Compassion Fatigue

Updated September 28, 2021

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If precautions are not taken, the caring and empathetic medical professionals can fall victim to the overwhelming circumstances, which may result in compassion fatigue. While this issue is already a heavy problem for nurses, the greater problem is that not many nurses are able to identify when they, themselves are at risk. Bringing awareness to compassion fatigue would not only help nurses find proper support, but would also be a preventive measure, as well as be effective to the hospital in job satisfaction, and increase the quality of care that is provided to patients. We can bring awareness by providing education to our hospitals that effectively explain to nurses and identify the symptoms that come with compassion fatigue, while also supplying encouragement and ideas of how to prevent and overcome this issue.

As critical care nurses, we spend our days working in an environment where life-sustaining care is given and recovery is not promised, but we work hard to make it a possibility. Throughout our shifts, we use our problem-solving skills, physical strength, and our emotions are always at the mercy of our patient. Needless to say, we work in a hard, stressful environment that only fellow health care providers can understand. Most nurses enter into this field with an intent to do good and provide excellent care in meeting the patients physical, emotional, and mental needs. With the tools for recognizing compassion fatigue, we can help nurses keep their empathy and tenderness while staying healthy and thriving in their day-to-day life.

Compassion fatigue should not be taken lightly, because while we may assume that it is just a personal issue, it is not. Our mental and emotional state is crucial to the success of our patients, the entire hospital, and every other relationship that we are a part of (Wood). Charles Figley, a main contributor to the research of compassion fatigue, shows just how important being proactive about this is, by stating that: “The most insidious aspect of compassion fatigue is that it attacks the very core of what brings helpers into this work: their empathy and compassion for others”.

In a twelve hour shift, our job can alter from checking vitals, to performing strategic life-saving measures, to holding a patient’s hand as they move on from this world to the next. It is easy and clear for us to recognize when we are physically tired, hungry, or exhausted. Physical exhaustion is pretty easy to recognize, because the resulting ailments are nearly unmistakeable. When it comes to our mental and emotional health, however, it is often a lot more difficult than we might realize to diagnosticate our irritability and avoiding behaviors as emotional exhaustion. This is because the symptoms can easily be redirected in our brains as a “bad mood” or an “off day”(Lombardo).

As nurses, we often are very concerned with the well-being of our patients, that our own comfort can be denied. Similar to how physical exhaustion comes from denying the body rest and nourishment, emotional exhaustion is because our emotional needs have not been met. Emotional exhaustion comes in many different forms, some of the most critical being: burnout, moral distress, and compassion fatigue. Compassion fatigue, however, is one of the most unrecognized among nurses. (Kinman and Leggetter)

The nurses that do recognize an internal issue, often mistake their compassion fatigue for burnout. This is mainly because burnout is a much more familiar term, whereas compassion fatigue is a relatively new concept. In fact, Carla Joinson, one of the first to recognize compassion fatigue, only first observed it in 1992 when she noticed that some nurses had lost their “ability to nurture” (Harris, et al). However, there are important differences between burnout and compassion fatigue that could greatly affect the course of treatment. Unlike burnout, while compassion fatigue may come with job dissatisfaction, it is not caused solely by uncertainty or prolonged frustration with the work environment itself. This being said, burnout is often a component of compassion fatigue, as is secondary post traumatic stress (STS). These two things brought together (stressful work and empathy with critical patients) are often what builds the phenomenon. It is also important to note that compassion satisfaction, however, is a stand-alone measure (Sacco, Tara L., et al).

Because this is a newer concept to nurses, the importance to bring awareness and proactiveness is even more vital. The symptoms that should be acknowledged as compassion fatigue are reduced ability of empathy, avoidance and dread, irritability, anxiety, oversensitivity, restlessness, and poor concentration (Lombardo). Figley has explained that this is something that develops over time, and can therefore be even harder to recognize.

A study, which was accomplished by The American Association of Critical-Care Nurses (AACN), used a ProQOL which consisted of the three sub-scales, compassion satisfaction, burnout, and STS, to identify which nurses in particular are more prone to developing compassion fatigue. This study included critical care nurses (n=221) that were in the units PICU, ICU, PCU, as well as NICU. It was found that nurses in the range of 20-29 year olds scored much higher in STS (P=.04) than the older (40-49 year old) nurses did. This being said, the younger nurses burnout score was similar to those of the 40-49 years olds. The study went on to say that a possibility for these conclusions is that the older nurses have more experience and have lived and learned to manage their emotional exhaustion. It is important for all nurses to be careful and take preventive measures, but younger and newer nurses should be especially watchful in guarding their emotional health. That being said, no one is immune and all nurses should be cautious (Sacco, et al).

In order to effectively prevent or overcome compassion fatigue, it is very crucial for us to have a strong support system both in and away from work. There are many hospitals that have EAP’s for nurses to go and share their thoughts freely among their fellow co-workers and counselors, which nurses should utilize when they are feeling vulnerable and broken. Just like patients need empathy from their caregivers, the same caregivers require support and empathy from those who can relate the most to them: their coworkers. Secondly, a good work-life balance is vital. While this may be difficult or even seem impossible at times, it is essential as nurses, for us to try and separate our work and home/personal lives. When work is already stressful, the last thing that needs to happen is that same stress weaving its way into your life outside of work. Lastly, adequate sleep, meals, and hydration can go a long way. Our days are long and staying upbeat and energized is very important. We need to learn how to take care of ourselves because otherwise, we are useless to our patients (Lombardo).

Our physical and emotional health is so important to our patients. While compassion fatigue may not affect our physical ability perform medical necessities for them, it can affect our desire to perform those skills as well as affect our ability to empathize with our patients. Empathizing with our patients is not something that goes unnoticed. Our patients physical and mental health rely on our empathy. Barbara Ficarra, RN, BSN, MPA said that “[…]by acknowledging their emotional state and listening attentively, we can engage our patients and empower them to be proactive and in charge of their health care”. That is why protecting our emotional health is important; not just for our sake and sanity, but for those around us, who are directly affected by us, as well (Ficarra).

Everyday life is already full of anxieties, but combine these with increasing workloads and heavy demands, and gradually our levels of stress will eventually stretch to unmanageable heights, resulting in compassion fatigue. Once there, recovery takes focused strength and energy in order to build back what we have lost. Awareness and preparation for compassion fatigue are important so that we do not reach the point where we have to fight our way back to being happy.

Today, nurses need the knowledge and tools to develop a lifestyle that accommodates restoration and rejuvenation from the physical and emotional strain that is inevitable, and we can accomplish this through educating and encouraging our nurses. Benjamin Franklin has stated that: “an ounce of prevention is worth a pound of cure”. This phrase could not be more true. Recovery from compassion fatigue is a long process, and while it is certainly worth the journey, prevention is much healthier and efficient, and is fundamental for a healthy and balanced life.

Works Cited

  1. Ficarra, Barbara. “How Empathy Can Help Empower Patients.” The Huffington Post,TheHuffingtonPost.com, 25 May 2011, www.huffingtonpost.com/barbara-ficarra/why-empathy-empowers-pati_b_783138.html.
  2. Harris, et al. “Nursing on Empty: Compassion Fatigue Signs, Symptoms, and System Interventions.” The Development of Ideal Body Image Perceptions in the United States | CE Article | NursingCenter, June 2015, www.nursingcenter.com/cearticle?an=00005217-201504000-00008.
  3. Jablow, Martha. “Compassion Fatigue: The Toll of Being a Care Provider.” AAMCNews, 11 July 2017, news.aamc.org/medical-education/article/compassion-fatigue-toll-being-care-provider/.
  4. Kinman, Gail, and Sandra Leggetter. “Emotional Labour and Wellbeing: What Protects Nurses?” MDPI, Multidisciplinary Digital Publishing Institute, 30 Nov. 2016, www.mdpi.com/2227-9032/4/4/89.
  5. Lombardo, Barbara. “Compassion Fatigue: A Nurse’s Primer.” Electronic Health Record: Driving Evidence-Based Catheter-Associated Urinary Tract Infections (CAUTI) Care Practices, 31 Jan. 2011, ojin.nursingworld.org/mainmenucategories/anamarketplace/anaperiodicals/ojin/tableofcontents/vol-16-2011/no1-jan-2011/compassion-fatigue-a-nurses-primer.html.accessedmarch14.
  6. Mol, Margo M. C. van, et al. “The Prevalence of Compassion Fatigue and Burnout among Healthcare Professionals in Intensive Care Units: A Systematic Review.” PLOS Medicine, Public Library of Science, journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0136955.
  7. Sacco, Tara L., et al. “Compassion Satisfaction and Compassion Fatigue Among Critical Care Nurses.” Critical Care Nurse, 1 Aug. 2015, ccn.aacnjournals.org/content/35/4/32.full.
  8. Schuster, Janice Lynch. “With Nurses at Risk of Compassion Fatigue, Hospitals Try to Ease Their Stress.” The Washington Post, WP Company, 10 June 2013, www.washingtonpost.com/national/health-science/with-nurses-at-risk-of-compassion-fatigue-hospitals-try-to-ease-their-stress/2013/06/07/b92b9e86-97e3-11e2-97cd-3d8c1afe4f0f_story.htm
  9. Wood, Debra. “Nurses’ Compassionate Care Affects Patient Outcomes.” TravelNursing, 2016, www.travelnursing.com/news/nurse-news/nurses-compassionate-care-affects-patient-outcomes/.
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