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Focusing on 'compassion fatigue' risks ignoring other causes of work-related stress

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It is time to rethink the concept of “compassion fatigue”, as focusing on it too much risks ignoring other key causes of work-related stress in nurses and other clinicians, claim researchers.

So-called “compassion fatigue” must be re-defined because it fails to address the significant work-related issues and burnout faced by nurses and other healthcare professionals, according to Canadian researchers.

“It is hard to envisage how a single conceptual model of compassion fatigue can be equally applicable to a psychotherapist… and a nurse”

Study authors

The academics reviewed 90 studies looking at compassion fatigue – a term that has become popular to describe a health professional’s response to stress, which is thought to lead to a loss of compassion in their work – to explore whether it was an accurate description.

The studies showed that the physical, emotional, social and spiritual health of healthcare professionals was impaired by cumulative stress related to their work.

But suggestions that compassion was “somehow the primary contributor to this phenomena” were “unfounded”, said the researchers in the paper called Compassion fatigue: A meta-narrative review of the healthcare literature.

They highlighted that it was more likely that workers were experiencing the negative consequences associated with a broad range of work-related stress, which then restricted their ability to be compassionate.

The authors of the paper found a number of problems with the way compassion fatigue was conceptualised and measured across the 90 studies.

They noted that compassion fatigue had originated as a concept in crisis counselling and had since been adopted among the nursing profession. But the researchers noted the wide variation of situations to which it was now applied.

“By focusing exclusively on compassion fatigue, other… negative ‘endpoints’… such as burnout… may not be adequately addressed”

Study authors

“It is hard to envisage how a single conceptual model of compassion fatigue can be equally relevant and applicable to a psychotherapist who may be chronically burdened with her clients’ distressing memories, a nurse who experiences acute trauma and is then expected to provide ongoing support and interventions to patients and families [and] a nurse working in a hospice frequently exposed to death and dying,” they said.

They also found studies on the concept were limited because they only focused on a few elements of compassion – such as behaviours and motivation – rather than the full range of factors, such as virtues, proactive responses and close communication.

Meanwhile, the most frequently used scoring system that featured in studies on the topic – the Professional Quality of Life Scale – did not provide a direct measure of compassion fatigue.

In addition, the scoring system relied on self-reporting, when compassion was in fact a “relational care construct, anchored in action aimed at relieving suffering”, said the researchers.

“In our review and critique of definitions and concepts, we do not intend to diminish the severity of stress responses that healthcare [professionals] face on a daily, moment-by-moment basis in caring for others,” they said.

“At the same time, terminology must not distract us from comprehending, studying and developing evidence-based interventions to address the physical and emotional fatigue experienced by healthcare providers,” said the report authors.

“In conclusion, we suggest that a new discourse on healthcare [professional] occupational stress and burnout is needed, which expunges the problematic concept of compassion fatigue,” they said in the International Journal of Nursing Studies.

“By focusing exclusively on compassion fatigue, other equally important negative ‘endpoints’ associated with healthcare professions, such as burnout, secondary traumatic stress, countertransference and vicarious traumatisation, may not be adequately addressed,” they added.

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