Caring for a stranger
Caring for a stranger as a nurse means bringing comfort to the patient’s pain, reducing their fears, ensuring a flow of communication between family and the healthcare team all while ensuring dignity is maintained in the patient. Yet there can be a cost to the constant maintaining of this delicate balance, which may translate to a healthcare worker’s exhaustion as burnout. In 1992, Figley7 brought awareness to the concept of compassion fatigue as a phenomenon of health care workers losing their identity and experiencing the emotional and physical suffering they witness of their patients within themselves, and those who give more empathy and compassion will be more at risk for burnout.
What is STS or burnout?
Figley7 goes on to defining secondary traumatic stress as behaviors and feelings triggered by the stress of alleviating suffering of trauma victims. Watts and Robertson define secondary trauma as an extreme persistent reaction experienced by nursing staff following an exposure to a potentially life threatening situation and is best measured by the Secondary Traumatic Stress Scale (STSS)13. For those working at the bedside in the emergency room, compassion fatigue or burnout may accelerate faster with the increasing amount of patient population and diverse acuity levels. One study demonstrated that out of 681 emergency medicine staff, 89% reported average compassion satisfaction and 59% plan on retiring early. A third of those with lower compassion satisfaction reported monthly behaviors of irritability with patients and colleagues coupled with lower care standards. The findings concluded urgent recognition and management of workplace stress reduction particularly on perceived control and support4.
Does burnout go unnoticed?
For those working at the bedside, it may not be clear that they may be suffering from compassion fatigue (CF,) secondary traumatic stress (STS) or burnout. While nurses have been trained to recognize the signs and symptoms of disease and suffering in others, they may not have received training in identifying suffering or burnout within themselves. Berg et al. noted that 25% of participants in a trauma team scored high for STS, 75% as at risk, and a third for burnout. The researchers also noted that participants did not believe they were having symptoms of compassion fatigue or burnout. This study provided recommendations for educating staff on CF and burnout, continued monitoring of symptoms, coping tools along with social support all at regular intervals1. If self-identification is problematic, then coping mechanisms will fall short if any measures are taken at all.
How have some nurses coped with burnout?
Another study of 117 emergency room nurses found that 64% reported STS with a statistical significance for those wanting to change careers and those using alcohol to cope with work related stress5. This study brings to light the urgent need of compassion cultivation in nurses within themselves which can translate to the bedside. The desire of experienced nurses wanting to leave the bedside adds to the epidemic of the nursing shortage. Johnson and Johnson predicts that by the year 2020, the United States will be short of nurses by 800,000 (Johnson and Johnson Campaign for Nursing’s Future).
What roles do experienced nurses play?
The wisdom of experienced nurses are important at the bedside, to problem solve, to provide experienced care and mentoring of novice nurses. When nurses have poor self-care, it can not only affect the nurses’ physical and emotional health but can also affect safe patient care, increasing the risk of medication errors and work-related injuries9. These authors noted that compassion fatigue or burnout can lead to decreased satisfaction and experienced nurses may leave the profession altogther9.
What are ways to combat burnout or compassion fatigue?
The best way to intervene is to bring awareness of the team member’s own emotions and its impact on patient encounters and to provide a concrete approach to self-care6. One workplace intervention integrated healthy snacks with holistic practices and found that participants experienced both a reduction in stress with a sense of relaxation while at work10. Another qualitative examination showed a positive reduction of compassion fatigue or burnout that employed a compassion fatigue resiliency program in which self-improvement benefited the participant personally and professionally11. 25 nurses that participated in an 8-week mindfulness-based stress-reduction program reported improved relaxation, self-care, work and family relationships2. Another study suggests that organizations that have meaningful staff recognition may contribute to compassion satisfaction8.
Why are burnout management and self-care resiliency programs crucial?
This recognition increases job satisfaction and retention which in turn reduces burnout and turnover that negatively affects the institution financially8. In an acute care hospital environment, compassion satisfaction may be protective against burnout3. With the increase of compassion satisfaction noted in these studies in interventions coupled with the studies pointing to the amount of CF, STS or burnout makes the introduction of a more comprehensive program of utmost importance, not limited to a one-hour workshop. By returning control to nurses, providing awareness of the benefits and integration of self-care practices can nurses replenish their compassion and decrease workplace-related stress. With the projected nursing shortage, America needs to keep experienced compassionate nurses at the bedside to care for patients and to provide guidance to novice nurses.
References:
1. Berg GM, Harshbarger JL, Ahlers-Schmidt CR, Lippoldt D. Exposing Compassion Fatigue and Burnout Syndrome in a Trauma Team: A Qualitative Study. J Trauma Nurs. 2016 Jan-Feb;23(1):3-10. doi: 10.1097/JTN.0000000000000172. PubMed PMID: 26745533.
2. Cohen-Katx J, Wiley S, Capuano T, Baker DM, Deitrick L, Shapiro S. The effects of mindfulness-based stress reduction on nurse stress and burnout: a qualitative and quantitative study, part III. Holist Nurs Pract. 2005 Mar-Apr;19(2):78-86. PMID:15871591.
3. Craigie M, Osseiran-Moisson R, Hemsworth D, Aoun S, Francis K, Brown J, Hegney D, Ress C. The influence of trait-negative affect and compassion satisfaction on compassion fatigue in Australian nurses. Psychol Trauma. 2016 Jan;8(1):88-97. Doi 10.1037/tra0000050. Epub 2015 May 11. PubMed PMID: 25961866.
4. Dasan S, Gohil P, Cornelius V, Taylor C. Prevalence, causes and consequences of compassion satisfaction and compassion fatigue in emergency care: a mixed-methods study of UK NHS Consultants. Emerg Med J. 2015 Aug;32(8);588-94. doi: 10.1136/emermed-2014-203671. Epub 2014 Sep 23. PubMed PMID: 25248545.
5. Duffy E, Avalos G, Dowling M. Secondary traumatic stress among emergency nurses: a cross-sectional study. Int Emerg Nurs. 2015 Apr;23(2):53-8. doi: 10.1016/j.ienj.2014.05.001. Epub 2014 My 22. PubMed PMID: 24927978.
6. Edmonds KP, Yeung HN, Onderdonk C, Mitchell W, Thornberry K. Clinical supervision in the palliative care team setting: a concrete approach to team wellness. J Palliat Med. 2015 Mar;18(3):274-7 doi: 10.1089/jpm.2014.0248. Epub 2014 Dec 17. PubMed PMID: 25517027.
7. Figley CR, ed. Compassion Fatigue: Coping with Secondary Traumatic Stress in Those Who Treat the Traumatized. New York, NY: Brunner Mazel Inc; 1995.
8. Kelly L, Runge J, Spencer C. Predictors of Compassion Fatigue and Compassion Satisfaction in Acute Care Nurse. J Nurs Scholarsh. 2015 Nov;47(6):522-8. doi:10.1111/jnu. 12162. Epub 2015 Aug 19. PubMed PMID: 26287741.
9. Kushner J, Ruffin T. Empowering a healthy practice environment. Nurs Clin North Am. 2015 Mar;50(1):167-83. doi: 10.1016/j.cnur.2014. 10.013. Epub 2014 Dec 13. Review. PubMed PMID: 25680495.
10. Markwell P, Polivka BJ, Morris K, Ryan C, Taylor A. Snack and Relax: A Stratefy to Address Nurses’ Professional Quality of Life. J Holist Nurs. 2016 Mar;34(1);80-90. doi: 10.1177/0898010115577977. Epub 2015 Apr 6. PubMed PMID: 25846550.
11. Potter P, Pion S, Gentry JE. Compassion fatigue resiliency training: the experience of facilitators. J Contin Educ Nurs. 2015 Feb;46(2):83-8. doi: 10.3928/00220124-20151217-03. Epub 2014 Dec 17. PubMed PMID: 25522376.
13. Watts J, Robertson N. Selecting a measure for assessing secondary trauma in nurses. Nurse Res. 2015 Nov;23(2):30-5. doi: 10.7748/nr.23.2.30.s7. PubMed PMID: 26563929.
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