“It is the first time in 30 years of experience that I did not feel like going back to work after the holidays.”
Laura M., doctor in an intensive care unit.
“The experience of the first wave of Covid-19 was apocalyptic. I thought about asking for a year’s leave of absence ”.
Miguel G., nurse at a regional hospital.
“When I was in the situation, I was not aware of what was happening. Now, over time, I realize that I did not act as professionally as I always have. No I see myself capable of reliving a similar situation“.
Consuelo S., a nursing assistant with 27 years of experience.
What happened to them?
The helping relationship implies an interaction between two or more people, with well-defined roles. One party asks for help and the other provides it. Like any relationship, involves an emotional interaction.
Well, exposure to patients in situations of trauma, suffering and emotional distress who demand help can represent a difficult to manage emotional fracture by health personnel. We are talking about compassion fatigue, also called empathy burnout.
It is estimated that when the Covid-19 pandemic ends, the prevalence of mental and emotional disorders in the group of health professionals will double. Let’s not forget that, with the exception of palliative care units, professionals have been very prepared to heal. But maybe not sufficiently endowed with personal tools for managing one’s own emotions when the therapeutic objective should focus on caring, instead of “fighting” against a disease, with the patient being the battlefield.
The circumstances of the Covid-19 pandemic have made health teams have had to prioritize. It is an emergency situation due to the avalanche of lawsuits and the risk of high contagion, and the first thing that has “fallen” from the structure of the “Health Team – Patient – Family” gear has been the latter: the family.
The health system, strained beyond its limits, has also had to put aside the care for health professionals themselves. Even in many teams, this care has been non-existent in a normal situation prior to the pandemic.
Compassion fatigue is a form of secondary stress of the therapeutic aid relationship. It occurs when the emotional capacity of the healthcare professional to cope with the empathic commitment to the suffering of the patient is overwhelmed.
The term compassion fatigue was coined by Joinson in 1992. It referred to a syndrome observed in the nursing staff caring for patients with potentially life-threatening illnesses.
Compassion fatigue syndrome most affects healthcare workers who are in what is popularly called “first line” of attention. It affects those who have the most human contact with the patient who suffers and who fears for his life because of the disease.
In this context, compassion is understood as the feeling of great sympathy and sorrow for another person affected by great suffering. A very human feeling that manifests itself next to adpersonal desire to alleviate emotional distress of the sick, or to eliminate its cause.
Helping others meets altruistic needs. Compassionate satisfaction comes from an intrinsic motivation (vocation) and brings fulfillment in the spiritual plane of the health professional. Being able to feel compassionate satisfaction implies giving yourself strength and hope to face the suffering of others.
Compassionate satisfaction endows the professional with great resilience. On the contrary, not being able to feel it leads to hopelessness and frustration, even reaching incapacitate the professional for the exercise of their functions.
Research on what triggers compassion fatigue points to four main factors:
No or insufficient self-care.
Unresolved trauma in the past, often similar to the patient’s situation.
Difficulties managing care pressure and stress.
Lack of job satisfaction.
For the evaluation of compassion fatigue, the ProQOL – IV (Professional Quality of Life. Compassion Satisfaction and Fatigue Subscales, by Hudnall Stamm, 1997-2005, which has been translated and adapted into Spanish by María Eugenia Morante, Bernardo Moreno and Alfredo Rodriguez, from the Autonomous University of Madrid). Includes the variables of satisfaction by compassion, burnout and compassion fatigue.
The psychological symptomsof compassion fatigue are various, and are often inadvertent or unrelated to this syndrome. They manifest as anxiety, dissociation, anger, sleep disturbances and nightmares, and feelings of helplessness.
Regarding the somatic symptoms, are manifested in the form of headache, weight gain or loss, nausea, dizziness, loss of consciousness and, in some cases, hearing difficulties.
They are also frequent psychosocial symptomssuch as drug abuse, substance abuse, overeating, avoiding or spending less time with patients and the appearance of sarcasm, cynicism and irritability.
The first action to take against compassion fatigue is prevention. At the time this article is published, the Covid-19 pandemic has shaken almost every healthcare system in the world. So that preventive measures can no longer be applied.
The first psychotherapeutic objective should be the recognition of the emotional phenomenon and awareness of individual symptoms and risk factors.
Self-knowledge will not prevent feeling natural emotions from exposure to the intense pain and emotional discomfort of patients, but it will have a greater coping ability of the situation.
In a clinical supervision You will also learn to have well defined professional limits. It does not imply the slightest loss of humanity at all in the relationship with the patient, but quite the opposite. Self-perceiving more stable and secure in an appropriate therapeutic setting will make the professional more human with patients and colleagues.
Self-awareness, acceptance of the situation, habits of self care (including committing oneself to one’s own supervision) and fostering strong personal and professional support networks will also be therapeutic goals of clinical supervision.
In short, it is something as simple and as complex at the same time as being able to enjoy a balanced balance between personal and professional life.
* This article was originally published on The Conversation.
UOC Psychology tutor; Professor of the Postgraduate Program in Care for People with Advanced Illness and their Families, UOC – Open University of Catalonia.