Sally worked as a staff nurse in a busy hospital. She often felt tearful and anxious and struggled through her shifts. She was frustrated and angry about not being able to offer more help to her patients and their families but time constraints and a heavy workload prevented her from doing this.
Sometimes at the end of a busy, tiring shift, she would head home, vowing to leave the oncology ward and move to a less emotionally charged working environment. On days like this, when she felt overwhelmed by tiredness, sadness, and negativity she would take a day's sick leave and spend the time in bed, too exhausted to go out or meet friends.
This highly trained and caring nurse was unaware that she was experiencing compassion fatigue which was affecting her personal and professional life. There are many healthcare professionals like Sally. These constant givers are struggling to cope, particularly during the current pandemic as the increased demands on their time, energy, and emotional resources coupled with the uncertainty and fear surrounding this health crisis, exacts a heavy toll on their day-to-day lives.
Carmel Sheridan, a local psychotherapist, mindfulness trainer, and the author of the book, "The Mindful Nurse", describes compassion fatigue as a form of burnout which affects people in the caring profession. It is particularly common among nurses who deal with death, often on a daily basis.
"It has been been described as 'a heavy heart, accompanied with debilitating weariness brought on by the empathetic responses to the pain and suffering experienced by others in the nurse's care'".
She outlines that healthcare professionals offer themselves as "therapeutic instruments" at work. "Interactions with patients and compassionate behaviours can help make patients feel better, but this can be extremely taxing for the giver, especially if you don't take enough care to replenish the energy you constantly and generously give others."
Carmel, who has practiced meditation for more than 25 years and facilitates mindfulness retreats and training programmes on self-care and compassion fatigue, says from 40 to 85 per cent of people in the caring profession suffer at some stage from compassion fatigue or exhibit trauma symptoms. People working in some specialties, including palliative care, oncology, paediatrics, and traumatology, are more prone to the condition.
Sap your energy
Many issues, ranging from moody and unenthusiastic co-workers to the overwhelming demands of the overstretched healthcare system, can sap your energy, she says. "Amid all the chaos and rush is the patient. Most of all, you want to be there for the patient who presents with pain, distress, fear, and a mix of heavyweight emotions."
People who choose nursing as a career typically do so because they want to care for and nurture others. But the downside of this, according to the psychotherapist, is that they tend to put the needs and feelings of other people first to the detriment of themselves. They fail to take time to replenish their own resources.
Compassion fatigue is a condition which is easily missed, often because it may be masked by something else, says Carmel Sheridan, who is also the author of "Failure-Free Activities for the Alzheimer Patient", and "Reminiscence: Uncovering a Lifetime of Memories." She cites Sally, the nurse referred to at the beginning of this article, as a case in point. She attributed her exhaustion and feelings of being overwhelmed to having a bad day at work.
Yet her recurring headaches, sadness, and frequent sickness were signs of compassion fatigue. "What, at first, appears to be a harmless and temporary hiccup in a nurse's mental and physical health can develop into a chronic condition," she says. "In extreme cases, compassion fatigue can lead to self-destructive behaviours, addictions, and even suicide. The Diagnostic and Statistical Manual of Mental Disorders now lists compassion fatigue as a type of post-traumatic stress disorder, which means that working with people in trauma can affect you as deeply as spending time in a war zone."
While there is an overlap between compassion fatigue and burnout and some symptoms are common to both, there is a distinction between these conditions.
"Burnout can occur after years spent absorbing the physical and emotional trauma of many patients, combined with a sense of one's own helplessness. The result of long-term work-related issues and ongoing stress, burnout usually has a slow and pernicious onset."
By contrast, compassion fatigue often strikes suddenly and delivers a "knockout punch", according to Ms Sheridan. "It can result from one particular event or long-term exposure to the suffering of others. A nurse who is burned out is more likely to develop compassion fatigue."
She quotes Deborah Boyle, the author of "Countering Compassion Fatigue: A Requisite Nursing Agenda", who notes another difference between both illnesses. "While the burnt-out nurse gradually withdraws, the compassionately fatigued nurse tries harder to give even more to patients in need. Both outcomes, however, are associated with a sense of depletion within the nurse, a running-on-empty feeling."
Telltale signs of compassion fatigue
The following is a list of symptoms most commonly associated with compassion fatigue:
• Avoidance or dread of working with certain patients
• Reduced ability to feel empathy towards patients or families
• Frequent use of sick days
• Lack of joyfulness
• Digestive problems such as diarrhoea, constipation, or an upset stomach
• Muscle tension
• Sleep disturbances, such as inability to sleep, insomnia, or sleeping too much
• Cardiac symptoms such as chest pain/pressure, palpitations, or tachycardia (a heart rate that exceeds the normal resting rate ).
• Mood swing
• Excessive use of nicotine, alcohol, illicit or prescription, drugs
• Anger and resentment
• Loss of objectivity
• Memory issues
• Poor concentration, focus, and judgment
Carmel Sheridan says any one of these symptoms may indicate you are suffering from compassion fatigue. However, people with this condition generally exhibit more than one symptom.
It is important to remember that the condition not only has a "serious impact" on healthcare professionals, particularly nurses' health and wellbeing, but also on patient care, she outlines.
There are a number of strategies which can help people combat it. These include self-care, setting boundaries, cultivating self-compassion, and incorporating mindfulness into your daily routine. Meditation, or any talking or relaxation therapies, are also helpful.
"The important take home message is this: You can take steps to avoid driving yourself to the point of exhaustion. In particular, you need to become aware of your behaviours and the physical and emotional states that make you vulnerable to compassion fatigue and burnout. When you feel fatigue and distress creeping up and threatening to move into red-zone levels, you need to ramp up your self-care."
Begin by being aware of your personal boundaries at work. "If you find yourself over-extending and feeling what your patients are possibly feeling (fear, sadness, or grief ) practice shifting your attention away from the difficult emotions and back to your body and breath. Re-engage after you have centred yourself."
Mindfulness and compassion practices will help build your resilience and help you regain fulfilment in your work, she says.
"Mindfulness can entangle you from the most pathological side effects of compassion fatigue. When you regain your balance, you need to focus your attention on self-compassion. This is the capacity for healthy nurturing of the self. Just as compassion is the willingness to acknowledge and be moved by the suffering of others, self-compassion extends this acceptance and care to you.
"As the antidote to compassion fatigue, self-compassion is essential for nurses. After all, just like on the airplane, if you don't put your oxygen mask on first, then you won't be able to help anyone else. The development of self-compassion is necessary if you are to provide sustained compassionate care for others."
You will recognise instantly if you practice self-compassion. You will be kind and gentle with yourself, even if you make mistakes. Lacking compassion for self is evident if you feel guilty for taking a day's sick leave, constantly criticise yourself, blame yourself even after others forgive you, and berate yourself for not being perfect.
"The remedy when things go wrong is to step outside that pull of self-judgment and practice self-compassion instead," advises Carmel Sheridan. "Rather than berating yourself when you slip up, be gentle. Speak kindly to yourself and accept what has happened. This doesn't mean that you let yourself off the hook for an error. Indeed, it is the opposite. When you are self-compassionate, you are more likely to own up to what happened. Turning towards your distress with compassion helps you to let go of defensiveness. Rather than judging yourself, you can now acknowledge difficult feelings such as guilt and shame. This frees up energy so that you can look for helpful solutions to your dilemma and focus on how to avoid repeating what went wrong."