Symptoms and Coping Strategies for Caregivers
Patricia Caldoron
Grand Canyon University
Symptoms and Coping Strategies for Caregivers
Compassion fatigue is a state in which an individual feels mentally, emotionally, and spiritually depleted. As medical professionals, nurses often encounter compassion fatigue because of their empathic relationships with patients and their dedication to helping prevent, cure, and manage illness. However, by becoming preoccupied with their patients’ problems and overwhelmed by their responsibilities and workloads in healthcare, nurses will often neglect their own physical, emotional, and spiritual needs. Prolonged neglect results in compassion fatigue symptoms that can be categorized into cognitive, emotional, behavioral, spiritual, and somatic concepts. All of those concepts are characterized by certain symptoms caused by maladaptive coping strategies, so nurses require constructive coping interventions that fulfill their physical, emotional, and spiritual needs to prevent compassion burnout.
Concept 1: The Cognitive Concept
Decreased concentration and disorientation are the most visible cognitive symptoms of compassion fatigue because they reflect in the nurses’ work activities. Other warning signs may include apathy, rigidity, and minimization. As compassion fatigue progresses, nurses become preoccupied with their patients’ traumas even outside of the workplace and their past personal traumas may surface (Portnoy, 2011).
Nature of the Problems and Their Causes
The cognitive symptoms associated with compassion fatigue are caused by prolonged exposure to suffering. According to Bush (2009), exposure to emotional pain experienced by other people results with increases in personal stress and emotional pain levels. The chronic psychological distress eventually causes changes in the caregivers’ cognitive schemas. Although changes in cognitive schemas are usually considered characteristic to vicarious traumatization, that term is usually used interchangeably with compassion fatigue (Bush, 2009).
Concept 2: The Emotional Concept
Nurses should keep professional boundaries at work, but constant exposure to emotional stress by observing suffering may eventually manifest in a variety of symptoms that are similar to the post-traumatic stress disorder. For example, nurses can experience anxiety, guilt, emotional numbing, distress, depression, and fear. Nurses also report feeling powerless and helpless, which is understandable given the fact that they cannot always help their patients (Boyle, 2011).
Nature of the Problems and Their Causes
For caregivers, the development of compassion fatigue occurs because of their empathic relationships with the patients. Empathy is necessary for understanding patients and caring for them, but nurses who are emotionally over-involved with their patients are more susceptible to emotional distress and compassion fatigue (Bush, 2009). Because observing suffering is a constant source of stress for emotional stress for healthcare workers, developmental experience and the ability to establish professional boundaries are factors that determine susceptibility to compassion fatigue. That explains why younger and less experienced nurses will more likely experience compassion fatigue than senior nurses (Bush, 2009).
Concept 3: The Behavioral Concept
Behavioral changes in compassion fatigue are responses to stressors that enable nurses to cope with the challenges of their working environment (Bush, 2009). However, behavioral changes are not necessarily positive adaptive strategies, such as building resilience or stress management techniques. More common coping strategies include withdrawal, mood swings, appetite change, hyper-vigilance, and irritability.
Nature of the Problems and Their Causes
Even though behavioral changes may become maladaptive, the response to stressors is usually involuntary. Avoidance approaches (e.g. social alienation, apathy, substance abuse, eating disorders) are a defensive mechanism that activates when constructive coping strategies fail. Therefore, nurses will use avoidance approaches to alleviate chronic stress. Chronic stress is the main cause of maladaptive behavioral changes in compassion fatigue, but it can be facilitated by lack of social support systems and personal stressors (Bush, 2009).
Concept 4: The Spiritual Concept
According to Bush (2009), the loss of self is unique to compassion fatigue when compared to other theories like burnout. Because nurses are often surrounded by death and suffering, they eventually start questioning the meaning of life. As compassion burnout progresses, they will experience a loss of purpose, sense of hopelessness, and loss of faith (Portnoy, 2011).
Nature of the Problems and Their Causes
Spiritual problems are difficult to identify and resolve because they affect the personal belief system and result in existential questions. Although chronic exposure to emotional stress and suffering is a recurring theme in the causes of each concept, spiritual problems are mainly dependent on a variety of nurses’ abilities. For example, nurses will more likely experience spiritual issues associated with compassion fatigue if they have difficulty with self-forgiveness, establishing empathic boundaries, and low self-awareness (Bush, 2009). Without those characteristics, nurses are unable to identify reactions to traumatic events and manage negative emotions, so they experience spiritual discomfort and compassion fatigue.
Concept 5: The Somatic Concept
Somatic pain does not have a physical cause. Nurses who experienced compassion fatigue report breathing difficulties, irregular heartbeat, sweating, headaches, insomnia, and similar issues. Somatic issues may also impair physical health because they weaken the immune system (Portnoy, 2011).
Nature of the Problems and Their Causes
Somatic issues are caused by cumulative stress. Even though they do not have an apparent physical cause, nurses who report somatic pain experience physical discomfort that eventually results in absenteeism, low motivation, and exhaustion. It is easy to overlook somatic problems because they usually start as insignificant aches and pains, but they gradually progress over time as stress starts to accumulate (Boyle, 2011). Therefore, it is possible to suggest that self-neglect is another cause of somatic problems, so addressing personal needs is a critical strategy for nurses to avoid compassion fatigue.
Physical, Emotional, and Spiritual Needs of the Caregiver
Physical Needs of the Caregiver
The physical needs of all human beings include living a healthy lifestyle and rest. Those factors can determine the physical quality of life and help individuals recover from work-related stress. Attending to those needs is necessary for nurses because self-care improves their capacity to care for others (Portnoy, 2011). However, it is important to understand that attending to physical needs alone is only one aspect of proper self-care. Physical needs help the healthcare practitioner maintain strength, endurance, and energy, but resolving emotional problems is critical for learning to prevent compassion fatigue.
Emotional needs of Caregiver
In order to maintain a healthy mindset, all humans require the satisfaction of emotional needs, such as friendship, inclusion, approval, trust, love, and similar needs. While being preoccupied with their patients’ emotional issues, nurses usually neglect their personal emotional issues (Portnoy, 2011). That is why restoring work-life balance can have a beneficial impact on the nurses’ emotional states and reducing the prevalence of compassion fatigue. More importantly, nurses also require a certain emotional distance from patients because over-involvement may result in adapting the patients’ emotions (e.g. fear and anxiety), which results in the loss of self (Boyle, 2011).
Spiritual needs of Caregiver
Spiritual practices are significant to many people because they can seek refuge from daily activities and stressful events in rituals, such as prayer and meditation. Spiritual practices may also help practitioners regulate their emotions better and improve somatic issues. On a physical level, removing stress with those practices could potentially improve physical energy, strength, and endurance. For nurses and other caregivers, attending to spiritual needs through religion, introspection, and resolving existential issues is critical because being exposed to tragedy, suffering, and death can create a sense of futility that encourages compassion fatigue development (Boyle, 2011).
Coping Strategies and Resources
Affective states, defensive mechanisms, cognitive expectations, and stress management skills were identified as the most common factors that cause compassion fatigue in nurses (Boyle, 2011). Therefore, developing strategies addressing those causes should help nurses prevent compassion fatigue. For example, self-caring rituals such as proper nutrition, physical activity, spiritual practices, and improving work-life balance (e.g. reducing overtime hours) should be implemented outside of the workplace to help caregivers address their physical, emotional, and spiritual needs.
In addition to self-caring strategies, healthcare workers can cope with compassion fatigue better if they seek professional help from mentors and supervisors. That strategy is recommended to all healthcare workers because third-party advice can be more objective and effective than personal opinions and attempts at alleviating compassion fatigue before it becomes a secondary trauma (Lombardo & Eyre, 2011). Knowing when to seek help is also critical because individuals may overlook or ignore their compassion fatigue symptoms, so online resources, such as Professional Quality of Life (ProQOL, 2013), offer information about compassion fatigue and measurement tools for self-assessment.
Conclusion
Chronic exposure to stress and patient suffering are the key causes of compassion fatigue. They can manifest as cognitive (e.g. low concentration, disorientation), emotional (e.g. powerless, depleted, depressed), behavioral (e.g. irritability, withdrawal, substance abuse), spiritual (e.g. loss of faith, loss of purpose), or somatic (e.g. headaches, breathing problems, immune system impairment) concepts. However, stress and suffering observation are constants in healthcare settings, so removing them as the main causes of compassion fatigue is impossible. Instead, nurses should practice coping strategies that help them fulfill their physical, emotional, and spiritual needs. Personal interventions (e.g. proper nutrition, physical activity, spiritual practices, improving work-life balance) and organizational interventions (e.g. support groups, counseling) can replace maladaptive coping strategies that facilitate compassion fatigue with constructive coping strategies that improve the nurses’ quality of life.
References
Boyle, D. A. (2011). Countering compassion fatigue: A requisite nursing agenda. The Online Journal of Issues in Nursing, 16(1), n. pag. doi:10.3912/OJIN.Vol16No01Man02
Bush, N. J. (2009). Compassion fatigue: Are you at risk? Oncology Nursing Forum, 36(1), 24-28.
Lombardo, B., & Eyre, C. (2011). Compassion fatigue: A nurse’s primer. The Online Journal of Issues in Nursing, 16(1), n. pag. doi:10.3912/OJIN.Vol16No01Man03
Portnoy, D. (2011). Burnout and compassion fatigue: Watch for the signs. Health Progress, 92(4), 46-50. Retrieved from http://www.compassionfatigue.org/pages/healthprogress.pdf
Professional Quality of Life. (2013). Professional quality of life elements theory and measurement. Retrieved from http://www.proqol.org/
