Executive Summary
The paper seeks to obtain a better understanding on Compassion
Fatigue, and Burnout. The paper attempts to explore reason workers become affected with Compassion Fatigue, and Burnout.
Additionally the benefits for the organization as a whole
of having a controlled level of Compassion Fatigue in employees – also referred
to as compassion satisfaction is explored. Various tools and techniques available
for managers and workers to identify and measure Compassion Fatigue and Burnout
are described. The paper also describes various intervention techniques to
prevent, as well as to combat Compassion Fatigue and Burnout in the
organization. Finally the paper describes pitfalls in Compassion Fatigue and Burnout
measurements and intervention techniques and care that managers need to take
when interpreting the results.
Introduction
Compassion Fatigue can be defined as the state
of exhaustion and impaired function resulting from prolonged exposure to demanding
emotional inter-personal stress in the work environment [2]. The symptoms of Compassion
Fatigue include symptoms of secondary traumatic stress, such as intrusive
thoughts, avoidant behavior, and hyper-vigilance. Job Burnout is a prolonged
response to chronic emotional and interpersonal stressors on the job, and is
defined by the three dimensions of exhaustion, cynicism, and inefficacy [6]. Compassion
Fatigue is an occupational hazard for health care providers and social workers
working with traumatized clients, whereas Burnout is an organizational hazard
for employees and managers working in difficult organizational environments. Burnout
differs from Compassion Fatigue, as it is not only a result of trauma work but
also an outcome of organizational stressors such as workload, work role
confusion, tense work relationships with coworkers and supervisors, and lack of
resources to do one’s job [14]. Widespread inflection of Compassion Fatigue and
Burnout among employees and caregivers results in a dysfunctional organization,
mistaken diagnosis and patient neglect. It is important that managers identify
the symptoms, measure and address the root cause.
Compassion Satisfaction and Compassion Fatigue and Burnout
Exhibit
1 displays the loose relation between professional quality of life, compassion
satisfaction, Compassion Fatigue, Burnout and secondary trauma.
Exhibit 1: Professional
Quality of Life, Compassion Satisfaction, Compassion Fatigue, and Burnout [9].
Compassion Satisfaction
Engaging in interpersonal work to
help others typically is fulfilling. Most employees experience and are
bolstered by satisfaction as they deal with clients in need [5]. Compassion
satisfaction is a positive sentiment the provider experiences when able to
empathetically connect and feel a sense of achievement in the care-providing
process [10].
Compassionate care towards the
clients or patients is a primary tenant in social workers and health care
providers. It is argued [5] that compassion satisfaction is a vital part of
being emotionally fulfilled by one’s works in human services field.
When social workers and health care
employees experience compassion, they hold deep feeling about another’s
suffering, which prompts them to attempt to relieve the other’s misery [5, 11].
The provider then puts the interests of the patient in the forefront. They are
fully engaged in the process of wanting to help, providing assistance to those
who are struggling, and providing protection for the victimized. This is known
as the compassion process. The provider first notices the emotional state of
the patient, then has empathic feelings, and finally responds to attempt to
alleviate the pain [5, 12]
Compassion Fatigue
Health care professionals such as
physicians, nurses, therapists, and social workers are expected to be
compassionate in their work. It is part of the role requirement for which they
are being paid. On the other hand, those who are overly responsive in their
compassionate role may experience negative consequences if they are spending
too much time with traumatized clients. Figley[2] defined Compassion Fatigue as a ‘‘state of
exhaustion and dysfunction (biologically, psychologically and socially) as a
result of prolonged exposure to secondary trauma or a single intensive event.’’
Compassion Fatigue is an occupational hazard for those in the helping
professions and is a natural consequence of working with people who have
experienced extremely stressful events. Compassion Fatigue is about
work-related, secondary exposure to extremely stressful events [5].
Burnout
Burnout is a
prolonged response to chronic emotional and interpersonal stressors on the job
and is defined by the three dimensions of exhaustion, cynicism, and inefficacy
[6]. The significance of Burnout lies to its negative impact on workers job
performance and individual health.
The Burnout is result of situations factors
(like, job characteristics, occupational characteristics and Organizational
characteristics) and individual factors (demographic, personality, job
attitudes).
Measuring Compassion Fatigue and Burnout
Social
workers experiencing Compassion Fatigue and Burnout are at a higher risk of
lower productivity and dysfunction. According to a study conducted by [4],
approximately 50% of child protection staff of Colorado County suffered from
high or very high levels of Compassion Fatigue.
In
order to prevent and combat Compassion Fatigue or burnout, it is important
recognize the signs and symptoms of its emergence.
Various
measurement instruments to measure Compassion Fatigue and Burnout are described
in detail in [12].
Compassion
Fatigue Self Test (CFST) was first introduced by Figley in 1995[3]. The
original CFST had 40 items divided between CF (23) and Burnout (17). CFST was
modified by Stamm and Figley with addition of a series of positively oriented
questions paralleling the negative orientation of CF items resulting in a
66-item instrument [12]. The addition of positive oriented questions were
intended to measure compassion satisfaction.
Professional
Quality of Life Scale (ProQOL) [10] which is most widely used [12] is a
revision of CFST and is composed of three discrete subscales. The first
subscale measures Compassion Satisfaction, the second measures Burnout and
third measures Compassion Fatigue.
The
ProQOL is structured as a 30-item self-report measure in which respondents are
instructed to indicate how frequently each item was experienced in the previous
30 days. Each item is anchored by a 6-item Likert scale (0 = never, 1 = rarely,
2 = a few times, 3 = somewhat often, 4 = often, and 5 = very often). Scoring
requires summing the item responses for each 10-item subscale. A total of 5
items (1, 4, 15, 17, and 29) must be reverse scored prior to computing scores.
The subscale scores cannot be combined to compute a total score. The most
current scoring guidelines (Stamm, 2005) are based on a conservative quartile
method whereby cut scores are based on the 75th percentile. As such, the
guidelines suggest that a score of 33 or below on the compassion satisfaction
scale may suggest job dissatisfaction. Guidelines for the Burnout scale suggest
that a score below 18 reflects positive feelings about one’s ability to be
effective in one’s work, and scores above 27 may be cause for concern in that
one may not feel effective. Regarding the Compassion Fatigue/secondary trauma
scale, scores above 17 should be considered to reflect a potential problem in
this domain. Internal consistency reliability estimates for the subscales are
reported as .87 for the compassion satisfaction scale, .72 for the Burnout
scale, and .80 for the Compassion Fatigue/secondary trauma scale [12].
Appendix
1 provides detailed characteristics of Compassion Fatigue assessments
instruments.
Implications for Managerial Practices and Conclusion
After
selecting the Compassion Fatigue and Burnout measuring tool, and applying to
the front line workers the next step is to implement various managerial steps
to reduce the occurrence, mitigate and reduce the impact. The ProQOL method was
used in workshops held at Newfoundland and Labrador Housing with frontline
social workers and social housing officers. Some of the below mentioned
managerial impact were placed at NL Housing.
It is the younger employees who are more
susceptible to Burnout and Compassion Fatigue [5, 6]. So a formal mentoring
relationship with an experienced employee would be helpful. The mentor chosen
by the manager should be willing to work with the mentee. Mentoring process not
only helps the mentee overcome the root causes of Compassion fatigue and avoid
Burnout but also helps mentor to develop leadership skills.
Employees with low level of hardiness are
at a higher risk of experiencing Burnout and Compassion Fatigue [6]. The risk
is higher for employees who have an external locus of control rather than an
internal locus of control and employees with low self-esteem. One new approach
to overcoming Burnout and enhancing employees’ well-being is psychological
strength training.
Increasing job engagement decreases risk
of Burnout. Job engagement is characterised by energy, involvement and
efficacy.
Compassion Fatigue is an occupational
hazard for health care providers working with traumatized patients, whereas Burnout
is an organizational hazard for employees and managers working in difficult
organizational environments. Symptoms experienced by providers experiencing Compassion
Fatigue include anxiety, intrusive thoughts, and feelings similar to their
traumatized patients, whereas symptoms associated with Burnout involve
depersonalization of others, feelings of low personal accomplishment, and
emotional exhaustion.
Interventions used by managers need to
vary depending on whether they are dealing with Compassion Fatigue or Burnout.
For Compassion Fatigue, managers can change the case mix so that the employee
does not have to continually deal with horrific experiences. Furthermore,
supervisors can arrange for training so that the provider can learn appropriate
professional distance and for stress management classes so that the provider
can develop healthy personal coping styles. If managers work towards a
compassionate organizational culture, they can lessen problems associated with Compassion
Fatigue [5].
At the individual level, a person may
review personal and work environments. This may be done individually, with
family, with a friend or colleague, or with a professional. Regardless of the
method, this is a plan about that person and for that person; it is his or hers
and not their employer’s or their doctor’s. A plan dictated from outside is
likely to lead to dissatisfaction and a marker for Burnout—an organization that
dictates personal beliefs is probably an organization that does not value their
personnel’s thoughts and feelings. [13]
With Burnout, managers have to deal with
burdensome organizational problems. For example, they will want to make sure
that the patient volume is not excessive. Beyond role overload, the manager
should attend to any dysfunctional cultural issues such as overuse of coercive
power. Both Compassion Fatigue and Burnout require intervention by the
managers, as both can result in low job satisfaction resulting in lack of
organizational commitment. Eventually, both dysfunctions negatively influence
retention and productivity [5].
Appendix 1 Characteristics of Compassion Fatigue assessment instruments [12]
References
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(1995). Compassion Fatigue: Coping with secondary traumatic stress disorder in
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Concepts
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http://proqol.org/
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Measuring compassion satisfaction as well as fatigue: developmental history of
the Compassion Fatigue and satisfaction test.
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Satisfaction among Employee Assistance Professionals: Protecting the Workforce
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