Introduction
Critical care nursing such as Intensive Care Unit (ICU) or Coronary Care Unit (CCU) can be a rewarding career as it involves caring for patients that are critically ill. This field of work requires both emotional and physical stamina in order to keep up with the pace of the job. Patients are typically in ICU for long periods of time, resulting in the development of interpersonal relationships between both nurses and patients and nurses and patients’ families. However, this bond can cause an emotional toll if the patient does not survive. On critical care floors, death rates are higher than survival rates, which can lead to compassion fatigue in nurses. In the last month, I was hired as a CCU nurse, which allowed me to foresee how I may develop compassion fatigue. The purpose of this paper is to use Walker and Avant’s method of concept analysis to understand compassion fatigue and its prevalence in critical care nurses and in other disciplines.
Literature Review
This literature review will explore compassion fatigue in nurses, teachers, and veterinarians. Identifying the reasons as to why these professions develop compassion fatigue, allows for a better understanding of the concept, the signs and symptoms, and how to minimize the effects of compassion fatigue.
Uses of the Concept
Compassion fatigue has been defined in a variety of ways by different sources and professions. The Merriam-Webster online dictionary (2019) defines compassion fatigue as the physical and mental exhaustion and emotional withdrawal experienced by those who care for sick or traumatized people over an extended period of time. According to Van Mol et al. (2015) compassion fatigue is defined as “physical and physiological distress in caregivers which occurs because of the demanding relationship with needy sick individuals.” In the ICU, nurses are constantly exposed to critically ill patients who are fighting for their life. These patients and their families require compassion and care from their nurses. According to Koenig (2014), “compassion fatigue is the natural emotional and behavioral reactions that occur from the knowledge of someone close experiencing a traumatic event, combined with the stress caused by the desire to help the traumatized individual.” Teachers are affected by compassion fatigue because they are likely to work with traumatized students who enter the classroom and often times look toward their teacher for guidance during difficult times. According to Kahler (2015), compassion fatigue is the result of caring too much and working hard, but at the same time, not recognizing and caring for your own needs. In a veterinarians’ line of work, they deal with abused animals, grief, pet loss, and performing euthanasia which often times can lead to compassion fatigue.
Defining Attributes
Attributes are those characteristics of a concept that appear repeatedly in the literature and are associated with the concept allowing the broadest insight (Walker & Avant, 2011, p. 41). Common characteristics that describe compassion fatigue in nurses, teachers and veterinarians include:
- Interacting with difficult individuals
- Ethical Dilemmas
- Presence of traumatic event
- Continuous disappointing situations
- Unable to control work environment
Antecedents
Antecedents are defined as events or incidents that must occur or be in place prior to the occurrence of the concept (Walker & Avant, 2011, p. 45). Antecedents that have been identified in critical care nurses, teachers and veterinarians prior to the feeling of compassion fatigue were feelings of failure, inability to meet the expectations of the patient, family member or student, “giving bad news” (Kahler, 2014), and “caregiver exposed to suffering” (Jenkins & Warren, 2012). A work colleague of mine was taking care of a patient who had multiple comorbidities, he coded due to a pulmonary embolism. The doctors, nurses and respiratory therapist worked hard to revive the patient, which they did. Once stabilized, my colleague worked hard all night to keep that patient alive. By the end of the night, the patient passed. She felt that she had failed her patient. In terms of education, one of my friends is a sixth-grade teacher. A student of hers who was a bright and hardworking began doing poorly in her math class. When the teacher pulled the student to the side, the student revealed she had an ill mom and three younger siblings she had to care for. When the teacher asked if there was anything she could do for her, the student responded no. As the student’s role model, my friend felt like couldn’t meet her students’ expectations. With veterinarians the concept of compassion fatigue continues. Because they’re exposed to sick animals more often and many times have to euthanize them, they too show symptoms of compassion fatigue.
Consequences
Consequences are defined as events or incidents that occur as a result of the occurrence of the concept (Walker & Avant, p. 45). Consequences that have been identified in critical care nurses, teachers and veterinarians after compassion fatigue occurs are quitting their job, suicide, lack of sleep, depression, and apathy. Teachers who are experiencing compassion fatigue may not be able to empathetically engage with and empower their students (Koenig, 2014). Critical care nurses give so much of their compassion to their patients and their families that after a while they lose their sense of care. Nurses diminished sympathy to someone suffering and the lessened desire to help, becomes prevalent (Jenkins & Warren, 2012). A study by Dr. David Bactrim, found veterinarians were 5.5 times more likely to have suicidal ideation than those of the normal population (Kahler, 2014). According to Jenkins & Warren (2012) they may also lose workdays due to physical complaints such as headaches and stomach pains.
Empirical Referents
Dr. Figley and Stamm developed a compassion fatigue self-test called ProQuol Professional Quality of Life Scale. It consists of thirty questions that are used as a screening tool for the positive and negative aspects of working within a profession. The ProQuol examines both compassion satisfaction and compassion fatigue. A numeric value is given to each thirty questions (1 being “never “and 5 being “very often.”) If the score is below 23 you are more than likely satisfied and happy with your job. If the score is above 40 you are dissatisfied with your job and should consider taking some time off or re-evaluate what is making you unhappy about your job. This questionnaire is effective in making the professional aware that they are displaying signs of compassion fatigue, allowing them to take the appropriate steps to prevent this.
Cases
Model Case. Jenkin’s model case in the concept analysis demonstrates the use of all the important attributes. Nurse A works in a medium-volume clientele hospital on a critical care unit. Nurse A works as the weekend charge nurse and is on her sixth 12 hours shift due to a colleague who is on medical leave as well as the need for the extra income. Three nights ago, Nurse A assisted with the admission of a motor vehicle collision (MVC) with multiple trauma victims a mother, and 3 younger children ranging from 13 to 19 years old. The two older children were from out of town and were home from college to visit their mother and younger sibling. The mother and the two older children died at the scene, and the youngest child was in critical condition and was transported by helicopter to the trauma center. Nurse A listened to the younger child ask about the mother and the two older siblings. Nurse A was empathetic to the questions and was upset and concerned about the others involved in the MVC. That night, nurse A had trouble sleeping, had nightmares, and replayed her interaction with the patient and their family over in her head. Nurse A does not call her patients by names, but by their diagnoses. Since that night her work performance declined as she made medication errors, documented on the wrong patient, and charting mistakes.
Borderline Case. A borderline case for compassion fatigue is based on a shift I had when I was working on the medical-surgical floor. It was my third shift in a row, and I was assigned seven surgical patients who were post-op. Because of these patient’s post-op status, they were frequently requesting pain medications and required close monitoring because of their multiple drainages. Since it was my third day with these patients, I was already acquainted with their diagnosis and needs. I was attentive to the care they needed and carried out all the doctor’s orders. However, I was fatigued and had a headache. Evidently, I didn’t have a smile on my face, and it took time to administer medication. When a family member approached me, I gave a quick reply and continued with my charting. Towards the end of my shift, I was drained and relieved that it was over.
Conclusion
The intent of this concept analysis is to bring more clarity to the term compassion fatigue and to bring self-awareness of its severity. Nurses who work on high acuity floor are more prone to developing compassion fatigue, thus if the nurses are self-aware, they can prevent it. A nurse or any other “caring” profession can hinder the antecedents to compassion fatigue by taking care of themselves through rest, meditation, talking to their colleagues, asking the manager for an assignment change, and taking vacations as needed. Taking these steps can decrease the high turnover rates on critical care floors, decrease suicide ideations or attempts, depression, and overall job dissatisfaction. As I continue my career on CCU, if I ever feel like I am having symptoms of compassion fatigue I will lean on my colleagues and take the necessary actions to maintain my mental and emotional health.
