Concept Analysis: Causes and Effects of Compassion Fatigue

Introduction

 A concept analysis is a structured process which provides nurses with the meaning for a nursing theory and lays the foundation for application of the concept in nursing practice. The following dissertation will help to discuss compassion fatigue as it relates to nursing and briefly describe the nursing theory utilized. The theoretical model that supports the compassion fatigue concept is Jean Watson’s theory of human caring. According to Sitzman and Watson (2014) self-care is an essential part of being able to effectively care for and support a healing environment for others. This paper will include the following sections: a definition/explanation of compassion fatigue, literature review, defining attributes, antecedent and consequences related to compassion fatigue, empirical referents, construct cases, and theoretical applications of compassion fatigue in nursing.

Definition/explanation of concept

Nurses are often considered caring and compassionate individuals. Nurses are continuously giving oneself to put others needs before their own. Peters (2018) states “compassion, empathetic ability, high use of self, and maintaining composure in stressful situations are reasons nurses are excellent caregivers.” As nurses experience stressful and traumatic situations throughout their work day, they can develop compassion fatigue. Sheppard (2015) explains that compassion fatigue may result when a nurse loses satisfaction from doing their job well, or other job-related distress that outweighs job satisfaction. Sacco (2017) states “In caring for severely ill patients and their families, frequently in stressful settings, it is recognized that nurses experience the negative physical and mental health manifestations of burnout, secondary traumatic stress, and compassion fatigue.” Being exposed to traumatic or emotional experiences by our patients leaves us feeling emotionally distraught at the end of the day. As we form close bonds with our patient’s we put ourselves at higher risk for experiencing compassion fatigue. Nurses may leave the nursing profession because they experience career dissatisfaction, poor job satisfaction, and feelings of spiritual emptiness which resulted from compassion fatigue (Harris & Griffin, 2015).

Literature review

 In a review of current nursing literature, the common theme amongst articles is that compassion fatigue can happen to any nurse and can be unpredictable. Throughout the nursing literature, researchers have taken on different perspectives on the concept of compassion fatigue. The nursing profession is both physically and emotionally demanding. Harris and Griffin (2015) define compassion fatigue as “physical, emotional, and spiritual result of chronic self-sacrifice and/or prolonged exposure to difficult situations that renders a person unable to love, nurture, care for, or empathize with another’s suffering.” Repeated exposure to emotional events results in nurses losing stamina and their motivation to care for patients effectively. Mennella and Pravikoff (2108) state that compassion fatigue has been identified as the main stress experienced in the nursing profession. Compassion fatigue has the ability to cause psychological and emotional distress in nurses who are continuously exposed to traumatic and emotional events while on the job. According to Hunsaker, Chen, Maughan, and Heaston (2015) described nurses affected by compassion fatigue as becoming ineffective in their work, depressed, apathetic, and emotionally detached from their patients. In an article by Sheppard (2015) she describes how burnout or compassion fatigue can result from certain conditions such as long work hours, short-staffing, workplace incivility, and feelings of dismissal or invalidation by their managers. Sacco (2017) describes nurses that have the most empathy, are at the greatest risk for developing compassion fatigue. In an article by Nolte, Downing, Temane and Hastings (2017) they describe specific consequences that may result from compassion fatigue which include fear, anxiety, hypervigilance, difficulty concentrating, sleep disturbances, feeling burdened, fatigued and overwhelmed. Overall, the literature shows many negative effects compassion fatigue can have on any healthcare provider.

Defining attributes

 Peters (2018) describes four essential attributes of compassion fatigue which include, diminished endurance/energy, declining empathic ability, helplessness/hopelessness, and emotional exhaustion. When you develop a close relationship with a patient and they pass away, you feel as if you could have done more and begin to place blame on oneself. Overtime, this repeated exposure begins to take its toll on a nurse’s wellbeing which then leads to compassion fatigue. Berger, Polka, Smoot, and Owen (2015) describe compassion fatigue as being responsible for the development of stress-related symptoms and job dissatisfaction among caregivers which leads to decreased productivity, increased sick days, and job turnover resulting in negative consequences for patients and employers. Sheppard (2015) states that “nurses who skip breaks, take extra shifts, or come in on their days off out of sense of duty may be more at risk for compassion fatigue.” Repeated exposure to stressful situations puts healthcare providers at the greatest risk of developing compassion fatigue.

Antecedent and Consequence

 The repeated exposure to suffering, chronic and intense nature of patient contact and prolonged stress are all antecedents of compassion fatigue. According to Harris and Griffin (2015) one antecedent is poor or lack of personal and professional support systems. According to Nolte, Downing, Temane, and Hastings (2017) difficult patient workloads and shortage of staff lead to compassion fatigue.  “Feeling a lack of support at work created a sense of being alone in a crowded room despite the presence of other nurses and healthcare providers”. (Nolte, Downing, Temane, and Hastings, 2017) One consequence of compassion fatigue is decreased coping mechanisms. Nurses may turn to alcohol or substance abuse to cope with compassion fatigue. Peters (2018) states that alcohol or substance abuse, absenteeism, and physical weight fluctuations may occur as a result of compassion fatigue. In an article by Berger, Polka, Smoot, and Owens (2015) they state that “empathic caregivers indirectly experience trauma of their patients, and their efforts to empathize and show compassion often leads to inadequate self-care behaviors and increased self-sacrifice.” According to Harris and Griffin (2015) nurses experiencing compassion fatigue often have a decline in their own personal health, which leads to inadequate nursing performance and patients feeling dissatisfied with the quality of nursing care received. 

Empirical Referents

 Two empirical referents to help identify compassion fatigue amongst caregivers are the Professional quality of life scale (ProQOL) and the compassion fatigue self-test. These scales are used to measure those who are vulnerable or at risk of developing compassion fatigue. The ProQOL that has been in use since 1995, is the most commonly used measure of the negative and positive effects of helping others who experience trauma and suffering. Sacco and Copel (2017) discussed that the compassion fatigue self-test was introduced in the 1980’s and is another questionnaire used to determine your risk of developing compassion fatigue.

Construct cases

 Model Case: J.R. is a 55-year old nurse with almost 30 years of experience in the pediatric intensive care unit. She is always expressing the joy and reward she sees from being able to help patients and their families during their stay. She is known on the unit for being very competent and positive in building up the team. She is a role model for fellow nurses by teaching them how to develop positive coping mechanisms and emphasizes self-care. She is active in the community by attending church functions and regularly spending time with friends. She believes she is at risk for burnout but keeps a positive attitude, appreciates everyone around her, and is always smiling.

 Borderline case: S.S. is a 31-year old nurse who works in an emergency department at a local hospital. She started working there without any critical care experience. She finds her job rewarding and satisfying but struggles with very complex patients. She sees many critical patients throughout her work day but struggles with a fear that she may do something wrong. Although she is struggling with self-confidence, she continues to ask questions and utilize her nursing resources.  She believes by taking a vacation every couple month’s will help her to re-energize and maintain a greater appreciation for her nursing career.

Contrary case: S. J. is a 45-year old nurse working on a renal diabetic unit at a community hospital. She has been on the same unit for 15 years. S.J. is a single mother who works full time and often works overtime to pay the bills. S.J. has missed out on many of her kids’ school events and hasn’t taken a vacation in over 5 years. Many changes have occurred on her unit and she has expressed to her managers the dislike for the new employees and dissatisfaction for her job. Last week, she made a medication error which caused a severe allergic reaction and her patient had to be transferred to a higher level of care. Since the event she has been having nightmares and cannot sleep. She has called out of work for many days and has started to look for a new job, even considering finding a new profession.

Theoretical applications of the concept

 The theoretical model that supports the compassion fatigue concept is Jean Watson’s theory of human caring. Sitzman and Watson (2014) describe Watson’s Theory of human caring as the basic empathic relationship between the patient and the nurse. According to Sitzman and Watson (2014) self-care is an essential part of being able to care for and support a healing environment for others. Self-care activities include self-reflection, yoga, meditation, breathing exercises, physical exercise, and eating a well-balanced diet. By engaging in self-care activities nurses can decrease the effects that may result from compassion fatigue. 

Conclusion

 Compassion fatigue is an important concept for healthcare professionals to understand. Nurses need to acknowledge and recognize the signs and symptoms, not only in themselves, but in their colleagues. Having a strong and supportive work environment will help with the negative effects of compassion fatigue. As I move forward in my role as a family nurse practitioner, I must always remember to take some time out of the day to focus on me. As Jean Watson discussed in her human caring theory, self-care activities are very important when working in such stressful situations. Sitzman and Watson (2014) state “caring is inclusive, circular, and expansive: Caring for self, caring for each other, caring for patients/clients/families, caring for the environment/nature, and the universe.” Eating a healthy well-balanced diet and staying physically active will help combat the effects of compassion fatigue.

References

• Berger, J., Polivka, B., Smoot, E., & Owens, H. (2015). Compassion fatigue in pediatric nurses. Journal of Pediatric Nursing, 30(6), 17. doi:10.1016/j.pedn.2015.02.005
• Harris, C., & Griffin, M. (2015). Nursing on Empty. Journal of Christian Nursing, 32(2). doi:10.1097/cnj.0000000000000175
• Hunsaker, S., Chen, H., Maughan, D., & Heaston, S. (2015). Factors that influence the development of compassion fatigue, burnout, and compassion satisfaction in emergency department nurses. Journal of Nursing Scholarship, 47(2), 186-194. doi:10.1111/jnu.12122
• Mennella H; Pravikoff D; CINAHL Nursing Guide, EBSCO Publishing, 2018 June 22 (Evidence Based Care Sheet), Database: Nursing Reference Center Plus
• Nolte, A. G., Downing, C., Temane, A., & Hastings-Tolsma, M. (2017). Compassion fatigue in nurses: A metasynthesis. Journal of Clinical Nursing, 26(23-24), 4364-4378. doi:10.1111/jocn.13766
• Peters, E. (2018). Compassion fatigue in nursing: A concept analysis. Nursing Forum, 53 (4), 466-480. doi: 10.1111/nuf.12274
• Sacco, T. L., & Copel, L. C. (2017). Compassion satisfaction: A concept analysis in nursing. Nursing Forum, 53(1), 76-83. doi:10.1111/nuf.12213
• Sheppard, K. (2015). Compassion fatigue among registered nurses: Connecting theory and research. Applied Nursing Research, 28(1), 57-59. doi:10.1016/j.apnr.2014.10.007
• Sitzman, K., Watson, J., (2014). Caring science, mindful practice: Implementing Watson’s human caring theory. New York, NY: Springer Publishing Company, LLC.