Table of Contents
Abstract
A nurse’s philosophical attitude guides his or her daily nursing practice. This understanding includes paradigms and theory, which reflects nurses values, and utilizes or pin points significant attributes within their nursing practice. The purpose of this paper highlights the various concepts of support, nursing self-care, supporting the practice and compassion fatigue. A registered nurse (RN) enters the profession of nursing with the ideals to help others, provide empathic and compassionate care for those patients with emotional, spiritual, psychological and physical needs. Empathic and caring nurses, however, can become victims of continuing stress from overwhelming tasks needed to care for their patients and family members. As a result they experience compassion fatigue. This issue affects not only the immediate RN in terms of their vision of their own practice, but also the workplace environment, productivity and may make them seek new and different opportunities.
Keywords: compassion fatigue, support, nursing self-care, resilience
Paradigm Case
In order to understand a nurse’s professional practice it is important to appreciate their philosophical outlook. Their attitude is derived from paradigm shifts and theories they have experienced. It reflects the RNs values, and wields significant influence over the nursing practice. Working any holiday can bring much stress and many emotions especially when it is Christmas. Approximately ten years ago I was scheduled to work on this day, and like many of us we wished we were at home celebrating with our family and friends. It was towards the end of the shift, snowing hard, and everyone was eager to head home for the night. I received an urgent call from the emergency department that a soon to be mother was in route to our facility. When she arrived she was brought to the labor and delivery department and placed on a monitor. There were signs of placental abruption as the mother was bleeding quite heavily and there were no fetal heart tones or movement.
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We immediately called an alpha cesarean section and requested all hands on deck as now both the mother and the baby’s lives were at risk. During surgery the father was asked to sit with other family in the waiting room due to the urgent issues at hand and the lack of space with so many personnel in the operating room. When the baby was past to me the doctor and I began cardio pulmonary resuscitation efforts and worked for well over an hour, but the end result was not good. It was determined the baby pasted away four-six hours prior to coming into the hospital. The other half of the operating staff continued to assist saving the mother. On this Christmas night someone was looking down upon her. She was in critical condition, but considered stable. She received many units of blood, and due to the snow she was not able to transfer to a higher level of care. She was monitored closely over the next several hours, and during this time I was able to unite the mother and the father with their baby. Unfortunately, they were not able to celebrate his birth.
On this Christmas night I made an obligation to myself to actively advocate for not only my patients but also their families. I learned through great professional knowledge and judgment I could provide, empathy, and compassion to the patient, family and my peers. Effective use of an interpersonal tool, such as advocacy, enhances the care giving environment (Selanders, 2012). On this night I learned that every situation affects each individual differently. Each staff member still works within the walls of this facility, but not all of them work within the same capacity. Many of the staff members from this night sought out different positions due to the high stress and various emotions of the situation. This paper encompasses compassion fatigue, support, nursing self-care and resilience.
Concept of Compassion Fatigue
Compassion is an essential quality for nursing, and the under tone throughout the profession. Yet the meaning of this concept is neither clearly defined within the scope of practice nor widely promoted in the context of our everyday working environments (Lambardo, 2011). For compassion to be realized, suffering must be identified and acknowledged (Schantz, 2007). Compassion is a trait that does not take away the pain or suffering, but it is the emotional state of the ones it affects.
On that particular Christmas night many healthcare professionals devoted all of their knowledge and expertise to help save a mother and soon to be newborn child. Unfortunately, the baby perished and this took a toll on every professional involved with the situation. Carla Johnson, coined this term compassion fatigue in 1992 when she noticed that nurses dealing with frequent heartache had lost their ability to nurture (Harris, Griffin, & Quinn 2015).Compassion fatigue brings out high emotional states, physical ailments, and spiritual characteristics results of chronic self-sacrifice and prolonged exposure to difficult situations (Harris, Griffin, & Quinn 2015). As a result of the high stress situation many of the staff involved lost their ability to feel love for their profession and in the days to come they began to lack empathy when other patients and staff felt suffering.
Over the next few months many of the staff involved in that Christmas night appeared exhausted and spoke sternly to their co-workers. Some called in ill quite often, and others complained of not sleeping. There was a new emptiness or emotional feeling within the environment. Some staff made decisions to leave their department and seek opportunities outside of their hired roles, and others coped with the event to the best of their abilities. Our situation nevertheless has been defined as compassion fatigue.
Compassion Fatigue and Related Concepts
The capacity for compassion and empathy seems to be at the nucleus of all nurses’ abilities to get through their shift. These attributes are the center of who the RN is, and do to these ideals they risk getting themselves wounded emotionally, spiritually, and mentally each day. Compassion fatigue affects each individual differently, and may occur in both personal and professional environments. Unresolved issues will often cause physical and emotional exhaustion, and impair the individual’s job performance. Scholars have found that RNs utilize action-oriented and problem solving adaptive coping responses (Crewe, 2016).
Many authors relate compassion fatigue to burnout. Throughout the literature, researchers have taken different perspectives on the concepts of compassion fatigue and burnout. Some see these concepts as related while others differentiate between the terms (Secor, 2015). Both compassion fatigue and burnout lead to a loss of a RNs empathy and compassion to care for the entire needs of the patient. Secor (2015), found that compassion fatigue and burnout will led to deprived patient outcomes, diminished job satisfaction, and complicated working environments. According to Harris, Griffin and Quinn (2015), compassion fatigue is an unconscious protective mechanism used by the caregivers to protect themselves from the stresses of patient care and could eventually lead to burnout. Empathetic engagement is essential to the healing process in all disciplines within the healthcare field.
Discussion
Compassion fatigue involves multiple facets of the human psyche, and is triggered by prolonged professional burdens and lack of supporting casts. The affected individual is hampered with work place stressors, poor coping skills, a sense that no one cared for or protected the RN, and personal issues emanating from difficulties in balancing home and professional demands. Many researchers and theorist have discussed the ideals of compassion fatigue and burnout over the past thirty-years. These ideals have not changed per say, but the importance of self care and positive mental health for all healthcare professionals has been at the forefront of current day nursing.
Effective prevention against or management of compassion fatigue is marked by strategies which are underpinned by awareness and thoughtful self-care. All healthcare professionals need to be able to deliver service excellence without compromising their wellbeing. Unfortunately, in this case I described above many of my co-workers and peers felt they could no longer work within their job descriptions due to their emotions. It is critical for the RN, peers, and leadership to recognize early warning signs of compassion fatigue or burnout. It is also essential these professionals in all facets engage is self-care practices, learns to adjust to their working stressors and environments, be aware of their own and peer self destructive attitudes and who they can reach out to in times of distress (Portnoy, 2011).
Unfortunately, few healthcare facilities understand what compassion fatigue is. Due to this, many will not acknowledge, provide or even discuss interventions for assisting with attributes related to compassion fatigue. This critical concept must be recognized and have thorough understanding when and individual is at their breaking point or dramatically suffering. Future direction of compassion, empathy, and positive healthcare must be supported by our healthcare facilities and utilize evidence based practices to have positive effects for our healthcare professionals. We are all imperfect individuals that are wired to struggle with all efforts in life, but we have the capability to provide compassion and empathy in times of need.
References
- Crewe, C. (2016). The Watson Room: Managing Compassion Fatigue in Clinical Nurses on the Front Line. 1. United States of America: Scholar Works. Retrieved October 5, 2018, from https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?referer=https://www.google.com/&httpsredir=1&article=3634&context=dissertations
- Harris, C., Griffin, & Quinn, M. (2015, April). Nursing on empty: compassion fatigue signs, symptoms, and system interventions. Journal of Christian Nursing, 32(2), 80-87. doi:10.1097/CNJ.0000000000000155
- Lambardo, B., & Eyre, C. (2011, January). Compassion fatigue a nurse’s primer. Online Journal of Issues in Nursing, 16(1). Retrieved October 4, 2018, from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-16-2011/No1-Jan-2011/Compassion-Fatigue-A-Nurses-Primer.html
- Portnoy, D. (2011, July-August). Burnout and compassion fatigue: look for the signs. Journal of the Catholic Health Association of the United States, 47-50. Retrieved October 5, 2018, from http://www.compassionfatigue.org/pages/healthprogress.pdf
- Schantz, M. A. (2007, April). Compassion: A concept analysis. Nursing Forum An Independent Voice For Nursing, 42(2), 48-55. doi:10.1111/j.1744-6198.2007.00067.x
- Secor, C. (2015, December). Compassion Fatigue: A Concept Analysis. United States of America. Retrieved October 5, 2018, from Sophia, the St. Catherine University https://sophia.stkate.edu/cgi/viewcontent.cgi?article=1067&context=dnp_projects
- Selanders, L.C., & Crane, P.C. (2012, January 31). The voice of florence nightingale on advocacy. Online Journal of Issues in Nursing, 17(1), 1. Retrieved September 26, 2018 , from https://www.ncbi.nlm.nih.gov/pubmed/22320877
