Compassion Fatigue in the Long-term care setting.

Introduction

Compassion fatigue (CF) is a concept that describes the physical and emotional exhaustion that affects helping caregivers such as nurses over time.  It is directly associated with gradual desensitization to patient’s needs,   increased medical errors, decreased quality of care, high anxiety and depression rates, and high-stress levels. Compassion Fatigue in the Long-term care

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Existing evidence suggests numerous strategies to address CF among nurses working with patients who require long-term care such as CF educational programs to increase awareness about CF, providing supportive work environments, organizational support, training, and resiliency programs among others. The purpose of this annotated bibliography is to identify techniques, predictors, and interventions to decrease CF resulting in efficient and safe care.Compassion Fatigue in the Long-term care setting.

Research Question: Do CF education programs and supportive work environments’ (flexible work schedules, adequate staffing and time-offs, and rotational-assignments) decrease CF among nurses working in long term care settings?

Annotated Bibliography- Compassion Fatigue in the Long-Term Care Setting

Kolthoff, K. L., & Hickman, S. E. (2017). CF among nurses working with older adults. Geriatric Nursing, 38(2), 106-109.

Kolthoff & Hickman (2017) emphasize the need to build a highly supportive environment that prevents compassion fatigue (CF) and professional burnout but sustains compassion satisfaction (CS). Compassion Fatigue in the Long-term care setting.Such an environment can be built through organizational philosophies, policies, and procedures that support staff to balance personal needs and work such as rotational assignments, time offs, flexible schedules, and education benefits. Organizations can also develop and implement trauma-informed initiatives and CF resiliency programs to increase providers’ knowledge on the mental, physical, and emotional effects of CF.  Nurse leaders should also conduct periodic CF screening and rescreening for early identification and intervention of CF. Kolthoff & Hickman (2017) recommend the Professional Quality of Life 5 Scale (PQLS) scale as an appropriate tool to conduct such assessments whose outcomes can be used to adjust and re-evaluate self-care plans.Compassion Fatigue in the Long-term care setting.

Ruiz-Fernández, M. D., Pérez-García, E., & Ortega-Galán, Á. M. (2020). Quality of Life in Nursing Professionals: Burnout, Fatigue, and Compassion Satisfaction. International Journal of Environmental Research and Public Health, 17(4), 1253.

The study by Ruiz-Fernández, Pérez-García & Ortega-Galán (2020) reveals specific work-related and socio-demographic characteristics associated with CF and CS. The most significant correlation is that of age and CF where older nurses or more experienced nurses have higher CF and lower CS levels. In comparison, younger nurses or nurses who are less experienced have low CF and higher CS levels.Compassion Fatigue in the Long-term care setting. Although interventions to address CF should focus on all nurses, older nurses can benefit more from interventions that aim at enhancing empathy, self-compassion, and compassion skills such as compassion programs and mindfulness. These programs reduce the symptoms of depersonalization, depression, and emotional burnout and increase high self-care levels, skills for emotional regulation, and enhance effective communication skills.Compassion Fatigue in the Long-term care setting.

Wu, S., Singh-Carlson, S., Odell, A., Reynolds, G., & Su, Y. (2016, July). CF, burnout, and compassion satisfaction among oncology nurses in the United States and Canada. In Oncol Nurs Forum (Vol. 43, No. 4, pp. E161-E169).

Wu et al (2016) emphasize the essence of supportive work environments to address CF. Supportive environments can be developed through responsible workforce designs that enhance effective leadership styles and teamwork which strengthen the quality of nurse-patient relations whose greatest predictor is time. Wu et al (2016) also recommend that nurses working with patients who require long-term care should be educated on specific tools to assess and care for themselves. These tools help to detect and manage physical and psychological consequences which can result in better patient outcomes and high job satisfaction.Compassion Fatigue in the Long-term care setting.

Yu, H., Jiang, A., & Shen, J. (2016). Prevalence and predictors of CF, burnout and compassion satisfaction among oncology nurses: A cross-sectional survey. International Journal of Nursing Studies, 57, 28-38.

Yu, Jiang & Shen (2016) suggest the need for nurse educators to conduct on-job training for nurses working in long-term care settings to increase their awareness of the negative impacts of working with long term care patients and the potential for CS. Compassion Fatigue in the Long-term care setting.This training should emphasize providing patient-centric care and the significance of cognitive empathy. In healthcare settings, nurse administrators should support, design, and implement target-specific interventions for nurses at high risk of CF such as those working in emergency care settings, nursing homes, and long-term care settings who present with passive coping strategies, and neuroticism. According to Yu, Jiang & Shen (2016), improving work environments through diverse positions, flexible work shifts, and active coping strategies can help to address CF by lessening the long-term burden of compassionate care.Compassion Fatigue in the Long-term care setting.

Wentzel, D. L., & Brysiewicz, P. (2018). A survey of compassion satisfaction, burnout, and compassion fatigue in nurses practicing in three oncology departments in Durban, South Africa. International journal of Africa nursing sciences, 8, 82-86.

The study by Wentzel & Brysiewicz (2018) showed increased levels of CS among healthcare providers which could be attributed to self-care, good social support networks, and increased personal resilience. The factors could lessen the stressful events associated with caring for patients and act as a defense mechanism against CF and burnout. Wentzel & Brysiewicz (2018) also noted that more experienced nurses had a high burnout and CF risk while those working in hospice care and were less experienced had low CF and burnout levels. This could be attributed to the fact that more experienced nurses developed an emotional connection with patients and felt trapped in their job.Compassion Fatigue in the Long-term care setting.

Pfaff, K. A., Freeman-Gibb, L., Patrick, L. J., DiBiase, R., & Moretti, O. (2017). Reducing the “cost of caring” in cancer care: Evaluation of a pilot interprofessional compassion fatigue resiliency program. Journal of Interprofessional Care, 31(4), 512-519.

The main suggestion by Pfaff et al (2017) to address CF  is creating a  compassionate,  safe and supportive environment that abandons hierarchies, makes nurses feel welcome, and organizational support. The researchers further recommend implementing CF programs using a facilitator as a change agent.  A key consideration of CF programs is conducting regular screening and self-assessments of work-related stress using reliable assessment tools. Alternatively, Pfaff et al (2017) recommend conducting off-site programs such as retreats that provide time for self-care and reflection. Organizational leadership should be committed to foster a collaborative culture of practice and prioritizes the well-being of employees such as interprofessional education, a clear vision, resource allocation, and strategic planning.Compassion Fatigue in the Long-term care setting.

Yılmaz, G., & Üstün, B. (2018). Professional Quality of Life in Nurses: Compassion Satisfaction and Compassion Fatigue. Journal of Psychiatric Nursing/Psikiyatri Hemsireleri Dernegi, 9(3).

Yılmaz & Üstün (2018) observed that supportive and educational interventions increase CS and reduce CF and burnout. Such interventions include physical and mental relaxation, organizational shift changes and support, changes in the processes of care, increased communication skills, and changing work schedules. Nurses working in long term care settings should also be educated on the symptoms of CF for the early detection of CF.Compassion Fatigue in the Long-term care setting. This knowledge is important for nurses to refine their resilience, increase self-care and personal awareness, promote assertiveness, the ability to say no, and deepen spirituality. Implementing CF programs particularly transactional model‐based education programs, is also an important approach to address CF. These programs should train nurses on effective meditation and breathing techniques, self-awareness and energy management, relaxation, and healthy diets.

Pehlivan, T., & Güner, P. (2018). Compassion fatigue: The known and unknown. Journal of Psychiatric Nursing/Psikiyatri Hemsireleri Dernegi, 9(2).

Pehlivan & Güner (2018) found burnout, moral distress, and compassion satisfaction as the major concepts related to CF. Burnout is associated with the outcomes of desensitization, emotional exhaustion, and low personal achievement and occurs with prolonged exposure to emotionally challenging situations. It is closely related to CF   since it also results in physical, psychological, and physical exhaustion. Moral distress involves a violation of ethical obligations and personal values and may worsen further with CF. CS    is a positive feeling that occurs when nurses feel that they have successfully maintained a process to assist other individuals and has been associated with decreased harmful outcomes of burnout and CF.Compassion Fatigue in the Long-term care setting.

Nightingale, S., Spiby, H., Sheen, K., & Slade, P. (2018). The impact of emotional intelligence in health care professionals on caring behavior towards patients in clinical and long-term care settings: Findings from an integrative review. International journal of nursing studies, 80, 106-117.

The findings of the study by Nightingale et al (2018) demonstrate that there is a direct correlation/relationship between emotional intelligence (EI), ability, and caring/CF. The researchers, therefore, recommend that, when recruiting nurses to work with long-term care patients, organizations should consider EI levels. Organizations should also implement CF programs that purpose to develop EI skills as this promotes good outcomes for both patients and nurses.

Upton, K. V. (2018). An investigation into compassion fatigue and self-compassion in acute medical care hospital nurses: A mixed-methods study. Journal of Compassionate Health Care, 5(1), 7.

Upton (2018) recommends that healthcare institutions must provide supportive, healthy, and compassionate environments that support the emotional well-being of nurses. Supportive environments include training and education to increase awareness of the symptoms, causes and reinforcing behaviors and cognitions of CF. Nurse leaders can help to encourage a self-compassionate workforce through uninterrupted and safeguarded breaks that allow staff to recharge and refuel, and flexible work shift patterns to balance home and work life. The most significant factor that influences the vulnerability and distress of nurses to CF is being undervalued by patients who have unrealistic expectations. To overcome this, organizational managers must adopt strategies and behaviors that allow staff to develop the appropriate CS levels, rewarding, acknowledging, and celebrating any extraordinary work done by nurses through organizational cultures that demonstrates appreciation and value of nursing staff.Compassion Fatigue in the Long-term care setting.

Gallardo, R., Rohde, D., Shaughnessy, M., Messer, M. A., Reyes, M. E., Marasigan, J. P., & Ghonsooly, B. (2018). Personality predictors of compassion fatigue in long-term care environments. North American Journal of Psychology, 20(3), 481.

Gallardo et al (2018) explain that major predictors in the work setting that may indicate CF in a direct caregiver are negative behavior traits such as neuroticism, irrational ideas, and inability to control impulses. The researchers correlate CF with work experience by emphasizing that, nurses with more work experience in long term care are at a higher risk of CF and causing unnecessary harm to patients. When unaddressed, CF can progress to burnout which negatively impacts outcomes and job satisfaction. The researchers recommend the essence of nurses working in long-term care settings to monitor the personality traits of direct caregivers and the levels of neuroticism and extraversion. Nurse administrators should conduct self-assessments to determine the impact that they may have on staff.Compassion Fatigue in the Long-term care setting.

Weidlich, C. P., & Ugarriza, D. N. (2015). A pilot study examining the impact of care provider support programs on resiliency, coping, and compassion fatigue in military health care providers. Military medicine, 180(3), 290-295.

According to Weidlich & Ugarriza (2015), the most important concepts for work-related burnout and CF whose secondary effect is professional work performance are coping skills and resiliency. Therefore, the best strategy to address CF and burnout is by improving resilience but this must extend beyond healthcare providers in the military to include nurses working in high-stressed settings such as EDs, ICUs, ORs. To prevent CF, burnout, and ineffective coping from persisting, Weidlich & Ugarriza (2015) recommends that, nursing programs should prepare nursing students on how to manage on-job stressors and increase performance. Alternatively, resiliency training should be incorporated in nursing curricula to prepare nurses no how best to manage stress, decrease CF, burnout, and CS.Compassion Fatigue in the Long-term care setting.

Ortega-Campos, E., Vargas-Román, K., Velando-Soriano, A., Suleiman-Martos, N., Cañadas-de la Fuente, G. A., Albendín-García, L., & Gómez-Urquiza, J. L. (2020). Compassion Fatigue, Compassion Satisfaction, and Burnout in Oncology Nurses: A Systematic Review and Meta-Analysis. Sustainability, 12(1), 72.

Ortega-Campos et al (2020) found that the main factor that affects nurses who work in oncology units with regards to CF is excess emotional workload due to constant situations associated with suffering, pain, and death of patients. Nurses at high risk of CF are less flexible psychologically and more self-judgmental. Mindfulness is the best solution to decrease burnout and CF by helping nurses to decrease emotional tension and perceived stress from their daily routines. Mobile-based technologies can be used to deliver mindfulness and increase job satisfaction, work commitment, creativity and innovation, and self-efficacy. According to Ortega-Campos et al (2020), active coping strategies such as daily meditation also decrease the effects of CF   and increases CS by decreasing anxiety and stress, great intelligence, inner peace, greater compassion, and QoL. Thus, promoting meditation and mindfulness also helps to promote CS and prevent the development of burnout and CF. Compassion Fatigue in the Long-term care setting.

Xie, W., Wang, J., Okoli, C. T., He, H., Feng, F., Zhuang, L., & Jin, M. (2020). Prevalence and factors of compassion fatigue among Chinese psychiatric nurses: A cross-sectional study. Medicine, 99(29).

Xie et al (2020) found moderately high levels of burnout, CS, and secondary traumatic stress among psychiatric nurses. The researchers propose healthy lifestyles (regular exercise and high quality of sleep), increased job satisfaction, and family support (children and harmonious and stable marital status) to promote high levels of CS, decrease secondary traumatic stress and burnout. In clinical nursing practice, nursing managers can formulate and implement target interventions and coping strategies to address CF and promote the psychological health of nurses.Compassion Fatigue in the Long-term care setting.

Conclusion

The findings of this annotated bibliography revealed that implementing CF education programs and ensuring supportive work environments through rotational assignments, time offs, flexible schedules, and education benefits decrease CF among nurses caring for patients in long term care settings. These findings will be used by the author to implement CF education programs and training in routine care. The programs will focus on increasing provider awareness of the symptoms of CF for early detection. Training will purpose to encourage nurses to refine their resilience, increase self-care and personal awareness, promote assertiveness, the ability to say no, and deepen spirituality.Compassion Fatigue in the Long-term care setting.