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Course: Fundamentals of Nursing�Topic: Self-Care of the Nurse

The Nurses International Community

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COPYRIGHT

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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

McSteen, 2010

Nurses witness their clients’ physical, emotional, spiritual, and existential suffering every day at work.
The repeated exposure to trauma can be a regular stressor for nurses.
Nurses may suffer physical and emotional symptoms related to their exposure to suffering and trauma that are associated with compassion fatigue (CF).

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What is Compassion Fatigue?

Compassion fatigue occurs when nurses develop a decreased ability for empathy from repeated exposure to others’ suffering.
“The physical and mental exhaustion and emotional withdrawal experienced by those that care for sick or traumatized people over an extended period of time” (Peters, 2018, p. 467)

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Causes

Edcan Cancer Australia, 2021
Peters, 2018

Causes of compassion fatigue may include:

Repeated exposure to suffering²
Heavy workloads and increasing acuity²
Time constraints that hinder quality care²
High intensity of interpersonal relationships²
Technological advances requiring increasingly sophisticated nursing skills¹
Decreased length of hospital admission¹
The necessity of dealing with the dying process^2,1
Lack of personal and professional support¹

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Who is at Risk?

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

McSteen, 2010

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Multiple Choice Question

Compassion fatigue stems from which of the following?

Lack of regular self-care activities
Issues with co-workers and/or management
Repeated exposure to verbal abuse from clients
Exposure to pain and suffering while caring for clients

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Symptoms of Compassion Fatigue

Experiencing the trauma event of the traumatized person:

Recollections of event
Dreams of the event
Sudden and unexpected re-experiencing 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

McSteen, 2010

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Symptoms of Compassion Fatigue

(cSteen, 2010

Persistent arousal:

Difficulty falling/staying asleep
Difficulty concentrating
Hypervigilance
Exaggerated startle response
Physiologic reactivity to cues

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Symptoms of Compassion Fatigue

Carson et al., n.d
Perregrini, 2019

Emotional:

Depression¹
Anxiety²
Hopelessness²
Irritability¹
Oversensitivity²
Restlessness¹
Use of substances to cope²
Anger, loss of objectivity²
Problem with memory & concentration²

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Symptoms of Compassion Fatigue

Carson et al., n.d
Peters, 2018

Physical:

Sleep disturbances: nightmares, insomnia¹
Headache²
Muscle tension¹
Gastrointestinal problems¹
Fatigue¹
Tachycardia, palpitations¹
Fluctuations in weights²

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Symptoms of Compassion Fatigue

Perregrini, 2019

At work:

Job dissatisfaction
Complaining about assignments
Decreased response times with client care
Frequently being off the unit
Verbalizing indifference toward client care/responsibilities
Lack of communication or interactions with team members
Increased call offs

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Case Study

A nurse who has been working in an emergency department for a several y years starts showing up to work smelling like alcohol. When a concerned colleague asks about it, the nurse states that he can’t fall asleep any more because he just lies there and thinks about client cases that didn’t go well. He says drinking helps him to “stop thinking” so he can sleep. His colleagues also notice that he’s irritable and complains of frequent headaches, but assume it’s due to lack of sleep. At home, the nurse no longer engages in his usual hobbies and tells his wife that he feels like he’s going to get killed in a car accident on the way to work.

What are some clues that this nurse is suffering from compassion fatigue?

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Impact of Compassion Fatigue

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

Increased medical errors¹
Decreased quality of care¹
Decreased satisfaction expressed by recipients of care¹
Increased turnover and absenteeism¹
Desire to quit the profession²
Significant impact on the professional and personal lives of affected personnel¹

Edcan Cancer Australia, 2021
Peters, 2018

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Prevention of Compassion Fatigue

McSteen, 2010

Because of the significant impact of compassion fatigue on both nurses and clients, preventing compassion fatigue is key. Certain protective practices utilized by nurses and strategies implemented at the workplace can help

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Prevention of Compassion Fatigue

Protective practices by nurses:

Regular self-care¹
Activities to reduce stress¹
Establish professional boundaries ¹
Develop time management skills ²
Compartmentalize work from the rest of life (leaving the job behind)²
Become involved in community/social action activities that provide life skills that carry over to work ²

Edcan Cancer Australia, 2021
McSteen, 2010

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Prevention of Compassion Fatigue

McSteen, 2010
Perregrini, 2019

Self-care is one of the most important protective practices for preventing compassion fatigue

Involves taking care of oneself by making time for non-nursing activities that reduce job-related stress^1,2
Includes attention to and care of physical, psychological, cognitive, interpersonal, behavioral, and spiritual aspects of the whole person ^1,2

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Self-Care Practices

Erdman et al., 2020
Perregrini, 2019

There are many kinds of self-care practices. The following are some examples of practices that promote psychological and physical well-being:

Self-reflection^1,2
Regular exercise^1,2
Adequate sleep^1,2
Maintain relationships¹
Talk about your feelings^1,2
Make time for hobbies^1,2
Cultivate mindfulness ²
Engage in spiritual practices^1,2
Stress management techniques^1,2

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Practicing self-reflection (Sheppard, 2016):

Set aside quiet time outside work
Examine events, experiences, and interactions from work in order to become more aware of triggers (people, situations, events) that cause stress, anxiety, anger, negative thoughts, etc.
Find ways to address each trigger
Acknowledge your emotions and treat yourself with compassion

Practicing mindfulness (Erdman et al., 2020):

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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Stress Management

Perregrini, 2019

Using stress management techniques can be an especially helpful component of self-care:

Journaling:

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

Yoga:

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

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Stress Management

Meditation:

Deep breathing, guided visualizations

Reframing of negative thoughts:

ABCDE model to reframe their negative thinking:

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

Erdman et al., 2020

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Reflection Question

List interventions currently available to you that can help you to prevent or address compassion fatigue.

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References:

Carson, S., Fiasconaro, A. & Freeman, C. (n.d.). Compassion fatigue in oncological nursing. New Jersey City University. https://sigma.nursingrepository.org/bitstream/handle/10755/616453/25_Carson_S_p80478_1.pd ?sequence=1&isAllowed=y

EdCaN. (2021). Self-care for nurses. Australian Government: Cancer Australia. https://www.edcan.org.au/edcan-learning-resources/supporting-resources/supportive-care/implementing-supportive-care/self-care

Erdman, S., Colker, L.J., Winter, E.C. (2020). Preventing compassion fatigue: Caring for yourself. Young Children, 75(3). https://www.naeyc.org/resources/pubs/yc/jul2020/preventing-compassion-fatigue

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References:

Hall, L. (2017, November 26). What is compassion fatigue? The signs, treatment and prevention. Open Colleges. https://www.opencolleges.edu.au/careers/blog/what-is-compassion-fatigue-signs-treatment-prevention

McSteen, K.L. (2010, October 15). Compassion fatigue in oncology nursing: A witness to suffering. Oncology Nurse Advisor. https://www.oncologynurseadvisor.com/wp-content/uploads/sites/13/2019/01/ona_ce_1010-1012_7955.pdf

Perregrini, M. (2019). Combating compassion fatigue. Nursing. 49(2), 50-54 doi: 10.1097/01.NURSE.0000552704.58125.fa

Contact info: info@nursesinternational.org

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References:

Peters, E. (2018). Compassion fatigue in nursing: A concept analysis. Nursing Forum, 53(4), 466-480. https://doi.org/10.1111/nuf.12274

Sheppard, K. (2016). Compassion fatigue: Are you at risk? American Nurse Today, 11(1), 53-55. https://www.myamericannurse.com/wp-content/uploads/2016/01/ant1-Compassion-Fatigue-1222.pdf

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