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Working Toward a Healthier You: Recognizing Compassion Fatigue
EDITORIAL OPINION
Working Toward a Healthier You: Recognizing Compassion Fatigue Vallire D. Hooper, PhD, RN, CPAN, FAAN THE AMERICAN NURSES ASSOCIATION (ANA) has declared 2017 as the ‘‘Year of the Healthy Nurse.’’1,2 At 3.6 million strong, the nursing profession serves as one of the most knowledgeable of health care providers, advising patients, friends, and families about how to obtain and maintain a healthy lifestyle. Despite this wealth of knowledge and ongoing desire to serve others, our profession unfortunately consistently scores lower on an assortment of health metrics as compared to the general population.2 For most of you, this is likely not a surprising fact. The ANA and the American Nurses Foundation (ANF) have partnered to launch a national challenge to improve the health of nurses across the nation. Initiated in May of this year, these two organizations are partnering with employers and nursing organizations to improve nursing health in five focus areas: physical activity, rest, nutrition, quality of life, and safety.2 While all of these areas are critical to overall health and well being, I would like to focus on one area that I feel we all frequently ignore: quality of life. Specifically, I would like to discuss a critical element often associated with decreased quality of life in nursing: compassion fatigue. Health care providers caring for patient populations who have experienced adverse and/or traumatic patient events may also experience negative impacts on their own physical and psychological well-being, particularly in the form of chronic emotional stress, often termed secondary
The ideas or opinions expressed in this editorial are those solely of the author and do not necessarily reflect the opinions of ASPAN, the Journal, or the Publisher. Vallire D. Hooper, PhD, RN, CPAN, FAAN, Nursing Practice, Education, and Research, Mission Health, Asheville, NC. Conflict of interest: None to report. Address correspondence to Vallire D. Hooper, 231 Grandview Road, Canton, NC 28716; e-mail address: vallire. [email protected]. Ó 2017 by American Society of PeriAnesthesia Nurses 1089-9472/$36.00 http://dx.doi.org/10.1016/j.jopan.2017.04.007
Journal of PeriAnesthesia Nursing, Vol 32, No 3 (June), 2017: pp 165-166
traumatic stress or compassion fatigue (CF).3 Compassion fatigue is defined as emotional, physical, and spiritual depletion related to secondary exposure to trauma and the overwhelming daily needs of victims of direct trauma. Common among all health care providers, but particularly among nurses, CF results from the indirect countertransference of the trauma/stress experienced by patients onto their care providers.4,5 Compassion fatigue results in a state of psychological exhaustion, ultimately limiting the provider’s capacity to provide compassionate care, and possibly leading to the provider leaving the profession. Symptoms can be classified as emotional (eg, anger, apathy, cynicism, desensitization, irritability, sarcasm), intellectual (eg, boredom, impaired concentration), physical (eg, somatic complaints, lack of energy/endurance, accident prone, weariness/fatigue), social (eg, callousness, isolation, indifference, unresponsiveness), spiritual (eg, disinterest in introspection, lack of spiritual awareness) and work related (eg, absenteeism, desire to quit, diminished performance).4-6 Compassion fatigue has also been associated with impacts on work quality and nursing retention and turnover. Research has associated higher levels of CF and burnout with lower patient satisfaction scores, increased incidence of sharps injuries, higher rates of hospital-acquired infections, decreased nurse productivity, and increased nurse turnover.7 Given the ‘‘get them in, get them out’’ mantra of perianesthesia nursing, we may think that we are less prone to developing CF. We may not have the daily, long-term patient and family interactions that many of our colleagues experience; however, we still encounter tragic, unexpected outcomes, patient/family challenges, and mass casualty or trauma events that take their toll on our mental stamina and reserve. Compassion fatigue is often difficult to recognize in oneself, so it is critical for all of us to be aware of the signs and symptoms in an effort to recognize and appropriately intervene on behalf of our colleagues in distress. It is also important for us to work within our units/departments as
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well as with our human resource/staff support departments to be aware of current support programs, and/or develop programs to provide staff support and combat CF in our work environments. Menschner and Maul3 recommend four intervention categories to help support staff and combat the development of CF: General wellness: Encouraging general wellness activities can go a long way in averting the development of CF. Yoga, meditation, and exercise activities counteract the daily impact of stressors contributing to CF. Ideally, your organization would have the resources to provide classes and activities, but if not, organize exercise activities as a unit. A 30 minute walk around your campus before or after your shift will go a long way towards both physical and mental fitness. Organizational: Foster a supportive, engaging culture for all employees. Educate all staff to recognize and appropriately intervene in the case of CF. Provide for sufficient breaks and time off of the unit during a shift. Encourage staff to take vacation time and respite away from the work place. Work with your organization to develop support strategies for staff in need.
Education: Staff should be educated on the recognition of signs and symptoms of CF as well as appropriate strategies and resources to intervene. Supervision: Senior and frontline managers should also be well versed in the recognition of CF and strategies to prevent or remedy its onset. Reflective supervision, a practice in which the clinician and supervisor meet regularly to address feelings regarding patient encounters/events, is a wonderful strategy that has been shown to be effective in combating CF. Take advantage of this focus year of the healthy nurse to evaluate your current physical and emotional health. Do you have a solid, embedded exercise routine? If not, what are the barriers and facilitators to enhancing your physical health? Don’t forget the emotional component. Are you weary? Are you burnt out? Do you need respite? What are steps that you can take for yourself, and to assist your colleagues to take in order to enhance your emotional well-being? Only in caring for ourselves can we provide the highest level of safe, quality care to our patients. Put yourself first for a change, a healthier you may be the key to total success!
References 1. ANA. 2017 Year of the Healthy Nurse. 2017. Available at: http://nursingworld.org/yearofhealthynurse. Accessed April 14, 2017. 2. ANF. Healthy Nurse, Healthy Nation: Leading the Way to Better Health. Silver Spring, MD: ANA Enterprise; 2017. 3. Menschner C, Maul A. Strategies for Encouraging Staff Wellness in Trauma-Informed Organizations. 2016. Available at: http://www.chcs.org/media/ATC-Staff-Wellness-121316_ FINAL.pdf. Accessed March 16, 2017.
4. Boyle D. Countering compassion fatigue: A requisite nursing agenda. Online J Issues Nurs. 2011;16:2. 5. Lombardo B, Eyre C. Compassion fatigue: A nurse’s primer. Online J Issues Nurs. 2011;16:3. 6. Boyle DA. Compassion fatigue: The cost of caring. Nursing. 2015;45:48-51. 7. Smart D, English A, James J, et al. Compassion fatigue and satisfaction: A cross-sectional survey among US healthcare workers. Nurs Health Sci. 2014;16:3-10.
Working Toward a Healthier You: Recognizing Compassion Fatigue Vallire D. Hooper, PhD, RN, CPAN, FAAN THE AMERICAN NURSES ASSOCIATION (ANA) has declared 2017 as the ‘‘Year of the Healthy Nurse.’’1,2 At 3.6 million strong, the nursing profession serves as one of the most knowledgeable of health care providers, advising patients, friends, and families about how to obtain and maintain a healthy lifestyle. Despite this wealth of knowledge and ongoing desire to serve others, our profession unfortunately consistently scores lower on an assortment of health metrics as compared to the general population.2 For most of you, this is likely not a surprising fact. The ANA and the American Nurses Foundation (ANF) have partnered to launch a national challenge to improve the health of nurses across the nation. Initiated in May of this year, these two organizations are partnering with employers and nursing organizations to improve nursing health in five focus areas: physical activity, rest, nutrition, quality of life, and safety.2 While all of these areas are critical to overall health and well being, I would like to focus on one area that I feel we all frequently ignore: quality of life. Specifically, I would like to discuss a critical element often associated with decreased quality of life in nursing: compassion fatigue. Health care providers caring for patient populations who have experienced adverse and/or traumatic patient events may also experience negative impacts on their own physical and psychological well-being, particularly in the form of chronic emotional stress, often termed secondary
The ideas or opinions expressed in this editorial are those solely of the author and do not necessarily reflect the opinions of ASPAN, the Journal, or the Publisher. Vallire D. Hooper, PhD, RN, CPAN, FAAN, Nursing Practice, Education, and Research, Mission Health, Asheville, NC. Conflict of interest: None to report. Address correspondence to Vallire D. Hooper, 231 Grandview Road, Canton, NC 28716; e-mail address: vallire. [email protected]. Ó 2017 by American Society of PeriAnesthesia Nurses 1089-9472/$36.00 http://dx.doi.org/10.1016/j.jopan.2017.04.007
Journal of PeriAnesthesia Nursing, Vol 32, No 3 (June), 2017: pp 165-166
traumatic stress or compassion fatigue (CF).3 Compassion fatigue is defined as emotional, physical, and spiritual depletion related to secondary exposure to trauma and the overwhelming daily needs of victims of direct trauma. Common among all health care providers, but particularly among nurses, CF results from the indirect countertransference of the trauma/stress experienced by patients onto their care providers.4,5 Compassion fatigue results in a state of psychological exhaustion, ultimately limiting the provider’s capacity to provide compassionate care, and possibly leading to the provider leaving the profession. Symptoms can be classified as emotional (eg, anger, apathy, cynicism, desensitization, irritability, sarcasm), intellectual (eg, boredom, impaired concentration), physical (eg, somatic complaints, lack of energy/endurance, accident prone, weariness/fatigue), social (eg, callousness, isolation, indifference, unresponsiveness), spiritual (eg, disinterest in introspection, lack of spiritual awareness) and work related (eg, absenteeism, desire to quit, diminished performance).4-6 Compassion fatigue has also been associated with impacts on work quality and nursing retention and turnover. Research has associated higher levels of CF and burnout with lower patient satisfaction scores, increased incidence of sharps injuries, higher rates of hospital-acquired infections, decreased nurse productivity, and increased nurse turnover.7 Given the ‘‘get them in, get them out’’ mantra of perianesthesia nursing, we may think that we are less prone to developing CF. We may not have the daily, long-term patient and family interactions that many of our colleagues experience; however, we still encounter tragic, unexpected outcomes, patient/family challenges, and mass casualty or trauma events that take their toll on our mental stamina and reserve. Compassion fatigue is often difficult to recognize in oneself, so it is critical for all of us to be aware of the signs and symptoms in an effort to recognize and appropriately intervene on behalf of our colleagues in distress. It is also important for us to work within our units/departments as
165
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well as with our human resource/staff support departments to be aware of current support programs, and/or develop programs to provide staff support and combat CF in our work environments. Menschner and Maul3 recommend four intervention categories to help support staff and combat the development of CF: General wellness: Encouraging general wellness activities can go a long way in averting the development of CF. Yoga, meditation, and exercise activities counteract the daily impact of stressors contributing to CF. Ideally, your organization would have the resources to provide classes and activities, but if not, organize exercise activities as a unit. A 30 minute walk around your campus before or after your shift will go a long way towards both physical and mental fitness. Organizational: Foster a supportive, engaging culture for all employees. Educate all staff to recognize and appropriately intervene in the case of CF. Provide for sufficient breaks and time off of the unit during a shift. Encourage staff to take vacation time and respite away from the work place. Work with your organization to develop support strategies for staff in need.
Education: Staff should be educated on the recognition of signs and symptoms of CF as well as appropriate strategies and resources to intervene. Supervision: Senior and frontline managers should also be well versed in the recognition of CF and strategies to prevent or remedy its onset. Reflective supervision, a practice in which the clinician and supervisor meet regularly to address feelings regarding patient encounters/events, is a wonderful strategy that has been shown to be effective in combating CF. Take advantage of this focus year of the healthy nurse to evaluate your current physical and emotional health. Do you have a solid, embedded exercise routine? If not, what are the barriers and facilitators to enhancing your physical health? Don’t forget the emotional component. Are you weary? Are you burnt out? Do you need respite? What are steps that you can take for yourself, and to assist your colleagues to take in order to enhance your emotional well-being? Only in caring for ourselves can we provide the highest level of safe, quality care to our patients. Put yourself first for a change, a healthier you may be the key to total success!
References 1. ANA. 2017 Year of the Healthy Nurse. 2017. Available at: http://nursingworld.org/yearofhealthynurse. Accessed April 14, 2017. 2. ANF. Healthy Nurse, Healthy Nation: Leading the Way to Better Health. Silver Spring, MD: ANA Enterprise; 2017. 3. Menschner C, Maul A. Strategies for Encouraging Staff Wellness in Trauma-Informed Organizations. 2016. Available at: http://www.chcs.org/media/ATC-Staff-Wellness-121316_ FINAL.pdf. Accessed March 16, 2017.
4. Boyle D. Countering compassion fatigue: A requisite nursing agenda. Online J Issues Nurs. 2011;16:2. 5. Lombardo B, Eyre C. Compassion fatigue: A nurse’s primer. Online J Issues Nurs. 2011;16:3. 6. Boyle DA. Compassion fatigue: The cost of caring. Nursing. 2015;45:48-51. 7. Smart D, English A, James J, et al. Compassion fatigue and satisfaction: A cross-sectional survey among US healthcare workers. Nurs Health Sci. 2014;16:3-10.