The profession of nursing entails developing a patient-nurse relationship to assist a patient in managing their basic care needs such as personal hygiene, rest, safety, and an ability to choose. Nurses provide patients, families and communities with all these factors above during times of distress, severe and protracted ailments, trauma and demise in varied settings. To offer care effectively and whether at home or in intensive specialized care at hospitals, nurse seek to establish trust with patients through high levels of honesty and ethical standards. These two factors make the nursing profession to lead as the most trusted profession in the Gallup polls (American Hospital Association, 2018). Gallup polls conduct a public opinion poll the level of honesty and principled standards to rate professions.
The nursing profession is very stressful due to several factors. First, nurses interact with patients in their most vulnerable state. This interaction exposes them to the pain and suffering of the patients, their families and society. Furthermore, nurses transition from assisting a patient acutely ill nearing the end-of-life to helping a patient who is about to undergo surgery. These constant changes and the expectation of providing personalized and holistic care to patients combined with a lack of resources and staffing issues creates a stressful environment for the profession of nursing.
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Additionally, violence at the workplace has increased in this profession with statistics from the Center for Disease Control and Prevention. Workplace violence injury rates doubling in the profession of nursing in the recent years and the quality and regulatory standards in the nursing profession has increased meaning nurses have to adapt to meet these regulatory standards despite having to work for long hours due to the shortage of nurses. Nurses are forced to work for long hours because they understand that patient contentment is crucial to their recovery as well as the financial strength of the hospital. These factors above expose nurses to compassion fatigue.
Compassion fatigue affects nurses and other caregivers such as social workers and first responders. Compassion fatigue (CF) exhibits itself in two ways: physically and emotionally corroding the mind, body and spirit of caregivers. Since most nurses fail to understand how to deal with CF, they resort to retire from the profession. This negative impact of CF contributes significantly to the shortage of nurses globally in the health care sector. The resolve of this concept analysis is to elucidate the notion of CF to effectively formulate prevention and mitigation methods within the profession of caregiving at both the individual and organizational level.
Reed’s theory of self-transcendence and Watson’s theory of human caring rely on the concept of compassion fatigue as a building block to the theories. However, this paper will principally emphasize on Watson’s theory of human caring. Also, the paper will attend to the definition of CF, literature review, defining attributes of compassion fatigue, antecedent and consequence of CF, construct cases, and the purpose of these concept analyses with Watson's theory of human caring.
Definition of Compassion Fatigue
Dr. Charles Figley formally defined CF as a condition that caregivers develop while assisting those people in pain and suffering. This condition affects the caregivers more than the individuals receiving help
2 nd definition
Kate Sheppard defines CF as a situation where caregivers lose the satisfaction that comes with helping others; instead, the caregivers develop pain and suffering which leads to low self-drive, absenteeism and low turnover among caregivers.
3 rd definition
According to Emily Peters (2018), CF or secondary traumatic stress (STS) is a situation in which an individual is overexposed to a stimulus that brings the conscious feeling of alleviating suffering from another individual to a point where the individual becomes impaired to the stimuli. This impairment creates a feeling of exhaustion both mentally and emotionally to the caregivers (Peters, 2018).
Burnout contrasted with Compassion Fatigue
Burnout is often confused with burnout because both of them manifest themselves in the form of exhaustion. Burnout can occur separately or together with secondary traumatic stress. Burnout prompts the feeling of negativity to work, exhaustion and resentment. Demanding jobs, lack of teamwork and lack of acknowledgement for one's achievement breed burnout in an employee. It is characterized by fast development as well as quick recovery after the stressors are eliminated.
However, CF develops when caregivers abandon their individual needs to assist their patients. It evolves when nurses reduce their boundaries with patients and fail to deal with grief. Ledoux (2015) contends that CF does not arise from abandoning the care of patients but from forfeiting the distinct caregiver’s physical and spiritual needs.
Literature Review
As earlier discussed, secondary traumatic stress affects not only a nurse but also other professions concerned with caregiving such as social workers, first responders and the clerics. Most scholars agree that CF and burnout are muddled together, but they are two different concepts even though they share some symptoms. The difference between the two ideas is that burnout is usually progressive while compassion fatigue is severe and burnout disappears as soon as the stressor is removed. Studies indicate that both burnout and compassion fatigue contributes significantly to poorer patient outcomes, reduced work satisfaction as well as toxic work environments. Other scholars contend that CF is a defensive mechanism by nurses and other caregivers to shield themselves against stresses related to their profession (Sansó, et al., 2015).
According to Sheppard, compassion fatigue is an occupational hazard due to the following factors. The nursing profession places its workers at risk because it exposes them to stressors. Secondly, compassion fatigue is a natural occurrence that manifests itself after caring (Sheppard, 2015) . Lastly, the profession of nursing prevents a caregiver from detaching himself or herself from stress. Nurses are continuously placed near tragedy. Sheppard also contends that burnout differs from CF because burnout is associated with the work environment while compassion fatigue is associated with the empathic connection between a nurse and a patient. She also argues that burnout occurs before compassion fatigue.
Defining attributes
Four broad categories define compassion fatigue; peril factors, sources, development and expressions. A peril is defined as something that increases the chance of harm or loss while the source is the cause of the concept and expressions are the manifestations. Several risk factors increase the prospects for a nurse to experience compassion fatigue. These include personal history and beliefs, demographics, protracted exposure and deficiency of support system. Possession of a risk factor does not equate to experiencing compassion fatigue; it shows the likelihood of developing it. The source indicates what leads to CF. Development process highlights the events that lead to compassion fatigue while compassion fatigue exhibits itself in several facets; either spiritual, emotional, physical or social (Siedine Knobloch Coetzee, 2010). Instances of manifestation include; low morale, negativity, exhaustion, absenteeism and poor patient outcomes.
Antecedent and Consequence
An antecedent is described as a precursor to an event. Based on this knowledge, both risk factors and causes act as antecedents to compassion fatigue. Personal history and belief, demographics, prolonged exposure to stressor serve as antecedents, but they do not necessarily mean an individual will experience CF (Kompanje, Marjan, Jan, Dominique, & Margo, 2015). Equipping nurses with this knowledge will assist them to take preemptive measures to cater to their individual needs to fight against compassion fatigue.
Consequences can be described as results of an event. Sheppard outlines that nurses manifest hypervigilance, distress, exhaustion and decreased patient contentment. These manifestations can be reversed by the development of healthy habits and positive rituals. These self-care rituals will prevent CF from advancing and recurring.
Empirical Referents
Majority of nurses fail to admit about compassion fatigue. This denial serves as a hindrance to healing and recovery. It is also difficult to determine the severity of this condition, but several tools have been developed to assist practitioners in ascertaining if they are experiencing burnout or compassion fatigue. This paper will look at the ProQol self-test that analyses the quality of life of a caregiver. The self-test has four options to select from “never”, “rarely”, “sometimes”, “often” and “very often” in multiple statements. This test indicates the severity of CF to assist the caregiver in dealing with it (Mattioli, Linda, & Emily, 2018).
Another test that analyzes the severity is the compassion fatigue self-test which is similar to the ProQol test but gives the user three options ranging from somewhat true to very true. Both tests take the total score to determine the severity and offer recommendations.
Construct cases
Model Case
Terrence is a facilitator and charge nurse of a 24- bed in the urological department. He has worked in the department for six years. He works for 40 hours a week in a shift of 10 hour days. The unit is usually filled resulting in short staffing which prompts them to work with new graduate nurses. Terrence is responsible for staffing and patient assignment in the department. The patients are chronically sick with some undergoing multiple surgeries. Terrence has numerous duties combined with caring for a high patient population.
He used to enjoy his profession, but poor staff turnover and the demise of multiple terminal patients have taken a toll on him. He shows little caring to his patients and dislikes training new hires. He desired to retire but felt the department would suffer. Terrence became more detached as he continued to work and began to feel a lack of energy to care for his patients.
Borderline case
Amanda served as a patient care assistant in the gastrointestinal unit. She switched to the emergency department recently to assist in the short staffing issues where she worked as a nurse for the past ten months. The hospital is situated in the highest crime rate per capita in the country. She is regularly in contact with patients suffering from gunshot wounds, stabbings, rape and acute health conditions. Prolonged exposures and she began to get attached with the patients. This induced anxiety and stress on her. This led to the development of the secondary traumatic disorder. Her condition manifests itself like CF, but they resulted from continuous caring of patients exposed to distressing happenings.
Contrary case
Christine has worked on the adult behavioral health unit for eight years. Christine cares for patients with mental ailments. She picks up additional shifts to shelter against shortages in staffing. Christine enjoys her job and finds fulfillment in assisting patients in recovering. She has even decided to return to school despite the increased workload. Christine experiences compassion satisfaction as opposed to CF.
Theoretical Applications of the Concept
Watson’s theory of human caring relates to the concept of compassion fatigue and the profession of nursing because the theory contends that human beings cannot be separated from themselves, other people or nature. Compassion fatigue arises from abandonment of individual needs which results in inability to care for other people. Watson’s theory illustrates the inter-relationship between the caregiver and nurse and the healing potential it possesses.
Conclusion
Dr. Watson termed the relationship between the patient and the nurse that relied heavily on empathy and communication. A nurse becomes inefficient in offering care to a patient when empathy is lost. Manifestations of CF have catastrophic effects for both the patient and the nurse. It is crucial to develop an effective tool to detect compassion fatigue and its severity among caregivers.
Reference
American Hospital Association. (2018, January 10). Nurse Watch: Nurses Again Top Gallup Poll of Trusted Professions and Other Nurse News . Retrieved from American Hospital Association: https://www.aha.org/news/insights-and-analysis/2018-01-10-nurse-watch-nurses-again-top-gallup-poll-trusted-professions
Kompanje, E. J., M. D., J. B., D. D., & M. M. (2015, August 31). The Prevalence of Compassion Fatigue and Burnout among Healthcare Professionals in Intensive Care Units: A Systematic Review. PLoS ONE, 10 (8). Retrieved March 23, 2019
Mattioli, D., L. W., & E. J. (2018, October). Focusing on the Caregiver: Compassion Fatigue Awareness and Understanding. Professional Issues, 27 (5), 323-328. Retrieved March 23, 2019
Peters, E. (2018, July 02). Nursing Forum . Retrieved from Wiley Online Library: https://onlinelibrary.wiley.com/doi/pdf/10.1111/nuf.12274
Sansó, N., L. G., A. O., A. P., S. S., & E. B. (2015). Palliative Care Professionals' Inner Life: Exploring the Relationships Among Awareness, Self-Care, and Compassion Satisfaction and Fatigue, Burnout, and Coping With Death. Journal of Pain and Symptom Management , 200-207. Retrieved March 22, 2019, from https://www.jpsmjournal.com/article/S0885-3924(15)00086-X/fulltext
Sheppard, K. (2015). Compassion fatigue among registered nurses: Connecting theory. Applied Nursing Research , 57-59. Retrieved March 22, 2019
Siedine Knobloch Coetzee, K. H. (2010, June). Compassion fatigue within nursing practice: a concept analysis. Nurse Health Science, 12 (2), 235-243. Retrieved March 23, 2019
