Compassion fatigue, which is also known, as secondary traumatic stress is a natural effect that occurs as a result of taking care of patients who are in pain, stressed, suffering, or traumatized.
Compassion fatigue commonly affects nurses who show extreme empathy for patients and their relatives.
Empathy is the act of putting oneself in another person’s situation or understanding one’s feelings (Walker & Alligood, 2001). It has always been a nurse’s role to show empathy to patients and their relatives. In the process of sympathizing and empathizing, nurses can easily develop compassion fatigue. Compassion fatigue affects nurses physically, psychologically, and spiritually in addition to affecting their daily duties. Nurses may intentionally stop working with certain patients or reduce their empathy for patients, and others may have repetitive call-ins to avoid working specific patient populations. These adverse effects can easily lower hospital or institution productivity.
Therefore, it is advisable for nurses to be encouraged to seek advice and counseling from counselors, mentors, psychologists, and other responsible persons.
It is also necessary for nurses to be aware of the symptoms of compassion fatigue to facilitate taking preventative measures as early as possible. The compassion fatigue theory is connected to the relationship between the patient and the care provider. The trauma and suffering experienced by the patient has a direct affect on the caregiver’s ability to empathize, engage, and develop therapeutic relationships with patients. This essay points out the main causes of compassion fatigue and the theoretical framework of the compassion fatigue theory.
Literature Review Several psychologists have come up with theories relative to compassion fatigue or secondary traumatic stress.
Figley (2009) explains that compassion fatigue is a natural consequence as a result of empathizing with patients suffering, patients in pain, and the traumatized patients and their relatives. Figley claims that nurses who are very compassionate to their patients and their relatives are more vulnerable to compassion fatigue than those who are less empathizing (Simpson, 2004). He claims that as nurses put more efforts into helping the traumatized patient and showing them compassion, the nurse tends to suffer more. During the process of empathizing with patients, nurses tend to reduce their self-efficiency and sacrifice more for their needy patients. Figley suggests that the care providers should be educated on self-care to combat compassion fatigue. Figley’s theory also has its limitations: for instance, it fails to point out the advantages of nurse-patient relationship and how this relationship can prevent secondary traumatic stress. Sabo (2006) pointed out this limitation. Koloroutis’ (2009) emphasizes three core aspects of nursing care using relationship-based nursing.
The three core relationships consist of the nurse’s relationship with the patient and the patient’s family, the nurse’s self-actualization, and nurse’s relationship with his or her colleagues. Koloroutis emphasizes that the nurse’s self-relationship is the most essential core relationship. Self-relationship enables the nurse to be self-assertive, helps him or her to solve his or her issues. Also, it enables a nurse to show empathy on his or her patients and family. Through the three core relationships, the patients’ problems can easily be solved. Teamwork is enhanced; hence the work productivity in the institution will increase. Harmer & Henderson (2010) claim that it is a nurse’s responsibility to empathize with patients and their relatives and to show them compassion.
In the process of showing compassion and empathizing with patients, nurses tend to develop compassion fatigue. Therefore, nurses should always seek intervention from mentors or professional counselors to prevent the development of compassion fatigue or secondary traumatic stress. Nurses also face many issues and challenges in the hospital setting. Nurses interact with multiple patients with different demands. Therefore, nurses should receive adequate support from superiors, family members, and colleagues to help keep their spirits up and to professionally complete their daily duties. Watson’s (2010) theory of human caring advocates relationship-based nursing.
This relationship enables the nurse to empathize with the patient and the patient’s relatives. The nurse understands the patient and helps the patient and the relatives to deal with the current medical condition. Empathizing with the patient is one way of showing concern and improves the quality of care rendered by the nurse. According to Watson, for a nurse to empathize with the patient, there should be a good relationship between the nurse and the patient. According to Adams et al. (2006), compassion fatigue is connected with the patient’s therapeutic relationship with the health provider.
As a healthcare provider empathizes with the patient, and enters into a therapeutic relationship, development of secondary traumatic stress tends to occur (Jenkins & Baird, 2002). The researchers also claim that there are other predisposing factors to compassion fatigue. These include trauma, low social status and personal history also not being in a position to cope up with increased demands. Sabo (2006) claims that a patient’s health outcome has contributed greatly to nurses developing compassion fatigue.
The nurse’s health has been neglected in that less emphasis has been placed on preventing the nurse from developing secondary traumatic stress. Sabo elaborates on how nursing job can affect the nurse’s health as he or she attempts to assist patients and patients’ families from suffering.
According to the various theories on compassion fatigue, it is clear that compassion fatigue also known as secondary traumatic stress results from empathizing with the patients and their families.
It is evident that the nurse is affected psychologically, physically, and spiritually. Some theorists advocate nurse-patient relationship. This relationship enhances nurse self-efficiency—enabling the nurse to maintain his or her health and show compassion and empathy for the patient and their family. It also increases nurse’s work productivity. According to Figley, nurses, especially those nurturing patients in emergency rooms, are more vulnerable to compassion fatigue. Figley points out that it is necessary for nurses to be educated on possible interventions to consider if compassion fatigue is detected. Figley claims that nurses who are very compassionate to their patients and their relatives are more vulnerable to compassion fatigue than those who are less empathetic.
He claims that as nurses put more efforts into helping the traumatized patient and showing them compassion the nurse tends to suffer more. During the process of empathizing with patients, nurses tend to reduce their self-efficiency and sacrifice more for their needy patients and their relatives. If compassion fatigue is suspected, nurses should seek counsel from professional counselors, mentors and any other persons with counseling techniques. Concepts Nurses have a code of ethics that serves a guide for rendering care.
The nursing code of ethics serves to promote health, alleviate patient pain and/or suffering, prevent the occurrence of illness, and restore patient health. Code of ethics enables nurses to know the right thing to do, action to take and how to solve problems. Nursing ethical principles are in place to guide nursing practice. Some of the ethical principles include autonomy, which is defined as the right to confidentiality and privacy; beneficence—the act of doing what is good for the patient and the family; justice—being fair and treating people equally, and fidelity—being honest or faithful and keeping the promises among others. Other concepts supporting this ethic are health promotion, caring, and expertise among others. Nurses should always maintain these principles in their professional practice (Harmer & Henderson, 2010). Autonomy is the act of keeping privacy and also giving independence.
Nurses should always keep patient issues. The patient has the right to independence. The patient has the right to make his or her decision. If a patient decides that his or her relatives should not know about his or her health condition, then the nurse should honor the patient’s wishes as well as inform the other team members of the patient’s wishes. The patient can also change his or her mind regarding particular decision, which he or she has made. Nurses and any other professionals from health team should allow the patient to change decisions. The nurse should respect what the patient has decided. Autonomy has some limitation, for example, in a situation whereby the patient is in a comma, the health care professional has a right to make a decision for him or her. Beneficence as the act of doing well for the patient and the family is an essential ethic in nursing.
Nurses should always strive to do what is best for the patient. Nurses should always attempt to empathize with their patients. Patients nearing end of life can be challenging for nurses. The patient is worried and anxious and so is the family. The families have fear, anxiety and excessive stress. Nurses should show compassion and empathy to them. The nurse should explain the situation to them and help them transition with dignity. Imminent death can be a difficult time, but the compassionate nurse can help a patient and family accept the inevitable. Other nursing concepts supporting the ethical values are caring, health promotion, and expertise among others.
Nurses’ concept of caring for the sick and needy patients is an essential ethic in the nursing profession. Nurses should always be concerned with their patients’ needs and attend to them by giving psychological support, counseling, and showing compassion to them. Since nurses are also affected in some way by their patients suffering, they should have self-care; seek for the support group, and counseling from professional counselors to prevent them from developing compassion fatigue (Jackson, Firtko, & Edenborough, 2007). Health promotion is always the main goal of all the clients or patients.
Nurses and the other health team should promote patient health by providing curative treatment to the sick, preventive care for those at risk of developing illness and rehabilitation to those patients with terminal illness. As illustrated in Figure 1, autonomy, caring, health promotion, and beneficence encompass the concepts of nursing. Health is not merely absence of a disease, therefore, spiritual, emotional, psychological and physical support should all be considered when determining if a patient is healthy. Figure 1
Key Concepts of Nursing Autonomy refers to independent actions or one’s own will Caring refers the time and attention dedicated to something or someone Beneficence refers to the act of doing good Health Promotion refers to the process enabling people to have increased control of and improvement in their health From Figure 1 above, it is clear that the nursing concepts relate with each other.
Beneficence and autonomy are ethical values while caring and autonomy are other concepts. Lack of one concept will affect the nursing profession in one way, or another. Nurses should always apply the above concepts in their daily work. Concepts of nursing have their advantages in that they enable nurses, patients, their relatives, and the entire healthcare team to know their roles. Conclusion Compassion fatigue also known as secondary traumatic stress is a natural effect that occurs to those providing care to the traumatized, the suffering, and those in pain.
Compassion fatigue is common to nurses who show empathy for their patients and family. Many theories have been discovered showing how taking care of the sick or those suffering predisposes a person to compassion fatigue. According to Figley, those who take care of patients in critical care areas and those who show profound empathy to patients are more vulnerable to compassion fatigue. Koloroutis introduced three core correlations using relationship based nursing. They include nurse-patient relationship, nurse-colleague relationship and nurse-self relationship. Koloroutis claims that self-relationship is crucial for a nurse to live a healthy life, empathize with patients and for a nurse to be proficient in his or her professional practice.
Therefore, it is important for nurses and other caregivers to develop self-care, join supportive groups, and also seek counseling from professional counselors and other relevant people. Nursing ethics or principles such as autonomy, loyalty, beneficence, care, and health promotion also give guidance to the nurse to know what is expected of him or her. Nursing code of ethics also dictates patient rights and can be used a guide for decision-making. The principles listed in the code of ethics guide nurses in their professional practice. The above model (Figure 1) demonstrates how concepts of nursing relate to each other. Nursing concepts also illustrate each person’s role; the patient role, nurses’ role and roles of other health care providers. Nurses should always apply this concept in their professional practice.
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