Compassion fatigue and healthcare professionals: Challenges

Burnout has been defined as physical, emotional and psychological exhaustion often as a result of excessive workload over which the individual may have limited or no control. In addition, burnout includes loss of a sense of personal achievements. The symptoms of burnout are increasingly being recognised when we have demands placed on us which we are not able to meet and cope with. We all have days when we feel under par and are not able to work to our full potential. This feeling is often transitory and after rest and relaxation we can pick up where we left off. Burnout on the other hand, is pervasive and debilitating. Burnout is not exclusive to medical or healthcare professionals but raises specific challenges in diagnosis and management. The sensation of burnout also includes feelings of depersonalisation where the individual loses their empathy and have poor reactions to patients and their care-partners.

Most healthcare professionals and workers, no matter where we work and what our background is, chose working in healthcare because we want to help others and make a difference to their functioning and lives by helping manage their illnesses. However, no matter what we do and where we work, often these excessive demands which may be reasonable or unreasonable can cause stress. Figley (1982/2013) calls this ‘cost of caring’ which leads to compassion fatigue. Under these circumstances, empathy, compassion and caring for others are affected and compassion fatigue sets in. Thus, compassion fatigue is an occupational hazard which is not uncommon among healthcare professionals (Remen, 2010). Being immersed in stress during working hours and taking some of the stress home, it is not surprising that individual healthcare professionals begin to lose their humanity.

The term compassion fatigue was used by Joinson (1992) for nurses who had lost their ability to nurture. Compassion fatigue has been reported from other professions as well. Stamm (2010) saw compassion fatigue as a manifestation of burnout and secondary traumatic stress (also known as compassion stress). Both compassion fatigue and burnout emerge from untenable work stress and demands of the job especially repeated and persistent exposure to distress experienced by others. Cumulative traumatic stress can therefore lead to compassion fatigue and burnout. The question remains whether these are separate entities or compassion fatigue is the first step in burnout?

Whereas compassion fatigue is accompanied by symptoms of dramatic shifts in mood, negative thinking, feeling tired, exhausted and detached, burnout also has exhaustion at physical, emotional and psychological aspects but is accompanied by a poor sense of accomplishment. In both cases, people may self-medicate and/or use large quantities of alcohol to cope with anxiety and other symptoms but more likely in cases of burnout. Other pathological responses such as addictions and gambling may occur. Individuals may feel anxious or depressed, sleep may be disturbed, poor concentration and inability to be productive can emerge. Physical symptoms of changes in appetite, constant tiredness and other somatic symptoms may appear.

Compassion fatigue has been also defined as stress related to exposure to a traumatised individual (Cocker & Joss, 2016). These authors note that compassion fatigue is a convergence of secondary traumatic stress and cumulative burnout. This leads to a state of physical and mental exhaustion because of a reduced ability to cope with everyday work environment. Compassion fatigue is often used to describe physical, emotional and psychological impact in professions which have the role and responsibility of helping others. By dealing with constant trauma individuals get stressed. These symptoms may well be seen as initial symptoms of burnout which is the cumulative stress. However, often there is a distinction between burnout and stress. It is helpful to understand and explore these differences. Stress can lead to over engagement, overactive emotions, hyperactivity or withdrawal with low energy and reduced interest and may lead to anxiety. Burnout, on the other hand, leads to disengagement, blunted emotions, helplessness and hopelessness with a sense of feeling trapped which affects motivation and reduces hope leading to detachment and depression.

Compassion figure is seen as secondary stress reaction and as mentioned above, affects various professions such as nursing, lawyers, first responders, etc. who deal with trauma regularly. Triggers of compassion fatigue include care delivery in dangerous conditions, especially being under pressure, dealing with death, grief and mourning. Being repeatedly and regularly present at accident scenes, graphic conditions and evidence of trauma can make people vulnerable to developing compassion fatigue. It is extremely likely that those working in emergency responses including healthcare field are more prone to developing compassion fatigue due to repeated exposure to traumatic events and settings especially if personal resilience is waning and wellbeing is affected. The symptoms of both compassion fatigue can be debilitating and frightening.

Burnout has emotional and physical exhaustion, feelings of disengagement and a lack of sense of achievement (Freudenberger 1974). Dealing with clinical ambiguity and managing team’s, patient and their care-partners as well as one’s own anxiety are core responsibilities of many healthcare professions and these may be affected in burnout. Individuals may find themselves unable to deal with criticism (Stevens, 2016) with being reported to the regulatory bodies. Burnout can lead to medical errors, impaired professionalism, poor patient satisfaction, increased rates of depression and suicidal ideation.

The question that needs answering is whether compassion fatigue is the first step or symptom of burnout or insidious part? Or is likely that compassion fatigue occurs first? Stoewen (2019a) points out that compassion is a necessary quality in healthcare and ethical need but also a priority. Compassion fatigue may present as burnout or secondary trauma. Stamm (2010) suggests that burnout as well as secondary trauma reflect compassion fatigue. Singer and Klimecki (2014) propose that compassion is also about mentalisation of other individual’s suffering. Stoewen (2019b) notes that compassion resilience can be built by understanding about compassion fatigue. Compassion consists of three facets according to Kanov et al. (2004). These include noticing, feeling and responding. Negative emotions can lead to empathic distress which may produce burnout.

LoboPrabhu et al. (2020) point out that compassion fatigue differs from burnout in that it is likely to be more common in those individuals who work with trauma as seen in combat related trauma, traumatic abuse, etc. Clinicians prone to developing compassion fatigue are said to be of younger age group, those with higher motivation, with personal life stresses, lack of social support, higher idealism, cumulative grief and those who face prolonged exposure to stressful environment (LoboPrabhu et al., 2020).

Managing compassion fatigue is dependent upon awareness of its symptoms and self-care to prevent it and if it appears to deal with it. Self-care includes keeping and making time for oneself, one’s peers, friends and family. Ensuring proper sleep, physical activities, listening to music or other relaxing acts, perhaps meditation or yoga. If these actions do not help, then seeking professional help through therapy and support from primary care physicians or occupational health physicians is an important first step.