A Commentary on Compassion Fatigue in the Nursing Profession KLD
Rhode Island College
A Commentary on Compassion Fatigue in the Nursing Profession
When we think of what key elements are required to be a nurse, there are several words that come to mind. Compassionate, caring, attentive, conscientious, diligent, and hard working are to name a few. The very attributes that highlight the nursing profession, are also the root of the cause of what is known as “Compassion Fatigue.” In the article “Countering Compassion Fatigue: A Requisite Nursing Agenda,” the author states that while nurses have a long history of bearing witness to the tragedies experienced by patients and families, their own reactions to premature death and profound loss have not been systematically addressed. Over the past two decades, researchers have studied the phenomenon described as “a nurse’s loss of ability to nurture.” Several words have been used synonymously to describe compassion fatigue, but a clear definition for compassion fatigue has yet to be established, making it difficult to clearly identify the phenomenon and react to it’s occurrence. In this article, the author aims to clarify the term compassion fatigue, and how it differs from nursing burnout. She identifies risk factors and describes the assessment of compassion fatigue, and then identifies the need to support nurses who regularly witness tragedy, and describes interventions that should occur in the workplace to confront compassion fatigue.
The author describes compassion fatigue as “a progressive state of emotional unease, that evolves first from compassion discomfort, then to compassion stress and finally to compassion fatigue; “a state where the compassion energy that is expended by nurses (and others) surpasses their ability to recover from this energy expenditure, resulting in significant negative psychological and physical consequences. It is associated with the ‘cost of caring’ and refers to the resultant strain and weariness that evolves over time.”
From my perspective, nurses often enter into the lives of patients during times of emergency, severe illness, pain, decline in health, dying and death. Through out the patient/nurse encounter, a relationship develops. When this occurs, the emotional boundaries may become intertwined, and the nurse may experience the patient’s pain and emotional distress through empathetic transcendence. This experience may be psychological or somatic. The nurse becomes psychologically exhausted, and therefore, the nurse’s empathetic response to patient illness, pain, etc. can no longer function properly, and is evident by withdrawal, loss of interpersonal skills, and lack of empathy.
Compassion fatigue is often confused with burnout, as both phenomena provoke responses involving empathy, however, the etiology of burnout is different. Burnout occurs gradually, and is a reaction to stressors in the work environment such as poor staffing, heavy workload, inadequate supplies or resources. On the other hand, compassion fatigue is said to have a sudden onset, and is a relational occurrence, that stems from caring for those who are suffering, and from the inability to change the course of the patient’s painful scenario or trajectory. Burnout causes decreased empathic responses and withdrawal, where as, compassion fatigue is evidenced by continued endurance or giving results in an imbalance of empathy or objectivity. Ultimately, both burnout and compassion fatigue may result in the nurse leaving their nursing position.
Those most at risk for experiencing compassion fatigue are “first responder” professionals. Police, fire fighters, military personnel are all in the front-line baring witness to tragedies on a regular basis. These groups frequently have well-established support systems in place to prevent severe emotional consequence. Counselors, chaplains, psychologists and time-off allowance are to name a few of the supports that these professionals often have available to them. Nurses, on the other hand, have less support systems in the workplace, although they also bare witness to urgent, life threatening situations on a regular basis. The one exception that is recognized and offers nurses strong support is end-of-life, palliative care nursing.
In the compassion fatigue assessment, the author provides five characteristics that may contribute to compassion fatigue, which 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, and coping abilities and techniques of stress management. To date, there are also instruments used to measure compassion fatigue via scale models, however, they are less pertinent to nurses than other professionals.
Finally, the author stresses the need for support for nurses who witness tragedy and death. Clinical practice settings need to integrate assessment strategies and support systems for nurses, who are not only first responders, but are sustained responders, as they are expected to provide ongoing support and interventions to highly vulnerable patients and families. In order to proactively manage compassion fatigue, it must be multifacited , and include prevention, assessment, and consequence minimization. The three areas that must be addressed to proactively manage compassion fatigue are the balance of work and life, education, and work setting interventions.
Work and life balance is essential, as we must care for ourselves in order to care for others. This involves incorporating exercise, leisure and relaxation into our daily lives. Ironically, while nurses percieve themselves as caring people, they find it hard to nurture themselves.
Education is another element to preventing compassion fatigue. The author states that lack of communication skills and strategies for supporting patients under stress may lead nurses into feelings of depression. Examples of basic communication and self care are: establishing boundaries in relationships with patients and families, cope with ethical conflict and dilemmas, and utilizing self-care strategies such as meditation and mindfulness. Continuing education programs that augment basic emotional support competencies in the practice setting, and special end of life training can enhance both nursing knowledge and skill.
Work setting interventions are another key factor in providing support for nurses at risk for compassion fatigue. For example, on-site counseling services, such as with a psychiatrist or counselor trained in the provision of emotional support for healthcare providers. These resources must be accessible and readily available for staff in order to be effective. Also, facilities that offer massage sessions provide physical and mental breaks from care giving stress. Work settings that offer staff a variety of emotional supports are often desired places of employment.
In conclusion, the reality of compassion fatigue is that it is an inevitable risk factor for nurses. A balance of work and life, along with education and work setting interventions are key to preventing and managing compassion fatigue, and should be available in clinical practice settings. In order to promote optimal multifacited nursing care to patients, nurses’ must first be sure to care for their own healthcare needs on a multifaceted level, not just physically, but sufficiently coping with emotional stress as well.
Boyle, D.,(2011) Countering Compasison Fatigue: A Requisite Nursing Agenda. OJIN: The Online Journal of Issues in Nursing, Vol. 6,No.1, Manuscript 2.