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Compassion Fatigue

If the nurse's ability to care is affected, quality of care could suffer

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Recently compassion fatigue is getting a lot of attention, especially in regards to nursing. For good reason; it could be very detrimental to your practice, permanently reducing your ability to care.

Carla Joinson, RN, coined the term in 1992 while researching burnout in emergency department nurses, and she noticed some nurses had lost their "ability to nurture."1 The concept of compassion fatigue has since been described by various authors and applied to a variety of groups outside of nursing, such as social workers, firefighters, therapists and disaster relief workers.2

Caring is a large part of the nurse's job. If the nurse's ability to care is affected, then the quality of care the nurse provides to patients could also be affected. It is important to note Joinson did not define compassion fatigue beyond the loss of the nurse's ability to nurture. Subsequent research has used the term incorrectly and interchangeably with secondary trauma syndrome or burnout. Recent research provided a concrete definition of the term in their exploratory study.3

What Is Compassion Fatigue?

Compassion fatigue is a progressive and cumulative process that is influenced by three factors: interaction with patients, the nurse's use of their own resources, and exposure to stress.3 It can be caused by a prolonged or continuous exposure to stressful events or by a very intense event.

Compassion fatigue is divided into three stages. The first stage is compassion discomfort, which is a temporary change that can be reversed by rest. Symptoms of compassion discomfort may include weariness, lessened enthusiasm, and weakening attention.3

If compassion discomfort is not addressed, it will progress to the second stage, compassion stress. During this stage, the nurse's stress level increases and his/her endurance level decreases. The nurse may experience loss of strength, diminished performance, irritability and an impaired ability to concentrate.3

The third and final stage is compassion fatigue. If nurses reach this stage, it is very likely they will never completely recover their ability to nurture. A nurse who has reached this stage is likely to feel indifferent or apathetic, have a desire to quit and have poor judgment. It is currently not known how long it takes to progress through the stages of compassion fatigue, or if it varies between persons.3 Due to differences in individual nurse's personal resources and capacity for resiliency, the time spent in each stage is likely to vary.

Why is Compassion Fatigue Important?

Looking at the progression of compassion fatigue and its symptoms, one thing is clear: compassion fatigue can have a major impact on a nurse's professional practice. It is easy to see how symptoms such as diminished performance, impaired ability to concentrate and poor judgment may lead to a poor quality of care for the patient.

A nurse experiencing compassion fatigue may become so exhausted and indifferent simple things of great importance to the patient may be overlooked. Little efforts such as making sure the call bell and telephone are within reach may mean a great deal to the patient. A nurse who has a lack of concentration is at greater risk for an error and is more likely to commit a serious medication error. Since the progression of compassion fatigue is cumulative, nurses may exhibit symptoms from more than one stage.

Previous research has used the term compassion fatigue interchangeably with secondary trauma syndrome, which identifies the causative factors as traumatic incidents.4 While a traumatic incident may cause compassion fatigue, it may also be caused by prolonged or continuous exposure to stressful events.3 This is important point for several reasons. First, prolonged or continuous stressful exposure may be more difficult to identify than a single traumatic event.

Second, research has shown compassion fatigue is not limited to nursing specialties that routinely encounter traumatic events, but can also be experienced by med/surg nurses.5 By definition, compassion fatigue is the end result of a process in which the nurse's compassion ability is diminished; occurring in any setting that a nurse is caring for another person.

What to Do about It?

Since compassion fatigue has only recently been defined, little is known about what interventions may be useful to prevent it. The available research suggests several strategies that may be effective in preventing compassion fatigue. Simple efforts such as taking a day off or requesting an assignment change may be enough for some nurses to reverse compassion discomfort.5 Informal debriefing, with colleagues, is used by many nurses because it tends occur naturally when close friendships are developed.5 Formal debriefing could also be encouraged although there is no research to date to substantiate its use. 5 Additional research suggests hospitals provide in-service education to raise awareness about compassion fatigue and provide life skills training. This will enable the nurse to recognize the early stages of compassion fatigue in him or herself, as well as in colleagues.3 Furthermore, nursing programs should introduce the concept into the curriculum to raise awareness about compassion fatigue is to introduce the concept into nursing program curricula, thereby allowing students to understand compassion fatigue and learn how to prevent this from occurring in their own practice.3 (Coetzee & Klopper, 2010).

References

1.       Joinson, C. (1992). Coping with compassion fatigue. Nursing, 22(4), 116-121.

2.       Hooper, C., et al. (2010). Compassion satisfaction, burnout, and compassion fatigue among emergency nurses compared with nurses in other select inpatient specialties. Journal of Emergency Nursing, 36(5), 420-427.

3.       Coetzee, S. K., & Klopper, H. C. (2010). Compassion fatigue within nursing practice: a concept analysis. Nursing and Health Sciences, 12(2), 235-243.

4.       Dominguez-Gomez, E., & Rutledge, D. (2010). Prevalence of secondary traumatic stress in emergency nurses. Journal of Emergency Nursing, 35(3), 199-204.

5.       Yoder, E. (2010). Compassion fatigue in nursing. Applied Nursing Research, 23(4), 191-197.

Joshua Bryant Cole is a recent graduate of Massachusetts College of Pharmacy and Health Sciences, Worcester.


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Compassion fatigue is very real. Somewhere in the mid nineties I was a CNA in a community hospital ER. After a series of unsuccessful codes and DOA cases [both young and old] I noticed myself harden. I guess I was experiencing the first stage of this, I actually remember were I was [at work] when I realized this change in myself. I was able to rectify it because I had noticed the shutdown and callus attitude I was newly taking on.
Debriefing is very valuable! Prior to becoming a CNA in the ER I was a HHA with a very supportive agency. They practiced debriefing on a monthly bases in a formal group setting with a highly decorated psychotherapist, it was mandatory and the time you spent there was on company time and the hours were put toward your 12 hr. annual re-certification [necessary for HHAs to keep current].
I have since become a registered nurse and have been for eight years now working in a vast array of settings and I have witnessed quit a few traumatic events. Yet I have never seen the support of debriefing offered anywhere since that first HHA job. I have often thought that ER, step down, floor nurses and long term care personnel not to mention cops and other first responders could highly benefit from such a supportive thing as mandatory monthly debriefing. It encourages a healthy prospective on our own psyche. We all know we must take care of ourselves in order to properly care for others. Society as a whole would benefit. Anyone see the movie CRASH? Remember the cop played by Matt Damon? Look, he didn't start out that way!
I hope this topic does become part of the nursing school curriculum and further more I hope someday soon companies realize its importance and offer a regularly scheduled [monthly or annual] debriefing to healthcare workers and first responders..

Claudette  Pike ,  RNJuly 29, 2011
Great River , NY




     

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