PERSPECTIVE OF COMPASSION
FATIGUE AMONG FRONTLINE CARE
Associate Professor cum Head of the department of Obg Nursing ,Rama college of Nursing,
Rama university, Kanpur Uttar Pradesh, India
Compassion fatigue, also known says secondary traumatic stress(STS), is a condition
characterized by a gradual lessening of compassion overtime. It is common among trauma
victims, and individuals who work directly with trauma victims such as nurses, psychologists,
and first responders. The current scenario in health sector so apt to tackle this cumulative
stress .The impact greatly effect on personal work atmosphere as well as the organization they
belongs to. Proper solid management in the era of burnout ultimately proportionate to the level of
excellence in the quality care .Developing positive energy is the ultimate core management of
compassion fatigue among nursing practice.
Key words:-STS, compassion overtime, cumulative stress, burnout
Self care is not a luxury; its all about a necessity and priority. Figley (1996) defines compassion
fatigue as: A state of tension and preoccupation with the individual or cumulative trauma of
clients as manifested in one or more ways: re experiencing the traumatic events,
avoidance/numbing of reminders of the traumatic event, persistent arousal, combined with the
added effects of cumulative stress(burnout).
Compassion fatigue has also been called "secondary victimization", "secondary traumatic stress",
"vicarious traumatization", and "secondary survivor". Other related conditions are "rape-related
family crisis" and "proximity" effects on female partners of war veterans. Compassion fatigue
has been called a form of burn out in some literature. However, unlike compassion fatigue,
"burnout" is related to chronic tedium in careers and the workplace, rather than exposure to
specific kinds of client problem.
85% of health care workers in various fields develop compassion fatigue.
According to Hooper, et al.(2010), approximately 85% of emergency room nurses meet
the criteria for compassion fatigue.
Beck, C. (2011) 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.
Culver,L.,McKinney,B., Paradise, L. (2011): Mental health professionals are another
group that often suffers from compassion fatigue, particularly when they treat those who
have suffered extensive trauma. A study on mental health professionals who were
providing clinical services to Katrina victims found that rates of negative psychological
symptoms increased in the group of those interviewed, 72% reported experiencing
anxiety,62% experienced increased suspiciousness about the world around them, and
42% reported feeling increasingly vulnerable after treating the Katrina victims.
Lawyers are four times more likely to suffer from depression than the general public.
Risk factors are present in the following:
Professionals and personal family members, friends, and associates of trauma survivors.
Psychologists, social workers, lawyers, disaster relief workers, nurses, psychiatrists,
medical doctors, emergency service professionals, police, crisis phone line attendants and
shelter workers among others.
Primary care providers for patients with terminal illnesses.
Caregivers for dependent people& those who have institutionalized clients.
Female psychologists and violence counselors
A history of personal trauma among child welfare workers and psychotherapists.
Mental health professionals working with victims of sexual violence.
Persons who are overly conscientious, perfectionists, and self giving
Low levels of social support or high levels of stress in personal life
Previous histories of trauma that led to negative coping skills, such as bottling up or
Health care field workers contribute to compassion fatigue. For example, a "culture of
silence" where stressful events such as deaths in an intensive-care unit are not discussed
after the event is linked to compassion fatigue.
Lack of awareness of symptoms and poor training in the risks associated with high-stress
Cognitive: lowered concentration, apathy,
rigidity, disorientation, minimization,
preoccupation with trauma.
Emotional: powerlessness, anxiety, guilt,
anger, numbness, fear, helplessness, sadness,
depression, depleted, shock, blunted or
enhanced affect. Experiencing troubling
dreams similar to a patients dreams. Suddenly
and involuntarily recalling a frightening
experience while working with a patient or
Behavioral: Irritable, withdrawn, moody, poor sleep, nightmares, appetite change, hyper-
Spiritual: Questioning life’s meaning, pervasive hopelessness, loss of purpose, questioning of
religious beliefs, loss of faith/skepticism.
Somatic: Sweating, rapid heartbeat, breathing difficulty, aches and pains, dizziness, impaired
immune system, headaches, difficulty falling or staying asleep, poor self-care (i.e., hygiene,
Bottled up emotions
Receives unusual amount of complaints from others
Voices excessive complaints about administrative functions
Substance abuse used to mask feelings
Compulsive behaviors such as overspending, overeating, gambling, sexual addictions
Legal problems, indebtedness
Reoccurrence of nightmares and flashbacks to traumatic event.
Chronic physical ailments such as gastrointestinal problems and recurrent colds
Apathy, sad, no longer finds activities pleasurable
Mentally and physically tired
In denial about problems.
Constant changes in co-workers relationships
Inability for teams to work well together
Desire among staff members to break company rules
Outbreaks of aggressive behaviors among staff
Inability of staff to complete assignments and tasks
Inability of staff to respect and meet deadlines
Lack of flexibility among staff members
Negativism towards management
Strong reluctance toward change
Inability of staff to believe improvement is possible
Lack of a vision for the future.
To combat compassion fatigue, self transformation is more essential than external medication.
Its mostly associated with changing the attitude towards life. Cultivation of positive energy and
dealing with circumstances rationally helps to overcome the traumatic conditions. The probable
methods of treatment are mentioned below:
Scrutinize the life. Notice things that cause stress and the reaction at that particular moment. Try
to avoid the same behavior, the next time when we come across such situations. Acknowledging
things and coping with the chronic depression becomes difficult if a person has a history of
trauma. Increase consciousness while dealing with circumstances that triggers personal pain.
Bottled up emotions elevate personal pain and suffering. Going underground can resurface anger
and relationship problems. Share the experiences on the events that was witnessed and discuss
the feelings with the near ones. This makes emotions volatile and helps to forget the grave
situation. Be composed while expressing self and do not go crazy while describing it.
Negative energy, lack of self-confidence and low with emotions are the main reasons that
enhance stressful conditions of severe fatigue. Inculcating positive personal qualities is a way to
get rid of compassion fatigue. Commitment and control over emotions help to overcome
passivity towards life. The most important thing is accepting tough situations as a challenge and
then finding out a solution to it.
d)Be strong and resilient
Possessing mental strength is a vital factor when it comes to treatment. Just focus the energy on
the resiliency and determination power. Do not get attached with anything too emotionally. Be
practical and strong if we are dealing with the sufferings of people. Cultivate the spirit of being
amazingly durable even in worst circumstances.
To offset and reduce the risk of burnout and compassion fatigue in staff members, organizations
and managers can
Create an open environment where employees have a venue for mutual support.
Encourage employees in meetings and with supervisors to talk about how they are
affected by their work
Offer training that educates employees about burnout and compassion fatigue and how to
recognize the symptoms
Share the caseload among team members, particularly the most difficult cases.
Make time for social interaction among teams. Social events and a yearly retreat away
from the work place can build cohesion and trust.
Encourage healthy self-care habits such as good nutrition, sleep, taking, taking work
Reward effort and offer flexible work hours.
Compassion fatigue is all about visualizing life with an eye of grievous empathy. People who
have a tendency to ingrain sorrows, should limit their exposure to such situations. Try to
engage in enjoyable activities if emotions of others get embedded in our psyche very soon.
Last but not the least, re-evaluate the life and view life from a different angle, devoid of pain
Care givers need to be able to deliver service excellence without compromising their well-
being. It is important for them and for their employers to recognize early warning signs of
burn out and compassion fatigue. It is also essential that workers in all levels of health
professions engage in self-care practices, learn to modulate their responses to the stresses
around them, be aware of destructive attitudes and reach out for help.
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