The Compassion Fatigue Plague in Healthcare

By Eric Dinenberg

An unfair demand is placed upon healthcare providers that doesn't get talked about nearly enough: We expect that clinicians will clear their minds of the first patient they saw when they go to see the second patient.  But what if the first interaction was extremely traumatic? Do we expect a caregiver who develops compassion fatigue after one patient interaction to bounce right into the next patient room and be 100% present to their needs?  

The prevalence of compassion fatigue ranges from 7.3% to 40% of workers in intensive care settings. It rises to 25% to 70% among inexperienced mental health professionals. The higher prevalence is often seen in health professionals who repeatedly witness and care for people after trauma.

I see my own colleagues suffering with compassion fatigue in the pain clinic where I teach mindfulness to patients. I also see it across the country in the in-person consulting work I do helping healthcare organizations train their staff on mindfulness. This local and national view of the problem, along with my background in Occupational Medicine, brings me to the conclusion that compassion fatigue is an important occupational hazard involved in the work of caring. We’re quick to address physical hazards such as handling and disposal of sharp instruments efficiently, yet we are slow to address emotional hazards. A healthcare organization that ignores the occupational hazard of compassion fatigue exposes itself to all the upheaval and financial costs involved in increased turnover. Ultimately, it fails to care for team members involved in the work of caring.


What is compassion fatigue?

The American Nurses Association (1) defines it as a combination of physical, emotional, and spiritual depletion associated with caring for patients in significant emotional pain and physical distress. Compassion fatigue may be experienced by any healthcare professional who provides empathic support and then personally experiences the pain and suffering of their patients and their families. A systematic review (2) notes that it was described first in the early nineties as the loss of compassion due to repeated exposure to suffering during work. Later, it was described as secondary traumatic stress resulting from caring for a traumatized person. From this time on, compassion fatigue has been referred to as secondary and posttraumatic stress or vicarious trauma.


What are the symptoms of compassion fatigue?

A person with compassion fatigue can suffer with issues such as exhaustion, frustration, and depression, and also with negative feelings driven by concerns such as hyper-vigilance, avoidance, and fear (2). Emotional symptoms can include mood swings, anxiety, depression, anger, and poor concentration, while physical symptoms can include headaches, digestive problems, sleep disturbances, and fatigue. Consequences at work may be avoidance or dread of working with particular patients, reduced ability to feel empathy, lack of joy in work, and frequent use of sick days (1).


Are compassion fatigue and burnout the same thing?

Not quite. Burnout is usually a cumulative process marked by emotional exhaustion, depersonalization (treating patients like objects) and a decreased sense of personal accomplishment.

Similarly, compassion fatigue can be cumulative, but may be due to a traumatic exposure of a single case. It differs from burnout in that in compassion fatigue even a single patient interaction could trigger the experience of trauma symptoms similar to those of their patients. A caregiver who has experiences this, and then develops an inability to engage in further caregiver-patient relationships is thought to suffer with compassion fatigue. Some researchers suggest that burnout is a precondition for compassion fatigue, while others describe burnout as the end result of traumatic stress in their professional life.


Solution: Protect against burnout and compassion fatigue with mindfulness training

If you’re a long term reader of the Whil blog, you know what mindfulness training is. Essentially, you’re training in present moment attention that conveys skills for personal resilience. Research shows hope for both compassion fatigue and burnout with mindfulness. It can reduce physician burnout and improve self-reported wellbeing and empathy among caregivers (3). It has also been shown to impact biometric markers among trainees. In fact, marine infantry platoons trained in mindfulness showed enhanced recovery in heart rate, breathing rate, and plasma neuropeptide Y concentration (a marker of stress) after a stressful combat simulation training session. Additionally, those Marines exhibited the “elite performer” brain pattern on functional MRI; the part of the brain responsible for emotional reactivity was lighting up less for those trained in mindfulness (4).

We can protect our caregivers from compassion fatigue by offering them the same elite performance training. Caregivers who are trained to be more present and less emotionally reactive are better equipped to prevent burnout and compassion fatigue. The result is improved engagement, decreased turnover, and excellent care.

With that said, here are 5 ways to prevent compassion fatigue among us:

  1. Carve out self-care time before work, at lunch, or after work. My dad is a Family Practice doctor and for as long as I can remember he brought his gym bag to work; he carved out time at lunch for physical activity.  Now I do the same!
  2. Practice mindfulness throughout your day by letting your hand washing cue you to mindfulness practice. Use it as a chance to do some deep breathing.
  3. Create a plan with your colleagues for what to do after traumatic encounters.  
  4. Practice mindfulness before or after work.
  5. Make sure you are using all your vacation time, and focus on really being on vacation when you are on vacation!

 

Check out more information on our healthcare career wellbeing training with Dr. Dinenberg here: 

Product brief: Taking care of others in healthcare

Robert Eric Dinenberg, MD, MPH has an album of guided meditations on iTunes, a track of which has received over one million views on YouTube. Dr. Dinenberg offers in-person mindfulness trainings for healthcare organizations. His website is www.XpeditionHealth.com and he can be reached at Eric.Dinenberg@XpeditionHealth.com.

 

REFERENCES

  1. Lombardo B, Eyre C (2011) Compassion fatigue: A nurse’s primer. OJIN 16(1) Manuscript 3: doi:10.3912/OJIN.Vol16No01Man03.
  2. vonMol M, Kompanje E, Benoid D, et al. The prevalence of compassion fatigue and burnout among healthcare professionals in intensive care units: A systematic review. PLoS ONE 10(8):e0136955.doi:10.1371/journal.pone.0136955.
  3. Krasner MS, Epstein RM, Beckman H, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009;302(12):1284-1293.
  4. Johnson DC, Thom NJ, Stanley EA, et al. Modifying resilience mechanisms in at-risk individuals: A controlled study of mindfulness training in Marines preparing for deployment. Am J Psychiatry. 2014;171(8):844-853.

 

Photo by rawpixel.com on Unsplash

 

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Posted by Eric Dinenberg- 20 October, 2018


Dr. Dinenberg is President and CEO of Xpedition Health, a company dedicated to in-person mindfulness trainings. He completed residency training in Occupational and Environmental Medicine at UCSF and his Masters of Public Health at UC Berkeley. He taught mindfulness in private practice for nine years, then for four years served as Chief Medical Officer for a national company integrating mindfulness into population health initiatives. He is author of Mindfulness and Peak Performance: Touch the Ground, Touch the Sky and the iTunes album, “Guided Meditations with Dr. Robert Eric Dinenberg.”