Concept Analysis of Compassion Fatigue

                Introduction

A compass is used to give direction for those traveling, similar to compassion which is necessary to guide nurses through their journey of caring for patients. The Latin etymology of compassion is defined as to suffer with another (Gemignani, 2013). The thought of continuous exposure to such vivid remembrances of trauma can be exhausting. The phenomenon of compassion fatigue is not a novel condition for nursing. Compassion fatigue reduces our capacity or our interest in bearing the suffering of others (Figley, 2002). This concept has been discussed in many disciplines, and its symptoms and effects are gaining further documentation. It is now widely recognized that the indirect exposure to trauma involves an inherent risk of significant emotional, cognitive, and behavioral changes in the clinician (Bride, Radey, & Figley, 2007). The following analysis involves the concept of compassion fatigue within the studies of psychology and nursing. Literature of such within these realms are reviewed and used to create a definition of the idea of compassion fatigue, and a model is formed to define the relationships among the concept components.

Review of Literature

Practitioners within the helping fields are aware of compassion fatigue existing but may not be aware of their potential for compromise while benefiting from their acts of improving another’s condition. Clinical work that addresses psychological trauma has compassion fatigue listed as an occupational hazard (Bride et al., 2007). A clinician may experience both compassion fatigue and compassion satisfaction simultaneously, but as fatigue increases, it may negate some of the clinician's ability to experience the satisfaction (Bride et al., 2007). Research within the field of specialty can bring insight into specific risk factors and details pertinent to one’s practice. Common terms associated with compassion fatigue are defined with a similarity between the two disciplines. Psychology literature is profound with experiential reports of the impact of compassion fatigue and frequent comparisons to secondary posttraumatic stress disorder and indications. Nursing articles stressed the need for further research on compassion fatigue and its effects on specific areas of interest within the nursing profession. The importance of recognizing the traits of the experienced state and creating a supportive environment among peers for a debriefing of distress was encouraged in the psychology reviews. Nursing highlighted the need to retain qualified staff to provide compassionate care by engaging nursing leaders to recognize and implement preventative strategies for the danger of compassion fatigue. Both disciplines provide valid insight into issues and background concerning compassion fatigue.

Nursing

Nurses can identify with the idea of losing their sense of self to the clients they care for. Boyle’s article described compassion fatigue as emanating from the relational connections nurses have with their patients and the emotional engagement and interpersonal intensity associated with witnessing tragedy within the work setting (Boyle, 2011).  If compassion fatigue is not addressed in its earliest phases, it can terminally alter the caregiver's ability to provide compassionate care (Boyle, 2011). The information contained in this article differentiated the aspect of exposure to trauma between nursing and other exposed helping professions. Often nurses see the suffering occurring in their work rather than the descriptions of what happened, evidenced by empathetic distress. Nurses are one of the “first responders” to the trauma. Nurses can easily become preoccupied with the trauma their patients have endured or experienced and may lead to the described stages of compassion discomfort, stress, and fatigue (Boyle, 2011).

The article by Mooney et al., (2017) utilized the assessment tool Professional Quality of Life Scale (ProQOL) to compare compassion fatigue, compassion satisfaction, and burnout within specialized units and including demographic factors. The nursing units surveyed were familiar with high levels of traumatic stress experienced by patients and staff. The results of this study found an inverse relationship with time in nursing practice to levels of compassion fatigue. Higher levels of compassion satisfaction were resulted among the male nursing staff compared to their female counterparts. The female nurses were found to be more susceptible to developing compassion fatigue than the male nurses, and the male nurses experience a higher overall professional quality of life than their female counterparts (Mooney et al., 2017).

Hospitals that participated in meaningful recognition programs were compared to those that did not in a quantitative study among intensive care unit nurses in Kelly & Lefton (2017). Again, the ProQOL tool was used to measure responses. It is discovered that if nurses are meaningfully recognized by their organizations for their work they had less burnout and higher compassion satisfaction. The findings of this study replicate the importance of meaningful recognition and satisfaction and bring awareness to growing trends (Kelly & Lefton, 2017). It is deduced that in an environment that recognizes nursing and its contributions the level of measurable compassion fatigue is decreased. This study also identified nurses with less experience were at a higher risk of compassion fatigue than their more experienced counterparts.

A systematic review of the literature addressing compassion fatigue across different levels of healthcare providers is assessed in the final article. The terms compassion stress, burnout, and secondary traumatic stress were explained and parted. Burnout was described as a more gradual result of time spent in stressful situations of work. The authors identified compassion fatigue as representative of the cost of caring and result in physical, emotional, and psychological symptoms that contribute to the decision of the healthcare provider to leave the profession (Sorenson, Bolick, Wright, & Hamilton, 2016). The lack of a well-constructed concept analysis for compassion fatigue has created limitations in understanding its effects and identifying strategies to prevent or treat it (Sorenson et al., 2016).

Psychology

Charles Figley has made many contributions from the field of psychology to the condition of compassion fatigue. Figley (2002) defines it as a state of tension and preoccupation with the traumatized patients by re-experiencing their traumatic events, avoidance/numbing of reminders persistent arousal associated with the patient. His article reviewed and compares burnout and countertransference to compassion fatigue. Figley (2002) states compassion fatigue and countertransference have a more rapid onset of symptoms, while compassion fatigue and burnout have a faster recovery from symptoms. Here he presents a model to guide those susceptible to compassion fatigue exhibited by the assimilation of client distress. This model seeks to resolve it and acknowledges the cost of working with the suffering. Psychotherapists must put their personal feelings aside and objectively evaluate their clients and plan the best treatments according to best practice guidelines while not avoiding compassion and empathy (Figley, 2002).