Historical Review in Understanding Burnout, Professional Compassion Fatigue, and Secondary Traumatic Stress Disorder From a Hospice and Palliative Nursing Perspective

Christina S. Melvin, MS, PHCNS, BC, CHPN


Journal of Hospice and Palliative Nursing. 2015;17(1):66-72. 

In This Article

Abstract and Introduction


This article compares and contrasts the terms burnout, professional compassion fatigue, and secondary traumatic stress disorder as they relate to hospice and palliative care nurses. Burnout describes distress experienced by employees related to job expectations and working conditions. In the 1990s, the term professional compassion fatigue emerged to describe the weariness experienced by health care providers repeatedly exposed to seriously ill, traumatized, suffering, and dying patients. More recently, the term secondary traumatic stress disorder has been used to describe the reactions of health care providers who experience a traumatic event vicariously by caring for seriously ill and dying patients. Recommendations include early detection of burnout, professional compassion fatigue, and secondary traumatic stress disorder. Strategies to preserve the nurse's ability to cope include developing supports, personal awareness, and refinement of resiliency skills, self-care strategies, assertiveness skills, debriefing sessions, spirituality, and the ability of the nurse to say no. The symptoms, recommendations, and intervention strategies for nurses are described.


This article will examine the physical and emotional costs of hospice/palliative care nurses caring for seriously ill, traumatized, suffering, and dying patients. Nurses spend more time in direct contact with patients and families than any other health care discipline, which predisposes them to physical and emotional distress. One of the underpinnings of end-of-life care is the provision of exquisite symptom management; the nurse is in a strong position to provide this expertise.[1] Pioneers in hospice and palliative care Dr Florence Wald, Dame Cecily Saunders, and Dr Elizabeth Kubler-Ross emphasized that persons in need of care at end of life "merit the most competent, expert, evidenced-based care provided in a way that embodies compassion, respect for dignity, and an appreciation for the whole person and family."[1]

Hospice and palliative care professionals continually witness the suffering and deaths of their patients; these nurses are at risk of developing physical and emotional distress. Nurses play a critical role in caring for patients who are suffering; the relief of suffering is at the center of nurses' work as a profession committed to dealing with the human response to illness, injury and suffering. Although this care is at the core of what nurses do, it is this very work that predisposes nurses to distress.

This article is a review of the literature, with an explanation of these terms that will outline the progression in the understanding of the physical and emotional distress that nurses may experience while caring for patients who are suffering, traumatized, seriously ill, and/or dying. The terms that will be discussed include burnout, professional compassion fatigue (PCF), and secondary traumatic stress disorder (STSD). Furthermore, case studies are included as exemplars illustrating these terms. As our understanding of these phenomena grows, so can the recognition and treatment. Although there are differences in definitions and symptoms in these terms, symptoms are recognizable and strategies must be implemented to assist distressed hospice/palliative care nurses. It is therefore essential that nurses understand what these phenomena are, can identify the symptoms if these appear, and are able to intervene should these be noted in their peers and/or themselves.