Compassion Fatigue

Original Editor - Amanda Ager 

Top Contributors - Amanda Ager, Alicia Fernandes, Tarina van der Stockt, Naomi O'Reilly, Lucinda hampton, Kim Jackson, Vidya Acharya, WikiSysop, Rucha Gadgil and Nicole Hills

Introduction

We become rehabilitation professionals because we have compassion and we are interested in positively influencing a person's quality of life. We give of ourselves so that we may help others obtain optimal health. This can also lead to "clinical burnout" or "compassion fatigue". There are many terms to describe this phenomenon, including:

• Compassion Fatigue
• Secondary Traumatic Stress Syndrome (STSS)
• Clinical Burnout
• Burnout Syndrome
• Moral Distress
• Occupational Burnout.

"Burnout" can be best understood as a syndrome that includes emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment. Symptoms of burnout include mental and physical exhaustion, accompanied by psychosomatic disorders and emotional problems. Burnout occurs most often in people employed in occupations requiring work with people (human services and medical services) as a result of coping with stress and experience numerous failures at work. Moreover, compassion fatigue denotes a state of emotional exhaustion that can occur as a result of intensive empathic involvement with people who are in distress.

• Clinical burnout can occur when a rehabilitation professional is exposed to chronic, job-related stressors.
• For clarity sake, the term Compassion Fatigue (CF), will be used hence forth.

Epidemiology

Compassion fatigue may start at any stage during a rehabilitation professionals career, irrespective of the work situation. Although controversial at the moment, women seem to have a higher level of professional burnout than men. It has also been noted that more experienced rehabilitation professionals may be at greater risk for the development of Compassion Fatigue.

Figley's model of compassion fatigue

Clinical Presentation

It is important to distinguish the difference between CF, workplace exhaustion and general depression. The main distinguishing factor with workplace exhaustion, is that these problems disappear outside work. Although there are blurred lines between Compassion Fatigue and depression, we can understand depression (major depressive disorder) as; a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed, both at work and at home. Whereas, Compassion Fatigue denotes a state of emotional exhaustion that can occur as a result of intensive empathic involvement with people who are in distress. Rehabilitation professionals experiencing Compassion Fatigue reported that they struggle to show compassion to their patients while dealing with job related stressors.

Signs and Symptoms of Burnout

• Work Addiction
• Excessive Stress
• Fatigue
• Insomnia
• A negative spillover into personal relationships or home life
• Depression
• Anxiety
• Alcohol or Substance Abuse
• Heart Disease;
• High Cholesterol
• Type 2 Diabetes (especially in women)
• Stroke
• Obesity
• Vulnerability to Illnesses
• Feeling like you are involved in workplace bullying.

It is possible that older and more experienced rehabilitation professionals hold positions of greater responsibility, in which demands are more difficult to meet. In these situations it can become increasingly difficult to maintain feelings of personal accomplishment.

Burnout among health care providers has also been linked to wider organizational factors, such as increased workload, time pressures, safety issues, role ambiguity, lack of supervision, and reduced resources.

Regardless of how you are feeling, you should be aware of the outlined signs and symptoms and consult a professional sooner, rather than later.

Risk Factors of Compassion Fatigue

• Environments like emergency rooms, disaster response settings, and intensive care units where caregivers deal with frequent trauma cases increase the risk of Compassion Fatigue .
• High workloads, long hours, and the pressure to meet tight deadlines can lead to increased stress and exhaustion, contributing to Compassion Fatigue .
• Insufficient supervisory and peer support can leave caregivers feeling isolated and overwhelmed, exacerbating the effects of Compassion Fatigue .

• Caregivers who have experienced their own trauma are more susceptible to Compassion Fatigue, as exposure to patients’ trauma can trigger their unresolved issues .
• High levels of empathy, while beneficial for patient care, can make individuals more vulnerable to emotional exhaustion and Compassion Fatigue .

• Less experienced professionals may be more at risk due to inadequate coping mechanisms and lack of exposure to traumatic situations in a controlled manner .
• Certain professions, such as nursing, social work, and emergency services, are inherently at higher risk due to the nature of their work .

• Studies have shown that female caregivers often report higher levels of Compassion Fatigue, possibly due to societal expectations and caregiving roles traditionally associated with women .
• Younger caregivers may lack the coping strategies that come with experience, increasing their risk of developing Compassion Fatigue .
• Individuals with lower resilience and poor coping skills are more prone to Compassion Fatigue. Effective coping mechanisms and resilience can mitigate the impact of stress and trauma exposure .
• Pre-existing burnout, characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment, can predispose individuals to Compassion Fatigue .

• Lack of institutional support and inadequate resources can contribute to the development of Compassion Fatigue. Supportive work environments and access to mental health resources are crucial in mitigating Compassion Fatigue .
• Continuous professional development and training on managing trauma exposure can help caregivers develop effective strategies to cope with Compassion Fatigue .

Impact of Compassion Fatigue on Professional Practice

• Leads to less effective patient communication and support .
• Higher likelihood of medical errors due to emotional exhaustion and decreased concentration .
• Causes irritability and withdrawal, impacting teamwork and communication .
• Professionals become isolated, affecting the holistic care approach .
• Leads to higher turnover rates and reduced productivity .
• Negatively affects sense of coherence and motivation, further diminishing job performance.
• Direct correlation with reduced satisfaction levels among patients .
• Higher levels of compassion fatigue associated with more patient complaints and legal issues.

Long-term Consequences of Unmanaged Compassion Fatigue

• Physical health problems such as hypertension, chronic pain, and gastrointestinal issues can arise due to prolonged stress and emotional exhaustion.
• Mental health issues including anxiety, depression, and post-traumatic stress disorder (PTSD) are common among those experiencing severe compassion fatigue.
• Persistent feelings of burnout and emotional exhaustion can lead to reduced job satisfaction, impacting overall well-being and career longevity.
• High levels of compassion fatigue are linked to increased turnover rates among healthcare professionals. This turnover not only disrupts individual careers but also affects the continuity of patient care.

Outcome Measures

• Different instruments measure distinct aspects of compassion fatigue.
• The Secondary Traumatic Stress Scale (STSS) measures PTSD symptoms related to clinical work with traumatized populations.
• The Trauma and Attachment Belief Scale (TABS) assesses disruptions in cognitive schemas across psychological needs.The Trauma and Attachment Belief Scale (TABS) is a psychometric tool designed to assess cognitive schemas and beliefs affected by traumatic experiences. It evaluates disruptions in five key areas: safety, trust, esteem, control, and intimacy. The TABS is a self-report questionnaire where respondents rate their agreement with statements reflecting their beliefs. Higher scores indicate greater cognitive disruptions. The TABS is used by clinicians to identify how trauma has impacted a client's core beliefs, guiding therapeutic interventions and providing a comprehensive assessment of the cognitive impact of trauma. .
• Clinicians should identify which aspects of compassion fatigue are most relevant to their context and choose an instrument accordingly.
• No instrument covers all dimensions of compassion fatigue, including trauma symptoms, cognitive distortions, general psychological distress, and burnout.
• Using multiple measures can provide a more holistic understanding of an individual’s experience of compassion fatigue.

The Secondary Traumatic Stress Scale (STSS)

it is a psychometric tool developed to measure the symptoms of secondary traumatic stress (STS) among professionals who work with traumatized individuals. Secondary traumatic stress, also known as vicarious trauma, occurs when individuals who are exposed to the traumatic experiences of others develop their own trauma-related symptoms.

Purpose- To assess the extent of trauma symptoms in professionals such as social workers, therapists, and other caregivers who are regularly exposed to the traumatic stories of their clients.

Components

•  The STSS consists of items that measure symptoms in three main areas: intrusion, avoidance, and arousal.
• Intrusion: Unwanted thoughts, nightmares, or flashbacks related to clients' traumatic experiences.
• Avoidance: Efforts to avoid reminders of clients' trauma, including emotional numbing or detachment.
•  Arousal: Symptoms such as hypervigilance, irritability, or difficulty sleeping.

Format- Typically, the STSS is a self-report questionnaire where respondents rate the frequency of their symptoms over a specified timeframe, such as the past week.

Scoring-Responses are usually on a Likert scale (e.g., from 0 = never to 4 = very often). The scores from each item are summed to provide a total score, with higher scores indicating higher levels of secondary traumatic stress.

Use-The STSS is used for screening purposes to identify professionals who may be experiencing significant levels of secondary traumatic stress and might benefit from further assessment or intervention.

Importance of the STSS

• Identification: Helps in early identification of STS symptoms, which is crucial for preventing long-term psychological distress.
• Intervention: Enables organizations to implement timely interventions to support affected staff.
• Research: Provides data for studies on the prevalence and impact of secondary traumatic stress in various professional settings.

The STSS is a valuable tool for maintaining the mental health and well-being of professionals who are at risk of developing secondary traumatic stress due to the nature of their work with traumatized populations  .

Management / Interventions

There is no "quick fix" for managing compassion fatigue. The most important action is to identify the key personal stressors. Everyone's situation is different and therefore the "triggers" will most certainly be different. The examination of your work-life balance will certainly be at the core of addressing how you are feeling. The first step is recognizing that there is an issue, followed by seeking the appropriate level of support or change in your life.

How to Reduce Burnout

• Identify and manage the source of stress to the best of your ability.
• Manage your expectations about what you can realistically accomplish in a day (it will still be there tomorrow!).
• Evaluate your options
• Adjust your thoughts and your attitudes
• Seek support as needed (speak to your boss, your colleagues, and your social support);
• Take care of yourself (eat well, sleep well and exercise!);
• Speak to a professional who can help you develop a personalized strategy for dealing with your CF.

The early identification of this emotional state is needed in order to prevent the depersonalization of the provider-patient relationship. Prevention and treatment are essentially parallel efforts, which include:

• Greater job control by the individual worker
• Group meetings
• Better communication on all levels (co-workers, subordinates, supervisors)
• Better recognition of individual worth
• Job redesign
• Flexible work hours
• Full orientation to job requirements
• Available employee assistance programmes and adjuvant activities.

Mindfulness-based Training

Mindfulness-based therapies (MBIs) have shown to reduce burnout, depression, anxiety. Mindfulness techniques improve one's ability to attend to the present moment without judgement. It is typically described as "to see with discernment." Mindfulness is defined as the thoughtful regulation of attention and awareness of the present moment and a nonjudgmental and curious willingness to experience the content (thoughts, feelings, sensations) of the present moment. Such training redirects one away from habitual reactions to any situations, and teaches new ways to respond that are more creative and less depleting.

Organisational Intervention

This targets work environment and creates a preventative or primary approach to reduce occupational stress thereby promoting a healthier workplace. However, it is far more difficult to feasibly implement. Let us also be clear, that Compassion Fatigue is also a leadership concern. The defense against the adverse outcomes of occupational stress begins at the organizational and leadership level. An organization that is committed to protecting people in reasonable and appropriate ways is investing in the future. Organizational protection and prevention is especially important because it addresses the workplace stressors and risk factors, aiming to change the environment. A strong network of leadership is a key defense against clinical burnout.

The bottom line remains that occupational stress can be inevitable, even at times necessary, elements of the work environment, but it does not have to translate into organizational dysfunction nor medical, psychological, or behavioral distress. Compassion fatigue is an avoidable and treatable syndrome among health care providers, which includes physiotherapists. The prevention, management and treatment of such feelings is both a personal and organizational concern. Do note attempt to face this alone, because the sad truth remains, that you are not alone (this affects more people than you may think). Speak to someone about your concerns and make changes to your work environment. Seek help early to avoid an importance disturbance to your quality of life.

Conclusion

Compassion fatigue is a significant concern among rehabilitation professionals, impacting their well-being and the quality of care they provide. It is characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment. Prevention and management strategies include identifying personal stressors, adjusting work-life balance, seeking support, and implementing organizational interventions. Early identification and intervention are crucial to prevent depersonalization and maintain the provider-patient relationship. Leadership and organizational commitment to addressing workplace stressors are essential for mitigating compassion fatigue. Additionally, utilizing measures such as the Secondary Traumatic Stress Scale (STSS) can aid in screening and identifying professionals at risk. Ultimately, addressing compassion fatigue requires both personal and organizational efforts to promote well-being and ensure quality care delivery.

Resources

For an interesting read, take a look at : Physicians are not burning out, they are simply suffering moral injury.

Check out this great YouTube video on Clinical Resilience: Preventing Burnout, Promoting Compassion, and Improving Quality by The Schwartz Center for Compassionate Healthcare (2014).