In May Sara Van Tonder (From Paarl) and Carien de Klerk from Good Hope Psychological Service in Stellenbosch presented a workshop to doctors working in emergency care on burnout and compassion fatigue.

On Friday, November 22, they worked with the same group of doctors and focused on the prevention and treatment of burnout. They also discussed trauma-informed care and how doctors can minimise secondary trauma in victims of violence.

Burnout: The doctors were reminded that selfcare for professionals is about actively looking after your own mental, physical and spiritual wellbeing. The concept of selfcare is similar to the safety procedure on an aircraft. “In the unlikely event of an emergency, fit your own oxygen mask first, before attending to children or dependants One aspect of self care is to practice mindfulness: Mindfulness means paying attention in a particular way :on purpose , in the present moment and non-judgementally.

Mindfulness: a state of non-judgemental awareness of what’s happening in the present moment, including the awareness of one’s own thoughts, feelings, and senses.

Awareness: During the state of mindfulness, you will notice your thoughts, feelings, and physical sensations as they happen. The goal isn’t to clear your mind or to stop thinking – it’s to become aware of your thoughts and feelings, rather than getting lost in them.

Acceptance: The thoughts, feelings, and sensations that you notice should be observed in a non-judgemental manner. For example, if you notice a feeling of nervousness, simply state to yourself: “I notice that I am feeling nervous”. There’s no need to further judge or change the feeling.

Nine ways mindfulness helps with stress:
• Mindfulness practice reduces activity in the amygdala
• Deep breathing stimulates the vagus nerve and lower stress responses associated with “fight-or-flight” mechanism.
• Mindfulness switches on your “being” mode of mind, which is associated with relaxation. The “doing mode” is associated with action and stress
• You are more aware and sensitive to the needs of your body
• You become aware of your thoughts. You can step back from them and not take them so literally.
• Mindfulness offers you the space to think differently about the stress itself
• You are better able to focus
• Your level of care and compassion for yourself and others rises

Trauma informed care: Trauma informed care is based on 5 principles:
1. Trauma awareness and acknowledgment Being aware of what trauma is and the impact it has. To bear witness to the patient’s experience of trauma.
2. Safety and trustworthiness Help patients feel they are in a safe space and recognize their need for physical and emotional safety. Consistency and predictability, telling patient what to expect.
3. Choice, control, and collaboration Include patients in the process and give them choices where possible.
4. Strengths-based and skills-building care Believe in the patient’s strength and resilience.
5. Cultural, historical, and gender issues Incorporate processes that are sensitive to a patient’s culture, ethnicity, and personal and social identity.

Helping professions who have to deal with survivors of an attack can keep the following in mind:
• Increase the sense of safety through attention to physical environment—ensure as much privacy as possible and have information related to trauma visible and accessible.
• Review and clarify limits to confidentiality
• Offer choice and emphasize the individual’s autonomy at numerous points in the processes.
• Keep the conversation safe, contained, and connected to present functioning
• Avoid creating a power dynamic by limiting the number of questions asked in a row.
• Ask about the individual’s strengths, such as their interests, goals, coping skills, community connections, survival strategies, spirituality, etc.
• Balance screening and assessment with engagement.

Contact Carien de Klerk at carien@ghps.co.za for more information.