See discussions, stats, and author profiles for this publication at: https://www.researchgate.
net/publication/278731360
Compassion fatigue: The cost of caring
Article in Nursing · July 2015
DOI: 10.1097/01.NURSE.0000461857.48809.a1 · Source: PubMed
CITATIONS READS
72 8,162
1 author:
Deborah Boyle
Advanced Oncology Nursing Resources
147 PUBLICATIONS 2,151 CITATIONS
SEE PROFILE
All content following this page was uploaded by Deborah Boyle on 07 November 2017.
The user has requested enhancement of the downloaded file.
Compassion
fatigue:
The cost of caring
48 l Nursing2015 l July www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
E
By Deborah A. Boyle, MSN, RN, AOCNS, FAAN
M
MPATHETIC CARING and interpersonal skills are at the core
oof nursing.1 Compassion requires an inner conviction and resil-
iency that sends the message, “I see and feel your pain.”2 But
while we in the nursing profession highly value compassion,
it can also get us into trouble.
Simply put, compassion fatigue is the cost of caring for
others in emotional pain.3 It’s been studied in first responders
such as police, firefighters, and paramedics, yet it remains
underrecognized, poorly understood, and minimally researched
in nurses, who also witness tragedy in their daily work. Like
first responders, nurses are secondary survivors of others’
health crises. This article discusses what we know about com-
passion fatigue, including how to recognize and combat it.
Defining compassion fatigue in nurses
Nursing involves exposure to trauma, death, disfigurement,
debility, and despair. This exposure accumulates over months
and years.
Over two decades ago, compassion fatigue was first ad-
dressed in the nursing literature. Based on observations of ED
nurses, compassion fatigue was described as the loss of the abil-
ity to nurture characterized by apathy and cynicism.4 The first
book published on the topic cited the prevalence of compassion
fatigue in counselors and mental health providers, and it was
associated with secondary traumatic stress disorder.3,4 Today,
however, little more is known about compassion fatigue within
the ranks of nursing.5
FUSE /GETTYIMAGES
What makes compassion fatigue in nurses different than that
experienced by other helping professions is the constancy and
proximity to tragedy over time.6 Nurses can’t remove them-
selves from their source of distress. Additionally, they may be
www.Nursing2015.com July l Nursing2015 l 49
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
caring for multiple patients with dev-
astating illnesses. Compassion fatigue Is it burnout or compassion fatigue?
may also result when a nurse reexpe- Essential to countering compassion fatigue is recognizing it. First and foremost,
riences traumatic events, similar to compassion fatigue must be distinguished from burnout. While nurses can experi-
flashbacks, which stem from remind- ence both, these are two distinct phenomena. Burnout is associated with work-
ers of past patients or stressful events place stressors such as manager unresponsiveness, lack of camaraderie and team-
from the nurse’s personal life. (See Is work, staffing shortages, working long hours, intense workloads, conflicts with other
nurses and healthcare providers, and time pressures. Compassion fatigue, on the
it burnout or compassion fatigue?)
other hand, emanates from the stresses nurses experience from their relationships
Compassion fatigue is a state in
with patients and families.5
which the compassionate energy
that’s been expended has surpassed
restorative capabilities.7 It emanates and anxiety are exhibited. Isolating manage it. Ask your family what their
from witnessing suffering and feeling oneself from others and no longer impressions are of you after the work-
impotent to do more to help.8 Most enjoying activities that previously day ends. Have they noticed a change
important, repeated exposure to brought joy is another indicator of in you? Are you able to separate work
stressful events occurring in patients compassion fatigue. Spiritually, nurs- from home? Also consider who your
and families with whom the nurse es may question their beliefs within main sources of support are. Are they
has developed a special relationship the context of the significant loss good listeners? Do you use them rou-
over time leads to emotional exhaus- they witness. Why do bad things tinely as a sounding board? Feedback
tion.9 With no outlet for emotional often happen to good people? Why from those close to you can provide
expression, nurses often “bottle up” are some patients and families bur- important insight into how work is
their feelings. Feeling dispirited, dened with so much affliction? influencing your personal life. You
nurses become short-tempered, A nurse’s performance may be may not be aware of this association.
fatigued, and resentful of the de- influenced in various ways. Both
mands made on them. They find productivity (on a daily basis and Work setting strategies
themselves unable to respond to the in terms of sick days) and efficiency Numerous work setting interventions
needs of their patients and withdraw (work execution and the association can help nurses deal with compas-
from emotionally charged scenarios. with errors) may be impaired. Some sion fatigue. The first step is to deter-
nurses decide to leave a current job mine what work setting resources
Consequences of or leave nursing for a different career. are available.10 Employee-assistance
compassion fatigue Numerous interventions can be programs may offer educational pro-
Compassion fatigue has physical, employed to deal with compassion grams in addition to counseling that
emotional, social, spiritual, and pro- fatigue.10 They generally fall under address stress reduction, work-life
fessional implications. (See Indicators three categories: self-awareness, balance, and the use of effective com-
of compassion fatigue.) Chronic ex- work setting strategies, and self-care. munication strategies. Lobbying for
haustion, insomnia, and other so- employee-assistance personnel to
matic symptoms may occur. Sadness, Self-awareness come to the unit (rather than expect-
apathy, cynicism, frustration, and Any effort undertaken to increase self- ing the nurse to go to them) sends a
judgmental responses may become awareness about compassion fatigue strong message of concern for nurses’
the norm. Elements of depression represents an important first step to emotional well-being. Support groups
can be developed and facilitated by
counselors or pastoral care colleagues.
Indicators of compassion fatigue7-10 Debriefing sessions after emotionally
• Physical: chronic fatigue, exhaustion, insomnia, aches and pains (headaches, charged events can help nurses ad-
muscle tension), gastrointestinal complaints dress their sense of loss. They also
• Emotional: sadness, apathy, cynicism, oversensitivity, frustration/irritation, give nurses a forum for discussing
depression, anxiety, blaming/judgmental, mood swings, lack of joyfulness, what they were able to do to rather
poor concentration, memory impairment, self-medication with food, alcohol than focussing on missed opportuni-
• Social: isolation, loss of interest or enjoyment in activities previously found ties. Complementary approaches such
desirable as chair massage, aromatherapy, jour-
• Work: avoidance or dread of working with certain patients, decreased productivity, naling, prayer, quiet time, and mind-
increased errors, turnover, job dissatisfaction, decreased efficiency, increased use of fulness meditation integrated into the
sick days, choosing to leave nursing as a career
workplace are other options that can
• Spiritual: existential questioning.
reduce work-related stress.
50 l Nursing2015 l July www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Take care of yourself Hazardous to your health 4. Joinson C. Coping with compassion fatigue.
Nursing. 1992;22(4):116, 118-120.
If nurses continue to run on empty, The multiple demands of our hectic
5. Boyle DA. Countering compassion fatigue: a
they can’t expect to successfully lives, coupled with stressful profes- requisite nursing agenda. Online J Issues Nurs.
maintain caring professional and per- sional responsibilities, make nursing 2011;16(1):2.
sonal lives. A good way to consider potentially hazardous to your health. 6. Austin W, Goble E, Leier B, Byrne P. Compassion
fatigue: the experience of nurses. Ethics Social
optimum self-care is to practice re- While compassion fatigue has his- Welfare. 2009;3(2):195-214.
sponsible selfishness.11 Draw a circle torically been understudied, under- 7. Coetzee SK, Klopper HC. Compassion fatigue
and divide it proportionately accord- recognized, and undertreated, it’s within nursing practice: a concept analysis. Nurs
Health Sci. 2010;12(2):235-243.
ing to where you spend your time likely that this phenomenon will re- 8. Yoder EA. Compassion fatigue in nurses. Appl
over a week: work, family, social ceive much-needed attention in the Nurs Res. 2010;23(4):191-197.
time, hobbies, and activities that coming years as the retention of car- 9. Jenkins B, Warren NA. Concept analysis:
compassion fatigue and effects upon critical care
bring you joy. Most of us probably ing, compassionate, and tenured nurses. Crit Care Nurs Q. 2012;35(4):388-395.
allocate only a small sliver of time nurses will become even more highly 10. Aycock N, Boyle D. Interventions to manage
to take care of ourselves, so a well- valued in our constantly changing compassion fatigue in oncology nursing. Clin
J Oncol Nurs. 2009;13(2):183-191.
formed self-care plan is most likely in healthcare environment. ■ 11. Bush NJ, Boyle D. Self-Healing Through
order. A self-care plan must embrace Reflection: A Workbook for Nurses. Pittsburgh, PA:
all aspects of wellness, hardiness, and Hygeia Media; 2012.
REFERENCES
resilience, including nutrition, exer- 1. Watson J. The theory of human caring: retro- Deborah A. Boyle is an oncology clinical nurse spe-
cise, stress reduction, and time for spective and prospective. Nurs Sci Q. 1997;10(1): cialist at the University of California Irvine Health/
49-52. Chao Family Comprehensive Cancer Center in
social activities, hobbies, and spiri- Orange, Calif.
2. Bush NJ. Compassion fatigue: are you at risk?
tual health. You must assume respon- Oncol Nurs Forum. 2009;36(1):24-28.
sibility for these behaviors much like 3. Figley CR, ed. Compassion fatigue: Coping with The author has disclosed that she has no financial
relationships related to this article.
Secondary Traumatic Stress Disorder in Those Who
you ensure time to eat and sleep; Treat the Traumatized. New York: Brunner/Mazel;
self-care is just that important. 1995. DOI-10.1097/01.NURSE.0000461857.48809.a1
www.Nursing2015.com July l Nursing2015 l 51
View publication stats
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
