Countering Compassion Fatigue: A Requisite Nursing Agenda

Deborah A. Boyle, MSN, RN, AOCNS®, FAAN

Disclosures

Online J Issues Nurs. 2011;16(1) 

In This Article

Abstract and Introduction

Abstract

Nurses have a longstanding history of witnessing the tragedy experienced by patients and families; however, their own reactions to profound loss and premature death have not been systematically addressed. There is a paucity of research describing interventions to prevent or minimize the ramifications of repeated exposure to traumatic events in the clinical workplace. Compassion fatigue is a contemporary label affixed to the concept of personal vicarious exposure to trauma on a regular basis. Yet this phenomenon of compassion fatigue lacks clarity. In this article, the author begins by describing compassion fatigue and distinguishing compassion fatigue from burnout. Next she discusses risk factors for, and the assessment of compassion fatigue. The need to support nurses who witness tragedy and workplace interventions to confront compassion fatigue are described.

Introduction

Nurses care for ill, wounded, traumatized, and vulnerable patients in their charge. This exposes them to considerable pain, trauma, and suffering on a routine basis (Coetzee & Klopper, 2010; Hooper, Craig, Janvrin, Wetzel, & Reimels, 2010). While many nurses perceive their work as a calling, few anticipate the emotional implications and sequelae that come from their close interpersonal relationships with patients and families (Aycock & Boyle, 2009; Walton & Alvarez, 2010). Compassion, or the feeling of emotion which ensues when a person is moved by the distress or suffering of another, is foundational to nursing practice (Hooper, et al., 2010; Schantz, 2007). A requisite competency is the repeated generation of compassion energy to foster connectedness and offer nurturance to those requiring nursing care (Dunn, 2009).

The term compassion fatigue was first used in the context of the study of burnout in nurses nearly two decades ago. At that time, Joinson (1992) coined the term to describe the 'loss of the ability to nurture' that was noted in some nurses in emergency department settings. Multiple environmental stressors, such as expanding workload and long hours, coupled with the need to respond to complex patient needs, including pain, traumatic injury, and emotional distress, resulted in nurses feeling tired, depressed, angry, ineffective, apathetic, and detached. Somatic complaints in nurses were also noted. These complaints often included headaches, insomnia, and gastrointestinal distress. This phenomenon appeared to escalate gradually over time as a result of cumulative stress, particularly when nurses ignored their symptoms and did not attend to their own emotional needs (Bush, 2009).

Figley (1995) subsequently identified compassion fatigue as a more user-friendly term to describe secondary traumatic stress disorder (STSD), an outcome of counter-transference whereby empathic caregivers indirectly experience the trauma of their patients (Kanter, 2007; Quinal, Harford, & Rutledge, 2009). As Figley (1995) continued to observe this phenomenon in mental health workers, he explained:

There is a cost to caring. Professionals who listen to clients' stories of fear, pain and suffering may feel similar fear, pain and suffering because they care. Sometimes we feel we are losing our own sense of self to the clients we serve (p.1).

Compassion fatigue historically has been studied in professional populations other than nursing (Yoder, 2010). Over the past two decades the dynamics of compassion fatigue have received more attention within the realm of caregiving stress, considering a wider array of health professionals. As the field of traumatology has grown, so has an interest in the nature and emotional complexity of professional caregiver reactions specific to the helping process (Thomas & Wilson, 2004).

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