The role of concept analysis within theory development is important because it allows for the development of concepts or concerns that are impacting nurses by guiding nurses to identifying gaps, topics that need clarification, or growing on existing concepts by examining and exploring. The selected nursing concept to be discussed in this essay is compassion fatigue (CF). Caregivers are exactly that: givers who care. Nurses put aside their own needs and wants and put ahead of themselves, the needs of the patients. Compassion is what drives nurses to give.
Giving above themselves and giving to someone else. Unfortunately, a variety of factors and different variables can skew the path of a nurse’s compassion. Nurses who show CF are emotionally exhausted by reporting sadness, depression, and general anxiety (Berg, Harshbarger, Ahlers-Schmidt, & Lippoldt, 2016). Roy’s Adaptation Model (RAM) discusses how nurses adapt both physically and emotionally to their environment. RAM provides a framework to aid in adaptation for patients (Kaur & Mahal, 2013). This framework can have an emotional and physical role within a nurses personal life as well.
Nurses are not only providers for others but must remember they are providers of themselves as well. The sections of this essay will discuss the definition and an explanation of the concept of CF, literature review, defining attributes that make up CF, discussion of one antecedent and one consequence, two empirical referents, the discussion of a construct case, the theoretical application of the topic, and a conclusion with self reflection from the author.
Definition/Explanation of Compassion Fatigue Webster’s dictionary defines CF as: physical and mental exhaustion and emotional withdrawal caused by caring for the sick (Compassion fatigue, n.d.). Lanier (2017) defines CF as the “physical, emotional, and spiritual result of chronic self-sacrifice”. CF is the consequence from the demand of caring for others through their stressful, emotional, and traumatic events. If emotional connectedness or motivation does not exist compassion fatigue will emerge. Compassion fatigue itself is defined as the loss of work-related satisfaction (Sheppard, 2015).
The article by Berg, Harshbarger, Ahlers-Schmidt, and Lippoldt (2016) discusses CF, STS, and Professional Quality of Life Scale IV (ProQol). It states that emotional distress leads to secondary traumatic stress (STS), detachment, and rigidity in personal relationships. All being contributions to CF. The article by Granek, Nakash, Cohen, Ben-David, and Ariad (2016) mentions the development of STS in oncologist and its effects on their compassion satisfaction (CS). It measures their CS using the ProQol tool and states that oncologist have high levels of STS due frequent exposure to patients with cancer. The article shares suggestion for improving STS by reflection and meditation.
The article by Sheppard (2015) discusses satisfaction engagement measured by the ProQol tool. Satisfaction among nurses being affecting by “untenable situations”, unfair treatment among leaders, and factors that define STS. It also mentions that some nurses are leaving to become nurse practitioners in hope to escape the demands of a hospital. Lanier (2017) differentiates between CF and burnout, attributes to CF, and physical and emotional symptoms that breed CF. Self reflection, taking time off, seeking help from others are some suggested ways of combating CF.
It also contributes coping solutions by giving guides on healthy caregiving, self care, a healthy workplace, and healthy change. Yılmaz and Üstün (2018) mentions an emotional symptom of CF being powerlessness. It can cause more stress, interpersonal conflicts, and decrease in quality of life overall. Like Merriman (2015), it mentions how STS is similar to post traumatic stress disorder (PTSD). The article by Kaur and Mahal (2013) examines Roy’s Adaptation Model. The concept of the environment, health, nursing, and the person can be applied to patients and nurses themselves. RAM’s basic concept encircles the idea the humans must adapt to environmental stimuli.
Nurses are always adapting and changing to acclimate to the ever-changing environment. Defining Attributes Three attributes that contribute CF are incivility, stress, and STS. Incivility comes in many shapes. Bullying, rude or discourteous behaviour, sabotage, unfair treatment, or intimidation, are just some examples of incivility. Sheppard (2015) states that being overlooked or incivility from a leader is one of the strongest contributors to burnout. Burnout and CF are almost synonymous however, burnout differs from CF in the sense that CF stems from an emotional source whereas burnout could be both physical and mental.
Physical burnout could be caused by the imbalance of demand and limitation of resources in regards to care (Lanier, 2017). For example, a nurse who volunteers in a time of crisis for an extended period of time may not lack compassion and drive but can experience burnout due to limited resources. Incivility experienced from others can reflect on the nurse and the nurse can reciprocate by being uncivil themselves as a form coping. Stress is another attribute that nurses are well experienced in. Stress in nursing can lead to lack of compassion at work and at home. Stress is individualized.
What may be stressful to one may not be stressful to another. Having high emotional intelligence can help regulate emotions when faced with stress (O’Connor, Nguyen, & Anglim, 2017). Having poor emotional intelligence is associated with ineffective coping skills which can lead to cognitive, behavioral, and emotional dysfunction and depersonalization (Smith, 2014). The creation of distancing oneself from the stressor(s) occurs when stress is present and is a coping skill. Avoidance, forgetfulness, preoccupation in thoughts, fatigue, and sleep disturbances can lead to poor work performance affecting self-esteem leading up to emotional exhaustion resulting in CF. “Professional stress can cause decreased productivity, morale, and work engagement” (Berg, Harshbarger, Ahlers-Schmidt, & Lippoldt, 2016).
Stress from work, such as incivility, can have a reciprocal effect on a nurse. They may bring the stresses home, putting strain on their family and more strain on themselves. In return, this can be brought back to work, creating preoccupation, thus creating more stress. A third attribute towards CF is secondary traumatic stress. Secondary traumatic stress is “an emotional response to trauma or distress” (Sheppard, 2015). It is trauma that is manifested by repetitive exposure to another’s traumatic events. Merriman (2015) indicates that secondary traumatic stress is similar to PTSD. Kellogg, Knight, Dowling, and Crawford (2018) states that age and experience do not predict STS.
Emotional disturbances can occur as a result such as thinking about cases often, flashbacks, or second guessing decision are just some occurrences from STS. Antecedent & Consequence Before compassion fatigue takes place one would feel a sense of powerlessness. Yılmaz and Üstün (2018) shares that powerlessness is a symptom of CF. Experiencing incivility can cause a feeling of powerlessness, stress is a multi-factorial concept that can lead to feelings of powerlessness, and secondary traumatic stress can lead to feelings of hopelessness and powerlessness when unable to overcome and cope with secondary traumatic stress. A consequence of compassion fatigue would be for one to leave the profession of nursing.
The three attributes discussed: incivility, stress, and secondary traumatic stress, can happen all at once or occuring in one episode. Individual nurses manage these attributes differently however, they can lead to professional exhaustion. Professional exhaustion that is experienced can reinforce one losing compassion for their job and it increases the chance of leaving their current job or leaving nursing altogether (Lorenz, Sabino, & Corrêa Filho, 2018).
Empirical Referents Two empirical referents related to compassion fatigue are the ProQOL and the Compassion Fatigue Self Test (CFST). The ProQol is a measurement tool that assesses three areas: STS, compassion satisfaction/CF, and burnout (Granek, Nakash, Cohen, Ben-David, & Ariad, 2016). It determines compassion and CF on a scale comprised of thirty questions (Berg, Harshbarger, Ahlers-Schmidt, & Lippoldt, 2016). The CFST is comprised of forty questions based on two areas: compassion and burnout. It is the first test developed to measure CF (Sinclair, Raffin-Bouchal, Venturato, Mijovic-Kondejewski, Smith-MacDonald, 2017). Construct Cases Sorenson, Bolick, Wright, and Hamilton (2016) defines CF as a negative effect of helping individuals suffering from traumatic events. A sexaul assault nurse examiner is a nurse that has “training in the medical, forensic, and legal treatment of sexual assault victims” (Bimber, 2014).
Nurses working in this field often experience STS caused by caring for victims, stress because of the situations, stress from time constraints for evidence for court purposes, and incivility from the patient due to resistance, patients families out of defense or fear, or because they are the abuser. A model case contains all attributes discussed. For example is a nurse working as sexual assault nurse examiner in a large city was working New Year’s Eve. She has been an examiner for five year now and is well aware of the importance of these exams. She loves her job and takes pride in helping her patients. In the early morning hours, she has a patient come in with her husband stating she was assaulted at a New Year’s Eve party. When the nurse asks the husband to leave, he starts yelling and insulting the nurse stating his demands to stay followed by threats.
The nurse has many others patients to see and time if of the essence to get the exams done. The unit if very busy and staffing is low due to the holiday. Group reflection has been postponed due to the unit demands and the staff therapist is on vacation. A borderline case is a case that contains some but not all of the attributes mentioned. For example a nurse working as sexual assault nurse examiner in a large city was working New Year’s Eve. She has been an examiner for five year now and is well aware of the importance of these exams. She loves her job and has pride in helping her patients. In the early morning hours, she has a patient come in with her husband stating she was assaulted at a New Year’s Eve party.
When the nurse asks the husband to leave, he complies and exits the room allowing the nurse to do the exam. The nurse has many others patients to see and time if of the essence to get the exams done. The unit if very busy and staffing is low due to the holiday. Group reflection has been postponed due to the unit demands and the staff therapist is on vacation. A contrary case is a case excludes all attributes. For example is a nurse working as sexual assault nurse examiner in a large city was working New Year’s Eve. She has been an examiner for five year now and is well aware of the importance of these exams.
She loves her job and has pride in helping her patients. In the early morning hours, she has a patient come in with her husband stating she was assaulted at a New Year’s Eve party. When the nurse asks the husband to leave, he complies and exits the room allowing the nurse to do the exam. Although she has other patients to see, staffing is above normal to allow for the influx expected from the holiday and she can get her work done with thoroughness. To combat the effects of secondary traumatic stress from her job, she participates in a group reflection at the end of each day with her peers as well as meeting with the in-hospital therapist at any time she wishes.
Theoretical Application of The Concept Roy’s Adaptation Model’s central concept discusses how people adapt to their environment. Roy’s Adaptation model has four domains: person, health, environment, and nursing. Applying this to a nurse with CF, Roy (2009) states, that a person must constantly adjust to an environment that is always changing and respond with adapting to the stimuli of the environment. The environment is “all conditions, circumstances and influences” (Roy, 2009). Health includes physical, mental, emotional health, and quality of life.
The nursing domain involves physical, psychological, social and spiritual aspects (Kaur & Mahal, 2013). Usually when thought of, this theory is applied to patients however, nurses must also integrate it for themselves. Nurses can create goals, interventions, and evaluations of their own lives to incorporate all modes of Roy’s Adaptation Model to themselves to promote their “best” selves. When that is done, CF can be avoided, insight to self is gained, and a positive outlook to various situations within the environment can be created. Conclusion In summary, CF a prevalent issue within nursing. Literature shows this by the extensive information available.
Many attributes are apart of CF and the ability to adapt to them must be present to aid in overcoming CF. Roy’s Adaptation Model provides a framework for nurses to guide them in learning how to holistically care for themselves and in turn, care for their patients with better understanding, insight, and compassion. CF is not just a concept that happens to floor nurses. It can happen in any line of work. Family nurse practitioners (FNP) must remember to have compassion and avoid factors that can lead to CF. FNP’s can get caught up in the demands of the job and those demands will be higher than those of previous roles.
Malpractice suits, incorrect diagnosing, pharmaceutical distribution, political and governmental stressors are more “fuel to the fire”. As nurses we come into the role with giving, caring, helping, comforting, supporting, and many like attributes associated with nursing. Time evolves in our careers and with experiences we develop into different humans and different nurses than we were before entering the field. Compassion can get lost in the demands of nursing but one skill such as self reflection can always bring us back to finding our compassion for our patient and ourselves, reminding us why we became nurses in the start.
