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Child Psychiatrist /Adult Psychiatrist

Compassion Fatigue in Health Care

For many health care professionals, compassion fatigue is considered a part of the job.1 Although different researchers use varying definitions of compassion fatigue, it is generally defined as distress associated with caring for patients who are suffering, resulting in exhaustion, depression, fear, anger, and detachment.


Health Care

The term compassion fatigue was first used in 1992 by Joinson, a nurse educator who defined it as nurses’ loss of the ability to nurture their patients due to intense workloads and complex patient needs. These nurses described feeling tired, depressed, angry, ineffective, apathetic, and detached. In 1995, Figley described compassion fatigue as “the cost of caring” and that it was essentially a secondary traumatic stress disorder, with symptoms similar those of posttraumatic stress disorder (PTSD).


Clinicians are routinely aware of their patients’ suffering, and compassion for them can lead to compassion fatigue. Compassion fatigue can have harmful consequences for health care professionals and patients alike, including ineffective care, clinical errors, and poor treatment planning. Compassion fatigue is also associated with decreased productivity and an increased likelihood of leaving the profession. This article describes the relationship between compassion fatigue and burnout, the causes and signs of compassion fatigue, and strategies for addressing it.


Compassion Fatigue vs Burnout


Compassion fatigue has often been equated with burnout. Although the 2 conditions are related and can coexist, they are not identical. While the distress of compassion fatigue is related solely to patient care, burnout is chronic stress related to the overall demands of a job and lack of resources; it is characterized by emotional exhaustion, depersonalization, and a lack of sense of personal accomplishment.


Burnout can be the consequence of attempting to meet the numerous demands health care workers face, such as caring for patients with complex needs, including those who are suffering or dying; time constraints; large workloads; and a lack of professional and social support. Both compassion fatigue and burnout can result in exhaustion, helplessness, frustration, loneliness, anxiety, and depression. Some researchers have suggested that compassion fatigue can lead to burnout, while other conceptualize burnout as a component of compassion fatigue.


Causes of Compassion Fatigue


Clinicians may develop compassion fatigue due to developing relationships and identification with patients who are suffering, demanding, and/or helpless. Many health care professionals are continually exposed to other people’s suffering, which can traumatize them and result in compassion fatigue. Hospitals and care facilities can be high-pressure environments where health care workers experience high patient load, casualty, and interpersonal conflict, all of which can contribute to compassion fatigue.


Risk factors for developing compassion fatigue include a lack of experience, lack of strong work-life boundaries, lack of support, lack of self-awareness, and a sense of ill-preparedness/inadequate skills. Other potential causes of compassion fatigue include large workloads, a high intensity of work, inadequate time to rest between shifts, having to complete repetitive tasks, a lack of recognition, poor managerial support, and caring for patients with complex needs. Compassion fatigue can also arise from internalized guilt if a health care worker internalizes the inability to treat or save a patient.


Signs of Compassion Fatigue


The symptoms of compassion fatigue can be physical, behavioral, psychological, or spiritual. Physical symptoms include exhaustion, insomnia, somatization, headache, stomach ache, and fatigue. Psychologically, individuals with compassion fatigue may develop emotional exhaustion, depression, inability to feel sympathy or empathy, cynicism, fear, anger, irritability, detachment, helplessness, and resentment. Behavioral symptoms include increased alcohol and substance use, avoidance of patients, and impaired clinical decision making. Symptoms of compassion fatigue can parallel those of PTSD, such as intrusive thoughts, irritability, and avoidance. Compassion fatigue can lead to indifference and a desire to resign.


Clinicians who experience these symptoms may distance themselves not only from patients but also from peers and friends who could potentially offer support. Compassion fatigue can lead to personnel issues such as increased mistakes while providing care, poor morale, and a higher rate of staff turnover.


Although there is no specific diagnostic test or criteria for compassion fatigue, several screening tools can be used to help identify it. These include the following:


  • Compassion Fatigue Self Test (CFST);

  • Compassion Fatigue Scale (CFS); and

  • Professional Quality of Life (ProQOL).


In order to minimize false negative results, the scoring guidelines for compassion fatigue screenings are generally conservative, which increases the probability of false positives.


Addressing Compassion Fatigue


Diminishing the symptoms and halting the progression of compassion fatigue is essential for preserving clinician health and ensuring optimal patient care. Being proactive and addressing the behavioral and psychological symptoms of compassion fatigue early on has greater potential for long-term success.


Recognizing that clinicians are valued and trained caretakers is the first step. Understanding health care workers’ issues and needs allows for a better understanding and taking the appropriate next steps. Health care organizations can start with a thorough onboarding process that including making clinicians aware of the prevalence and symptoms of compassion fatigue and resources available for addressing common issues that might lead to compassion fatigue. Increasing awareness of the symptoms of compassion fatigue is critical because it can enhance clinicians’ ability to recognize those symptoms in themselves and others.


Having support readily available and decreasing any stigma surrounding compassion fatigue is also important. In order for clinicians to accept help, they must first be made aware that help is available. When deciding to seek help, some clinicians might be concerned about confidentiality and what their peers might think. Organizations can address this by having leadership teams, wellness committees, human resources personnel, employee assistance programs, or medical staff services that emphasize confidentiality and the importance of clinician health.


A health care employer also can provide clinicians with assistance with administrative and clerical duties such as scheduling, and offer advice and training on topics such as time management, stress management, conflict management, and improving communication and relationship skills.


A few programs have been developed specifically to address compassion fatigue. For example, Gentry et al developed the Accelerated Program for Compassion Fatigue, which is a 5-session training program that helps at-risk workers identify symptoms of compassion fatigue, recognize triggers, take advantage of available resources, and promote resiliency and self-efficacy. Most compassion fatigue interventions are centered on acknowledging the condition, its symptoms, and its consequences. Long-term benefits from these interventions can be maximized by giving clinicians ongoing access to tools and resources.


Self-care interventions such as exercise, eating a healthy diet, and maintaining social relationships are commonly suggested to help health care workers achieve work-life balance and address symptoms of compassion fatigue. Other interventions that focus on reducing stress include yoga, mindfulness, meditation, music therapy, or a combination of these.


Summary


Early intervention is essential to minimize the adverse effects of compassion fatigue. Making clinicians aware of and knowledgeable about the signs and consequences of compassion fatigue and providing resources and support is an important first step. Adequate social support, personal development, and career development all can help protect against compassion fatigue. Promoting resiliency can allow health care professionals to remain physically and mentally healthy despite the stress of patient care.


Note: This article originally appeared on Psychiatry Advisor

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