Spirituality in Nursing: Compassion Fatigue

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Table of Contents

Introduction
The five concepts of compassion fatigue
Nature of the problems and their causes
Physical, emotional and spiritual needs of the caregiver
Coping strategies and resources to help caregivers deal with compassion fatigue
Conclusion
References List

Introduction

Anewalt (2009) defines compassion fatigue as the physical, spiritual, and emotional depletion experienced by health care providers, first respondents, and emergency room personnel while giving care to patients in significant physical and emotional distress. The term appeared for the first time in literature over two decades ago when Joinson coined it in reference to the ‘loss of the ability to nurture’ (1992) among nurses working in emergency care settings. By then, Joinson was conducting her seminal work on the effects of burnout on nurses in the emergency care department. Joinson noted that compassion fatigue was closely related to burnout and that it mainly affected people in care-giving roles. According to Anewalt (2009), the main indicators of compassion fatigue include: detachment, reduced self-worth, hyper-arousal, avoidance of activities, and hopelessness, among others. Figley (2003) further notes that the symptoms of compassion fatigue may last for more than a month and that they are likely to permeate the mental, behavioral, physical, and spiritual facets of the care-giver’s life.

The five concepts of compassion fatigue

The five concepts of compassion fatigue as outlined by Figley (2003) are cognitive, spiritual, emotional, somatic, and behavioral.

Cognitive

Caregivers experience reduced self-esteem, concentration, and perfectionism. They are also likely to demonstrate signs of apathy. Since caregivers are so preoccupied with the trauma faced by patients, thoughts of self-harm or indeed harming others are not uncommon (Figley, 2003).

Spiritual

The horrific trauma associated with compassion fatigue can shake the care-giver’s faith to the point that him/her questions the meaning of life or whether God exists and why he lets good people to suffer. As a result, caregivers can experience loss of self-satisfaction and purpose. In addition, they are also likely to lose their faith in God.

Emotional

Compassion fatigue is often accompanied by the following symptoms: emotional lows and highs, hypersensitivity, and feelings of helplessness and powerlessness (Figley, 2003). Caregivers suffering from compassion fatigue are also likely to feel depressed and guilty.

Somatic

Compassion fatigue is directly related to somatic symptoms such as dizziness, profuse sweating, a compromised immune system, shock, tachycardia, and difficulty in breathing (Figley, 2003).

Behavioral

Examples of behavioral symptoms that are likely to accompany compassion fatigue include: irritability, anger outburst, hyper-vigilance, moodiness, impatience, poor self-care, sleep disturbances, losing items, loss of appetite, and withdrawal from clients, family and friends (Figley, 2003).

Nature of the problems and their causes

According to Collins and Long (2003), the onset of compassion fatigue can be very sudden. The exposure to patients facing traumatic experiences can trigger symptoms of compassion fatigue care-givers. This happens when caregivers are unable to separate their individual feelings of anxiety and stress from the trauma suffered by the patient (Thomspon, 2013).

Slocum-Gori et al. (2011) describe compassion fatigue as the emotional cost that caregivers have to pay for taking care of patients. According to Yang et al. (2012), compassion fatigue occurs when caregivers are over-involved in patient trauma. Some professionals have been reported to abandon traumatized patients under their care when they are overwhelmed by the effects of compassion fatigue. Compassion fatigue comes about in response to the stress experienced by the caregivers. It comes abruptly without warning and could be characterized by isolation, confusion, and helplessness. Caregivers who cannot cope with and adapt to the condition are likely to suffer psychologically and physically. Consequently, their quality of life reduces (Yang et al., 2012). If caregivers do not receive professional help, they become depressed. Some of them may even contemplate leaving the profession altogether.

Compassion fatigue is the by-product of care giving. It refers to the emotional, physical, spiritual, behavioral and mental exhaustion experienced by a caregiver as a result of recurrent exposure to traumatized patients. Caregivers suffer from compassion fatigue through one of the several ways. Primary, it occurs due to a traumatic stress that comes about after the caregiver has experienced trauma firsthand. Secondly, there is traumatic stress that comes about after the caregiver is directly exposed to a traumatized patient. Such traumatic experiences include witnessing the death of a patient (Florida Center for Public Health Preparedness, 2004); emphatic transmission that comes about after the caregiver has listened firsthand to the narrative of patients and clients who have undergone trauma (Florida Center for Public Health Preparedness, 2004); and anxiety transmission from the patient.

Physical, emotional and spiritual needs of the caregiver

Caregivers need to find a balance between their physical, emotional, and spiritual wellbeing. The caregiver’s individual wellbeing is important and this can be achieved by setting professional boundaries. At times, caregivers should learn to say no, especially when they feel drained physically, emotionally, and spiritually (Showalter, 2010). Breaks or time off would be a good thing to replenish the caregiver’s emotional reserves. Meditation, prayers, and partaking in spiritual rituals and practices would help caregivers to attain spiritual nourishment.

Coping strategies and resources to help caregivers deal with compassion fatigue

Although prevention strategies and resiliency can be quite effective, sometimes it is very hard to prevent compassion fatigue. The good news is that compassion fatigue symptoms respond very well to treatment (Yang et Al., 2012). On the other hand, the healing process can be slow. The first step to recover from compassion fatigue involves accepting that one is suffering from the condition. To cope with compassion fatigue, a caregiver requires access to professional help. This could be in the form of a professional counselor or a mentor. Additionally, the caregiver’s supervisor in the workplace could also prove useful by offering personalized intervention strategically. The personal intervention plan should only be executed following the successful completion of the assessment.

First, it is important to identify the resources available to the caregiver at the workplace to help him/her deal with compassion fatigue. Some workplaces have implemented an Employee Assistance Program (EAP), whose role is to improve work-life balance, reduce stress as well as give assistance to employees suffering from such conditions as compassion fatigue. Caregivers are required to embrace positive self-care strategies as a crucial step towards making full recovery. Also, caregivers are advised to develop healthy rituals. Caregivers are also encouraged to adopt new approaches to self-care. Examples include yoga classes and mediation. Health care providers should also set aside space for a relaxation center where caregivers can have a rest briefly in a comfortable and quiet setting.

Health care providers should also consider implementing programs like the Schwartz rounds where caregivers get a rare chance to open up and share their experiences with traumatized patients. This strategy has been proved to be psychotherapeutic (Thompson, 2012).

Conclusion

Caregivers often have to work under an environment characterized by heart wrenching and highly emotional situations daily. In addition, increased demand for time, productivity, energy, and workloads causes a rise in the caregivers’ stress levels. This is likely to trigger compassion fatigue. To deal with compassion fatigue, caregivers should learn the importance of satisfying their emotional, physical and spiritual needs. Acknowledging the symptoms of compassion fatigue is the first step towards recovery. Additionally, caregivers should adopt positive self-strategies like getting sufficient sleep, nutrition, and hydration. Other strategies include meditation and massage.

References List

Anewalt, P. (2009). Fired up or burned out? Understanding the importance of professional boundaries in home health care hospice. Home Healthcare Nurse, 27(10), 591-597.

Collins, S., & Long, A. (2003). Too tired to care? The psychological effects of working with trauma. Journal of Psychiatric and Mental Health Nursing, 10(3), 17-27.

Figley, C. R. (2003). Compassion Fatigue: An Introduction, Gift From Within. Web.

Florida Center for Public Health Preparedness. (2004). Understanding compassion fatigue: helping public health professionals and other front-line responders combat the occupational stressors and psychological injuries of bioterrorism defense for a strengthened public health Response. Web.

Joinson, C. (1992). Coping with compassion fatigue. Nursing, 22(4), 118-20.

Showalter, S. (2010). Compassion fatigue: what is it? Why does it matter? Recognising the symptoms, acknowledging the impact, developing the tools to prevent compassion fatigue, and strengthen the professional already suffering from the effects. American Journal of Hospice & Palliative Medicine, 27(4), 239-242.

Slocum-Gori, D.H., Chan, W., Carson, A., & Kazanjian, A. (2011). Understanding Compassion Satisfaction, Compassion Fatigue and Burnout: A Survey of the hospice palliative care workforce. Palliative Medicine, 27(2), 172-178.

Thompson, A. (2013). How Schwartz rounds can be used to combat compassion fatigue. Nursing Management, 20(4), 16-20.

Yang, L. C., Lin, T.R., Yu, Y.L., Yang, L.C., Tsai, S.H., & Hung, C.H. (2012). Compassion fatigue and coping strategies for hospital nurses. Compassion Fatigue symptoms, 59(3), 93-9.

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