Compassion fatigue, also known as secondary traumatic stress (STS), is a condition of gradual lessening of compassion over time (Sabo, 2011). It is common among individuals who work directly with victims of trauma like nurses, psychologists, physicians, cancer-care providers, emergency room personnel, chaplains, and other healthcare professionals. Nurses intend to provide compassionate and empathetic care to patients but become victims of continuous stress while meeting the needs of the clients and their families (Lombardo & Eyre, 2011).
Warning signs for compassion fatigue Caregivers place the patient’s needs ahead of their own needs hence are more prone to distress (Chase, 2005). General symptoms affect physical, psychological/emotional, behavioral, professional, and spiritual functions (Aycock & Boyle, 2009). Compassion fatigue is reflected by weakness, dizziness, fatigue, and hypertension. Frequent head, back, and muscle aches persist with rapid pulse and gastrointestinal complaints. The reduced resistance to infections led to frequent illnesses and sleep deprivation (Boyle, 2011).
The manifestations of psychological emotions include a sense of apathy, frustration, boredom, depression, and hopelessness with a sense of low personal accomplishment, poor concentration, isolation, irritation, and anxiety. There is a tendency of avoiding intense patient situations with criticism and depersonalizing patients (Aycock & Boyle, 2009). Sarcasm, cynicism, absenteeism, and stereotyped communications are the symptoms affecting behavior. There is a paramount tendency for abuse of chemicals and self medication. Spiritually withdraw from fellowship and project poor judgment towards existential issues.
There is lack of interest in introspection and doubt value systems or beliefs drawing conclusions that a major change is necessary. Professionally, intense patient situations are avoided with tardiness, diminished performances and impersonal communications. They exhibit a desire to quit or be absent from work for longer periods (Aycock & Boyle, 2009). Nature of problems and their causes. Caregivers are constantly exposed to the pain and suffering during empathetic cares leading to stress (Chase, 2005). The final stage of long periods of stress results in compassion fatigue (Chase, 2005).
Formal (paid) healthcare providers and informal (family members) caregivers are affected by this stress (Abendroth, 2011). They are under stress due to the past experiences and preoccupation to the patient’s condition. The hectic, fast paced working conditions, staff shortages, increased workloads, and increased patient volume does not provide ample time for self care leading to work-related stress which in due course converts to compassion fatigue (Chase, 2005). Compassion fatigue may be expressed in them as frequent outbursts of anger with irritability and reduced care giving (Abendroth, 2011).
Personal and professional relationships suffer due to this increased stress (Chase, 2005). The stress faced by the caregivers affect the care provided to the patients as well as the well-being of the caregivers themselves (Chase, 2005). Physical, Emotional, and Spiritual needs of the caregiver Caregiving can lead to ill effects on health of the caregivers. Improper eating habits, insomnia, and continuous stress may lead to fatigue, injury, and illness. Body needs nutritious food to nourish itself. Resting whenever tired and planning a schedule for sleep would be beneficial to overcome fatigue.
Exercises enables to foster a good health by blood pressure, ease depressions and anxieties, and decrease physical and mental tensions (Lombardo & Eyre, 2011). Sharing feelings with others help to relieve depression, stress, boredom, and anxiety which are the manifestations of emotions of the caregiver. Steps should be taken to destress oneself whenever felt overwhelmed. Checking for the warning signs of depression and anxiety and getting periodical assistance would be beneficial. Spiritual issues of patients and the caregivers gain importance when illness or adversities creep in.
Being aware of one’s own spirituality enables ease in dealing with the adverse situations in healthcare. Taking enough time to pray, meditate or practice spiritual rituals enables to nurture oneself and get peace of mind (Pfifferling & Gilley, 2000). Attending services at church and speaking to chaplains helps to relieve onself from the mental stress. Coping strategies and resources Coping strategies are essential in assisting caregivers in managing preventive measures against compassion fatigue (Uren & Graham, 2013).
The psychosocial health and well-being of nurses working with traumatized patients is severely affected during empathetic caring (Sabo, 2011). More workloads and limited resources influence the potential risk of developing burnout and compassion fatigue (Sabo, 2011). Coping strategies may be work-related or personal. Work related strategies may include changing shifts, limiting number of days worked, or taking extra days off from work (Yoder, 2010). Positive and negative emotions and their interrelationship determine the emotional experiences and coping abilities of the caregivers (Uren & Graham, 2013).
Maintenance of work-life balances help caregivers to nurture them in order to nurture others (Boyle, 2011). Establishing a self-care plan and carrying it relentlessly ensures a calm state (Boyle, 2011). The self-care plan includes healthy diet and exercise, pleasurable activities not related to work, journaling, and meditation to recharge ourselves (Boyle, 2011). Counsel and support is necessary whenever personal stress is carried over to work settings (Boyle, 2011). Perceived incompetency in communication is overcome by continuing education programs and Specialty education programs (Boyle, 2011).
On-site counseling, consultant guidance, and peer support helps in solving emotional issues (Boyle, 2011). Involving in Art therapy and massage sessions provides mental and physical breaks from caregiving stress (Boyle, 2011). Attention to one’s own spiritual needs is of paramount importance (Boyle, 2011). Spending plenty of quiet time alone is necessary. Practicing meditation is the best way to bring the wandering thoughts to a common focus (Pfifferling & Gilley, 2000). Compassion fatigue can be prevented or treated but depends on the cultural beliefs and expectations of society on caregiving roles (Abendroth, 2011).
Assessing and addressing caregivers’ needs and providing care consultation, education and training, support groups, counseling, and respite care yields better outcomes for the caregiver as well as the patient and is a primary component of public programs (Feinberg & Houser, 2012). Counseling is provided by the Employee Assistance Programs to the employees regarding personal and work-related issues. These programs enable the employees to overcome problems related to compassion fatigue and enhance their empathetic caring and interpersonal skills.
Talking to a mentor, experienced nurse, or supervisor may help and assist in identifying strategies like change in shifts, reducing overtime, to cope with the work conditions. Availing the support of Pastoral Care Departments would be beneficial to cater to the needs of patient, families, and the staff. New-nurse support groups focus on identifying areas of concern of new nurses and assist them in recognizing the available resources to decrease stress and prevent compassion fatigue (Lombardo & Eyre, 2011).
Caregivers protect the vulnerable and dependent. They offer cognitive, behavioral, and emotional support to the patients suffering from pain. Caregiving is tiring and emotionally draining, hence rendering practical and emotional support to the caregivers ensures effective caregiving. Better understanding of caregiver needs and compassion fatigue empowers the nurses in implementing preventive measures to promote self care, enhance patient outcomes and, manage therapeutic relationships (Abendroth, 2011).