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

A Clinical Perspective

The purpose of this article is to examine the physical and emotional cost of hospice/palliative care nurses caring for seriously ill, traumatized, suffering, and dying patients. Although it is recognized that caring for these patients can be considered a privilege, there is often associated costs (both physical and emotional) to nurses in this area of practice. Although some of the emotional and psychological symptoms of burnout, PCF, and STSD clearly overlap, negative consequences do occur as a result of the experience and may be difficult to reverse. It is the need to recognize and treat the distressed nurse experiencing these symptoms that is critically important.

Bruce and Boston[28] described the emotional impact that 7 nurses and physicians experienced while working in an inpatient palliative care setting. These health care providers described feelings of guilt, dissatisfaction, letting patients down, and concerns about the shift away from supporting patients and families during the dying process. Participants described the notion of the ripple effect with suffering. One participant described how the pain or suffering of the patient spreads out like the ripples of a pond after a stone is thrown in. This participant stated that, at times, she was unable to differentiate between what was her pain and what was a rippling effect of the patient's pain.[15]

Showalter[23] described the concept of "Krumpled Kleenex" when health care providers are not adequately supported and experience "remnants that become stuffed," in other words, that their own emotional pain becomes stuffed, much like Kleenex being crumpled in one's pocket. Furthermore, many professional caregivers report that in addition to the everyday work stressors, "there is a sense that one never has time, or recognition of the need to 'refill the well' in their personal life."[23] Showalter[23] also suggested that when health care professionals suffer with PCF, they become physically, mentally, and spiritually exhausted, yet they continue to provide care for their patients. Many have described this syndrome as "being sucked into a vacuum that slowly brings them down."[23]

Nurses who have the capability to be more resilient seem to cope better with distressing experiences within the work environment. Resiliency within a nurse is a highly positive trait that enables some nurses to more adeptly handle emotionally charged work stressors. The emerging field of psychoneuroimmunology provides evidence of a significant biologic link between the state of mind and emotions of an individual and the health and well-being of that individual. Stress, particularly prolonged stress, can have negative effects both physically and mentally.[29]