Combating Compassion Fatigue in Nursing


One of the main roles played by caregivers is expression of compassion and empathy towards patients. This aspect of patient care is as important as medication because it plays a key role in the recuperation process. Caregivers should connect emotionally and spiritually with patients. However, caring too much for the welfare of patients without focusing on personal wellbeing is perilous to caregivers. Compassion fatigue is the effect of showing too much compassion and empathy towards patients without making time for self-care activities (Bush, 2009). Compassion fatigues exerts pressure and pain on caregivers. Therefore, learning how to manage it is critical. Nursing work is one of the major causes of job stress and compassion fatigue because it is very demanding. Causes of compassion fatigue include patients’ physical and emotional needs, work challenges, and environmental stressors (Espeland, 2006). These factors make nurses tired, detached from work, depressed, and ineffective in providing patient care. Strategies for combating compassion fatigue include improving job satisfaction, developing stress coping strategies, involvement in stress relief courses and training programs, change of attitudes regarding patients and work, reorganization of caseloads, flexible working schedules, and self-care strategies.

Warning signs of compassion fatigue

The warning signs of compassion fatigue include poor self-care, excessive blaming, bottled up emotions, job dissatisfaction, absenteeism, conflicts with colleagues, depression, poor service, irritability, anger, and frequent headaches (Bush, 2009). Other symptoms include difficulty concentrating, recurrent nightmares, compulsive behaviors, and denial regarding the existence of problems. Vicarious traumatization refers to a form of compassion fatigue that occurs when nurses take care of traumatized patients and in the process get affected by the trauma (Espeland, 2006). Symptoms include difficulty maintaining personal relationships, loss of autonomy, intolerance to emotional situations, and recurrent memories of traumatic experiences (Chen, Lin, Wang, & Hou, 2009). Causes of compassion fatigue include response to job stressors, stressing work environments, prolonged exposure to traumatic events, and negative attitudes towards work and patients (Ekedahl & Wengstrom, 2008). The five major concepts of compassion fatigue include psychological, behavioral, cognitive, intellectual, and physical concepts.

Cognitive symptoms of compassion fatigue include low self-esteem, low self-worth, and helplessness (Espeland, 2006). Caregivers find it very difficult to concentrate on easy tasks and as such maintain high performance. They provide poor quality patient care that affects their feelings of self worth and self esteem. Low productivity and poor performance result in increased cases of absenteeism, low morale, and lack of motivation. Physical symptoms of compassion fatigue include increased susceptibility to infection, frequent headaches and migraines, exhaustion, and irregular sleep patterns (Bush, 2009). Other symptoms include muscle tension, digestive problems, and cardiac complications. These symptoms decrease productivity and performance. Psychological symptoms include depression, irritability, apathy, frequent feelings of the desire to abdicate work, and anger (Chen, et al. 2009). Caregivers experience frequent bouts of intense anger that affect their relationships with patients and colleagues. Other symptoms include anxiety, anger and resentment, poor focus, oversensitivity, mood swings, restlessness, and use of substances such as illegal drugs and alcohol (Bush, 2009). This problem originates from dealing with emotionally-demanding problems. Victims develop negative self images, become depressed, develop resentment, become cynic, and find difficulty in expressing compassion and empathy. Intellectual symptoms include poor judgment, difficulty concentrating on work related tasks, forgetfulness, and lack of interest in self-reflection. In addition, caregivers experience disordered thinking. One of challenges that caregivers face is emergency situations that require prompt decisions. In such situations, nurses suffering from compassion fatigue find it very difficult to make decisions that could save the lives of patients. Behavioral symptoms of compassion fatigue include excessive use of licit drugs and substances, frequent bursts of anger, absenteeism, social isolation, avoidance f clients, and frequent conflicts with partners in different relationships. In severe cases, caregivers might leave their professions. Absenteeism and isolation result from lack of motivation and emotional overload. Nurses might prefer to spend time alone in order to reflect and meditate.

Physical, emotional, and spiritual needs of caregivers

It is important to fulfill the various needs of caregivers in order to facilitate patient care delivery. The physical needs of caregivers include proper diet, exercise, relaxation, and means of fighting fatigue (Gupta, 2010). Proper diet is needed in order to provide the body with the energy required for both physical and mental performance. Proper diet includes a balanced diet, lots of water, low amounts of fatty and sugary foods, and low amounts of caffeine. Methods of fighting fatigue include sufficient sleep and frequent breaks to revitalize and release stress (Gupta, 2010). Physical exercise is an important aspect of caregivers’ physical needs because it lowers blood pressure, reduces anxiety, maintains good health, and helps caregivers to avoid being overwhelmed by responsibilities. The emotional needs of caregivers include means to express personal feelings and freedom to pay attention to one’s feelings. It is important for caregivers to identify and address feelings of anger, guilt, anxiety, sadness, frustration, grief, and depression in order to guarantee their wellbeing (Espeland, 2006). Caregivers need to express their feelings in order to avoid the buildup of emotions to levels that cause compassion fatigue. Finally, the spiritual needs of caregivers include self-awareness, self-forgiveness, hope, purpose, compassionate caring, and development of empathy (Bush 2009). Feelings of purpose and usefulness foster the spirituality of caregivers. In order for caregivers to provide quality patient care and at the same time take care of their needs, it is important for them to satisfy the aforementioned needs. The wellbeing of caregivers is critical to the quality of patient care and job satisfaction. Therefore, fulfilling the aforementioned needs should be prioritized.

Coping strategies for caregivers

Several strategies are available that caregivers can use to cope with compassion fatigue. The most important strategy is improving job satisfaction and developing stress coping strategies (Espeland, 2006). Developing stress coping mechanisms is an important strategy for dealing with both environment and job related stressors. Job satisfaction can be increased by improving working conditions, equipping caregivers with management skills, and introducing rewards systems in order to discourage the application of destructive stress coping mechanisms (Ekedahl & Wengstrom, 2008). Another strategy is to offer caregivers training programs that train them how to improve their self worth and self esteem (Chen at al. 2009). These two aspects are directly related to job satisfaction, performance, and productivity. Another important coping strategy is developing the significance of work in order to ensure that patients receive quality care that satisfies them (Gupta, 2010). In addition, it involves methods of conveying hope to patients when dealing with difficult situations. Recreation and relaxation are also effective coping methods that are available to caregivers. A research study conducted by Ekedahl & Wengstrom (2008) revealed that nurses use preserving, revaluating, and reconstructive strategies to cope at work. Relaxation strategies include physical exercise, meditation, prayer, reflection, and sufficient sleep. Physical exercise reduces blood pressure, aids in stress management, and increases self-esteem. Finally, changing thought process is another coping strategies used by caregivers (Ekedahl & Wengstrom, 2008). In order to deal with such situations, it is important for caregivers to change their thoughts and attitudes regarding patients, tough situations, and their work. For instance, replacing cannot-do attitudes with can-do attitudes is important for coping with tough situations. Many nurses become overwhelmed because of negative attitudes that erode their self-esteem and confidence.


Compassion fatigue is one of the challenges that face caregivers mainly due to the challenging nature of their work. They deal with patients with different physical, emotional, and spiritual problems. In several cases, caregivers focus so much on patients that they neglect their wellbeing. This neglect results in a state of emotional, spiritual, and physical overload referred to as compassion fatigue. Symptoms of this condition manifest in five main areas namely behavioral, physical, intellectual, psychological, and cognitive areas. The most common symptoms of compassion fatigue include poor self-care, excessive blaming, bottled up emotions, job dissatisfaction, absenteeism, conflicts with colleagues, depression, poor service, irritability, anger, and frequent headaches. Other symptoms include difficulty concentrating, recurrent nightmares, compulsive behaviors, and denial regarding the existence of problems. In order to cope with this problem, caregivers have several strategies at their exposure that they can apply. These coping strategies include recreation and relaxation, improvement of job satisfaction and working environments, developing the significance of work, participating in stress relief training programs, and the use of preserving, revaluating, and reconstructive strategies. These strategies help caregivers to address their numerous emotional, physical, spiritual, psychological, and intellectual needs.


Bush, N. J. (2009). Compassion Fatigue: Are You at Risk? Oncology Nursing Forum, 36(1), 24-28.

Chen, C-K, Lin, C., Wang, A-H., & Hou, T-H. (2009). A Study of Job Stress, Stress Coping Strategies and Job Satisfaction for Nurses Working in Middle-Level Hospital Operating Rooms. Journal of Nursing Research, 17(3), 199-211.

Ekedahl, M., & Wengstrom, Y. (2008). Coping Strategies in a Multidisciplinary Healthcare Team-A Team Comparison of Nurses in Cancer and Hospital Chaplains. European Journal of Cancer Care 17(1), 42-48.

Espeland, K. E. (2006). Overcoming Burnout: How to Revitalize Your Career. The Journal of Continuing Education in Nursing, 37(40), 178-184.

Gupta, V. (2010). Managing Stress in a Palliative Care Team. Pediatric Nursing 22(10), 14-18.

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