GOOD GRIEF! Managing Compassion fatigue for Nurses

As an addition to Understanding Compassion Fatigue, CF is a slowly developing psychological condition that can be nipped at the bud if soon detected.

The warning signs vary individually but several common indicators have been noted through research. These indicate that one is moving to the danger zones of CF;  (Mathieu, 2017)
• Exhaustion
• Reduced ability to feel sympathy and empathy
• Anger and irritability
• Increased use of alcohol and drugs
• Dread of working with certain clients/patients
• Diminished sense of enjoyment of career
• Disruption to world view, Heightened anxiety or irrational fears
• Intrusive imagery or dissociation
• Hypersensitivity or Insensitivity to emotional material
• Difficulty separating work life from personal life
• Absenteeism – missing work, taking many sick days
• Impaired ability to make decisions and care for clients/patients
• Problems with intimacy and in personal relationships

OUTCOME OF CF include various personal to professional detriments which affect how nurses care for clients & interact with colleagues. The three categories as postulated by Lombardo & Eyre, 2010 are;

Physical: Headache, gastrointestinal discomfort, nightmares & insomnia ( Kelly et. al., 2015 ).Emotional: Mood swings, irritability & depression, lack of concentration & poor judgment. Work-related: Eluding particular situations and/or patients, lowered capacity to perceive empathy & lack of meaning in work (Lombardo & Eyre, 2010), Lowered level of work gratification (Jarrad, 2018).

COPING WITH & PREVENTING CF; The first step in recognizing and combating the symptoms of cumulative grief and compassion fatigue is acknowledgment. Most importantly for recovery and management is how to handle a stressor but not the stressor itself.

Prevention;

  1. Formal education programs on management of CF in learning institutions & hospitals teach health care providers coping mechanisms against emotionally trying situations that lead up to CF (Benoit et al., 2007; Pietrantoni & Prati, 2008).
  2. Teamwork; We all know how efficient it is to work with positive, synergistic team members. This eases the tension and pressure related to work making it more enjoyable and nontasking.  Speaking to trusted colleagues who empathize and encourage each other lowers the chances of a compassion fatigue (Benoit et al., 2007; Pietrantoni & Prati, 2008). Be the energy you´d like to be around.
  3. Recognise nursing as a vulnerability to CF as a care oriented profession which is physically and psychologically involving. This reminds nurses to develop conscious effort to reinvigorate themselves habitually. This way, they can tap into their constructive energizers to assist them in decompressing while releasing professional and personal life stressors. These coping avenues vary individually but the goal remains the same. They include; Yoga, running, gardening, meditation,  etc (Benoit et al., 2007; Pietrantoni & Prati, 2008).
  4. Identify & counter individual drainers; Recognising the particular anxieting situations and early warning signs will allow a nurse to implement restorative strategies that eventually prevent CF. These drainers can come from work or home. Some professionals are in the ¨sandwich generation¨ caring for both young children and ageing grandparents (Baverstock & Finlay, 2015). Noting individual drainers from both ends will allow better management of each thus improving overall well being of the nurse.
  5. Tackling obstacles to healthy grieving, such as;hiding grief reactions
    • insufficient time to process grief
    • inadequate social support from colleagues
    • problems with facing individual mortality (Papadatou, 2000)

An understanding of the coping responses of nurses can help develop resilience-promoting interventions tailored to ease the resolution of CF issues (Jarrad et al., 2018). The Coping Inventory for Stressful Situations, by Endler & Parker  (Jarrad et al., 2018) identified three coping styles:

  • task-oriented coping (i.e. taking actions to solve the situation)
  • emotion-oriented coping (e.g. self-blame and anxiety)
  • avoidance-oriented coping (replacement behaviours to substitute the problem)

Emotion & avoidance oriented coping mechanisms may lead to self harming or destructive behavior such as substance abuse & withdrawal (Jarrad et al., 2018).

MANAGING COMPASSION FATIGUE;

  1. Counselling & seeking professional help for unresolved grief allows nurses to express themselves to a on what they are going through who assists them recover through evidence based practices. (Braunschneider, 2013).
  2. Self-reflection strategies; According to Potter et al., it is important for nurses to use self-reflection after a difficult day at work because it allows them to identify the emotions they are feeling and the reason they are feeling them. Sometimes, the emotions that a nurse is feeling may not be directly related to a patient; instead, the emotions may arise from a situation in their personal life, and it is important for the nurse to be able to distinguish between the two and manage appropriately (Potter et al., Fundamentals of Nursing, 727).
  3. Utilizing self-care habits such as consuming balanced diet, exercising regularly, resting sufficiently & staying positive aid to in physical to psychological therapy. These practices not only obscure CF & burnout but promote personal to spiritual development (Braunschneider, 2013).
  4. Transitioning from work to home (Kearney et al., 2009) & Separating work from home life is one way of creating a work life balance . Braunschneider, 2013 puts it well,  ¨Nurses not only care for themselves and their families, but they must also care for their patients. Many times nurses become so emotionally invested in their work that they cannot stop thinking about it when they reach home, which may lead to problems in their personal lives. Since nurses care for their patients all day and then come home to care for their families, it is important for nurses to keep the two separate and find time for themselves to clear their heads and relax.¨
  5. Participating in relaxation exercises such as deep breathing, meditation, and journaling. These exercises encourage nurses to disseminate their emotions while focusing on providing care for themselves (Braunschneider, 2013)
  6. Support groups are therapeutic for health care providers to share similar experiences with the other colleagues & find familiar solutions (Braunschneider, 2013).
  7. Realizing the positive impact nurses have on patients’ lives (Aycock & Boyle, 2009; Papadatou, 2000) is motivating!
  8. Spirituality, faith, and religion can be adopted as ways of dealing with grief and its outcomes (Shinbara & Olsen, 2010).
  9. Use humor throughout and/or after a shift, whether good or bad, we will always find a silver lining through the best medicine!

It is beneficial to always consider ourselves as holistic vulnerable care providers. To be able to care for others at optimum levels depends on how well we understand ourselves & the dynamics of this incredible profession. This way, we will remain empathetic, competent and compassionate professionals.

The next episode on Organizational Detriments of Compassion Fatigue; How to aid health workers overcome grief  will discuss institutional interventions to counter & manage cumulative fatigue.

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