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Self care - Striking a balance

Practising good self care is critical if healthcare professionals are to avoid experiencing ‘compassion fatigue’, writes Karen Brennan

Whether it’s nursing on the ward, in a palliative care setting, in the community, or in a busy emergency department, the need for nurses to care for themselves in order to stay well is becoming more important than ever. Although the role of nurse brings with it a high degree of job satisfaction, it is frequently challenging.

At various stages of a nurse’s career, their role will become increasingly difficult, stressful, draining and emotionally upsetting. While a certain amount of these challenges may be experienced in the cut and thrust of modern nursing, when these symptoms become chronic, it can lead to what is known as ‘compassion fatigue’.

This article outlines some of the theory on ‘compassion fatigue’ and also offers helpful practical tips and advice for nurses who are experiencing its effects. Education, self-care strategies and skills training can make a world of difference in a climate of continued cuts and stretched resources.

Although the concept has been around for a long time, the phrase ‘compassion fatigue’ is generally attributed to one of the main theorists in the area, Charles Figley. 1 However, it was in fact a nurse, Carla Joinson who, in 1992, first used the phrase in a nursing magazine in relation to her work with staff in a busy emergency department.2 She looked at the effects of compassion fatigue, which can lead to burnout in those working in caregiving roles. Subsequent research in the area has yielded much promise in terms of advice for alleviating its effects.

So what exactly is compassion fatigue? Grunfeld simply described it as “the cost of caring for others”.3 Being present with patients and their families on a daily basis, witnessing their suffering and dealing with their needs can be very demanding emotionally.

Compassion fatigue can have far reaching effects on a healthcare worker’s personal as well as professional life. It can change how one looks at life, and in turn affect their work with patients.

Symptoms of compassion fatigue can develop quickly or more gradually. They can include deep physical and mental tiredness and a reduction in a nurse’s capacity to empathise with their patients and those around them. It can also involve a deterioration in relationships with patients’ families, other members of staff and even the nurse’s own personal relationships outside work.

Physical symptoms typically include lethargy, exhaustion, stomach problems, headaches and back pain. Behavioural and emotional effects include insomnia or oversleeping, anxiety, isolation, cynicism, poor concentration, loss of optimism, loss of motivation, lack of interest in personal appearance, becoming accident or error prone, being reactive, angry, depressed and also over-consuming nicotine, alcohol, drugs or food.

Unfortunately, compassion fatigue can also be accompanied by desensitisation to the suffering of others: it attacks the very reason why caring people decide to work in a caring role in the first place.

From an organisational perspective compassion fatigue can result in decreased efficiency, poorer job performances, low morale, higher rates of sick leave (hiking the cost of agency hire) and staff attrition (increasing recruitment costs). The 2005 Canadian National Study on Nurses Health4 found that almost one-fifth of nurses reported that mental health issues had made their workload difficult to handle in the previous month. Fifty percent of stress-related time off was attributed to physical illness and 10% to mental health problems.2

Viewing compassion fatigue, as many do, as just an occupational hazard can cause the problem to go unrecognised and prevent it from being dealt with constructively. Meanwhile, nurses who may be suffering its effects continue to suffer silently.

Some people are anxious about bringing the matter to their supervisors for fear that it will be seen as a weakness. They may also fear that they will be perceived to be ‘not coping’ or ‘not suited’ to nursing. However, the opposite is true in the majority of cases. Figley noted that it is the nurses who care the most and are very compassionate and empathetic in their work that are at the greatest risk of compassion fatigue.1 It is because they are so good at their jobs that this may be the case.

The irony of compassion fatigue is that it drains the individual of the self-interest needed to provide proper self care. This can lead to negative self evaluations, particularly if it is perceived that others are managing better. Often those suffering from compassion fatigue may over work and under self care, starting a downward spiral. As previously mentioned, this can be a gradual process or swift and acute. It frequently occurs in response to external stressors, which can make existing challenges at work feel more difficult.

It is important to note that compassion fatigue is a set of symptoms and not a disorder. It is likely that most nurses and midwives will have experienced some of its symptoms at one time during their career.

Developing a culture of communication that promotes understanding is key to preventing compassion fatigue. Awareness about the condition is the first step, followed by the development of skills on both a personal and professional level to achieve balance and retrieve a sense of well-being and job satisfaction.

For busy nurses, becoming knowledgeable and developing awareness of trigger points is great for getting back to being a healthier caregiver. If exhaustion is experienced after work on a daily basis, accompanied by unhealthy consumption, lack of interest in self care or other symptoms, it may be time to explore the cause of the problem.

US-based nursing consultants Lombardo and Eyre have assisted nurses to overcome compassion fatigue through skills training.5 This includes helping trainee nurses to develop interpersonal and communication skills with others, and fostering greater self-awareness. Skills development is important for understanding and treating the symptoms.

It is important to note that compassion fatigue can be extremely draining and some nurses find themselves at a loss as to what is making them feel so unwell. Becoming aware of how you feel in certain situations (for example before meetings, on the way to work, or working with certain patients) can help you to identify trigger points. Awareness also gives you space to develop strategies to deal with these issues.

The organisation, ‘Self Care for Carers’, in Dublin facilitates educational courses in compassion fatigue awareness, both in-house, on behalf of organisations who wish to run these for their staff, and as open public courses.

The organisation recognises a change in people’s attitudes when they begin to understand the causes and effects of the condition on their life and work.

Self Care for Carers trains nurses and other healthcare staff in key areas of healthier caregiving to build towards a process of person-centred sustainable self-care practices.

Self-care planning – how you recharge your batteries – is critical to this. This includes practising exercise, good nutrition, relaxation time, creative or play endeavours, time with friends and family and time alone. Boundary management is also very important, particularly if a nurse has a tendency to become over involved with patients. Healthy distancing is vital and can be achieved through resiliency and the development of self-care skills.6

As the old saying goes ‘the best things in life are free’, so learn to value your free time and say ‘no‘ to unsuitable requests on your personal time. Become empathetic towards yourself and be kind to your own needs and wishes. Respect your own boundaries, your right to health, and your need for enjoyment and relaxation.

Humans have a natural heartfelt response to someone who is in pain. Good nursing practice flourishes when the relationship between the patient and nurse is caring and empathetic. Within this nursing dynamic, compassion fatigue can affect nurses who care to a high degree about their patients. Building skills in self care is an important step towards sustainable healthy caregiving which benefits the nurse and the patient alike.

Karen Brennan will run a workshop, entitled ‘Boosting Your Self Care in Challenging Nursing Roles’, in INMO HQ on February 26. This is a practical, person-centred day of learning on how to optimise your self-care to be resilient, to stay well, and to thrive in your nursing role. It is suitable for all nurses and midwives, but particularly for those working in acute areas such as palliative care, oncology, intensive care units etc.

See page 39 for more information. For more details on developing healthier care giving skills and resources, see www.selfcareforcarers.ie

Karen Brennan is the director of Self Care for Carers in Dublin


  1. Figley CR. Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York: Brunner/Mazel, 1995
  2. Joinson C. Coping with compassion fatigue. Nursing 1992; 22 (4): 16-122
  3. Grunfeld E. Cancer care workers in Ontario: prevalence of burnout, job stress and job satisfaction: CMAJ 2000; 163(2): 166-169
  4. Canadian Institute for Health Information: National Survey of the Work and Health of Nurses 2005; 83-003-XPE
  5. Lombardo B, Eyre C. Compassion Fatigue: A Nurse’s Primer. OJIN: The Online Journal of Issues in Nursing, 2011); 16(1); Manuscript 3
  6. Neff K. Self Compassion: Stop Beating Yourself Up and Leave Insecurity Behind, 2011; 1st Ed. William Morrow
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