Anna Maria CollegeNursing ProgramsNUS 314 - Essentials of Nursing Research
The Abstract
Nurses enter the medical field with the belief of changing the lives of their patients by providing quality care and helping them overcomes their health concerns. However, most of them do not anticipate the challenges that may arise from taking care of patients with special health concerns. In this case, nurses are prone to experience various issues that arise from taking care of patients. This study aims at identifying the risk factors that icnr4ease the chances of nurses experiencing compassion fatigue. Many nurses in practice experience secondary Post traumatic stress disorder that arises from taking care of patients for long periods of time. With time, the nurses take the grievances experienced by their patients personally and this leads to secondary PTSD. Interpretative methodology is used in this research to identify how nurses in different special care fields undergo and cope with compassion fatigue. In this research 30 nurses from different special care units including those taking care of the elderly were asked and observed for a while. They were then asked how they coped with compassion fatigue that arises during their work experience. The research identified the risks of one experiencing compassion fatigue, coping strategies and future moves to change this trend. It applied the PICOT model to deal with the various aspects of the study.
The Introduction
In the past, various researches have been conducted to determine the causes of burnout. However, little qualitative research has been done to determine the effects of compassion fatigue on nurses. This study aims at using PICOT model to come up with various issues that come up with the issues of compassion fatigue among nurses. In this case, it is crucial to define key terms associated with the topic under study. These terms include Compassion fatigue, Burn out, care giving, elderly care and PICOT model.
According to Lombardo (2011), Compassion fatigue is the different feeling of exhaustion felt by nurses which can be physical, emotional, spiritual or mental all caused by the stress they undergo during their daily provision of care to patients. This is a form of burnout experienced by many nurses though the level of burnout in regards to compassion differs with the type of connection the nurse has with the patient and the time spent together. Burnout on the other hand is the feeling of tiredness a nurse experiences due to the demands of the job. Research shows that burnout differs with the age and the coping abilities of the nurses providing care to patients at different levels. Elderly care is defined as the health care delivery for the elderly patients who spend a lot of time in a health facility or at home where a nurse has to attend to their different health demands. The PICOT model is an acronym for Population, patients or the problem under study. Intervention is the initiative that aims at solving the problem. On the other hand C stands for comparison of one intervention initiative with the other and how effective one is over the other one. Outcome is the effects of the intervention program. T stands for the time allocated for the intervention to occur before the outcomes are seen.
PICOT
P: Population and problem- this research study aims at identifying compassion fatigue among nurses in different special health care delivery units.I: Intervention- This research study aims at doing a comprehensive research on the issue of compassion fatigue with particular focus on how the nurses get compassion fatigue, its relation to burn out and various ways of coping with and preventing compassion fatigue among the nurses.
C: Comparison- There are various alternatives to the research under study. This includes assuming that compassion fatigue exists or focusing the research study on burn out which focuses on the general aspect of nurse fatigue rather than compassion fatigue which is a specific area of research. O: Outcome- the research aims at coming up with a comprehensive and detailed research that identifies the various aspects of compassion fatigue. The intervention outcomes will be a measure of the intensity and success of the program.T: time- the time for this study is not specified as it depends with various aspects of the research.
Hypothesis
Compassion fatigue is associated with nurses working with patients for long periods and becoming attached to them. This results in physical, emotional and spiritual exhaustion and anxiety. It can be prevented or nurses undergoing this form of stress helped cope with the issues using various mechanisms like communication.
Literature Review
Compassion fatigue is a serious issue affecting nurses in different special care units. It has been noted y previous research that nurses undergo various issues and burnout is one of the major issues affecting nurses of all ages. In this case, however nurses undergo o compassion fatigue and this is an area that still requires extensive research to determine the various aspects of this problem.
Population and problem
This is a serious issue in the health care sector. Nurses play a crucial role in ensuring that patients are nursed back to their previous or better health states than they were in before they went to the health facility. It is therefore, an issue when a nurse fails to perform their duties well due to the effects of compassion in their lives. It is therefore, crucial to do extensive and comprehensive research to identify the causes, prevention and treatment of compassion fatigue among nurses. The issue of compassion fatigue affects nurses on different levels, and this impairs their ability to provide quality and safe care to their patients. This literature review identifies various aspects of care units that put nurses at a greater risk of compassion fatigue as compared to other fields (Ward-Griffin, St-Amant & Brown, 2011).
Various literature review sources provided an insight no the various aspects of POCIT that assisted in coming up with comprehensive results in this research study. Some key aspects included the main problems that come up as nurses provide care to their patients. It was evident from various research articles that the focus of the researchers was to identify the reasons for compassion fatigue among nurses. It is evident that nurses feel a therapeutic connection with their patients as they help them and care for them during their time of need. Over time, nurses become close to the patients and they develop a bond that leaves a nurse anxious when anything happens to the patient. Several theories have been used by various scholars to explain the reasons for compassion fatigue among nurses. Many claim that empathy is the key reason why some nurses experience compassion fatigue according to Sabo (2011), nurses feel the patient’s suffering, pain and trauma. The more emphatic nurses are therefore, in a more vulnerable opposition to develop compassion fatigue as compared to those with less empathy. The ability of a patient to respond and enter into relationship is the key risk factor in this case.
The theoretical model that can best explain this explanation is the Stress-Process theory as explained by Sabo (2011). In this article, the author cites that the theoretical model provides a link between the person’s ability to empathize and the residual stress compassion that comes from their empathy levels. The model provides that the risk factors of an individual being compassion fatigue also arises from the ongoing suffering of a patient, the memories a nurse has of a particular patient and the suffering they underwent and finally the disruptions these events causes in their lives (Harrowing, 2011) Defining empathy among the nurses is a key issues that will help understand how the theoretical explanation of the stress- process model works. Sabo (2011) defines empathy as the ability of a nurse to open up their world and let others enter. This entails sharing their emotions and experiences. In turn this increases their vulnerability to compassion fatigue.
The conceptions of empathy also vary with four major aspects being the human trait, professional state that is learned, caring for others and the special bond formed over time through friendships. However, it is crucial to note that there are various limitations to this theoretical model that seeks to link empathy to compassion fatigue among nurses. One of the key issues is its failure to provide a clear link between the ways different issues in the health care setting interact to affect the level of a nurse’s empathy level. There are various symptoms that can help one identify key signs of a nurse suffering from compassion fatigue. This includes physical, emotional and work-related stress according to Lombardo (2011) work related symptoms include reduced empathy, fear of working with terminally ill patients and frequent absenteeism. Physical symptoms include digestive issues, headaches and sleep disturbances.
Interventions
There are various interventions that can be put in place to ensure that nurses reduce their exposure to compassion fatigue. It is evident that nurses enter the relationship with patients with or without their knowledge. Most of them assume that they are doing their duty as nurses and hoe to keep their emotions intact without entering into an emotion form of contact with the patient. However, it is crucial to enable the nurses to understand how the different aspects of care and time spent with the patients go a long way in exposing them to compassion exposure. Some of the measures that can be undertaken include further exploration of factors beyond the aspect of empathy that has been associated with compassion fatigue. According to Sabo (2011) resilience and hope are key features that can help in solving the issue of compassion fatigue among nurses. As such, nurses’ benefits from the relationships established between them and their patients. Over time, they feel like family and as their relationship matures, so do their compassion levels. It is therefore, crucial to come up with measures that will enable the nurses to have hope and be resilient to whatever outcome comes from the relationship they build with their patients. By giving the nurses and the patient’s hope of a better outcome than what they are expecting, nurses will learn to accept and embrace the outcomes of their relationships with the patients.
The other intervention measure according to Boyle (2011) is the work life balance. This entails coming up with ways of nurturing oneself. In return, a nurse will be in a good position to maintain calm when faced with challenging situations. It is common to find nurses who assume that they are caring and can provide support to others when they are not in a position to support them personally. Investing in work life balance is therefore, crucial in helping nurses address their needs during crises. This may entail having a nurse identify some of the identifiers of stress that make their life at home or at work stressful. By so doing, the burse will be in a better position to deal with the issues as compared to those who do not know the indicators of stress in their life.
The other intervention measure is education. This entails becoming aware of various danger signals in the work environment. Communication skills are a key issue that can help nurses deal with compassion fatigue in the workplace. However, most nurses lack the skills to communicate with others in a proper manner. Those who lack this competency tend to feel sad and depressed as they keep their emotions bottled up inside them. This requires nurses to have skills that will help them identify personal coping strategies, come up with proper caring styles, developing boundaries, resolving interpersonal conflicts and coping with dilemmas. This helps the nurses come up with ways of solving issues that may otherwise make it difficult for them to deal with compassion fatigue. This goes hand in hand with Watson’s human caring theory that explains the role of communication and caring in helping nurses deal with various aspects of their job.
Work setting changes is also an important aspect of intervention that can help change the issue of compassion fatigue among nurses. Changing the health intervention setting will give nurses and easier time as compared to harsh work intervention setting. Proper measures that deal with conflicts and turnover rates will help build a collaborative and satisfactory environment where nurses will feel free to interact with others and share their issues. These measures can include on the site counseling by therapists and social workers, support groups where emotional issues are discussed or debriefing. Art therapy is also critical in helping nurses deal with emotional and physical strain caused by compassion fatigue.
Comparison
It is vital to compare how different interventions can work in an effort to understand the best method that will best apply in the situation. Various intervention plans can work to change the situation in the health facilities that are most affected by compassion fatigue. It is therefore, crucial to have alternative. This entails doing further research on measures like encouraging nurses to reduce their level of attachment to patients by focusing on the professional aspect of their employment. This may not be effective as nursing is a passionate job that requires one to deal with patients on a personal level. The other alternative is exploring other reasons that cause compassion other than empathy. Much focus has been put on the link between empathy and compassion fatigue yet there may be other key reasons as to why most nurses suffer from compassion fatigue.
Outcomes
The outcomes of the interventions put in place to help reduce the level of compassion include fewer cases of nurses suffering from anxiety and anger outbursts. Before, intervention nurses suffering from compassion fatigue were prone to anger outburst and sleeping on the job. However, with the intervention put in place nurses are in a better condition to communicate openly with others and perceive their relationship with patients in a positive manner. According to Lombardo (2011), many nurses who undergo intervention programs take a positive view of what goes on around them and their coping abilities increase with time.
Time
The time factor in this research is not limited as it is a continuous process that requires proceeding as nurses face continuous problems as they deal with new and old patients.
Limitations and Future research
The existing literature reviews do not fully explore the role of self-sacrificing nurses in the health sector. The research focuses on work related reasons and fails to appreciate the role of self-sacrificing nurses who sacrifice their personal lives for the sake of patients. Research is therefore, required to determine the role of this aspect in the risk of nurses developing compassion fatigue. There is also less research on the role of the relationship nurses have with the patients and their families and the role it has on shaping the compassion fatigue among nurses (Uren & Graham, 2013).
The Methods Section
This is a qualitative study that collected information from various literature review sources and the sample was selected randomly from various sources it utilized various research articles by using key words like Compassion fatigue, burnout among nurses, and care for the elderly and interventions for nurses suffering from compassion fatigue. In designing the study design, focus was based on the authors of the literature review materials. Sample selection also focused on the position of the nurses and the care they provided to patients. This would help determine the experience they have and their abilities to cope with compassion fatigue.
Procedures
The data used in this research were collected solely. The data was collected thrice a week for one month. This was to ensure that complete and quality data was obtained from the various sources identified to be having the best data to be used in the research. The data will be collected from nurse journals through search engines using key words. In selecting data from experienced nurses in health facilities, data will be collected thrice in a period of two months. Each participant will respond to the questions and the data will be collected in this manner.
Data Analysis Techniques
Data analysis will entail identifying its relevance in terms of the time of research hand publishing dates. Up to date data will be highly relevant to the study as it will reflect on the current issues affecting and that can shed light to the research topic. The data will be analyzed according to the key issue. PICOT model will assist in determining the relevance of the data in regards to the topic under study. Scrutiny will be on the ability of a material to conform to the data required in the study.
References
Harrowing, J., (Jan 31, 2011). "Compassion Practice by Ugandan Nurses Who Provide HIV Care" OJIN: The Online Journal of Issues in Nursing, 16(1), Manuscript 5.
Lombardo, B., & Eyre, C. (Jan 31, 2011). "Compassion Fatigue: A Nurse’s Primer" OJIN: The Online Journal of Issues in Nursing, 16(1), Manuscript 3.
Sabo, B. (Jan 31, 2011). "Reflecting on the Concept of Compassion Fatigue" OJIN: The Online Journal of Issues in Nursing, 16(1), Manuscript 1.
Uren, S., & Graham, T. (April 15, 2013). "Subjective Experiences of Coping among Caregivers
in Palliative Care" OJIN: The Online Journal of Issues in Nursing, 18(2).
Ward-Griffin, C., St-Amant, O., & Brown, J. (Jan 31, 2011). "Compassion Fatigue within
Double Duty Caregiving: Nurse-Daughters Caring for Elderly Parents" OJIN: The Online Journal of Issues in Nursing, 16(1), Manuscript 4.
