Kate Upton reveals how her study into compassion fatigue shows an increasing need for health care organisations to support their employees.
I have always considered that, as nurses, we are privileged to be present at some of the most significant and meaningful points in a person’s life, gaining rewarding experiences from caring well for those who are suffering and dying.
Unfortunately, the consequence of such work, which is physically, intellectually and emotionally demanding, is our vulnerability to developing compassion fatigue (CF).
CF can develop when a nurse’s psychological resilience becomes overwhelmed by prolonged, continuous and intense contact with seriously ill patients. An imbalance between the compassionate energy we use caring for patients and our restorative capabilities may result in CF.
The effect of CF is multifaceted, with symptoms including intrusive thoughts, sleep disturbances, avoidance, increased blood pressure, fatigue, weight gain, depression, immune dysfunction and not least, a loss of compassion.
CF not only takes its toll on nurses on a personal level but on their work-place and patients as well, through increased sick leave, reduction in productivity, poor clinical performance, decreased staff retention and, ultimately, dissatisfied patients.
“The inevitable consequence of this has led to nurses being regarded as lacking care and compassion.”
The additional concern is that, in order to self-manage the emotional and physical symptoms of CF, nurses may adopt maladaptive coping strategies, such as avoidance, withdrawal and emotional numbing. These psychological changes can have direct negative impact on the safety and quality of patient care, a situation coined “the cost of caring”.
The inevitable consequence of this has led to nurses being regarded by their patients, patient’s families, the media and governmental reports, as lacking care and compassion.
A political response, aimed to improve the quality of patient care has been the implementation of the “6 Cs”, a set of ideals that nurses are expected to embed in the care they provide.
But how can nurses live up to these standards? Instead, they are set up to fail within organisational cultures that emphasise individual blame, resulting in nurses being scapegoated and condemned.
I recently conducted a mixed-methods study investigating the prevalence and severity of CF in UK acute medical care hospital nurses (publication in preparation). Nearly half (46%) the sample of qualified nurses were acknowledging moderate to very severe levels of CF symptomatology.
The qualitative data identified factors that influence the nurses distress and vulnerability to CF.
These included conflict between the desire to deliver high quality patient care, and the reality of being unable to meet these ideals, together with feelings of being overwhelmed and undervalued by the expectations of patients, ward managers and the employing hospital organisation.
In addition, the nurses complained of their work being protocol and target driven within the “infamous madness” of the general acute medical care hospital environment, where the workload is very demanding and patients have multiple and complex needs.
“It is crucial for health care organisations to recognise that patient care is provided in the context of organisations, not in isolation”
My study also examined the level of self-compassion (SC) in the nurse sample. Self-compassion is as it sounds; that is, just as you would be kind and supportive to a friend who is struggling and feeling overwhelmed, SC gives you an internal “voice” which acts as a source of resilience and emotional regulation, encouraging more empathic concern and compassion for oneself.
Significantly, my study revealed a correlation between low SC and the presence of CF.
In conclusion, it is crucial for health care organisations, such as the NHS and their leaders, to recognise that patient care is provided in the context of organisations, not in isolation.
Indeed, compassion and high-quality patient care can only be improved once the whole care system and environment is addressed, rather than finding fault at the individual level. The design of care environments and, the processes and culture of patient care provision need to recognise the existence of CF and how it can develop in nursing staff.
Threatening cultures, weak leadership, and an emphasis on task rather than process, offer a fertile substrate for CF. For nurses to be fully present, connected and compassionate with their patients, care environments need to encourage the self-compassion and well-being of their nursing staff, enhancing their ability to be resilient to CF.
Within compassionate organisations nurses can be offered an opportunity to provide the authentic compassionate patient care that is both expected of their profession and which they aspire to deliver.
After gaining a Degree in Nursing at the University of Birmingham, Kate Upton nursed in a variety of health care settings, followed by 13 years Nurse Lecturing back at UoB. Kate is currently a visiting lecturer at the Department of Medicine, Aston University Medical School, as well as a freelance lecturer and tutor.
Having recently completed a postgraduate study investigating Compassion Fatigue and Self-Compassion in Acute Medical Care Hospital Nurses, Kate is actively aiming to raise awareness of the study’s findings and recommendations to assist in improving the emotional and physical well-being of health-care staff.