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“In dealing with those who are undergoing great suffering, if you feel burnout setting in, if you feel demoralized and exhausted, it is best, for the sake of everyone, to withdraw and restore yourself. The point is to have a long-term perspective.” ~Dalai Lama
Compassion fatigue is a very real threat among healthcare workers and caregivers, especially for advanced practice nurses. The symptoms cover a wide spectrum of behavioral and attitudinal changes, leading to adverse effects in an individual's personal and professional life.
As Charles Figley (1995) says, there is a cost to caring. What this cost looks like and what measures healthcare professionals and caregivers can take to avoid such a cost is the focus of this short paper. Ultimately, my research into compassion fatigue, caregiver burnout, and other related issues found two major insights.
First, compassion fatigue can affect anyone and any part of life, and therefore should be seen as a real danger in the healthcare field. The second finding, however, is a little more hopeful.
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While there may not be a proven clinical treatment to compassion fatigue, there are many preventative and reactive measures that individuals can take to avoid experience compassion fatigue. Each of these insights are looked at in turn below, by identifying 'warning signs' for compassion fatigue, discussing the nature and cause of the problem, analyzing the physical, emotional, and spiritual needs of the caregiver, and providing examples of coping strategies and resources that can aid healthcare professionals and caregivers in overcoming compassion fatigue.
Compassion fatigue is unique to individuals working in care giving professions because it results specifically from the stressors associated with those kinds of professions. As Bush (2009) states, the problem is "a unique and expanded form of burnout, not only environmental stressors of the work place negatively affecting nurse caregivers but the patient's physical needs and emotional needs contributing to nurses becoming tired, depressed, angry, ineffective, apathetic and detached” (p. 17). This makes it clear that compassion fatigue affects many areas of an individual's life.
Bush (2009) contends that this fatigue occurs on a continuum from acute to chronic symptoms, affecting seven domains of an individual's life: cognitive, emotional, behavioral, personal relations, somatic, work performance, and spiritual. The 'warning signs’ mentioned above can be identified as the specific stressors associated with healthcare and care giving. Gupta and Woodman (2010) identify these stressors as "Being short staffed, increased expectations and demands, increased complexity and numbers of referrals, increased numbers of deaths, too many meetings and not having enough time for administrative tasks, job sharing, being reactive, crisis driven, no time to build relationships, staff communication problems” (n.p.).
This extensive list can be treated as the signposts of on-coming compassion fatigue. If any of these stressors occur, individual care givers and nurses ought to be "on the look out", so to speak. The combination of the warning signs and symptoms with the personal needs of the care giver makes it clear that compassion fatigue is a very real issue that must be addressed at a personal and institutional level.
As discussed above, while there may be no known clinical treatment methods for those suffering from compassion fatigue, there are several preventative measures that both individuals and institutions can take to ensure that this problem does not continue to spread. As Espeland (2006) states, “individuals need to change their thought process and viewpoints about the people and things that may be contributing to their burnout” (p. 26). Care giving individuals have personal needs, and they must recognize these needs in order to remain healthy.
Self-Care Huggard (2003) identifies the two simplest forms of these preventative measures as personal self-care and social self-care. As Huggard (2003) states, “Taking a break from work, participating in breathing exercises, exercising, and other recreational activities all help reduce the stress associated with compassion fatigue and burnout]” (p. 11). Huggard also stipulates that it is important to establish “clear, professional boundaries and [accept] the fact that successful outcomes are not always achievable” (p. 12).
Social self-care, in contrast, is implemented on the institutional level. Institutions (such as hospitals and clinics) must realize the personal needs of their care givers and respond accordingly, if they are to maintain a sustainable and stable working environment. We see this most clearly in the work of Chen, Lin, Wang, and Hou (2009), who focus on specific steps that a hospital should take to both prevent and respond to burnout and compassion fatigue. These are all specific methods of a generalized personal self-care that is important in any situation. Bush (2009) gives more specific suggestions for the personal aspect of self-care, saying that “Nurses should continue to work with compassion, vulnerability, and tenderness, but learn how to manage sadness in growth-enhancing rather than destructive ways” (p. 16).
These methods start with learning how to set boundaries and limits for oneself between work and personal life. Creating boundaries between patients' lives and the lives of care givers makes it much easier to carry on in one's work compassionately. Once one establishes these boundaries, individuals should also learn to reach out for support to friends and family members.
Simply put, a listening ear can make all the difference. Thirdly, individual care givers ought to apply action oriented, problem-solving behaviors that seek solutions to stressful healthcare environments. This can include both personal methods of stress management (such as good communication skills) and making suggestions for improvement to the institution. Finally, one must learn how to forgive and love oneself. This is perhaps the most important step in both preventing and responding to compassion fatigue.
In addition to these measures of self-care, an important professional issue to APRNs is caring at the structural level. This final level of healthcare important to the art of care in nursing practice is that of the overarching system, or structure. Nearly every social or professional endeavor relies on the cooperation of structure – whether it be institutional or governmental. The case of nursing care is no exception. Even if nurses have a personal commitment to care and healthcare professionals have an educational mandate to encourage this care, the practice cannot be sustained if it is not supported by the healthcare system.
Laurie Gottlieb, the Editor-in-Chief of the Canadian Journal of Nursing Research, released an insightful and challenging editorial in 2004 related directly to the structural changes needed to maintain care in nursing practice. In the letter, Gottlieb highlights the many personal and professional challenges faced by nurses in relation to a failing Canadian system. These highlights are worth quoting at length: The system under which nurses work has not been as generous, supportive, committed, and loyal to them as nurses have been to it. It is well documented that nurses have shouldered a disproportionate share of the burden wrought by financial cuts, downsizing, and mergers.
Nurses have been marginalized, de professionalized, and demoralized. They have endured abuses and working conditions that few other health professionals have had to face. They have paid dearly with their own health, frozen and lost wages, elimination of jobs, a decimated leadership structure, working conditions that border on the inhumane, loss of status, workplace violence and abuse, shortages, recruitment and retention difficulties – the list goes on. (Gottlieb, 2004). This laundry list of challenges can only be solved at the structural level. A nurse's personal commitment to the ethic of caring is simply not enough. Individuals will burn out. The profession's attempt to instill care into nursing students will not be enough in the long run, if there is no support. In addition to these efforts, steps must be taken by the healthcare system at the institutional and structural level in order to affect a lasting support of nursing's devotion to care. This may not necessarily mean drastic changes, but it does necessitate an examination of the core of the structure, to ensure that aligns with the nursing ethos of caring.
It is clear that care is an integral part of nursing as a profession and a practice - it is "the glue that brings the patient to us” (Watters, 2009). Care, when properly implemented by a nurse, is exactly what makes nursing such a unique and necessary part of the healthcare system. Therefore, the above levels of care have been briefly examined in order to give a picture of what is needed to continue, or enhance, the practice of caring nursing in the field of healthcare. Personal commitment is not enough. Education is not enough. Structural changes are not enough.
Instead, individual nurses, healthcare professionals, and policymakers must work together in order to affect the needed changes and continue the successes. Care in nursing is at a crossroads, and the careful consideration and application of the above research will prove beneficial for both the personal practice and professional standards of nursing for advanced practice nurses and other healthcare professionals. By taking the two most basic measures outlined above, advanced practice nurses can insure themselves against compassion fatigue.
The Threat of Compassion Fatigue Among Healthcare Workers and Caregivers. (2021, Dec 22). Retrieved from https://studymoose.com/the-threat-of-compassion-fatigue-among-healthcare-workers-and-caregivers-essay
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