Compassion Fatigue and what you can do about it

compassion fatigueToday I went to a journal club meeting on compassion fatigue. What does compassion fatigue even mean? Why is it important? And how can we combat it?

First let us define a few words.
Passion means an intense emotion.
Compassion means you’re intensely aware of others’ suffering and you have the desire to do something about it.
Sympathy is when you feel sorry for others.
Empathy is when experience others’ pain.

As a nurse, you probably will feel all of these emotions for your patients. You understand the patients’ suffering and you’re willing to do something about it. You feel sympathy for these patients. In fact, your entire unit probably feels sympathy. And your goal is to alleviate suffering.

However, empathy can be emotionally taxing and draining. You have to be careful not to be too empathetic for each patient  as doing so will drain your emotional capacity.

But what happens when there’s too much compassion? What is the opposite of compassion?

Indifference. You stop caring. It’s too much and you’re not satisfied.

What does this look like?

People may lash out at others. Others isolate themselves. People will often call out sick because they feel overloaded. They feel scared that they will make a mistake that could cost them their license or worse, a patient’s life. Nurses will feel burnout and eventually drop out of nursing. That is not good for the profession.

What can you do to combat compassion fatigue?

1. Set small and obtainable goals (SMART goals).

This applies to any setting, but especially in the critical care setting where there are chronic patients and dying patients who may make little difference everyday (either positively or negatively). The goal may not be curative but rather for comfort. If the patient is in pain, your goal could be to provide comfort.

Sometimes family members will have unreasonable goals for their loved ones because they are unfamiliar or are in denial of the serious condition. They may think that their loved one is going to go home being the same way they were before arriving at the hospital. In this case, your goal could be to alleviate the family’s fears and to be honest with the patients’ condition.

Setting your own small and measurable goals for the patient for those 12 hour shifts will allow you to feel good about the care you give.

2. Taking care of yourself.

The stability of your personal relationships at home will affect how you handle yourself at work. If you’re stable and confident with yourself, you will come away believing in yourself that you’re doing the best you can. Having enough time for yourself is crucial. Exercise, eat healthy, and building a positive network.

3. Work as a team.

Lastly, remember that you’re working as a team and not in isolation. Your coworkers also feel compassion for you and your patients. The more senior coworkers may have had experiences similar to the one you’re currently dealing with and can suggest goals for you.

Giving the same good, evidenced based nursing care for each patient is something my unit does consistently, no matter what condition the patients are in. In some cases, the patients get better. In other cases, patients get worse or stay chronically ill. By treating everyone in the same way, we feel that the patients’ destiny is not in our hands, but is determined by something higher up.

How to care for the dying

CARES: How to Care for the Dying

Within the first four months of working as a new bedside nurse, I’ve encountered two patients who were actively dying. I wasn’t sure what to do. After coming across this article from Medscape though (btw you need a free login to read this article), I finally understand what the palliative care nurse practitioners were doing.

The City of Hope came up with a tool called CARES to help the nurse take care of those who are dying.

C stands for comfort. You aim to alleviate pain and suffering for the patient. Additional testing and blood draws should be questioned, as the aim is to comfort, not treat.

C: Comfort

A stands for airway. We used a scopolamine patch placed behind the ear. It’s used to help stop secretions from building up. While oxygen and oral secretion will not necessarily help, it may be comforting for the patient to have those things.

How to care for the dying

A: Airway

R stands for restlessness or delirium. It occurs in 25-85% of actively dying patients. It could be due to uncontrolled pain, a distended bladder, or it could be that the patient feels that there are unresolved issues with the family. Playing familiar music and providing a non-stimulating environment will help.

How to care for the dying

R: Restlessness or Delirium

E stands of emotional and spiritual support. Don’t underestimate a listening ear and providing clear and open communication. Whatever can be done to promote a comfortable and peaceful death should be considered.

How to Care for the Dying

E: Emotional and Spiritual Support

S stands for self-care. The nurse is often stressed and may need to debrief too.

CARES: How to Care for the Dying

S: Self Care