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Guilt, loss of sleep, low energy, difficulty concentrating, feelings of detachment.
These are only a few of the wide array of emotional, psychological and physical symptoms of compassion fatigue - a condition that can develop in any individual with repeated interpersonal encounters with patients who are ill and suffering, and their families.
Healthcare employees are at a higher risk of developing compassion fatigue where there is little communication or support to deal with the emotional and psychological toll of their work.
"As much as 20 to 30 per cent of healthcare professionals can experience compassion fatigue," explains Dr. Mary Jane Esplen, Affiliate Scientist at the Princess Margaret Cancer Centre and Professor and Vice-Chair at the University of Toronto's Department of Psychiatry.
"I don't think anyone's immune to it."
Compassion fatigue can affect nurses, physicians, social workers, volunteers, and any other employees who have repeated encounters with patients.
Why does compassion fatigue occur?
"The people most at risk of compassion fatigue are those with a high degree of exposure to the emotional distress of others and little opportunity to communicate or share their own feelings," says Dr. Gary Rodin, Head of the Department of Supportive Care at the Princess Margaret, adding that it is a global problem for healthcare professionals.
Dr. Rodin explains that the traditional perception of compassion fatigue is that it occurs as a result of an excess of compassion for patients, but this is not necessarily accurate.
"It actually often occurs for the opposite reason," he says. "In busy medical clinics, people are not engaging emotionally with their patients or with their own feelings."
"The solution for compassion fatigue is to learn how to connect with patients and their emotional distress, and to also process one's own feelings. It's often calming for both parties to be able to do that."
Dr. Esplen, also the Executive Director at the de Souza Institute where she leads a
course on understanding and addressing compassion fatigue, adds that there needs to be a cultural shift in health care to combat compassion fatigue and protect healthcare professionals from developing it.
"Health professionals sometimes see showing emotion or experiencing challenges as a sign of weakness or failure in the profession," she says. "These are stigmatizing ideas that act as barriers to those seeking help."
"It's actually a protective variable in helping professionals manage compassion fatigue if we feel more confident in our ability to provide emotional care and to have psychosocial discussions."
How can we prevent compassion fatigue?
Education and awareness is the number one protective tool against compassion fatigue, says Dr. Esplen.
"We deal so much with death and traumatizing illnesses in the medical profession," she says. "I don't know why we expect our junior faculty to just know how to do this without the appropriate training."
"We are working with universities to make nursing and medicine graduates receive training on taking care of themselves, and that goes hand-in-hand with the technical training required to take care of their patients."
In addition to education, mindfulness-based intervention, team support and improved communication strategies are just a few of the approaches that Dr. Esplen wants to see practiced in hospital units to prevent compassion fatigue in healthcare professionals.
"There is some evidence that where there's high level of compassion fatigue or burnout, then that's associated with poorer patient outcomes," she says. "So, facilitating well-being of our healthcare professionals also means improving our patient outcomes."
While Dr. Esplen provides the course nationally via telehealth, she hopes to see the course on compassion fatigue offered online soon to make the topic more easily accessible to all healthcare employees.
"We want to be part of a solution that brings compassion fatigue to the forefront," she says. "We should be proactive and pre-emptive, and develop a culture of checking up on our own health and taking care of ourselves."