Compassion fatigue

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, teachers, psychologists, police officers, paramedics, emergency medical technicians (EMTs), firefighters, animal welfare workers, and health unit coordinators. Non-workers, such as family members, relatives, 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.

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 and/or resistant to helping people who are suffering.[5]

History

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 utilized 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

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

Between 16% and 85% of health care workers in various fields develop compassion fatigue. In one study, approximately 85% 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]

Healthcare professionals experiencing compassion fatigue may find it difficult to continue doing their jobs. 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.[18]

Caregivers for dependent people can also experience compassion fatigue; this 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. This phenomenon also occurs for professionals involved with long term health care. It can also occur for loved ones 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 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 suspiciousness about the world around them, and 42% reported feeling increasingly vulnerable after treating the Katrina victims.[19]

Compassion fatigue, or vicarious trauma, refers to the secondary exposure to trauma seen in fields where workers are directly in contact with the sufferer(s). Symptoms appear quickly, usually manifesting at trauma symptoms like visualizing the event, insomnia, fear, and avoiding anything that can remind someone of what happened. 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, of safety, and of control.[20] Those with a better ability to empathize and be compassionate are at a higher risk of developing compassion fatigue.[21]

Those who experience compassion fatigue, or STS, can begin to exhibit patterns where they feel disengaged, inadequate, overwhelmed, parental, undervalued, over-involved, sexualized, or positive.[22]

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."[23] 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[24] is the expansion of the discussion around compassion fatigue and 'burnout.'

In lawyers

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

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.[25]

Personal self-care

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.[26]

Social self-care

Social support and emotional support can help practitioners maintain a balance in their worldview.[27] Maintaining a diverse network of social support, from colleagues to pets, promotes a positive psychological state and can protect against STS.[26]

See also

References

  1. 1 2 Day, Jennifer R.; Anderson, Ruth A. (2011-09-08). "Compassion Fatigue: An Application of the Concept to Informal Caregivers of Family Members with Dementia". Nursing Research and Practice. 2011: 1–10. doi:10.1155/2011/408024. PMC 3170786. PMID 22229086.
  2. 1 2 3 "Compassion Fatigue - Because You Care" (PDF). St. Petersburg Bar Association Magazine. Archived from the original (PDF) on November 20, 2008. Retrieved February 2007. Check date values in: |accessdate= (help)
  3. ↑ Conrad, David; Kellar-Guenther, Yvonne (2006). "Compassion Fatigue, Burnout, and Compassion Satisfaction among Colorado Child Protection Workers". Child Abuse & Neglect. 30 (10): 1071–1080.
  4. ↑ Holcombe, T. Melissa; Strand, Elizabeth B.; Nugent, William R.; Ng, Zenithson Y. (2016). "Veterinary social work: Practice within veterinary settings". Journal of Human Behavior in the Social Environment. 26 (1): 69.
  5. ↑ "Traumatic Stress & The News Audience". Dart Center for Journalism and Trauma. Retrieved June 2008. Check date values in: |accessdate= (help)
  6. ↑ Figley, C. (1982). Traumatization and comfort: Close relationships may be hazardous to your health. Keynote presentation at the Conference, Families and close relationships: Individuals in social interaction, Texas Tech University, Lubbock, Texas, February.
  7. ↑ Figley, C. R. (1983). Catastrophes: A overview of family reactions. In C. R. Figley and H. I. McCubbin (Eds.), Stress and the Family: Volume II: Coping with Catastrophe. New York: Brunner/Mazel, 3-20.
  8. ↑ Lisa McCann, I.; Pearlman, Laurie Anne (1990-01-01). "Vicarious traumatization: A framework for understanding the psychological effects of working with victims". Journal of Traumatic Stress. 3 (1): 131–149. doi:10.1002/jts.2490030110. ISSN 1573-6598.
  9. ↑ Remer, R., & Elliott, J. E. (1988). Characteristics of secondary victims of sexual assault. International Journal of Family Psychiatry, 9(4), 373-387.
  10. ↑ Erickson, C. A. (1989). Rape and the family. Treating stress in families, 257-289.
  11. ↑ Verbosky, S. J.; Ryan, D. A. (1988). "Female partners of Vietnam veterans: stress by proximity". Issues in Mental Health Nursing. 9 (1): 95–104. ISSN 0161-2840. PMID 3356550.
  12. 1 2 3 Beck, C (2011). "Secondary Traumatic Stress in Nurses: A Systematic Review". Archives of Psychiatric Nursing. 25 (1): 1–10. doi:10.1016/j.apnu.2010.05.005.
  13. ↑ Ricard, Matthieu (2015). "IV". Altruism: The Power of Compassion to Change Yourself and the World. Brown and Company. pp. 56–64. ISBN 978-0316208246.
  14. ↑ Differential pattern of functional brain plasticity after compassion and empathy training, Olga M. Klimecki, Susanne Leiberg, Matthieu Ricard, and Tania Singer, Department of Social Neuroscience, Max Planck Institute for Human Cognitive and Brain Sciences
  15. ↑ D’Souza, Egan, & Rees, 2011
  16. 1 2 Meadors; et al. (2008). "Compassion Fatigue and Secondary Traumatization: Provider Self Care on the Intensive Care Units for Children". Journal of Pediatric Health. 22 (1).
  17. ↑ Hooper; et al. (2010). "Compassion Satisfaction, Burnout, and Compassion Fatigue Among Emergency Nurses Compared With Nurses in Other Selected Inpatient Specialties". Journal of Emergency Nursing. 36 (5): 420–427. doi:10.1016/j.jen.2009.11.027.
  18. ↑ Sorenson, Claire; Bolick, Beth; Wright, Karen; Hamilton, Rebekah. "An Evolutionary Concept Analysis of Compassion Fatigue". Journal of Nursing Scholarship. 49 (5): 557–563. doi:10.1111/jnu.12312.
  19. ↑ Culver, L., McKinney, B., Paradise, L. (2011). Mental Health Professionals' Experiences of Vicarious Traumatization in Post-Hurricane Katrina New Orleans, 16(1), 33-42.
  20. ↑ Van Hook, M. P.; Rothenberg, M. (2009). "Quality of life and compassion satisfaction/fatigue and burnout in child welfare workers: A study of the child welfare workers in community based care organizations in Central Florida". Social Work & Christianity. 36 (1): 36–54.
  21. ↑ Figley, C. R. (1995). Compassion fatigue as secondary stress disorder: An overview. Compassion fatigue: coping with secondary traumatic stress disorder in those who treat the traumatized (1-20). New York: Brunner/Mazel.
  22. ↑ Betan, Ephi; Heim, Amy Kegley; Zittel Conklin, Carolyn; Westen, Drew (2005-05-01). "Countertransference Phenomena and Personality Pathology in Clinical Practice: An Empirical Investigation". American Journal of Psychiatry. 162 (5): 890–898. doi:10.1176/appi.ajp.162.5.890. ISSN 0002-953X.
  23. ↑ "Physicians aren't 'burning out.' They're suffering from moral injury - STAT". STAT. 2018-07-26. Retrieved 2018-09-27.
  24. ↑ Talbot, Dean. "Moral Injury of Healthcare".
  25. ↑ Potter, Patricia; Pion, Sarah; Gentry, J. Eric. "Compassion Fatigue Resiliency Training: The Experience of Facilitators". The Journal of Continuing Education in Nursing. 46 (2): 83–88. doi:10.3928/00220124-20151217-03.
  26. 1 2 Huggard, P. (2003). Secondary Traumatic Stress: Doctors at risk. New Ethicals Journal. http://home.cogeco.ca/~cmc/Huggard_NewEthJ_2003.pdf
  27. ↑ "Politically Active? 4 Tips for Incorporating Self-Care, US News". US News. 27 February 2017. Retrieved 5 March 2017.

Further reading

  • Adams, R.; Boscarino, J.; Figley, J. (2006). "Compassion Fatigue and Psychological distress among social workers: a validation study". American Journal of Orthopsychiatry. 76: 103–108. doi:10.1037/0002-9432.76.1.103. PMC 2699394.
  • Barnes, M. F (1997). "Understanding the secondary traumatic stress of parents". In C. R. Figley (Ed). Burnout in Families: The Systemic Costs of Caring, pp., 75-90. Boca Raton: CRC Press.
  • Beaton, R. D. and Murphy, S. A. (1995). "Working with people in crisis: Research implications". In C. R. Figley (Ed.), Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized, 51-81. NY: Brunner/Mazel.
  • Figley, C. R. (1995). "Survival Strategies: A Framework for Understanding Secondary Traumatic Stress and Coping in Helpers". Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. NY: Brunner/Mazel. pp. 21–50. ISBN 9780876307595.
  • Hall, J.; Rankin, J. (2008). "Secondary Traumatic Stress and Child Welfare". International Journal of Child and Family Welfare. 11 (4): 172–184.
  • Kinnick, K; Krugman, D.; Cameron, G. (1996). "Compassion fatigue: Communication and burnout toward social problems". Journalism & Mass Communication Quarterly. 73 (3): 687–707. doi:10.1177/107769909607300314.
  • Kottler, J. A. (1992). Compassionate Therapy: Working with Difficult Clients. San Francisco: Jossey-Bass.
  • Joinson, C (1992). "Coping with compassion fatigue". Nursing. 22 (4): 116–122.
  • Phillips, B. (2009). Social Psychological Recovery, Disaster Recovery. (p. 302). Boca Raton, FL: CRC Press - Taylor & Francis Group.
  • Putman, J.; Lederman, F. (2008). "How to Maintain Emotional Health. When Working with Trauma". Juvenile and Family Court Journal. 59 (4): 91–102.
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