Countering Compassion Fatigue, Essay Example

Introduction to Concept

Compassion fatigue for nurses is a complex and challenging circumstance that is often a result of working with patients with chronic or terminal diseases whose quality of life is dramatically reduced over time. Nurses who work with cancer patients, for example, often experience compassion fatigue as a consequence of the administration of care and treatment at the bedside, particularly since patients are seriously ill and face critical health challenges at this level. Nurses who work with this type of patient population are required to demonstrate a strong and empowering approach to the practice environment; however, this type of workload has a significant impact on their overall health and wellbeing in many different ways due to the pressure and stress of this role and the responsibilities that it carries. Therefore, nurses must be able to examine their own issues related to working with critically ill patients and how these influence their own physical, emotional, mental, and psychological health status. From a conceptual point of view, there must be a greater emphasis on understanding the dynamics of working with cancer patients and others whose health continues to decline.

Nurses may experience varying degrees of difficulty related to these events and must be able to recognize their own limitations with respect to this population group. These actions will demonstrate the importance of working with patients who face these challenges so that nurses are able to optimize their ability to work to improve or at least maintain their quality of life. At the same time, nurses must be able to balance their own needs effectively in order to minimize personal emotional turmoil and other negative experiences that may be influenced by these activities. The following discussion will address compassion fatigue in greater detail, using a concept analysis to ensure that patients receive optimal care and treatment at all times, while nurses are able to self-manage their own health and stress levels without significant difficulties or consequences in this regard.

Literature Review

Nurses often experience compassion fatigue in their work with patients who have terminal illnesses such as cancer, and this may lead to their own traumatic experiences and other issues that impact their psychological and mental health (Sabo, 2011). The impact of working with patients with cancer or other serious illnesses is highly stressful for nurses and undoubtedly creates new challenges from the perspective of maintaining a clear approach to patient care and treatment (Sabo, 2011). Nurses who are unable to manage their fatigue and stress as result of working with this patient population may experience premature burnout; therefore, this reflects the importance of addressing stress in a timely manner and to identify any possible predictors of compassion fatigue that may occur (Sabo, 2011). A concept known as vicarious traumatization must also be considered as a key component of compassion fatigue, as nurse may experience their own degree of trauma by working closely with patients who are experiencing trauma at a high level (Sabo, 2011).

For nurses who work with seriously ill patients, there is not always an approach in place that will enable them to manage stress and the daily responsibilities of the position effectively. Therefore, it is important for nurses to develop a method of balance or a means of understanding the emotional context of nursing and its impact on work performance and wellbeing (Boyle, 2011). From this perspective, “Compassion fatigue characterizes a progressive state of emotional unease. It evolves from compassion discomfort, to compassion stress, and finally to compassion fatigue, a state where the compassion energy that is expended by nurses (and others) surpasses their ability to recover from this energy expenditure, resulting in significant negative psychological and physical consequences” (Boyle, 2011). Therefore, nurses possess significant obstacles in their efforts to administer high quality, compassionate nursing care without stress levels that impact their performance at a high level.

Understanding compassion fatigue also requires nurses to be mindful of the issues that they are likely to experience that limit their level of satisfaction in the workplace. A study by Drury, Craigie, Francis, Aoun, & Hegney (2014) notes that compassion fatigue has a detrimental impact on high levels of stress, burnout, traumatic experiences, depression, and anxiety, among others. Therefore, it is important for nurses to receive the appropriate attention and focus in the workplace environment as a means of supporting their own health and wellbeing at a high level (Drury et.al, 2014). It is important to focus on the development of new strategies to ensure that nurses experience higher levels of satisfaction and are able to contribute in the workplace effectively at all times, while also minimizing the risks associated with burnout and compassion fatigue as best as possible (Drury et.al, 2014).

Compassion fatigue is associated with the theoretical perspective known as Watson’s theory of human caring, which involves the “basic empathic relationship between the nurse and the patient; this theory advocates for relationship-based nursing (RBN). At the core of RBN is empathy and the communication of this empathy to the patient and the family” (Lombardo & Eyre, 2011). Therefore, nurses who work in this capacity must be able to relate to their patients effectively in order to offer a compassionate approach to patient care; however, this also requires an examination of the key variables that influence relationship building between nurses and their patients (Lombardo & Eyre, 2011). Most importantly, compassion fatigue is the extension of nurses beyond a reasonable level to the point that they are overstressed and are too emotionally attached to their patients. This reflects a need to achieve a greater balance between nurse-patient relationships and nurses’ levels of stress and burnout that may be attributed to these events.

Nurses who work with seriously ill patients often become too engaged and involved in their care to the point that it impacts their personal lives and professional careers at excessive levels; therefore, it is necessary to evaluate this impact in the context of healthcare practice. Nurses who lose patients to terminal illnesses often experience extreme difficulties in this regard and may be unable to focus on much else in their lives (Melvin, 2012). Nurses who work in palliative care or hospice settings are particularly affected and require significant attention and focus due to high levels of stress, burnout, and other challenges (Melvin, 2012). Therefore, it is important to evaluate the complex causes of this condition and how it impacts nurses on many different levels in order to have a clearer understanding of what steps are required to ensure that nurses receive the attention and focus that they deserve (Melvin, 2012).

In critical care units, compassion fatigue is a common phenomenon that requires an understanding of how nurses may experience a loss of the ”ability to nurture,” thereby creating a need to understand the causes of this phenomenon and how it impacts nurses at a high level (Jenkins & Warren, 2012). These factors demonstrate a need to further examine the causes of compassion fatigue and what steps are required to ensure that nurses receive the appropriate tools and resources to manage their workloads and to balance these with their other responsibilities (Jenkins & Warren, 2012). At the same time, the concept of burnout must be explored further in order to understand how it impacts nurses and contributes to their level of disengagement, stress, and their lack of enthusiasm towards their work with patients, even when social support is available (Yom & Kim, 2012). From this perspective, it is likely that nurses will continue to experience difficult challenges that require their full attention and focus in order to be effective in meeting the needs of a given patient population while limiting the effects of compassion fatigue so that nurses are able to manage their roles and responsibilities more effectively and appropriately (Yom & Kim, 2012).

Compassion fatigue may occur across many areas of nursing practice; however, oncology units are likely to experience this phenomenon at high levels due to the ongoing nature and scope of patient care and treatment (Perry, Toffner, Merrick, & Dalton, 2011). It is important for nurses to be mindful of their own interactions with patients and to recognize the benefits of developing strategies to overcome or manage compassion fatigue effectively and without further complications (Perry et.al, 2011). Compassion fatigue will impact nurses in different ways; however, the common complications include high levels of stress, poor diet, mental fatigue, and challenges within personal and professional relationships (Perry et.al, 2011). From this perspective, nurses must be provided with the tools and resources that will enable them to self-manage more effectively and to be supportive of each other in times of need when patient care responsibilities become too significant (Perry et.al, 2011). Most importantly, the level and type of support that nurses receive is critical to their overall health and wellbeing, and if they are unable to manage their responsibilities to their patients, their work performance will suffer as a result (Perry et.al, 2011). Developing an effective work-life balance will take some of the pressure off of nurses in these situations and enable them to recognize their limitations with respect to their responsibilities at work and how they interact with patients on a regular basis (Perry et.al, 2011).

Finally, one of the critical areas of consideration for nurses who may experience compassion fatigue is group cohesion, whereby “it is critical to identify protective factors to prevent the onset of negative nurse outcomes (compassion fatigue, burnout, and job dissatisfaction) and to promote positive nurse outcomes (job satisfaction, compassion satisfaction)” (Li, Early, Mahrer, Klaristenfeld, & Gold, 2014, p. 89). From this perspective, it is important for nurses to have positive relationships with their colleagues and to take the steps that are required to ensure that patient care and treatment are well-balanced with the other responsibilities that are required (Li et.al, 2014). This perspective also demonstrates that nurses must be on the same page with each other and with their organizations with respect to their needs, expectations, and objectives as professionals, and this requires their employing organizations to also examine their responsibilities and to take the steps that are required to provide support in this regard (Li et.al, 2014). Nurses who receive this support in the workplace are likely to benefit significantly and will have greater job satisfaction and an ability to achieve a greater work-life balance on a regular basis (Li et.al, 2014).

Key Characteristics/Attributes

Compassion fatigue represents a difficult set of circumstances that impact nursing performance and quality of care. To be specific, this concept possesses a physical, emotional, mental, and psychological context, particularly as nurses are likely to be impacted in one or more ways by the stress that they experience due to working with patients with significant needs. Compassion fatigue is a phenomenon that impacts nurse wellbeing, as well as a concept under which there are many variables that contribute to the cause. As a concept, compassion fatigue also stimulates discussion regarding how nurses respond to these needs and their ability to bounce back and recover from these circumstances effectively. Compassion fatigue introduces questions regarding the influence of work-life balance and stress management on nursing in order to effectively manage the needs of patients with terminal illness and other needs.

Antecedents and Consequences

With compassion fatigue, the common antecedents for this concept include the administration of care and treatment to patients, particularly those who have terminal illnesses. When nurses administer care to this patient population, there is likely to be a high level of stress and possible emotional attachment to this group, and this reflects a need to further examine the challenges of the profession and their impact on patient wellbeing. Another antecedent is the resources that are available to nurses who work with these patients and what steps are required to maintain a positive and meaningful approach to administering patient care effectively.

The primary consequences of compassion fatigue include high levels of stress and frustration that are associated with this patient population in order to meet their needs effectively, while also maintaining standards that promote high quality of care. Nurses also experience stress and burnout at high levels because they often lack the support and guidance that is required to achieve an effective work-life balance in this regard. Another consequence of compassion fatigue is the lack of resources that are available to support their administration of care and treatment at a high level, perhaps because budgetary concerns are too great in other areas that influence the ability to be effective in managing this patient population. Finally, nurses often experience a number of limitations with respect to their ability to provide effective patient care because they are stretched too thin and cannot provide the level of care that they desire on a continuous basis.

Model Case

From the perspective of the nurse who experiences compassion fatigue, it is important to develop an understanding of the key characteristics of this concept and how it impacts nurses, their ability to administer patient care effectively, and their overall quality of life. A case example involves an oncology nurse with eight years of experience in this specialty area. Over the past year, her work performance has taken a hit because she is starting to question her level of commitment to her role and the responsibilities that she has at this level. Most importantly, the nurse has become emotionally attached and invested in her patients at a very high level (antecedent); therefore, she is often unable to let her work go when she leaves work and heads home. This has taken a toll on her emotional state, as she has become increasingly frustrated and emotional with her husband and two children at home (consequence). The nurse is very passionate about her role and her patients to the point that it is exhausting at times to come to work (antecedent); however, her personal life has suffered and she is experiencing side effects such as difficulty sleeping and poor diet as of late (consequence).

Contrary Case

A male nurse who has just been hired to work in the oncology unit has three years of prior experience working in a medical-surgical unit at the same hospital. He is very young, carefree, and enjoys his work, but does his best not to take it home with him. He is recently engaged and is planning a wedding, so much of his time is spent outside of work in this regard. At work, he appears to be communicative and supportive of other nurses, and often assists as needed in order to ensure that they are able to manage their workloads effectively. He is a positive person and does his best not to get too involved with his patients beyond the required standards of care and treatment. Therefore, he has not experienced any degree of compassion fatigue and has not developed a strong emotional attachment to the work environment. In addition, the nurse works out daily, follows a strict nutrition plan, and has an active social life, all of which keep him balanced and able to manage his workload in a positive manner. Therefore, he does not suffer from compassion fatigue and does not have a significant emotional attachment to his patients or his role as a professional nurse.

Related Case

A social worker who is responsible for working with low-income families in a local neighborhood has ten years of experience in this role. With each case, her responsibilities appear to be increasing; furthermore, she finds herself becoming increasingly attached to her cases and the families whom she supports (antecedent). At the same time, she is frustrated with the lack of resources that are available to she and her colleagues (antecedent). -As a result, the social worker is experiencing serious challenges outside of work, as she is constantly checking her emails and responding to them from other locations, while becoming increasingly disengaged from her friends and family (consequence). She is also experiencing difficulty sleeping and is consuming too much food on the go with low nutritional value (consequence). Her mind races constantly and she finds it difficult to concentrate, both in and out of work (consequence).

Borderline Case

A family member who is the next of kin for an aunt who is suffering from stage 4 breast cancer must make all medical decisions on her behalf, and she is currently not responding to treatment and is reaching the need for hospice care (antecedent). As a result, the family member is experiencing high levels of stress, numerous crying spells, and has become more difficult to deal with at work and at home (consequence). In addition, she is also withdrawn to some degree with her family and friends, and her colleagues at work have noticed a shift in her behavior and her stress level (consequence). The family member’s responsibility to her aunt requires significant time and effort until the appropriate decisions are made on her behalf (antecedent); therefore, it is difficult for the family member to move on with her own life and to balance her other responsibilities with her aunt’s health status and plan of care so that she experiences greater satisfaction throughout her life.

Conclusion

Compassion fatigue is a complex phenomenon that occurs in the nursing profession and in many other professions that has serious physical, mental, psychological, and emotional consequences that may disrupt the work-life balance and overall performance. Therefore, it is important for nurses to identify the concept, particularly when they work with patients who have terminal diseases or who require end-of-life care. Nurses do not often receive the appropriate level of support and guidance in the workplace environment in order to manage the responsibilities of caring for these patients. Therefore, it is likely that they will become increasingly overwhelmed and overstressed as this work continues. As a result, patient care administration and quality may suffer and impact overall work performance to the point that it becomes increasingly difficult to work under these conditions, thereby limiting the impact that nurses have on patient care quality.

Nurses may become stressed to the point of exhaustion; have trouble sleeping, eating, and exercising on a regular basis; and may not be able to balance their work and personal relationships effectively. These issues take a toll on their wellbeing and fall under the umbrella of compassion fatigue and its different complications. Therefore, nurses must be able to overcome or to minimize the effects of compassion fatigue through their efforts to achieve a greater work-life balance. This is not likely to occur unless they receive the support and guidance in the workplace that is necessary to achieve the desired balance and to support their endeavors to improve the balance that they need to administer high quality care to terminally ill patients on a continuous basis, while also considering the factors that will likely influence their personal lives in a positive manner and engage them in behaviors that will have lasting benefits throughout their lives.

References

Boyle, D. (2011). Countering compassion fatigue: A requisite nursing agenda.The Online Journal of Issues in Nursing, 16(1).

Drury, V., Craigie, M., Francis, K., Aoun, S., & Hegney, D. G. (2014). Compassion satisfaction, compassion fatigue, anxiety, depression and stress in registered nurses in Australia: Phase 2 results. Journal of Nursing Management, 22(4), 519-531.

Jenkins, B., & Warren, N. A. (2012). Concept analysis: compassion fatigue and effects upon critical care nurses. Critical care nursing quarterly, 35(4), 388-395.

Li, A., Early, S. F., Mahrer, N. E., Klaristenfeld, J. L., & Gold, J. I. (2014). Group cohesion and organizational commitment: protective factors for nurse residents’ job satisfaction, compassion fatigue, compassion satisfaction, and burnout. Journal of Professional Nursing, 30(1), 89-99.

Lombardo, B., & Eyre, C. (2011). Compassion fatigue: A nurse’s primer. OJIN: The Online Journal of Issues in Nursing, 16(1).

Melvin, C. S. (2012). Professional compassion fatigue: what is the true cost of nurses caring for the dying. International journal of palliative nursing, 18(12), 606-611.

Perry, B., Toffner, G., Merrick, T., & Dalton, J. (2011). An exploration of the experience of compassion fatigue in clinical oncology nurses. Canadian Oncology Nursing Journal/Revue canadienne de soins infirmiers en oncologie,21(2), 91-97.

Ray, S. L., Wong, C., White, D., & Heaslip, K. (2013). Compassion satisfaction, compassion fatigue, work life conditions, and burnout among frontline mental health care professionals. Traumatology, 19(4), 255.

Sabo, B. (2011). Reflecting on the concept of compassion fatigue. Online Journal of Issues in  Nursing, 16(1).

Yom, Y. H., & Kim, H. J. (2012). Effects of compassion satisfaction and social support in the relationship between compassion fatigue and burnout in hospital nurses. Journal of Korean Academy of Nursing, 42(6), 870-878.