Concepts of Compassion Fatigue and Warning Signs
Compassion fatigue is defined as a secondary traumatic stress disorder because the person experiencing it does not directly experience a trauma, but an empathic engagement with others results in a traumatic experience that depletes a person mentally, emotionally, and spiritually. The main concepts related to compassion fatigue are fatigue, empathy, and engagement.
There are various definitions of fatigue, but all definitions agree that fatigue is a state of impaired performance resulting from caring for other people in times of distress, and it inhibits the caregiver’s ability to cope with stress and guilt (Sabo, 2011). The concept of empathy is critical for understanding compassion fatigue. It usually occurs in nurses who show more empathy when working with their patients because empathy is the ability to share a patient’s experience and feelings (Sabo, 2011). Although engagement is a similar concept to empathy, it is specific to relationship-based nursing, and nurses who cannot set adequate boundaries become emotionally over-involved with their patients experience a decrease in their emotional well-being (Sabo, 2011).
The warning signs of compassion fatigue can be categorized as cognitive, emotional, behavioral, spiritual, and somatic. The most common cognitive signs of a compassion fatigue onset are decreased concentration and disorientation, but other warning signs may include rigidity and apathy (Portnoy, 2011). Emotional experiences reported in compassion fatigue include anxiety, emotional numbness, guilt, fear, feeling powerless, and helplessness (Boyle, 2011).
In order to cope with the professional challenges that cause stress, nurses will exhibit various behavioral changes to respond to those stressors, and the occurrence of maladaptive coping strategies is one of the warning signs for compassion fatigue (Bush, 2009). Examples of negative coping strategies that increase the risk for compassion fatigue can include withdrawal, irritability, and mood swings (Portnoy, 2011).
Spiritual symptoms of compassion fatigue also need to be considered because nurses work with people who are suffering and death is a common occurrence in healthcare. Therefore, nurses will often experience a loss of self (Bush, 2009). As their compassion fatigue condition progresses, they may also develop other symptoms, such as loss of purpose and loss of faith (Portnoy, 2011).
Finally, a nurse may experience somatic symptoms associated with compassion fatigue. Those warning signs include sweating, increased resting heart rate, shortage of breath, headaches, insomnia, immune system problems, and other physical symptoms that have no apparent physical cause (Portnoy, 2011). When somatic warning signs begin to occur, it is important to identify their causes because they will lead to exhaustion, low morale, and high absenteeism rates.
Nature and Causes of Compassion Fatigue
Compassion fatigue is common in professions that provide assistance to individuals during times of crisis because consistently dealing with suffering leads to cumulative stress (Espeland, 2006; Bush, 2009). Compassion fatigue is caused by stress, but it is important to mention that its onset is facilitated when the affected nurse lacks a social support system (Bush, 2009).
Although cumulative stress is the common cause for all cases of compassion fatigue, the nature of the issue can be different. For example, some nurses may experience a loss of identity because of the existential questions posed after witnessing pain, suffering, and death (Portnoy, 2011). Nurses that do not set boundaries will experience compassion fatigue because of empathy (Bush, 2009). Maladaptive coping strategies, such as avoidance approaches, are behavioral changes that occur when a nurse does posses adequate stress management skills or when positive adaptive strategies fail (Bush, 2009).
Caregiver Needs
In order to prevent compassion fatigue, caregivers are encouraged to satisfy their physical, emotional, and spiritual needs. Physically, all human beings require rest, relaxation, and a healthy lifestyle (i.e. physical activity, dieting, etc.). Nurses should attend to those needs because caring for themselves is essential for improving their ability to take care of other (Espeland, 2006).
Emotionally, the nurses become preoccupied with the traumas they share with their patients, and that preoccupation extends beyond the workplace, so their personal traumas are more likely to surface and result in compassion fatigue (Portnoy, 2011). In order to avoid emotional trauma, it is important to satisfy the emotional needs for friendship, approval, trust, love, and similar needs.
Finally, the spiritual needs of the caregiver must be considered. The study by Ekedahl and Wengström (2008) showed that chaplains on multidisciplinary teams will less likely experience compassion fatigue than nurses, so it is recommended that nurses include spiritual practices in their daily routines. Those practices can improve their emotional regulation because they fulfill the need to address existential issues associated with compassion fatigue and the need to make a temporary distance from stressful events (Boyle, 2011).
Coping Strategies for Caregivers
Self-care outside the workplace is the most important coping strategy because it can help nurses address their physical, emotional, and spiritual needs (Boyle, 2011). A variety of different strategies should be used to address the different needs of the caregiver. For example, self-forgiveness and religious practices can be used to satisfy the caregiver’s spiritual needs (Espeland, 2006). Building a social support network or keeping a journal are coping strategies that can satisfy the emotional needs of nurses and minimize the risk for compassion fatigue (Espeland, 2006). Finally, eating well, exercising, and relaxing activities are recommended for nurses to maintain their physical health (Espeland, 2006).
Self-care strategies are important for all nurses who want to avoid compassion fatigue, but various resources can also be utilized in order to receive social support. Seeking help from mentors and supervisors is one option available to nurses who are experiencing the warning signs of compassion fatigue because third-party opinions can identify and alleviate compassion fatigue signs effectively because it is more objective than personal assessments (Espeland, 2006). Nurses can also utilize online resources, such as Professional Quality of Life (2013), that provide information about compassion fatigue and assessment tools that can identify the onset of compassion fatigue.
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.
Ekedahl, M., & Wengström, Y. (2008). Coping processes in a multidisciplinary healthcare team–A comparison of nurses in cancer care and hospital chaplains. European Journal of Cancer Care, 17(1), 42-48.
Espeland, K. E. (2006). Overcoming burnout: how to revitalize your career. Journal of Continuing Education in Nursing, 37(4), 178-184.
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/
Sabo, B. (2011). Reflecting on the concept of compassion fatigue. The Online Journal of Issues in Nursing, 16(1), n. pag. Retrieved from http://www.nursingworld.org/ MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-16-2011/No1-Jan-2011/Concept-of-Compassion-Fatigue.html
