GOOD GRIEF! Understanding Compassion Fatigue In Nursing

At work,Jully is the bubbly meticulous nurse, committed to assist clients and their families. The joy of caring from diagnosis to recovery is a journey she is gratifitied by, as a caregiver. Yet, when she got report that one patient had passed on or during a shift, a resuscitation was futile, she would console relatives with genuine empathy.Continually, Jully would iron her uniform and captain the nursing team in the unit, the best nurse she could be.

Over time, friends surprisingly realised that she became withdrawn, quiet and partying more than not. Jully got highly irritable and lacked motivation. Unlike usual, she had a feeling of something being wrong yet she can not pin point it. Adding to the background hum of dissatisfaction were feelings of loneliness & dissociation.

Within months, Jully hardly saw her friends, missed important family engagements yet remained unbothered. She smiled on que and soldiered on, apathetically, despite mental ordeals.  Physically, she gradually became lethargic, lost her appetite & weight and got sick often.  Once, while staring at herself through a mirror, she broke down to tears. For no reason.

Eventually she resigned from her job where she had just received a promotion. What she describes as ¨putting one foot in front of the other in a, hopefully, right direction¨prompted her to quit & stay indoors for a fortnight.

Julliet was unknowingly suffering from Compassion Fatigue due to cumulative Grief.

Compassion fatigue (CF) is the caregiver’s cost of caring and results when caregivers are exposed to repeated interactions requiring high levels of empathic engagement with distressed clients (Sorenson et al., 2016). It is drawn from post traumatic stress disorder & is a contributing factor to burnout.

According to the American Psychiatric Association, PTSD can have an effect on the third-party to the distress. In such situations, it is referred to as ¨secondary catastrophic stress reaction¨, a description of CF. CF progresses from a state of compassion discomfort to compassion stress and, finally, compassion fatigue. If not effaced in its early stages of compassion discomfort or compassion stress, CF can permanently alter the compassionate ability of the nurse ( Coetzee & Klopper, 2010) & their existential integrity.

How CF develops:

Natural emotional investment from genuine empathy for patients´lives by health care providers can over time tranverse between work and personal life. The mounting pressure from both ends can deplete their emotional reserves especially if they do not nurture themselves accordingly. Additionaly, the inevitable demand to constantly work at optimum levels, nurses may develop emotional fatigue (Jarrad et al., 2018).

Forming close caring relationships is correlated with an increased risk of cumulative fatigue. It is not forbidden for these relationships to be created, however, caution ought to be taken as at times, certain clients may remind a nurse of someone significant in their lives. These clients´trauma or death may trigger emotional debilitation (Jarrad et al., 2018).

Once a long-term client is discharged or passes on, another client comes in to the same nurse who has had no time to decompress or ´recover´ between these experiences. This cycle builds up cumulative grief which leads to compassion fatigue (Mendes, 2014 ).

Moreover, nurses may set a certain standard for themselves to achieve which when they fail to meet , self blame ensures. This continues, despite common limited resources among other limitations. These challenges are at times beyond the nurses´control. The British Journal of Nursing describes these feelings as natural but acknowledges ¨ it is important for nurses to recognise that in their professional capacity as a nurse, there are limits to what they can do. Of course, this does not take anything away from the value of each individual nurse and the high-quality compassionate care they offer.¨ (Mendes, 2014).

Whom it affects;

CF can happen to any nurse at anytime during the job course. However some nurses may be at greater risk than others such as oncology, emergency, intensive care, pediatric and hospice nurses. Their increased risk to CF is due to frequent encounter with patient/family tragedies & mortalities (Sheppard, 2016).

Risk Factors;

  1. Forgoing self-care; This is one of the greatest risk factors (Jarrad et al., 2018). In order to keep going, it is important to reenergize. Without this, the bulk of physical to psychological engagements can wear us out. By attending to our emotions & caring for ourselves holistically, we can recognize our energizers which we utilize to rejuvenate ourselves.
  2.  The Nursing Profession; As an occupational hazard, CF affects all care providers to various levels of severity (Françoise ,2007). Nurses, of almost all medical professionals, spend a large amount of their professional time in direct contact with patients. Often entering the lives of their clients at very critical health junctures, nurses become engrossed in multifaceted to end-of-life care (Jarrad et al., 2018).
  3. Work Related Stressors may potentate CF  (Nolte et al., 2017). Nurses spend a substantial amount of their time with individuals who live on the facade of ¨normal society.¨ These clients´ unique contexts can consume nurses´ physical, emotional to intellectual power in a manner provoking CF in addition to the effects of work environment which is often stressful, understaffed and overwhelmed with negativity (Mathieu, 2007, Drury, 2014).
  4.  The intensity of the patient setting. HCPs caring for traumatized individuals, including traumatized or stressed infants, children, mothers, and victims of intimate partner violence, are at risk for developing CF and RCs (Jarrad et al., 2018).
  5. The negative effects of providing careare aggravated by the severity of the traumatic experiences to which nurses are exposed. Those traumatic experiences may bring to life a group of unpleasant feelings such as exhaustion, anger, irritability, diminished sense of enjoyment and impaired ability to make decisions and care for patients. Subsequently, some nurses develop negative coping behaviours including alcohol and drug use or abuse (Jarrad et al., 2018).

The next episode is on managing compassion fatigue for nurses.

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