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cwentworth

cwentworth

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  1. cwentworth

    Mindfulness: A Cure for Auto-Pilot

    Have you ever felt that your automatic pilot just switched on the moment you walked in the door? No matter what setting you are working in, nursing demands a complex skill set. To keep up on any given day, one must have their critical thinking, multi-tasking, speed, and accuracy skills polished and at the ready. It is clear why at the end of a 12-hour shift it seems as if every ounce of physical, emotional and cognitive energy has been consumed, leaving you empty. It makes sense that you would want to protect your energy level, not to mention side-step any metaphorical land mines quietly waiting to explode. Switching on Auto-pilot may seem like a quick fix, a desperate attempt to conserve your valuable energy to get through the day, but this experiential avoidance may be having a paradoxical effect. Humans have an inherent natural survival instinct that determines our reaction to unpleasant or uncomfortable events in our environment (e.g., combative or resistant patients, family members or difficult staff). This primitive instinct tries to steer us away from unpleasant things because of their potential for harm. This same instinct affects our internal processes as well, disconnecting us from unpleasant thoughts (e.g., worry or judgement), emotions (e.g., frustration, grief, stress, helplessness), or sensations (e.g., physical fatigue or tension). We protect ourselves by using experiential avoidance and, for some, it looks like switching on the auto-pilot. The irony is that experiential avoidance has been found to actually maintain psychological distress (Hayes et al., 1996). No matter how hard you try to escape yourself and all of your internal thoughts, feelings, and experiences, you are stuck with you. Interestingly, struggling with discomfort is what actually maintains this cycle and changing the relationship with the present experience is what helps long-term. It can seem a bit nebulous, but in order to relieve yourself from the struggling, you must open yourself up to experiencing the very thoughts, feelings and sensations that you are trying to avoid. It takes a lot of practice. However, it will serve you well if you can develop a willingness to contact whatever comes up during the work day - even if what comes up creates stress, irritation or sadness. Mindfulness-based research purports that although experiential avoidance (i.e., automatic pilot) can alleviate distress in the moment, over time it teaches us to become intolerant of our own internal experience. Jon Kabat-Zinn, a world authority on the use of mindfulness, defines it as: "Paying attention in a particular way: on purpose, in the present moment, and non-judgmentally." Mindfulness is about waking up, connecting with ourselves, and appreciating the fullness of each moment of life. Kabat-Zinn calls it, "The art of conscious living." It is a profound way to enhance psychological and emotional resilience, and increase job satisfaction. Accepting your authentic experience in the moment is the complete opposite of avoidance. When we learn to practice mindfulness in our daily lives and apply an open and accepting attitude to all internal and external experiences (including the painful ones), then we free ourselves from suffering. Notice that I did not mention that you would be free from pain? Pain is part of life. Suffering does not have to be. When we sit with unpleasant thoughts, feelings, and sensations (even if only briefly), they lose their power over us. They become just thoughts - just feelings - and just sensations. Research shows mindfulness training can help nurses cope more effectively with stress and reduce the risk of professional burnout. A study based on Jon Kabat-Zinn's 1979 study was conducted on a trial of nurses and found that those who participated in an 8-week Mindfulness-Based Stress Reduction training program (MBSR) had significantly fewer self-reported burnout symptoms, along with increases in relaxation, mindfulness, attention and improved family relations, compared to nurses in a control group. The next time that you experience some aversive, unpleasant, or unwanted experience, use it as an opportunity to choose to respond to the event differently than you normally would. Try to engage with curiosity and openness. Try to notice the unpleasant event, welcome it into your experience, examine it for what it is, accept it completely (which does not mean approve of it), and then allow yourself to let it go. Example of a Mindfulness Exercise (practice 10 minutes a day): Focus on your breathing. Notice the sensations of the breath as it travels in and out of your body. Don't try to make the breath happen in any particular way; just notice your breathing as it is happening. Of course, your mind will get caught up in other mental events, such as planning or daydreaming. But mindfulness simply invites your attention back to the breath without criticizing or judging the mind's wandering. This "awareness of breath" meditation helps slow your mental activity and builds the capacity to stay focused. Taking a few slow, mindful breaths before entering a patient's room can activate the parasympathetic nervous system, causing the "relaxation response," which helps you feel more centered and more fully present with the patient. Pain is inevitable, suffering is optional ~ Anonymous.
  2. cwentworth

    The Insidious Nature of Compassion Fatigue

    You are so right and thank you for stating that compassion fatigue can affect everyone. I wrote it completely from my perspective and afterwards, I thought about those of you who work in nursing homes, geropsych units, outpatient, med/surg, etc... I'm hoping that bringing this issue out into the open will help us feel less shameful about it. We might all start talking about it and then (hopefully) supporting one another.
  3. cwentworth

    The Insidious Nature of Compassion Fatigue

    Wow! Your job sounds incredible in so many ways - there is tremendous potential for burn out and such opportunity to find meaning and purpose in life. I am amazed at your commitment and willingness to approach such suffering on a daily basis. You are a special person who may need to realize the importance of self-care. You are definitely welcome to participate in my study. You do not need to be an ER nurse to participate in the Pilot Program! All you need to do is click on the link (demographic survey) and I will send you the information that you need. Thank you for what you do.
  4. cwentworth

    The Insidious Nature of Compassion Fatigue

    Participant Introductory Letter & Informed Consent Dear Registered Nurses, You are invited to participate in a research study! Caring for the mental health population can present unique challenges in an emergency department setting. As part of my doctoral work at Rivier University, I am conducting a research study to pilot a new method of mental health training for registered nurses working in emergency departments across the country. You are invited to participate in this exciting study. Requirements for Participation Participation in the study requires completing a demographic questionnaire, viewing a 30-minute training webinar, completing a posttest and two short surveys (before and after the webinar). Completing these measures should take no longer than 10-15 minutes for each administration. Study Procedures This is an experimental, pretest, posttest design, with random sampling and strict confidentiality. Data will be collected through a private online survey tool called, Survey Monkey. All personal information (e.g., email address) will be kept strictly confidential. Receipt of your completed demographic form and surveys will serve as your agreement to participate. In order to participate, please complete the surveys without the assistance of friends or co-workers, and send materials back by April 30th, 2017. Once you agree to participate in this study, you will be sent an email that will include links to; a demographic questionnaire, two surveys, training video and posttest (75% = passing grade). After you have completed all initial tasks, you will be asked to fill out another set of surveys. After all necessary documentation is received and the study has been completed, you will be notified about the results via email. Risks & Benefits The risks of participating in this study are minimal. Although your participation would result in less than 1 hour of overall dedicated time (including webinar and 20-minutes of paperwork) the web-based model will allow you to participate in a private location at your leisure. The benefits of participating in the study are; gaining increased insight and knowledge and making a contribution to the field of science and nursing education. Costs & Compensation Your participation in this study will not cost you anything other than your time. All necessary materials, including supporting documents and resources, will be provided. The findings of this research may inform nurses and administrators about new methods of training for ED nursing staff. You can refuse to take part in this study, stop participation at any time, or not answer questions, without penalty. Your personal information will be de-identified. All documents will be numerically coded. If you have any questions or concerns, please feel free to call me at (603) 933-0934 or my advisors, Robert Walrath, PsyD or Angela Moussou PhD, (603) 888-1311. Your contribution is very important. I hope you will participate. CLICK ON THE LINK BELOW AND COMPLETE THE DEMOGRAPHIC INFORMTION TO GET STARTED! Confidential Demographic Information Survey Sincerely, Colleen Wentworth Colleen Wentworth, MA, LCMHC cwentworth@rivier.edu
  5. com·pas·sion fa·tigue (noun): indifference to charitable appeals on behalf of those who are suffering, experienced as a result of the frequency or number of such appeals. Most of us who work in healthcare or deal with mental health or substance abuse patients on a regular basis are subject to compassion fatigue. Sometime during my ED career, I noticed that my attitude towards my patients had changed. I was becoming much more judgmental, edgy, somewhat hopeless, and quite cynical. It was only after I read an article on compassion fatigue that I realized that this is what I was experiencing. My compassion fatigue was a tricky phenomenon because it had such an insidious nature. I found it hard to believe that I started off quite this dark, bitter, and irreverent! My compassion fatigue accumulated from within, after each shift, over time, wearing away my shine and genuine love of helping others. Healthcare workers, especially those of us who work in an ED setting, continuously bear witness to the worst of human suffering physical, emotional, and spiritual. Naturally, very difficult emotions can be stirred up depending on how the situation resonates with us. Personally, I had a very difficult time dealing with alcoholics who were frequent flyers. I had an underlying belief that they were abusing the system and, often times, our staff. I had difficulty with the emotions that would come up over their constant demands for food, snacks, medication, and cab vouchers. In some ways, I felt as if we were enabling their sick cycle. When I realized that these feelings stemmed from my own inability to help a loved one with alcoholism, I became more self-aware and more accepting. I became aware that I was trying desperately to stuff, reject, ignore or transform my emotions (e.g., by eating, getting angry or using dark humor) to cope quite unsuccessfully I might add! I realized that I wanted to "fix" them. Even worse, I wanted to relieve my old pain fixing them. Recognizing compassion fatigue in ourselves can be difficult and there are many different sources of compassion fatigue. It is important to note that this is not an exhaustive list and compassion fatigue can take many forms. The following list of "symptoms" was taken from a wonderful web-based resource called, the Compassion Fatigue Awareness Project . This resource states that you may have compassion fatigue if you engage in the following set of behaviors: Excessive blaming Bottling up emotions Isolation from others Receiving more complaints from others Voicing excessive complaints about administrative functions Substance abuse used to mask feelings Compulsive behaviors such as overspending, overeating, gambling, sexual addictions Poor self-care (i.e., hygiene, appearance) Legal problems, indebtedness Re-occurrence of nightmares and flashbacks to traumatic event Chronic physical ailments such as gastrointestinal problems and recurrent colds Apathy, sad, no longer finds activities pleasurable Difficulty concentrating Mentally and physically tired Preoccupied In denial about problems If you sense that you experience compassion fatigue, chances are good that you are correct. I know that when we first started exchanging the term, compassion fatigue, everyone knew exactly what it was and how it felt. Your best defense against compassion fatigue begins with some self-examination, honesty, and awareness. Your openness to this process may lead to new insights into how old pain or trauma is triggered and relived over and over through your patients. There are some good resources that can help guide you on a journey of self-discovery and healing that will mediate the effects of compassion fatigue. Simple techniques are also helpful such as regular exercise, healthy eating habits, enjoyable social activities, journaling, and restful sleep. Accepting the reality of compassion fatigue in your life only serves to validate the fact that you are a deeply caring human being. It can be possible to successfully care for others while caring for yourself. I would really like to hear your stories about compassion fatigue. Below is a Ted Talk video titled, How to Manage Compassion Fatigue in Caregiving, by Patricia Smith. I found this to be quite helpful and validating.
  6. cwentworth

    Social Media Etiquette for Nursing Professionals

    Like most modern advancement - it can be a blessing and a curse. Social media is not a good fit for those with anger issues, have uncontrollable impulsivity, drink heavily, feel the need to post intimate messages to their partner, or use it to gain leverage in some ongoing family conflict. These people may have to learn the hard way and actually experience the resulting consequences, personally, before any behavior will change.
  7. cwentworth

    Finally Leaving Nursing...For Good!

    There is wonderful opportunity for growth - mentally/spiritually - through discomfort. You can learn about who you are and, more importantly, who you are not. It sounds like you are in the process of developing and refining your professional identity. There is no "failure" in that. It shows that as you experienced life as a nurse, you found your true self. I wish you all the best in the future. Thank you for your honesty!
  8. Annoying character flaws are one thing, this is something else! We all have to get along to work together, but when patient care is involved, the severity rises to a whole new level. A critical care unit does not and should not offer the opportunity for this outrageous behavior. I may think differently if you were talking about an outpatient practice or different setting. It is beyond inappropriate and the relational dynamics may be enabling this to continue. Our hospital has a "see something, say something", which is an anonymous reporting method. It is obvious that you have tried to rectify this through appropriate channels, now it is time to go a step further. I may reach out to patient care services or your hospital ethics committee. It certainly is a good learning/training opportunity for your fellow co-workers. So glad you shared!
  9. cwentworth

    When Your Patient is an Addict...How to Deal

    This was a fabulous read. I also have experience working with patients with addiction in the ER. To say it's "frustrating" work is a gross understatement. In any other context, their behavior towards us would be considered abusive. Like many of you, I've been called vulgar names, had my life threatened, had objects (usually food items) thrown at me. If I went to Staples, demanded a turkey sandwich and a giner ale and then proceeded to melt down in the store when I was told, "it might be a little bit", I would be arrested. However, I remind myself that these people are sick. They are emotionally, physically and spiritually bankrupt. Their drugs have robbed them of any positive qualities and ability to care about their life or the lives of others. Fortunately, I am in the position where I bare witness to their recovery. I witness the benefit of your hardwork, nurturance and compassion. Knowing that recovery is possible maintains my equinimity.
  10. It depends on what you mean by "socializing". I think that "socializing" with co-workers outside of work can be great for team-building, developing trust and improving morale. Dinner, movies, shopping, baby showers, or sports activities are all fun group activities to do together. However, "partying" with co-workers can be a tricky situation. I think we all can agree that alcohol does not facilitate or promote healthy professional boundaries. Prior to agreeing to go out with co-workers, it may be wise to find out what, where, how, and who. I don't mean to over-analyze, but you may need to consider the structural hierarchy of those going out (Do you want to hang out with someone who you are supervising?) and the group dynamics (Do they all get along?). There is a way to have a social life, maintain professional boundaries and have a good time - just be thoughtful about how you do it.
  11. cwentworth

    Most ridiculous patient requests?

    My strangest request happened during a home visit at a Continuing Care Community. My client lived in an independent apartment. She had hurt her foot and needed to keep it elevated. She asked me to pour her a glass of wine. I felt like a waitress again!
  12. cwentworth

    Go Fund Me for Co-workers?

    I have to agree with most of these posts. I feel that GFM provides an opportunity for predators to take advantage of those kind people who want to "help" others through a rough time. On the other hand, I have seen GFM pages for co-workers who have lost everything to a fire, want to help a loved one without health insurance or pay for some vital medical equipment - this is different. I can verify whether or not my co-worker's catastrophe is valid or not. Also, the choice is mine whether or not I wish to donate. GFM attracts those who want to manipulate, misrepresent, and prey on others (without recourse). Unfortunately, every dollar earned serves as a positive reinforcement for their misdeeds. Like with anything else, it is our responsibilty to be smart and discerning or else you may get burned.
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