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Stressed Health Care Workers Battle 'Compassion Fatigue'
Date:4/10/2009

It's an emotional detachment that can have an impact on patients, experts say

FRIDAY, April 10 (HealthDay News) -- A type of emotional burnout called "compassion fatigue" is common among doctors, nurses and other health care workers tending to people with cancer, yet experts say little research has been done on the phenomenon, which can lead to anxiety, cynicism, chronic tiredness, irritability and problem drinking.

Often these health care workers become emotionally detached to protect themselves from the feelings of loss that accompany losing a patient. Some end up leaving their jobs.

"It's a chronic exposure to really tough circumstances," explained Dr. Caroline Carney Doebbeling, a research scientist at the Regenstrief Institute and associate professor of medicine and psychiatry at Indiana University School of Medicine in Indianapolis. "It's very important to explain why is it so hard to keep nurses, why is it so hard to keep people going in patient care for the men and women who go into fields like oncology or AIDS treatment."

Doebbeling is senior author of a study in a recent issue of the Journal of Health Psychology.

Compassion fatigue "is very common," confirmed Dr. Sean O'Mahony, medical director of palliative care at Montefiore Medical Center in New York City. "As health care gets busier and busier, and more complex with technological advances, that's higher volumes of very sick patients for, unfortunately, shorter periods of time. I think it's very easy to try to pull back from the emotional impact of seeing other people suffering."

According to the paper, the term "compassion fatigue" emerged in the 1990s to describe the mental distancing some health care professionals develop as a way to protect themselves.

To learn more, the researchers reviewed 57 studies with the keywords "compassion fatigue" published from 1950 to 2008.

Only one of these studies looked at the cancer setting, the rest focused on nurses, trauma workers and people suffering from trauma.

"In the medical literature, you don't hear much about compassion fatigue," Doebbeling said. "There's a smattering of it in the nursing literature, and most of it has come out of the nursing social worker psychology literature. And it's been looked at in cases of a terrorist attack like 9/11 or a natural disaster such as Hurricane Katrina."

But for those workers, the burnout is more acute. More typically, compassion fatigue "is an insidious process that eats away at people," Doebbeling said.

People experiencing more chronic compassion fatigue pointed to giving patients and families bad news, treating pain and family issues as large stressors.

What are some ways to combat the syndrome?

Maintaining a professional network of people who are also grappling with these issues is one way, Doebbeling said.

"There is an awareness that witnessing often quite traumatic situations for patients and families is emotionally burdensome for staff, and there are efforts to incorporate counseling into the work environment through peers," O'Mahony said.

Supervisors are also being trained to identify burnout, especially when it reaches the point that it can impact the patient.

According to Carol Taylor, director of the Center for Clinical Bioethics at Georgetown University in Washington, D.C., the article also points to the need for health care professionals to find balance in their lives. "The article discusses practical, personal and institutional strategies for coping," she said.

O'Mahony said he and his team now meet once a week to discuss and deal with emotions linked to patients who had died the previous week.

Setting realistic goals is another key, Doebbeling said.

"You become a doctor or a nurse because want to save people or help people. Nowhere along the way does anyone tell you that doing good might be [end-of-life] hospice treatment, instead of the next best drug trial," she said. "We need to train and culture young physicians that death is a natural part of all of this. It doesn't mean that someone failed. It's getting to a point where it's as acceptable to progress in a path toward a peaceful death as opposed to, 'I'm going to fight to every last inch.' Because you do get set up to think you've failed."

More information

There's more on this topic at the Compassion Fatigue Awareness Project.



SOURCES: Caroline Carney Doebbeling, M.D., research scientist, Regenstrief Institute, and associate professor of medicine and psychiatry, Indiana University School of Medicine, Indianapolis; Sean O'Mahony, M.B., medical director of palliative care, Montefiore Medical Center, New York City; Carol Taylor, R.N., Ph.D., director, Center for Clinical Bioethics, Georgetown University Medical Center, Washington, D.C.; March 2009, Journal of Health Psychology


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