Compassion Fatigue and Quality of Care: A Policy Analysis
Nurses enter their profession in hopes of a rewarding and fulfilling career caring for those in need. However, many of them do not realize the stress that can accumulate by caring for those who need them the most. Long-term stress as a caregiver can lead to a condition known as compassion fatigue. This form of burnout affects caregivers in every area of the nursing profession. Caregiver fatigue is a result of experiencing trauma that has occurred to others, but to which the nursing professional is exposed vicariously through their role as caregiver of the person.
Caregivers can experience stress symptoms such as difficulty falling or staying asleep, irritability, anger outburst, startle responses, anxiety, and other common stress symptoms (Abendroth, 2011). If the condition continues the nurse may experience a decreased capacity to be empathetic to the needs of others. Caregiver fatigue differs from burnout in that it has a more acute onset. Nurses working in specialty areas such as intensive care are the most vulnerable to caregiver fatigue (Abendroth, 2011).
Caregiver fatigue has an impact on the ability of the nurse to provide a high standard of care to the patients. The symptoms of caregiver fatigue can lead to high turnover rates for nurses, exacerbating the existing nursing shortage. It also has an affect on the ability to keep experienced nurses on the staff. It can lead to mistakes and quality problems in patient care. Caregiver fatigue can have a dramatic affect on the ability of the facility to deliver high quality care for their patients. Introducing policies to help reduce were caregiver fatigue is essential in preserving quality of care among patients and a lifelong love of their profession in nurses. The purpose of this research is to understand the mechanism of caregiver fatigue and to develop effective policies that will help decrease the incidence of caregiver fatigue among nurses and other caregivers.
Background of the Problem
The problems associated with caregiver fatigue have become an important issue among managers and administrators in the healthcare profession. As mentioned previously, caregiver fatigue has a direct impact on staffing and human resources issues, as well as quality control issues. Medical mistakes and reduced quality of care can lead to increased legal liability for the facility. Current literature on caregiver fatigue indicates that it is both preventable and treatable (Abendroth, 2011). This would lead to the conclusion that effective policies could be developed to help minimize or eliminate the impact of caregiver fatigue.
Several factors have been found to impact the onset and severity of caregiver fatigue. Cultural beliefs and societal caregiving role expectations have an effect on the coping mechanisms and resiliency of the caregiving staff (Abendroth, 2011). The position and specialty in which they practice also has an effect on their psychosocial and physical health. Nurses who work in intensive care, mental health, pediatrics, and oncology were found to be the most vulnerable to work related stress (Sabo, 2011). Fundamental aspects of the therapeutic relationship, particularly empathy and engagement with the patient, take the worst toll on stress among nurses. Some of indicated that a reliance on technology to sustain or prolong life have also served to increase stress among healthcare providers (Sabo, 2011).
Caregiver fatigue can be summarized as emotional exhaustion, which results in a feeling of distancing themselves from those for whom they care (Sabo, 2011). Organizational characteristics can also play a role in the development of caregiver fatigue. The nurse's expectations also play a role in their ability to cope with the stresses of their position. One example of this is the nurse that expects the patient to have a certain outcome if they provide a certain level of care. For instance, they may develop the belief that if a patient does not improve or recover from their condition that they did not do enough to help them. The expectation that they will be able to make an impact on situations beyond their control is unrealistic and sets them up for the development of stress related issues (Sabo, 2011).
Organizational issues such as a high patient-to-nurse ratio, complexity of patient cases, social support, leadership skills, and the degree of autonomy in making decisions can also have an impact on the development of caregiver fatigue (Sabo, 2011). Nurses often enter their profession with unrealistic expectations as to what their daily duties and roles will involve. This is the first step to reducing the incidence of caregiver fatigue. However, this is not an issue that can be addressed at the organizational level and should be addressed early in the educational programs for nursing students. Future healthcare providers should be provided the opportunity to understand fully what their role will be in the future. They need to develop a sense of reality before they are advanced in their nursing programs. Once they become nurses in an organization they have already spent much in terms of effort and money for a profession that may or may not meet their expectations. Organizations need to work with educational facilities to produce nurses who fully understand what their job will entail once they enter the workforce. Unmet expectations are a key source of caregiver burnout (Leiter, & Laschinger, 2006).
Compassion fatigue is considered to be a natural consequence of knowing that someone has experienced a trauma and the desire to help them. The stronger the relationship between the nurse and patient, the greater the capacity to develop compassion fatigue (Sabo, 2011). This is not to say that a nurse should attempt to be cold and uncaring, they simply need to realize their vulnerabilities and take steps to prevent the onset of compassion fatigue. Several factors increase a nurse's risk for developing compassion fatigue. These are: continued exposure to the suffering of others, memories that have an emotional response for the caregiver, and unexpected disruptions in the nurse's life (Sabo, 2011). Recognizing the risk factors can help and the development of programs to prevent or reduce caregiver fatigue among staff members.
Compassion fatigue poses several legal and ethical issues for the nurse and the facility. Quality of patient care is a primary concern among these issues. Compassion fatigue results in the reduced capacity to provide quality care for patients. This can create a legal liability for the facility. In addition, the symptoms might become so severe that the nurse has to seek mental health treatment for themselves. In some cases, this could be considered a work related injury and subject to compensation for the staff member. Nurses who are experiencing caregiver fatigue also cause a strain and burden on other staff members due to their reduced capacity. Ethical issues associated with caregiver fatigue are largely associated with how to treat and manage the nurse that has developed caregiver fatigue.
Issue Statement and Rationale
The literature agrees that caregiver fatigue is a universal problem among nurses and other healthcare providers. It also agrees that the need to reduce the incidence of caregiver fatigue in a facility is essential in preserving the quality of care for patients. Finding solutions to caregiver fatigue also has an impact on the current shortage of nurses. Compassion fatigue has an impact on the overall functioning of the organization and its mission to deliver quality care to its patients and the community that it serves. The rationale for policies designed to reduce caregiver fatigue are based on literature on the subject.
The literature also agrees that several characteristics of the nurses themselves contribute to compassion fatigue. They also agree that intervention strategies need to be focused in several key areas. Efforts need to be focused and the balance between work life and other portions of the caregivers life (Boyle, 2011). They need a focus on education, particularly in the area of communication, coping skills, self-care strategies, conflict resolution, and the ability to establish boundaries and relationships with patients and the patients' families (Boyle, 2011). Work setting interventions have also been suggested to help nurses better to cope with the issues that they face. Some suggestions for work interventions include: the provision of counseling services, support groups, debriefing sessions, art therapy, massage sessions, bereavement interventions, and attention to the spiritual needs of the nursing staff (Boyle, 2011).
Policy Alternatives and Rationale
Current policies regarding the prevention and treatment of caregiver fatigue among nurses and other health care professionals lacks consistency. The importance of caregiver fatigue is not recognized equally on a global basis, or among facilities in the United States. This lack of recognition of the importance of the issue is a key concern in this policy statement. The following summarizes policies regarding care giver fatigue and appropriate interventions for its prevention and treatment.
1. It is recognized that caregiver fatigue is an important issue that reduces quality of care for patients and it has long-term negative effects on staff members.
2. The organization will work with local nursing colleges to assure that students are aware of the risks associated with their…