Compassion Fatigue in Healthcare Professionals

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Introduction
What causes compassion fatigue?
What are the risk factors for compassion fatigue?
Prevent and manage cystic fibrosis
References


Compassion fatigue, what is it? This term is frequently used, in the context of the ongoing coronavirus disease 2019 (COVID-19) pandemic, with millions of people hospitalized for a few months during many successive waves of the pandemic. It refers to “a state of exhaustion and biologically, psychologically, and socially dysfunctional as a result of prolonged exposure to compassionate stress and all it invokes.”

Coetzee and Klopper describe it as “a loss of the nurturing capacity that is essential to compassionate care. The essential challenge for healthcare professionals is to free themselves; be present and empathetic. If this process stagnates, the emotional cost of care can become a burden in personal life, manifesting in emotional distress such as cystic fibrosis..”

Here, secondary stress from trauma combines with cumulative burnout – the inability to cope with daily tasks, responsibilities and the environment due to mental and physical exhaustion.

People who are most in contact with traumatized people and exposed to their traumatic experiences are most at risk of compassion fatigue (CF). This includes doctors, first aiders, social and community care workers, and other health and service workers. Effects include poor relationships with colleagues, deteriorating standards of patient care, and poor mental health, including post-traumatic stress disorder (PTSD), anxiety and depression.

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What causes compassion fatigue?

The reasons for this condition among these workers stem from the cost of empathy and compassion towards those they serve. The cost of participating vicariously in and helping to resolve their client’s or patient’s trauma puts the health and sanity of the care provider at risk and puts their safety at risk. This risk also extends to their families and employers’ organisations.

This secondary traumatic stress (STS) occurs as an often intense state of being preoccupied with the pain and distress of their clients. When it accompanies burnout, it results in anger, extreme fatigue, and irritable behavior. The caregiver may take drugs or alcohol to dull the pain. They may become numb to pain, showing a lack of sympathy or empathy.

They no longer like to work and help their former clientele. They miss work excessively and struggle to decide how best to care for those they serve.

The more direct the contact with the victim of trauma, especially when exposure to trauma is explicit and detailed, the greater its negative impact. Due to the increased incidence of depression, anxiety, PTSD and other mental health issues, absenteeism, psychological injury claims, staff turnover and reduced productivity are all likely to increase. ‘increase.

Burnout is caused by the inability to achieve one’s goals as a caregiver, causing feelings of loss of control, frustration, a tendency to work even harder to achieve the desired outcome, and low morale. STS, conversely, is another type of coping strategy in the face of such exposure, occurring because the client or patient experiences harm despite the efforts of the caregiver. This leads to feelings of guilt and distress.

Burnout and STS both end in FC unless mitigated by Compassion Satisfaction (CS). It refers to resilience, the feeling of having done what was possible, and the ability to let go of the guilt of failure. Both negative and positive components are therefore present in cystic fibrosis, including hyper-vigilance, avoidance, fear and intrusion, as well as exhaustion, fatigue and depression.

What are the risk factors for compassion fatigue?

Cystic fibrosis can be triggered by caring for life-threatening patients or by providing unnecessary or palliative care in such situations. The strain of witnessing constant suffering, making end-of-life decisions in consultation with distressed and confused loved ones, and maintaining constant vigilance while dealing with high-tech medical equipment.

Caregivers who perform physically or emotionally demanding tasks are also at risk. Having to work overtime or working extra days is also a risk factor. Besides heavy workload, having too little time to rest between shifts, repetitive tasks, lack of agency or control, and job dissatisfaction are all linked job-related risk of cystic fibrosis.

In addition, lack of support from managers and not being recognized for one’s contribution leads to a higher risk of employer-related CF.

Empathetic caregivers are at risk for CF because they may identify with the patient’s feelings when associated with low resilience. Long-term exposure to overwhelming care needs results in a defensive blunting of empathy, leading to CF.

There is an urgent need to understand what drives the CF to help caregivers stay healthy, build resilience, and thus regain high functioning at work or elsewhere when dealing with traumatized patients or clients. The premature loss of workers from these occupations can lead to less skilled and less trained workers entering these workplaces. The increased stress this places on them in turn promotes the development of cystic fibrosis in them.

Compassion fatigue

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Prevent and manage cystic fibrosis

Warning signs of cystic fibrosis can include physical symptoms (headaches, trouble sleeping, stomach problems, and lower back pain) and mental distress signaled by unstable mood, hostile or irritable reactions, and loss of confidence in itself. Cognitive disorders, such as memory loss, poor concentration, difficulty thinking clearly and making decisions, and an increased tendency to worry, may also appear. Behavioral symptoms include lethargy and low stamina, frequent crying spells, substance or alcohol abuse, self-isolation, or risky behavior.

The presence of cystic fibrosis could lead to moral distress or avoidance behavior, causing workers to start hating their jobs and being absent, or even leaving the profession prematurely. This drain on brains and skills could lead to economic damage and poor quality of care for distressed patients and their families.

Since at-risk occupational groups can be identified, it is recommended that these workers be offered programs to help build resilience, which appears to be key to avoiding CF by fostering a sense of agency and empowerment. self esteem. Become aware of your trigger points, share your experiences with others similarly affected to learn from them, put in place strategies to reduce such intense triggering of negative emotions such as hopelessness and frustration, and fostering compassion for oneself as well as for the worker are skills that need to be imparted to workers in these areas.

One such program includes self-care skills, building a network of connections for support, becoming more intentional rather than reacting to situations, controlling one’s internal and external activity to regulate autonomic activity, and learning to perceive situations with maturity, both in oneself and towards the workplace.

Communication training could facilitate better interactions with patients and loved ones and reduce conflict with colleagues and employers. It could also help to better express empathy for patients and clients, which in turn promotes a sense of self-efficacy, improved care, and a better sense of well-being.

This relatively new concept needs to be explored with more research to quantify the risk of future health problems such as depression or anxiety due to CF in workers, independent of other risk factors; determine the intervention or combination of interventions that can reduce CF; and assess the financial benefits of such interventions such as investments in well-being and productivity, and the ultimate profitability, of the care organization or the employer, in addition to the obvious moral and legal obligations to do so.

References:

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