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1 Running head: BURNOUT & COMPASSION FATIGUE LITERATURE REVIEW Burnout and Compassion Fatigue Literature Review Barbara J. Henry Northern Kentucky University

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1

Running head: BURNOUT & COMPASSION FATIGUE LITERATURE REVIEW

Burnout and Compassion Fatigue Literature Review

Barbara J. Henry

Northern Kentucky University

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Running head: BURNOUT & COMPASSION FATIGUE LITERATURE REVIEW

Introduction

Burnout and compassion fatigue are conditions that occur in many professionals,

particularly nurses working in high trauma specialties such as oncology. The purpose of this

paper is to review the literature and briefly describe the conceptual framework for burnout and

compassion fatigue in oncology nurses. The literature search was conducted using CINAHL,

MEDLINE, and PSYCHInfo databases along with articles obtained from Really Simple

Syndication (RSS) feeds and hand selection using the search terms of “burnout.” “compassion

fatigue,” “burnout and compassion fatigue in nurses,” and “burnout and compassion fatigue in

oncology.” Findings were grounded in the literature from nursing, medicine, psychology, social

work, and palliative care professions. The literature review was limited to the past 10 years

except for older original works on burnout and compassion fatigue. Articles on related topics

were also reviewed. Articles selected for the literature review are directly urelated to the

research question: how does a therapeutic retreat effect burnout and compassion fatigue in

oncology nurses?

Background and Conceptual Framework

In Boyle’s review of literature, antecedents to burnout and compassion fatigue included

the following: 1.) exposure to traumatic care of cancer patients, 2.) vulnerable individual

personality traits and lack of coping skills, or 3.) lateral violence from others (2011). Bush, like

Boyle, is a nursing author who has written extensively on burnout and compassion fatigue in

oncology nurses. Bush noted that burnout and compassion fatigue occur when emotional

boundaries are blurred and the nurse absorbs distress, anxiety, fears, and trauma of the patient, (a

concept called countertransference in psychiatry), (2009). Collins & Long reported a

consequence of compassion fatigue and burnout is “unresolved emotional pain that caregivers

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Running head: BURNOUT & COMPASSION FATIGUE LITERATURE REVIEW

‘store away’” (2003 p 18). Difficulty balancing work and life outside work may be an

antecedent to or consequence of burnout and compassion fatigue as well.

Many articles define and describe the concepts of burnout and compassion fatigue. The

concept of burnout was first conceptualized by Christina Maslach who developed the Maslach

Burnout Inventory (MBI) tool to measure burnout in healthcare and other professional workers

(Maslach,& Schaufeli, 1993). Compassion fatigue was first introduced by Joinson in 1992

during an investigation of burnout in emergency nurses. Joinson never formally defined

compassion fatigue and in 1995, it was adopted by psychologist Charles Figley as a term for

secondary traumatic stress disorder (Figley, 1995).

Pilkington suggested a conceptualization of burnout and compassion fatigue from the

perspective of the Neuman systems model (2008). Jean Watson’s seven assumptions of nurse

caring provide the theoretical underpinnings of potential for burnout and compassion fatigue

(Current Nursing, 2012).

Burnout, compassion fatigue, and related concepts have been topics of interest in nursing

literature, particularly in the past five years (Knobloch Coutzee & Klopper, 2005). The concept

of lateral violence has emerged in the literature as both an antecedent and consequence of

burnout and compassion fatigue (Sheridan-Leos, 2008).

Description and Critique of Scholarly Literature

There are very few randomized clinically controlled trials (RCTs) examining burnout and

compassion fatigue in oncology nurses or healthcare professionals. Most articles are reviews of

RCTs, review of literature, and qualitative studies.

A 2010 study utilized a two arm randomized controlled mixed methods trial using 65

medical personnel with direct patient contact as participants (Brooks, Bradt, Eyre, Hunt, &

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Running head: BURNOUT & COMPASSION FATIGUE LITERATURE REVIEW

Dileo, 2010). Results showed no statistically significant difference in change scores between the

control and experimental groups for self-reported burnout, sense of coherence, and job

satisfaction (Brooks, et al., 2010). Qualitative findings indicated that music imagery and creative

mandala drawings helped participants relax, rejuvenate, and refocus enabling them to complete

their shifts with renewed energy (Brooks, et al., 2010). A limitation of this study was the sample

size and that shortly after the study began a major restructuring at one of the hospitals resulted in

layoffs, increased shifts, and fear of termination for open admission of feeling burned-out during

the process, and many planned music-imagery sessions were cancelled affecting study findings

(Brooks, et al., 2010).

16 participants in a brief mindfulness intervention for nurses and nurse aids experienced

significant improvements in burnout symptoms, relaxation, and life satisfaction compared to 15

wait list control participants (Mackenzie, Poulin, & Seidman-Carlson, 2006). Each week,

participants from large urban geriatric teaching hospital attended one of 6 sessions held during

the day and evening shifts and received a CD of guided mindfulness exercises, which they were

instructed to practice for at least 10 minutes per day 5 days per week along with a manual

summarizing key points from the sessions and homework assignments (Mackenzie, et al., 2006).

Mackenzie and colleagues utilized the MBI, Smith Relaxation Dispositions Inventory, and

Intrinsic Job Satisfaction subscale from the Job Satisfaction Scale, Satisfaction with Life scale,

and 13 item version of the Orientation to Life Questionnaire to measure quantitative data (2006).

An obvious limitation of this study was the sample size, but results of the study support the

feasibility and potential effectiveness of brief mindfulness training in reducing burnout and

improving morale in nurses (Mackenzie, et al, 2006.)

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Running head: BURNOUT & COMPASSION FATIGUE LITERATURE REVIEW

Marine, Ruotsalainen, Serra, & Verbeek conducted a review of RCTs on interventions

aimed at prevention of psychological stress and burnout in healthcare workers (2009). Authors

presented a meta-analysis and qualitative synthesis of 14 RCTs, 3 cluster randomized trials, and

2 crossover trials with a total of 1,564 participants in intervention groups and 1,248 participants

in control groups (Marine, et al., 2009). The main limitation of these studies were that only two

of the trials were of high quality. Interventions were grouped into person-directed and work-

directed. One trial showed stress remained low a month after the intervention, another showed a

reduction in emotional exhaustion and in lack of personal accomplishment maintained up to two

years post-intervention with refresher sessions (Marine, et al., 2009). Two studies showed a

reduction in anxiety maintained up to a month post-intervention (Marine, et al., 2009). The

authors recommended larger and better quality trials and concluded that person-directed

interventions including cognitive behavioral approaches like coping skills training combined

with relaxation techniques can be effective in reducing burnout in healthcare workers compared

to no intervention (Marine, et al., 2009).

Najjar and colleagues reviewed 57 studies with healthcare workers and found a variety of

terminology used to describe burnout and compassion fatigue (Najjar, Davis, Beck-Coon, &

Carney Doebbling, 2009). The authors described 14 studies on compassion fatigue with various

healthcare professionals, the largest sample being 336 county child protection staff and one

clinical trial examining the treatment effectiveness of the Certified Compassion Fatigue

Specialists Training (CCFST) for mental health professionals (Najjar, et al., 2009). The authors

acknowledged that conceptual and methodological research on the problem is lacking, and

summarized personal, professional, and organizational strategies to manage and treat compassion

fatigue (Najjar, et al., 2009).

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Running head: BURNOUT & COMPASSION FATIGUE LITERATURE REVIEW

In a study on nurse practice environments and patient outcomes, Friese (2005) used a

large sample of 1956 registered nurses including 305 oncology nurses. The study was a

secondary analysis of survey data collected in 1998 using statistical analysis instruments

including logistic regression (Friese, 2005). Though the data was old, a limitation of the study,

the author found that oncology nurses had superior patient outcomes compared to non-oncology

nurses and that emotional exhaustion was significantly lower for nurses working in magnet

hospitals compared to those working in non-magnet hospitals (Friese, 2005). Friese’s key points

were that nurse concern with practice environments was reflected by their job dissatisfaction,

burnout, and perceived quality of care, and to improve outcomes, practice environments should

be assessed routinely to optimize the success of nursing interventions (2005).

Kash, Holland, Breitbart, Berensen, Dougherty, Ouellette-Kobasa, and Lesko identified

the concept of a hardy personality, social support, and relaxation methods as moderating

variables that may decrease burnout and compassion fatigue in oncology professionals (2000).

Three attributes of a hardy personality found to be buffers against stress were: commitment to

self and work, a sense of being able to control or influence events, and a sense of challenge in the

face of a changing environment (Kash, et al., 2000). The cross-sectional survey data from 83

nurses and 178 oncologists at Memorial Sloan Kettering Cancer Center (MSKCC) was studied

over a two year period (Kash, et al., 2000). The MBI, demoralization scale of the Psychiatric

Epidemiology Research Interview (PERI), somatization scale of the Hopkins Symptom

Checklist, Kobasa personality scale, peer cohesion subscale of the Work Environment Subscales,

perception of religious person scale, and a stress questionnaire were used to quantify results

(Kash, et al., 2000). Nurse sense of accomplishment was much lower than house oncology

medical staff, which the authors attributed to nurses seeing patients with cancer when they are

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Running head: BURNOUT & COMPASSION FATIGUE LITERATURE REVIEW

most ill, a sense of futility about cancer treatment, anger and cynicism about limited role of

nurses in the overall treatment trajectory (Kash, et al., 2000). Stressors that contributed most to

burnout and demoralization were negative work settings, high number of patient deaths, and

struggling over a DNR decision with another colleague or family member (Kash, et al., 2000).

These psycho-oncology expert authors concluded that cancer centers must explore means of

reducing work stress in order to emotionally equip professionals to effectively communicate and

provide support to patients (Kash, et al., 2000).

In a study of emergency nurses and nurses from three other specialty hospital units:

oncology, nephrology, and intensive care, the authors found a risk for higher risk for burnout and

compassion fatigue in oncology nurses (Hooper, Craig, Janvrin, Wetsel, Reimels, Anderson,

Greenville, & Clemson, 2010). Findings failed to support the hypothesis that emergency nurses

are at greater risk for burnout and compassion fatigue compared to nurses from other specialties

(Hooper, et al., 2010). Compassion satisfaction, burnout, and compassion fatigue scores were

measured using the Professional Quality of Life, Fourth Revision (ProQOL R-IV) instrument.

Limitations of the study were the small sample size of 109 respondents chosen from one 461 bed

acute care hospital in the Southeast measured at a single point in time. Despite study limitations,

authors concluded that raising the awareness of the emotional impact on nurses of caring for

patients will lead to the development of ongoing support programs for hospital nurses (Hooper,

et al., 2010).

Yoder also utilized the ProQOL scale to measure compassion fatigue, compassion

satisfaction, and burnout in nurses employed at a 123 bed Midwest Magnet community hospital

(2010). Yoder found that 15% of participants had ProQOL scores indicating risk for compassion

fatigue, 2010). In addition to the Pro-QOL scale, Yoder solicited qualitative data by asking

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Running head: BURNOUT & COMPASSION FATIGUE LITERATURE REVIEW

participants to “describe a situation where you experienced compassion fatigue and burnout and

what strategies did you use to deal with the situation?” (2010, p.193). 71 nurses completed the

narrative portion and described trigger situations for burnout and compassion fatigue: 1.) patient

condition/status, 3.) challenging behavior, 4.) futile care, 5.) workload, 6.) management

decisions, 7.) personal limits, and 8.) personal experiences (Yoder, 2010). Coping strategies

included: a.) change personal engagement, b.) change nature of work involvement, c.) debrief

informally, d.) take action to change/manage current situation, e.) develop ritual, f.) life outside

work, g.) spiritual or religious, h.) introspection, and i.) attitude modification (Yoder, 2010).

Yoder’s study limitations were small sample size from one hospital taken at one point in time.

Edmunds provided further detail on Yoder’s findings that compassion fatigue was triggered by

patient care situations in which the nurse 1.) believed their actions would not make a difference

or not be enough, 2.) had problems with the system-high census and acuity, heavy patient

assignments, overtime and extra work day(s), 3.) had personal issues such as inexperience or

inadequate energy, 4.) identified with the patients, or 5.) overlooked serious patient symptoms

(2010.)

Contrary to most studies, Barnard, Street, & Love found that there was no statistically

significant relationship between level of perceived work supports and level of burnout (2006).

Barnard, et al., 2006 surveyed 101 cancer nurses working at a specialist oncology metropolitan

Australian hospital. More than 50% of participants experienced a list of 50 stressors from an

amended version of the Stressor Scale for Pediatric Oncology Nurses and found that most work

support came from peers rather than supervisors or the organization (Barnard, et al., 2006). In

addition to the stressor scale, burnout was measured by the MBI. According to Barnard, et al.,

94% participants indicated that 2 items in particular were sources of stress: “when nurses and

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Running head: BURNOUT & COMPASSION FATIGUE LITERATURE REVIEW

doctors are not communicating well about patients,” and “feeling I can’t get all my work done”

(2006). Nurses were also given a free response comment section concerning support required

from the organization, which listed the following as the most important needs: 1.) further

nursing education, 2.) nursing administration/management support, 3.) recognition, rewards, and

support, 4.) regular staff counseling and debriefing, and 5.) services for staff (Barnard, et al.,

2006). The strength of this study is the use of two quantifiable and one qualitative tool, though a

weakness is the small sample size from one institution collected at one point in time.

There has been a great deal published about the prevalence of burnout and compassion

fatigue in oncology nursing, but less on interventions to decrease the problem. Compassion

fatigue is amenable to intervention; with therapeutic support programs and retreats, nurses may

continue to work in their chosen field (Sabo, 2011). Sabo’s extensive review of literature,

similar to that of Boyle (2011), presented a recommendation that more energy should be focused

on psychosocial health and well-being of nurses (2011).

In a quasi-experimental RCT among staff of 29 hospital oncology units in the

Netherlands, Le Blanc, Hex, Schaufeli, Tarsi and Pesters evaluated the effects of a team-based

burnout intervention program combining a staff support group with a participatory action

research approach. Nine oncology units were randomly selected to participate (2007). Before the

“Take Care” program started (Time 1), directly after the program ended (Time 2), and 6 months

later (Time 3), participants filled out a questionnaire on their work situation and well-being

(LeBlanc, et al., 2007). Staff who participated in the program experienced significantly less

emotional exhaustion at both Time 2 and Time 3 and less depersonalization at Time 2, compared

with staff who did not participate in the program (LeBlanc, et al., 2007). Often in the formal

training of oncology nurses, there is no solid basis of psychosocial awareness, knowledge, and

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Running head: BURNOUT & COMPASSION FATIGUE LITERATURE REVIEW

skills to facilitate coping (LeBlanc, et al., 2007). Participants in the “Take Care” program

experimental group felt significantly less exhausted than those in the control group immediately

after the program and again six months later (Le Blanc et al., 2007).

Medland, Howard-Rubin, and Whitaker (2004) identified psychosocial wellness and the

avoidance of burnout as key to retention of oncology nurses, and described a program to enhance

oncology nurse coping skills. Turnover rates on the oncology units was greater than 40%

compared to a hospital average of 14.2%, which lead to the study (Medland, et al., 2004). Five

full day “Circle of Care” retreats with 150 oncology staff members were held away from the

clinical area in a relaxed setting in a large Midwest cancer center (Medland, et al., 2004). The

retreats offered interactive and informal presentations on wellness, bereavement, developing

stress management skills like relaxation, journaling, cultivating team effectiveness, and art

making activities (Medland, et al. 2004). Participants viewed a videotape on a positive

management philosophy and discussed the “CARES” philosophy, a framework for incorporating

stress management and self-care into practice (Medland, et al. 2004). Practice changes to

decrease burnout and increase ongoing focus on staff support at the facility were implemented

based on ideas generated at the retreats (Medland, et al. 2004). Though the study and

intervention provided valuable data on a burnout and compassion fatigue intervention, the

authors did not utilize any quantitative data or tools to measure the effects.

Adcock and Boyle examined existing interventions to manage compassion fatigue in

oncology nurses (2009). They surveyed 231 Oncology Nursing Society chapter presidents in

2007 and received 103 responses. 22% or fewer respondents had on-site resources such as:

employee assistance programs (EAPs), pastoral care, counselor or psychologist, psychiatric

clinical nurse specialist, and support group (Adcock & Boyle, 2009). The authors found that

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Running head: BURNOUT & COMPASSION FATIGUE LITERATURE REVIEW

those with EAPs have three free visits available per year with discount for ongoing services, and

that a barrier to obtaining other counseling services was the lag time between request and

scheduled time available for an appointment (Adcock & Boyle, 2009). Only 5% of respondents

reported exposure to staff support groups and that the groups were rarely continued over time

(Adcock & Boyle, 2009). Though off-site retreats to promote renewal were experienced by only

a few respondents, qualitative data reflects the value of these retreats to participants (Adcock &

Boyle, 2009). A weakness in this study is that no quantitative data or measures were obtained.

Hayes and colleagues wrote about retention strategies implemented at large Eastern U.S.

cancer centers that decrease burnout and increase support for oncology nurses (Hayes, Reid

Ponte, Oakley, Stanhellini, Gross, Perryman, Hanley, Hickey, & Somerville, 2005). Strategies

included: a New Graduate Development Program, Support Mentorship and Respect Together in

Nursing (SMaRT) a mentoring program designed to support minority nurses entering oncology,

Oncology Nursing Leadership Advisory Group with cross institutional participation, oncology

nursing grand rounds and educational programs, Spirit Rounds, Reflective Practice rounds,

narratives for individual reflection on practice, ambulatory nursing retreats for reflection and

renewal, and individual meetings with a psychiatric clinical nurse specialist for new graduates,

all with favorable outcomes despite some initial implementation difficulties (Hayes et al., 2005).

This study reported qualitative but not quantitative data.

Bauer Wu and colleagues facilitated overnight staff renewal retreats with oncology

nurses from a large Eastern U.S. cancer center in 2005 (2005). Goals of the retreats included

bringing staff together outside the work setting to relax, have fun, revisit self-care and self-

reflection as well as rekindling spirit in order to feel rejuvenated and professionally re-inspired

(Bauer Wu, 2005). The retreat theme was “Creating Balance and Peace in a Life of Blessings

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Running head: BURNOUT & COMPASSION FATIGUE LITERATURE REVIEW

and Losses,” with participant choice of four experiential break-out sessions: “Keeping the

Hope” using art, imagery, and story to restore hopefulness as a self-care practice, “Coming

Home to Your Body,” using therapeutic movement, “Being Peace” using mindfulness meditation

to foster peace and balance in everyday life, and “What Matters Most” for self-reflection and

expression through collage and writing (Bauer-Wu, 2005). Though no quantitative evaluation

tools were used, the author reported that participants acknowledged appreciation for the unique

experience of fun, personal growth, and knowledge (Bauer Wu, 2005).

Potter and colleagues studied prevalence of burnout in a large Midwest U.S. cancer

center, and an intervention based on the needs of the center that did not have an existing program

in place. Staff facilitators were trained to meet the unique needs of the staff and presented a

series of four 90-minute training sessions and a four hour retreat designed to help RNs gain skills

to reduce burnout (Potter, et al., 2010). The ProQOL R-IV was administered pre and post-

intervention, along with qualitative measures reflecting positive outcomes for program

participants. There was no wait list control group.

An 8-week mindfulness-based stress reduction program was offered to 25 nurses at an

Eastern U.S. hospital and health network funded by the organization and the senior VP for

clinical services who was one of the study investigators (Cohen-Katz, Wiley, Capuano, Baker,

Deitrick, & Shapiro, 2005). Qualitative and quantitative data from the study found the

intervention to be effective in improving relaxation, self-care, work and family relationships,

though the process at times generated challenges like restlessness, pain, and dealing with

difficult emotions (Cohen, et al, 2005).

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Inferences for Future Research

Further research is needed to develop a theory of compassion fatigue for nursing practice

(Knobloch Coutzee & Klopper, 2010). Additional research may determine factors that

contribute to the progression from compassion discomfort to compassion stress, and compassion

fatigue, and determine time line involved in this process (Knobloch Coutzee & Klopper, 2010).

More studies are needed that evaluate interventions for preventing and reducing nursing burnout

compassion fatigue as well (Knoblach Coutzee & Klopper, 2010).

Randomized clinical trials conducted at multiple sites on the effect of therapeutic

interventions on oncology nurse burnout and compassion fatigue are needed to establish

empirical data on solving the problem. Studies show that the effects of these interventions may

last 6 months to 2 years (Marine, et al., 2009) demonstrating cost savings to healthcare

organizations providing regular burnout and compassion fatigue interventions to recruit and

retain nurses and improve patient outcomes.

Conclusions

Fatigue, stress, sadness, decrease in morale, and poor work performance, are all

influenced by psychosocial factors that have often been ignored by nurses and healthcare

administration (Boyle, 2012). Klobach Coutzee & Klopper (2010) believed that increased

knowledge of compassion fatigue and its manifestations may enable nurses to become aware of

others who might be suffering and facilitate the development of a peer support network, making

it possible for nurses to seek assistance in dealing with the detrimental effects of compassion

fatigue. An employee assistance program should be established in every health-care institution,

with free counseling and life skills education services allowing nurses to seek assistance in

dealing with the emotional burden of their work (Klobach Coutzee & Klopper, 2010).

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Running head: BURNOUT & COMPASSION FATIGUE LITERATURE REVIEW

Burnout and compassion fatigue impact recruitment and retention of oncology nurses and

may influence patient satisfaction and patient safety (Potter et al., 2005). Encouraging self-care

strategies and offering interventions within and outside the workplace address a key distinction

of nursing practice, namely that of holistic care for patients and nurses (Boyle, 2011).

With experience, self-care, and support from peers and healthcare organizations,

competent oncology nurses learn to establish appropriate boundaries that are more semi-

permeable than other clinical specialties. Because of the semi-permeable boundaries unique to

oncology nursing and high risk of developing burnout and compassion fatigue, oncology nurses

need annual therapeutic programs in addition to more frequent support outlets. Compassionate

nurses are an essential and dwindling resource in today’s healthcare system, and nurses must be

supported and cared for by providing nurses with time to share feelings and develop coping

strategies (Edmunds, 2010).

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References

Graded references are listed according to the following legend from O’Neil, Dluhy,

Fortier, & Michael (2004) and Polit (2012) :

Legend Type: R= Research L= Literature N= National Guideline

Levels: I= Systematic Review of RCT, Systematic Review of Non-Randomized Trial

II=Single RCT, Single Non-Randomized Trial

III= Systematic Review of Correlational or RCT, Observational Studies

IV= Single Correlational or Observational Study

V=Systematic Review of Descriptive/Qualitative/Physiologic Studies

VI=Single Descriptive/Qualitative/Physiologic Study

VII=Opinion of Authorities, expert committees

Strength: A= Good evidence to support a recommendation

B= Moderate evidence to support a recommendation

C= Poor evidence to support a recommendation

O'Neill, E.S., Dluhy, N.M., Fortier, P.J., & Michael, H.E. (2004). Knowledge acquisition,

synthesis, and validation: A model for decision support systems.

Journal of Advanced Nursing, 47 (2), 134-142.

Polit, D. F. (2012). Evidence-based nursing: Translating research evidence into practice. In D. F.

Polit, Nursing Research: Generating and Assessing Evidence for Nursing Practice (pp.

25-47). Philadelphia, PA: J. B. Lippincott Company.

Reference Citation Type Level Strength Comments

Aycock, N. & Boyle, D. (2010).

Interventions to manage

compassion fatigue. Clinical

Journal of Oncology Nursing,

13(2), 183-191.

R IV A National survey to

determine resources

available to oncology

nurses for dealing with

burnout and compassion

fatigue (B&CF).

Reference Citation Type Level Strength Comments

Barnard, D., Street, A., & Love,

A. (2006). Relationships between

stressors, work supports, and

burnout among cancer nurses.

Cancer Nursing. 29(4), 338-345.

R IV B Pilot study of 101

Australian oncology

nurses using self-report

questionnaires and

Maslach Burnout

Inventory, moderate to

low burnout results.

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Running head: BURNOUT & COMPASSION FATIGUE LITERATURE REVIEW

Reference Citation Type Level Strength Comments

Bauer-Wu, S. (2005). Seeds of

hope, blossoms of meaning.

Oncology Nursing Forum, 32(5),

927-933.

R VI B Summary of B&CF

programs for oncology

nurses.

Reference Citation Type Level Strength Comments

Brooks, D.M., Bradt, J., Eyre, L.,

Hunt, A., & Dileo, C. (2010).

Creative approaches for reducing

burnout in medical personnel.

The Arts in Psychotherapy, 37,

255-263.

R II B RCT using music and art

therapy to reduce burnout

in 65 medical

professionals at an urban

hospital.

Reference Citation Type Level Strength Comments

Boyle, D. (2011). Countering

compassion fatigue: A requisite

nursing agenda. Online Journal of

Issues in Nursing, 13(1).

R I A Review of current

literature and research and

need for B&CF.

Reference Citation Type Level Strength Comments

Bush, N.J. (2009). Compassion

fatigue: Are you at risk?

Oncology Nursing Forum, 36(1),

24-28.

R VII B Case studies on B&CF,

differences/similarities

between B & CF, and

self-care.

Reference Citation Type Level Strength Comments

Cohen-Katz, J., Wiley, S.,

Capuano, T., Baker, D., Deitrick,

L., & Shapiro, S. (2005). The

effects of mindfulness-based

stress reduction on nurse stress

and burnout a qualitative and

quantitative study, part III.

Holistic Nursing Practice.

March/April, 78-86.

R IV B 8 week MBSR program

for 25 nurses improved

relaxation, work & family

relationships, caused

restlessness, emotional

pain dealing with difficult

emotions in group

discussions.

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Running head: BURNOUT & COMPASSION FATIGUE LITERATURE REVIEW

Reference Citation Type Level Strength Comments

Collins, S. & Long, A. (2003)

Too tired to care? The

psychological effects of working

with trauma. Journal of

Psychiatric and Mental Health

Nursing, 10, 17-27.

R III B Review of literature on

B&CF in several areas of

nursing specialties

including emergency,

oncology, and psychiatry.

Reference Citation Type Level Strength Comments

Current Nursing. (2012b). Jean

Watson’s Philosophy of Nursing.

Retrieved from:

http://currentnursing.com/nursing

_theory/Watson.html

L VII C Website describing

nursing theory that can be

applied to a theoretical

model and research on

nursing B&CF.

Reference Citation Type Level Strength Comments

Edmonds, M.W. (2010). Caring

too much: Compassion fatigue in

nursing. Applied Nursing

Research. 23, 191-197.

L VII B Editorial on nursing

B&CF and summary of

Yoder study and

implications.

Reference Citation Type Level Strength Comments

Figley, C. (1995). Compassion

fatigue: Coping with secondary

traumatic stress disorder in those

who treat the traumatized.

Brunner/Mazel: New York.

L VII B Expert textbook/guide on

compassion fatigue.

Reference Citation Type Level Strength Comments

Hayes, C., Reid Ponte, P.,

Coakley, A., Stanhellini, E.,

Gross, A., Perryman, S., Hanley,

D., Hickey, N., & Somerville, J.

(2005). Retaining oncology

nurses: strategies for todays

nurse leaders. Oncology Nursing

Forum. 32(6), 1087-1090

R VII B Leaders from 3 hospitals

collaborated on retention

of oncology nurse

strategies like creating

nursing advisory groups,

supporting new grads, &

meeting emotional needs

of nurses at all levels.

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Running head: BURNOUT & COMPASSION FATIGUE LITERATURE REVIEW

Reference Citation Type Level Strength Comments

Hooper, C., Craig, J., Janvrin,

D.R., Wetsel, M.A., Reimels, E.,

Anderson, Greenville, and

Clemson, S.C. Compassion

satisfaction, burnout, and

compassion fatigue among

emergency room nurses compared

with nurses in other selected

inpatient specialties. Journal of

Emergency Nursing. 36(5), 420-

427.

R IV B Failed to support

hypothesis that

emergency nurses had

higher compassion fatigue

than other specialties and

found that oncology

nurses had higher

compassion fatigue; used

cross sectional survey &

ProQOL tool.

Reference Citation Type Level Strength Comments

Joinson, C. (1992). Coping with

compassion fatigue. Nursing,

22(4), 116, 118-120.

R IV B Original mention of

B&CF in nursing

literature as observed in

emergency nurses losing

their capacity to care.

Reference Citation Type Level Strength Comments

Kash, K.M., Holland, J.C.,

Breitbart, W., Berenson, S.,

Dougherty, J., Ouellette-Kobasa,

S., & Lesko, L. (2000). Stress

and burnout in oncology.

Oncology, 14(11), 1-12.

R IV B Psycho-oncology experts

study of burnout in

oncology professionals

using a variety of

quantitative measures-

found nurses sense of

accomplishment lower

than MDs.

Reference Citation Type Level Strength Comments

Knobloch Coetzee S.K., &

Klopper, H.C. (2009).

Compassion fatigue within

nursing practice: A concept

analysis. Nursing and Health

Sciences, 12, 235-243.

R III B Concept analysis paper

including literature

review on B&CF as well

as concept map on CF.

19

Running head: BURNOUT & COMPASSION FATIGUE LITERATURE REVIEW

Reference Citation Type Level Strength Comments

LeBlanc, P.M, Hox, J.J.,

Schaufeli, W.B., Taris, T.W., &

Peeters, M.C.W. (2007). Take

care! The evaluation of a team-

based burnout intervention

program for oncology providers.

Journal of Applied Psychology,

92(1), 213-227.

R II A RCT quasi experimental

study of staff from 29

oncology wards, 9 wards

randomly selected to

participate in the program

measured over time-

directly after, 6 months

after and 2 years after.

Reference Citation Type Level Strength Comments

Mackenzie, C.S., Poulin, P.A., &

Seldman-Carlson, R. (2006). A

brief mindfulness-based stress

reduction intervention for nurses

and nurse aides. Applied Nursing

Research 19, 105-109.

R II B RCT with mixed methods

analyzing a MBSR

intervention for nurses

and nurse aides.

Reference Citation Type Level Strength Comments

Marine, A., Ruotsalainen, J.H.,

Serra, C., & Verbeek, J.H. (2009).

Preventing occupational stress in

healthcare workers (review). The

Cochrane Library 2009, Issue 1.

R I A Cochrane review of 14

RCTs and other lower

quality trials with large

sample and control groups

recommending larger and

better trials to improve

QOL and decrease costs

of B&CF.

Reference Citation Type Level Strength Comments

Maslach, C., & Schaufeli, W. B.

(1993). Historical and conceptual

development of burnout. In W. B.

Schaufeli, C. Maslach, & T.

Marek (Eds.), Professional

burnout: Recent developments in

theory and research (pp. 1–16).

Washington, DC: Taylor &

Francis.

L VII B Expert textbook and guide

on burnout.

20

Running head: BURNOUT & COMPASSION FATIGUE LITERATURE REVIEW

Reference Citation Type Level Strength Comments

Medland, J., Howard-Ruben, J., &

Whitaker, E (2004). Fostering

psychosocial wellness in

oncology nurses: Addressing

burnout and social support in the

workplace. Oncology Nursing

Forum, 31(1), 47-54.

R IV B Qualitative evaluation of

a program developed

because of high turnover

rate in the oncology unit

compared to the rest of

the hospital.

Reference Citation Type Level Strength Comments

Najjar, N., Davis, L.W., Beck-

Coon, K., & Doebbeling, C.C.

(2009). Compassion fatigue: A

review of the research to date and

relevance to cancer-care

providers. Journal of Health

Psychology, 14(2), 267-277.

R I B Review of 57 studies

identifying prevalence of

compassion fatigue in

oncology providers,

instruments, and

prevention and treatment.

Reference Citation Type Level Strength Comments

Pilkington, F.B. (2009).

Theorizing the concept of burnout

in nursing. Nursing Science

Quarterly, 22, 199.

L VII B Editorial and introduction

to B&CF articles,

suggested developing

nursing model based on

Neuman.

Reference Citation Type Level Strength Comments

Potter, P., Deshields, T,

Divanbeigi, J., Berger, J.,

Cipriano, D., Norris, L., & Olsen,

S. (2010). Compassion fatigue

and burnout: Prevalence among

oncology nurses. Clinical Journal

of Oncology Nursing. 14(5):E56-

E62.

R IV B Descriptive cross

sectional survey with

moderate evidence to

support the

recommendations based

on the outcomes. The

main author is an expert

on the topic.

Reference Citation Type Level Strength Comments

Sabo, B.M. (2011). Reflecting on

the concept of compassion

fatigue. , Online Journal of Issues

in Nursing, 16(1), 1-19.

R V B Review of literature with

case scenarios, suggesting

lack of theoretical clarity

and need for quantitative

and qualitative research

on nurse B&CF.

21

Running head: BURNOUT & COMPASSION FATIGUE LITERATURE REVIEW

Reference Citation Type Level Strength Comments

Sheridan-Leos, N. (2008).

Understanding lateral violence in

nursing. Clinical Journal of

Oncology Nursing, 12(3), 399-

403.

L VII B Professional issues article

on the related concept of

nursing lateral violence-

antecedent/consequence

of B&CF.

Reference Citation Type Level Strength Comments

Yoder, E.A. (2010). Compassion

fatigue in nurses. Applied Nursing

Research, 23(4), 191-197.

R II A Quantitative and

qualitative study on

B&CF in nurses with

narrative triggers and

coping strategies.