Guest blog from Jayne Ellis, CEO from UKHCA commercial members EF Training
Every day all over the UK thousands of Social Care Staff are caring for millions of people and although they may have the time, training, resources and physical PPE they need to do a fantastic job, most do not have the Emotional PPE they need to keep them psychologically safe.
Does your team? And do you have a plan?
When I speak to staff and managers working in the sector around 95% of them are not familiar with the term Compassion Fatigue but 100% of them recognise the symptoms!
Sara’s Story – Part 1
As I unpacked the dishwasher a glass slipped through my fingers and smashed onto the kitchen floor; I lost it! I started yelling at my husband and kids; blaming them for not packing the dishwasher in the right way. I ranted on for several minutes bringing up other related things they did that annoyed me until I realised that I had made my son cry. I stopped and looked at their shocked faces, turned round, left the kitchen and went and sat in the bathroom to calm down. I burst into tears and wondered what on earth was wrong with me?
Do you recognise this situation? Have you ever felt like this? Do you know what is wrong with Sara? She has been working as a carer for many years, had lots of training and is now a senior member of staff. She is a kind empathetic and compassionate person so why is she behaving like this?
Sara’s Story – Part 2
As I sat in the bathroom, I thought about how else I was feeling. Most of the time these days I was either so ‘wired’ I couldn’t switch off and relax, or was constantly worrying about work and lying awake at night thinking about the people I care for and wondering if I had made a mistake. At home I was aware that, like today, I had become increasingly snappy and bad tempered and if I was honest with myself, I was probably drinking too much and eating all the wrong things. My emotions were all over the place. At work I was either feeling very anxious and responsible for everyone, driven to do everything myself or very worryingly rather detached and unemotional like I was just going through the motions but not really there. How had this happened? I love my job and the people I look after – it’s all I have ever wanted to do but lately I’m doubting myself as some days I’m feeling so overwhelmed by everything. I don’t know if I can do this anymore.
I have heard variations of this story from hundreds of care staff we have trained in all sectors. Sara is a wonderful carer who loves what she does and I bet that the people she cares for love her too. I know that if you were her manager you would also value her and depend on her as she will be the staff member you can rely on who will probably always say yes to more work and be willing to go the extra mile. But Sara is suffering and she is struggling to understand why she is feeling the way she does because although she has had lots of training to help her be the best carer she can be what has been missing is any emotional health and safety training. If Sara was injured at work she would know exactly what to do and so would her manager but in this case Sara will probably not tell anyone how she is feeling for fear of looking weak.
She will feel guilty that she is not coping but will carry on anyway thinking she is the only one who feels this way and hoping that the symptoms will just go away. This might go on for a while until something will push her ‘over the edge’ and either she will become physically ill, normally with back or neck pain, suffer acute anxiety or even just hand in her notice as she can’t cope any more. More seriously for the organisation is Sara could turn her frustration on colleagues and she may be accused of bullying or even in some cases service users and their families may complain about her.
Compassion Fatigue – the cost of caring
What Sara is feeling is Compassion Fatigue, which is something experienced by everyone who works in a caring role. First written about in the late 1980’s by an American Traumatologist, Charles Figley, Compassion Fatigue is the “inevitable consequence of being immersed every day in other people’s trauma and suffering”. The more compassionate and empathetic you are the better you are at your job, but this also puts you a greater risk of ‘taking on’ the suffering as if it was your own. This process is called vicarious or secondary trauma and it is inescapable. When you witness another person’s suffering your nervous system goes on high alert and assumes that this ‘trauma’ is happening to you as well so gets you ready to run or fight. But you can do none of these things as your job is to stay calm and cope, so you repress the feelings and carry on. But the physical and emotional reaction does not go away and unless you deal with these feelings they build up over time and you experience the symptoms of Compassion Fatigue.
These symptoms include, feelings of acute anxiety, being unable to rest or relax and feeling that you need to be at work all the time as you are the only one who is capable of doing the job well. It can also manifest itself as feeling constantly irritable and short tempered, unable to sleep or feeling very withdrawn and detached. Your immune system is also affected by the constant stress, so some people experience multiple minor illnesses or constant headaches and back pain.
Recognising the Problem – or Ignoring it!
In the world of physical health and safety things are very different, laws and legislation has meant that employers are compelled to provide education and PPE and this has seen a dramatic drop in the numbers of people hurt or killed at work. From 1990 to 2018 this number has dropped from 180,000 to 70,000 but at the same time the numbers of people reporting emotional harm has risen from 250,000 to over 550,000.
It’s time to change the approach as it’s clear that what is currently being done is not working. It’s time to view the emotional health and safety of staff with equal importance to their physical health and safety and adopt a similar proactive, preventative strategy.
Responding to the Problem – training and awareness
The response must be to, at the earliest opportunity, in the career of every carer to explain to them clearly the emotional dangers of their job in the same way as you explain the physical ones. We teach them to use hoists to save their backs so we must teach them strategies to help them cope with the emotional strain. The training needs to be delivered on induction and then be part of the annual refresher courses. It must contain clear information outlining the physical and psychological impact of the role, identify the symptoms of Compassion Fatigue and what to do when they experience them. It must also encourage them to be proactive in their self-care and self-compassion to enable them to have reserves of emotional energy to draw on in times of difficulty.
Recovery and Resilience
When carers are aware of the impact the role has on them, understand the importance of self-care practices and know what to do when they experience acute symptoms they are able to recover from some of the feelings that Sara describes and become emotionally stronger. What we have seen happen to teams who have had our training is that there is a drop in sickness rates, increased retention, and improved morale. This leads to happier healthier, motivated staff who can do even better at caring for their service users.
Sara’s Story – Part 3
After I had calmed down and had a cry I spoke to my family and apologised. They told me that they were very worried about me and asked me to go and talk to someone at work. I didn’t want to as I thought that they would think I wasn’t able to cope with the job, so I just carried on. But then something happened! We got an email telling us that work had arranged a training day on Compassion Fatigue, I will admit that I didn’t really know what this was, but it sounded interesting, so I signed up. About half way through the morning the trainer started to explain in detail what compassion fatigue was and what the symptoms were and I just wanted to cry (in fact a few people did) everything she said was how I was feeling , we were all feeling the same! I wasn’t going ‘mad’ and not coping, it was normal and there were things we could do when we felt like it that helped you recover and actually if you took time to care for yourself you could be stronger than before. So I began the road back to being my normal self. I told my family about it and asked them to keep me on track with the self-compassion and I’m OK now and still working in the job I love.
I met Sara (not her real name) in 2018 and I know her story because as part of the training we use a pre and post course questionnaire and gather detailed feedback which has enabled us to change and adapt the training as well as prove its effectiveness. Compassion Fatigue is an occupational hazard when working in a caring role, but like other hazards it can be risk assessed and managed. It doesn’t have to be something that is accepted as ‘part of the job’ you don’t have to ‘man up’ you can learn to foster and sustain emotional resilience, which enables you and your staff to continue to do a job that is so vital to so many people.
Jayne Ellis
CEO EF Training
This Blog was produced when the Homecare Association was known as UKHCA.
