Compassion Fatigue: When Caring Takes Its Toll

Every day, oncology nurses provide care to patients who rely on them not only for their physical care, but also emotional and even spiritual care. Close relationships are formed as the oncology nurse cares for these patients and families over a period of time. Many oncology nurses may find themselves unprepared for the emotional challenges that arise in caring for these patients and their families. These emotional issues can include things such as the death of a patient with whom the nurse has developed a close relationship, a moral or ethical dilemma that the nurse has seemingly no control over, or a chaotic family situation in which the nurse’s therapeutic communication techniques have been challenged.¹ The oncology nurse may be left feeling physically, emotionally, and spiritually drained.

Compassion Fatigue Defined

Compassion fatigue was first mentioned in relation to professional healthcare in 1992 by Carla Joinson.² Joinson identified behaviors characteristic of compassion fatigue. These include chronic fatigue, irritability, dread of going to work, aggravation of physical ailments, and a lack of joy in life. Figley³ defined compassion fatigue as a state of tension and preoccupation with the individual or cumulative traumas of clients.

Oncology nurses expend a tremendous amount of energy and concern over the long term as they care for patients who may or may not recover from their illness. Compassion fatigue may not happen with the care of 1 patient, but the repeated exposure to oncology patients may lead to the condition.

Compassion Fatigue Symptoms

• Excessive blaming
• Bottled-up emotions
• Isolation
• Receiving unusual amount of complaints from others
• Complaining excessively about administrative functions
• Substance abuse
• Compulsive behaviors
• Poor self-care
• Legal problems, indebtedness
• Reoccurrence of nightmares or flashbacks to a traumatic event
• Chronic physical ailments
• Apathy, sadness, no longer finding activities pleasurable
• Difficulty concentrating
• Mentally and physically tired
• Preoccupied
• In denial about problems

Compassion Fatigue versus Burnout

We do not want to confuse compassion fatigue with burnout. Very often, the terms are used interchangeably. However, Potter et al⁴ make the case that while compassion fatigue and burnout are closely related and the definitions can often be ambiguous, the definitions of burnout point to environmental stressors, while the definitions of compassion fatigue address “the relational nature of the condition.” Distinguishing between burnout and compassion fatigue is difficult and controversial. Although burnout often results in less empathic responses to patients, removal from emotion-laden clinical situations, and leaving one’s clinical position, compassion fatigue may result in more emotional giving that ultimately ends with an inability to attain a healthy balance of empathy and objectivity.⁵

Compassion fatigue can have far-reaching effects. It can affect an entire organization, with increased and chronic absenteeism, increase in workers’ compensation claims, high staff turnover rates, and friction between employees, staff, and management. Since many caregiving institutions are nonprofi ts, they inherit added challenges such as low wages, lack of space, high management turnover rate, and constantly shifting priorities.

Combating Compassion Fatigue

For the oncology nurse, combating compassion fatigue starts with recognizing the symptoms and making changes that lead to a personal transformation. You should have an internal locus of control. Ask yourself, “What can I infl uence?” Develop a personal statement to guide your life, self, and family. Also ask yourself, “Why am I in this profession? What is my mission?”

Improvement starts with developing your own self-care plan and techniques to incorporate into your life that improve compassion fatigue symptoms. Start with learning mindfulness meditation, an excellent way to ground yourself. Find time to recharge your batteries daily, by committing to exercise and eating healthier. Make it a priority to engage with what you value most, which often means connecting with family and close friends.

Speaking with managers, peers, spiritual advisors, friends, and family can also help alleviate symptoms.

When compassion fatigue symptoms become overwhelming, professional assistance may be required, such as seeking out a trained counselor or mental health specialist.

Kathleen Gamblin, RN, BSN, OCN®, is a thoracic oncology nurse navigator at WellStar Health Systems in Marietta, Georgia.

Sharon Francz, LPN, BHA, is an oncology nurse navigator and the president and co-founder of the National Coalition of Oncology Nurse Navigators (NCONN).

References

• Aycock N, Boyle D. Interventions to manage compassion fatigue in oncology nursing. Clin J Oncol Nurs. 2009;13(2):183-191.
• Joinson C. Coping with compassion fatigue. Nursing. 1992;22:116-120.
• Figley CR, ed. Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. London: Brunner-Routledge; 1995.
• Potter P, Deshields T, Divanbeigi J, et al. Compassion fatigue and burnout: prevalence among oncology nurses. Clin J Oncol Nurs. 2010;14(5):E56-62.
• Pfifferling JH, Gilley K. Overcoming compassion fatigue. Fam Pract Manag. 2000;7(4):39-44.