Authors

1. Hodge, Lori MSN, RN, OCN, NEA-BC
2. Lockwood, Suzy PhD, MSN, OCN, CHPN

Abstract

Review question/objective: The specific review question is:

In the acute care oncology setting, can structured interventions implemented by nurse leaders decrease compassion fatigue among healthcare providers?

More specifically, the objectives are to identify: the effectiveness of structured interventions by nurse leaders to decrease compassion fatigue in healthcare providers in acute care oncology settings.

The quantitative objective is to identify the effectiveness of structured interventions on compassion fatigue.

The qualitative objectives are to identify the meaningfulness and appropriateness of structured interventions on compassion fatigue.

Background: The art of nursing has at its core the concept of compassion, which Straughair attributes to scriptural roots from a God who has instructed us to be kind and compassionate to one another.1 The term "compassion" is not easy to define due to its subjective nature and is often confused with such concepts as sympathy, empathy and caring. When shown in the true sense of the word, compassion can be the nursing profession's most valuable and precious asset; yet when absent can diminish the value of nursing and have detrimental effects on the profession.2

While there is little debate that compassion is a fundamental value in nursing, there is increasing debate about its existence in contemporary nursing. Nurses are less often citing their motivation for entering the profession as 'a calling' or to fulfill a desire to care for others and more often citing such alternatives as attractive salaries or job security.2 As a result, the profession may place more emphasis on the technical skills and measurable outcomes and allow the virtues of compassionate nursing care to erode. Recent reports support this possible lack of compassionate healthcare by highlighting negative patient outcomes, poor quality standards, compromised nursing care and in worse case scenarios, a disregard for basic human dignity. This is not to say that prospective nurses enter the profession with a disregard for high-quality compassionate care; compassion may instead be an aspiration they hope to acquire rather than a quality they possess which drew them into the profession.1

One deterrent to the provision of compassionate care may be directly linked to compassion fatigue, a term used to describe the physical, emotional and spiritual effects from repeated or overwhelming exposure to patients facing life-threatening or life-altering illnesses or accidents. Emergency departments and first responders to crisis situations are particularly vulnerable to compassion fatigue, as are those in oncology settings where there is frequent exposure to pain, suffering, death and dying. Nurses suffering from compassion fatigue tend to depersonalize their care, which may be perceived as a lack of compassion.2 Other signs and symptoms of compassion fatigue range from irritability and mild sleep disturbances to anger and depression and can progress to serious physical ailments.3 Post-traumatic stress syndrome is an extreme manifestation of compassion fatigue often observed in war zones.

Healthcare organizations can be seen as both a cause and a victim of compassion fatigue; likewise, healthcare organizations can be part of the problem and potentially part of the solution. Potter, et al.,4 recognize the organizational structure and the social environment of organizations as relevant contributors to compassion fatigue. The culture of a healthcare organization is a determining factor for the impact of compassion fatigue; a culture that is focused on profitability at the expense of poor staffing levels will not value time spent at the bedside and will minimize the opportunities to provide compassionate care. In addition, an organizational culture that is insensitive and unresponsive to the individual needs of the patients will be reflected in tolerant attitudes by the employees toward poor standards of care. Findings from a study indicated what appeared to be a lack of compassion by caregivers represented instead inherent staffing issues and organizational cultures that hindered the caregiver's ability to adequately perform their caring and compassionate roles.1

Compassion fatigue is not limited to individuals; entire organizations may experience compassion fatigue as evidenced by high rates of turnover from burnout, excessive absenteeism and decreased productivity. Each of these symptoms will produce a negative impact on patient satisfaction.4 Organizations suffering from compassion fatigue may experience constant changes in co-worker relationships, thus jeopardizing the ability for teams to work well together and build positive momentum towards quality outcomes. Negativity towards leadership is another symptom of compassion fatigue, as employees become less tolerant of change, less respectful of rules and policies and less intent on meeting deadlines and completing assigned tasks. Compassion fatigue can result in a workforce that is unable to effectively meet productivity or patient satisfaction standards, further straining a financially overburdened healthcare system.3

The literature suggests multiple strategies, such as debriefing and the promotion of self-care that can lessen the risk and impact of compassion fatigue on the individual caregiver and on the organization as a whole. The Indiana State Nursing Association Bulletin3 recognizes that the very nature of those attracted to professional caregiver roles may enter the field with some degree of compassion fatigue stemming from an inherent tradition of caring for other's needs before caring for their own.3 Under this assumption, it is suggested that interventions be focused on the role of 'self' through self-awareness, self-care and self-compassion. One study suggests that interventions should be targeted towards those staff at risk; in this case the healthcare providers in the acute care oncology setting.4 Focused education to increase the awareness of compassion fatigue, specifically the risks, causes, signs for early detection and available resources to combat the detrimental effects of compassion fatigue should be considered with this caregiver population.5

Recent nursing literature has identified a strong relationship between a perceived lack of compassionate care, negative patient outcomes and the financial impact on healthcare organizations.5 Nurse leaders are well aligned to lead the transformation back to the delivery of compassionate patient care. Examination of the Cochrane Library, JBI Library of Systematic Reviews, CINAHL and other relevant databases failed to produce current or planned reviews on the topic of the impact of interventions that can be implemented by nurse leaders to decrease compassion fatigue. A systematic review to include literature from emergency and trauma care, psychology, behavioral health and spiritual counseling in addition to oncology and hospice nursing will be used to identify multiple strategies and recommendations for the prevention and management of compassion fatigue. The identified strategies will be further examined to determine the impact that implementation will have in the acute care oncology setting. The information will prove valuable for nurse leaders seeking to guide caregivers toward the provision of compassionate patient care and guide healthcare organizations towards a culture that endorses the concept of compassion and supports efforts to proactively combat compassion fatigue.1 The review will focus on interventions that are appropriate for healthcare providers in the acute care oncology setting recognizing that: 1) all healthcare providers in this setting including unlicensed assistive personnel and health unit coordinators are at risk for compassion fatigue, and 2) the workplace environment for this caregiver population holds unique challenges when compared to outpatient oncology settings.

In conclusion, it is evident the contemporary nursing profession needs to refocus on the concept of compassion. Recent reports citing negative patient outcomes and poor quality standards from the possible lack of compassion should motivate nurses to take action and redirect their professional path.1 Compassion fatigue should be defined and incorporated in nursing education and nursing practice to allow nurses to recognize and combat its negative effect on patient outcomes.5 Through supportive leadership and corporate strategies that consider the influence of the organizational culture and environment, the negative impact of compassion fatigue on the organization can be effectively minimized. By refocusing on the nursing profession's most valuable and precious asset, we can return to the use of compassionate care to deliver true high-quality patient care and patient outcomes.2