Introduction
Nursing is a job that requires individuals to take care of a patient in times when they may be at their lowest, fighting to get better, or at the end of their life. In order to be a successful nurse one must embody two things; knowledge, and compassion. As a nurse, there is opportunity to be with a patient for up to twelve hours a day allowing them to get to know patients on a deeper level aside from their history and diagnoses. Although the main focus of a registered nurse is patient care, an important role nurses have involves caring for the immediate family in times of emotional and mental distress (Brenda, 2008, pg. 24). Contrary to what some may believe, being a nurse requires more than administering medications, and changing bed sheets. Nursing is more than just a job, and to do this successfully, this is where compassion is necessary. While there are many successful cases in which a patient recovers and gets discharged home, there are also cases in which the journey encompasses pain and exhaustion putting the nurse, patient, and family through adverse consequences. Unfortunately this can be demanding of the registered nurse, putting them at risk for developing compassion fatigue.
According to the Merriam-Webster dictionary, the term compassion is defined as “sympathetic consciousness of others’ distress together with a desire to alleviate it,” (“Compassion,” 2018), while the term fatigue is defined as “weariness or exhaustion from labor, exertion, or stress” (“Fatigue,” 2018). When the two words are used together, the term compassion fatigue can be described as the emotional, physical, and spiritual depletion one may experience in accordance with caring for patients in significant physical and emotional distress (Lanier, 2017, pg. 10). Compassion fatigue is often found in registered nurses who work in high acuity settings where their emotional and mental stability are put to the test.
Problem statement
The cornerstone of nursing involves caring for a patient in times when they are not at their optimal level of health and wellness. When nurses are consistently experiencing the stress and emotional instability of patients, it may negatively impact their personal lives and affect their work ethic due to adverse psychological effects (Brenda, 2008, pg. 24). Compassion fatigue becomes a problem when the victim is overwhelmed with chronic self-sacrifice for those they are caring for because it inhibits their ability to provide love, empathy, and care for another’s suffering. Although compassion fatigue is not considered to be a mental illness, it is powerful enough to restrict a nurse from connecting with the patient in an appropriate emotional way (Lanier, 2017, pg. 10).
Literature review
Introduction
The literature review of this paper consists of eight research articles which were all gathered from the databases through the Dominican University of California Alemany Library. The articles that were retrieved convened information on compassion fatigue and how it affected the lives of nurses throughout their career. Each article focuses on defining compassion fatigue and the symptoms one would feel if compassion fatigue is affecting them. Each article highlights the detrimental effects compassion fatigue could have on a nurses work ethic and personal life.
The Effects of Compassion Fatigue on Nurses Employed in the United States
The article Professional Compassion Fatigue: What is the True Cost of Nurses Caring for the Dying (2012), retrieved from the CINAHL Plus with Full Text database, examines the effects of compassion fatigue on palliative care and hospice nurses. The study uses a descriptive qualitative design with a sample size of six women who have a work experience range of 11 to 33 years (Melvin, 2012, pg. 606). The participants were employed in a community home health agency located in the northeast region of the United States. The data were collected using a semi-structured interview style using questions that allowed the participants to provide relevant information at their own discretion. The interview was recorded and later transcribed verbatim.
In the 2012 study, Melvin sought to explore if nurses who continuously face death and dying are at risk of developing professional compassion fatigue, and the emotional and physical consequences these nurses might encounter. The results provided that one participant (n=1) was suffering from compassion fatigue at the time at the interview and the other (n=5) participants had confronted characteristics of compassion fatigue during their career (Melvin, 2012, pg. 68). Melvin established themes derived from the data analysis which allowed for the declaration of coping strategies to help deal with compassion fatigue.
Though this study provided substantial information on compassion fatigue, there are limitations to consider. The sample size (n=6) is not sufficient enough to make a definitive conclusion on the effects of death and dying relative to nurses developing compassion fatigue. However, although the sample size was small, the results revealed that compassion fatigue can affect those who work in an emotionally demanding setting.
In the article Compassion Fatigue Among Registered Nurses: Connecting Theory and Research (2015) obtained from the ScienceDirect database, Sheppard evaluates compassion fatigue among registered nurses. In this qualitative study, the sample of registered nurses (n=16) who were employed in a level-1 trauma center were asked open ended questions to facilitate responses that reflected on their experiences with compassion fatigue. The study, theoretically framed around the Professional Quality of Life conceptual model, examined their findings and how the results related to it.
In the study the researcher identifies the purpose of the article as addressing compassion fatigue in nurses due to an increase in patients who identified as “former nurses,” and engaging with nurses whom leave the profession after a short time. The results yielded that nurses involved in the study experienced a decrease in compassion satisfaction due to burnout and secondary traumatic stress, however none identified these factors as the leading variables to compassion fatigue.
The limitations this study encounters consists of a small sample size (n=16), and failure to define the results in a clear numerical way. This allows for analytical error and decreased reliability. The reliability of this study is further questioned due to the lack of information provided about the data collection method. Although this article faces a number of limitations, this study is pertinent to the research of compassion fatigue and the effects it has on a nurses personal and professional life.
The study Compassion Fatigue in Nurses, conducted by Yoder (2010) analyzes situations that lead nurses to compassion fatigue and various coping methods used. This article was retrieved from the ScienceDirect database. The author formulated the research around four questions that involved the prevalence of compassion fatigue among nurses; identified triggers of compassion fatigue; and methods of coping with said triggers. This study had a design that involved both qualitative and quantitative components in order to effectively convey the results in a thorough manner. The participants of this study were nurses employed in a Midwest Magnet community hospital across multiple high acuity floors. The qualitative component of the study involved a sample size of n=71, while the quantitative component yielded a sample size of n=106. The data were collected in the form of a mailed out three-part questionnaire, including demographic information, the Professional Quality of Life Scale, and a two question narrative response.
Due to the qualitative and quantitative nature of the study, the results successfully and accurately conveyed how compassion fatigue affects registered nurses across many high acuity floors in the hospital. Through the quantitative results and analysis, it is understood that compassion satisfaction among registered nurses negatively correlated with the subscales leading to the conclusion that those with higher scores in compassion satisfaction were more pleased with oneself and connected to others, and therefore able to avoid the symptoms of compassion fatigue (Yoder, 2010, pg. 193). The qualitative results displayed were based on the nurses (n=71) who completed the two part narrative questionnaire regarding trigger situations of compassion fatigue and coping strategies to deal with the situation at hand. The results of situations that triggered compassion fatigue were able to be categorized into three themes; caring for patients, system issues, and personal issues (pg. 194). Though it is clear that compassion fatigue is a common theme among these nurses, evidence shows that coping strategies were used to help prevent or reverse the effects of compassion fatigue.
This information emphasizes that compassion fatigue is seen across many high acuity floors in a hospital and stresses the common triggers of compassion fatigue depicted through the sample provided. It is understood that while there are common triggers of compassion fatigue, there are also many ways in which nurses cope with the detrimental symptoms. Therefore it is crucial to understand that coping strategies are necessary in order to relive compassion fatigue in those who are suffering from it.
The article, Predicting the Risk of Compassion Fatigue (2006) seeks to explore the relationship between the leading characteristics of nurses and prevalence of compassion fatigue. This article was retrieved from CINAHL Plus with Full Text. The researcher elected for a non-experimental descriptive design for the study with a sample size of associate degree nurses (n=101), registered nurses (n=183), LPNs (n=29), and ARNPs (n=4), employed throughout 22 hospice facilities in Florida (Abendroth, 2006, pg. 346). The data were collected using two instruments; a demographic questionnaire, and the Professional Quality of Life Compassion Satisfaction and Fatigue Subscales: Revision-III. The 2006 study was conducted around four clearly defined research questions and included a purpose a purpose of producing a model to predict the risk of compassion fatigue using the demographic and work-related factors obtained through the study.
Through the findings in the 2006 study, the results revealed that 26.4% (n=57) of the participants were categorized into high-risk, 52.3% (n=113) were identified as moderate risk, and 21.3% (n=46) were at low risk for compassion fatigue. This shows that nearly 80% of the sample size (n=170) provided were identified as moderate to high risk for compassion fatigue. There were several factors that were taken into account. The nurse to patient ratio for this sample of nurses was one nurse to approximately six patients (M=5.59). This is significant because according to the Center to Advance Palliative Care the recommended nurse to patient ratio is one-to-four (Abendroth, 2006, pg. 350). Another factor that the average amount of hours worked per week. The findings concluded that the sample (n=216) had an average weekly work time ranging from 8 to 90 hours with an average of 40.5. The study also highlighted that the sample experienced an average seven deaths within a 30-day period (2006). This is significant to consider due to hospice nurses experiencing more deaths than nurses employed in any other speciality.
The 2006 study shows validity and reliability through the results provided. The findings suggested that although nearly 80% (n=170) of the sample size (N=216) were identified as moderate to high risk category for compassion fatigue, work related factors and demographics did not lead to the prevalence of compassion fatigue itself. The researchers justified that compassion fatigue was a result of personal stressors such as PTSD, or self-sacrifice rather than work setting (Abendroth, pg. 353, 2006). Findings also suggested that noteworthy variable which puts a nurse at risk for compassion fatigue consist of the negative effects of overly identifying with patients (cite?). In conclusion, this study justifies that compassion fatigue is preventable when the risk factors are identified, and through identification of these risks, nurses could benefit in an optimal manner.
Compassion Fatigue Affecting Nurses Employed Outside of the United States
In the 2017 article, researchers Joana Duarte and José Pinto-Gouveia seek to investigate the correlation between pathogenic empathy-based guilt and compassion fatigue. This article was retrieved from CINAHL Plus with Full Text. A core part of nursing involves empathy and compassion. Two words that often embody a positive connotations have the ability to become harmful in the form of pathogenic empathy-based guilt (Duarte et al., 2017, pg. 43). This descriptive, correlational, cross-sectional study uses a convenience sample of nurses (n=298) employed in public hospitals throughout Portugal. The sample (n=298) included nurses with an average of 14.98 years of practice. Data were collected over one year using the Professional Quality of Life Scale, the Interpersonal Reactivity Index, and the Interpersonal Guilt Questionnaire (Duarte et al., 2017, pg. 43). Each scale is significant to the study because it measures variables that play a role in the prevalence of compassion fatigue.
The purpose of this article evaluates the relationship between empathy and guilt, and the negative impact it may have on professional work ethic. The results from the data collection found significant indirect effects of survivor guilt, and omnipotent guilt on the relation between empathic concern and compassion fatigue (Duarte et al., 2017, pg. 45). The researchers found that negative self-oriented emotions in response to others’ distress were associated with compassion fatigue. An important finding suggested that perspective taking, and obtaining the ability to infer the thoughts and feelings of others however realizing that it may not coincide with their own is not directly correlated with compassion fatigue (cite?). Furthermore, the study suggests that a crucial variable associated with higher levels of compassion fatigue are survivor and omnipotent responsibility guilt.
This article connected the gap in knowledge concerning empathy-based guilt and compassion fatigue. The findings emphasize the reality nurses face when internalizing the emotions of others, and possess unbalanced empathy that can degrade their ability to provide care. Although there were limitations to the sample size, this study had a balance of male to female nurses in their sample compared to that of other articles previously mentioned.
In the article Compassion Satisfaction, Compassion Fatigue, and Burnout in Spain and Brazil: ProQOL Validation and Cross-cultural Diagnosis, the researchers look to supply a diagnosis of compassion fatigue levels in health care providers providing palliative care. The researchers identified a gap in knowledge concerning compassion fatigue due to the observation that palliative care professionals’ quality of life has been a concern. This article was retrieved through the CINAHL Plus with Full Text. The study embodied a cross-sectional design with a sample size of Spanish palliative care professionals (N=385), and Brazilian palliative care professionals (N=161). Data were collected using the Survey Monkey platform through the Professional Quality of Life instrument (Galiana et al., 2017, pg. 599).
Galiana et al. defined the reliability and validity of the data collection method by using comparative fit index, scoring at >0.90 and the root mean square error of approximation, scoring at <0.08 (2017, pg. 600). After establishing that the validity and reliability were calculated, the researchers proceeded with the data collection. The results suggested that Spanish and Brazilian palliative care professionals demonstrated high levels of compassion satisfaction, and medium levels of secondary traumatic stress (Galiana et al., 2017 pg. 598). The results found that the Professional Quality of Life model is an assessment tool reliable for determining levels of compassion fatigue in health care professionals.
This article demonstrates the importance of defining compassion fatigue and establishing a reliable method for diagnosis. Researchers also emphasized that healthcare professionals should be aware of the negative impacts that it may have on work ethic and personal life. Through the research established, it can be concluded that the Professional Quality of Life is an adequate model for diagnosing compassion fatigue in nurses.
In the article Compassion Satisfaction, Compassion Fatigue, Work Life Conditions, and Burnout Among Frontline Mental Health Care Professionals (2013), the effects of compassion fatigue are examined in mental health care professionals, including psychiatric nurses. The researchers identified that mental health care professionals often provide direct care to individuals with poor mental health often requiring a lot of support and emotional involvement (Ray, 2013, pg. 255). This study was taken from the PsycARTICLES database. The researcher formulated the study around a nonexperimental, cross sectional, predictive survey design in which a questionnaire was distributed by mail to a sample of mental health care professionals (N=430). The sample size was deemed appropriate for the study through calculation and power analysis, yielding an alpha of 0.05, and a power level of 0.80. The calculations further revealed that a sample size of 85 participants was necessary in order to achieve moderate effect size further validating the study sample (N=169) size (pg. 259). The sample size was obtained from a hospital site in Southwestern Ontario. The data were collected using two questionnaires in which responses were solely included based on the requirement in which the participant must engage in direct client care either in a one on one or group setting (pg. 259).
The purpose of this study was to determine the relation between work life conditions and compassion fatigue among frontline mental health care professionals (Ray et al., 2013, pg. 255). The results demonstrated that the participants were primarily full time workers (68.0%), with a remainder working part-time (14.8%) or casual (16.6%). The researchers validated that compassion fatigue scores were higher in those with a trauma history and a higher level of emotional exhaustion than those without a history of trauma (pg. 263).
In the 2013 study, the researchers emphasize the importance of work life conditions on compassion fatigue and compassion satisfaction. This article demonstrates the relation between work life conditions and compassion fatigue through careful analyzation of the data provided. This is significant because realizing that personal and situational factors in a work setting can trigger compassion fatigue can be an important precursor in preventing compassion fatigue before it happens.
Theoretical Framework
Dorothea Orem, the nurse whom was reliable for the creation of the self care theory in nursing demonstrates the importance in which self care is essential to a person’s health and well-being, as well as the promotion of self-development (Taylor et al., 2011, pg. 38). Orem’s theory stresses that if a person wants to improve, it is required that they take care of themselves. In order to prevent compassion fatigue in registered nurses, one must be aware of the predisposing work related factors, but furthermore understand the importance of self-care. This theory is relative to compassion fatigue because the detrimental effects it brings upon the person suffering from it can benefit through the means of self-care which is “directed toward bringing about specific regulation of human functioning and development” (Taylor et al., 2011, pg. 40).
Proposal for Further Study
1. Introduction
Compassion fatigue is developed by a person when they begin to internalize the pain or emotional distress of others in their work environment (Lanier, 2017, pg. 10). While compassion fatigue is not seen as a mental illness, it has the ability to negatively impact not only the work ethic of the sufferer, but their personal life as well. The literature review of this paper demonstrated that compassion fatigue is seen in nurses employed in a high acuity setting, however there is a gap in knowledge regarding ways to alleviate it. For the purpose of this study, high-acuity settings will be defined as those which require nurses to closely observe their patients to ensure that they remain stable or improve (“What is High-Acuity Nursing,” 2017).
2. Purpose
In this study, the nursing student aims to explore the relation between self-care methods and alleviation of compassion fatigue in nurses working in a high-acuity setting. Therefore the research questions are as follows:
1. How does self-care help in relieving symptoms of compassion fatigue?
2. What are methods of self-care that help alleviate symptoms of compassion fatigue?
2.1. Ethical Considerations
The participants will be individually contacted with a packet of information regarding this study. In the packet, details will be provided regarding the purpose of the study along with the guarantee of anonymity and confidentiality. The decision to participate in this experiment will be solely up to the individual. Furthermore, the decision to respond to the survey will be identified as the participants informed consent.
3. Hypothesis
Through careful analyzation of the theoretical framework regarding Orem’s self-care theory, the nursing student hypothesizes that through methods of self-care, and awareness of compassion fatigue the nurse would benefit in a positive holistic way.
4. Methods
4.1. Procedure
The nursing student will contact all nurse managers employed at Kaiser Permanente hospitals in Northern California. The nurse managers who will be contacted will be in charge of the emergency department, intensive care unit, cardiac intensive care unit, pediatric intensive care unit, neonatal intensive care unit, post-anesthesia care unit, surgical intensive care unit, and medical intensive care unit. Packets will be provided to each nurse manager in the perspective Kaiser Permanente facility with the intent for the packets to be placed in the hospital mailbox of each registered nurse employed at that location. The participant would then fill out the two questionnaires and use the envelope provided in the packet to send the information back to the research facility. The proposed sample size for this study is 300 registered nurses.
4.2. Instrument
4.2.1. Quantitative
The first part will be the quantitative portion of the study involving two parts. One part will be a demographic questionnaire to obtain information regarding the participant’s age, highest level of nursing education, number of years worked as a registered nurse, speciality the nurse is employed in, the number of hours worked per week, and the shift the nurse regularly works. The second part involves the Professional Quality of Life Scale (ProQOL R-IV). The ProQOL R-IV is a 30 item questionnaire developed by Beth Hundall Stamm to measure compassion satisfaction and compassion fatigue in the last 30 days (Stamm et al., 2018).
4.2.2. Qualitative
The second will be the qualitative portion involving two questions requiring a narrative response from the participant. The two questions will be as follows:
1. What are ways in which you perform self-care?
2. Do you find self-care to be helpful in alleviating compassion fatigue?
5. Analysis
5.1. Quantitative
The demographics of the participants will be placed into categories in order to demonstrate the similarities and differences among the sample size. The demographics of each participant is important in determining how compassion fatigue affects each nurse in accordance with the demographic information provided. The ProQOL R-IV data will be presented based on sample averages for each sub-scale; burnout, compassion satisfaction, and compassion fatigue/secondary trauma. The sample size averages will then be compared to the theoretical averages provided by through the ProQOL Manual (cite).
5.2. Qualitative
The narrative responses will be analyzed according to each question asked of the participant. The information provided is significant to the evaluation of self-care in regards to the amount relief it provided for the symptoms of compassion fatigue. Through the data collected we will be able to determine if self-care is a positive influence in the nurse experiencing compassion fatigue and if self-care can be encouraged in nurses working in high-acuity settings.
Conclusion
Establishing methods to alleviate the symptoms of compassion fatigue is crucial for the nurse experiencing the negative symptoms it produces. Compassion fatigue has the ability to negatively impact a nurses work ethic and personal life. In order to create a healthy environment both personally and professionally, one must be aware of the ways compassion fatigue can be relieved. Self-care is a mode of relief in the presence of compassion fatigue, and with correct understanding and use, those experiencing compassion fatigue can receive comfort in nurses lives.