Reflecting on the Concept of Compassion Fatigue

Brenda Sabo, PhD, RN

Disclosures

Online J Issues Nurs. 2011;16(1) 

In This Article

Abstract and Introduction

Abstract

A review of the literature on the health of nurses leaves little doubt that their work may take a toll on their psychosocial and physical health and well being.Nurses working in several specialty practice areas, such as intensive care, mental health, paediatrics, and oncology have been found to be particularly vulnerable to work-related stress. Several types of occupational stress have been identified, including burnout, compassion fatigue, and vicarious traumatization. While the emphasis of this article is on compassion fatigue and its theoretical conceptualization, the concepts of burnout and vicarious traumatization are also discussed. Two questions are posed for discussion: 1) Does compassion fatigue exist on a continuum of occupational stress? If so, is burnout a pre-condition for compassion fatigue; 2) What are the relationships between the types of occupational stress? To what extent does non-resolution of compassion fatigue increase the risk for developing vicarious traumatization? Case examples are provided to support this discussion.

Introduction

A review of the literature on the health of nurses leaves little doubt that their work may take a toll on their psychosocial and physical health and well being. Nurses working in several specialty practice areas, such as intensive care (Bakker, Le Blanc, & Schaufeli, 2005); mental health (Jenkins & Elliott, 2004), paediatrics; (Maytum, Bielski-Heiman, & Garwick, 2004); and oncology (Bakker, Fitch, Green, Butler, & Olsen, 2006; Ekedahl & Wengstrom, 2007), have been found to be particularly vulnerable to work-related stress. Researchers exploring the nature of occupational stress among care providers, including nurses, physicians, social workers, and psychologists, have suggested that aspects of the therapeutic relationship, specifically empathy and engagement, which are fundamental components of nursing, play a role in the onset of the stress. Further, non-relationship factors may also contribute to nurses experiencing a sense of ambiguity and/or conflict about their ability to provide the care they think is needed. These factors include increased patient complexity, reliance on advancing technology to sustain or prolong life, continued emphasis on medical models supporting cure over care, and perceived lack of time (Blomberg & Sahlberg-Blom, 2007; Edwards & Burnard, 2003; Ekedahl & Wengstrom, 2007; Hertting, 2003; Hertting, Nilsson, Theorell, & Larsson, 2004). It is possible that ongoing exposure to these factors may lead nurses to experience compassion fatigue, one form of occupational stress.

In this article I will provide an overview of the concepts of burnout, compassion fatigue, and vicarious traumatisation (see Table). While emphasis is placed on compassion fatigue and its underlying theory, an overview of the other two types of occupational stress, namely burnout and vicarious traumatisation, are also provided. Following this overview I will address two questions: 1) Is compassion fatigue part of a continuum of occupations stress; if so, is burnout a precondition to compassion fatigue? and 2) What are the relationships between types of occupational stress and to what extent does non-resolution of compassion fatigue increase the risk for developing vicarious traumatization? I will provide three scenarios to address these questions and enhance the discussion.

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