In a previous article, Kate Upton reported that, in her recent study, nearly 50% of a sample of acute medical care hospital nurses were identified as suffering from compassion fatigue (CF), and today askes, how can it be combated?
My research into CF highlighted that the physical and emotional strain on many nursing staff resulted from being vicariously affected by the care they provided for very sick patients (secondary traumatic stress), and by feeling overwhelmed by a care system that undervalues them.
This detrimental effect on a nurse’s well-being has become too familiar, leading to many leaving the profession - a situation openly and bravely articulated recently by one such nurse.
So, what can be done to help prevent such a situation arising? What can buffer and minimise the development of CF and promote compassionate patient care? My study revealed that an important predictor of CF is a low level of self-compassion.
This includes beating oneself up over making mistakes (self-judgment), being overly immersed in one’s emotions and thoughts (over-identification) and thinking oneself to be the only person in the world to be feeling inadequate (isolation).
Those acute medical nurses with low levels of self-compassion had a tendency to self-criticicise, thinking they had not done their best at work and could have done more.
“It has to be recognised that it is of benefit to have a self-compassionate workforce”
They also had a propensity to over-identify with their thoughts and feelings. This was overwhelming to them and damaging to their home life. In addition, they had a tendency to suffer with these negative experiences in isolation, feeling they were “struggling” and “drowning” on their own.
Self-compassion (Neff, 2003) means being kind to oneself if we fail, make mistakes or feel inadequate (self-kindness). It involves getting things in perspective and not allowing negative emotional thoughts to become overwhelming (mindfulness) and recognising that feelings of inadequacy, frustration and disappointment are universal (common humanity).
The nurses in my study acknowledged the importance of adopting these approaches, but felt unsupported by the organisational health care culture to think in that way.
So how can self-compassion be achieved? This is where health care organisations and management can step in with an understanding and consideration of the diverse needs and expectations of their multi-generational workforce.
Firstly, it has to be recognised that it is of benefit to have a self-compassionate workforce. This includes improving staff awareness of CF, its relationship with self-compassion and the importance of cultivating individual wellbeing and resilience.
Fundamentally, it requires health care managers to adopt behaviours that give their staff permission and opportunity to develop an appropriate level of self compassion, whilst implementing strategies to remove barriers to achieving it.
“Although the problems for nursing staff in the NHS are complex and multifaceted, it is becoming clear that nursing staff with self-compassion have a better chance of managing the stresses of their work and care environment”
Suggested approaches to encourage a more self-compassionate workforce include identifying those most predisposed to developing CF and using a nurse’s level of self-compassion as a predictor of CF.
In addition, implementing targeted support programmes, such as the mindfulness-based stress reduction and compassion circles, and providing regular debriefing sessions, both formal (Schwartz rounds) and informal (at staff handover), particularly for younger and less experienced members of staff.
This should allow and encourage staff to talk openly about their emotional experiences and help them to realise that they are not alone in how they feel. Such pro-active listening to staff concerns helps them to feel less isolated and neglected.
And furthermore, through establishing protected and uninterrupted breaks for staff to recharge and refuel, together with flexible shift patterns to better balance work and home life.
These are central organisational and cultural approaches that can actively demonstrate the value and appreciation placed on nursing staff through meaningful recognition.
Although the problems for nursing staff in the NHS are complex and multifaceted, it is becoming clear that nursing staff with self-compassion have a better chance of managing the stresses of their work and care environment.
Improving the workforce levels of self-compassion predominantly involves changes in managerial behaviour and attitude.
With support and encouragement from health care organisations, staff will be better able to deliver compassionate, connected care, that is both satisfying to themselves, to their work colleagues and to their patients.