Compassion fatigue

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Compassion fatigue, also known as secondary traumatic stress (STS), is a condition characterized by a gradual lessening of compassion over time. Scholars who study compassion fatigue note that the condition is common among workers who work directly with victims of disasters, trauma, or illness, especially in the health care industry.[1] Professionals in other occupations are also at risk for experiencing compassion fatigue, e.g. attorneys,[2] child protection workers[3] and veterinarians.[4] Other occupations include: therapists, child welfare workers, nurses, radiology technologists, teachers, journalists, psychologists, police officers, paramedics, emergency medical technicians (EMTs), firefighters, animal welfare workers and health unit coordinators. Non-workers, such as family members and other informal caregivers of people who are suffering from a chronic illness, may also experience compassion fatigue.[1] It was first diagnosed in nurses in the 1950s.[citation needed]

People who experience compassion fatigue can exhibit several symptoms including hopelessness, a decrease in experiences of pleasure, constant stress and anxiety, sleeplessness or nightmares, and a pervasive negative attitude. This can have detrimental effects on individuals, both professionally and personally, including a decrease in productivity, the inability to focus, and the development of new feelings of incompetency and self-doubt.[2]

Journalism analysts argue that news media have caused widespread compassion fatigue in society by saturating newspapers and news shows with decontextualized images and stories of tragedy and suffering. This has caused the public to become desensitized or resistant to helping people who are suffering.[5]

History[edit]

Compassion fatigue has been studied by the field of traumatology, where it has been called the "cost of caring" for people facing emotional pain.

Compassion fatigue has also been called secondary victimization,[6] secondary traumatic stress,[7] vicarious traumatization,[8] and secondary survivor.[9] Other related conditions are rape-related family crisis[10] and "proximity" effects on female partners of war veterans.[11] Compassion fatigue has been called a form of burnout in some literature. However, unlike compassion fatigue, “burnout” is related to chronic tedium in careers and the workplace, rather than exposure to specific kinds of client problems such as trauma.[12] fMRI-rt research suggests the idea of compassion without engaging in real-life trauma is not exhausting itself. According to these, when empathy was analyzed with compassion through neuroimaging, empathy showed brain region activations where previously identified to be related to pain whereas compassion showed warped neural activations.[13][14]

In academic literature, the more technical term secondary traumatic stress disorder may be used. The term "compassion fatigue" is considered somewhat euphemistic. Compassion fatigue also carries sociological connotations, especially when used to analyse the behavior of mass donations in response to the media response to disasters. One measure of compassion fatigue is in the ProQOL, or Professional Quality of Life Scale. Another is the Secondary Traumatic Stress Scale.

Risk factors[edit]

Several personal attributes place a person at risk for developing compassion fatigue. Persons who are overly conscientious, perfectionists,[15] and self-giving are more likely to suffer from secondary traumatic stress. Those who have low levels of social support or high levels of stress in personal life are also more likely to develop STS. In addition, previous histories of trauma that led to negative coping skills, such as bottling up or avoiding emotions, having small support systems, increase the risk for developing STS.[16]

Many organizational attributes in the fields where STS is most common, such as the healthcare field, contribute to compassion fatigue among the workers. For example, a “culture of silence” where stressful events such as deaths in an intensive-care unit are not discussed after the event is linked to compassion fatigue. Lack of awareness of symptoms and poor training in the risks associated with high-stress jobs can also contribute to high rates of STS.[16]

In healthcare professionals[edit]

Between 16% and 85% of health care workers in various fields develop compassion fatigue. In one study, 86% of emergency room nurses met the criteria for compassion fatigue.[17] In another study, more than 25% of ambulance paramedics were identified as having severe ranges of post-traumatic symptoms.[12] In addition, 34% of hospice nurses in another study met the criteria for secondary traumatic stress/compassion fatigue.[12]

Compassion Fatigue is the emotional and physical distress caused by treating and helping patients that are deeply in need, which can desensitize healthcare professionals causing them a lack of empathy for future patients.[18] There are three important components of Compassion Fatigue: Compassion satisfaction, secondary stress and burnout.[19] It is important to note that burnout is not the same as Compassion Fatigue; Burnout is the stress and mental exhaustion caused by the inability to cope with the environment and continuous physical and mental demands.[20]

Healthcare professionals experiencing compassion fatigue may find it difficult to continue doing their jobs. While many believe that these diagnoses affect workers who have been practicing in the field the longest, the opposite proves true. Young physicians and nurses are at an increased risk for both burnout and compassion fatigue.[21] A study published in the Western Journal of Emergency Medicine revealed that medical residents develop Compassion Fatigue and within this group medical residents who work overnight shifts and that work more than eighty hours a week are in higher risk of developing Compassion Fatigue.[22] In these professionals with higher risk of suffering from Compassion Fatigue, burnout was one of the major components. Burnout is a prevalent and critical contemporary problem that can be categorized as suffering from: emotional exhaustion, de-personalization, and low sense of personal accomplishment.[23] They can be exposed to trauma while trying to deal with compassion fatigue, potentially pushing them out of their career field. If they decide to stay, it can negatively affect the therapeutic relationship they have with patients because it depends on forming an empathetic, trusting relationship that could be difficult to make in the midst of compassion fatigue. Because of this, healthcare institutions are placing increased importance on supporting their employees emotional needs so they can better care for patients.[24]

Another name and concept directly tied to compassion fatigue is moral injury. Moral injury in the context of healthcare was directly named in the Stat News article by Drs. Wendy Dean and Simon Talbot, entitled "Physicians aren’t ‘burning out.’ They’re suffering from moral injury."[25] The article and concept goes on to explain that physicians (in the United States) are caught in double and triple and quadruple binds between their obligations of electronic health records, their own student loans, the requirements for patient load through the hospital and number of procedures performed – all while working towards the goal of trying to provide the best care and healing to patients possible. However, the systemic issues facing physicians often cause deep distress because the patients are suffering, despite a physician's best efforts. This concept of Moral Injury in healthcare[26] is the expansion of the discussion around compassion fatigue and 'burnout.'

Caregivers[edit]

Caregivers for dependent people can also experience compassion fatigue, which can become a cause of abusive behavior in caring professions. It results from the taxing nature of showing compassion for someone whose suffering is continuous and unresolvable. One may still care for the person as required by policy, however, the natural human desire to help them is significantly diminished desensitization and lack of enthusiasm for patient care.[27] This phenomenon also occurs among professionals involved in long-term health care, and for those who have institutionalized family members. These people may develop symptoms of depression, stress, and trauma. Those who are primary care providers for patients with terminal illnesses are at a higher risk of developing these symptoms. In the medical profession, this is often described as "burnout": the more specific terms secondary traumatic stress and vicarious trauma are also used. Some professionals may be predisposed to compassion fatigue due to personal trauma.

Mental Health Professionals[edit]

Mental health professionals are another group that often suffer from compassion fatigue, particularly when they treat those who have suffered extensive trauma. A study on mental health professionals that were providing clinical services to Katrina victims found that rates of negative psychological symptoms increased in the group. Of those interviewed, 72% reported experiencing anxiety, 62% experienced increased suspicion about the world around them, and 42% reported feeling increasingly vulnerable after treating the Katrina victims.[28]

Critical Care Personnel[edit]

Critical care personnel have the highest reported rates of burnout, a syndrome associated with progression to compassion fatigue. These providers witness high rates of patient disease and death, leaving them to question whether their work is truly meaningful. Additionally, top-tier providers are expected to know an increasing amount of medical information along with experienced high ethical dilemmas/medical demands. This has created a workload-reward imbalance--or decreased compassion satisfaction. Compassion satisfaction, relates to the “positive payment” that comes from caring.[29] With little compassion satisfaction, both critical care physicians and nurses have reported the above examples as leading factors for developing burnout and compassion fatigue.[30] Those caring for people who have experienced trauma can experience a change in how they view the world; they see it more negatively. It can negatively affect the worker's sense of self, safety, and control.[31] In ICU personnel, burnout and compassion fatigue has been associated with decreased quality of care and patient satisfaction, as well as increased medical errors, infection rates, and death rates, making this issue one of concern not only for providers but patients.[23] These outcomes also impact organization finances.[29] According to the Institute of Medicine, preventable adverse drug events or harmful medication errors (associated with compassion fatigue/burnout) occur in 1% to 10% of hospital admissions and account for a $3.5 billion cost.[32]


Those with a better ability to empathize and be compassionate are at a higher risk of developing compassion fatigue.[33] Because of that, healthcare professionals—especially those who work in critical care, are regularly exposed to death, trauma, high stress environments, long work days, difficult patients, pressure from a patient’s family, and conflicts with other staff members- are at higher risk.[32] These exposures increase the risk for developing compassion fatigue and burnout, which often makes it hard for professionals to stay in the healthcare career field. Those who stay in the healthcare field after developing compassion fatigue or burnout are likely to experience a lack of energy, difficulty concentrating, unwanted images or thoughts, insomnia, stress, desensitization and irritability[27]. As a result, these healthcare professionals may later develop substance abuse, depression, and suicide.[34]  A 2018 study that examined differences in compassion fatigue in nurses based on their substance use found significant increases for those who used cigarettes, sleeping pills, energy drinks, antidepressants and anti-anxiety drugs. Unfortunately, despite  recent, targeted efforts being made to reduce burnout, it appears that the problem is increasing. In 2011, a study conducted by the Department of Medicine Program on Physician Well-Being at Mayo Clinic reported that 45% of physicians in the United States had one or more symptoms of burnout. In 2014, that number had increased to 54%.[23]

In lawyers[edit]

Recent research shows that a growing number of attorneys who work with victims of trauma are exhibiting a high rate of compassion fatigue symptoms. In fact, lawyers are four times more likely to suffer from depression than the general public. They also have a higher rate of suicide and substance abuse. Most attorneys, when asked, stated that their formal education lacked adequate training in dealing with trauma. Besides working directly with trauma victims, one of the main reasons attorneys can develop compassion fatigue is because of the demanding case loads, and long hours that are typical to this profession.[2]

Prevention[edit]

There is an effort to prepare those in the healthcare professions to combat compassion fatigue through resiliency training. Teaching workers how to relax in stressful situations, be intentional in their duties and work with integrity, find people and resources who are supportive and understand the risks of compassion fatigue, and focus on self-care are all components of this training.[35]

Personal self-care[edit]

Stress reduction and anxiety management practices have been shown to be effective in preventing and treating STS. Taking a break from work, participating in breathing exercises, exercising, and other recreational activities all help reduce the stress associated with STS. Conceptualizing one's own ability with self-integration from a theoretical and practice perspective helps to combat criticized or devalued phase of STS. In addition, establishing clear professional boundaries and accepting the fact that successful outcomes are not always achievable can limit the effects of STS.[36]

Social self-care[edit]

Social support and emotional support can help practitioners maintain a balance in their worldview.[37] Maintaining a diverse network of social support, from colleagues to pets, promotes a positive psychological state and can protect against STS.[36]

Self-compassion as self-care[edit]

In order to be the best benefit for clients, practitioners must maintain a state of psychological well-being.[38] Unaddressed compassion fatigue may decrease a practitioners ability to effectively help their clients. Some counselors who use self-compassion as part of their self-care regime have had higher instances of psychological functioning.[39] The counselors use of self-compassion may lessen experiences of vicarious trauma that the counselor might experience through hearing clients stories.[40]  Self-compassion as a self-care method is beneficial for both clients and counselors.[41]

Mindfulness as self-care[edit]

Self-awareness as a method of self-care might help to alleviate the impact of vicarious trauma (compassion fatigue).[42] Students who took a 15 week course that emphasized stress reduction techniques and the use of mindfulness in clinical practice had significant improvements in therapeutic relationships and counseling skills.[43] The practice of mindfulness, according to Buddhist tradition is to release a person from “suffering” and to also come to a state of consciousness and relationship to other people's suffering. Mindfulness utilizes the path to consciousness through the deliberate practice of engaging “the body, feelings, states of mind, and experiential phenomena (dharma).” The following therapeutic interventions may be used as mindfulness self-care practices:

See also[edit]

References[edit]

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