Compassion fatigue is an evolving concept in the field of traumatology. The term has been used interchangeably with secondary traumatic stress (STS), which is sometimes simply described as the negative cost of caring. Secondary traumatic stress is the term commonly employed in academic literature, although recent assessments have identified certain distinctions between compassion fatigue and secondary traumatic stress (STS).
Compassion fatigue is a form of traumatic stress resulting from repeated exposure to traumatized individuals or aversive details of traumatic events while working in a helping or protecting profession. This indirect form of trauma exposure differs from experiencing trauma oneself.
Compassion fatigue is considered to be the result of working directly with victims of disasters, trauma, or illness, especially in the health care industry. Individuals working in other helping professions are also at risk for experiencing compassion fatigue. These include doctors, caregivers, child protection workers, veterinarians, clergy, teachers, social workers, palliative care workers, journalists, police officers, firefighters, paramedics, animal welfare workers, health unit coordinators, and student affairs professionals. Non-professionals, such as family members and other informal caregivers of people who have a chronic illness, may also experience compassion fatigue. The term was coined in 1992 by Carla Joinson to describe the negative impact hospital nurses were experiencing as a result of their repeated, daily exposure to patient emergencies.
Symptoms People who experience compassion fatigue may exhibit a variety of symptoms including, but not limited to, lowered concentration, numbness or feelings of helplessness, irritability, lack of self-satisfaction, withdrawal, aches and pains, exhaustion, anger, or a reduced ability to feel empathy. Those affected may experience an increase in negative coping behaviors such as alcohol and drug usage. Professionals who work in trauma-exposed roles may begin requesting more time off and consider leaving their profession.
Significant symptom overlap exists between compassion fatigue and other manifestations, such as posttraumatic stress disorder (PTSD). One distinguishing factor lies in the origin of these conditions, with PTSD stemming from primary or direct trauma, while compassion fatigue arises from secondary or indirect trauma.
History
Compassion fatigue has been studied by the field of traumatology, with Charles Figley playing a pivotal role by characterizing it as the "cost of caring" experienced by individuals in helping professions. The term was introduced to the literature in 1992 by Carla Joinson to describe the negative impact hospital nurses were experiencing as a result of their repeated, daily exposure to patient emergencies. However, the phrase had been in use as early as 1961,Cousins, Norman. "Compassion Fatigue", via Emporia Gazette, April 6, 1961, page 4. and was popularized in 1985 when Bob Geldof cited it as his reasoning for ending his charity work after Live Aid."'Compassion fatigue' overtakes Bob Geldof", Reuters, via Red Deer Advocate, October 21, 1985, page 7C.
To a certain extent, the term "compassion fatigue" is considered somewhat euphemistic and is used as a substitute for its academic counterpart, secondary traumatic stress.
Compassion fatigue has also been called secondary victimization,Figley, C. (1982). Traumatization and comfort: Close relationships may be hazardous to your health. Keynote presentation at the Conference, Families and close relationships: Individuals in social interaction, Texas Tech University, Lubbock, Texas, February. secondary traumatic stress,Figley, C. R. (1983). Catastrophes: A overview of family reactions. In C. R. Figley and H. I. McCubbin (Eds.), Stress and the Family: Volume II: Coping with Catastrophe. New York: Brunner/Mazel, 3-20. vicarious traumatization, and secondary survivor. Other related conditions are rape-related family crisis and "proximity" effects on female partners of war veterans.
Measuring and assessments Some of the earliest and most commonly used assessment are Compassion Fatigue Self Test (CFST), Compassion Satisfaction and Fatigue Test (CSFT) and Compassion Fatigue Scale—Revised.
The self-assessment ProQOL (or Professional Quality of Life Scale) contains three sub-scales: compassion satisfaction, burnout, compassion fatigue / secondary traumatic stress.
The Secondary Traumatic Stress Scale (STSS) assess the frequency of intrusion, avoidance, and arousal symptoms associated with indirect exposure to traumatic events through clinical work with traumatized populations.
Risk factors
Many organizational attributes in the fields where STS is most common contribute to compassion fatigue among the workers, such as in healthcare where a "culture of silence" is normalized by not discussing stressful events, such as deaths in an intensive-care unit, after the event increase rates of CF. Additional contributing organizational factors can result from conditions such as long work hours, short-staffing, workplace incivility, and feelings of dismissal or invalidation by their managers.
Lack of awareness of symptoms and poor training in the risks associated with their trauma-exposed profession results in higher rates of STS.
Traumatization symptom levels usually depend on three criteria: proximity, intensity, and duration. Proximity refers to how close the provider is to the traumatic event, intensity is defined by how extensive and extreme the traumatic event is, and duration refers to how long the provider is involved with the traumatic event. APA( 2002) DSM-IV-text revision cited in "Compassion Fatigue and Secondary Traumatization: Provider Self Care on Intensive Care Units for Children," Patrick Meadors & Angela Lamson;J Pediatr Health Care. (2008) 25.
Compassion fatigue increases in intensity with increased interactions among the needy. Because of this, people living in urban cities are more likely to experience compassion fatigue. People in large cities interact with more people in general, and because of this, they become desensitized towards people's problems. Homeless people often make their way to larger cities. Ordinary people often become indifferent to homelessness when they see it regularly.
Pathological altruism can contribute to depression.
Family Recent studies reveal that the "overall compassion fatigue and compassion satisfaction levels were moderate, thus highlighting the potential risk of compassion fatigue for family caregivers", indicating that primary family caregivers of patients could also experience compassion fatigue or STS.
In healthcare professionals
Between 16% and 85% of health care workers in various fields develop compassion fatigue. In one study, 86% of emergency room nurses met the criteria for compassion fatigue. In another study, more than 25% of ambulance paramedics were identified as having severe ranges of post-traumatic symptoms. In addition, 34% of hospice nurses in another study met the criteria for secondary traumatic stress/compassion fatigue.
There is a strong relationship between work-related stress and compassion fatigue which include factors such as: attitude to life, work-related stress, how one works, amount of time working at a single occupation, type of work, and gender all play a role. Research done among nursing during the COVID-19 pandemic found that active coping strategies, such as seeking support socially and problem- solving, were associated with higher compassion satisfaction and lower levels of burnout, while avoidance-based coping was associated with higher emotional distress. Coping strategies were found to predict approximately 25.4% of the variance in compassion fatigue outcomes in this population.
Compassion fatigue is the emotional and physical distress caused by treating and helping patients that are deeply in need. This can desensitize healthcare professionals to others' needs, causing them to develop a lack of empathy for future patients. There are three important components of Compassion Fatigue: Compassion satisfaction, secondary stress, and burnout.Stamm BH. (2010). The concise ProQOL manual. Pocatello ID ProQOL Org. Burnout is not the same as compassion fatigue; burnout is the stress and mental exhaustion caused by the inability to cope with the environment and continuous physical and mental demands.
Healthcare professionals experiencing compassion fatigue may find it difficult to continue doing their jobs. While many believe that these diagnoses affect workers who have been practicing in the field the longest, the opposite proves true. Young physicians and nurses are at an increased risk for both burnout and compassion fatigue. A study published in the Western Journal of Emergency Medicine revealed that medical residents who work overnight shifts or work more than eighty hours a week are at higher risk of developing Compassion Fatigue. Burnout was another major contributor to these professionals who had a higher risk of suffering from Compassion Fatigue. Burnout is a prevalent and critical contemporary problem that can be categorized as suffering from emotional exhaustion, de-personalization, and a low sense of personal accomplishment.McKoldrick, K. (2018) Physician Burnout and Well-being: Why They Matter. Current Reviews in Clinical Anesthesia: Lesson 9, Volume 39. They can be exposed to trauma while trying to deal with compassion fatigue, potentially pushing them out of their career field. If they decide to stay, it can negatively affect the therapeutic relationship they have with patients because it depends on forming an empathetic, trusting relationship that could be difficult to make amid compassion fatigue. Because of this, healthcare institutions are placing increased importance on supporting their employee's emotional needs so they can better care for patients.
Studies compiled in 2018 by Zang et al. indicate that the level of education one obtains in the field of healthcare has an effect on levels of burnout, compassion satisfaction, and compassion fatigue. Studies show, it is indicated that those with higher levels of education in their respective field will experience lower rates of burnout and compassion fatigue, while also having increased levels of compassion satisfaction.
Another name and concept directly tied to compassion fatigue is moral injury. Moral injury in the context of healthcare was directly named in the Stat News article by Drs. Wendy Dean and Simon Talbot, entitled "Physicians aren't 'burning out.' They're suffering from moral injury." The article and concept go on to explain that physicians (in the United States) are caught in double and triple and quadruple binds between their obligations of electronic health records, their student loans, the requirements for patient load through the hospital, and procedures performed – all while working towards the goal of trying to provide the best care and healing to patients possible. However, the systemic issues facing physicians often cause deep distress because the patients are suffering despite the physician's best efforts. This concept of moral injury in healthcare is the expansion of the discussion around compassion fatigue and burnout. Cross-cultural research has found variation in how compassion is expressed, with differences shown across different populations between the U.S., Latin America, and Turkey in measures of empathy and helping behavior.
C.N.A.s/caregivers