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Insights from Lift

Compassion Fatigue - Part 1

 “The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet.” Remen, 1996

People who work in caring roles, either professionally or personally, are at risk of developing Compassion Fatigue. Sometimes referred to as ‘the cost of caring’, Compassion Fatigue can emerge suddenly or gradually over time in those of us who work day in day out with patients or those of us who are caring for a loved one with illness.

There is debate in the literature about the exact definition of Compassion Fatigue, but it is more than just feeling worn out or tired of caring for others, and it is more than the common effects of work place stress.

The following is a list of possible signs of Compassion Fatigue, taken from various articles, that you may recognise in yourself – the first 4 on the list are particularly relevant:

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  • Deep physical and emotional exhaustion

  • Pronounced loss or deterioration in empathy for patients, loved ones and/or colleagues

  • Feelings of worthlessness and inefficacy (at work)

  • Irritability

  • Feeling overwhelmed and depleted

  • Chronic dissatisfaction with work-related issues (ie. politics and resourcing)

  • Loss of interest of motivation for helping

  • Extreme state of physical and mental stress

  • Hyper arousal and hyper vigilance

  • Preoccupation with thoughts about the suffering and traumatic experiences of others

  • Anxiety

  • Feeling numb or shutdown

  • Anger and irritability

  • Dread of working with certain patients or seeing ill loved ones

  • Irrational fears

  • Hypersensitivity or insensitivity to emotional content

  • Impaired ability to make decisions and care for patients

  • Low mood

  • Low motivation generally

  • Loss of passion and enthusiasm

  • Unhappiness

  • Sense of foreshortened future

  • Exaggerated startle response

  • Difficulty concentrating

  • Self-doubt

  • Increased use of alcohol or drugs

  • Intrusive imagery or dissociation

  • Stress-related illness, headaches, digestive issues

  • Absenteeism

  • Sleep changes

  • Nightmares

  • Appetite and weight changes

  • Loss of interest in social activities or connecting with others

  • Relationship issues

 

You are not experiencing Compassion Fatigue (even just Burnout) if you have just a few of these symptoms – you need a whole bunch. And we need to be aware that many of the signs of Compassion Fatigue listed above also look a lot like a mood disorder, like depression, or an anxiety disorder.

 

So, what makes us vulnerable to compassion fatigue?

 

For professional helpers (nurses, doctors, physios etc), work or environmental factors play a role, such as: work pressure; the volume of patients and paperwork; support resources (or lack thereof); and long-term exposure to illness or deaths are all factors. For personal carers (loved ones), these environmental/work factors can have an impact also.  

But many personal factors also play a role in how vulnerable a helper may be to developing Compassion Fatigue. Personal factors include: work-life balance (some people are better at that than others); perfectionism (how hard you drive yourself, how self-critical you are and your expectations of yourself; use of social support; past care giving experiences; work experience; personal relationship boundaries; and many others.

Health care professionals are particularly vulnerable to Compassion Fatigue, as they often enter the lives of patients at very critical and are trying to alleviate the patients fear and sadness.  The emotion, empathy and intuition required for helping can leave us vulnerable to Compassion Fatigue, as we can feel like we aren’t doing enough.

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So, if you are concerned about your wellbeing or wonder how you are tracking in your caring role, consider doing the ProQOL measure. It is an easy, self-report, free online 30-item questionnaire that includes information about how to score your results. The questionnaire assesses 3 areas, which the creators determined contribute to professional quality of life (as a carer) – Burn Out and Secondary Traumatic Stress, which they collate to get a Compassion Fatigue score, and Compassion Satisfaction.

The QOL is nice because it introduces the concept of Compassion Satisfaction. Compassion Satisfaction is the ability to enjoy or feel satisfied with what you do as a carer/helper.

It is a great concept to contemplate because keeping it front of mind can help us balance out Compassion Fatigue. They are on a spectrum and can coexist, so the goal is to increase Compassion Satisfaction and reduce Compassion Fatigue. Think about Compassion Satisfaction as the benefit of caring (as opposed to the cost of caring) and allow yourself to stop and notice every now and then, what benefits you are gaining from your caring role.

 

Try the measure here: https://proqol.org/uploads/ProQOL_5_English.pdf


How can you safely access exercise when you have cancer?

Despite the growing body of evidence around the benefits for people with cancer accessing exercise while they undergoing treatment, there are still significant barriers.

As a result, people who are having treatment for cancer commonly reduce their exercise levels and miss out on the positive outcomes exercise offers such tumour suppression and reduced tumour presence, reduced fatigue associated with cancer treatment and improved chemotherapy completion rates.

  • People who are undergoing treatment for cancer will commonly experience physical barriers to exercise, such as fatigue, nausea, pain and weakness.

  • Treatments such as chemotherapy will often result in a compromised immune system, meaning increased vulnerability to infection and further sickness from people in the community. Going to a regular gym is not safe when you are in this position as infection control risk is not adequately managed.

  • Treatments for cancer will commonly result in the body responding differently to exercise. Examples of this include changes in blood pressure and variations in heart rate as a response to exercise. Clinical observations such as these must be monitored and managed in the context of the patient's full medical history and current cancer treatment regime, so that exercise can be accessed safely.

  • People undergoing treatment for cancer are required to be continually assessed and monitored each time they want to exercise as their medical stability and therefore safety to accessing exercise is highly variable.

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So how can exercise be made safe for people who are having treatment for cancer?

  • Exercise needs to be prescribed under the supervision and monitoring of a medical practitioner.

  • Exercise needs to be accessed in an environment which has specifically been designed to cater for the infection control and chemotoxic precautions required by this population.

  • Patients need to be educated by health professionals about the significant benefits appropriately designed exercise can provide to their treatment outcomes and quality of life.

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