and to be present with my patients.

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"Research has shown that working part time, or only seeing clients or patients part time and doing other activities the rest of the workday can be a very effective method to prevent compassion fatigue."  This quote illustrates something that many of us can relate to. Working in a private practice clinic can be very busy at times, and I will admit that there are days where I am probably seeing more patients on my caseload than I can effectively handle. Having to multitask and juggle having multiple patients in the clinic at once can lead to fatigue and overwork, and working full time can just add to that burnout.  I think that the ideal solution to preventing compassion fatigue or burnout is by working part-time with patients, and the rest of the day can be spent either working as a PT in another role (eg. teaching, consulting), and/or partake in leisurely activities and hobbies one enjoys. This will improve the overall mental and physical health of the provider as well as the health outcomes for the patient.

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Personal strategies on managing CF (Borko)

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Personal strategies on managing CF (Borko)

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“Improved self-care is the cornerstone of compassion fatigue prevention. This may seem obvious, but most helpers tend to put their needs last and feel guilty for taking extra time out of their busy schedules to exercise, meditate or have a massage. On the personal front, helpers need to carefully and honestly assess their life situation: Is there a balance between nourishing and depleting activities in their lives? Do they have access to regular exercise, non-work interests, personal debriefing? Are they caregivers to everyone or have they shut down and cannot give any more when they go home? Are they relying on alcohol, food, gambling, shopping to de-stress?  Helpers must recognise that theirs is highly specialised work and their home lives must reflect this.” (Mathieu, 2007).

Compassion fatigue and burnout are correlated. It’s important to recognize these symptoms as they can have a huge influence on the well-being of the health care professional as well as on the patient safety.

Attached is some more information on burnout among health professionals and its effect of patient safety.

https://psnet.ahrq.gov/perspectives/perspective/190/burnout-among-health-professionals-and-its-effect-on-patient-safety

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" Developing compassion fatigue is a gradual, cumulative process and so is healing from its effects "

This article is an eye opener and it also explains as to why certain people who are higher up in the medical field after a certain point like to change their path of career and move on to teaching or administration. Compassion fatigue might also be a reason why there might be insensitivity or lack of empathy for the patient. This can be devastating for the therapist and no good can come out of it as they would lose their emotional connect with the patient and might reduce their capacity as a health care professional.
In this noble field, it is important to care for our patients but we must not forget self-care at the same time. There are various ways for self-care ranging from a walk in nature to taking a vacation and we have access to most of these resources. We must make self-care a priority as if we are not 100% fine, we are doing a disservice to our patients.
Self care is a priority and necessity and not luxury in the work that we do.
-Shikha

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Thoughts on the healing ministry of Jesus from Ministry of Healing by E.G. White reading provides illustrations and examples of a loving and compassionate Savior who is not only touched with our physical pain and suffering but offers healing and restoration to our physical body, mind, and soul if we would reach out to Him in faith and believe. The healing ministry of Jesus offers faith in God that will transforms lives as He is able to not only heal us physically but can save us from a dying world of sin and offers peace and a transformed life to live and serve with compassion and glorify Him. I particularly like the following quote “Faith is a mightier conqueror than death. If the sick can be led to fix their eyes in faith upon the Mighty Healer, we shall see wonderful results. It will bring life to the body and to the soul” (White, p.63).

Jesus Praying The picture above shows Jesus praying to His heavenly Father. Jesus often took time to retreat and rest to stay in communication with His Father. “As the throng that had followed him departed, he went into the mountains, and there alone with God, He poured out His soul in pray for others….to His toil-worn workers today as to His first disciples He speaks these works of compassion, “Come ye yourself apart…and rest awhile” (White, p. 59). Jesus gave us a great example of taking time to retreat and to rest, and also to commune with God. In so doing, we can help to minimize compassion fatigue.

Schneider, W. (n.d.). 1. Pre-Remarks About Prayer. Retrieved from http://www.fountainoflife-givingwater.com/books-2/learning-to-pray-from-jesus/1-pre-remarks-about-prayer/

White, E. G. (1999). Online Books - The Ministry of Healing. Retrieved from http://www.whiteestate.org/books/mh/mh.asp

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When I read this article I started to think about how many professional or people in general who have or are experiencing these signs and symptoms-Just Running on Empty.
Signs and Symptoms of Compassion Fatigue
Each individual will have their own warning signs that indicate that they are moving into the
danger zone of compassion fatigue. These will include some of the following:
• Exhaustion
• Reduced ability to feel sympathy and empathy
• Anger and irritability
• Increased use of alcohol and drugs
• Dread of working with certain clients/patients
• Diminished sense of enjoyment of career
• Disruption to world view, Heightened anxiety or irrational fears
• Intrusive imagery or dissociation
• Hypersensitivity or Insensitivity to emotional material
• Difficulty separating work life from personal life
• Absenteeism – missing work, taking many sick days
• Impaired ability to make decisions and care for clients/patients
• Problems with intimacy and in personal relationships
(Mathieu, 2007).