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Compassion Fatigue in Health CareWendy L. Ward, Ph.D., ABPP

Objectives To identify signs and symptoms of CF List prevention techniques List treatment techniques and how to

obtain

What is Compassion Emotion: when moved by the distress or

suffering of another Foundational to nursing practice Nurses must repeatedly generate

compassion to foster connectedness and offer nurturance

The Call to Nursing

Emotionally committed Healing others

physically and emotionally

Selfless/putting your needs last

The toll that this takes is immense; and it is easy to get depleted of positive energy

Nurses are particularly at-risk Present at critical times Become partners in patients’ healthcare journeys Prolonged, repeated interactions over time Nurses work within a family framework that may

be fraught with anticipatory loss, tension, disbelief,

They stay after bad news or death Witness tragedy and suffering Little to no respite Sleep disruption Self-sacrifice

Compassion FatigueJoinson (1992) ‘loss of the ability to nurture’In a study on nurses and burnout

Varied definitions Exhaustion Severe malaise The ‘cost of caring’ Emotional Strain Preoccupation with patient’s trauma Feelings of frustration, powerlessness, sadness Neglect own needs even basic ones—eating,

sleeping, hygiene Somatic complaints The associated decrease in morale and work

performance

Varied Terminology Across Studies

  Borrowed stress   Compulsive

sensitivity   Disabled resiliency   Empathic distress   Empathic strain   Empathy fatigue   Empathy overload

Existential suffering   Fatal availability   Indirect trauma   Secondary

victimization   Soul pain   Vicarious trauma   Wounded healer

Distinguishing Compassion Fatigue From Burnout

Conflict, frustration, and/or exhaustion from the work setting

VsEmotional engagement and interpersonal intensity associated with witnessing tragedy within the work setting

Manifestations of Compassion Fatigue

Emotional:   Anger   Apathy   Breakdown   Cynicism   Desensitization   Discouragement   Dreams, flashbacks, preoccupation (r/t patient

experiences)   Feelings of being overwhelmed   Attitude of hopelessness   Irritability   Lessened enthusiasm   Sarcasm

Manifestations of Compassion FatigueIntellectual:   Boredom   Concentration impairment   Disorderliness   Weakened attention to detailPhysical:   Increased somatic complaints   Lack of energy   Loss of endurance   Loss of strength   Proneness to accidents   Weariness, sense of fatigue, exhaustion

Manifestations of Compassion FatigueSocial:   Callousness   Feelings of alienation, estrangement, isolation   Inability to share in or alleviate suffering   Indifference   Loss of interest in activities once enjoyed   Unresponsiveness   Withdrawal from family or friendsSpiritual:   Decrease in meaning   Disinterest in introspection   Lack of spiritual awareness

Manifestations of Compassion FatigueWork:   Absenteeism   Avoidance of intense patient situations   Desire to quit   Diminished performance ability (i.e., medication errors,

decreased documentation accuracy/record-keeping)   Stereotypical/impersonal communications   Tardiness

Sources: Aycock & Boyle, 2009; Coetzee & Klopper, 2010; Showalter, 2010

Applied to Family Caregivers and Across Multiple Professional Groups

Risk Factors for CFCaring professionals Complex patient physical needsComplex emotional needsExpanding workload Budget cutsLong hoursEHR and administrative demandsLittle awareness/low priority for self-careLittle or no formal supports in place

Assessment of Compassion Fatigue Different, overlapping definitions Variety of measures Needs more research

Compassion fatigue has not been explored, described, or explained in a manner that would allow nurses to identify and combat compassion fatigue effectively.

Coetzee and Klopper (2010)

Available Instruments Fall Short Domains fail to capture unique aspects

of the nurses' role May target only select populations (e.g.,

trauma).

The Compassion Fatigue Scale The Secondary Traumatic Stress Scale The Professional Quality of Life Scale

Outcomes Reduces nurse’s ability to provide

compassionate care Nurse’s physical and emotional health Absenteeism Staff turnover Good people leave the nursing profession

Self-care enables nurses to invest time and energy into nurturing the self, in order to nurture others.

What To Do Prevention Early Intervention Intervention

Prevention In general, an

increased awareness of the emotional demands facing today’s nursing workforce is of utmost importance

Prevention: Self-Awareness Physical health Intellectual health Social health

Spiritual health Emotional health

Relaxation 5 senses Deep, diaphragmatic breathing Blank Mind Mantra Visualization

How meditation changes your brainhttp://io9.com/how-meditation-changes-your-brain-and-makes-you-feel-b-470030863

Early Intervention

Signs You are Stressed Feel that you need a drink at the end of the

day Irritable and short-tempered Overeat or lose your appetite Headaches, stomachaches, fatigue Make more mistakes than usual Trouble paying attention Poor sleep, especially if you repeatedly wake

up very early in the morning, worrying Turn down social invitations because seeing

friends and family seems too much like effort

Early Intervention Education and self-awareness Becoming aware of danger-signal

responses...is necessary Identifying key triggers of these

responses significant personal introspection particularly when nurses ignored their

symptoms and did not attend to their own emotional needs

Early Intervention Re-assess areas of wellness as you did today Enhance proficiency boundary setting Stress management training Time management training Increase time with social support Protect sleep time Increase physical activity Engage in self-soothing activities Reduce workload, work hours, change type of work, take vacation/sick time

Intervention

Intervention Identify personal, successful coping

strategies Respite Social support Positive daily events An activity a week that has meaning Life coach/Strategic Life Planning Talk with your boss Individual therapy Psychotropic medication Individualized employment plan (FMLA

Work Setting Interventions On-site counseling These resources

must be visible, accessible, and offer practical solutions

Support groups for staff De-briefing sessions Art therapy Massage sessions Bereavement interventions, for

example funeral attendance, memorial service participation, and the sending of sympathy cards to families

Attention to spiritual needs

Institutional Benefits Increased staff morale and productivity,

engagement in facility initiatives, reduced sick time, lower turnover rates, and higher patient and family satisfaction

Conclusion

Encouraging self-care strategies and offering interventionsAddressing the real but unrecognized phenomenon of compassion fatigue in nursing has the potential to influence both the recruitment and retention of highly effective nurses.

Research on personal qualities, such as resiliency, hardiness, and social support, could shift the focus from pathology to effective adaptation in those engaged in caring work with patients experiencing pain, suffering, and trauma

Compassionate Care

(Sabo, 2006). An enhanced understanding of other characteristics that can predict, minimize, or buffer the consequences of compassion fatigue, such as age, gender, coping style, spiritual orientation, tenure/longevity, peer cohesion, and the role of nurse managers, is direly needed (Abendroth & Flannery, 2006; Erickson & Grove, 2007; Najjar et al., 2009; Newsom, 2010; Perry, 2008). Investigation of opportunities to promote compassion satisfaction are also of value (Alkema et al., 2008; Coetzee & Klopper, 2010).