Compassion fatigue is a condition characterized by emotional and physical exhaustion leading to a diminished ability to empathize or feel compassion for others, often described as the negative cost of caring. It is sometimes referred to as secondary traumatic stress (STS).
According to the Professional Quality of Life Scale, burnout and
secondary traumatic stress are two interwoven elements of compassion
fatigue.
Compassion fatigue is considered to be the result of working directly with victims of disasters, trauma, or illness, especially in the health care industry. Individuals working in other helping professions are also at risk for experiencing compassion fatigue. These include child protection workers, veterinarians, teachers, palliative care workers, journalists, police officers, firefighters, animal welfare workers, public librarians, health unit coordinators, and Student Affairs professionals. Non-professionals, such as family members and other informal caregivers of people who have a chronic illness, may also experience compassion fatigue. The term was first coined in 1992 by Carla Joinson to describe the negative impact hospital nurses were experiencing as a result of their repeated, daily exposure to patient emergencies.
People who experience compassion fatigue may exhibit a variety of symptoms including lowered concentration, numbness or feelings of helplessness, irritability, lack of self-satisfaction, withdrawal, aches and pains, or work absenteeism.
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.
Compassion fatigue is considered to be the result of working directly with victims of disasters, trauma, or illness, especially in the health care industry. Individuals working in other helping professions are also at risk for experiencing compassion fatigue. These include child protection workers, veterinarians, teachers, palliative care workers, journalists, police officers, firefighters, animal welfare workers, public librarians, health unit coordinators, and Student Affairs professionals. Non-professionals, such as family members and other informal caregivers of people who have a chronic illness, may also experience compassion fatigue. The term was first coined in 1992 by Carla Joinson to describe the negative impact hospital nurses were experiencing as a result of their repeated, daily exposure to patient emergencies.
People who experience compassion fatigue may exhibit a variety of symptoms including lowered concentration, numbness or feelings of helplessness, irritability, lack of self-satisfaction, withdrawal, aches and pains, or work absenteeism.
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.
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, secondary traumatic stress, vicarious traumatization, and secondary survivor. Other related conditions are rape-related family crisis and "proximity" effects on female partners of war veterans. 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.
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.
There is some recent academic literature suggesting that
compassion fatigue is a misnomer and should be replaced with the term,
empathy fatigue. Evidence supporting this change comes from a
burgeoning literature examining the neurophysiology of empathy versus
compassion meditation practices.
Whereas empathy can be defined as feeling what another feels and
cumulative negative effects over time can come from the accretion of the
assumptions of others painful emotions and experience. Compassion
relates to a feeling of caring, loving or desire to improve the lot of
others and may or may not require awareness of others feeling and
emotions, but instead arises from a humanistic or even altruistic desire
for subject to be free of suffering. Studies of training of compassion
practices among health care provides has demonstrated positive effects
compared to empathy practices which do not improve provider functioning.
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,
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.
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.
In healthcare professionals
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. In another study, more than 25% of ambulance paramedics were identified as having severe ranges of post-traumatic symptoms. In addition, 34% of hospice nurses in another study met the criteria for secondary traumatic stress/compassion fatigue.
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. There are three important components of Compassion Fatigue: Compassion satisfaction, secondary stress and burnout.
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.
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.
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.
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.
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.
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."
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 is the expansion of the discussion around compassion fatigue and 'burnout.'
Caregivers
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. 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
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.
Social workers are being exposed to stressful experiences in their day
to day work activities. Many social workers are at a constant battle
not only within their casework but within themselves. A social worker's
career comes at a personal price with putting personal beliefs aside,
managing compassion fatigue, and getting the mental help needed to cope
with the traumas that are dealt with daily. The way a social worker
feels must be put aside when in the field due to the possibility of
those feeling swaying the appropriate action that must be taken. If a
social worker is consciously aware of compassion fatigue and burnout
happening within themselves early on, then they hold capability to seek
the help needed to combat them before any negative impression is felt
externally. Being able to objectively evaluate situations at work aides
in keeping social workers professionally safe. Self-awareness of
compassion fatigue and burnout flow into the mental and physical
management that keep those feelings under control. When a social worker
puts in the time to take care of themselves their personal life and work
life are both positively influenced.
Critical care personnel
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.
With little compassion satisfaction, both critical care physicians and
nurses have reported the above examples as leading factors for
developing burnout and compassion fatigue.
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.
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. These outcomes also impact organization finances.
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.
Those with a better ability to empathize and be compassionate are at a higher risk of developing compassion fatigue.
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.
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. As a result, these healthcare professionals may later develop substance abuse, depression, and suicide.
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%.
In student affairs professionals
In
response to the changing landscape of post secondary institutions,
sometimes as a result of having a more diverse and marginalized student
population, both campus services and the roles of student affairs
professionals have evolved. These changes are efforts to manage the
increases in traumatic events and crises.
Due to the exposure to student crises and traumatic events,
student affairs professionals, as front line workers, are at risk for
developing compassion fatigue. Such crises may include sexual violence, suicidal ideation, severe mental health episodes, and hate crimes/discrimination.
Some research shows that almost half of all university staff
named psychological distress as a factor contributing to overall
occupational stress. This group also demonstrated emotional exhaustion,
job dissatisfaction, and intention to quit their jobs within the next
year, symptoms associated with compassion fatigue.
Factors contributing to compassion fatigue in student affairs professionals
Student affairs
professionals who are more emotionally connected to the students with
whom they work and who display an internal locus of control are found to
be more likely to develop compassion fatigue as compared to individuals
who have an external locus of control and are able to maintain
boundaries between themselves and those with whom they work.
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.
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.
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.
Social self-care
Social support and emotional support can help practitioners maintain a balance in their worldview.[54]
Maintaining a diverse network of social support, from colleagues to
pets, promotes a positive psychological state and can protect against
STS.
Self-compassion as self-care
In order to be the best benefit for clients, practitioners must maintain a state of psychological well-being.
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.
The counselors use of self-compassion may lessen experiences of
vicarious trauma that the counselor might experience through hearing
clients stories. Self-compassion as a self-care method is beneficial for both clients and counselors.
Mindfulness as self-care
Self-awareness as a method of self-care might help to alleviate the impact of vicarious trauma (compassion fatigue).
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.
The practice of mindfulness, according to Buddhist tradition is to
release a person from “suffering” and to also come to a state of
consciousness of 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:
- Somatic therapy (body)
- Psychotherapy (states of mind)
- Emotion focused therapy (feelings)
- Gestalt therapy (experiential phenomena)
| Scales Used for Assessment | Administration | Measure | Accessible |
|---|---|---|---|
| Professional Quality of Life Measure ProQOL | self -test | compassion satisfaction, burnout, and secondary traumatic stress | online, available |
| Compassion Fatigue and/Satisfaction Self Test for Helpers | self-test | compassion fatigue | online, available |
| Maslach Burnout Inventory | administered | burnout | available for purchase |
