Essentials

Evidence-Based Strategies to Mitigate Compassion Fatigue Among Oncology Nurses

Reagan Payson

Cibele W. Webb

oncology nursing, compassion fatigue, self-compassion, coping strategies
CJON 2022, 26(6), 664-667. DOI: 10.1188/22.CJON.664-667

Oncology nurses are at higher risk for compassion fatigue (CF) than nurses working in other specialties. This increased incidence occurs as a result of the type of stress oncology nurses encounter in the workplace (e.g., caring for patients with life- threatening illnesses). Exacerbating this problem is the nurse’s lack of knowledge related to using adaptive coping strategies to mitigate the effects of CF. This article reviews information about CF and introduces the practice of self-compassion as a strategy to minimize the effects of CF in oncology nurses.

At a Glance

  • CF is a serious condition that negatively influences oncology nurses’ quality of life and ability to provide care, threatening patient safety and the nurse’s well-being.
  • Education about CF is needed to facilitate the implementation of adaptive coping mechanisms.
  • Learning self-compassion and implementing mindfulness-based programs, including therapy and self-care activities, have been shown to prevent CF and mitigate its effects.

Jump to a section

    C ompassion fatigue (CF) is a form of secondary trauma resulting from various forms of distress in the workplace, eventually diminishing many healthcare workers’ ability to provide empathy and compassion for their patients (Compassion Fatigue Awareness Project, 2021; Lightbody-Warner, 2020). Depending on their nursing specialty, nurses’ risk of developing CF ranges from 22% to 45% (Jin et al., 2021). Reports have estimated that 37% of oncology nurses have experienced the signs and symptoms of CF, establishing oncology as one of the specialties of health care whose practitioners are at higher risk for developing this form of secondary trauma (Finley & Sheppard, 2016). The leading causes of CF are work-related stress, ethical dilemmas in the workplace, and more years of nursing experience (Duarte & Pinto-Gouveia, 2017; Pehlivan & Güner, 2020; Wells-English et al., 2019). If left unaddressed, CF can lead to physical and psychological problems (see Figure 1), resulting in burnout and high job turnover rates (Jarrad & Hammad, 2020; Wells-English et al., 2019).

    FIGURE1

    Various psychological factors contribute to the development of CF. Oncology nurses may be empathetic toward their patients in an attempt to understand their patients’ perspectives. However, the work-related stress that oncology nurses may experience can detrimentally affect their ability to be empathetic, which makes them more prone to experience negative consequences associated with burnout and CF. With continuous exposure to trauma on the unit, including experiencing patients dying, being short-staffed, and feeling inadequate or not good enough during stressful and emotional situations, oncology nurses may become desensitized, judgmental, and less willing to meet patients’ needs because of the degree of personal stress in the workplace (Duarte & Pinto-Gouveia, 2017; Pehlivan & Güner, 2020; Wells-English et al., 2019).

    In addition, as a result of caring for patients at the end stages of life and assisting them and their loved ones in the grieving process, oncology nurses may experience grief (Jarrad & Hammad, 2020). More experienced oncology nurses have a greater susceptibility to suffering from CF because they may have encountered this difficult scenario more times than less experienced nurses. They may have increased exposure to situations associated with grief and may also be more experienced with ethical dilemmas in the workplace (Wells-English et al., 2019). Ethical dilemmas commonly experienced by oncology nurses may relate to patient and family decision-making regarding end-of-life care, including treatments the nurse may believe are unnecessary or inappropriate, such as providing aggressive treatment to a patient who is terminally ill. Another example of an ethical dilemma is an unsafe nurse–patient ratio, which impedes the nurse’s ability to provide safe and adequate care to patients. Dealing with ethical dilemmas can be discouraging and frustrating to oncology nurses, increasing their risk of CF (Duarte & Pinto-Gouveia, 2017; Good Therapy, 2020; Pehlivan & Güner, 2020; Wells-English et al., 2019).

    A common way that oncology nurses handle their stress is by relying on passive coping skills, which may result in harmful consequences (Lightbody-Warner, 2020). Passive coping skills are techniques that involve avoiding the problem rather than directly controlling the situation. Examples of passive coping skills include using medications or alcohol to manage stress, ignoring current feelings and emotions rather than addressing them, and using excuses such as “it’s just part of the job” to justify the work-related stress and trauma that nurses experience. To foster adaptive coping skills to prevent and mitigate CF, nurses can practice self-compassion and self-care (Lightbody-Warner, 2020).

    Implications for Nursing

    Self-Compassion

    Self-compassion is an evidence-based coping strategy that can be used to successfully mitigate CF (Neff, 2022). Self-compassion consists of three dimensions: self-kindness, sense of common humanity, and mindfulness (see Table 1). Self-compassion helps individuals develop a more extensive awareness of their own emotions and allows them to feel compassion toward themselves and others (Neff, 2022).

    TABLE1

    To develop self-compassion, oncology nurses can take the time to process their emotions. During a difficult situation, nurses can acknowledge their stress rather than ignore it. Nurses can engage in self-kindness rather than self-judgment by being mindful of conflicting and stressful feelings. For example, rather than saying, “I failed during my last shift because I felt such fear and sadness,” which is a self-judgment statement, the nurse could say a self-compassion statement, such as “The situation during my last shift became overwhelming, and although I felt fear and sadness, this doesn’t make me a bad nurse.” Nurses can acknowledge and accept their emotions and recognize that all nurses—regardless of their level of nursing experience or skill—can experience these emotions. This acceptance is related to a sense of common humanity and can lead to nurses seeking help to prevent or treat CF. By accepting these emotions and seeking help or using adaptive coping mechanisms, oncology nurses may become more mindful and able to develop self-compassion (Neff, 2022).

    Oncology nurses can use self-compassion to minimize CF. Practicing self-compassion can result in nurses no longer ignoring or believing they exaggerate their trauma-related emotions. Through self-kindness and a sense of common humanity, nurses can develop the ability to accept grief and stress as emotions that are part of the common human experience. Rather than viewing these feelings as troubling or as punishment, practicing self-compassion can facilitate the development of adaptive coping skills to help nurses lessen the effects of CF (Neff, 2022).

    Education

    Establishing a knowledge base about CF is an effective strategy because it enables nurses to recognize the signs and symptoms of CF. Early awareness empowers nurses to proactively seek help and manage CF more successfully (Pehlivan & Güner, 2020). Many healthcare employers offer counseling at no cost via employee assistance programs, and nurses can be encouraged to inquire about these benefits. Counseling may help nurses identify adaptive coping skills and discover new self-care techniques. Self-care activities include exercise, relaxation, journaling, hobbies, and complementary therapies such as yoga, music and art therapies, acupuncture, and more. Self-care activities involve anything that encourages feelings of joy and maintains a healthy buffer between an individual’s work life and personal life. By participating in healthy forms of self-care such as partaking in exercise and other hobbies, nurses can practice self-compassion and mitigate the signs and symptoms of CF (Good Therapy, 2020; Neff, 2022). Self-care encourages good health and allows the individual to tackle stress directly rather than passively.

    If not addressed, prolonged CF in nurses can potentially result in harm to patients. Lightbody-Warner (2020) stresses the importance of reminding healthcare workers that seeking help is acceptable. If left unaddressed, CF can result in nurses being unable to provide safe and high-quality care. As a result of the physical and psychological symptoms of CF, nursing care may be detrimentally affected (Wells-English et al., 2019). For example, nightmares and inability to sleep may cause fatigue, which can result in a nurse forgetting to mention important information during the shift-change report or failing to ensure that a patient’s bed is locked and can also impede the nurse’s ability to make rounds in a timely manner. The nurse’s impaired behavior can increase the patient’s risk of harm (Good Therapy, 2020; Lightbody-Warner, 2020; Wells-English et al., 2019).

    Implementing CF awareness programs (CFAPs) is a strategy that nurse managers can incorporate during new-hire orientation to increase nurses’ ability to recognize CF early, potentially preventing its harmful physical and psychological effects (Duarte & Pinto-Gouveia, 2017). Increased awareness of CF signs and symptoms can facilitate the introduction of adaptive coping mechanisms. CFAPs provide information and resources so that nurses are aware of their susceptibility to CF. The programs provide examples of healthy preventive measures to help avert CF’s harmful effects, including therapy, exercise, journaling, relaxation, and other forms of self-care. In addition, CFAPs teach nurses about cognitive empathy, which is described as nurses putting themselves in their patients’ shoes to determine the best course of action when following a care plan. Mindfulness-based interventions can support cognitive empathy (Duarte & Pinto-Gouveia, 2017). By identifying and applying mindfulness-based interventions that work for them early on, nurses can protect themselves from the harmful effects of CF (Duarte & Pinto-Gouveia, 2017; Good Therapy, 2020; Neff, 2022).

    Nurse managers can help nurses with feelings of CF by listening to their concerns and implementing pep talks before a shift and after challenging workplace situations. During a pep talk, managers can thank nurses for doing their best in providing care while prioritizing nursing care tasks. This helps nursing staff to maintain a positive outlook even during difficult circumstances. Listening to nurses’ feedback also allows early identification of increased workplace-related stress. It enables managers to find techniques to help improve the unit, as well as encourage the implementation of CF mitigation strategies, such as seeking counseling and emphasizing the importance of individual self-care (Pehlivan & Güner, 2020).

    TEST

    Conclusion

    CF is a serious condition that can negatively influence oncology nurses’ quality of life and ability to provide high-quality and safe patient care. Early recognition of signs and symptoms of CF can prevent workplace-related stress and burnout. Oncology nurses can be empowered to practice self-compassion, seek therapy as needed, and implement self-care activities to mitigate CF. Nurse managers can help minimize the effects of CF by listening to nurses and implementing strategies that reduce workplace challenges while praising nurses’ best efforts to provide compassionate, safe, and high-quality care to patients and families.

    About the Authors

    Reagan Payson, BSN, RN, is an RN at ThedaCare Regional Medical Center–Appleton in Wisconsin; and Cibele C. Webb, PhD, MSN, RN, CNE, is an assistant professor in the Department of Nursing at Saint Mary’s College in Notre Dame, IN. The authors take full responsibility for this content and did not receive honoraria or disclose any relevant financial relationships. Payson can be reached at reaganpayson.bsn@gmail.com, with copy to CJONEditor@ons.org.

    References

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    Finley, B.A., & Sheppard, K.G. (2016). Compassion fatigue: Exploring early-career oncology nurses’ experiences. Clinical Journal of Oncology Nursing, 21(3), E61-E66. https://doi.org/10.1188/17.CJON.E61-E66

    Good Therapy. (2020). Compassion fatigue. https://www.goodtherapy.org/blog/psychpedia/compassion-fatigue

    Jarrad, R.A., & Hammad, S. (2020). Oncology nurses’ compassion fatigue, burn out and compassion satisfaction. Annals of General Psychiatry, 19(1), 1–8. https://doi.org/10.1186/s12991-020-00272-9

    Jin, M., Wang, J., Zeng, L., Xie, W., Tang, P., & Yuan, Z. (2021). Prevalence and factors of compassion fatigue among nurses in China: A protocol for systematic review and meta-analysis. Medicine, 100(3), e24289. https://doi.org/10.1097/md.0000000000024289

    Lightbody-Warner, M. (2020). Compassion satisfaction and compassion fatigue: Helpful tips for our frontline workers. https://med.uth.edu/psychiatry/2020/10/29/compassion-satisfaction-and-c…

    Neff, K. (2022). Self-compassion guided practices and exercises. bit.ly/3DBKlQj

    Pehlivan, T., & Güner, P. (2020). Effect of a compassion fatigue resiliency program on nurses’ professional quality of life, perceived stress, resilience: A randomized controlled trial. Journal of Advanced Nursing, 76(12), 3584–3596. https://doi.org/10.1111/jan.14568

    Wells-English, D., Giese, J., & Price, J. (2019). Compassion fatigue and satisfaction: Influence on turnover among oncology nurses at an urban cancer center. Clinical Journal of Oncology Nursing, 23(5), 487–193. https://doi.org/10.1188/19.CJON.487-493