Q & A: Assessing and addressing compassion fatigue in nursing - Caryl Eyre, R.N., Cincinatti, OH, USA

What is compassion fatigue?

Compassion fatigue is when the caregiver becomes depleted on many levels, physically, psychologically, spiritually, when they are caring for a patient.

Could you tell me about compassion fatigue in nursing?

What we’ve seen over the years is that this is happening more often. We have a very different situation in healthcare now, we have a very, very high acuity, we have difficult patients, we have patients who, although the emphasis in health care is on getting people in and out quickly, we have some very complicated cases of patients who are there for months, and those kinds of patients are very challenging. I think our caregivers experience this kind of compassion fatigue when they’re caring for this kind of patient, and then another one comes in, and then another one comes in.

 

It’s very different than when you have frustration with equipment or when you don’t have enough staffing – that’s not caring fatigue. That can be burnout, but it’s really not compassion fatigue. We really stress relationship-based care, and patients and families like that – they like to have a relationship with their caregiver, especially if someone’s there for a long time. They like the same caregivers over and over, you know getting a new caregiver is hard, but then it can be very difficult for the caregiver and that creates the very right conditions for compassion fatigue.

What can nurses and nurse managers do to combat compassion fatigue?

We really try to be on the lookout for compassion fatigue on an individual basis because education is part of this. Really educating staff on what compassion fatigue is, educating staff on what they can do, and how they can really manage that work stress. It’s really an ongoing education process.

At my workplace, I look at self-care strategies, stress-management strategies, things they can do at work, things they can do at home, and I usually try to, if I’m meeting with someone individually, assess what are they doing – are they making time for themselves, are they applying the stress management techniques that they know? And usually when you have someone with compassion fatigue, you’re going to see huge gaps in what they’re doing. For example, they come home from work, they might eat something, they go right to bed, they might sleep for 12 hours, they might have disrupted sleep – so you really zero in on all those things and then see what you can do to help.

Can you tell me about the 'Watson Room' your staff have created to help combat compassion fatigue?

I really promote trying to get a stress-free zone in every work area. We have everything from a small little table with a room divider, to a room that used to be an ugly environmental service room where they kept supplies, and that the staff transformed into their stress-free zone. They call it their 'Watson Room', after Jean Watson, a nursing theorist who talks about those kinds of rooms. They got donations so they have a recliner, they painted it a pretty colour, they have a water feature, they have very nice curtains on the wall and they have a rug so it’s warm. It really is for one person, it’s a small little room, and people can go in there. They’re not to bring their phones in there, they’re to hand off their pager before they go in there, but it’s a place where they can go and kind of decompress.

How do you overcome budget constraints in carrying out these types of projects?

We have a system that supports that but in healthcare, finances are always difficult, so you really have to be creative in finding ways to get things that are going to be budget-friendly or budget-neutral. No one has any money in their budget for a self-care room, a decompression zone, a Watson room – you just have to kind of figure out yourself, but it’s amazing to see the energy that people can put in this when you get them on board.

What else can healthcare organizations do to protect their nurses from compassion fatigue?

We have an integrative medical centre that has begun to offer some very affordable classes, like we have yoga on site, and they have some resiliency training that is very, very affordable. Again, it takes a commitment and nurses may need to come in on their day off, or stay a little bit later at work, but there has been a real awareness on the part of the system that we need to keep our employees healthy and offer these kinds of things. Out of this integrative medical network, also comes the Heal the Healer Conference, this will be its fourth year. It’s an all-day conference and it’s really dedicated to promoting the wellbeing of the caregivers. It’s just been incredible and I think that has been a huge supportive gesture.

 

Could we do more? Absolutely, I’m sure we could, but when you look at the budget constraints that everyone has, you have to, again, be creative. We have things like discounted gym memberships, and we have a wellness program that everyone can participate in, where they can get money back by logging their pedometer in and acknowledging what they’ve done. It takes all of 2 minutes, but over time, some of these healthy techniques become habits, so I’m always promoting that.

 

I have also become really interested in mindfulness, because I think when things get very stressful and very busy, when you can get a little centred and focused, it helps with feeling a sense of confidence and control over your work setting. So I do some exercises, just 2 or 3 minutes, either using a quick guided imagery, or a mindfulness exercise with decaffeinated cinnamon tea, where I have the nurses listening to the kettle brewing, and then I pour the tea into tea pot, you can kind of smell the aroma of cinnamon.

 

It’s really appealing to a lot of people so I leave it with different work groups so that they can have their little 2-minute tea breaks. It’s also about not stimulating yourself with caffeine, I mean I love coffee and there are times when I need coffee, but I find that it can work the opposite if I’m stressed, so the tea really helps people to wind down, and just focus on the actual brewing.

 

Sometimes, we meet with people periodically to talk, but if someone really needed some intensive, we would refer them to our employee assistance programme (EAP), which is wonderful. They’re very knowledgeable about the stressors nurses have, and about compassion fatigue.

 

There are all kinds of things, that when I started out in nursing, 40 years ago, these things just weren’t there. I always say that it’s easier to recognize compassion fatigue in someone else than yourself, but once you can recognize it, it becomes your responsibility to figure out a plan and to find resources, and that’s a hard thing to do when you’re depleted but it’s very important.

 

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