The Phenomenon of Compassion Fatigue in Oncology Nurses

Introduction

"Our patients instruct us in so much that is painful, but our patients lead us to love, appreciate, and enjoy so much that we would not otherwise have known to cherish. We come to care about what they care about because they care about it and we care for them"

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(Levine, 2005)

Levine in his words, beautifully captures the sentiments that draw most nurses into the field of oncology, but sometimes these same emotions and caring for their terminally ill patients can make work-life difficult for oncology nurses sometimes. After repeated exposure to patients' traumatic experiences such as suffering, end-of-life care, and death, oncology staff may experience secondary traumatic stress (STS) or compassion fatigue. (Figley, 1995,) (LaRowe, 2005) described CF as "debilitating weariness brought about by repetitive, empathic responses to the pain and suffering of others" (p. 21) Compassion fatigue (also called secondary or vicarious trauma) can compromise the nurse's ability to care for his or her patients.

The term compassion fatigue was first coined by(Joinson, 1992). Joinson described compassion fatigue as a unique and expanded form of burnout, that affects people in the caregiving profession (nurses ministers and councilors) these stressors arise from the demands of the workplace as well as the physical and emotional needs of the patients. When these stressors become overpowering they become invasive and interferes with the nurse's ability to function. It gradually makes them tired, depressed, angry, ineffective, and finally apathetic and detached. Symptoms of STS (difficulty sleeping, intrusive thoughts about patients, sense of a foreshortened future, etc) may lead to decreased job satisfaction or impaired job function, high job turnover, depression, and burnout. (Quinal, Harford, & Rutledge, January 15, 2009.,)

Method

A literature review was conducted focussing on research articles by nurses on the phenomenon of compassion fatigue in the oncology setting with the use of a theoretical framework to guide the research. CINAHL, Ovid, Proquest, SAGE and EBSCO databases were searched using 4 keywords: 'compassion fatigue,' 'oncology' 'nurses'. After assessing the titles and abstracts of the articles three primary research articles were extracted which fulfilled the inclusion criteria.

Data Analysis

1. An exploration of the experience of compassion fatigue in clinical oncology nurses.- By Beth Perry, Greg Toffner, Trish Merrick and Janice Dalton

The study is a descriptive exploratory qualitative study that targeted the experience of CF in Canadian clinical oncology RNs. The purpose of the study was to explore how Canadian clinical oncology registered nurses (RNs) described their experiences of CF. Data was collected using an online questionnaire and a narrative by the oncology nurses describing a time they experienced CF. (Perry, Toffner, Merrick, & Dalton, 2011)

After data analysis, the findings were organized into 5 major themes

I. Defining CF

II. Causes of CF

III. Factors that Worsen CF

IV. Outcomes of CF and

V. Circumstances that Lessen CF

A conceptual model called the stress process model was used as the framework of this research.(Perry et al., 2011) The model considers caregivers' stress in four domains, background, and context of stress; the stressors; the mediators of stress; and the outcomes or manifestations of stress (Aneshensel, Pearlin, Mullan, Zarit, & Whitlatch, 1995)

According to the model, life events can lead to negative changes in peoples' roles, changes whose persistence wears away desired elements of self-concept, and that through this set of linkages stress is aroused. Coping and social supports, for their part, can intervene at different points along this process, thereby mediating the outcomes.

This model has guided the researchers in furthering the understanding of these themes and has served as a foundation to develop practice implications. (Perry et al., 2011) For eg. Nurses exposure to patient suffering was identified as a primary stressor. Lack of support from colleagues and circumstances from their own life, like, difficulties in marital relationship, problems with children, or stress of caring for elderly parents, etc were thought to be secondary stressors. Being a seasoned nurse who with their maturity and experience, has gained a perspective can see the interactions with cancer patients as positive this could be a factor that mediates the effects of stressors on them also support from colleagues if it is positive can mediate the effect of stressors. (Perry et al., 2011)

The length of time the nurses took care of the patient who died, the intimacy of relationship they had with the patient and family, how intense the disease and its effects on the patient were and the therapies the patient had undergone all provide a background or context factors. The response these nurses who were studied showed to cope with CF were identified as the outcome like changing jobs, adopting a different attitude, decreasing the depth of relationships they have with patients or finding a purpose in what they are doing. (Perry et al., 2011)

2. The exhaustion of caring: A quantitative study of compassion fatigue as experienced by pediatric oncology registered nurses within an inpatient pediatric hospital setting - By Leslie Bradley

This quantitative, descriptive research study was conducted to identify the prevalence of CF, within an inpatient pediatric oncology setting, as experienced by registered nurses using the Beth Hudnall Stamm's Professional Quality of Life Scale (ProQOL) Version 5 (2009) to measure the characteristics of CF (Bradley, 2013)

A convenience sampling was used in this study and data were analyzed by two methods: descriptive and inferential statistics.

The results of the study proved that CF was not experienced by the nurses in this study.

The response rate of the survey was 51% which fell within the goal range of 50-75%. (Bradley, L) and hence it cannot be generalized. (Bradley, 2013)

Dorothea Orem's "Model of Nursing" theory served as the guiding framework for this study because the researchers were of the opinion that even though the concepts identified by Orem were focussed on patients participation in self-care leading to recovery and return to health it is also applicable to anyone who needs to provide care to self when suffering (mental, physical, spiritual or cognitive) or going through a difficult time as nurses do when experiencing CF. (Bradley, 2013)

Self-care is defined by Orem as the practice of all the activities that individuals initiate and perform on their behalf in order to maintain life, health, and well-being (Orem, 2001) so the author found that the application of this theory would be useful in developing education and prevention strategies for nurses at risk for CF. (Bradley, 2013)

3. Perceived Quality of Work Life and Risk for Compassion Fatigue Among Oncology Nurses: A Mixed-Methods Study - by Ellen Giarelli, Jami Denigris, Kathleen Fisher, and Elizabeth Nolan

A descriptive mixed-methods study was conducted "To examine factors that influenced the nurse's perceived quality of work-life and risk for compassion fatigue (CF)."(Giarelli, Denigris, Fisher, Maley, & Nolan, December 12, 2015.)

The objective of the study was to illustrate the associations between factors such as nurses' characteristics and personal life stress, and their perceived quality of work-life and the nurse's belief about their risk for CF (Giarelli et al., December 12, 2015.)

A descriptive study was conducted using questionnaires and in-depth interviews for 8 months. The impact of events scale was used to measure the stress level of these nurses and two distinct responses to stress - intrusion (the preoccupation with stressful events in thoughts, dreams, and feelings) and avoidance (evading feelings or reminders of a stressful situation) (Giarelli et al., December 12, 2015.)

A life events scale was used to document the list of external events and situations (stressors) and calculate the individual nurses' scores for STS and burnout (Giarelli et al., December 12, 2015.)

Results

Personal life stressors were found to cause a compelling impact on well-being for 30% of nurses, which would mean these nurses were at a higher risk of CF, However, qualitative data did not complement these findings and suggested that overall work experiences for 55% of nurses were "life-affirming and rewarding. (Giarelli et al., December 12, 2015.)

The nurses attributed work-related stress to communication breakdowns, work environment, and care driven factors.

The principles from social constructivism were applied to serve as a framework for the aims of the study and to guide the researchers in finding a solution to managing work-related stress. (Giarelli et al., December 12, 2015.)

Social constructivism is a sociological theory of knowledge according to which human development is socially situated and knowledge is constructed through interaction with others. (McKinley, 2015). A social construct or construction concerns the meaning, notion, or connotation placed on an object or event by a society, and adopted by the inhabitants of that society with respect to how they view or deal with the object or event(" Encyclopedia of Philosophy ," October 25, 2019,)

Nurses who work in the oncology deduce their meaning to the events that take place around them including reactions to suffering and death of patients, work-related stressors and personal stressors. The implication is that CF experienced by the nurse (or his or her risk for CF) is a consequence of the social interaction within a given environment. (Giarelli et al., December 12, 2015.) A major focus of social constructionism is to uncover how individuals and groups participate in the construction of their perceived social reality - in this case, the risk for CF. (Giarelli et al., December 12, 2015.)

References

Aneshensel, C., Pearlin, L., Mullan, J., Zarit, S., & Whitlatch, C. (1995). Profiles in caregiving: The unexpected career. San Diego: Academic Press.

Bradley, L. D. (2013). The exhaustion of caring: A quantitative study of compassion fatigue as experienced by pediatric oncology registered nurses within an inpatient pediatric hospital setting (Doctoral dissertation, Arkansas Tech University). Retrieved from https://search-proquestcom.libaccess.sjlibrary.org/docview/1475266283/fulltextPDF/ADE90DE57B2F476APQ/1?accountid=10361

Figley, C. R. (1995). Compassion fatigue as secondary traumatic stress disorder. New York: Brunner/Mazel.

Giarelli, E., Denigris, J., Fisher, K., Maley, M., & Nolan, E. ( December 12, 2015.). Perceived Quality of Work Life and Risk for Compassion Fatigue Among Oncology Nurses: A Mixed-Methods Study. Oncology Nursing Forum, 43(3), E121-131. Retrieved from https://web-b-ebscohostcom.libaccess.sjlibrary.org/ehost/pdfviewer/pdfviewer?vid=1&sid=9f284c03-5ada-436ba527-b147e0d178db%40sessionmgr103

Joinson, C. (1992, April 1). Coping with compassion fatigue. Nursing, 116-121. Retrieved from https://web-a-ebscohostcom.libaccess.sjlibrary.org/ehost/pdfviewer/pdfviewer?vid=1&sid=d72eb6bf-31e4-49c2-99c1-e19613c23878%40sdc-v-sessmgr03

LaRowe, K. (2005). Transforming compassion fatigue into flow. Boston: Acanthus.

Levine, S. (2005). Unattended sorrow: Recovering from loss and reviving the heart. New York: Holtzbrinck.

McKinley, J. (2015, 18 Sep 2015). Critical Argument and Writer Identity: Social Constructivism as a Theoretical Framework for EFL Academic Writing. Critical Inquiry in Language Studies, 12, 184-207. http://dx.doi.org/https://doi.org/10.1080/15427587.2015.1060558

Perry, B., Toffner, ., Merrick, ., & Dalton, J. (2011). An exploration of the experience of compassion fatigue in clinical oncology nurses. Canadian oncology nursing journal, 21(2). Retrieved from http://canadianoncologynursingjournal.com/index.php/conj/article/view/160/168

Quinal, L., Harford, S., & Rutledge, D. (January 15, 2009., January 15, 2009.). Secondary Traumatic Stress in Oncology Staff. Cancer Nursing, 32(4), E1-E7.

http://dx.doi.org/10.1097/NCC.0b013e31819ca65a

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