CARING FOR EACH OTHER CARING FOR YOURSELVES Understanding

CARING FOR EACH OTHER: CARING FOR YOURSELVES Understanding the Emotional Life of Those Living with Pulmonary Disease and the Emotional Impact on Respiratory Health Care Professionals

The Emotional Life of Patients Learning to live with a “new normal” often means learning to live differently. Living differently may involve living with “less”. Ninety percent of chronic illness is ‘invisible’. Pulmonary disease is often very visible.

Emotional Life Patients have two lives--the ‘outer life’ representing the physical and the ‘inner life’ representing the psychological and spiritual realm. The ‘inner life’ is the life we don’t often get to see but is the true center of the individual’s world.

Psychological and Behavioral Issues • Anxiety • Depression • Major Depressive Disorder • Non compliance • Alcohol and drug misuse/abuse/dependence

Patients with chronic illness have a 15 -20% greater incidence of depression. Depression is a chronic illness that complicates physical illness re: treatment compliance and healing. Treatment compliance and healing are impacted by disrupted sleep, poor nutrition, lack of exercise or movement.

Physical illness and uncontrollable pain as well as a felt sense of lack of control in general are major factors in up to 70% of suicides. Empowering patients through knowledge and encouragement decreases depression and increases compliance…”team work”.

The patient is the ‘expert’ on THEIR illness in THEIR life. How is the pulmonary disease impacting your patient’s physical AND emotional life? LET’S TAKE A LOOK AT……………….

ANXIETY

Facets of Anxiety is not just a response o to ‘the unknown’ o irrational fear o learned response o chronic ‘nervousness’ o being afraid ANXIETY CAN BE…….

…. a GOOD thing……. It gets our attention and let’s us know that something VERY important is going on. Anxiety is a signal. It can be caused by steroids, lack of oxygen, anemia, low Hgb, drug side effects, weaning off of steroids too quickly, daily diet.

Signs of Anxiety Fidgeting Rapid speech Avoidance Nausea Diminished eye contact Weight loss, diarrhea, reported sleeplessness Silence (deer in the headlights)

Signs of Depression

Depression and sadness are not the same Many of the signs of depression are similar to anxiety and may include: • Frequent and prolonged crying • Flatness of affect • Suicidal/homicidal ideation • Non-compliance with treatment/meds • Isolative behavior • psychosis

Possible Causes… • • • Re-awakening of early ‘issues’/traumas Alcohol abuse/addiction Prescription abuse/addiction Family issues (marriage, children) Sexual issues Alienation from family, friends, loneliness…”Living on the Moon”.

PTSD-TSS-PTG Post Traumatic Stress Disorder (B. van der Kolk, M. D. , 2014) Traumatic Stress Syndrome(Pasik, 1993) Post Traumatic Growth Traumatic Stress Syndrome is very similar to PTSD but a “milder version” PTG is a positive change experienced as a result of the struggle with a major life crisis or traumatic event.

More PTG…. . “Highly emotional events in psychologically healthy people may produce less illusion and more wisdom” (Calhoun & Tedeschi) “Looking at life with the blinders off…”(ibid)

PTG (cont’d. ) New opportunities and new possibilities arise from the crisis or illness experience. An increased sense of one’s own strength… A greater appreciation for life in general A deepening of one’s spiritual life or significant change in one’s belief system.

Emotional Growth and Connection

Exactly the Same-Completely Different Burnout…. . Is a gradual process/phenomena including: • Job strain • Erosion of idealism • A void of achievement • An accumulation of intensive contact with clients.

Symptoms of Burnout Physical: § Fatigue § Sleep disruption § Somatic problems: gastro. , headaches, frequent colds Emotional: § Irritability, anxiety, depression, guilt, sense of helplessness

Burnout Symptoms (cont’d. ) Behavioral: § Aggression § Callousness, pessimism, defensiveness, cynicism § Substance abuse Interpersonal: § Withdrawal from clients or co-workers § Dehumanizing/intellectualizing patient/coworkers/self problems

Compassion Fatigue and Secondary Traumatic Stress (C. R. Figley, 1985, 1986, 1989) “The professional work centered on the relief of the emotional (and physical) suffering of patients automatically includes absorbing information that is about suffering. Often it includes absorbing that suffering as well”.

A Word from St. Francis… “Start by doing what’s necessary; then do what’s possible; and suddenly you are doing the impossible” “What is ours to do…. ?

Some Good News: Resiliency • The ability to put events into less stressful perspectives…. immediate ‘reframing’ • Proactive behavior to move toward the event and not away from the event…make it “work” for you.

More Good News: Hardiness and Resilience (Kobasa& Maddi) • Commitment, Control, and challenge • H & R function as a resistive resource in the encounter with stressful conditions. • Many individuals and caregivers dealing with chronic illness posses the ability to function well and adapt to continuously stressful events. • Includes courage and motivation to turn stressful circumstances from potential disaster to multiple chances to grow.

HOPE

Components of Hope Confidence in the outcome Embracing reality Relationships with others Belief in the possibility of a future Spiritual beliefs ACTIVE involvement (Wishing and Hoping are different…) • Inner readiness • • •

Spanky is Hope

More on Hope… Patients with chronic illnesses need to maintain hope that there is a future though the path may be different from others… ”Different” does not mean “bad” or “less than”.

Farfal is different but greater than…

Even if you’ve dealt with a condition personally, everyone’s experience is unique. It is OK not to be able to relate to a patient’s condition or experience. Your job is to be ‘present’ to the experience. We practice the ministry of presence and absence. (Henri Nouwen, “The Wounded Healer”)

Questions, Comments, Thanks