Compassion and compassion fatigue

Compassion is defined as "sympathetic consciousness of others’ distress together with a desire to relieve it" (The Merriam-Webster Dictionary, 2013). Compassion requires empathy, sympathy, sensitivity, non-judgment, a tolerance of distress, and a motivation to relieve suffering.

As Dewar (2011) further explains compassion is “…the way in which we relate to human beings. It can be nurtured and supported. It involves noticing another person's vulnerability, experiencing an emotional reaction to this and acting in some way with them, in a way that is meaningful for people. It is defined by the people who give and receive it, and therefore interpersonal processes that capture what it means to people are an important element of its promotion.”

The benefits of compassion

Compassion can actually make us less vulnerable, increase and motivate our strength to act, and increase our resilience and sustainability.

When we demonstrate compassion to another person the hormone oxytocin is secreted from the pituitary gland, and this has a positive effect on our emotional, cognitive and social behaviours. Oxytocin improves our psychological stability, reduces our stress responses and enhances our trust.

Compassion fatigue has been described as a "...state of significant depletion or exhaustion of the nurse’s store of compassion, resulting from repeated activation over time of empathic and sympathetic responses to pain and distress in patients and in loved ones" (Pembroke, 2015).

Nurses and midwives provide daily, hourly care for patients, and families affected by illness. They may witness and respond to trauma, impending death, loss and grief. This may make nurses and midwives more vulnerable to experiencing the signs and symptoms of compassion fatigue.

The emotional investment may overextend a nurse or midwife’s ability to manage the demands of being compassionate and empathetic. This is a serious issue, and can impact directly and adversely on their own physical, psychological and emotional health. 

Coetzee and Klopper (2010) describe the consequences of compassion fatigue as "……. changing behaviour and loss of the capacity to interact and engage intimately with others for whom they have responsibility".

Signs and symptoms of compassion fatigue include:

• exhaustion, absence of energy, feeling constantly mentally and physically tired
• apathy, sadness, no longer finding pleasure in activities
• questioning meaning and purpose of life
• depression 
• anxiety 
• difficulty in concentrating and functioning 
• isolation from others both at work and/or socially
• difficulty in maintaining inter-professional relationships
• feeling detached from others 
• insomnia
• reoccurrence of nightmares and flashbacks to a traumatic event
• unrelenting thoughts and concerns  
• receiving an unusual amount of complaints from others
• chronic physical ailments such as gastrointestinal problems, chronic pain and headaches
• reduced motivation to maintain your own hygiene and appearance
• increased pessimism and suspicion
• increasingly blaming and judgmental of others' actions
• irritability and anger, or
• poor self-esteem.

Maladaptive coping behaviours

If you are feeling compassion fatigued you may turn to coping behaviours that aren't good for your health or the health of others around you. These could include:

• substance abuse, to manage and mask feelings, or
• compulsive behaviours such as overspending, overeating, or gambling.

Not all nurses, midwives and students will experience compassionate fatigue. In fact, professional satisfaction and motivation to practise is more common because the care provided ensures a compassionate approach.

Frequently, those at risk of compassion fatigue provide high standards of care, and are well regarded by the team and by those in their care. This is important, as being aware of the risk of compassion fatigue occurring allows a conscious effort to prioritise and engage in activities that will help restore and balance energy.

It is normal if you feel compassion fatigue at some stage in your career as it can be draining look after others all the time. If you do feel this way there are lots of things you can do to look after yourself.

Self-care strategies include:

• joining healthy activities such as exercise, massage, yoga, and meditation
• eating a healthy and balanced diet
• drinking plenty of water
• ensuring you get sufficient rest and sleep
• remaining engaged in family and personal relationships
• organising your life so you become proactive as opposed to reactive, or
• participating in leisure and recreational activities.

If you are concerned, or others are raising concerns, taking no action will make you vulnerable to physical, emotional and psychological health problems. You have a responsibility to care for your own health needs and it is important to be proactive in maintaining your own health and seek support.

Why not read some of our other articles that relate to looking after your health:

• Mindfulness
• Mental health self-care.

Our service provides free and confidential support 24/7, to nurses, midwives and students Australia wide. If you would like to speak to someone call 1800 667 877, or you can request support via email.

If you would like to know a bit more about the service before getting in contact — take a look through accessing support.

Coetzee S.K. & Klopper H.C. (2010). Compassion fatigue within nursing practice: a concept analysis. Nursing and Health Sciences 12 (2), 235–243.

Dewar, B. (2011). Caring about Caring: An Appreciative Inquiry about Compassionate Relationship-Centred Care. PhD Thesis, Edinburgh Napier University, Edinburgh.

Merriam-Webster (2013) Compassion. Merriam-Webster online dictionary.

Nursing and Midwifery Board of Australia. (2016). ‘Registered nurse standards for practice’. Retrieved 27 January, 2017.

Pembroke, N. (2015). Contributions from Christian ethics and Buddhist philosophy to the management of compassion fatigue in nurses. Nursing and Health Sciences, 18(1), 120-124.