Background: Compassion fatigue, with a cited prevalence up to 40%, may emerge as nurses continually connect with patients who are suffering and absorb the patient’s trauma or pain or when nurses care for traumatized patients and re-experience their patient’s traumatic events. Sometimes termed the “cost of caring (Figley, 1995), the emotional demand may lead to compassion fatigue if there is not an active plan to address, prevent, and manage the triggering factors and emotional response.
Objectives
The objective of this qualitative systematic review was to examine the available evidence on direct care nurses’ experience of compassion fatigue (CF) within any nursing specialty or care setting. The results of this completed systematic review serves as a launching point for programs to prevent or manage compassion fatigue.
Methods:
The standard JBI qualitative metasynthesis approach was used. A three-step search strategy across 12 databases was used to discover published and unpublished studies in English from 1992 to 2017. Included studies were assessed by two independent reviewers using standardized critical appraisal tools. Data was extracted using a standardized data extraction tool from JBI-QARI. Findings were aggregated and synthesized into categories then a final metasynthesis process to produce a comprehensive set of synthesized findings.
Results
Twenty-three studies produced 264 findings. These findings made up 18 categories based on similarity of meaning and subsequently developed four syntheses after meta-synthesis. The first metasynthesis was: The work and professional environment of nursing creates a risk for compassion fatigue. Findings clearly indicated that the ongoing demands of connecting with patients and family during vulnerable times while working within a “war zone like” atmosphere amidst rapid fire, high priority demands and high workload expectations can create high levels of stress which the nurse may respond feeling powerless and overwhelmed. Metasynthesis two, “In the heat of the moment- responding to distress” captures the need for coping and protection mechanisms against the stress of the work and the professional environment. Metasynthesis three, “Running on empty” is a metaphor for the profound, progressive, physical and emotional fatigue that leaves the nurse feeling as if they can’t go on and practicing while feeling disconnected and drained, like a gas tank on empty. The final metasynthesis, “Keeping compassion fatigue at bay” highlights the broader need for greater compassion fatigue awareness and both organizational and personal strategies that can be undertaken to prevent or manage compassion fatigue.
Implications
The major implications of this review are that compassion fatigue prevention and management must be brought to the forefront of nursing and that both personal and organizational coping strategies and adaptive responses are needed to keep the nurse balanced and renewed to be able to continue compassionate connection and caring. The findings are used to present a model of compassion fatigue which highlights factors contributing to its occurrence as well as interventions to take at different points to prevent and minimize the impact of compassion fatigue. The model can be used by organizations and individuals to actively plan for compassion fatigue prevention and management.
Conclusion
The systematic review had a high level of evidence based on CONQUAL analysis. A model depicting the findings illustrates the complexity of the phenomenon. The review has corroborated, clarified, and reinforced the knowledge about compassion fatigue- its antecedents, nurses’ response to stress, symptoms of compassion stress and compassion fatigue and bother personal and organizational coping measures that should be taken to remain resilient and free of compassion fatigue.
Keywords
Acute Illness, Qualitative Methods, Organizational and Workforce Issues