Archive for category: Occupational Therapy At Work


“The Cost of Caring” — Coping with Compassion Fatigue

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

Co-written with Kayla Colling, Student Occupational Therapist

There are many reasons we become health care providers.  Sometimes it is a passion for helping a certain population, a desire to help people achieve specific goals, or the recognition that people are needed to fill gaps in health care delivery.  Whatever the reason, there are physical and emotional risks that come with “helping” work.

If you are a helping or social professional who uses compassion and empathy with your clients who have experienced trauma and suffering, you may already be familiar with compassion fatigue.  Nurses, physicians, trauma therapists, social workers, workers in child protective services, and military healthcare teams are recognized to be at risk of exposure to second hand trauma through their work and may benefit from understanding and recognizing compassion fatigue.  Other health care providers, such as occupational therapists, advanced practice registered nurses (APRNs), respiratory therapists and physical therapists may also suffer the consequences of compassion fatigue in their work with people and their families that are experiencing a health crisis.

What is compassion fatigue?

Compassion fatigue is often described as the “cost of caring”.  It can also be called “secondary traumatic stress”, which is a more clinical term, but it is generally agreed that these terms are interchangeable.

Compassion fatigue occurs when providers are exposed to another person’s trauma and suffering.  This could be through routine interactions at our workplaces, when we provide compassion and empathy to clients or patients who have experienced trauma.


Compassion fatigue impacts individuals physically, emotionally and spiritually, and tends to have a rapid onset of symptoms.  The symptoms listed below are not exhaustive and not exclusive to compassion fatigue, so they should not be used to diagnose.  If you are concerned, consider making an appointment with your physician or other mental health worker to discuss your concerns.

Physical:  chronic fatigue, frequent headaches, gastrointestinal complaints, sleep disturbances, muscle tension, aches and pains, and anxiety.

Emotional and Spiritual:  heavy heart, emptiness, decreased sense of purpose, low self-esteem, high self-expectations, helplessness and hopelessness, numbness, apathy, depression, anger, irritability.

Behaviour Changes: avoiding or dreading work, calling in sick frequently, inability to maintain empathy, chronic lateness, overworking, and difficulty focusing and concentrating.

So it’s like burnout?

Burnout has a more gradual onset and results from an accumulation of ongoing, daily stressors at work that wear us down if we do not take proper care of ourselves and try to address the contributing workplace issues.  Symptoms of burnout tend to be more subtle and are sometimes misinterpreted.  It is still very important that we try to both address and prevent burnout, but this is clinically different from compassion fatigue.

Building Resiliency/Prevention

Although we cannot entirely prevent compassion fatigue from happening, we can take steps to reduce the risk, recognize warning signs and seek support early in order to reduce the impact on ourselves, our coworkers, our clients and our friends and families. 

By reading this blog, you have already taken a step toward learning more about it.  If we can normalize these emotions after exposure to these types of situations, it might help us to seek and accept support when we need it.

If your workplace permits, it can be helpful to have regular debriefings, even if a specific incident or crisis has not occurred.

Self-care strategies have been shown to help prevent compassion fatigue.  These strategies will likely include enhancing your boundaries to separate your work life from your home life as much as possible.  It also often involves balancing your activities outside of work as well, including engaging in a variety of relaxing, pleasurable and productive activities throughout the week.  Importantly, getting enough sleep at night and eating healthy and regular meals are also parts of self-care.  Avoiding maladaptive coping mechanisms (such as turning to alcohol, increasing smoking, eating or spending) is also important, including recognizing when things are deteriorating to get help quickly.

Practicing self-compassion can also help us to build resilience against compassion fatigue.  You can find meditations to help cultivate self-compassion, or it might be something you explore through reading, watching TedTalks, attending a course or workshop, or talking to your therapist about.  Having a regular mindfulness or meditation practice may also help you build resilience, along with other positive and adaptive outlets like exercise and social time.


If you are interested in learning more about compassion fatigue, check out the references below.

If you want to “check in” with yourself, you may be interested in looking at the Professional Quality of Life Scale (ProQOL) available here.  This scale will allow you to calculate scores on scales that consider compassion satisfaction, burnout and secondary traumatic stress (compassion fatigue).  I am not suggesting using this scale for self-diagnosis but it can sometimes be helpful to indicate if there is a concern you might want to speak to a professional about.

The symptoms of compassion fatigue can be severe – if you are concerned for your safety, please call your local crisis/distress line for support.  Find a crisis line near you.


Sorenson, C., Bolick, B., Wright, K. & Hamilton, R.  (2016).  Understanding compassion fatigue in healthcare providers: A review of current literature.  Journal of Nursing Scholarship, 48(5), 456-465.  doi: 10.1111/jnu.12229

Sorenson, C., Bolick, B., Wright, K. & Hamilton, R.  (2017).  An evolutionary concept analysis of compassion fatigue.  Journal of Nursing Scholarship, 49(5), 557-563.  doi: 10.1111/jnu.12312

Vu, P. &Bodenmann, P.  (2017).  Preventing, managing and treating compassion fatigue.  Swiss Archives of Neurology, Psychiatry and Psychotherapy, 168(8), 224-231.  doi: 10.4414/sanp.2017.00525



Aging in Place: Making the “Stay or Go” Decision

This great resource provides some helpful advice to seniors that face the difficult decision to “stay or go” when it comes to housing as they age:

McMaster Optimal Aging Portal: Should I stay or should I go? Factors influencing older adults’ decisions about housing

The “Bottom Line” as outlined in this link is helpful, but I have added some other thoughts relating to the important “stay or go” decision:

The Bottom Line

Older adults’ loss of independence and declining capacity often lead to a decision to move to safer housing where care will be provided.

It is true that one of the most important factors in staying or going from the home includes the ability to get care.  Homecare from the public sector is not usually sufficient and private care is costly.  Friends, family and neighbors can only do so much.  But what if there was a way to delay the need for care by being proactive and addressing declining health actively by making changes to promote safety and independence BEFORE care needs become significant?  Occupational therapy can help people to be safer and more independent at home, and should be one of the first people you consult with if you are facing declining function.

The most important factors when making this decision are usually social and psychological considerations, not merely practical or economic considerations.

This is also true.  Isolation and reduced ability to self-motivate, engage and activate important self-care and home tasks greatly impact if someone can manage with or without supports.  Often the loss of a spouse or partner creates isolation and quickly forces people to have to adapt to a new way of living and managing alone.  This can often be the catalyst that determines if a home is too much to manage, or if a person can remain where they are.  Many seniors have the economic resources and family support to make changes to their home or living situation, but often they resist using these resources to manage their own needs.

Having a better understanding of the range of factors influencing older adults will help family members and professionals better support them in the decision-making process.

Also a great point.  However, I would argue that solving issues related to senior housing and living needs to be a customized approach.  “Understanding seniors” does not create a roadmap of how to help people through their unique challenges.  There is no cookie cutter solution and getting input and help at the actual home (i.e. not in an office or clinic) is the ideal approach to develop the most appropriate solutions.

Consider occupational therapy if this can help you or a loved one to stay home safely, independently and for as long as possible.

Learn more about factors to consider when looking to Age in Place in our post, Occupational Therapy and Aging in Place.


“MO”-Tip of the Week: Learn the Male-Specific Symptoms of Depression

Our O-Tip of the week series delivers valuable “OT-Approved Life Hacks” to provide you with simple and helpful solutions for living.

For the month of Movember, a month dedicated to Men’s Health, our “MO”-Tip series will provide you with OT-approved ways to take care of the men in your life.  

According to Movember Canada, across the world, one man takes his own life every one minute.  By learning some of the less-recognized symptoms of depression that are more prominently seen in men we may be able to prevent this.  These include:

  • Being irritable, short-tempered, or inappropriately angry
  • Spending a lot of time on work (they may be trying to escape their feelings by keeping busy)
  • Reckless driving, extreme sports, or other risky behaviours
  • Excessive controlling behavior
  • Alcohol or substance abuse (men are far more likely to abuse substances)

These behaviours are untraditional of typical depressive symptoms but mean that men who may benefit from emotional aid are often slipping under the radar for health professionals, and this can lead to disastrous consequences including poor quality of life and higher rates of suicide.  If you, or a man you know, is experiencing these symptoms speak to a healthcare professional.

This Movember, commit to walking or running 60 km in recognition of the 60 men we lose each hour to suicide.  Learn more here.

Learn more in our post, Stressed or Depressed” – Man Therapy



What are Common OT Recommendations After Assessment?

Research completed by student Occupational Therapists Ashley Carnegie and Natalia Puchala, Supervisor Julie Entwistle.
Blog completed by Ashley Carnegie, Occupational Therapist

As an Evidence Based Research Project through McMaster University, Solutions for Living set out to summarize and highlight common OT recommendations after initial assessment.  The goal was to publish these findings to help student OTs, or OTs looking to enter the sector, to understand the scope, depth and breadth of the recommendations we tend to make.  Here are the highlights of our research findings, the completed study will be submitted for publication to OT journals when finalized.

Occupational Therapists play a valued role in Ontario’s auto insurance sector. In this, Occupational Therapists are hired by lawyers for assessment and treatment, or by insurers to conduct Insurance Examinations. Assessments usually start the OT service delivery process and serve to determine and outline the impact the client’s motor vehicle collision, and resulting injuries has had on all aspects of their previous life (e.g. self-care, productivity, leisure).  These assessments end with recommendations for the treatment and care that are needed to help the client recover. Occupational therapy treatment recommendations are designed to support clients in maximizing their potential to return to pre-accident function in all areas of life.

Despite the 1000+ Ontario Occupational Therapists working in this role, available literature about this sector is limited and does not adequately capture the role of occupational therapy in this setting. Therefore, in this study, a retrospective chart review was conducted of 205 occupational therapy assessments conducted with clients who had a motor vehicle collision. The aim, as indicated earlier, was to summarize OT recommendations post-assessment to help others interested in learning more about this area of practice. Recognizably, Solutions for Living by Entwistle Power Occupational Therapy was the only company involved in this chart review, and different companies may, and are likely to, have different findings.  Further, clients seen for OT assessment are already pre-screened to be eligible candidates for service, and thus assessments with “no recommendations” are unlikely.

Through the 205 charts reviewed, the results demonstrated the following:

Common Injuries

















Intervention Recommendations



















These interventions are in-line with best practices and standard treatment for the most common injuries identified in this study.

Surprisingly, only 3% of OT assessments recommended use of the OTA in treatment delivery, highlighting that most OTs tend to initiate treatment directly.  It is felt that therapists may introduce OTA later in treatment once rapport with the client has been established, but the use of OTA early for some education and device delivery may prove more cost-effective and is something OT’s should consider.

Additional Results

Attendant care: 91% of clients needed attendant care. The average dollar amount recommended for attendant care was $3565, the median was $1733, and the range was between $0 and $10,544. A trend was identified between number of injuries and attendant care recommendations; The amount of attendant care recommended increased with the number of injuries.

Assistive Devices: 91% of clients needed assistive devices. The average dollar amount for devices was $757.46, the median was $397.94, and the range was between $0 and $5670.

Occupational therapy treatment: The average number of occupational therapy treatment sessions recommended was 6; with an average duration of 12 weeks. Injury or number of injuries was not predictive of OT sessions or duration recommended.  Notably, however, recommendations are often made to conservatively encourage insurer approval and only represent the first treatment block.  Multiple blocks of treatment are common.

This retrospective chart review outlined typical injuries, common intervention recommendations, and recommendations for attendant care and assistive devices following an occupational therapy assessment. Although there is some uniformity in recommendations, the lack of consistency indicates the customization taken by OT’s in assessing for client’s unique and specific needs.  This individualized approach is necessary and encouraged as being best-practice and client-centered.  Of further note, it was evidenced that OT’s play a very important part in system navigation and help to outline and connect the client to other necessary providers.   Doctors, lawyers, insurers and other professionals should recognize that OT’s are valuable front-line providers and can be the keystone to helping clients to get the help they need.

As demonstrated, Occupational Therapists play a vital role in Ontario’s auto insurance sector and their assessments are pivotal in helping clients to get care, devices, education and treatment, along with connection to other professionals. This study is the first to showcase the OT role in Ontario’s insurance sector, and more research is needed to look more closely at OT service delivery.

Stay tuned for the entire research study with its methods, findings and recommended next steps.  We will be sure to circulate the article on our blog once published


Invisible Disabilities and the Impact of OT

A new interview series by fellow Occupational Therapist Karen Gilbert called The Art and Science of Everyday Living is shedding light onto the value of Occupational Therapy for those with “invisible” health conditions.  Covering topics like living with chronic pain, chronic fatigue, and anxiety, Karen interviews Occupational Therapists who share their resources and best practices.  Check it out!

The Art and Science of Everyday Living


The A to Z of OT: Z is For… Helping You Catch Some Zzz’s

According to a 2002 survey by Statistics Canada approximately 3.5 million Canadians struggle with sleep.  If you or someone you love has trouble falling or staying asleep an Occupational Therapist can help!  Learn more about the solutions to help you get a better night’s sleep in our post, Trouble Sleeping?  We Have Solutions for You!


October is Occupational Therapy Month and to celebrate we will be sharing a new series called the A to Z of OT.  In our attempts to further educate the public about what Occupational Therapists do we will be highlighting twenty-six of the awesome ways OTs provide Solutions for Living.  

We encourage you to follow along and to add to the discussion by highlighting other awesome things OTs help with for each corresponding letter!


The A to Z of OT: Y is For… Yoga Therapy

After experiencing physical trauma, there is a severe body and mind separation that impacts the abilities of the nervous system and alters the pattern of the body, breath, and mind structure. This is where the practice of yoga and mindfulness meditation can assist the recovery.  Learn more about Occupational Therapy and the use of Yoga, Mindfulness and Meditation in our post, Yoga for the Healing Brain.


October is Occupational Therapy Month and to celebrate we will be sharing a new series called the A to Z of OT.  In our attempts to further educate the public about what Occupational Therapists do we will be highlighting twenty-six of the awesome ways OTs provide Solutions for Living.  

We encourage you to follow along and to add to the discussion by highlighting other awesome things OTs help with for each corresponding letter!


The A to Z of OT: X is For… AtaXia

Ataxia is characterized by a loss of muscle control and coordination, and can affect the whole body or only specific parts.  Ataxia has a pronounced impact on how people go about the activities in their day. Without adequate muscle control and coordination, tasks like getting dressed, walking, and preparing a meal become more challenging.  Learn more about Ataxia and how Occupational Therapists help individuals with Ataxia find functional solutions in our post, Game… Set… Cerebellum.


October is Occupational Therapy Month and to celebrate we will be sharing a new series called the A to Z of OT.  In our attempts to further educate the public about what Occupational Therapists do we will be highlighting twenty-six of the awesome ways OTs provide Solutions for Living.  

We encourage you to follow along and to add to the discussion by highlighting other awesome things OTs help with for each corresponding letter!


The A to Z of OT: W is For… Workplace Wellbeing

There are many ways that Occupational Therapists promote wellness and wellbeing for those in the workplace.  From ergonomics to accessibility; injury prevention to return to work programs, OTs assist in the workplaces in many facets.  We are going to focus on an important way that Occupational Therapists can assist employees and employers at work – by improving mental health.  Learn more about how OT’s can provide essential information and assistance to enable the support of mental wellness at work in our OT-V video below, or in our post,  Promoting Mental Wellness at Work.


October is Occupational Therapy Month and to celebrate we will be sharing a new series called the A to Z of OT.  In our attempts to further educate the public about what Occupational Therapists do we will be highlighting twenty-six of the awesome ways OTs provide Solutions for Living.  

We encourage you to follow along and to add to the discussion by highlighting other awesome things OTs help with for each corresponding letter!