Where Is Our "Safe Haven"?

The profession of nursing carries with it a high risk for burnout and compassion fatigue. Where do we find our "Safe Haven" when we are emotionally exhausted? Nurses Announcements Archive Article

Where Is Our "Safe Haven"?

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?

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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, Morificecript 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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dzadzey

About dzadzey, MSN, RN

CCRN and AGCNS working in Central Ohio

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There are 2 things that offer safe haven for me, I use both together on many occasions. 1-A good trustworthy co-worker who can understand what my issues are. We talk every time we work together, we wait on each other and walk out to the parking lot together. There are benches there and we frequently sit and talk after our shift is over. It's not that we just agree on everything because we don't. It's that we listen to each other. Like some one once said to me "everyone needs a good listening to". 2- My faith. I am a Quaker and I practice what we call "sitting in the light". I find a quiet place either in or out of my Quaker Meeting and sit in silence and listen for God. It is an exercise in mediation, submission, openness, and reliance on a force greater than myself. It is not an exercise for the faint of heart and is not as easy as what it might seem. It takes much energy to not "act" but simply sit in the "light of God" and soak it up. Some folks are not open to sitting in silence and waiting for communication. I was born to do it, it offers me great peace and relief and has always something I can slip into very quickly. If the work is chaos or home is chaos I can simply turn everything "off", sit and tune out for hours or just a few minutes. It is a very calming thing to do. I worked a lot of hospice and could and would sit with dying patients and never speak a word, just sit as a presence with them, hold their hand and be there for them. One 3 year old who died of retinoblastoma went down hill very quickly one day and we could not find her mother. I picked her up and sat in a rocking chair for quiet a while and held her in the light. I could not leave her alone and she and I just went to the silence and rocked. My patient was peaceful and passed quietly with no stress on her. For me this is the ultimate way to release the stress and tension from anything, everything and everybody. Again not everyone can or should try it but for me it works in a wonderful way. It also keeps me from flying off the handle, over-reacting, screaming, crying, etc. It allows me to take a breath and respond to the needs of others in a calm and quiet manner. Kindness comes out of it and it is so easy to pass that on to others. It turns away the harsh brittleness of the world and folks who are screaming and crying. I have seen many reactions to death and dying and all have been appropriate for the family and the culture. I always tell families and loved ones to do what they feel they need to. On the other hand no one has ever turned away from an offer for me to sit with them in silence. I also leave it to them to tell me if they need to talk but they rarely do. We had a death in the middle of the night and the man was obviously loved by a very large family(about 20 people). His 3 sons were preachers. They came out of his room and asked if they could use our TV room for a little while just to pray. Another nurse and I told them we would let them use it as long as they would pray for us too. They laughed and agreed, said they thought that would be a great idea. We heard them praying, they got fired up which was fine but in the middle of the night, all of a sudden it got real quiet and then they started singing gospel hymns about crossing over, very softly. It was absolutely gorgeous and we sat there and listened to the "concert" from our computer stations. They stayed about 45 min. and then came out and thanked us. We told them we were disappointed that they had quit singing. It was such a calming experience having them share that with us. Everyone deals with things in their lives differently, no one is wrong or right, you just have to find a way to experience your own personal way to cope.

I have been working with patients since I was a teenager. Combat Medic in the Army, CNA, HHA, LPN, LPNII, RN. I have worked Psych, LTC, Rehab, Med/Surg, ICU, CCU, COU, Tele, Cardiac Stepdown, Hospice, Home Health. I have done a lot over my 30 plus years working in nursing. The key to surviving for me is simple. Don't let yourself stay on a unit that is sucking the blood from your life. DO NOT WORK EXTRA, picking up a lot of time is guaranteed to burn you out. Do your time and go home. I have also always stayed away from management or any desk job. Those jobs may get you off the floor, but will be with you 24/7.

There is a lot to be said for not being bothered when you are off. I work now as a Wound Care RN and work 3 days a week. When I'm off, I'm off. I have no responsibility at all to the unit. I have outlasted many RN's over the years. When you find a good home, stay there and live your life.