compassion fatigue among oncology nurses
Background: Recognizing the dark, depleting side of caregiving may provide insight on why nurses leave the field, thus contributing to the national nursing shortage. The psychological phenomenon of compassion fatigue provides insight to the nursing profession’s emotional burden by identifying the effects of secondary traumatic stress (witnessing the trauma of patients and internalizing their pain), burnout (workplace environment conflict), and low compassion satisfaction (not feeling an intrinsic reward when connecting to patients). Currently, oncology nurses have the highest rates of turnover and the highest rates of compassion fatigue (CF) when compared to any other nursing specialty. There is also a significant lack of coping-strategy education and mental health resources for oncology nurses. CF causes negative psychological, physiological, and social manifestations and is correlated with a decrease in job performance, increased risk of error and lower patient satisfaction. In order to establish effective interventions, we must first understand the unique experiences of CF among oncology nurses.
Method: Secondary data analysis. During semi-structured, in-depth interviews, five in-patient oncology nurses were asked to describe their experiences with compassion fatigue and how their experiences impacted their health, work performance, and personal lives. Thematic analysis was utilized to identify shared psychological, somatic, emotional, social, and job performance consequences of compassion fatigue.
Results: Six themes were identified. #1: You’re just going to die. Caring for patients with high mortality rates caused nurses to depersonalize their patients, assuming all would die. # 2: All your emotions are spent. Symptom clusters included feeling emotionally depleted, unable to give, collective unit sadness, and the inability to feel “normal”. # 3: I still cry about him. Participants voiced feeling haunted by the death of certain patients, usually long-term, young patients with children. #4: This could happen to me or mine. Participants personalized cancer, and assumed that every ailment among self or others was cancer. #5: I just need to go to bed. Physiological symptoms included exhaustion, anger, frustration, and sobbing. #6: You don’t always get out of it what you put into it. Sources of frustration and resentment stemmed from lack of time, high patient loads, ethical dilemmas, and conflicts with oncologists. Examples of healthy and harmful coping mechanisms and high compassion satisfaction were also identified. Lastly, many oncology nurses did not intend to enter the field, but rather “oncology picked me”.
Implications: Oncology nurses may be at significant risk of compassion fatigue. It is essential that education programs be provided for nurses working in high-risk settings. Improved education may help oncology nurses to recognize risk factors, obtain support, and ultimately lessen the attrition stemming from unresolved compassion fatigue.