Compassion fatigue: Who cares for the caregivers?

FROM the beginning of time, those who care for the ill have given more than physical comfort to their patients. Every day, registered nurses give a great deal of themselves emotionally in the process of providing care to their patients. The emotional cost of giving is inevitably borne by the giver who may be unprepared to combat the changes that occur when burnout reaches the stage of compassion fatigue.

The difference between burnout and compassion fatigue is that burnout produces emotional withdrawal and diminished empathy, whereas those with compassion fatigue try to continue to give of themselves and feel as though they have failed at their profession (Pfifferling and Gilley, 2000). In either case, physical, emotional and spiritual exhaustion ensues. Compassion fatigue can be distinguished from burnout in that caregiver symptoms often parallel those of the patient population served. For example, Figley (1995) identified a phenomenon called secondary traumatization when he noted that the families of rape victims sometimes experienced similar symptoms to the survivor.

Symptoms

Nurses lead complicated lives. As well as being workers, they are parents, partners, siblings and members of larger communities. Those who experience symptoms may find it difficult to distinguish compassion fatigue from life stress or depression. Although symptoms vary, persons who are experiencing a combination of symptoms of both anxiety and depression may have compassion fatigue:

Anxiety related symptoms

Abusing drugs, alcohol or food

Anger

Blaming

Frequent headaches

Gastrointestinal complaints

High self-expectations

Hypertension

Depression and symptoms included in depression

Diminished sense of personal accomplishment

Exhaustion (physical or emotional)

Chronic lateness

Hopelessness

Increased irritability

Less ability to feel joy

Symptoms belonging on both lists

Inability to maintain balance of empathy and objectivity

Low self-esteem

Sleep disturbances

Workaholism

(adapted from Pfifferling and Gilley, 2000)

Recovery

Self-care is an important step in recovery. However, caregivers may be so exhausted that they are unable to recognize the difference between self-care and selfishness. The effort required to take the time to eat well, exercise, reflect and make choices often overwhelms the fatigued nurse.

The most important step in recovery then, is to recognize that a problem exists and to seek out support. Talking to an experienced, non-judgmental professional who is compassionate and expects positive results is a wise choice and preferable to talking to similarly disaffected colleagues who may simply aggravate your negative feelings. In my experience, as a former registered nurse and as a therapist, nurses usually have need of a good sense of humour in bleak times.

A more in-depth look at recovering from compassion fatigue will be published in the July issue.

By Betty Stevens-Guille, PhD., C. Psych.

AROVT THE AUTHOR:

Betty Stevens-Guille is a former registered nurse with an extensive academic and clinical background in trauma. She leads the Stress and Trauma

Recovery Centre in Edmonton. For more information phone 780.486.6169 or e-mail: bstevensguille@shaw.ca.

Copyright Alberta Association of Registered Nurses Jun 2003
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