Recently, while waiting to see my own doctor for a routine visit, I leafed idly through a waiting-room copy of Chatelaine magazine. One headline caught my eye: “The Science Behind Self-Care”. Intriguing title, and one that seemingly promised an evidence base for the activities we undertake in order to manage our complex and demanding lives, and mitigate the effects of ongoing stresses. Using the term “science” suggests to casual readers that there has been rigorous investigation into the questions of what constitutes self-care, how we might best undertake it, and what results we can expect. So, what were these science-backed self-care activities? Number one on the list was to eat chocolate, second was to read for pleasure, third was rosemary essential oil, fourth was 12 minutes of daily yoga and fifth was self-massage of the feet. And what were the promised outcomes if such activities were undertaken? Better performance on “cognitive tests” with chocolate, 20% increased “life satisfaction” with reading, better recall with rosemary essential oil, improved bone density with yoga, and decreased blood pressure with 45 minute (!) daily foot massages. I tried to imagine the hour each day these activities would require: 12 minutes of yoga followed by a 45 minute self-administered foot massage with rosemary oil, followed by 3 minutes of eating chocolate and reading a book. Sounds lovely, actually. And yet, also a bit laughable.
Those of us most in need of self-care are often those in the caring professions. While there were no citations for the science quoted in Chatelaine, it seems evident that something other than chocolate and foot massages (however nicely scented) is required in order to address the profound effects of professional care giving on the care providers themselves. Terms like “burnout”, “compassion fatigue” and “secondary trauma” are used to describe the powerful negative effects on health care professionals of working in the high-stress, high-stakes environments of hospitals and outpatient clinics. These experiences have been shown not only to negatively impact the health and quality of life of health care providers, but to adversely affect patient outcomes as well. Few of us know what to do beyond the type self-care strategies Chatelaine describes, and even those strategies don’t work. A Canadian study examined whether self-care techniques exactly like the ones advocated in Chatelaine were effective in addressing the vicarious trauma experienced by over 200 trauma counselors. The answer was a clear “no”. The therapists themselves expressed belief in the efficacy of self-care and leisure activities, but the measurement scales told a different story. Despite believing that self-care should work, it did not reduce their trauma scores. One factor strongly correlated with their trauma scores: how much time they spent working directly with traumatized patients. Other research has demonstrated that compassion fatigue occurs across all health care disciplines, and is not confined only to those working with obviously traumatized patients.
What then are care providers to do? If spending time with our neediest and most complex patients is our greatest risk factor for compassion fatigue and vicarious trauma, and accessible self-care strategies do little to assuage this, how should we cope? These questions are the focus of an emerging literature on compassion fatigue and burnout. For instance, there is promising early evidence for individual interventions such as mindfulness, and systemic interventions that examine critical factors like workplace culture and systemic constraints. However, the current literature is sparse, and there is very little literature directly testing interventions to reduce compassion fatigue. In her article “Beyond Kale and Pedicures: Can We Beat Burnout and Compassion Fatigue?” trauma expert Francoise Mathieu notes that “we [health care providers] need to take ownership of our own personal contribution to the climate we work in and the culture we are creating”, but this is hard to do when already in a state of depletion, and with little information on what strategies may be helpful to us. If the prevailing culture tells us that massage and food treats should result in healthier happier lives, while our own experience is that these strategies do little to touch our compassion fatigue or secondary trauma, then we need further resources. We need our institutions and our research bodies to prioritize the kind of science that investigates what will really help care providers. We need to know what interventions will actually prevent or reduce the psychological sequelae of our work, before we can plan for changes in our work environments and ourselves.
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