Compassion Fatigue
Keri McDuffie
Grand Canyon University: HLT 310
May 29, 2013

Introduction
Compassion fatigue was first indentified by Jonson in 1992 when she noticed a group of nurses in the Emergency Department who seemed to have lost their ability to nurture. (Coetzee, Klopper 2010) Compassion fatigue, although identified a decade ago, was never really clarified, defined or explored, leaving nurses predominantly disposition to compassion fatigue unaware of how to identify or how to prevent it from happening. Nurses can experience compassion fatigue when they too begin to feel similar fear, pain and suffering their patients are experiencing, indirectly taking on the patients feelings as their own. Symptoms are gradual in the beginning, with the symptoms like weariness and malaises to altering the nurse’s ability to cope with stress ultimately having negative psychological and physical consequences. (Boyle 2011)
Boyle (2011) describes those at highest risk for developing compassion fatigue are those who are on the front lines of medicine, those who absorb traumatic stress of those they help. While many first responders like firefighters, police and paramedics readily have complex training and debriefing modules to help them cope with the traumatic situations (Boyle 2011) they encounter every day, nurses do not. Nurses often have an ongoing relationship with their patient care and are responsible for the patient 24 hours a day, daily having to respond to acute care situations and ongoing life threatening emergencies, consistently absorbing the needs of the patient and patient family members.
Warning signs of five concepts of compassion fatigue
The five defining characteristics that have be identified they may contribute to the risk of passion fatigue include; the emotional state of the helper, individual expectations and ability to process information, ego defensive processes, idea logic belief system and coping abilities/support system. (Boyle 2011)
Emotional State of the Helper The emotional state of the helper describes a person’s ability to interact with the outside world. If a person is typically happy light hearted and tends to see things on the bright side, she or he might have a better chance of not suffering from compassion fatigue then say a depressive down and out type person. For example, let’s say that nurse Jackie is an eager new nurse just starting out in the ED, who has a special relationship with all her patients and finds reward and satisfaction in her job, she has a positive disposition and tries to make light of heavy situations, although she is working extra hours and is overloaded by short staffing she takes pride in her work and believes she makes a difference. On the other hand let’s say nurse Nancy is an older seasoned nurse who has worked on the oncology unit for 15 years, although compassionate, Nancy tends to see the bad in every situation and stresses out when things get rough, she cares for her patients but is always worried she doesn’t do enough to make a difference when it matters most. It’s the difference in the emotional states that makes a difference in how they can process a heavy stressful situation.
Individual Expectations and ability to Process Information When a situation does not work out the way a person would expect or hoped it to be it can increase a person’s risk for compassion fatigue as well. New nurses are often victims to compassion fatigue often due to unmet expectations of the job. Ne young nurse tend to idealistic and highly motivated are often unprepared for the role ambiguity, heavy workload and changing environment. (Bush 2009) For example, new Nurse Betty has a strong sense of self and believes she is going to make a difference in healthcare, she has strong convictions and often excelled in her studies and was a favorite in clinical, always going the extra mile to make a difference, after school she got a job in ED where she had a constant heavy fast paced workload, where no matter how hard she tried it never seemed to make a difference, patients did not take to her as well as those in school and because of the fast paced environment found herself making more mistakes then usual, she was falling short of the picture she had painted for herself, and was now unsure of her commitment to nursing. She was falling short of the expectations of not only her job but herself, making her predisposed to compassion fatigue.
Ego Defensive Processes How well a person can handle stress and process traumatic can also increase the risk for compassion fatigue. A highly sensitive easily manipulated individual is a nurse on a trauma floor, working with patients in a constant state of pain who have experienced traumatic events who will look to the nurse for support, will not be able to cope with all the stress associated with that type of environment, it is just simply too much to process and being highly sensitive will only make working in the environment worse.
Ideological Beliefs A person’s ideologic belief is how they tend to look at the world, i.e. one’s goals, expectations and actions. If a nurse who believes that all people should be responsible for their own fate, that it is a person’s choice to be in the situation they are in, works in a community clinic with at risk teens would find it emotionally and mentally exhausting. He would be in a constant battle with trying to show care and understanding for the same individuals he personally believes has the power to change their situation. He would be in a constant state of inner turmoil and would eventually succumb to compassion fatigue.
Coping Abilities/Support System In the healthcare profession it is very important to have strong coping and support systems in place, whether it is religion, family or some other type of personal coping mechanism. Nurse encounter all different kinds of illness, metal, physical, emotional, if we are constantly providing support and guidance to those who have no one, then we need some kind of support to fall back on. Sometimes the only way a nurse can survive getting though a rough day is knowing she has family at home who she can lean on after a long day. If a nurse doesn’t have family, friends or way of dealing with all the tress they encounter on a daily basis then it is inevitable that they will crack under the pressure of the job.
Physical, emotional, and spiritual needs Compassion fatigue can affect every aspect of a person, including physically, emotionally and spiritually. It is obvious that nursing is a high demand underappreciated job and only a certain type of person is able to handle that kind of situation. Knowing your physical limits are important, overworked and being under staffed can have profound effects on your body, if you don’t get proper rest and recognize when you need to ate a breather. If a nurse is experiencing compassion fatigue it can manifest into physical symptoms such as, aches and pains, headaches, weariness, loss of strength, and demised performance. (Coetzee&Koppler 2010) It is important to protect your emotional state as well, being emotionally involved with your patients is just a part of the territory, and so you have to be careful not run yourself into a depression. Your pouring all your emotions into your patients every day, you experience happiness with them when hearing good news, hold their hands in time of grief and go to battle for them when you don’t feel their getting proper treatment. If you can’t recharge and take time to regroup your emotions you can become, desensitized, withdrawn and irritable, unable to be compassionate for your patients anymore. Spirituality is a big part of your emotional state as well, taking time to parry and reflect, let go of things you can’t control and being able to seek solace in God will all help both your spiritual and emotional state, making you more emotionally available to your patients.
Interventions
The irony of compassion fatigue is that while nurses are acutely aware of their patient’s needs, they often forget to nurture themselves. (Boyle 2011) The fact is that it’s impossible to be around so much suffering and grief and not expect it to have an effect on you; you can’t play with fire and expect not to get burned a little. Interventions for compassion fatigue are a multi-dimensional and holistic. Much like how compassion fatigue affects every part of a person, spiritually, mentally, physically and emotionally. One way many hospitals have begun to approach helping nurses who feel overworked and tired is through employee assistance programs. (Boyle 2011) Employee assistance programs often involve free onsite counseling to anyone who needs it, and can refer employees further if they feel they are beyond the support and help they can provide. It’s important for individuals to recognize personal boundaries in work and personal life, have limits can help reduce a lot of stress that we sometimes overload ourselves with. Meditation, praying or establish a relationship with your local church community can also benefit the worn and weary.
Conclusion
Help is available, recognizing the issue is half way to recovery, establishing balance in work and personal life, having a support system, and having therapeutic coping mechanisms are all tools that can be used to manage compassion fatigue. Bottom line, passion fatigue is real and it affects many different professional on different levels, more research and studies are still needed to further explore this relatively new phenomenon.

References
Boyle, D. A. (2011). Countering Compassion Fatigue: A Requisite Nursing
Agenda. Online Journal Of Issues In Nursing, 16(1), 1. doi:10.3912/OJIN.Vol16No01Man02 retrieved from http://library.gcu.edu:2048/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2011048803&site=ehost-live&scope=site

Bush, N. (2009). Compassion fatigue: are you at risk?. Oncology Nursing Forum, 36(1),
24-28. doi:10.1188/09.ONF.24-28 retrieved from http://library.gcu.edu:2048/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2010154574&site=ehost-live&scope=site

Coetzee, S., & Klopper, H. (2010). Compassion fatigue within nursing practice: a concept analysis. Nursing & Health Sciences, 12(2), 235-243. doi:10.1111/j.1442-2018.2010.00526.x retrieved from http://library.gcu.edu:2048/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2010664978&site=ehost-live&scope=site