Journal of Human Services: Training, Research, and Practice Journal of Human Services: Training, Research, and Practice

Volume 6 Issue 1 Article 5

9-29-2020

Weaving in Wellness: Infographics for Self-Care Weaving in Wellness: Infographics for Self-Care

Adair Finucane SUNY University at Buffalo, [email protected]

Mickey Sperlich SUNY University at Buffalo, [email protected]

Whitney Mendel Daemen College, [email protected]

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Recommended Citation Recommended Citation Finucane, Adair; Sperlich, Mickey; and Mendel, Whitney (2020) "Weaving in Wellness: Infographics for Self- Care," Journal of Human Services: Training, Research, and Practice: Vol. 6 : Iss. 1 , Article 5. Available at: https://scholarworks.sfasu.edu/jhstrp/vol6/iss1/5

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Abstract

Human service professionals are at risk for burnout, vicarious trauma (VT), and compassion

fatigue (CF) throughout their careers, and contemporary levels of burnout, VT, and CF suggest a

need for interventions. Engagement in mindfulness and self-care has been found to buffer these

risks while increasing worker wellbeing. This article presents infographics intended for

facilitating practical self-care engagement. The accompanying infographics provide guidance for

mindful self-care behaviors woven into daily transitions. They present a low-cost means of

promoting self-care strategies throughout agencies and organizations. This, along with minimal

time commitments for each practice, makes these infographics an accessible intervention for

human service professionals. These infographics may also act as a primer for more involved

mindfulness and self-care training.

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Weaving in Wellness: Infographics for Self-Care

Challenging working conditions such as large caseloads, limited resources, and work

stress in many human services positions may increase the likelihood of burnout, vicarious trauma

(VT), and compassion fatigue (CF) (Hensel et al., 2015; McFadden et al., 2014; Miller et al.,

2017). However, simply being a provider of human services may be the greatest risk factor for

developing professional burnout (Newell & MacNeil, 2010), as well as CF (Alkema et al., 2008).

Further, human service professionals need not have long careers in the field before experiencing

VT, CF, and burnout. For instance, students in health service psychology doctoral programs were

found to have higher levels of stress and lower levels of self-care and quality of life than

graduate students in other professions (Ayala et al., 2017), and social work students in field

placements are at risk for VT, CF and burnout at rates comparable to other helping professionals

(Harr & Moore, 2011). Similarly, a study of graduate students in psychology found that 38% of

students reported experiencing CF and burnout (El-Ghoroury et al., 2012). Thus, even in optimal

environments and with those just beginning their careers, it is critical for human service workers

to have methods for addressing these factors. The present article briefly examines the risks of

burnout, VT, and CF along with the concepts of self-care and mindfulness among human service

professionals. We then introduce a set of infographics, which are visual representations of data or

information, intended to promote holistic self-care practices. These infographics provide a low-

cost opportunity to promote self-care for human services professionals.

Burnout, Vicarious Trauma, and Compassion Fatigue

Burnout is defined as a negative experience, primarily psychological in nature, that

workers experience in response to job-related stress (Acker, 1999). This experience is often

characterized by exhaustion, workers’ lack of engagement, and depersonalization of clients

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(Acker, 1999). Burnout can include emotional, physical, and interactional symptoms. A

systematic review of the literature related to burnout among psychologists (in a variety of

settings) found that emotional exhaustion, a main dimension of burnout, was reported across the

literature, as well as confirmation of a robust relationship between high workload and burnout

(McCormack et al., 2018). One recent study of clinical and counseling psychologists found that

nearly 48% endorsed moderate to high levels of emotional exhaustion, with the challenge of

work-life balance and managing distressed clients with chronic or complex issues causing the

most severe clinician distress (Simpson et al., 2019). Social worker burnout is also common

across various facets of the profession (Kim & Kao, 2011). Burnout for hospice social workers is

exacerbated by death anxiety (Quinn-Lee et al., 2014). In both child protective work and hospice

social work, burnout is frequently associated with higher workload and difficult cases (Balbay et

al., 2011; McFadden et al., 2018). The physical impact of burnout has been documented in the

nursing field: it is associated with increased risk of poor general health (Khamisa et al., 2016).

Across human service professions, worker burnout is an abiding feature, and threatens not only

the individual worker’s experience but also organizational functioning; a recent meta-analysis of

studies found that clinician burnout is related to lowered levels of patient safety (Garcia et al.,

2019).

McCann and Pearlman (1990) conceptualized VT as an issue faced by clinicians and

other helpers that can follow working with clients who have experienced trauma. VT involves

the practitioner experiencing posttraumatic stress symptoms following engaging with

traumatized clients, in spite of not having directly witnessed traumatic occurrences. Negative

affective changes in reference to client experiences, in addition to intrusive thoughts, nightmares,

and disturbing imagery, are common reactions to vicarious traumatization (Dunkley & Whelan,

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2006). In some contexts, the prevalence of VT can be quite high; for example, one study of

domestic violence victim advocates found a VT prevalence of approximately 50%, with risk

factors including hourly length of workweek, hours of direct service, and working with adult

survivors of child sexual abuse (Benuto et al., 2018).

The term “compassion fatigue” is used in the helping professions to describe clinicians’

responses to client trauma and distress (Adams et al., 2006). Psychometric data gathered from

social workers with a traumatized client base suggests that burnout and VT are actually

underlying dimensions of compassion fatigue (Adams et al., 2006). Whereas vicarious

traumatization tends to refer specifically to symptoms of PTSD, CF considers the impact of

client experiences on the clinician more holistically, referring to the emotional, physical, and

spiritual depletion social workers and other helpers can experience following exposure to client

trauma (Pfifferling & Gilley, 2000). Among a random sample of clinical social workers and

clinical psychologists who identified as having some expertise in trauma treatment, six percent

endorsed compassion fatigue, and 12% endorsed burnout; with increased risk among those who

had high caseloads of clients with PTSD, and who did not used evidence-based trauma

treatments (Craig & Sprang, 2010). Practice context was also influential in an investigation of

compassion fatigue in oncology nurses; finding that CF is more common for those who have

worked longer in clinical nursing, those working in secondary hospitals, and those with passive

coping strategies (Yu et al., 2016).

Self-Care

Human service professional’s self-care may be one way to prevent and redress effects of

burnout, vicarious trauma and compassion fatigue. Self-care involves behaviors that aid in

balancing personal and professional facets of life, as well as healthy lifestyle practices (Bamonti

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et al., 2014). Dorociak et al. (2017) offer a broad definition of self-care: “a multidimensional,

multifaceted process of purposeful engagement in strategies that promote healthy functioning

and enhance well-being” (p. 326). It has been conceptualized as the process of giving oneself

permission to take time for navigating professional challenges (Riley & Wachs, 2003), and

includes adapting, rather than accepting, work environments (Keidel, 2002).

Professional self-care, defined as “the process of purposeful engagement in practices that

promote effective and appropriate use of the self in the professional role within the context of

sustaining holistic health and well-being” (Lee & Miller, 2013, p. 98), is used relatively

infrequently, especially when compared with personal self-care practices such as spending

quality time with loved ones and participating in enjoyable activities (Loeffler et al., 2018). Yet,

some have argued that self-care is in fact an ethical imperative, in that self-care works to prevent

personal problems a human service professional may have from interfering with their ability to

perform work-related activities (e.g., Barnett et al., 2007; Maranzan et al., 2018).

Underutilization of self-care practices may be explained by having limited perceived or actual

access to self-care opportunities, for personal or economic reasons. Cultural ideals of self-care

(e.g. eating a nutritious diet, reducing stress, and getting plenty of rest) have been critiqued as

being bound in socioeconomic privilege (Nichols et al., 2015). Thus, these practices are more

available to those with access to means. Also, in spite of being necessary due, at least in part, to

the difficulties of professional work, self-care is frequently represented as something human

service professionals engage in during their off-work hours (Lloro-Bidart & Semenko, 2017).

Demands on human service professionals outside of work may be considerable and leave limited

time and financial resources for devoting to wellness. This reality highlights a need for

accessible opportunities to engage in self-care (Loeffler et al., 2018).

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Self-Care Strategies

There are a wide variety of self-care strategies that human service professionals might

employ. One 2015 study of 786 social workers from throughout the United States found that

from a list of 45 self-care activities across 5 domains (physical, professional, emotional, spiritual,

and psychological), participants reported journaling, practicing yoga, participating in stress

management training, and negotiating one’s needs as least often practiced self-care activities. In

contrast, they reported laughing, quality time with friends and family, and connecting with co-

workers to be the most commonly used self-care practices (Bloomquist et al., 2015). In this

study, the professional, emotional, and spiritual domains were most likely to buffer against

burnout and increase compassion satisfaction. Researchers looking at self-care among

psychologists also see a role for self-care in mitigating stress and suggest that self-care activities

are most beneficial when woven into daily practices and routines, rather than being added to the

clinician’s already full list of professional obligations (Wise et al., 2012).

Mindfulness

Wise, Hersh, and Gibson (2012) also suggest mindfulness as a foundational strategy for

promoting well-being among psychologists. Based on our inherent capacities for relaxation and

insight, mindfulness is a systemic approach to living that focuses on awareness of the present

moment (Kabat-Zinn & Hanh, 2013). In the social work literature, mindfulness is also frequently

cited as an effective self-care strategy (Gockel et al., 2013; McGarrigle & Walsh, 2011). A self-

care guide for practitioners, supervisors, and administrators has been developed that frames self-

care not as occasional activities, but as a state of mind, and essential to social worker training

(Cox and Steiner & 2013), and books have been written outlining self-care strategies aimed at

building resilience against burnout (Grise-Owens et al., 2016; Smullens, 2015). Similarly,

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mindfulness has been cited as an important way to promote well-being among professional

counselors (e.g., Coleman et al., 2016), psychologists (e.g., Wise et al., 2012), and nurses (e.g.,

Bazarko et al., 2013).

Self-Care for Mitigating Risk

There is empirical support for the notion that education and engagement in self-care

mitigate the emotional risk factors associated with human service provision (Lewis & King,

2019). For instance, social workers report that engaging in self-care practices is helpful in coping

with VT and alleviating job-related stress (Bober & Regehr, 2006; Bloomquist et al., 2015), and

can lead to lower levels of burnout (Salloum et al., 2015; La Mott, 2017). Thieleman and

Cacciatore (2014) found that traumatic bereavement volunteers and professionals who engaged

in increased levels of mindfulness practice were at less risk of compassion fatigue.

The need for increased training and expanded curricula in self-care for human service

professionals is also becoming clear. Butler et al. (2017) found that among 195 MSW students,

all students reported being faced with or reacting to trauma exposures in the course of their

training; those with lower levels of self-care reported higher levels of burnout and secondary

traumatic stress symptoms, while those who reported higher levels of self-care experienced

higher levels of compassion satisfaction. Other human service professions are also recognizing

the need for more self-care instruction, including for professional counseling programs (Coaston

& Lawrence, 2019; Nelson, Hall, Anderson, Birtles, & Hemming, 2018; Shapiro, Brown, &

Biegel, 2007), clinical psychology programs (Bachik & Kitzman, 2020; Pakenham & Stafford-

Brown, 2012), nursing programs (Ashcraft & Gatto, 2018; Nevins & Sherman, 2016), and

medical schools (Ayala et al., 2018).

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Given the direction of the emergent literature on self-care and its promising potential for

ameliorating the effects of burnout, VT and CF, the time is ripe to consider how to better

promote and foster self-care practices in workplaces that employ human service professionals.

Workplace Culture: Room for Improvement

In the workplace, employees receive subtle and overt messages about which behaviors

are and are not condoned or considered appropriate. Workplace culture in non-profits also tends

to promote the agency’s mission at the expense of self-care for individuals and the organization

as a whole (Kanter & Sherman, 2017). These messages can have a direct impact on which – if

any – self-care practices human service professionals choose to engage in during work hours.

McGarrigle and Walsh (2011) discuss the importance of a work environment that unambiguously

allots time, gives permission, and offers space for social workers to engage in self-care practices.

We also find that building a workplace culture that actively promotes self-care requires that the

values and behaviors of those in leadership positions reflect this respect for time, permission, and

space. Critically, their research suggests that organizational leaders be involved in supporting

human services practitioners in integrating self-care practices into their daily routines. Such

support demonstrates another claim supported by McGarrigle and Walsh’s (2011) findings: the

importance of the workplace and individual social worker sharing responsibility for a

practitioner’s incorporation of self-care. When agencies value self-care, providing education and

resources that enhance social worker well-being and performance, they create an opportunity to

benefit clients and agencies over time (Xu et al., 2019). These findings are echoed by Wise,

Hersh, and Gibson (2012) for the promotion of self-care among psychologists, in envisioning a

future in which self-care is “truly valued, supported and promoted by the profession in a manner

that complements and sustains our ongoing well-being and professional competence” (p. 487).

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Infographics as a Self-Care Intervention

Sharing responsibility for promoting self-care in the workplace might take the form of

agencies facilitating worker involvement in mindfulness practices such as those in Mindfulness-

Based Stress Reduction (MBSR; Kabat-Zinn & Hanh, 2013) and Acceptance and Commitment

Training (ACT; Hayes et al., 2004; Hayes et al., 1994), which have shown effectiveness in

decreasing stress and burnout levels in social workers (Brinkborg et al., 2011; Shapiro et al.,

2005), psychologists (Eriksson et al., 2018), as well as oncology nurses (Duarte & Pinto-

Gouveia, 2017). While interventions of this nature may be instrumental in shifting the tide and

creating a culture geared towards wellness, they require considerable time and financial

resources, as well as buy-in from both leadership and organizational staff.

Infographics offer a clear way to guide the viewer in visualizing a concept. They have

been referred to as “tool[s] for your eyes and brain to see what lies beyond their natural reach”

(Cairo, 2013, p. 10). When compared to text-based messages, infographics have a greater

likelihood of inciting cognitive elaboration (e.g. active learning and critical thinking) (Bice &

Faith, 2019).

Research on the effectiveness of posters depicting infographics promoting wellness is

scant. However, what literature does exist on the topic suggests that infographics are a helpful

way for comm