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"The pessimist complains about the wind;

The optimist expects it to change;

The realist adjusts the sails."

Clinicians who work with people in a variety of settings are confronted with a new workplace epidemic which is known as Compassion Fatigue. The clinicians who are most susceptible to this condition work with people who fit one or more of the following categories:

• Injured veterans survivors of the Afghanistan and Iraq Wars or other prior wars
• Veterans suffering from PTSD from being in the Afghanistan and Iraq Wars or other prior wars
• Patients dealing with life threatening illness like cancer, heart and lung conditions, HIV-AIDS, or other systemic health conditions
• Hospice eligible individuals facing imminent death due to old age, injury, disease or illnesses
• Survivors of torture, trauma, or natural or man-made disasters

Compassion fatigue is thought to be a combination of secondary traumatization and burnout precipitated by the care delivery that brings health-care professionals into contact with the suffering (Szabo, 2006).

"Compassion fatigue is when caregivers have such deep empathy they develop symptoms of trauma similar to the patient” according to director of the Army Institute of Surgical Research Colonel Kathryn Gaylord (Wilson, 2008). Wilson points out that Compassion Fatigue can also resemble burn out which occurs when emotional exhaustion is experienced due to increased workload and institutional stress and does not involve trauma (2008). Wilson finally points out that Compassion Fatigue can have detrimental effects on doctor patient relationships since doctors suffering from the disorder often either grow distant from patients or get too close (2008).

It is believed that Secondary Traumatic Stress might be a contributing factor to developing Compassion Fatigue. According to Bride (2007) it is when clinicians who come into continued, close contact with trauma survivors may also experience emotional disruption, becoming indirect victims of the trauma. These clinician Bride (2007explains have the natural, consequent behaviors and emotions resulting from knowledge about a traumatizing event experienced by the trauma survivors they come in contact with resulting in them experiencing a secondary stress from helping or wanting to help these traumatized or suffering people.

The opposite of Compassion Fatigue is Compassion Satisfaction, which is the ability for clinicians to derive a great sense of meaning and purpose from their work (Tyson, 2007). Tyson goes on to say that Compassion Satisfaction  may aid in alleviating existential terror endemic to the human condition when a society is at war since it may be an important buffer in managing and transcending alterations in belief systems, and physiological or emotional reactions seen in Compassion Fatigue (2007).

Charles Figley (1995) in his ground breaking work on Compassion Fatigue postulated that there were four reasons why clinicians would develop this condition. They were

1. Poor self-care
2. Previous unresolved trauma
3. Inability or refusal to control work stressors
4. Lack of satisfaction for the work

Abendroth and Flannery (2006) identified the following four variables as being predictors if Hospice Nurses were more likely to experience Compassion Fatigue. They were

1. Trauma
2. Anxiety
3. Life demands
4. Excessive empathy (leading to blurred professional boundaries)

It is imperative that clinicians focus on preventing or dealing with Compassion Fatigue according to Linley and Joseph (2007) because they need to take steps to ensure that they are functioning at their best in the therapeutic relationship with the people they serve through facilitating their own personal well–being and avoiding burnout.

Take some time now to do your own self-assessment to see if you are suffering from signs or symptoms of Compassion Fatigue.

Interpretation of your Self-Assessment

If you rated three or more items over 8 or if you rated 5-10 over 5, you are most likely experiencing some level of compassion fatigue and it would be important for you to take action to prevent it from getting worse or happening at all in the first place.

To help in your self assessment consider this: Mendenhall (2006) identified the following characteristics of clinicians who are experiencing Compassion Fatigue:

1. Physically: Chronic sense of exhaustion and fatigue, insomnia, headaches, stomachaches, lack of appetite, physical agitation or retardation, frequent bouts of sickness (e.g., colds, sore throats)
2. Psychologically: often feel irritable, are overwhelmed by the volume and content of their work
3. Relationship with Clients: sense a reduction in their baseline empathy for others, feel numb to patients’ pain, are cynical regarding clients’ ability to change and/or perceive them as being responsible for many of their problems
4. Organizationally: often report a sense of feeling scattered and unable to meet their professional and personal obligations

So why should and your fellow clinicians work on continuously self-assessing yourselves? Bride, Radey and Figley (2007) report that it is expected that most clinicians will at times experience symptoms of compassion fatigue, as these are normal reactions to trauma work. However, for some clinicians the experience of compassion fatigue may become so severe as to interfere with their clinical effectiveness and their personal mental health and it is for this reason that ongoing monitoring is necessary.

Tehrani (2007) states that it is best practice for clinicians to not wait to become symptomatic but rather to use inventory tools to look for the presence of challenges to their fundamental assumptions, values and beliefs. Tehrani goes on to say that with early assessment clinicians have the opportunity to transform their discomfort into personal growth and development and that this should be the aim of a professional supervision and support model to address Compassion Fatigue in the clinical workplace (2007).

What Can You Do to Address Compassion Fatigue?

You can do any or all of the following best practices:

·        Recognize the symptoms of compassion fatigue

·        Learn to ask for help

·        Be aware and accept the limitations of your family, your job, and yourself

·        Maintain discipline in daily responsibilities and duties

·        Take “time out” during the day

·        Take short vacations at least twice a year

·        Try to change little things that gnaw at you and accommodate to those you can't change

·        Organize your time so you can concentrate on vital tasks

·        Admit compassion fatigue is a real problem for you and don't try to cover it up

·        Distinguish between stressful aspects of your job or home life that you can change, and those you can't change-change what you can

To back up this self-help plan, Radey and Figley (2007) point out clinicians need to do the following four self-care steps to avoid suffering from Compassion Fatigue:

1. Boundary maintenance
2. Self-care
3. Seek out good training
4. Seek out good supervision

If clinicians are able to achieve all four of these preventive tasks, they assure that clinicians will thrive as compassionate professionals.

What can be done in the Clinical Work Place to Lessen the Impact of Compassion Fatigue?

It is imperative that supervisors and administrators work to establish a Compassion Fatigue prevention program in their departments or agencies including some of these best practices:

·        Identify realistic attainable goals for each department and evaluate accordingly

·        Help staff to maintain personal growth both at home and on the job

·        Encourage and support staff to develop an active outside life with a variety of interests

·        Encourage staff to personalize the work environment with meaningful pictures, objects, colors, etc.

·        Encourage staff to be comfortable with themselves by setting limits how far to become involved with clients and colleagues

·        Encourage and practice good communication skills on the job

·        Provide for flexible working conditions on the job

·        Encourage trying new ideas “outside of the box”

·        Sponsor “decompression techniques” activities such as meditation or exercise that relieve tension and put staff into a more relaxed state

·        Build support systems among staff to discuss problems and help each other look for solutions. Don't just air gripes - look for solutions

Politsky (2007) reported on a Compassion Fatigue Prevention program implemented in her Oncology Department. This program offered staff a safe place, among colleagues to discuss their recent feelings and de-stress. Participants were provided services such as yoga, meditation and therapeutic massage. All staff completed a Compassion Fatigue Survey and all staff were treated with a 45 minute therapeutic massage. A program does not need to necessarily utilize all of these components but it is important to begin to do something now to insure that staff are being protected and assisted to address this problem.

At the minimum it is important for departments to run training on the Compassion Fatigue and encourage self-assessment and monitoring for it. Sprang, Clark and Whitt-Woosley (2007)  found that specialized trauma training did enhance Compassion Satisfaction and reduced levels of Compassion Fatigue and Burnout, suggesting that knowledge and training might provide some protection against the deleterious effects of trauma exposure.

Dealing with Compassion Fatigue is a TEAM effort which requires administration, co-workers, your families and significant others to understand that it takes a lot of effort to prevent and deal with this insidious and disabling condition!

References:

Abendroth, M. & Flannery, J. (2006). Predicting the Risk of Compassion Fatigue: A Study of Hospice Nurses. Journal of Hospice and Palliative Nursing: 8(6): 346-356.

Bride, B. (2007). Prevalence of Secondary Traumatic Stress Among Social Workers. Social Work: 51(2): 63-70.

Bride, B., Radey, M. & Figley, C.R. (2007). Measuring Compassion Fatigue. Clinical Social Work Journal: 35:155-163.

Figley, C. R. (Ed.) (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York: Brunner/Mazel.

Linley, P.A. & Joseph, S. (2007). Therapy work and therapists’ positive and negative well-being. Journal of Social and Clinical Psychology: 26(3):385–403.

Mendenhall, T. (2006). Trauma-Response Teams: Inherent Challenges and Practical Strategies in Interdisciplinary Fieldwork. Families Systems, & Health: 24(3):357-362.

Politsky, S. (2007) Revitalizing Yourself. Oncology Nursing Forum: 34(2): 494.

Radey, M. & Figley, C.R. (2007). The Social Psychology of Compassion. Clinical Social Work: 35(1):207–214

Sprang, G., Clark, J. & Whitt-Woosley, A. (2007). Compassion Fatigue, Compassion Satisfaction, and Burnout: Factors Impacting A Professional’s Quality of Life. Journal of Law and Trauma, 12:259–280.

Szabo, B. (2006). Compassion fatigue and nursing work: Can we accurately capture the consequences of caring work? International Journal of Nursing Practice: 12: 136–142.

Tehrani, N. (2007). The cost of caring – the impact of secondary trauma on assumptions, values and beliefs. Counselling Psychology Quarterly: 20(4): 325–339

Tyson, J. (2007). Compassion Fatigue in the Treatment of Combat-Related Trauma During Wartime. Clinical Social Work Journal; 35:183–192

Wilson, E. (2008). New Program Offers Care for Caregivers. Department of Defense Military Health System News, 23 May 2008.