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Tag Archive for: occupational therapy

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“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.

Symptoms

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.

Resources

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.

References

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

 

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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

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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

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The A to Z of OT: Q is For… Quality of Life

One of my favourite quotes about Occupational Therapy is, Medicine adds days to life… OT adds life to days.”  Occupational Therapists provide solutions for living and therefore, help individuals achieve optimal function and maximum quality of life based on each person’s unique situation.

Take a look at our Occupation Is series, where we explore the journey of “occupation” complete from morning to night, highlighting how OT’s help to improve quality of life when things break down along the continuum that is living.

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The A to Z of OT: L is For… Leisure Activities

Occupational Therapists define the word “occupation” as the way people “occupy” their time. So, for us, this term actually includes all roles involved in living including how we have fun! 

Occupational therapists recognize the importance of leisure activities for persons with and without disabilities.  Learn more about how OTs work with clients to help them bring more fun back into life in our previous post, Leisure Anyone? 

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!

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The A to Z of OT: K is For… Kids Health

Occupational Therapists work with people of any age, including children.  Occupational Therapists can assist children in many ways including, growth and development, learning disabilities, physical disabilities, overcoming eating issues and more.  Learn about some of the many ways an OT can help children in our post, Occupational Therapy Works for Kids.

 

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!

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The A to Z of OT: J is For… Job Demands Analysis

A physical (and cognitive) demands analysis goes beyond the standard job description, as these typically only define the job to be performed in terms of duties and roles. In contrast, a physical and cognitive demands analysis digs deeper into the job and clearly outlines all the different demands that will be placed on that worker in that position.

Physical components such as lifting, carrying, walking, and fine motor skills, along with cognitive demands like visual and perceptual skills, attention, and memory are important to understand and document.  Then, when hiring workers, these reports serve as a reference point for ensuring the right hire, and are also essential in making solid decisions about someone’s ability to return to a job after injury or illness.

Learn more about Job Demands Analysis in our post, The Physical Demands Analysis – Risk Reduction for Employers, Employees and Physicians

 

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!

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The A to Z of OT: I is For… Injury Prevention

“An ounce of prevention is worth a pound of cure.”  Benjamin Franklin

Did you know that in Canada falls are the leading cause of injury amoung older Canadians?  And that 20-30% of seniors experience one or more falls each year?  Falls are also the number one cause of both brain and spinal cord injury in seniors.  How can we put a stop to injuries caused by falls?  PREVENTION. Really, it is the best medicine.  Learn how Occupational Therapists help to prevent falls in the following episode from our OT-V video series.

 

 

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!

 

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The A to Z of OT: H is For… Handwriting Help

One of the main reasons that parents seek Occupational Therapy services for their children arises from problems with printing and handwriting.   Although once taught in schools, the learning of this basic and essential skill is no longer part of curriculums.  While many children quickly take to printing, many have difficulties.  When difficulties arise, an Occupational Therapist can help.  Learn how Occupational Therapists help provide solutions to printing problems and make learning creative and fun in the following video from our OT-V video series

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!

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The A to Z of OT: G is For… Goal Planning

“A goal without a plan is just a wish.”  One of the main ways occupational therapists assist clients is by helping them set and achieve goals.  In order for a goal to be achievable, it must be a SMART goal.

Learn more about SMART goals and how an occupational therapist can help you achieve these in our previous post, An OT Knows How to Help You Achieve Your Goals.

 

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!