In the health sector the focus is mainly on the well-being and recovery of a patient, the nurses’ role is to provide hands-on care to the patient, administering medication, monitoring and observing the patients’ condition, continuously maintaining and updating the patients records and collaborating with doctors. Nurses Association (2008) Nurses fall victim to compassion fatigue because of the empathy and compassion required of them on a daily basis, as a result some nurses experience compassion fatigue when dealing with excessive demands of patients, heavy workloads and long working hours. When a nurse is preoccupied with their work they often neglect themselves which if not managed well may result in compassion fatigue. Compassion fatigue is also known as secondary traumatic stress (STS), a condition characterised by a gradual lessening of compassion over time Dr. Charles Figley defined compassion fatigue as “A state experienced by those helping people in distress; it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic stress for the helper.” Todaro-Franceschi (2012)
Compassion fatigue is a relevant concept in nursing because day in and day out caregivers struggle to function in their work environments due to long hours, overtime and not enough rest. When a nurse is preoccupied with the suffering of patients they may neglect their own physical and mental care, this may present challenges which in turn over time may result in compassion fatigue which is sometimes also referred to as “burnout”. Figley C. R (2013) The concept analysis model which will be used in the analysis of compassion fatigue is Rodgers 1989. The areas that will be discussed are the purpose of the analysis, the framework that will be used in the analysis and the rationale for its use, the usefulness of concept analysis for nursing practice and lastly any concept which may be further explored. Ludgate & Teater (2014)
The purpose of the analysis
The purpose of this analysis is to investigate the concept of compassion fatigue while looking into the terms that are closely related to it. The analysis will also examine published journals and literature that is linked to compassion fatigue and any concepts that are related to it and how they affect each other. This analysis will furthermore delve into the characteristics and consequences of compassion fatigue in nursing. Additionally, a model case of compassion fatigue will be used to explain concept to assist in bringing even more understanding to the concept. It is also of great importance to consider the usefulness of obtaining more understanding into the concept of compassion fatigue in the nurse. Lastly, this analysis will discuss possible concepts that can be explored further.
Rodgers (1989) framework for concept analysis
Rodgers concept analysis method is evolutionary which if simply put means that the nursing discipline is metamorphic or constantly transforming itself. Nursing involves different interrelationships and therefore for one to perceive a concept as fixed or rigid with defined borders would not be an ideal technique of capturing a concepts true nature. McKenna & Cutcliffe (2012) Rodgers argued that a concept is defined by a set of attributes over time. These attributes come about through the use, application and association of a concept. Rodgers argued that as society changes over time so do concepts, therefore it is important to consider the concepts position within other concepts and how it is useful within the network of nursing roles. One nurses experience is unique to another’s, therefore the concept allows for different clusters of attributes to explain itself rather than one set of attributes. McKenna & Cutcliffe (2012) Rodgers concept analysis framework is therefore ideal as a method of studying the concept of compassion fatigue as it allows for the examination of the concept within other concepts and focuses on the unambiguous use of a concept. But more importantly it treats each nurses experience of compassion fatigue as unique only to themselves at a given situation and time. Figley C. R (2013)
Additionally, Rodgers’ evolutionary concept analysis is systematic and focuses on precise phases during the analysis process, this method can contribute to explaining, describing and clarifying fundamental concepts in nursing science. It not only analyses a concept by looking into how it has been used within the discipline but also how it is used in other health sciences. Tofthagen (2014)
Surrogate terms of Compassion Fatigue
Compassion fatigue, vicarious trauma and burnout are substitute terms that are complimentary but at the same time different from one another. Compassion Fatigue refers to the deep physical and emotional erosion that occurs when nurses are unable to regenerate and refuel, it has in some cases has been referred to as burnout these concepts are slightly similar but different. The term burnout which has been used since the 1980’s is defined as the physical and emotional exhaustion that workers can experience as a result of low job satisfaction, feeling overwhelmed or powerless at work. However, burnout doesn’t not mean that an individual has lost the ability to feel compassion for others or that their view of the world has been altered. Additionally, compassion fatigue is treatable whereas burnout is harder to predict. Compassion fatigue occurs suddenly and burnout tends to occur overtime. Lastly, in some extreme cases of burnout some workers can easily resolve this problem by changing their occupation or job which can provide an instant relief to a nurse suffering from job-related burnout. While on the other hand certain actions can be taken to treat compassion fatigue. T M. Skovholt, (2016)
Vicarious trauma is a concept that was coined by Pearlman & Saaknitne (1995) to define the profound shift in how care professionals view the world when working with patients who are or have experienced trauma. The repeated expose to traumatic material alter some care givers fundamental beliefs about the world which could lead to possible damage. Nurses can experience both compassion fatigue and vicarious trauma at the same time. The symptoms snowball over time and become very evident not only in the nurses professional life but their personal life too. Compassion Fatigue and Vicarious Trauma can also become and occupational hazard when working in the health care sector. Pearlman & Saaknitne (1996)
Literature and search strategy
Several books written on compassion fatigue were used in this analysis to explain the concept and the various concepts related to the Compassion Fatigue, these are citied throughout the analysis. These included “, “The Compassion Fatigue Work Book”, “Overcoming Compassion Fatigue”, “Treating Compassion Fatigue and The Resilient Practitioner: Burnout Compassion Fatigue”. The keywords used in the search criteria were “compassion fatigue”, “burnout”, “stress secondary traumatic”, “nursing health”, “stigma” and “empathy”. Additionally, several journals from databases such as Science Direct Freedom Collection, Nursing Times and CINAHL Complete and Wiley Online Library where used to further explain in depth the concept of compassion fatigue. The results these databases yielded were as follows: explanation as to why Rodgers’ evolutionary concept analysis was chosen as the method to use in the analysis of compassion fatigue, the explanation of the attributes, antecedents and consequences of compassion fatigue and also the examination of other concepts related to compassion fatigue.
Lastly, a 2014 case study by Kate Sheppard, PhD, PMHNP-BC was used to help elucidate the concept of compassion fatigue by carrying out a developmental study on registered nurses. Her study was entitled “Compassion fatigue among registered nurses: Connecting theory and research”. Sheppard’s analysis on compassion fatigue resulted in four themes these are: life is unfair, endless suffering, unable to let go and wanting support but pushing away. These themes are discussed in great details in the case study below.
Attributes of Compassion Fatigue
Every nurse feels the intrinsic “calling” to care for those suffering or traumatised people, this may result in stress and empathy resulting in the nurse focusing on the pain and suffering of her patient while neglecting her own emotional, physical and mental needs. Lack of self-care could lead to the onset of Compassion fatigue. According to Skovholt & Trotter-Mathison, (2016) The symptoms of Compassion fatigue can be put into five categories:
Cognitive – poor attention or concentration span, disorientation, apathy, preoccupation with patients’ trauma, and rigidity.
Emotional – a feeling of powerlessness, high levels of anxiety, constantly feeling guilty, feelings of anger, numbness, helplessness, fear, sadness or feelings of depression, constantly feeling tired or depleted, shock, sudden involuntary revolution of dramatic experiences.
Behavioural- Moody, irritable, isolating oneself, withdrawn, insomnia, nightmares, loss of appetite and hyper-vigilance which may result in anxiety and exhaustion.
Spiritual – the individual may start to question the meaning of life, some individuals begin to question religious beliefs which may result in a loss of faith or sceptism.
Somatic – aches and pains, rapid breathing or difficulty breathing, dizziness, headaches, immune system dysfunction and difficulty staying awake or falling asleep.
The antecedents and consequences of Compassion Fatigue
The effects of compassion fatigue in nurses may result in high staff turnover, an increase in absenteeism, high levels of absenteeism means that a lot of work load and pressure is put on the other nurses at work as they have to make up for the absent nurses. Compassion fatigue also results in the reduction of patients’ safety, quality of care and patient satisfaction with may lead to difficulties in retaining and recruiting staff. Unresolved compassion fatigue can significantly affect job performance. Those suffering from compassion fatigue tend to self-medicate, drink excessively or take drugs in order to numb the intense emotions. Others may also go on to distance themselves from family, friends, colleagues or patients. Todaro-Franceschi (2012)
It is important to identify and deal with compassion fatigue before it results in burnout to ensure the wellbeing of the nurse who cares for several patients. It is imperative that health organisations put in place programs that educate and empower nurses on self-care, the symptoms of compassion fatigue and creating a balance between “professional and personal stressors”. Brysiewicz & Wentzel (2014)
Concepts that are related to Compassion Fatigue
Compassion fatigue and burnout are often linked together as similar concepts but Stamm (2002, 2005) and Valent (2002) believed that these two concepts were related but distinct concepts. Valent believed that compassion fatigue and burnout both came from separate unsuccessful survival tactics; compassion fatigue came from a rescue care tasking response which when simply put means that compassion fatigue occurs when a caregiver or nurse cannot rescue their patient from harm resulting in a feeling of guilt and distress. On the other hand burnout occurs from assertiveness – goal achievement response which means that a nurse cannot achieve their personal goals which in turn results in “frustration”. Valent (2002). Lastly, Figley C (1995) Theorised that compassion fatigue arises unexpectedly or suddenly and subsides quicker than burnout which arises and decreases slower than compassion fatigue.
Model Case of Compassion Fatigue
Kate Sheppard PhD, PMHNP-BC conducted a development study on compassion fatigue among registered nurses in 2014 inorder to help clarify the concept. She based her study on the hybrid model defined by Schwartz-Barcott and Kim (2000). Sheppards thematic analysis resulted in four themes. Theme one: “Life is unfair” – the participants believed that life is unfair and that bad things always seem to happen to innocent people while those who abuse their bodies with drugs and alcohol seemed to live longer lives. Theme two: “Endless suffering” – the participants witnessed the endless pain, suffering, grief and despair of their patients and families, the nurses were left feeling powerless and hopeless as they was nothing they could do to put a stop to their pain and mystery. Theme three: “Unable to let go”– all the participants recalled their first patient’s death and this memory still caused them intense sadness, pain or anger. Additionally, participants described how they frequently skip lunch, skip breaks, stay late and sometimes even going to the extent of calling the unit on their day off to check on their patients progress. Most the participants said they found this very exhausting as it felt like working 24 hours a day seven days a week. Theme four: “Wanting support but pushing away” – many of the participants explained how they wanted to talk to a partner, friend or family member but the attempt to talk only caused them more agony. The nurses found the people they attempted to talk to asked too many questions when all they wanted was someone to listen without trying to “fix them”. This made most of the participants uncomfortable to discuss what they were going through at work resulting in them pushing away any possible support.
The study revealed any of the participants admitted that they may be experiencing compassion fatigue. However, majority of the nurses felt that the term “compassion fatigue” was stigmatising and negative because even though they fit the criteria they felt they still had compassion for their patients. They also added that compassion is seen as expected or inherent part of being a nurse, so the idea of a nurse being lacking as looking compassion was regarded and shameful and something they wouldn’t want to admit to themselves or anyone. Sheppard (2015)
The usefulness of Compassion Fatigue for nursing practice
It is of great importance for nursing practices to understand the organisational symptoms of compassion fatigue and the possible impact it can have on a nursing practise. Compassion fatigue can result in high levels of absenteeism and staff turnover. If compassion fatigue is not identified and dealt with accordingly it can result in co-workers inability to work well as a team or outbursts or aggressive behaviour among staff. Inability of staff to carry out assigned duties and tasks and meet their deadlines. Staff may also be less flexible and can be negative towards management. Additionally, nurses can develop an unwillingness to accommodate change. All of the above organisational symptoms of compassion fatigue can easily result in chaos and problems with running a nursing practise.
Concepts to explore further?
It is paramount for health institutions to provide help as denial is one of the most damaging symptoms of compassion fatigue. The onset and developed of compassion fatigue hinder a nurses ability to assess the levels of stress and fatigue in their lives, this in turn frustrates an effort to begin the process of healing. Further research can be carried out on the health organisations education and training on tests that can help identify and recognise the symptoms of compassion fatigue. These tests include Professional Quality of Life (ProQoL) Self-Test, Empath Test and Life Stress Self-Test and many others. However, it is important to remember that these tests help determine if an individual needs to seek further assistance, they do not replace a qualified medical diagnosis.
A nurse is a compassionate individual with a desire and a drive to help others in need, however nurses can become overwhelmed by constant exposure to the experiences and feelings of their patients which can leave them vulnerable to compassion fatigue. If their compassion fatigue, left untreated can stimulate a deterioration of ones quality of life and result in a decline in the general wellbeing of a nurse. It is therefore imperative for the health sector to be able to identify the symptoms of compassion fatigue and offer treatment and address the prevention steps during its primary stages.