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Compassion fatigue: Toward a new understanding of the costs of caring
Abstract
discusses the emergence of information that forms the basis of our understanding of Compassion Fatigue and Compassion Stress / recognize that something specific must be done to counteract the challenges of Compassion Stress and Fatigue / we now know . . . that something can be done to help caring [health] professionals / we can help professionals to recognize their shortcomings—their special vulnerability to Compassion Stress and Fatigue—and help them cope more effectively with the cost of caring / there is no doubt that traumatic events will continue to occur and affect hundreds of thousands of people each year / these traumatized people require the services of professionals who are well prepared to help and, in turn, to help themselves / therefore, we need to keep these caring professionals at work and satisfied
why are there so few reports of secondary trauma / why STSD [secondary traumatic stress disorder] / definition of secondary traumatic stress [STS] and stress disorder / contrasts between STS and other concepts / countertransference and secondary stress / burnout and secondary stress / why Compassion Stress and Compassion Fatigue / implications for training and educating the next generation of professionals (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Supplementary resource (1)
... Highly empathetic MHPs are particularly susceptible to the contagion effect, they face occupational dangers such as burnout (BO) (Figley 1995), secondary traumatic stress (STS) (Bride et al. 2007), and compassion fatigue (CF) (Figley 1995(Figley , 2002. MHPs often absorb their patients' emotional suffering, leading to burnout and secondary traumatic stress, and potentially limit their capacity for empathy (Showalter 2010; Thompson et al. 2014;Yoder 2010). ...
... Highly empathetic MHPs are particularly susceptible to the contagion effect, they face occupational dangers such as burnout (BO) (Figley 1995), secondary traumatic stress (STS) (Bride et al. 2007), and compassion fatigue (CF) (Figley 1995(Figley , 2002. MHPs often absorb their patients' emotional suffering, leading to burnout and secondary traumatic stress, and potentially limit their capacity for empathy (Showalter 2010; Thompson et al. 2014;Yoder 2010). ...
... The term 'compassion fatigue' was introduced by Joinson in 1992, and originally referred to as emotional exhaustion experienced by nurses caring for suffering patients. Charles Figley later expanded this concept to encompass individuals working with those who have undergone extremely stressful events (Figley 1995). Compassion fatigue has been used interchangeably with secondary traumatic stress and burnout (Day and Anderson 2011;Phelps et al. 2009). ...
Mental health professionals (MHPs) often provide care with empathy and compassion, which demands significant effort and energy. MHPs are at a risk of compassion fatigue and burnout due to this ‘cost of caring’ for others. The study examines the sex-based differences in compassion fatigue, coping styles, and resilience among MHPs, as well as the relationships among these three variables. Participants (N = 415 MHPs; Male = 103, Female = 312), selected through purposive sampling, were asked to complete the Professional Quality of Life Scale-R-5 (ProQOL), Coping Orientation to Problems Experienced Inventory (Brief-COPE), and Connor-Davidson Resilience Scale (CD-RISC-10). The results revealed that female MHPs exhibited higher levels of compassion satisfaction, whereas male MHPs demonstrated greater resilience. Results revealed a negative correlation between resilience & burnout, resilience & secondary traumatic stress, problem-focused coping & burnout, and avoidant coping & compassion satisfaction. Positive correlation was found between resilience & compassion satisfaction, problem-focused coping & compassion satisfaction, problem-focused coping & secondary traumatic stress, problem- focused coping & resilience, emotion-focused coping & burnout, emotion-focused coping & secondary traumatic stress, avoidant coping & burnout, and avoidant coping & secondary traumatic stress. MHPs had high compassion satisfaction, moderate to low burnout and secondary traumatic stress.
... These three factors leading to BO result from consistently serving a high-needs population, detachment resulting from acquired cynicism over time, and feelings of inadequacy when failing to help a high-needs population [15]. According to Ludick and Figley [17], burnout can lead to CF, which can develop from STS. Compassion fatigue refers to the emotional and physical exhaustion that occurs over time when a person or persons working with individuals in crisis and experiencing traumatic events begin to experience stress and a lack of drive to continue helping those in need [18]. ...
... These conditions may lead to undesirable psychological and physical conditions for teachers. Figley [18] recommended further research to determine how the cost of caring too much for students in crisis, which leads to STS, might contribute to outcomes such as CF, BO, poor SOS, and ITR from the teaching profession. ...
... The CFR model postulates that a long period of imbalanced accumulation of negative energy without positive experiences is detrimental to the individuals' well-being and increases their STS. Figley [18] defined CF as normal behavior and emotional response associated with the desire to help those experiencing stress or trauma. ...
The current study explored the adverse outcomes of secondary traumatic symptoms experienced by secondary school teachers on their compassion fatigue, burnout, sense of satisfaction, and intention to resign from the teaching profession in low SES schools in the United States context. The study was inspired by Ludick and Figley’s Compassion Fatigue and Resilience model and Figley’s work on Compassion Fatigue . A non-experimental design was employed, and data were gathered from a random sample of 131 teachers. The data-gathering instrument was an online questionnaire featuring validated measures, including the Secondary Traumatic Stress Scale (STSS) and the Professional Quality of Life Scale (PQLS). ANOVA and regression analyses were conducted to analyze the data. The findings of the study revealed a significant relationship between teachers’ experience of secondary traumatic symptoms and the measured outcomes, including compassion fatigue, burnout, and intention to resign from the teaching profession. The findings also revealed a statistically significant difference between novice and veteran teachers in secondary traumatic symptoms, burnout, and intentions to leave the profession. The findings underscored the necessity for targeted support programs aimed at assisting educators who encounter secondary traumatic symptoms while working with students affected by adverse childhood experiences in low-socioeconomic school settings. The study would contribute valuable insights into the nuanced challenges faced by teachers working in low-socioeconomic schools as it highlighted the need for proactive support mechanisms, professional development initiatives, and tailored interventions in these school settings. The findings also call for a shift in the education landscape toward prioritizing teacher well-being, fostering resilience, and creating supportive work environments.
... As the mental health of healthcare providers in emergency and trauma care settings deteriorated during the COVID-19 pandemic, STS came to be considered more important in today's society than ever (Kellogg 2021). STS is one of the main reasons why many healthcare providers leave their jobs (Figley 1999). Even experienced nurses are not immune to a high level of STS (Barleycorn 2019); therefore, it is important to develop preventive interventions for all nurses, from novice to expert, to foster better mental health and job satisfaction (Mealer and Jones 2013). ...
Aim
To synthesise recent literature related to secondary traumatic stress in nurses, specifically working in emergency and trauma care.
Design
A scoping review.
Methods
The Joanna Briggs Institute methodology and PRISMA for Scoping Reviews were used.
Data Sources
The literature search was conducted in November 2023 using PubMed, EMBASE and CINAHL.
Results
The selected papers were published between 2009 and 2023, with a significant portion adopting Figley's definition of secondary traumatic stress: the consequence of witnessing other people's abnormal distressing events. Eight papers conceptualised secondary traumatic stress as a separate concept from compassion fatigue and four treated secondary traumatic stress as a subcomponent of compassion fatigue. Factors associated with secondary traumatic stress were categorised into personal, occupational and symptomatic factors. Specifically, age, gender, years of experience and work shift were the most frequently mentioned factors.
Conclusion
Many nurses experience secondary traumatic stress when working in emergency departments or traumatic care settings. However, more research is required to establish a consistent conceptualisation, operationalisation and impacts of risk factors. Further research should be conducted that considers job‐related and individual factors of secondary traumatic stress. In addition, it is necessary to develop psychological and occupational nursing interventions to help nurses at high risk for secondary traumatic stress.
Implications for the Profession and/or Patient Care
This review emphasises the significance of early detection and treatment for nurses with a high risk of occupational distress by synthesising articles addressing secondary traumatic stress‐associated factors.
Impact
An understanding of secondary traumatic stress is critical to protect nurses working in trauma care settings alongside emergency departments. Based on our study findings, evidence‐based assessments of high‐risk groups should be conducted, considering personal, occupational and symptomatic factors. In addition, secondary traumatic stress could be a multilevel phenomenon requiring both individual and institutional support.
Reporting Method
PRISMA‐ScR was used in this scoping review.
Patient or Public Contribution
No patient or public contribution.
... This environment necessitates careful consideration of the reciprocal nature of power dynamics between clients and practitioners. The transactional characteristics of the therapeutic alliance require explicit attention to practitioners' professional autonomy, boundary maintenance, and preservation of dignity to mitigate occupational hazards including burnout, stress secondary trauma and other "costs of caring" (Figley, 1995). This bidirectional focus on wellbeing serves to sustain practitioner resilience while upholding the foundational integrity of rights-based practice, ultimately enhancing outcomes for both client and social worker. ...
Social work is recognized as a human rights profession. However, integrating human rights principles into everyday practice has remained a challenge. Building on previous work, this paper introduces an innovative “three spheres” framework, which recognizes three distinctive, yet interconnected spheres of rights-based practice in social work: (1) respecting rights, where social workers meet their own human rights obligations; (2) claiming rights, where social workers assist clients in accessing their rights; and (3) changing rights, where social workers influence policy changes that better protect and facilitate clients’ rights. We argue that while all of these spheres necessitate a human rights framework that regards clients as rights holders, each sphere frames and applies social workers’ rights-based practice in unique ways. The article clarifies the distinct purposes, normative sources, and social work roles in each sphere while exploring their interconnectedness.
... It was understandable that someone who had never been exposed to the horrific impacts of such a largescale, devastating disaster would experience secondary traumatic effects. Thankfully, though, this happens to a small percentage of people, usually those who also have other health or mental health concerns that place them at high risk for this kind of reaction (Figley, 1999). I was relieved to hear, when checking in with them 2 weeks later, that they were functioning quite well and feeling back to themselves again. ...
Twenty Years Later: A Look Back at Responding to the Acute Mental Health Needs in the Immediate Aftermath of Hurricane Katrina is a personal reflection of the disaster behavioral health field activities across various sites in the early aftermath of Hurricane Katrina. Assignment to and readiness for behavioral health deployment, trauma exposure, and secondary traumatic stress responses are described from the clinician’s experience alongside other responders and survivors. The article highlights the strength of those impacted by this event and their resilience despite a lack of support throughout devastated areas. It closes with a call to increase preparedness in disaster response and behavioral health activities specifically.
... The vulnerability model (Tone & Tully, 2014) posits that affective empathy can contribute to the emergence of internalizing problems, including anxiety (McGrath et al., 2012) and depression (Cicchetti & Toth, 2009). There is also evidence that empathic concern can lead to depression as a result of overbearing the emotions of others (Figley, 1995) or the breakdown of moral idealization (Decety & Cowell, 2014). Gambin and Sharp (2018) discovered that empathic concern can intensify depressive symptoms by triggering excessive feelings of responsibility and guilt. ...
This study examines the complex effects of empathic concern on mental health and behavioral manifestations and the potential indirect paths through excessive adaptation. A cross-sectional design with 1355 participants was employed. Empathic concern, excessive adaptation, prosocial behaviors, reactive aggression, depression, and positive mental health were assessed using established scales. Structural equation modeling and Bayesian linear regression were applied to analyze the paths. For direct paths, empathic concern positively predicted prosocial behaviors and positive mental health, whereas it was negatively related to depression and reactive aggression. For indirect paths, excessive adaptation was found to mediate the relationship between empathic concern and the outcome variables with the exception of positive mental health. By elucidating the mediating role of excessive adaptation, the results herein not only deepen our understanding of the dual effect of empathic concern on mental health and behavioral manifestations but also offer important insights for the medical and educational fields.
... Andererseits kann nach Trommsdorff (2002) Involvement auch mit Aktivierung übersetzt werden, da er es als "die auf Informationserwerb und -verarbeitung gerichtete Aktiviertheit zu objektbezogenen (Informations-)Prozessen." (S. 47-48) beschreibt. 7 Dieser Effekt wird auch als compassion fade (Markowitz et al., 2013) (abnehmendes Mitgefühl), compassion collapse (Cameron, 2017) (Mitleidskollaps), psychic numbing (Lifton, 1969) (psychische Betäubung) oder compassion fatigue (Figley, 1995) (Mitleidsmüdigkeit) bezeichnet (Butts et al., 2019, S. 16 (Dickert et al., 2016;Kogut & Ritov, 2005a, 2005bSudhir et al., 2016;Västfjäll et al., 2014). Zurückzuführen ist der Betroffenenzahl-Effekt vor allem auf die Verzerrung der abnehmenden Sensibilität nach Kahneman und Tversky (1984). ...
In dieser Arbeit wurde untersucht, ob, und in welcher Form, Digital Nudging im E-Mail-Marketing von Non-Profit-Organisationen (NPO) in der Not- und Katastrophenhilfe (NKH) dabei unterstützen kann, Einmal- und Mehrfachspendende unter geringem Ressourcenaufwand in Dauerspendende zu konvertieren. Dazu wurden mithilfe der Design Science Research Methodologie und der Digital-Nudge-Design-Methode vier Artefakte entwickelt, die den vier Digital-Nudge-Mustern Anker, Voreinstellungs-Anker, Phantom-Köder und Identifikations-Kohärenz entsprechen.
... Weber et al. (2005) found that principals attended more towards the needs of their teachers to ensure their wellbeing rather than to that of themselves, and in the state of exhaustion fail to prioritise their own wellbeing. This phenomenon is what Figley (1995) described as compassion fatigue. ...
In the face of unprecedented pressures, stressors, and complex demands, principals and school leaders make a vast number of decisions on behalf of the students and communities they lead, as an inherent feature of leadership. This study originated from the researcher's own sense-making as a school principal for over twenty years and reveals what Loyens and Maesschalck (2010) referred to as opening the black box of decision-making, using ethnographic methodology to explore how decisions are made, describing the decision-making processes, and exploring the impact of decisions leaders undertake to make the call. Principal autonomy, although widely acknowledged as essential in decision-making, remains ambiguous and largely under researched in terms of how it is actually implemented and effectively used with fidelity.
... Emotional exhaustion is the manifestation of physical and emotional depletion experienced by an individual who experiences extreme stress at work (Maslach & Leiter, 2008). Emotional exhaustion can emerge as a result of compassion fatigue (i.e., extreme empathy for others, which causes second-hand stress; Figley, 1995) and sacrifice syndrome (i.e., prioritizing work to the point of neglecting one's own needs). When principals are overworked and stressed and fail to prioritize their own wellbeing, they typically become frustrated and their performance is hindered (Weber et al., 2005). ...
Purpose: The purpose of this article is to propose a model of the prosocial school leader that shows how the principals’ social emotional competencies (SECs), wellbeing, and leadership form the foundation that influences the overall school climate, teacher functioning and wellbeing, family and community partnerships, and downstream student outcomes.
Proposed conceptual argument or model: The authors hypothesize that effective leadership practices, healthy relationships, effective SEL program implementation, and effective family and community partnerships all mediate school climate, teacher performance, and student outcomes. Implications: Finally, the authors discuss how to support principals to develop the SECs necessary to lead and implement SEL initiatives in their buildings.
Emergency medical services (EMS) professionals are exposed to the trauma experienced by their patients regularly. This exposure to others’ traumatic experiences is known as vicarious trauma or indirect trauma. When it becomes problematic for the worker’s well-being, the resulting symptoms are referred to as vicarious traumatization or secondary traumatic stress. Existing literature highlights the importance of recognizing vicarious trauma and subsequent symptoms experienced by these professionals, as well impacts this may have on their workplaces. However, comprehensive reviews of vicarious traumatization among those involved in responding to prehospital emergency medical situations are limited. A four-phase Preferred Reporting Items for Systematic Reviews and Meta-Analyses selection process was employed to identify publications from 1995 to 2022 that considered the epidemiology of vicarious traumatization among EMS professionals. Trained reviewers screened articles based on inclusion criteria: (a) EMS professionals; (b) vicarious traumatization/related terms; and (c) analysis of epidemiological data on prevalence, risk/protective factors, or manifestations. Initially, 4,147 unique manuscripts were identified. After removing duplicates, one reviewer screened titles, and additional articles were identified through bibliography searches. Two reviewers independently screened abstracts, resolving disagreements during full-text screening, where a third reviewer settled any conflicts. A total of 31 articles were included in this review. Findings regarding the epidemiology of vicarious traumatization are summarized. The occupational hazard of vicarious/indirect trauma is unavoidable, but vicarious traumatization/secondary traumatic stress can be mitigated with improved workplace measures.
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