The profession of nursing carries with it a high risk for burnout and compassion fatigue. While these two terms may seem synonymous, there are some significant differences. These differences aside, however, the issue of how nurses can successfully cope with the potentially debilitating emotional and physical exhaustion that come with the close and intense contact with the emotions of patients and their families as we provide nursing care, needs to be addressed. There are a number of tools and techniques available, but are we making the most effective use of them?
This signage, in the current context, begs the question of, "Where is the safe haven for nurses?" It's a question, the answer to which, nurses must be seeking from the administrators of acute and long term care facilities alike.
Compassion Fatigue and Burnout
Compassion fatigue and burnout may seem to be interchangeable concepts, and have some similarities, but they are separate and distinct. In both cases, we see "added coping and adaptational demands on nurses" (Boyle, 2011). The most significant distinction lies in their acuity, with burnout occurring over time and compassion fatigue presenting more acutely (Boyle, 2011). Additionally, burnout is generally a reaction to stresses experienced in the workplace, while compassion fatigue is a consequence of the experiences of the pain and suffering nurses are exposed to while caring for their patients (Boyle, 2011). In terms of those with a tendency to suffer from compassion fatigue, older nurses (≥ 50 years of age) seem to suffer less from compassion fatigue than do their younger co-workers. This may be attributed to their greater clinical and life experience (Sacco, Ciurzynski, Harvey, & Ingersol, 2015). Regardless of age and experience, compassion fatigue can have leave its mark on any nurse or other member of the patient care team. So, what can we do to make that "safe haven"? That place where we can take the time to recover our spent energies, our emotional and spiritual equilibrium?
Building a "Safe Haven"
There are three key components to creating the safe havens nurses and other members of the healthcare team need to foster recovery from the stresses leading to compassion fatigue. These are prevention, assessment and mitigation of the consequences that can arise while caring for acutely and critically ill patients.
Work-life balance is a crucial aspect of this process, as it provides nurses the time and opportunity to take time to establish and follow a plan of self-care so that they can effectively care for their patients (Boyle, 2011). But this plan must be scrupulously and "relentlessly carried out in an attempt to enhance a calm state" (Boyle, 2011). This latter point, in my mind however, seems to be self-defeating. How can one achieve a measure of calmness, serenity and equanimity through such relentless pursuit? Mindfulness and diligence are more appropriate for this endeavor.
As care givers, we have to recognize a very fundamental fact: we simply cannot face the suffering of patients and their families on a daily basis and remain unscathed by that experience (Boyle, 2011). Such an expectation is unrealistic at best and self-deceiving at worst.
On an individual level, it requires mindfulness of our own internal states, and the knowledge to recognize the signs of our own compassion fatigue...
Symptoms of Compassion Fatigue
WORK RELATED:
Avoidance or dread of working with certain patients
Reduced ability to feel empathy towards patients or families Frequent use of sick days
Lack of joyfulness
EMOTIONAL:
Mood swings Restlessness Irritability Oversensitivity Anxiety
Excessive use of substances: nicotine, alcohol, illicit drugs Depression Anger and resentment Loss of objectivity Memory issues
Poor concentration, focus, and judgment
PHYSICAL:
Headaches
Digestive problems: diarrhea, constipation, upset stomach Muscle tension
Sleep disturbances: inability to sleep, insomnia, too much sleep Fatigue
Cardiac symptoms: chest pain/pressure, palpitations, tachycardia
Source: (Lombardo & Eyre, 2011)
At the organizational level, we see Employee Assistance Programs (EAP) and Pastoral Care providing support for nurses coming up against the wall that is compassion fatigue (Lombardo & Eyre, 2011). These, however, seem to be more reactive than proactive strategies. More proactive strategies would include having EAP counselors available on site for those nurses facing an emotionally challenging patients and/or families; debriefing sessions to aid in identifying stressors nurses face in caring for patients; making time for support groups during working hours to aid nurses in coping with the emotional fallout; and interventions to aid in bereavement for those patients who passed and making space on the unit or other space in the facility where nurses can find that safe haven (Boyle, 2011).
Conclusion
Dealing with compassion fatigue requires effort...proactive effort...on the part of individual nurses and the organizations they work for. On the individual level, we need to be mindful of our internal state and diligence in following a process by which we care for ourselves so that we can better care for our patients. We must, in this process, be gentle with ourselves. We will make missteps and mistakes in the process, the expectation of perfection is both unrealistic and counterproductive (Chordron, 1991). We must be proactive instead of reactive. At the organizational level a proactive stance is essential to prevent and ameliorate the effects of compassion fatigue for nurses and other caregivers. If organizational support is limited, or difficult to obtain, nurses need to step up and insist on having that "safe haven". Our health, and that of our patients, depends on it.
References:
Boyle, D. A. (2011). Countering Compassion Fatigue: A Requisite Nursing Agenda. The Online Journal of Issues in Nursing, Vol. 16, No. 1.
Chodron, P. (1991). The Wisdom of No Escape and the Path of Loving-Kindness. Boston, MA: Shambala.
Lombardo, B., & Eyre, C. (2011, January 31). Compassion Fatigue: A Nurse's Primer. The Online Journal of Issues in Nursing, Vol. 16, No. 1, Manuscript 3.
Saakvitne, K. W., Tennen, H., & Affleck, G. (1998). Exploring Thriving in the Context of Clinical Trauma Theory: Constructivist Self Development Theory. Journal of Social Issues, Vol. 54, No. 2, 279-299. Retrieved from Exploring Thriving in the Context of Clinical Trauma Theory: Constructivist Self Development Theory
Sabo, B. (2011). Reflecting on the Concept of Compassion Fatigue. The Online Journal of Issues in Nursing, Vol 16.
Sacco, T. L., Ciurzynski, S. M., Harvey, M. E., & Ingersol, G. L. (2015). Compassion Satisfaction and Compassion Fatigue Among Critical Care Nurses. CriticalCareNurse, Vol. 35, No. 4, 32-43. Retrieved from Critical Care Nurse
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