Stress is encountered in many forms by various health care providers. These stressors affect their performances in a huge way, oftentimes their performances on the job, relationships with co-workers, relationships with patients and relatives and also their immediate families suffer negatively. Finding solutions to the stress encountered by health care providers has been shown to increase and improve their effectiveness, productivity and various relationships. Stressors identified by the nurses at a paediatric palliative hospital include; increased mortality, being short of staff, increased demands and expectations, increased complexity of the cases and referral numbers, frequent meetings and limited time for administrative duties ,extra roles, poor communication among co-workers, being reactive and lack of time to build family relationships. Though, in the real sense of it, the stressors were not eliminated, but a programme was designed to help health care providers cope with the stressors better. Their stress levels were rated on the Likert scale and graded from 0 to 10, with ten as the highest score. After about two years of addressing the perceived stressors, it was discovered that the scores on the Likert scale decreased drastically and their productivity increased. If these stressors are not tackled, a stress disorder known as compassion fatigue could result. This stress related disorder is common among vocations that offer care for those in crisis. It prevents health care providers from offering their patients maximum care.
Compassion fatigue is a gradual reduction of a health care practitioner to provide compassion. Naturally, compassion is expected from nurses and doctors in the discharge of their duties. It is required to manage patients effectively, it is needed to gain their trust, it is needed to provide optimal care to the patients (Chen et al, 2009). Though, the healthcare provider might not commit clinical blunders, but lack of compassion or reduced compassion blunts the caregiver’s clinical dexterity. When the caregiver is not motivated and fatigued, they become irritable and sometimes going as far as avoiding some patients they deem difficult. According to Johnson, compassion fatigue is far more than just the environmental stressors in the workplace that are negatively affecting the caregiver; the nurse, but also, the physical and emotional needs of the patient. All these contribute to the nurse's becoming depressed, angry, tired, apathetic, detached and ineffective. In the past , Compassion fatigue and burn out were used interchangeably, but there is a clear line of demarcation between the two. Though, they almost mean the same thing. Burnout can be said to be having feelings of failure, being excessively exhausted as a result of the rigours of work and being worn out. It manifests as psychological, physical and behavioural reactions which include diminished caring, monumental sense of demoralisation and emotional exhaustion. Often times, before compassion fatigue finally sets in, there are some warning signs that are exhibited by the nurse in this instance, such include; feeling a sense of hopelessness, worthlessness and helplessness, having numerous nightmares, detaching oneself from things that one enjoyed doing in the past, loneliness and depression, unexplained irritability and too much attachment to the patients physical and emotional needs. Compassion fatigue is said to be directly related with age (Oncology Nursing Forum, 2009).. It is commoner in the young, as they are full of energy, vibrant, lively, they are full of high ambitions and not prepared for role ambiguity. In the process they take up extra responsibilities and work extra hours. The problem begins when after taking up extra responsibilities, the nurse cannot balance her previous schedule, her new responsibility and demands on the home front. The nurse expects a new level of support from the spouse, the children and co-workers. Gradually, there is detachment from the spouse as the nurse dedicates all her energy to the care of her patients and the new responsibilities. Surely, this is the genesis of serious crisis in the family.
At work, the main problem is the increasing work demand. The hospital is short staffed, and the number of cancer patients are increasing daily and their health is not getting any better. This alone increases the nurse-patient ratio. The number of oncology patients who are ill increase, eventually many more die, the nurse grieves with the family. This cycle continues, with limited contact with outpatients and cancer survivors. As hospital finances dwindle, there is a dearth of skilled social workers; this increase the pressure on the nurse to acquire additional skills so as to retain her job. She feels her work is not appreciated; there is increased stress both physically and emotionally. Even after taking long hours of rest during her free periods she still feels highly fatigued. Symptoms such as headache, lack of quality sleep and backache are rampant. The fatigue starts having its toll on her, she starts having nightmares. She dreams of losing her patients to the cold hands of death. This dreams undoubtedly increased fear and anxiety in the nurse. She stops going for her routine jogging, she finds it very difficult to concentrate on her studies and at work. Sooner or later, the feeling of incompetence overshadows the nurse and this leads to the feeling of worthlessness. As time went by, she became detached from family and friends but poured all her attention to her patients pains and their grieves. She started feeling their pain as her pain, and their losses as her loss also. The caregiver is not without needs. The needs include physical, emotional and spiritual.
The physical needs of the caregiver include that aspect of the caregiver’s life that services the physical being. These are feeding, exercising relaxation. For the caregiver to function optimally, she must feed well and be healthy. Balanced diet is the key to feeding well. There is a tendency for care givers to skip meals and eat unhealthy foods or junks. A good balance between carbohydrates to provide energy for the rigours of the job, protein for regeneration of ageing cells and vitamins to nourish the body is the target.
Also, caregivers must pay attention to their emotional needs. The needs range from anxiety, depression, anger, frustration, fatigue and detachment from a loved one. Taking adequate care of the emotional needs will also increase productivity. In addition, knowing when to seek help from counsellors and mental health physicians is part of taking care of the emotional needs.
The spiritual needs of a caregiver is a very important aspect of their lives. Though, spirituality means different things to each of us and we all profess different faiths. Spirituality is essential for the caregivers overall growth. It makes the care giver empathise with the patient. Also, the issue of prayers come in, caregivers pray for their patients and sometimes pray with their patients. All these goes a long way in alleviating the patient and the caregivers pains depending on their faith.
The coping strategies that can be used by caregivers are those that will prevent burn outs and compassion fatigues. Wherever caregivers find themselves, ambiguity of roles should be eliminated. Whenever the workload is enormous, co-workers should be able to help each other out. Also, caregivers should not be unnecessarily attached emotionally to their patients and the patient’s relatives. Finally, caregivers should have time to themselves to recharge their batteries, to have fun with family and friends, eat well and increase their level of spirituality.
In conclusion, compassion fatigue is a stress related disorder that affects health care providers. It affects oncology caregivers more as their work is tasking, gruelling and they easily empathize with their patients who are perpetually in pains (Espeland, 2006). It should be prevented in its entirety so that the caregiver does not become a patient of the unit.
References
Oncology Nursing Forum (2009). Compassion Fatigue: Are you at Risk, from the Oncology Nursing Forum
Hospice Management Advisor (2010). Program to Combat 'Compassion Fatigue'
Espeland (2006). Overcoming Burnout: How to Revitalize Your Career; by, from the Journal of Continuing Education in Nursing
Chen, Lin, Wang, and Hou (2009). A Study of Job Stress, Stress Coping Strategies, and Job Satisfaction for Nurses Working in Middle-Level Hospital Operating Rooms. Journal of Nursing Research.
Gupta and Woodman (2010). Managing Stress in a Palliative Care Team. Paediatric Nursing
Ekedahl and Wengstrom (2008). Coping Processes in a Multidisciplinary Healthcare Team -- a Comparison of Nurses in Cancer Care and Hospital Chaplains The European Journal of Cancer Care
