Self-Care is Ethical Practice

Caregivers tend to be so focused on helping others that they don’t dedicate enough time and resources for their personal care.  Some feel guilty or selfish when their focus is turned toward themselves.  Self-care for the caregiver should be viewed as a professional ethical obligation and not as an option.  When a caregiver is not adequately taking care of his/her needs it can put the client/patient at risk.  Good self-care practices can help the caregiver to perform the responsibilities of his/her position optimally and with increased compassion.

Most professional code of ethics include statements regarding “impairment” and some address caregiver “self-care” more directly.  The Green Cross Academy of Traumatology has comprehensive Standards of Self-Care Guidelines that are designed for professional caregivers (to view CLICK HERE).  This code states that the purpose of the guidelines is twofold:  “First, do not harm to yourself in the line of duty when helping/treating others.  Second, attend to your physical, social, emotional, and spiritual needs as a way of ensuring high quality services to those who look to you for support as a human being”.  (www.greencross.org/)

Most code of ethics begin with the principle of “first, do not harm” as it relates to the client/patient.  While this is a must, it is also imperative that we maintain a dual focus on the client/patient and ourselves while doing our caregiving work to ensure optimal service, to uphold the integrity of our professions and to maintain personal well-being.  Ethical errors are more likely to occur when the caregiver experiences symptoms of compassion fatigue and/or burnout.  Self-care has been identified as the greatest protection against experiencing secondary trauma symptoms because it increases caregiver resiliency.

Increased attention given to the subject of self-care by professional associations is helpful in creating awareness regarding its importance.  A good example of this is the statement made by National Association of Social Workers in NASW Social Work Speaks, 2011 – 2014.  “Professional self-care is an essential underpinning to best practice in the profession of Social Work ….. Self-care has relevance to all social workers in the setting with which they practice ….. NASW supports the practice of professional self-care for social workers as a means of maintaining their competence, strengthening the profession and preserving the integrity of their work with clients.”

Compassion fatigue is linked to ethical errors, therefore it stands to reason that it is unethical to neglect self-care.  Self-care is the responsibility of each professional.  The benefits of practicing effective self-care are far-reaching and can impact everyone you come into contact with.  Self-care is ethical practice!

 

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Self-Care Toolbox

A toolbox of self-care tools and qualified people to assist with self-care is helpful to draw upon to keep oneself replenished.  Using self-awareness to continually monitor personal needs and energy level is essential for optimal self-care.  Different situations call for different tools and having several to choose from, depending on the circumstance, is beneficial.  I recommend doing something to nurture and relax yourself daily.  Doing so can help you to maintain balance and resilience during times of stress.

Your toolbox can include anything you do for yourself that helps to relieve stress, nurtures you and/or revitalizes your energy.  Only you know what works best for you.  Seeking out new tools to add to those you already use can be invigorating and fun.  Examples of self-care tools include meditation, sea/epsom salt baths, nature walks, exercise, journaling, tapping (Emotional Freedom Technique), Reiki and acupressure point massage.

It is also recommended to have a team of qualified professionals whom you can call upon to assist with your self-care needs.  Examples include a counselor/therapist, life coach, exercise trainer, massage therapist, chiropractor and acupuncturist. Appointments with qualified professionals can be scheduled regularly (a monthly massage, for example) or scheduled as needed.

Support from trusted friends, peers, mentors and/or supervisors is an important part of a self-care toolbox.  The people you work with can be a great resource because they can closely identify with work stressors and situations encountered.

Identifying, building and utilizing your self-care toolbox is great prevention of compassion fatigue and creates the resilience necessary to handle the intense work of a caregiving professional.  By taking care of your needs, you will have more energy to serve your clients.  Additionally, from this place you’ll have more to give your family and friends.

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Self-Care Movement

What we need is a self-care movement in which each person loves, cares and takes responsibility for him/herself.  By acknowledging and responding to our needs, we have more energy and compassion for those we serve.  As professional caregivers we have the influence to greatly impact our clients/patients by teaching and modeling effective self-care.  We have the opportunity to create and lead a self-care movement, but in order to do so we must be proficient with our personal self-care and “walk our talk”.  It begins right here, within ourselves and our professions.

Several researchers of secondary trauma, related to caregiving professionals, have identified self-care as an issue that should be addressed within multiple levels.  This is important because professional caregivers are at high risk of experiencing stress injuries due to the intense nature of their work and exposure to secondary trauma.  Self-care is viewed as the responsibility of the individual, of educators in the academic setting, and at the professional level within the workplace (Gokhan, Meehan & Peters, 2010;  Newell & Macneil, 2010; Radey & Figley, 2007).

The individual can address self-care by holding him/herself to a high standard of self-care practice.  By maintaining a commitment to excellent self-care habits, the caregiver is more likely to maintain balance and resiliency during times of occupational stress.  It is helpful to design a self-care plan that has specific intentions regarding self-care methods and frequency of application.  The individual caregiver can seek out self-care resources and tools through research, training workshops, on-line training and by working with qualified professionals.  Additionally, working toward wholeness within ourselves by healing unresolved issues and traumas can be freeing.

Self-care can be addressed within academia by including stress management and self-care courses into the university’s curriculum.  An ideal time to offer such courses is when students are doing on-the-job practicums and internships.  Creating awareness regarding secondary trauma and teaching effective stress management tools before entering into the caregiving professions could better prepare students to handle the intensity of their work and result in career longevity.

Organizations can address self-care by providing their employees with stress management/self-care training and continuing education.  Wellness programs are an excellent way to support employees with their self-care needs.  Additionally the organization can reinforce professional self-care by encouraging employees to take lunch breaks, providing manageable workloads and reasonable work hours, ensuring adequate supervision and training, and by cultivating a positive environment that results in employee satisfaction.

By addressing self-care within multiple levels caregivers are more likely to experience satisfaction and flourishing within their work.  When the caregiver is feeling optimal he/she can provide superior client/patient care.  From this place the caregiver can positively impact the client/patient by modeling and teaching effective self-care.  This is an opportunity to create much needed change within our society.  As Ghandi said, “Be the change that you wish to see in the world.”

Citations

Gokhan, N., Meehan, E., & Peters, K., (2010).  The value of mindfulness-based methods in teaching at a clinical field placement.  Psychological Reports, 106(2), 455-466.

Newell, J., & MacNeil, G., (2010).  Professional burnout, vicarious trauma, secondary traumatic stress, and compassion fatigue:  a review of theoretical terms, risk factors, and preventative methods for clinicians and researchers.  Practices in Mental Health, 6(2), 57-68.

Radey, M. & Figley, C., (2007).  The social psychology of compassion.  Clinical Social Work Journal, 35(1), 207-214.

 

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What is Self-Care?

A focus on self-care is becoming increasingly important as the demands within caregiving professions seem to be intensifying.  Self-care is any activity of an individual that is done with the intention of improving or maintaining wellness.  Professional self-care can be defined as the incorporation of skills and strategies by caregivers to preserve their personal, familial, emotional and spiritual needs while serving the needs of their clients (Newell & MacNeil, 2010).

Categories for self-care can include 1) physical:  body work, exercise, adequate sleep, nutrition:  2) psychological:  effective relaxation time, contact with nature, forms of creative expression, balance between work and recreation;  3) social/interpersonal:  supportive relationships and knowing when/how to obtain help;  and 4) professional:  balancing work and home life, setting boundaries and limits, and getting help/support through peers, role models, and supervisors (Charles Figley interview, 2005).

Self-care has been identified as the greatest strategy to prevent or reduce the undesirable effects of Compassion Fatigue, Secondary Traumatic Stress, Vicarious Traumatization and Burnout.  Professional caregivers are at much higher risk than other professionals of experiencing compassion fatigue due to the nature of our work (Radey & Figley, 2007).

Compassion is a very important element in the success of a caregiver engaging clients in direct practice work.  In order to gain the trust of the clients we mush develop a positive working relationship and be able to empathize with the client.  “Sometimes our hearts go out to the clients to the point where we feel their pain and suffering, which can lead to mental, physical and emotional fatigue” (Radey & Figley, 2007).  Chronic exposure to others’ traumatic events is also a factor that puts caregivers at higher risk of experiencing compassion fatigue.  Compassion fatigue can lead to burnout, a condition of emotional, physical, psychological, and spiritual exhaustion that results from practicing with people who are vulnerable or suffering (Newell & MacNeil, 2010).

Citations

Compassion fatigue:  An expert interview with Charles R. Figley, (2005).  Retrieved 4/15/14 from http://www.medscape.com/viewarticle/513615.

Newell, J., & MacNeil, ., (2010).  Professional burnout, vicarious trauma, secondary traumatic stress, and compassion fatigue:  a review of theoretical terms, risk factors and preventative methods for clinicians and researchers.  Best Practices in Mental Health 6(2), 57-68.

Radey, M., & Figley, C., (2007).  The social psychology of compassion.  Clinical Social Work Journal 35(1), 207-214.

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Scheduled Time Off

Scheduling time off for vacation, “staycation” or weekend getaways can be essential in preventing burnout.  “Burnout is a progressive loss of idealism, energy, and goals as the result of personal or occupational stress.  Burnout results from high levels of stress over time.  Continuing personal or work stress, without rest, will eventually lead to burnout” (CR Figley (Ed.) Encyclopedia of Trauma. Sage Publications).

Getting a break from the demands of life, both professional and personal, can be necessary.  Sometimes we need a change of scenery to let go, rejuvenate, and gain fresh perspective.  This can often be accomplished by scheduling time off from work and away from home.  It is best to schedule time off before reaching the point of frustration and exhaustion.  Vacation to a new destination, a favorite place previously visited, a workshop or retreat, visiting out-of-town family and/or friends could be exactly the break you are needing.

If you have some paid time off but cannot financially afford a vacation away from home, I recommend the “staycation”.  Spending vacation time at home can also be a refreshing break.  Time off may seem extended by “unplugging” for a while by taking a break from email and turning off the cell phone.  Letting people know in advance that you will be doing so is a good idea.  Setting boundaries around your scheduled time off can give a sense of freedom and relaxation.  Giving yourself permission to do what you want to do, moment by moment, and without a schedule during your time off is a wonderful gift to yourself.

If time off from work is not an option, you may also get a nice break by scheduling a weekend getaway trip.  A quick change of environment can have similar relaxing and refreshing effects as a vacation.  The same intentions as the “staycation” mentioned above could be done during a weekend at home.  Sometimes saying “not now” or “no” to others and “yes” to yourself is necessary self-care.  You’ll have more to give others when you tend to your needs and rejuvenate yourself.  By giving from this place, everyone wins.

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Compassion Satisfaction

“Compassion satisfaction is the pleasure we derive from being able to do our work well.  Higher levels of compassion satisfaction are related to your ability to be an effective caregiver” according to Dr. Beth Hudnall Stamm.  The Professional Quality of Life Scale (PROQOL) Version 5 (2009) was developed by Dr. Beth Hudnall Stamm and can be used to measure compassion satisfaction, burnout and secondary traumatic stress.  This self-assessment is available as a resource on our website.

There are multiple ways in which compassion satisfaction can be cultivated.  Rather than than focusing on the negative or challenging aspects of the work, one can generate positive feelings by focusing on the aspects of the work that are enjoyable.  Remembering accomplishments, positive feedback from clients/patients/supervisors, times when a difference was made in someone’s life, and feeling gratitude for such opportunities can help shift a person’s perspective and elevate his/her mood.  Creation of a “smile file” to keep positive feedback from others, awards, cards, etc. can be helpful to review at times when the work seems overwhelming and you have lost sight of your positive impact.

Building a support network within the workplace can make work more enjoyable.  Reaching out to people in the same profession for support is helpful as they are likely to have experienced similar frustrations and joys while doing their jobs.  It is nice to take the time out to enjoy lunch and conversations with friends at work.  Identifying supervisors and mentors to whom you can go to for advice and/or learning opportunities can be gratifying.

Effective self-care can help you to maintain resiliency and keep your balance, thus contributing to compassion satisfaction.  Creating balance between work, family/friends and personal needs is essential.  Continually assessing and adjusting self-care between these three areas is important in establishing and maintaining balance.  When it seems as if one area of your life is dominating the others, it is time to make an adjustment.  To do so requires contemplation and mindfulness regarding what is working and what is not.

I encourage you to find opportunities to laugh, have fun, play and relax during time spent away from work in order to recharge and return to work refreshed.  It is too easy to get caught in the demands and responsibilities of both work and the home/family.  There will always be more to do and sometimes it can wait.  Your needs are important too!  You’ll have more to give when you acknowledge and respond to your needs.

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Tips for Starting a Meditation Practice

Meditation may seem foreign or intimidating if you have never tried it.  Learning to meditate is actually very simple and can be as natural as breathing.  For the sake of stress relief, the purpose of meditation is to calm the mind and relax the body by inducing the parasympathetic relaxation response.  The more often you do it, the better the results.  Below are some tips to help you get started.

  • Find some quiet time by yourself that will be uninterrupted.  This could be in the morning before you get out of bed or in the evening before going to sleep.
  • Get comfortable by sitting on a cushion, chair, or lying down on your back with your spine straight.
  • Set the intention of “being” rather than “doing”.  You can set other intentions such as letting go, giving your mind and body permission to relax, connecting with yourself, etc.
  • Start by noticing your breath and how it feels in your chest, belly, nostrils or wherever.
  • Continue to focus on your breath, moment by moment and breath by breath.
  • You may notice that your breath begins to change as you give it attention or that you begin to feel sensations in your body by giving it your awareness.
  • You may notice your mind wandering and if so, just notice without judgment as this is what minds do. 
  • This awareness and acceptance can assist with detaching from thoughts and prevent you from getting carried away by them.
  • Observe what is going on and what you are experiencing, without judgment, for that is the moment of awareness. 
  • You can bring your awareness back to your breath over and over, as necessary. 
  • Initially, this practice can take time to get used to.  It requires patience, self-compassion and appreciation for attempting a new practice and taking the time to nurture yourself. 
  • When you are finished be sure to ground yourself by bringing your awareness back to the room and into your body by noticing your feet on the ground and how your body feels as you move. 
  • Following guided meditations can be helpful and relaxing as you begin a practice.  For your convenience, complimentary guided meditation downloads can be found on our website.     

 

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Benefits of Meditation

Meditation is recognized as a great stress relief tool with vast and potentially life altering benefits.  Meditation can be done anywhere by anyone.  It can be done while sitting, lying down, taking a shower, eating, cooking, walking, dancing, painting, writing, listening to music, praying, doing yoga………and the list goes on.  Life can be a meditation if living is done mindfully by experiencing and being present moment by moment. 

The benefits of meditation include, but are not limited to:  reduced stress, elevation and maintenance of positive emotions, increased resilience, mind-body connection, greater awareness, self-reflection, clarity, acceptance of present moment reality, quiet mind, increased concentration, greater creativity/imagination and connectedness to all that exists.  Meditation has become the subject of study for neuroscientists and there have been findings to support that meditation positively changes how the brain functions during stressful situations.  Additionally, consistent meditation practice has been shown to restore health in people who experience pain and illness.    

Meditation is a practice worth adding to your self-care regimen or building upon if you already meditate.  Our next blog will provide tips on how to begin a meditation practice.

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Mindful Living

Life can be a meditation if living is done mindfully and with intention in each moment.  According to Dr. Jon Kabat-Zinn, meditation expert, “mindfulness is the practice of experiencing reality in the present moment through awareness”.  This requires slowing down and being fully present in the here and now.  We often get caught in the stories cycling in our minds about past events or thinking about the future.  We can learn from the past, but it is gone and does not serve us to dwell there.  Thinking about the future can be helpful for the purpose of planning, however can create fear and anxiety regarding the unknown.  The future is not reality and has not yet happened.  The present, the moment of here and now as it is experienced, is the only moment that is real.

One can experience great peace and acceptance by living in the present moment.  There are many gifts and much beauty missed in the present moment because we can find ourselves identifying with the stories played out in our minds regarding the past and/or future.  This is part of the human condition and there is no reason for self-judgment as the purpose of the mind is for thinking.  Over-identification with our thoughts can be counterproductive as they are often driven by emotion and based upon opinions and judgments rather than on reality.  Getting out of our minds and fully living in our bodies through experiencing can be liberating.  In upcoming blogs I’ll explain the benefits of meditation and give tips on how to begin a meditation practice.      

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Spring Cleaning and Clearing

Spring is a great time to do some cleaning up and clearing from the outside-in and the inside-out.  It can be a time for space creation and renewal as one’s energy is often elevated and more motivated for change.  Many people have reported feeling lighter after doing some deep cleaning or getting rid of things that they no longer need or that no longer serve them.  It may be that positive feeling of accomplishment when such endeavors have been completed or the feeling of freedom from letting go.  Additionally, it feels great to donate those things we no longer want to someone who is in need.  It can take some motivation to get started on cleaning, clearing and organizing projects, but the benefits are well worth it.

We can also affect our external world by creating and clearing space internally.  Are there emotions, attachments, relationships, and/or habits within yourself that you would like to release?  Are there activities you still do that are no longer of benefit or people you spend time with that drain your energy or you no longer enjoy?  These questions are worth contemplating and if the answer is yes, now is a good time to release that which no longer serves you in order to create more spaciousness.

Perhaps time spent with a therapist or life coach could be beneficial.  It is possible that taking up a new activity or spending time with a new friend might be enjoyable.  Making more space for yourself to take pause, contemplate and/or relax could be what you do with the additional space created.  We can sometimes feel resentful of the time and effort given to others when we are not spending enough time meeting our needs.  Self-awareness regarding personal needs and responding to those needs can help us to restore balance and peace within a busy life.

I encourage you to think on these things and put intention into what you want to keep, let go of and bring into your life.  It is helpful to evaluate that which is working well and no longer working in your life.  Contemplate on how you can make space and take action.  It is a great time to spring forward in life, as the possibilities are limitless!

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