Compassion Fatigue in Emergency Nursing



Running head: COMPASSION FATIGUE IN EMERGENCY NURSINGCompassion Fatigue in Emergency NursingJessica BerlinUniversity of Central FloridaCompassion Fatigue in Emergency NursingEvery shift in the emergency department (ED) brings new challenges for nursing staff. New patients arrive every minute; some more acute than others, but all deserving of a caring and concerned nurse. A term synonymous with nursing is compassion. It is through the everyday challenges associated with emergency nursing, that the term compassion fatigue (CF) was developed. CF is a state of exhaustion that stems from the repetitive exposure to ED overcrowding, trauma, unrealistic patient expectations and the general chaos, physical and emotional stresses associated with caring for patients in distress (Flarity, Gentry & Mesnikoff, 2013; Sánchez, Valdez & Johnson, 2014). For example, a patient arrives to a nurse, already caring for 4 other patients, with the complaint of fatigue and weight loss. This patient is later diagnosed with cancer. The patient and nurse both cry together, and the nurse finds herself consumed with the care and concern for her cancer patient. Inevitably, a few hours later, the patient is admitted and the ED nurse must care for a new patient.Without seeing the full spectrum of the patient care process and outcome, nurses are becoming more susceptible to CF. This is especially true in trauma patients where it can take several years after the event to develop, as emergency nurses don't always see a resolution. It is also worth noting that CF has been closely related to post traumatic stress disorder (PTSD) and nursing burnout. Burnout is a state of exhaustion associated with work stress and emotional overload. Unlike PTSD and burnout though, CF is an overwhelming feeling of a need to help others to the point that it negatively affects the nurse or caregiver (Dasan, Gohil, Cornelius & Taylor, 2014; Flarity et al., 2013; Stewart, 2009).It is important to understand that CF is a normal response to stressful and traumatic situations, and tasks related to emergency nursing which have led to the psychological and emotional problems associated with CF (Stewart, 2009; Wentzel & Brysiewicz, 2014). Constant exposure to the trauma and chaos associated with the ED, is both professional and personally taxing on nurses. Through this repetitive exposure, nurses are more prone to develop a perceived lack of empathy and CF that might interfere with their ability to provide high quality nursing care (Flarity, Gentry & Mesnikoff, 2013). Nurses that suffer from CF have been shown to put the needs of their patients ahead of their own, leading to harmful emotional and physical effects (Wentzel & Brysiewicz, 2014). With each new day, compassion in emergency nursing is tested. After 12 hours, providers go home, go to sleep, wake up, and do it all again a mere 12 hours later, no questions asked (Stewart, 2009). The perception of nurse caring, has driven the quality and efficiency of the organization as a whole. In instances where compassion was lacking, patients reported a feeling of demoralization and general unhappiness (Buckley, 2014). CF not only affects individuals, but also affects the dynamic of the whole ED, patients included (Hooper, Craig, Janvrin, Wetsel & Reimels, 2010). The idea that caring, as opposed to skill and knowledge base, affects patient outcomes is frequently underestimated by healthcare staff (Buckley, 2014). On average, a typical visit to the ED lasts a mere 154 minutes, thus allowing only a brief time to make an appropriate impression as a healthcare provider (Fernandez-Parsons, Rodriguez & Goyal, 2013). Hospitals throughout the world are seeing emergency wait times upwards of four hours, making patients more irritable and more difficult to satisfy when they reach the nurse. With these increased wait times come increased stress on staff resulting in poor quality care. Because of this increased need for high quality care, hospitals are encouraging staff to be more sympathetic and caring, often times resulting in CF (Dasan et al., 2014).CF is an issue in healthcare today because, aside from intellect and skill, nurses must exhibit a sense of care and concern in order to maintain a quality relationship with their patients (Flarity et al., 2013). A key factor in predicting patient satisfaction is the perception of nurse caring (Hooper et al., 2010). As a result from the Affordable Care Act, healthcare organizations are focusing more than ever on their quality of care. Caring as a nurse is the core of the profession, and consequently, is the main component when it comes to the economic success of a facility. When patients feel inadequately cared for, health grades go down, in turn causing financial suffering for hospitals. When CF sets in, health grades suffer, therefore hindering hospital reimbursement due to a patient's dissatisfaction (Buckley, 2014). Since July 2007, hospitals participating in reimbursement programs are required to publically submit their Hospital Consumer Assessment of Healthcare Providers' Survey (HCAHPS) results. With patient census' growing, and reimbursement dependent upon patient satisfaction, nursing compassion is highly valuable in healthcare organizations. Understanding how emergency nurses respond to these demanding situations is key (Hooper et al., 2010).Recognizing the effects related to CF is important in determining how patients perceive their care delivered. When a nurse becomes so involved in providing care that he or she absorbs the patient's own pain, the nurse ends up putting the patient's needs before his or her own (Stewart, 2009). As a result, psychological and emotional problems develop within the nurse, ultimately affecting the patient and their perceptions related to their care (Wentzel & Brysiewicz, 2014). According to Flarity et al. (2013), 60% of nurses reported an occurrence of CF in their last month of working. Providers that suffer from CF, have the potential to develop and suffer from ailments like depression and anxiety that ultimately influence the operation of the unit (Stewart, 2009). The effects of CF and organizational distress have grown to include an increase in absences, nursing turnover, emotional distancing, a decrease in quality of care, lack of empathy, weight gain, insomnia, tension and anger, among countless other ill effects (Flarity et al., 2013; Nelson & Quick, 2013; Sánchez et al., 2014; Wentzel & Brysiewicz, 2014). Risk factors for CF include workplace environment, like EDs, and the amount of nursing experience each nurse possesses (Dasan et al., 2014). CF affects not only the patient in regards to the quality of nursing care delivered, but also with job retention and satisfaction levels for both patients and nurses alike (Fernandez et al., 2013). With costs upwards of $200,000 associated with recruiting and training new nursing staff, retaining employees is essential for nurse leaders. Nurse leaders are being faced with the difficult task of assessing and intervening with staff impacted by CF (Flarity et al., 2013). The key to managing these symptoms, are prevention, assessment and selecting the appropriate intervention technique (Sánchez et al., 2014). Understanding the importance of humor, storytelling and mediation will allow nurses the techniques needed to help with CF. Various models and educational programs have been designed around the issue of CF. Examples include the Accelerated Recovery Program that focuses on addressing the resolution of symptoms, the Mindfulness-Based Stress Reduction method that utilizes meditation and yoga to address symptoms, the Academy of Traumatology/Green Cross to promote self-awareness, and finally the Creative Compassion Model that teaches sufferers how to overcome adverse emotional responses to stress (Wentzel & Brysiewicz, 2014). Surveys like the ProQOL R-IV survey used in the Hooper et al. (2010) article, can also be used to assess levels of CF in ED nurses. The development of targeted strategies designed to aid individuals with CF and promote teamwork, may provide an increase in compassion satisfaction among patients and staff (Dasan et al., 2014). Programs have been designed to diminish the effects of CF, may be useful in addition to healthcare training initiatives (Flarity et al., 2013). Other interventions include counseling, debriefing sessions, journaling, massage, exercise, and even play like hula hooping and blowing bubbles has been suggested. As odd as hula hooping at work may seem, play requires the focus needed to release and let go from the problems which cause CF (Sánchez et al., 2014; Stewart, 2009). Healthy work environments should encourage morale boosting activities and resources available to combat the symptoms of CF. Nurses exposed to high stress environments like the ED, need ample time away from work, communication with friends and family, and support, both spiritually and emotionally, in order to balance work and social life (Hooper et al., 2010). Awareness and prevention, along with individual and organizational strategies should be encouraged in high stress departments, such as the ED (Stewart, 2009). By promoting self awareness and calling attention to this issue in EDs, signs and symptoms may be identified and managed early on. In doing so, nurse leaders can help form a balance between appropriate levels of stress and CF related to working in the ED. Involving staff in programs developed to combat CF will not only assist the individual suffering, but will also promote a healthy work environment (Hooper et al., 2010). No matter what the form of play or release the nurse chooses, nurses need the encouragement to separate themselves from the stressors associated with CF.As with all strategies designed to cope with CF, finding the balance between work and home life is important. Self care and awareness, along with employee assistance programs have been identified (Wentzel & Brysiewicz, 2014). By proactively addressing CF, leaders will be better prepared with handling patient satisfaction issues, recruitment, and will be able to identify the appropriate intervention techniques to allow nurses to maintain the appropriate levels of care and concern for their patients (Hooper, 2010). ReferencesBuckley, J. (2014). The real cost of caring or not caring. Journal of Emergency Nursing, 40(1), 68-70. doi:10.1016/j.jen.2013.09.006Dasan, S., Gohil, P., Cornelius, V., & Taylor, C. (2014). Prevalence, causes and consequences of compassion satisfaction and compassion fatigue in emergency care: A mixed-methods study of UK NHS Consultants. Emergency Medicine Journal, 0, 1-7. doi: 10.1136/emermed-2014-203671Fernandez-Parsons, R., Rodriguez, L., & Goyal, D. (2013). Moral distress in emergency nurses. Journal of Emergency Nursing, 39(6), 547-552.Flarity, K., Gentry, J., & Mesnikoff, N. (2013). The effectiveness of an educational Program on preventing and treating compassion fatigue in emergency nurses. Advanced Emergency Nursing Journal, 35(3), 247-258. doi:10.1097/TME.0b013e31829b726fHooper, C., Craig, J., Janvrin, D. R., Wetsel, M. A., & Reimels, E. (2010). Compassion satisfaction, burnout, and compassion fatigue among emergency nurses compared with nurses in other selected inpatient specialties. Journal of Emergency Nursing, 36(5), 420. doi:10.1016/j.jen.2009.11.027Nelson, D. L. & Quick, J.C. (2013).?Organizational behavior: Science, the real world, and you(8th ed.). Mason, OH: South-Western.Sánchez, C., Valdez, A., & Johnson, L. (2014). Hoop dancing to prevent and decrease burnout and compassion fatigue. Journal of Emergency Nursing, 40(4), 394-395. doi:10.1016/j.jen.2014.04.013Stewart, D. (2009). Casualties of war: Compassion fatigue and health care providers. MEDSURG Nursing, 18(2), 91-94.Wentzel, D., & Brysiewicz, P. (2014). The consequence of caring too much: Compassion fatigue and the trauma nurse. Journal of Emergency Nursing, 40(1), 95-97. doi:10.1016/j.jen.2013.10.009 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download