Compassion fatigue in 5 questions

Healthcare workers such as nurses, doctors and psychologists show an enormous amount of empathy and compassion every day. They give so much of themselves and do so with their heart and soul. But when the exposure to human suffering grows and grows, even healthcare professionals can reach their emotional limits.

“Compassion is not a bottomless reservoir”, says Anneleen Vanlook, prevention advisor for psychosocial aspects at Mensura. “You could compare it to a water jug, filling several glasses. If this jug is not refilled on time, it will be empty at some point. This can also happen to healthcare professionals. We give so much as care workers, that we become emotionally exhausted all of a sudden. The worst scenario is that we are unable to even muster empathy for patients or clients. This emotional burden is called compassion fatigue.

A lack of empathy is an extreme for of compassion fatigue in itself, says Anneleen. “Compassion fatigue usually manifests more innocuously, such as: losing your patience, becoming irritated with patients more easily, becoming distracted when talking with clients, or avoiding contact with certain patients.  As healthcare professionals, it is important we recognise and acknowledge these signs and make time for our own needs to prevent it from getting worse.

There are several possible underlying causes, but the fundamental issue is usually the same: high exposure to human suffering. “Various factors can provoke this” explains Anneleen. “Issues such as high caseload, difficult and complex causes, a feeling of powerlessness or a hopeless situation like a palliative patient. Don’t forget that many healthcare employees take on a caring role both at work and in their homes.”

“Healthcare professionals usually manage to recharge their batteries in time. If they can’t, however, the worst case scenario could be an inability to empathise, which is exactly what gives healthcare professionals fulfilment.”

“Empathy and compassion create a bond between healthcare professional and client. This empathic connection is essential for quality care, but also for the healthcare professional’s motivation and fulfilment. In this respect, empathy seems to be a double-edged sword. On the one hand, it is what drives healthcare professionals, but if we go beyond our limits we lose our empathic ability. Compassion fatigue strikes at the heart of a healthcare professional. If not addressed in time, compassion fatigue could eventually lead to serious health issues, such as depression or burnout.”

It is essential to be aware of the risks and acknowledge the problem. But there’s the rub: “Compassion fatigue has always existed but it’s a relatively unknown phenomenon. It’s a taboo subject, directly opposed to the essence of care. Healthcare professionals who show signs of compassion fatigue are often reluctant to talk about it for fear of being ‘a bad caregiver’. However, compassion fatigue is not abnormal and does not necessarily pose a problem, provided we recognise the signs in time, and make time for self-care. Raising awareness among employers in sectors susceptible to these issues is key concern.”

The shortage of (GP) doctors and the structural drop-out of nurses means that many hospitals and practices are under pressure. The demand for psychological assistance in our society is also peaking. Psychologists are struggling with waiting lists, the complexity of cases within Mental Health Care is increasing and many non-profit organisations can no longer cope with the resources provided by the government. At the same time, healthcare organisations are also focusing more on caring for their own workers.

Anneleen says: "Surely the corona crisis has partly broken a taboo around mental well-being. On the other hand, there is certainly still work to be done and it is not always easy for healthcare employers to free up resources for this kind of support. It is important that our vigilance does not falter and that employers do not lose sight of this workload but include it in their wellbeing policies. In the battle for talent, this too will increasingly come into play to remain an attractive employer within the healthcare sector as well."

Employees can take action themselves to prevent compassion fatigue, or to manage it responsibly. There are four specific factors that can protect healthcare professionals from compassion fatigue:

1. Self-care
   Caring for others starts with caring for oneself. As an organisation, have an interest in the person behind the healthcare worker. Create space for managers to monitor their team members in one-to-one meetings. This allows them to help watch over the boundaries and self-care of each employee (maintain a realistic work schedule, monitor file loads, make time for relaxation and hobbies). Also, do not keep calling on the same colleagues to replace sick colleagues and provide compensation that benefits them too. 
    
2. Disconnection
   Creating mental and physical distance when needed - especially from the most stressful situations - is crucial. Disconnection means a healthy work-life balance and letting go of the patients’ problems when you get home. A ritual to end your working day may be useful. A short stroll, noting down remaining to-do’s for the next day, or a chat with a colleague might help.
    
3. A sense of accomplishment
   Healthcare professionals usually achieve a sense of fulfilment from their job. This feeling of satisfaction may end up on the back burner due to high workload, complex cases and little progress. Encourage employees to reflect on interventions that are successful and to enjoy every achievement, however small. Try to allay a lack of perspective by shifting the focus from the outcome - recovery or healing - to the care itself: be proud of the support you provided today. Express your appreciation also as an employer by regularly mentioning this commitment. 
    
4. Social support
   It is essential for healthcare professionals to feel they are not in it alone, especially if they are confronted with suffering regularly. This support should be present both at home and at work. The encouragement from colleagues in particular is important to build a barrier against compassion fatigue. After all, colleagues know exactly what the job is all about. As such, encourage employees to gravitate towards each other for a chat or a talk about work. Invest in a pleasant team atmosphere, too and structurally make time for intervision moments. Teams that are built on trust have a lower threshold when it comes to asking for help.