New Program Offers 'Care for Caregivers'

By Elaine Wilson
Special to American Forces Press Service

May 22, 2008 - The U.S. Army Institute of Surgical Research here has launched a program aimed at caring for a segment of the military population much more accustomed to administering care than receiving it. The program, called Care for the Caregivers, is designed to identify and treat a syndrome called "compassion fatigue" in military health care providers.

Compassion fatigue, also known as secondary traumatic stress disorder, is the emotional residue or strain of exposure of working with patients recovering from traumatic events.

The relatively new term, coined by Dr. Charles Figley in the 1990s, is becoming increasingly popular as caregivers are faced with the long-term care of trauma patients surviving the battlefield in greater numbers than ever before.

"We're starting to notice signs of compassion fatigue in caregivers of wounded warriors," said Army Col. Kathryn Gaylord, director of the Army Institute of Surgical Research's Care for the Caregivers program. "Caregivers are giving everything of themselves to care for patients, but there's a price sometimes associated with that."

Taxed by deployments of their own and the complicated care of severely wounded servicemembers, caregivers are beginning to exhibit signs of trauma normally reserved for patients. With symptoms such as heightened irritability, anxiety, depression and sleep disturbances, the syndrome bears a marked resemblance to post-traumatic stress disorder.

"Compassion fatigue is when caregivers have such deep empathy they develop symptoms of trauma similar to the patient," Gaylord explained.

While similar in nature, Gaylord pointed out the difference between compassion fatigue and "burnout," an emotional exhaustion many people experience due to increased workload and institutional stress. Unlike compassion fatigue, burnout does not contain a trauma element.

Over time, compassion fatigue can lead a caregiver to grow distant from patients or, on the flip side, too close. Both can be detrimental to the patients and families.

Caregivers at the burn center, for instance, treat the same patients for months or even years, which can lead to a strong connection, and a strong sense of failure, guilt and loss if a patient does not survive.

"We treat patients for many weeks to months, during which time they undergo many operations and procedures," Gaylord said. "A strong relationship develops with the patient's family; we get to know them very well."

Army Spc. Antonio Cevallos, a physical therapy technician at the institute, is familiar with the ongoing intensity of day-to-day care. He went from transferring patients wounded in Iraq via ground ambulance in Kuwait to treating wounded warriors in the burn center.

"I see a lot more here [at the institute]," he said. "Compared to minutes or hours of one-on-one contact, it's days and weeks. It has its ups and downs."

Cevallos said he grew close to several patients and was pained to see two patients deteriorate, then pass away.

"It's difficult at times," he said. "But what keeps me going is the fact that I'm helping other people. As long as I keep my purpose, it keeps me above water."

Caregivers are trained to be compassionate, but there is little training in the military on how to handle the stress of compassion, said Gaylord, who hopes to remedy the problem through the Care for the Caregivers program.

The doctor described the program as a combination of prevention training and treatment through the use of seminars and stress-management techniques.

"We have a series of world-renowned experts coming here to speak on topics such as grief, relaxation, nutrition and exercise," said Gaylord, who said the key to prevention is to find ways to manage and alleviate stress.

The seminars include education on the latest relaxation techniques, including "Alpha Stim," which is cranial electrical stimulation and vibration sounds that trigger the brain to relax.

In addition, Gaylord and her staff are building a respite room at the institute, which will serve as a peaceful haven caregivers can retreat to and regenerate. Wanting a state-of-the-art area, Gaylord contracted an architect who designed relaxation rooms for Nike and Hilton.

"The room will be very relaxing with a waterfall, music, massage chair, special motion chair and a video with headsets," she said.

Gaylord also plans to integrate group sessions and questionnaires that will help identify issues and track the impact of the program.

Cevallos said having a support system at work is beneficial.

"Sometimes you need to talk to someone or relax with a group," he said. "I've sat down in a session, and it was soothing. There's a sense of comfort from being with other people who are going through similar experiences."

Army Chaplain (Maj.) Philip Kochenburger, Brooke Army Medical Center chaplain, attended a compassion fatigue seminar on loss, grief and trauma May 9 and used an air travel safety briefing analogy to describe the importance of caring for caregivers.

"The flight attendants always tell you to put on your own oxygen mask first before you help others," he said. "The same is true of caregivers. They have to make sure they take care of themselves along with the patients."

Gaylord said the focus will remain on resiliency and mental well-being.

"We'd like to eventually delve into the research aspects of this so we can determine what makes some people more innately resilient than others."

(Elaine Wilson works in the Fort Sam Houston Public Information Office.)