41 st Annual Nurse Practitioners of Oregon Education Conference October 11, 2018 Self-Care Using Mind-Body Medicine Rebecca Castner, PharmD, BCACP, AAHIVP Assistant Professor of Pharmacy Practice OSU/OHSU College of Pharmacy OHSU Family Medicine at Richmond Email: castner@ohsu.edu
Objectives • At the end of the presentation, participants will be able to: – Discuss importance of self-care for healthcare professionals – Discuss impact of self-care on patient health outcomes – Discuss common mind-body medicine modalities 2
Self-Care: The Necessity of Practicing What We Preach • Think back on the past week you’ve been in clinic. – How many times did you recommend self-care for stress reduction/mental health? – How many times did you practice self-care yourself? 3
Medicine’s Culture of Stress • Medical providers are taught to view stress as a “Badge of Honor” – We are a field rife with overachievers – Vacations may be regularly banked/unused; when vacations do occur, providers often continue to check in regularly – Providers may thrive on stress • Critical to understand ”good stress” vs “bad stress” • Without judicious oversight, productivity can come at the expense of appropriate self-care and healthy boundaries • This can become the perfect base environment for development of burnout 4
What is Burnout? • No one accepted definition • “A state of physical, emotional or mental exhaustion combined with doubts about your competence and the value of your work” – Mayo Clinic – Bigger than a simple lack of motivation or passion (although these are common characteristics of how burnout manifests) • It is a field of active research, and for good reason – it is on the rise – Studies suggest up to 50% of physicians are experiencing burnout at any given time – Burnout is often recurrent, with a very long recovery time Know the signs of job burnout. (2015, September 17). Retrieved from https://www.mayoclinic.org/healthy-lifestyle/adult-health/in- 5 depth/burnout/art-20046642
Why Does Burnout Happen? • According to the Mayo Clinic, the following are common causes of burnout: – Lack of control – Unclear job expectations – Dysfunctional workplace dynamics – Mismatch in values – Poor job fit – Extremes of activity – Lack of social support – Work-life imbalance Know the signs of job burnout. (2015, September 17). Retrieved from https://www.mayoclinic.org/healthy-lifestyle/adult-health/in- 6 depth/burnout/art-20046642
Burnout Risk Factors • According to the Mayo Clinic, risk factors for development of burnout include: – You identify so strongly with work that you lack a reasonable balance between your work life and your personal life – You try to be everything to everyone – You work in a helping profession, such as health care, counseling or teaching • Working with sympathy, not empathy, is important – “Compassion fatigue” – similar, but not the same » Compassion fatigue typically occurs faster than burnout, and recovery time is shorter » Compassion fatigue is typically defined as a condition resulting from emotional strain of working with patients who are suffering consequences of traumatic events » Burnout causes are cumulative and are not historically associated with trauma, although that thought may be changing – “Do no harm” – apply it to yourself too! – You feel you have little or no control over your work – Your job is monotonous Know the signs of job burnout. (2015, September 17). Retrieved from https://www.mayoclinic.org/healthy-lifestyle/adult-health/in- 7 depth/burnout/art-20046642 Compassion Fatigue. (2017, January 04). Retrieved from https://www.stress.org/military/for-practitionersleaders/compassion-fatigue/
Consequences of Burnout • Excessive stress • Heart disease • Fatigue • High cholesterol • Insomnia • Type 2 diabetes, especially • A negative spillover into in women personal relationships or home life • Stroke • Depression • Obesity • Anxiety • Vulnerability to illnesses • Alcohol or substance abuse • Cancer • Death 8 Know the signs of job burnout. (2015, September 17). Retrieved from https://www.mayoclinic.org/healthy-lifestyle/adult-health/in- depth/burnout/art-20046642
Burnout and PTSD • Shared characteristics of both burnout and PTSD include: – Occurrence after exposure to traumatic event or extreme stressor – Respond with fear, hopelessness, and/or horror – Sleep disturbances and/or nightmares – Depression and/or withdrawal – Frequent mood changes and/or generalized irritability – Avoidance of activities that promote recall of trauma • We know PTSD is extremely difficult to treat – Studies on burnout suggest it takes a long time to recover from burnout fully, and people who experience burnout once may be more likely to have recurrent burnout if not addressed fully Puleo, G. (2018, August 27). Is Burnout a Form of PTSD? How These Similarities Can Affect Business. Retrieved from https://a-new- 9 way-to-work.com/2017/08/09/is-burnout-a-form-of-ptsd-how-these-similarities-can-affect-business/
12 Stages of Burnout • Psychologists Herbert Freudenberger and Gail North identified 12 phases of burnout: 1. Compulsion to Prove Oneself 7. Social Withdrawal 2. Working Harder 8. Obvious Behavior Changes 3. Neglecting Personal Care and 9. Confusion of Needs Identity/Depersonalization 4. Displacement of Conflict 10. Inner Emptiness 5. Revision of Values to Validate 11. Depression Self Worth 12. Mental or Physical 6. Denial of Problems and Shame Collapse/”Burnout Syndrome” 10 Todaro-Franceschi, V. (2013). Compassion fatigue and burnout in nursing: Enhancing professional quality of life . New York: Springer Pub.
Mind-Body Medicine Techniques • No widespread consensus for what constitutes a mind-body medicine technique or practice – The National Center for Complementary and Alternative Medicine (since renamed as National Center for Complementary and Integrative Health) listed the following as mind-body practices: • Meditation • Yoga • • Tai chi Hypnotherapy • Acupuncture – Other techniques commonly considered mind-body interventions include: • Reiki • Qigong • Massage Therapy • Therapeutic Touch • Aromatherapy 11 What is CAM. (2014, January 9). Retrieved from: http://nccam.nih.gov/health/whatiscam
Mind-Body Medicine and Healing/Immune Function • Robust data supporting improved immune function with mindfulness meditation • Improved healing time in a variety of conditions such as psoriasis with mindfulness meditation • Improved tolerability of chemotherapy adverse effects with both mindfulness meditation and reiki Kabat-Zinn, J. (2013). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness . New York: Bantam Books Trade Paperbacks. 12 Touchstone Process. (n.d.). Retrieved from https://www.centerforreikiresearch.org/RRTouchstone.aspx
Mind-Body Medicine and Pain • Acupuncture recommended by the American Pain Society and the American College of Physicians for the treatment of lower back pain in those with insufficient relief from self-care measures, such as heat therapy and taking analgesics • Evidence supports meditation and acupuncture in treating pain and physical dysfunction associated with knee osteoarthritis • Strong evidence for improved pain management with mindfulness meditation • Data suggests reiki likely effective for chronic pain Chou R, Huffman LH, American Pain Society (APS). Guideline for the evaluation and management of low back pain: evidence review. Spine 2009;34:1078-93. Giacobbi PR Jr, Stabler ME, Stewart J, et al. Guided imagery for arthritis and other rheumatic diseases: a systematic review of randomized controlled trials. Pain Manag Nurs 2015 October ; 16: 792–803. Kabat-Zinn, J. (2013). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness . New York: Bantam Books Trade Paperbacks 13 Center for Reiki Research - Conclusion. (n.d.). Retrieved from https://www.centerforreikiresearch.org/RRConclusion.aspx
Mind-Body Medicine and Headache/Migraine • Strong evidence for acupuncture in prevention of migraine, and also supports use in frequent episodic or tension-type headache • Yoga and meditation may be beneficial for migraine and tension headache treatment Linde K, Allais G, Brinkhaus B, et al. Acupuncture for the prevention of episodic migraine. Cochrane Database of Systematic Reviews 2016;6:CD001218 Millstine D, Chen CY, Bauer B. Complementary and integrative medicine in the management of headache. BMJ 14 2017;357:j1805
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