Background

The term “compassion fatigue” was first coined by Joinson in 1992 when she described a unique form of burnout she observed among fellow healthcare providers in the Emergency Room. The term was later defined and expanded upon by Dr. Charles Figley in 1995 as “a combination of physical, emotional, and spiritual depletion associated with caring for patients in significant emotional pain and/or physical distress.” Such depletion may stem from long-term care of one or more patients who have experienced trauma, constant exposure to patients who relate traumatic experiences, or to care of patients who relate discrete traumatic events.   Compassion fatigue occurs when an individual experiences both Secondary Traumatic Stress (stress resulting from helping or wanting to help a traumatized person) and burnout. Inherent in this definition is recognition that a caregiver’s experience of empathy can reach a point where continued exposure to the stressor may overtax the caregiver’s ability to effectively manage the stress.

Trainees and attending physicians are at risk for compassion fatigue due to the long hours they work and the intensity of their patient care experiences. As an example, in one study, up to 90% of new physicians between 30-39 years old reported compassion fatigue and noted its negative effects on their family life.

Despite the ubiquity of compassion fatigue, it is rarely addressed or discussed.   In a maladaptive attempt to develop resilience against compassion fatigue, healthcare providers often work to dissociate themselves from the traumatic events by objectifying those for whom we care. We describe, remember, or identify patients by disease or symptom rather than as a fellow human being. Regrettably and paradoxically, this very act can both potentiate our own compassion fatigue while modeling maladaptive behaviors to our trainees. By contrast, open discussion with colleagues; reflection and self-awareness; desensitization from distressing situations in which the healthcare provider is likely to encounter in the future; self-care; and stress management techniques are likely to decrease the risk of compassion fatigue.  With this in mind, this session is designed to help you:

• recognize events that may trigger compassion fatigue
• recognize signs and symptoms of compassion fatigue, and
• recognize the need for reflection and self-care to prevent or recover from compassion fatigue

Assignment

1. Reflect on a situation in which your reaction to witnessing, being a part of, or hearing about the traumatic events experienced by others resulted in your feeling symptoms of compassion stress and/or compassion fatigue. This could be in a wide variety of settings and with a wide array of individuals including patients, patient family members, colleagues, your own family members, or friends. Come to the group with notes that:
   1.  Describe the situation. Set the stage and be prepared to be specific to help the group fully appreciate the scenario. In this process, consider whether you have had previous experiences related to either (a) similar stressors or (b) similar reactions to different stressors.
   2. Examine how you coped with this situation, how that impacted you and your interaction with others in the moment, and how the experience impacted ongoing interactions in this relationship and/or other relationships in your life..
   3. Describe insights you have gained about yourself by reflecting on this situation/role and how you think it will impact your future identification and management of emotions that arise after patient care experiences or traumatic life events.
   4. Describe how this reflection and/or the supplemental resources have affected your thinking about compassion fatigue and self-care. Discuss how it will impact your future interaction with patients
2.  Review one or more of the resources below prior to the small group discussion and come prepared to discuss your reactions or thoughts to them. Be prepared to discuss if they were insightful to either of the scenarios that you discuss below.