Running head: COMPASSION FATIGUE: A CONCEPT ANALYSIS

Compassion Fatigue: A Concept Analysis Felicitas Cacal Chamberlain College of Nursing NR 501: Theoretical Basis for Advance Nursing May 27, 2012

COMPASSION FATIGUE: A CONCEPT ANALYSIS Compassion Fatigue: A Concept Analysis Concepts are considered vital elements of theories. The scientific basis of nursing is reinforced by the theories which give a description, explanation and prediction to the practice of nursing. Concepts provide the direction for producing the observations in the pragmatic world

(King, 1988). Walker & Avants (2005) is the method that will be utilized for the analysis of the compassion fatigue concept. The process will include eight steps. These eight steps are choosing a concept, determining the purpose of the analysis, identifying the uses of the concept, defining the attributes, discussing two model cases, identifying additional model cases which are borderline and contrary cases, discussing the antecedents and consequences, and define the empirical referents. The Purpose of Concept Analysis The purpose of analyzing compassion fatigue is to identify this concept within the nursing practice. Identifying an appropriate concept and formatting of the aims of the analysis are the first two steps in Walker and Avants (2005) method. Examining and discussing the distinctiveness of compassion fatigue will assist in illuminating this concept. The concept of compassion fatigue was selected due to the rigorous demands that the nursing profession face daily. Constant demands from the regulatory compliance to providing the needs of the patients and family members may take its toll (Frandsen, 2010). Further explorations of the categorization will define how essential it is to identify the true meaning in order to assist in combating this phenomenon in the health care world. Compassion Fatigue Defined Compassion fatigue is common across all spectrums of the healthcare profession. Healthcare professionals, especially the nurses, are witnesses to pain, suffering and trauma on a

COMPASSION FATIGUE: A CONCEPT ANALYSIS daily basis. As compassionate healers, taking on the emotional pain and suffering by those they are privileged to care for may affect the individuals ability to function at an optimal level (Showalter, 2010). Compassion fatigue was first recognized in nurses in the 1950s. This is sometimes referred to as burnout or secondary traumatization. Compassion fatigue is also referred to as the result of caring for patients that have physical and emotional pain and its

damaging effects which includes the inability to focus, decline of productivity, self doubt, loss of enthusiasm and passion (Lester, 2010). The term compassion fatigue was initially utilized in the study of burn out in nurses twenty years ago. This type of behavior was noted in some nurses working in an emergency care settings. The characteristic can easily be described as the inability to nurture effectively when caring for the patients. Headaches, inability to sleep and gastrointestinal issues are some of the somatic complaints that nurses have. This observable fact seems to gradually increase when the nurses did not pay attention to the symptoms and when they did not attend to their emotional needs (Boyle, 2011). Although compassion fatigue was observed in professional workers and caregivers, and discussion has ensued in several literatures over the last twenty years, a precise definition has not been determined. Because of this, numerous terms have been used simultaneously to describe this occurrence. Burnout, as mentioned earlier, is a term that is used in conjunction with compassion fatigue. While burnouts thrust comes from conflict within the work setting such as disagreements with other staff members or manager or dissatisfaction with the salary, compassion fatigue comes from witnessing tragedies and the emotional attachment from the incident. Burnout results from incidents or issues that have evolved over a period of time and compassion fatigue have a sharper onset (Boyle, 2010).

COMPASSION FATIGUE: A CONCEPT ANALYSIS Compassion fatigue provides the signal that lives are not balanced and changes are necessary to re-establish physical and emotional health. It provides the opportunity to check self assessment and growth towards a well balanced life. A balanced life can only be achieved if the

problems are recognized early and if the problems are met with a positive attitude (Parker, 2011). The potential factors which can lead to compassion fatigue can be categorized according to personality, attitudes regarding work, and organizational distinctiveness. Personality traits that may contribute to compassion fatigue include the Type A personalities and the big five traits which are extroversion, neuroticism, agreeableness, openness to experience, and conscientiousness (Sabo, 2010). The above mentioned traits may prompt the individuals to increase the risk for the development of stress. Nursing is a profession which requires the aptitude in technology in combination with caring interpersonal skills. Empathy, warmth and respect are few of the behaviors that nurses must demonstrate when caring for patients. Nurses with the tendency to have high work life demands and excessive empathy are at risk for developing compassion fatigue (Flannery, 2008). Work related attitudes may also cause compassion fatigue. Inconsistencies with the nurses beliefs which include the values of caring and the organizations principles and vision may enhance the impending fatigue of compassion. Stressors related to the job such as increased patient and nurse ratio, and increased patient care acuity may place the individual at risk (Boyle, 2011). Uses of the Concept of Compassion Fatigue The literature search was not limited to nursing literature as advocated by Walker and Avant (2005). In the search strategy, bibliographic databases including Medline, CINAHL,

COMPASSION FATIGUE: A CONCEPT ANALYSIS Ebscohost, and Ovid were used. Relevant search terms such as compassion, fatigue, and burnout were typed in the search engine. The Defining Attributes

Walker and Avant (2005) believe concepts are framework bound and attributes should be a cluster or be grouped together because grouping similar attributes will capture the meaning and will be able to recommend insights into the concept. Based on this definition and literature review, the defining attributes to compassion fatigue are: Risk factors Causes Process Manifestations Model Cases In order to exhibit all the significant characteristics of compassion fatigue, a model case will be used. This will permit insight into the structure of the concept and will permit to clarify the meaning and the context (Walker & Avant, 2005). Two examples will be discussed in the following section. Veronica has been a charge nurse of a 15 bed labor and delivery unit for about 30 years. She works 40 hours a week in a very busy floor. Laboring patients needs a lot of support as well as the significant other. As a charge nurse, Veronica is exposed to managing a busy unit with a mix of low risk and high risk types of patients with particular needs. More often, the unit is not well-staffed. Veronica has been exposed to this kind of environment for a long time now. Veronica loved her job, but in the last year the situation has gone from bad to worse. Changes in

COMPASSION FATIGUE: A CONCEPT ANALYSIS her physical, social and emotional functioning began to take place. Veronica chose to ignore the signals and the problem progressed. Veronica began to notice the changes in her life. She called in sick more often and her level of performance decreased. Veronica downplayed these signals. She began to think that she

is being a danger to others due to the careless mistakes she was making. She had nothing more to give and have become physically and emotionally exhausted. Another example of a model case is as follows: Kelly has worked in the ER for five years. The unit had a very high turnover rate. She had numerous contacts with trauma patients and she had to fulfill their needs as well as the family members. There is shortage of nursing staff in the unit and there had been no support from management. All these factors caused a lot of stress for Kelly. She no longer appreciated her profession and she had been ignoring all the subtle signs such as decreased attention span and decrease ability to help in assisting patients with their needs. As time progresses, the symptoms became more and more obvious. Her inability to concentrate had become progressively worse and she began to make more mistakes at work. She was feeling emotionally unstable and began to doubt herself. Kelly has become compassion fatigued. A Borderline Case Concepts that include many or most but not all of the defining characteristics of the concepts being deliberated are called borderline cases (Walker & Avant, 2005). An example of a borderline case is as follows: Jenny had worked as a nurse in the emergency room for the last six years. The patient population she cared for are those that are considered harshly traumatized. She was constantly surrounded by histories of patients that have had near death experiences. Comforting the patients

COMPASSION FATIGUE: A CONCEPT ANALYSIS and family members was her job. She witnessed the patients that died and those that lived. Although she felt stressed and work had left her exhausted physically and emotionally, this was her job and she cared about the patients. In the recent months, she felt as if her compassionate energy had been depleted. Contrary Case According to Walker & Avant (2005), a contrary case is the opposed concept of the model case. The purpose of the contrary case is to give an example of what the concept is not. An example of this is as follows: Kate had worked in a medical surgical unit for about five years and had been exposed to similar working environment as any other professional nurse. The unit is constantly

understaffed and multiple admissions were very common in any given day. Kate loved her work. She felt fulfilled emotionally and connected with her patients. She used the proper resources and kept up the skills necessary to care for the type of patient populations that she had to deal with daily. Her self-worth was enhanced every time she saw her patients getting better. She felt that she had a sense of purpose and significance to her patients. The progression of compassion fatigue is augmented and increased as time passes. When one is compassionate and caring, the process is healing and rounded in nature which provides a relationship of mutual respect and understanding between the patient and the nurse (Hoffman, 2009). Antecedents According to Walker & Avant (2005), antecedents are incidents that must happen before the concept must occur. Compassion fatigue antecedents such as self awareness, work life balance, self care, the ability to allocate the proper resources, and education which will validate the skills, are antecedents that will help combat compassion fatigue. Taking the time to

COMPASSION FATIGUE: A CONCEPT ANALYSIS breathe and implementing strategies to develop self care while giving care to patients will decrease the incidence of compassion fatigue. (Showalter, 2010). Consequences Consequences are incidents or events that transpire as a result of the occurrence of the concept (Walker & Avant, 2005). Consequences such as improved mental and physical health, job satisfaction, increased self worth, and increased motivation for professionals just to name a few. Enabling healthcare workers to decrease compassion fatigue will promote healing but also benefit the organization in which the care givers are employed. Benefits such as increasing productivity and increasing morale, becoming more involved in the organizations initiatives, reduce sick time and the turnover rates will be lower. As a result of decrease incidence of compassion fatigue among the nurses, there will be higher incidence of satisfaction among patients and family members. Empirical Referents

Walker & Avant (2005) had asked how to measure a concept when that concept is highly abstract. Empirical referents may and can be referred back to the attributes and provides clear phenomena to which the concept should be directed to. The empirical referents for compassion fatigue firmly resulted from the refinement of the definition and the distinctiveness of the concept. For research purposes, there are literatures and books that have been written on the concepts which suggest that the concepts exist. Studies and surveys have also been done to define the attributes which are empirical referents as well. Conclusion The analysis of the concept of compassion fatigue provided the ability to discover the definition of this concept utilizing the method as described by Walker & Avant (2005). It painted

COMPASSION FATIGUE: A CONCEPT ANALYSIS a clear picture of the urgency of dealing with the concept in the workplace of healthcare professionals. Establishing resources for workers with counseling regarding life skills should be considered. Educating nursing students regarding risk factors and the causes of compassion

fatigue will empower them with important information that will help them cope with stress from work and will help them to develop skills to prevent compassion fatigue.

COMPASSION FATIGUE: A CONCEPT ANALYSIS References Flannery, A. (2008). Predicting the risk of compassion fatigue. J Hospital Palliative Nursing, 8(6), 346-356. Frandsen, B. (2010). Long Term Living: for the Continuing Care Professionals. Long Term Living, 59(5), 50-52. Hofman, P. (2009). Addressing Compassion Fatigue. Healthcare Executive, 40-42. King, I. (1988). Concepts: Elements of Theories. Nursing Science Quarterly, 1(1), 22-25. Lester, N. (2010). Compassion fatigue. Mental Health Practice, 14(2), 11-11. Sabo, B. (2011). Reflecting on the Concept of Compassion Fatigue. Online Journal Issues Nursing, 16(1), 1-13. Showalter, S. (2010). Compassion Fatigue: What Is It? Why Does it Matter? Recognizing the Symptoms, Acknowledging the Impact, Developing the Tools to Prevent Compassion

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Fatigue, and Strengthen the Professional Already Suffering From the Effects. American Journal of Hospice & Palliative Medicine, 27(4), 239-242. Walker, L., & Avant, K. (2005). Strategies for Theory Construction in Nursing (4th ed., Rev.). Upper Saddle River, NJ: Pearson Prentice Hall.