Compassion Fatigue

It is no doubt that in these trying times, our emotions are being put to their limits almost everyday. From the coronavirus running rampant throughout the world to devastating natural disasters, it’s no wonder we may feel suspended above an abyss of hopelessness, wary of what is next to come. After being in lockdown for about a year now, we can no longer use our fast- paced, day-to-day lives as an excuse to avoid these emotions. Instead, we’re forced to confront these atrocities head on, bearing all the sadness and emotional turmoil that come with them. Our hearts break for each family that loses a loved one, each person lying on a hospital bed, each parent who must feed their hungry child, each person that struggles to find some place warm to sleep at night. Our hearts break...until they don’t. The pain subsides,quickly replaced by numbness, indifference, and a lack of concern. When did our empathy turn into apathy? When did our compassionate, accepting hearts turn cold and unyielding? When did we suddenly stop caring?

This is a phenomenon better known as compassion fatigue (CF). Before defining compassion fatigue, it is important to note what compassion is. Compassion is a natural response to human vulnerability that elicits feelings of empathy, sympathy, and concern that can urge one to act on the behalf of others to ease their suffering (Pehlivan, 2017). It is a quality that is intrinsic to humans and is a key strength for many professions, especially for healthcare. Compassion fatigue, on the other hand, is the gradual decrease of compassion as one is exposed to heartache and helplessness repeatedly: it is our natural way of coping with persistent pain. Healthcare workers and professionals are especially susceptible to experiencing this phenomenon because they deal with unfortunate events and ongoing pain persistently. 

CF is the convergence of two main components: burnout and secondary traumatic stress. These two terms are similar and often interchangeably used, but they do have some key differences (Cocker, 2016). When you experience burnout, you may feel exhausted and overwhelmed, but this does not mean you have lost the ability to be compassionate or to overcome the feeling. On the other hand, when negative effects can make one feel like the trauma of those they are helping is happening to them, they are experiencing secondary traumatic stress. It is a condition that commonly affects nurses, child welfare workers, first-responders, therapists, etc, as they constantly deal with the emotional duress that comes with hearing about the first hand trauma of others. When these two components converge, they result in compassion fatigue. Figure 1 lays out these concepts in the model below:

In the figure, which focuses on compassion fatigue through a healthcare lens, the process begins with the healthcare provider's care of the suffering patient: their willingness to help and their ability to establish genuine compassion and empathy. However, prolonged intensive care can lead to secondary traumatic stress and burnout; as a result, this leads to a reduction in the healthcare provider’s capacity to care and give energy, empathy, and  general compassion (Pehlivan, 2016).

Not only is compassion fatigue the reduced ability to sympathize and empathize, but it also includes other common characteristics such as anger, exhaustion, irritability, depression, anxiety, and substance abuse. These can all result in the impaired ability to properly and decisively care for patients as well as an increase in absenteeism. Furthermore, these consequences are exacerbated by the amount and severity of the traumatic events that the provider is exposed to, spiraling into long-term debilitating mental health effects, such as depression or anxiety. Consequently, coping mechanisms and strategies are absolutely critical in preventing compassion fatigue as a whole.

Compassion fatigue is not as well known or talked about as anxiety or depression, but it has implications that can inevitably lead to very serious mental health conditions like them. Awareness is critical in mitigating its effects, especially amongst healthcare workers during the current coronavirus pandemic. Some ways in which compassion fatigue can be prevented include the implementation of debriefing sessions, support groups, or wellness programs. For example, a research study done in 2015 evaluated the emotional distress among healthcare professionals in the ICU, with an emphasis on the prevalence of burnout and compassion fatigue and preventive strategies. Ten studies measured the effect of an intervention, such as more flexible work schedules, wellness programs targeting emotional distress, improving communication skills, and general strategies including relaxation exercises such as yoga and mindfulness. The results showed that implementation of these techniques were associated with significantly lower rates of burnout and compassion fatigue following the intervention. Specifically, reductions of roughly 50% and 60% were reported in the relative risk of burnout, compassion fatigue and depression (Van Mol, 2015).

Similar strategies to counteract compassion fatigue in healthcare workers can also be applied to combat it generally. Self care and personal mental health maintenance are just as important for everyone. Habits such as meditation, journaling, positive affirmations, and consistent exercise help to decompress and provide some relief from the unfortunate and tragic events happening everyday. These, in turn, build a healthier, stronger, and a more resilient foundation; when your mental toolbox is being consistently strengthened and updated, this positive mindset is eventually reinforced and ingrained deeper into the psyche. However, if the situation gets worse, therapy or visiting a clinical psychologist might be the next best option (Adimando, 2018). These strategies, of course, are not a one-size-fits-all approach: anyone can mix-and-match these wellness techniques in order to pursue the best course of action to get them through these difficult times.

Compassion is a fantastic quality to have, but like most things in life, too much of a good thing can tip the scale in the other, less desirable direction. Sometimes we find ourselves pulled in every which way until we are stretched too thin. and it can be hard to recognize that our problems are viewed through our own microscope, where each pixel is amplified, drowning out the rest of our surroundings. It is important to always remember that compassion and empathy towards people are what makes our human experience both unique and undeniably taxing at times, yet it is also what keeps us grounded to reality and helps us view our own issues within the context of the world.

References

Adimando, A. (2018). Preventing and Alleviating Compassion Fatigue Through Self-Care: An    Educational Workshop for Nurses. Journal of Holistic Nursing, 36(4), 304–317. https://doi.org/10.1177/0898010117721581

Cocker, F., & Joss, N. (2016). Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review. International journal of environmental research and public health, 13(6), 618. https://doi.org/10.3390/ijerph13060618

Pehlivan, T. (2017, January). Compassion Fatigue: The Known and the Unknown. Retrieved March 1, 2021, from https://www.researchgate.net/publication/321453273_Compassion_Fatigue_The_Known_Unknown

Van Mol, M. M., Kompanje, E. J., Benoit, D. D., Bakker, J., & Nijkamp, M. D. (2015). The Prevalence of Compassion Fatigue and Burnout among Healthcare Professionals in Intensive Care Units: A Systematic Review. PloS one, 10(8), e0136955. https://doi.org/10.1371/journal.pone.0136955