Ian R Barker: Compassion fatigue—the neglected problem

ian_barkerCompassion fatigue—also known as vicarious traumatisation results in a gradual reduction in compassion over time. It is more common in those dealing with trauma or caring for close relatives (1). If often presents as hopelessness, decrease in experience of pleasure, constant stress and anxiety, and a pervasive negative attitude (2). Interestingly, it has been claimed that as a result of the media portraying constant tragedy the general public has been somewhat more cynical and resistant to suffering, a form of compassion fatigue.

Such desensitisation and loss of compassion was noted in the Francis report as one of the causal factors at Mid Staffordshire hospital where hundreds of patients died as a result of poor medical care. In one study 85% of Emergency Department nurses met the criteria for compassion fatigue (3). We must improve understanding of the impact of this condition and its potential prevalence, and efforts made to avoid brushing it under the carpet or assuming that the problem is intrinsic rather than as a consequence of their work. The government would be better to recognise this problem and deal with it constructively rather than introducing criminal sanctions such as “wilful neglect,” which aims to punish people rather than try to understand why they have lost compassion in their work.

Risk factors include:

• Those who are overly conscientious or perfectionists
• Those with low levels of social support
• Those with high levels of personal stress
• Organisational factors such as a culture of silence

Figley co-author of Compassion Fatigue reports of the “cost of caring,” those working with trauma patients often feel for their own safety as do those who work with victims of crime (4). Ironically those who have the largest capacity for empathy tend to be more at risk.

So how can it be prevented? Stress reduction has been shown to be effective at reducing the risk of compassion fatigue, regular breaks from work, exercise and recreational activities can all help. Mother Teresa recognised the problem and advocated nuns taking a break every four years (5). In addition having a strong social network can promote a positive outlook and further reduce the risk of developing fatigue stress. The importance of awareness should not be underestimated, as a doctor working in the NHS for 11 years, I have yet to have any formal or informal training on compassion fatigue, how can we prevent it if we are not even aware of its existence?

It remains fundamental that such conditions are not only recognised with healthcare services but preventative measures taken. We must move away from scapegoating healthcare professionals and realise the traumas of their job. If we are to promote compassion in healthcare we must first recognise the emotional implications of caring, only then can we truly ensure compassion in all aspects of healthcare.

1) Najjar N et al: Compassion fatigue: A review of the research to date and relevance to cancer-care providers: Journal of Health Psychology: 2009: 14 (2): 267-277
2) Babbel S: Compassion Fatigue—Bodily symptoms of empathy: Psychology Today: July 2012
3) Hooper C et al: Compassion satisfaction, burnout and compassion fatigue among emergency nurses compared with nurses in other selected inpatient specialties: Journal of Emergency Nursing: 2010: 36(5), 420-427
4) Figley C: Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized: 1995: Brunner/Mazel
5) Haggard P: Secondary traumatic stress: New ethics journal: September 2013: 9-14

Ian R Barker is an anaesthetic consultant at Imperial Collage Healthcare NHS Trust. 

Competing interests: None declared.