Overcoming Compassion Fatigue

Compassion fatigue is characterized by physical and emotional exhaustion and a profound decrease in the ability to empathize.

The term compassion fatigue was first used in the context of the study of burnout in nurses. Joinson coined the term to describe the ‘loss of the ability to nurture’ that had been identified in some nurses in emergency department settings. Multiple environmental stressors, such as expanding workload and long hours, coupled with the need to respond to complex patient needs, including pain, traumatic injury, and emotional distress, resulted in nurses feeling tired, depressed, angry, ineffective, apathetic, and detached. Nurses often reported physical complaints such as headaches, insomnia, and gastrointestinal distress. This phenomenon appeared to escalate gradually over time as a result of cumulative stress, particularly when nurses ignored their symptoms and did not attend to their own emotional needs.

Compassion fatigue is characterized by physical and emotional exhaustion and a profound decrease in the ability to empathize. It is a form of secondary traumatic stress, as stress occurs as a result of helping or wanting to help those who are in need. It is often referred to as “the cost of caring” for others who are in physical or emotional pain. If left untreated, compassion fatigue not only can affect mental and physical health, but it can also have serious legal and ethical implications when providing therapeutic services to people.

While it is not uncommon to hear it referred to as burnout, the conditions are not exactly the same. While they both impose added coping and adaptational demands, they have many differences. Burnout arises when assertiveness-goal achievement intentions are not met. Compassion fatigue evolves when rescue-caretaking strategies are unsuccessful, leading to caregiver feelings of distress and guilt. With both burnout and compassion fatigue, feelings of frustration, powerlessness, and diminished morale ensue.

Compassion fatigue is distinguished from burnout by three variables: triggers or etiologies, chronology, and outcomes. The impetus for burnout stems from conflict within the work setting. Conflicts can include disagreements with managers or co-workers, dissatisfaction with salary, or inadequate working conditions. Compassion fatigue, on the other hand, emanates from relational connections nurses have with their patients or the patient’s family. It stems from emotional engagement and interpersonal intensity associated with witnessing tragedy within the work setting. Burnout usually evolves over time. Compassion fatigue may have a more acute onset. While the ‘burnt out’ health care professional gradually withdraws, the ‘compassionately fatigued’ employee tries harder to give even more to patients in need. Both outcomes, however, are associated with a sense of depletion within the professional, a ‘running on empty’ feeling.

So how do we prevent this, and what do we do to manage it when we know we have been impacted by it? The management of compassion fatigue must be multifaceted and include prevention, assessment, and consequence minimization.

  1. Development of a self-care plan is critical in a prevention plan. The metaphor of “putting your oxygen mask on first” when on an airplane before helping others very much applies to this situation. One way to do this by getting consistent exercise and attention to diet. This shifts your attention to pleasurable, non-work-related activities that promote pacing and personal planning. Journaling and meditation are other self-care strategies that reduce your risk. A routine of getting proper amounts of sleep can also go a long way towards prevention. Furthermore, a healthy balance between work and leisure activities needs to be implemented in order to keep your risk factors to a minimum.
  2. The identification of compassion fatigue requires an assessment of various characteristics.  Five characteristics that may contribute to compassion fatigue include:
  • affective states in the helper
  • cognitive expectations and individual capacities to process information
  • ego-defensive processes
  • stress effects on the helper’s self-capacities, ideological beliefs, and systems of meaning
  • coping abilities and techniques of stress management

Available instruments that measure the presence of compassion fatigue are limited in scope and appropriateness for use with nurses.   The following three tools have been used most frequently to measure compassion fatigue:

  • The Compassion Fatigue Scale
  • The Secondary Traumatic Stress Scale 
  • The Professional Quality of Life Scale

Some signs (as quoted in “Psychology Today”) are:

  • Feeling burdened by the suffering of others
  • Blaming others for their suffering
  • Isolating yourself
  • Loss of pleasure in life
  • Difficulty concentrating
  • Insomnia
  • Physical and mental fatigue
  • Bottling up your emotions
  • Increased nightmares
  • Feelings of hopelessness or powerlessness
  • Frequent complaining about your work or your life
  • Overeating
  • Excessive use of drugs or alcohol
  • Poor self-care
  • Beginning to receive a lot of complaints about your work or attitude
  • Denial

In fact, according to the Compassion Fatigue Awareness Project, “denial is one of the most detrimental symptoms” because it prevents those who are experiencing compassion fatigue from accurately assessing how fatigued and stressed they actually are, which prevents them from seeking help.

  1. If you recognize the signs and symptoms of compassion fatigue within yourself, it’s important to develop a multi-pronged approach. Seeking professional support is always a great option. You can also create a self-care to address six core areas: physical, psychological, emotional, spiritual, professional, and relational health. By creating a holistic plan, you can adequately monitor improvements along the way in each of these key areas.

As examples of how this can play out, nurse #1 is someone who was impacted by compassion fatigue but did not have strategies to prevent, identify, and overcome. Nurse #2 had guidance and assistance and was ultimately able to conquer it and continue her career:

Nurse #1 attended nursing school and planned a career in cardiac nursing. Her mother had experienced multiple cardiac events and hospitalizations throughout most of her life. During Nurse #1’s childhood years, her mother had multiple admissions for congestive heart failure. Each admission became more difficult for her mother. The nursing staff and the family became very familiar with each other during these repeated admissions. This situation motivated Nurse #1 to pursue a career as a cardiac nurse.

After graduation Nurse #1 began working on a busy Telemetry Unit. Several patients on this unit experienced multiple admissions to the unit. Nurse #1 seldom took breaks; she quickly acquired the skills needed to work on this unit and soon became a leader on the unit. Within a short time span, three of her primary patients died. The patient census remained high and the workload remained intense. Nurse #1 began viewing her work as drudgery. She could barely arrive at work on time and rarely offered to be a consistent caregiver for a challenging patient. Her co-workers observed her changing behavior as she struggled to find some work-life balance. This changing behavior was also noticed by the nurse manager who attempted to adjust Nurse #1’s scheduled to work twelve-hour shifts. However, this adjustment took a toll on her physically and emotionally. After a period of time, she started working in the outpatient clinic at the hospital. However, this new work environment did not diminish her over involvement with certain patients and their families. Although Nurse #1 attempted to adjust to this new setting, she continued to care for patients with end-of-life, cardiac-disease processes. Eventually, she left this position to pursue a less stressful work environment.

Nurse #2 was a nurse who exhibited anxiety and job dissatisfaction on a regular basis. She was often overwhelmed with her complex, patient-care assignments and expressed much sadness about her patients’ social and emotional problems. She was frequently tearful and verbally acknowledged not wanting to come to work. In addition, she was sensitive to feedback and felt a lack of support from some of her peers and supervisors. She had difficulty sleeping, worried about work on her days off, and talked openly about wanting to leave the hospital.

Nurse #2 talked often with several clinical nurse specialists who helped her focus on achieving a healthy work-life balance. They counseled her on positive self-care strategies and effective communication techniques and guided her in considering long-term career plans. Although attempts were made to help improve the situation in her unit, she continued to experience anxiety and dissatisfaction.

Despite her growing unhappiness, she identified a specific area of nursing in which she had always wanted to work. Arrangements were made for her to talk with the supervisor and schedule a shadowing experience in this area. She decided to transfer to this new area and has since made a positive adjustment. Being proactive in meeting her own needs and addressing work-related needs has resulted in Nurse #2 feeling more energized about her work assignment and more eager to come to work.

The impact of compassion fatigue on healthcare professionals can be profound. It may cause stress-related symptoms and job dissatisfaction among caregivers and decreased productivity and job turnover within the healthcare system. By being aware of the warning signs of compassion fatigue, having a plan in place to prevent it, treating it when the first signs appear healthcare professionals can continue to positively impact their lives and the lives of the patients and families they encounter. 

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