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Course: Oncology Nursing

Topic: Self-Care

The Nurses International Community

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Module Goals

Learners will be able to:

Describe the concept of compassion fatigue, triggers, signs and symptoms, and treatment.
Compare and contrast self-care practices that promote psychological and physical well-being.
Describe stress management techniques such as yoga, meditation, mindfulness, journaling.

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Introduction

Kerstin L. McSteen, 2010

Oncology nurses witness their patients’ physical, emotional, spiritual, and existential suffering every day atwork.
The repeated exposure to trauma can be a regular stressor for the nurses.
Although nurses may have learned how to deal with exposure to pain and suffering, a nurse may suffer the physical and emotional symptoms that are commonly associated with compassion fatigue (CF), also known as secondary traumatic stress (STS).

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Compassion Fatigue

McSteen, 2010

Charles defined compassion fatigue as:

“the natural consequent behaviors and emotions resulting from knowing about a traumatizing event experienced by a significant other—the stress resulting from helping or wanting to help a traumatized or suffering person”

According to Figley,1995, as cited in McSteen, 2010 “the cost of caring for others in emotional pain” and “an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it is traumatizing for the helper.”

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Causes

Edcan Cancer Australia, 2021

Causes of Compassion Fatigue may include:

Complex healthcare states and comorbidities.
The high level and intensity of interpersonal relationships.
Increasing acuity.
Technological advances requiring increasingly sophisticated nursing skills.
Decreased length of hospital admission.
The necessity of dealing with the dying process.

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Causes

Edcan Cancer Australia, 2021

In palliative care, unique factors may magnify the risk of compassion fatigue. These include:

Accumulated losses
Emotionally charged care
Sustained and exclusive focus on terminal illnesses and terminal care
Mortality issues of the clinician (existential, spiritual, or personal)

Image by, Stock Image

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Who is at Risk?

Kerstin L. McSteen, 2010.

Nurses who appear to be at higher risk for compassion fatigue include the following:

Nurses who are new to the field and are less experienced
Nurses who have a history of personal trauma and have not worked through the issues related to the trauma
Nurses who are working for long hours
Nurses who are already experiencing professional burnout
Nurses who are less competent in communication
Nurses without adequate collegiate and personal support systems

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Case Study/Critical Thinking Question/What would the nurse do?

Compassion fatigue stems from which of the following?

Lack of physical exercise
Issues with a coworker
Problems with your boss
Caring for one’s own patients

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Symptoms of Compassion Fatigue

Kerstin L. McSteen, 2010.

Re Experiencing the trauma event of the traumatized person:

Recollections of event
Dreams of the event
Sudden and unexpected reexperiencing of the event
Distressing reminders of the traumatized person and event

Avoidance/numbing of reminders of event:

Efforts to avoid thoughts and feelings
Psychogenic amnesia
Diminished interest in activities
Detachment from others
Sense of foreshortened future

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Symptoms of Compassion Fatigue

Kerstin L. McSteen, 2010

Persistent arousal:

Difficulty falling/staying asleep
Difficulty concentrating
Hypervigilance for the traumatized person
Exaggerated startle response
Physiologic reactivity to cues

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Symptoms of Compassion Fatigue

Carson, Fiasconaro & Freeman, n.d

Emotional:

Depression
Anxiety
Irritability
Oversensitivity
Restlessness
Use of substances to cope
Problem with concentration, focus, memory
Anger, loss of objectivity

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Symptoms of Compassion Fatigue

Carson, Fiasconaro & Freeman, n.d

Physical:

Sleep Disturbances: Nightmare, insomnia
Headache
Muscle tension
Gastrointestinal problems
Fatigue
Cardiovascular Alignment: tachycardia, palpitation

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Case Study/Critical Thinking Question/What would the nurse do?

What are possible symptoms of compassion fatigue? (Select all that apply)�

Fatigue
Irritability
Unexplained fever
Tachycardia
Anger

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Impacts of Compassion Fatigue

The clinical importance of compassion fatigue has been highlighted through its impact on outcomes such as:

Increased medical errors
Increased turnover and absenteeism
Decreased quality of care
Decreased satisfaction expressed by recipients of care
Significant impact which burnout has on the professional and personal lives of affected personnel

Edcan Cancer Australia, 2021

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Prevention of Compassion Fatigue

Protective practices for nurses are recommended to:

Help compartmentalize work from the rest of life - identify ways to leave the job behind
Establishing professional boundaries
Promote emotional and physical health
Include regular self-care techniques for managing stress

Edcan Cancer Australia, 2021

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Prevention of Compassion Fatigue

Kerstin L. McSteen, 2010

Self care is a critical component of prevention
Self care includes attention to and care of physical, psychological, cognitive, interpersonal, behavioral, and spiritual aspects of the whole person
Variety of self care activities in preventing and managing the hazards of compassion fatigue include:

Regular and vigorous physical exercise, along with nurturing interventions like massage, can help to reduce stress

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Prevention of Compassion Fatigue

Kerstin L. McSteen, 2010

Assertiveness training
Time management skills
Working on improving personal communication skills, and becoming involved in community/social action activities can provide life skills that carry over to work
Meditation and spiritual practice are important tools in understanding our response

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Self Care Strategies

Be kind to yourself

Physical needs: Eat nutritiously balanced meals; adequate sleep; regular exercise
Social needs: Cultivate and maintain close friendships, share your feeling to your family, friends
Mental health needs: Activities that keep your mind sharp, such as working crosswords and other puzzles, reading books
Emotional needs: Establish appropriate ways to process your emotions. Talk to someone close to you—a spouse, partner, relative, or friend—to air your feelings

Sarah & Colker, 2020

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Self Care Strategies

Sarah & Colker, 2020

Cultivating Mindfulness:

Set aside time
Observe the present moment as it is. The goal is to pay attention to the present moment without judgment
Let your judgments roll by. When you notice judgments arise, make a mental note of them and then let them pass
Our minds often get carried away in thought. Mindfulness is the practice of returning, again and again, to the present moment.
Don’t judge yourself for any thoughts that crop up. Just practice recognizing when your mind has wandered off and gently bring it back

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Self Care Strategies

Sarah & Colker, 2020

Reframe your negative thought:�ABCDE model to reframe their negative thinking:When an experience that triggers pessimistic thoughts, use self-talk to walk thoughts from A (adverse event) to E (energization):

A = An adverse event occurs.
B = Immediately have negative beliefs about the events
C = Experience the consequences of having these thoughts and beliefs
D = Intentionally dispute the pessimistic beliefs
E = Feel energized when successfully dispute the negative thoughts

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Case Study/Critical Thinking Question/What would the nurse do?

Reflection:

What are practices of mindfulness? (Select all that apply)

Leave work early on occasion
Pay attention to the present moment without judgment
Intentionally dispute the pessimistic beliefs
Talk to someone close to you

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Intervention of Compassion Fatigue

Interventions to cope with compassion fatigue

Services through employee assistance programs
For new hires, acknowledgment by managers of the inherent emotional stressors,and assurance of ongoing employer suppor
Education and training in communication skills, conflict resolution, ethical issues, self care, and healthy coping

Kerstin L. McSteen, 2010

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Intervention for Compassion Fatigue

Making prompt and timely supportive resources available to staff to allow for emotional expression (examples include on-site counseling in the form of staff support groups).
Critical incident debriefing, and routine daily rounds and patient care conference discussions.
Pastoral care (often overlooked but identified as an important support by many of those surveyed).
Retreats for informal interactive exchanges, team building, and artistic and narrative expression.

Kerstin L. McSteen, 2010

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Other Strategies for management of Stress

Meditation:

Deep breathing, guided visualizations.

Yoga:

Relieve anxiety, psychological tension.
Bring balance to your thoughts, activities and emotion.

Journaling:

Involves the practice of keeping a diary or journal that explores thoughts and feelings surrounding the events of your life.

Image by, Pixabay

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Case Study/Critical Thinking Question/What would the nurse do?

Reflection:

List interventions currently available to you that may help you to deal with compassion fatigue.

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References:

Carson, S., Fiasconaro, A. & Freeman, C. New Jersey City University, New Jersey, U.S.A (n.d.). Sigma Nursing: Compassion Fatigue in Oncological Nursing. Retrieved from https://sigma.nursingrepository.org/bitstream/handle/10755/616453/25_Carson_S_p80478_1.pdf?sequence=1&isAllowed=y�
Edcan Cancer Australia (2021). Australian Government Cancer Australia : Self Care for Nurses. Retrieved from: https://www.edcan.org.au/edcan-learning-resources/supporting-resources/supportive-care/implementing-supportive-care/self-care�
Hall,. L. (2017). Open Colleges : What is compassion fatigue? The sign, treatment and prevention. Retrieved from: https://www.opencolleges.edu.au/careers/blog/what-is-compassion-fatigue-signs-treatment-prevention

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References:

Kerstin L. McSteen (2010) . Oncology Nurse Advisor: Compassion fatigue in oncology nursing: A witness to suffering. Retrieved from https://www.oncologynurseadvisor.com/wp-content/uploads/sites/13/2019/01/ona_ce_1010-1012_7955.pdf

Sarah Erdman Laura J., Colker Elizabeth C Winter, 2020. NAEYC: Preventing Compassion Fatigue: Caring for Yourself. Retrieved from: https://www.naeyc.org/resources/pubs/yc/jul2020/preventing-compassion-fatigue

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