The Impact of Compassion Fatigue on Oncology Nurses
Compassion serves as a crucial quality for nurses to acquire, while assisting patients in the healing process. More specifically, oncology nurses face emotionally-challenging situations with themselves, as they witness the health of some patients lead to a significant decline. Nurses are faced with the obstacle of the most efficient way to deliver care to individuals who present themselves in oncology units with fatal cancer. Compassion fatigue involves the recurring, caring, and heartfelt response nurses deliver as a result of the visible distress presented by patients (LaRowe, 2005, p. 21).
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Due to the density of a cancer diagnosis, oncology nurses face a great amount of stress as they determine the best way to address their patient’s stressors (Perry, Toffner, Merrick, & Dalton, 2011). Furthermore, with frequent situations involving death and dying due to incapacitating prognoses of cancer, nurses face a bout of emotions associated with sorrow that manifests into forms of compassion fatigue as well (Aycock & Boyle, 2009). Additionally, most oncology nurses are faced with a lack of emotional support resources to help them address any mental health needs they may require (Aycock & Boyle, 2009).
Aside from nurses acting as an observer for the course that a diagnosis takes their patient on, they also serve an important role as a communicator with patients and their loved ones, which can contribute to greater emotional stress on the nurse (Al-Majid, Carlson, Kiyohara, Faith, & Rakovski, 2018). Seeing how the cancer diagnosis affects family members of the patient can be stressful for the nurse, as it is important to address the emotional needs of the patient and their loved ones simultaneously. Moreover, nurses may lack necessary training to know exactly what to say and how to comfort a patient and his/her family during a cancer diagnosis. Each stressful shift that an oncology nurse undergoes has the possibility to contribute to poor behavioral results, which ultimately effects the quality of care delivered to patients (Finley & Sheppard, 2017).
With frequent exposures to trauma, nurses become susceptible to increased anxieties and overall sadness (Sydenham, Beardwood, & Rimes, 2017). To alleviate the immensity from all the cancer diagnoses, nurses tend to create an emotional barrier between themselves and the patient to minimize their emotions in the best way they can (Arimon-Pagés, Torres-Puig-Gros, Fernández-Ortega, & Canela-Soler, 2019). When patients pass away in oncology units, some nurses tend to be in an extreme disbelief due to the frequent delivery of care that has been delivered to the patient (Fetter, 2012). This prevents the nurse from being able to fully process the death of their patient, and struggle to deal with the emotional grief that can be present (Yu, Jiang, & Shen, 2016).
Five articles regarding the impact of compassion fatigue on oncology nurses were explored. To find out the main contributors leading to compassion fatigue, and to gather information regarding the impact of compassion fatigue on oncology nurses, a Professional Quality of Life (ProQOL) Scale was used in most studies (Al-Majid et al., 2018; Arimon-Pagés et al., 2019; Yu et al., 2016).
The ProQOL scale used to survey oncology nurses was derived from Stamm’s compassion fatigue framework (Stamm, 2010). All five articles describe the same three components that make up compassion fatigue, which include compassion satisfaction, burnout, and secondary traumatic stress (Al-Majid et al., 2018; Arimon-Pagés et al., 2019; Finley et al., 2017; Perry et al., 2011; Yu et al., 2016). These three items were individually scored on the surveys in the form of a Likert scale ranging from never to very often to assess the level of each impact that acted as a factor leading to compassion fatigue (Al-Majid et al., 2018; Yu et al., 2016). Higher scores on the scale for compassion satisfaction indicated positive feelings associated with work, while high scores on the secondary traumatic stress scale coincided with poor emotions resulting from events in the workplace (Al-Majid et al., 2018; Arimon-Pagés et al., 2019). Other information obtained on the ProQOL scale included age, sex, number of years working in the oncology unit as a nurse, number of hours worked per shift, stress levels, and job satisfaction (Al-Majid et al., 2018; Arimon-Pagés et al., 2019; Stamm, 2010, Yu et al., 2016).
To obtain data, packets of surveys were distributed to oncology nurses with information about the study’s purpose, how it would be obtained anonymously, instructions, and where to return it once completed if there was consent given to participate (Al-Majid et al., 2018; Yu et al., 2016). Some studies gave participants up to six weeks for completion, while others collected packets at the end of the same day that it was delivered (Al-Majid et al., 2018; Arimon-Pagés et al., 2019; Yu et al., 2016).
Instead of a written version of collecting data through a survey like the other methods, Finley et al. (2017) organized open-ended interviews with novice oncology nurses to encourage the flow of qualitative information. To make sure accurate results were being obtained from the interviewer of the open-ended questions, one psychiatric nursing specialist was called in to maintain a consistent compilation of data throughout the interviewees (Finley et al., 2017). Additionally, Perry et al. (2011) focused on a model concentrated on documented stress by caregivers. This framework collected information pertaining to the origination of stress, how the stress is managed, and the result of the stress in the caregiver’s everyday life (Perry et al., 2011). The data was obtained through an online advertisement posted on a website for research purposes (Perry et al., 2011). An online set of questions was delivered to participants after obtaining consent, along with the open-ended question asking participants to describe the most recent time to reflect upon when they were effected by compassion fatigue (Perry et al., 2011). Unlike the Professional Quality of Life Survey, qualitative data was assessed and grouped into patterns after obtaining information from the open-ended interview and questions derived from the online advertisement (Finley et al., 2017; Perry et al., 2011).
Multiple studies supported the idea that nurses who care for patients in urgent, life-threatening scenarios are predisposed to higher levels of compassion fatigue (Al-Majid et al., 2018; Arimon-Pagés et al., 2019). Approximately every article concluded that there was a greater need for mental and emotional support to nurses suffering from the grieving process after losing patients (Al-Majid et al., 2018; Yu et al., 2016). There are not many strategies set in place to combat the impact of compassion fatigue in oncology nurses, which leads to poorer job satisfaction, and decreased levels of compassion delivered to patients over time (Al-Majid et al., 2018).
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Summary of Findings
After analyzing all the data collected from multiple studies, it is evident that compassion fatigue has a major impact on the well-being of nurses inside and outside of the workplace. Nearly every conclusion supported the need for the implementation of more efficient strategies to mitigate compassion fatigue and promote greater job satisfaction in oncology units (Al-Majid et al., 2018; Arimon-Pagés et al., 2019; Finley et al., 2017; Yu et al., 2016). While minor efforts have been made in very few hospitals to emotionally support oncology nurses, those nurses who did receive training prior to participating in the study stated that the it was ineffective, as they it took place after they already had years of experience under their belt (Arimon-Pagés et al., 2019; Yu et al., 2016). The very few nurses who received training said it would have been more effective prior to beginning their job altogether as an oncology nurse, as it would have prepared them to cope successfully while encountering negative stressors (Arimon-Pagés et al., 2019; Yu et al., 2016).
Overall, the results from most articles indicated very minimal support from colleagues, and administrators, which ultimately sped up the rate at which the oncology nurses were effected by compassion fatigue (Arimon-Pagés et al., 2019; Perry et al., 2011; Yu et al., 2016). Some effects of compassion fatigue led oncology nurses to report feeling unhappy with the care they were delivering, depression and anxiety inside and outside of the hospital, decreased desire to attend work each shift, and a lack of motivation to care for themselves (Al-Majid et al., 2018; Arimon-Pagés et al., 2019; Finley et al., 2017; Yu et al., 2016). The impact of compassion fatigue has the ability to manifest into greater problems if it is not addressed early on.
Since compassion fatigue is a problem that most oncology nurses struggle with daily, it is important for strategies and interventions to be implemented in hospital settings to prevent it from occurring entirely. Oncology nurses need to have a support system available to them when they are struggling with any situation that may arise in their workload. The planned research project will evaluate whether participation in weekly consultation groups will or will not affect the number of oncology nurses impacted by compassion fatigue.
The PICO question is: Does the incorporation of a weekly consultation group led by a psychologist decrease the prevalence of compassion fatigue in oncology nurses, as opposed to the control of no support group in an alternative oncology unit over the duration of six months?
To determine the effectiveness of a weekly consultation group led by a psychologist to decrease the effects of compassion fatigue in oncology nurses, an organized plan must be established. Two oncology units will be involved in the process, as one oncology unit will be provided with the intervention, a weekly consultation group, while the other unit, or control group, will not be offered the support group. The consultation group will consist of a small group of oncology nurses ranging from five to ten people, and it will be led by a psychologist. During the consultation group, topics will be discussed involving efficient approaches to cope with stressors, communication methods to consult with patients and their loved ones, the grieving process, the loss of a patient, etc. The group is not limited to those topics only, as the oncology nurses are welcome to bring their own desired topics to the consultation group for discussion as well. Nurses will be encouraged to speak freely about their emotions regarding each topic presented at the session, and for colleagues to bounce emotions and ideas off one another. This will create closer connections between colleagues, which will allow the oncology nurses to feel greater support overall.
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Before and after six months of the incorporation of weekly consultation sessions, oncology nurses will self-report their feelings associated with factors of compassion fatigue (burnout, job satisfaction, self-care, compassion satisfaction, secondary traumatic stress, etc.) on a Likert scale. Results will be compared from baseline to the follow-up (after six months of the intervention), using a paired t-test, and if there is a significant decline in depressive thoughts, greater self-care, and more positive feelings associated with job satisfaction, then the intervention will evidently be a positive asset for oncology nurses. The control group will only fill out one self-reported survey, which will be the same assessment delivered to the group receiving the consultation intervention at baseline, which will be evaluated through an independent t-test. At the end of the study, the results gathered after six months from the group receiving the intervention will be compared with the control group’s self-reported survey.
For the proposed project to be implemented effectively, a psychologist will need to be hired on the oncology floor. Since the consultation sessions will consist of small groups, the psychologist needs to be available one day a week throughout an entire day, so that the session can take place during multiple times to accommodate the participation of every nurse in the unit. Prior to each month, the oncology nurses will be given the time that they are eligible to attend the consultation group each week for the month. The nurse manager will be responsible for coordinating which nurses will look after patients while nurses step out for the hour to attend the meeting.
One limitation of the proposed study involves the method of data collection. Objectively, there is no way to assess firsthand if the nurses are or are not benefiting from the intervention, other than by word of mouth through self-reporting. There is no way to assess whether the oncology nurses will self-report with complete honesty if they are not true to themselves regarding their feelings and emotions.
Another limitation involves the oncology nurses’ willingness to participate. The sessions will not be mandatory, so it is up to the nurses to find the desire to attend the consultation service if they feel it’s necessary. It can be a challenge to convince someone to break up their workday to attend a meeting that they would not typically attend.
Lastly, it can be extremely challenging for the nurse manager to find enough coverage for the nurses attending the sessions weekly. Commonly, there are never enough nurses on a floor at a given time, so this can pose a threat to the care delivered to patients, especially since this is occurring on a high-acuity floor.
- Al-Majid, S., Carlson, N., Kiyohara, M., Faith, M., & Rakovski, C. (2018). Assessing the degree of compassion satisfaction and compassion fatigue among critical care, oncology, and charge nurses. The Journal of Nursing Administration, 48(6),310-315. doi:10.1097/NNA.0000000000000620
- Arimon-Pagés, E., Torres-Puig-Gros, J., Fernández-Ortega, P., & Canela-Soler, J. (2019). Emotional impact and compassion fatigue in oncology nurses: Results of a multicentre study. European Journal of Oncology Nursing, 43. doi:10.1016/j.ejon.2019.09.007
- Aycock N, Boyle D. (2009). Interventions to manage compassion fatigue in oncology nursing. Clinical Journal Oncology Nursing, 13(2), 183-191.
- Fetter, K.L. (2012). We grieve too: one inpatient oncology unit’s interventions for recognizing and combating compassion fatigue. Clinical Journal Oncology Nursing, 16(6), 559-561.
- Finley, B. A., & Sheppard, K. G. (2017). Compassion Fatigue: Exploring early-career oncology nurses’ experiences. Clinical Journal of Oncology Nursing, 21(3), E61-E66.doi:10.1188/17.CJON.E61-E66
- LaRowe, K. (2005). Transforming compassion fatigue into flow. Boston: Acanthus.
- Perry, B., Toffner, G., Merrick, T., & Dalton, J. (2011). An exploration of the experience of compassion fatigue in clinical oncology nurses. Canadian Oncology Nursing Journal, 21 (2),91-105. doi:10.5737/1181912x2129197
- Stamm, B.H. (2010). The concise ProQOL manual. Pocatello, ID: ProQOLorg. Retrieved from http://www.proqol.org/uploads/ProQOL_Concise_2ndEd_12-2010.pdf
- Sydenham, M., Beardwood, J., Rimes, K.A. (2017). Beliefs about emotions, depression, anxiety and fatigue: a mediational analysis. Behavioral Cognitive Psychotherapy. 45, 73-78. doi:10.1017/S1352465816000199
- Yu, H., Jiang, A., & Shen, J. (2016). Prevalence and predictors of compassion fatigue, burnout and compassion satisfaction among oncology nurses: A cross-sectional survey. International Journal of Nursing Studies, 57, 28-38. doi:10.1016/j.ijnurstu.2016.01.012
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