The very same qualities that make us excel as carers also put us at risk for compassion fatigue. Fundamentally, being compassionate and feeling compelled to care sets us up to be hurt.
While I was writing this book, I attended a conference sponsored by the National Institute of Nursing Research, where a number of brilliant people gathered together to explore where we have been and where we are going with palliative and end of life care. The title of the conference, coincidentally, was, “The Science of Compassion.” The kickoff for this summit was a town hall discussion on ethical issues in end of life care. The topic turned to the vulnerability of people who are dying; however, it became glaringly apparent during the discussion that in designating some people as more or less vulnerable, we might be doing a disservice to some or all. Who is it that decides who is vulnerable and who is not? The bottom line is that all people are vulnerable at different points in their lives, and that, of course, includes us nurses. Our recognition of human vulnerability is in large part the basis of compassionate caring and is also the source of compassion fatigue.
DEFINING COMPASSION FATIGUE
Compassion fatigue is a syndrome that carers may develop when they internalize pain or anguish related to other people in their work environment. As noted earlier, the term compassion fatigue is ambiguous and is often used interchangeably with secondary traumatic stress (STS) and, on occasion, vicarious trauma.1 It is sometimes referred to as a lesser (or unique form) of burnout.
Some of the most inclusive work on the subject has been written by trauma study pioneer Charles Figley (1995, 2002a, 2002b), who thinks that compassion fatigue is a more user-friendly term than STS, which is closely aligned with post-traumatic stress disorder (PTSD).2 He believes that the modern-day description of this syndrome is equivalent to his early depiction of secondary victimization as well as the similar concept of “emotional contagion.”3 Basically, when carers become preoccupied with another’s experience (of being traumatized), we too are traumatized (Figley, 1995, 2002b).
Figley (2002a) also described compassion fatigue as a chronic lack of self-care, and this definition is in keeping with Joinson’s (1992) portrayal of compassion fatigue. It has been said that the most basic thing nurses provide in the delivery of care to others is ourselves, and unless we can find ways to continuously renew ourselves from the drain associated with our nursing practice, we will not only lose energy but also enthusiasm for our work (Joinson, 1992). What is always implicit in any description of the syndrome is that those who develop compassion fatigue are, on some level, internalizing pain and suffering from their relationship with others in the workplace, usually co-suffering with another human being, and it is manifesting itself in harmful ways on a multidimensional level. If it is not recognized and tended to, it can spiral out of control and may eventually result in burnout (Benson & Magraith, 2005; Figley, 2002b).
WHO IS AT RISK?
Nurses who work in areas where patients usually do not return to a previous level of wellness are especially at risk of compassion fatigue; however, it is important to realize that we bear witness to suffering in all areas of health care. Palliative care nurse pioneers Betty Ferrell and Nessa Coyle (2008) emphasized this in a book on the nature of suffering and the goals of nursing. Suffering is part of the human condition, and while we each may be able to describe some universal idea of what it means to suffer, the lived experience of suffering is unique for every person. Consequently, none of us can ever assume that suffering is or is not taking place; we need to look deeper than the surface.
People with chronic, and what are referred to as life-limiting illnesses, as well as acute, life-threatening illnesses, are often treated aggressively, and treatments can result in additional suffering for them and their loved ones. Their suffering is a part of the nurse’s daily work, and whether or not the nurse acknowledges it, he or she internalizes at least some of the anguish. Even a seemingly benign task such as obtaining bed scale weights might be quite traumatic for both the cared for and the carer. And, while I may still shudder to recall those bed scale weight days in the ICU (and really I do!), other coworkers may not; such is the uniqueness of human beings.
Since what is traumatic to one person may not be to another, it is imperative to recognize the possibility that someone might be traumatized, even when we think not. It is also important to explore what the term trauma implies to you. You may realize that some of the experiences you have had were very traumatic, although at the time you did not realize it (see also Chapter 10).