The work of nurses and other caregivers is very challenging because it demands a lot of time besides exerting a negative impact on people’s physical and emotional wellbeing. Different studies have found that many nurses, especially those assigned to the intensive care, operating rooms, and mental health departments, are exposed to several occupational risks (Boyle, 2011; Sabo, 2011). These risks include occupational stress, pain, and prolonged suffering. Compassion fatigue is a term used to describe the abovementioned factors and other stressors that trouble nurses and caregivers at the workplace. According to Sabo (2011), the term compassion fatigue is defined as, “the natural consequent behaviors and emotions resulting from a traumatizing event [that is] experienced by a significant other – stress resulting from helping, or wanting to help, a traumatized or suffering person” (p. 1). This concept is used interchangeably with other nursing issues such as burnout, secondary traumatic stress, vicarious trauma, emotional contagion, and compulsive sensitivity (Bush, 2009). This paper describes the nature, causes, and warning signs of the abovementioned concepts of compassion fatigue. In addition, the paper explains the physical, emotional, and spiritual needs of nurses and other caregivers. Finally, the paper proposes various coping strategies and resources that the caregivers can use to combat compassion fatigue and other related issues.
Concepts of Compassion Fatigue
Espeland (2006) notes that burnout is widely defined as, “a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment…among individuals who work with [suffering] people on a daily basis” (pp. 178-179). In the context of nursing, burnout may refer to a gradual, but prolonged process of physical and mental exhaustion that arises from too much work (Sabo, 2011). The major causes of burnout are classified into personality attributes, workplace factors, and work-related characteristics. Specifically, people who have poor problem-solving skills and avoidant characteristics are at a high risk for developing work-related burnout. Similarly, burnout may arise from high patient-to-nurse ratios, work complexities, lack of social support or community, value conflict, and lack of autonomy. On the other hand, some of the major warning signs of burnout may include chronic exhaustion, negative emotions (frustration, depression, anger), and feelings of ineffectiveness (Espeland, 2009).
Secondary Traumatic Stress
Secondary traumatic stress or borrowed stress refers to a situation whereby the caregiver experiences increased trauma and stress because of caring for traumatized and depressed patients (Sabo, 2011). Here, note that the caregiver may become emotionally-engaged with patients through a therapeutic relationship. In so doing, the caregiver tends to absorb or borrow the feelings and experiences of their patients, including trauma and stress. The onset of secondary traumatic stress is closely associated with various factors such as increased caregiver engagement and empathy as well as lack of work-life balance. Moreover, the duration of the therapeutic relationship may influence the development of secondary traumatic stress. The major warning signs of secondary traumatic stress may include extended work absenteeism, depression, frequent unhealthiness, and provision of suboptimal services (Chen, Lin, Wang, & Hou, 2009).
In the literature, it is well established that psychological distress affects both the traumatized patients as well as the attending healthcare professionals. Vicarious trauma occurs when the caregivers become traumatized after providing care to suffering or traumatized patients (Sabo, 2011). It may arise when the caregivers are exposed to patient accounts of cruelty, suffering, and pain as well as through the process of empathic openness (Sabo, 2011). Its major warning signs include difficulties in the establishment of interpersonal relationships, the inability to control strong emotions, experiencing frequent intrusive memories, and losing control of one’s own independence (Sabo, 2011).
Compulsive sensitivity occurs when the caregivers become highly concerned about the needs, feelings, and experiences of other people. While this is good in terms of ensuring that the caregivers can provide the best possible care to their patients, it may cause a lot of harm to the caregiver in the long-run. More specifically, compulsive sensitivity is disadvantageous because it forces the caregiver to become eternally committed and responsible for all the needs of the patients. Moreover, compulsive sensitivity is both mentally and physically demanding, and it may eventually cause stress and burnout. Furthermore, compulsive sensitivity is closely associated with excessive caring, unnecessary worries, and psychological illnesses as well as physical injuries (Boyle, 2011).
Emotional contagion develops when the caregivers become emotionally- and empathically-engaged with their patients. Emotional contagion refers to a situation whereby an individual impersonates the characteristics of other people, including facial expressions, movements, and vocalizations as well as emotions (Bakker, Le Blanc, & Schaufeli, 2005). Emotional contagion may occur unconsciously or consciously. When a caregiver ‘tunes in’ to the feelings, experiences, and emotions of their patients, they may eventually begin to imagine that they are undergoing similar experiences. In so doing, the caregiver may become angry, sad, traumatized, or sickly by interacting with patients. The major warning signs of emotional contagion may include resentment, unnecessary anger, depression, and increased irritability (Bakker et al., 2005).
The Physical, Emotional, and Spiritual Needs of Caregivers
Thus far, it appears that various issues related to compassion fatigue may cause a lot of suffering, exhaustion, and hopelessness among nurses and other caregivers. Therefore, there is an urgent need for nurses and caregivers to take control of their work-life issues by ensuring that their physical, emotional, and spiritual needs are fulfilled adequately. Here, note that the caregivers have different physical needs such as commitments to regular physical activity, leisure time, proper nutrition, and proper rest or sleep. These needs must be fulfilled to ensure that the caregivers operate optimally because they are not “superhuman” (Chapman, 2007). Similarly, all caregivers have emotional needs, which should also be fulfilled. For instance, there is need for the caregivers to engage in relaxation and mental stimulation exercises to ensure that their mind, body, and soul are in harmony. Moreover, it is important for the caregivers to relax their muscles and other body parts after a long day’s work to achieve both physical and emotional restoration (Chapman, 2007).
Finally, all caregivers must fulfill their spiritual needs by taking care of their souls. Usually, the soul receives minimal attention compared to the body and mind, but it is imperative to note that the lack of spiritual health may eventually lead to an unhealthy body and mind. Some of the most important spiritual needs that must be realized by everyone include restoration of the soul, spiritual encouragement, and building one’s faith. These three spiritual needs are very important because they play a central role in the development of good health and emotional wellbeing. For instance, spiritual nourishment is an effective way of achieving internal peace; and usually, it helps people to overcome worries, stress, anger, hopelessness, and depression. Similarly, spiritual mediation plays a key role in stimulating body relaxation, which in turn helps people to relief stress and anxiety (Chapman, 2007).
Recommendations and Conclusion
From the foregoing discussions, it appears that nursing is a challenging and extremely-demanding profession owing to the existence of many work-related risks such as compassion fatigue and other issues such as burnout, secondary traumatic stress, and vicarious traumatization. There are many factors that may contribute to the development of the abovementioned work-related issues, but it appears that the most prevalent cause is empathic engagement. When nurses and other caregivers become emotionally-engaged with their patients, they run the risk of borrowing the latter’s pain and suffering as well as their emotions and behaviors. One of the best known strategies that are used to combat compassion fatigue involves providing compassionate care to oneself. Here, note that it is important for nurses and other caregivers to remain resilient and unshaken as they provide care to patients who have a high level of trauma, pain, and suffering (Bush, 2009). This can only occur when one is prepared mentally, physically, and emotionally to face all kinds of situations.
Furthermore, nurses and other caregivers must be willing to remain assertive and maintain stable work-life boundaries. Assertiveness is a positive trait that allows individuals to interact with others without compromising their own needs and rights as well as those of other people. Effective communication is another important characteristic that should be practiced by all nurses and other caregivers to avoid conflicts with colleagues and other people. In addition, planning for time and undertaking manageable amounts of work will help nurses and other caregivers to reduce burnout and occupational stress (Gupta & Woodman, 2010). Lastly, it is important for nurses and other caregivers to develop a positive attitude towards work and life so that they can approach different challenges and struggles with an open mind (Espeland, 2006).
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