Becoming a nurse and caring for others can be very rewarding and fulfilling. However, caring for those in need can also lead to severe stress in all areas of nursing. In 1992 Joinson, a nurse, described the phenomenon of compassion fatigue (CF) as a unique form of burnout that affects people in caregiving professions. Figley (1995) defined it as a secondary traumatic stress reaction resulting from helping or desiring to help a person suffering from traumatic events. Its symptomology is nearly identical to that of post traumatic stress disorder (PTSD), except CF applies to caregivers who were affected by the trauma of others. Caregivers with CF may develop a preoccupation with their patients by re-experiencing their trauma; they can develop signs of persistent arousal and anxiety as a result of this secondary trauma. Examples of this arousal can include difficulty falling or staying asleep, irritability or outbursts of anger, and/or exaggerated startle responses. Most importantly, these caregivers ultimately experience a reduced capacity for, or interest in being empathic toward the suffering of others. Scholars differ in their perspectives of CF especially at it relates to burnout. However, they tend to agree that in general CF has a more sudden and acute onset than burnout, a condition that gradually wears down caregivers who are overwhelmed and unable to effect positive change. Understanding CF can empower nurses to utilize preventive measures that promote self care, improve patient outcomes, and optimize therapeutic relationships.
Sabo, in her article, “Reflecting on the Concept of Compassion Fatigue,” reports that nurses working in specialty areas, such as intensive care, are quite vulnerable to work-related stress. She focuses on the theoretical conceptualization of CF, positing that care providers’ declining ability to provide empathy in a therapeutic relationship is considered a key factor in compassion fatigue. Sabo explores Figley’s (2002a) model of CF noting that the personal characteristics of resilience and hope, as well as the nature of relationships, may add more depth to Figley’s model. She emphasizes the need to better understand the roles of empathy and engagement as contributors to CF.
In “Countering Compassion Fatigue: A Requisite Nursing Agenda” Boyle, as does Sabo, distinguishes CF from burnout. Whereas CF stems from witnessing another’s traumatic events, burnout evolves from dissatisfaction with working conditions. The author admits that both constructs result in outcomes associated with nurses’ sense of emotional/physical depletion. Boyle, too, values the need to address resilience in CF research initiatives, especially since nurses are considered first responders who often have little or no formal support to counter the effects of CF. She further indicates that available tools for assessing CF are limited in scope and provide minimal help for nurses who are in dire need of onsite workplace interventions, such as counseling, support groups, and/or de-briefing sessions, to address CF.
Lombard and Eyre bring an interesting case-study approach to their discussion of CF in “Compassion Fatigue, A Nurse’s Primer.” They emphasize how CF can negatively affect job satisfaction and care providers’ health, resulting in decreased productivity and increased turnover, a significant concern as nurses comprise the largest group of healthcare providers in the country. Lombard and Eyre, too, suggest that imbalanced, empathic, relationship-based care can contribute to CF. Interventions, including a knowledge of CF symptoms and healthy workplace environments, can help to prevent CF among healthcare providers.
Ward-Griffin, St-Amant, and Brown introduce an additional population considered to be at risk for CF in their article, “Compassion Fatigue within Double Duty Caregiving: Nurse-Daughters Caring for Elderly Parents.” Their qualitative study of nurse-daughters identifies the variable of being an informal family caregiver while at the same time working as an employee in a healthcare setting as another contributor to CF. This ‘double duty’ caregiving leads to the blurring of boundaries between professional and personal care ultimately predisposing the nurse to CF. They report that a lack of resources, along with increasing family expectations contribute to CF. Yet unlike the first three articles, their research promotes a greater focus on the inherent socio-economic and political contextual factors associated with CF. They emphasize that society’s expectations of daughters as caregivers compounded with professional nursing responsibilities prevents these individuals from even temporarily breaking free of the caregiver role. The authors argue that policy changes at the societal level are needed to decrease CF among double duty caregivers.
In “Compassion Practice by Ugandan Nurses who Provide HIV Care” Harrowing describes the importance of education as an essential intervention to combat the development of CF. This unique ethnographic study considers the perspective provided by caregivers who offer compassionate care in the Ugandan culture. She describes the specific economic and sociopolitical challenges that confront Ugandan nurses who are immersed in the consequences of the HIV epidemic both within their families and communities and also within their professional work settings. Harrowing reports that Ugandan nurses were able to face barriers of care and enhance their experiences of compassion satisfaction by maintaining a positive attitude and gaining new knowledge/skills. Unlike the other authors who link CF to burnout, this study found some consequence of burnout, such as leaving the profession, to be nonexistent in Uganda due to lack of other employment opportunities in this country.
CF is a preventable and treatable phenomenon; yet, it is also a phenomenon impacted by factors such as cultural beliefs and societal caregiving role expectations that are beyond the nurse-patient relationship. Although numerous models have been developed to guide researchers in better understanding this phenomenon of CF, further clarification of these constructs is still needed. For example, empathy is an important construct for nursing care; yet disturbing its balance can yield deleterious effects on the health of nurse caregivers.
The impact of CF can extend beyond paid (formal) healthcare providers. Symptoms of CF have been recognized in informal caregivers, such as family members who care for loved ones who have been directly traumatized by past experiences. These caregivers can experience CF symptoms as they become preoccupied by their relative’s condition. This may result in irritability with frequent outbursts of anger and a reduced capacity for caregiving. The health of these caregivers must not be ignored, especially since the value of the care they provide is very high. Testing constructs, such as resiliency and its relationship in maintaining the balance between compassion satisfaction and CF in both formal and informal caregiving populations, is essential for finding ways to mitigate the effects of this clinical phenomenon. Supporting changes in policy and promoting interventions that will enhance formal and informal caregiver health and productivity in all settings are paramount to affecting positive change in our healthcare system. The journal editors invite you to share your response to this OJIN topic addressing Compassion Fatigue either by writing a Letter to the Editor or by submitting a manuscript which will further the discussion of this topic which has been initiated by these introductory articles.
Maryann Abendroth, PhD, RN
© 2011 OJIN: The Online Journal of Issues in Nursing
Article published January 31, 2011