COMPASSION FATIGUE &
Renee Rafferty, MS, LPC
Director of Behavioral Health Services
Providence Health & Services, Alaska
The heart can hold what it loves for a lifetime.
WHAT IS COMPASSION FATIGUE?
Compassion fatigue has been defined as a
combination of physical, emotional, and spiritual
depletion associated with caring for patients in
significant emotional pain and physical distress
(Anewalt, 2009; Figley, 1995).
Joinson (1992), a nurse, was the first to describe
the concept in her work with emergency room
personnel. She identified compassion fatigue as a
unique form of burnout that affects individuals in
WHAT IS COMPASSION FATIGUE?
Through our efforts to empathize and show
compassion, healthcare workers are impacted by
the suffering and trauma the patients experience
and the challenges of the work.
Unlike Post Traumatic Stress Disorder (PTSD)
the caregiver does not physically experience the
traumatic event but does experience the event
emotionally by caring for the patient (Sabo,
COMPASSION FATIGUE OR BURNOUT?
Compassion Fatigue Burnout
Found in occupations dealing directly with
trauma victims. Can be found in all sorts of occupations.
Occurs from exposure to trauma. Occurs from overworking oneself and occupational stress.
WHAT IS SECONDARY TRAUMATIC STRESS
Traumatic learning through witnessing or
interacting with trauma survivors.
May occur after daily exposure to traumas in
conjunction with empathetic response.
May occur after one overwhelming stressful
SECONDARY TRAUMATIC STRESS
Vicarious traumatic stress Suffering patient
Media Dying patients
Entertainment Witnessing suffering
Stories Witnessing trauma results
Witnessing traumatic narratives
Big T – Big events that people recognize as
intense and overwhelming.
War, Death, Disasters, Abuse, Neglect, Illness,
Accidents, physical violence
Little t – Smaller events that cause people to feel
overwhelmed and powerless
Rejection, loss, embarrassments, hearing stories
of physical violence,
WHAT IS TRAUMA?
Physical Emotional Thoughts Behavior
Headaches Dread of working with
Poor concentration Restlessness
•Reduced ability to feel
Loss of objectivity Frequent use
of sick days
Hopelessness Memory loss Drinking
Anxiety Intrusive thoughts about
Lack of joyfulness “I can’t do this.” Isolating
Pain Anger “The world is a bad place.” Breaking
Resentment “ It’s someone’s fault” Aggressive
Lethargy Oversensitivity “This work is too hard.” Isolation
OTHER CAUSES OF COMPASSION
Increase in acuity of our patients
Our system has failed to provide training and
treatment for anything other than the presenting
Trauma associated with violence in the
An increase in violence is occurring in hospital
settings throughout our nation
Caregivers are overwhelmed
Patient population is more acute
Caregivers struggle feeling ineffective
Swing between believing they have to “put up
with violence” and wanting protection
HOW DOES THIS INCREASE IN VIOLENCE
IMPACT HEALTHCARE PROFESSIONALS?
Repeated activation of the threat-response
system through painful learning
Nervous system becomes chronically
Become disconnected from work, leadership , and
Healthcare professionals are deeply rooted to the
They want to feel like they can help someone get
They become distressed when they don’t have the
tools and they cannot see that what they are
doing is effective.
INTERVENTIONS ARE MULTI-TIERED
Environmental and legal protection
Whole person care
DOES EVERYONE IN HEALTHCARE HAVE
TO GET COMPASSION FATIGUE
We can continue to thrive by changing our
perceptions and growing our skill sets.
We are resilient.
BUILDING BLOCKS OF RESILIENCY
Self-regulation Tools – Can I get calm?
Purpose- Am I connected to the meaning behind
Community of health – Where? With who? How?
CAN YOU HAVE TOO MUCH COMPASSION?
Feeling deeply allows us to connect with the
Creating “Armor” can hurt us too
Awareness of the impact of the trauma can help
us to navigate the complexity and keep our
Boundaries protect us
Behaviorally: Self-regulation is the ability to act
in your long-term best interest, consistent with
your deepest values.
Emotionally: Self-regulation is the ability to calm
yourself down when you're upset and comfort
yourself up when you're experiencing a big
Keeping your body calm
Managing your thoughts
Managing your feelings
WHY DO WE NEED SELF-REGULATION?
One hand on abdomen, one on chest.
Inhale to count of 7,
Focus on moving abdomen forward and not
Exhale to same count.
Once comfortable, you won’t need hand
“In my experience, healthily vulnerable
people use every occasion to expand,
change, and grow.”
-Fr. Richard Rohr
REDUCING OUR OVERALL ANXIETY
According to Dr. David Lewis-Hodgson
of Mindlab International, which conducted the
research, the top song produced a greater state of
relaxation than any other music tested to date.
In fact, listening to that one song -- "Weightless" -
- resulted in a striking 65 percent reduction in
participants' overall anxiety, and a 35 percent
reduction in their usual physiological resting
ARE YOU DOING YOUR OWN HEALING?
“We’d like to believe that there are two kinds of
people in the world – those who need help and
those who offer help.
The truth is that we are both. We need to give
and we need to need.”
-The Compassion Collective
Koloroutis (2007) identified three core relationships
for transforming practice using RBN (The nurse’s
relationship with patients and families, the nurse’s
relationship with self, and the nurse’s relationship
The nurse’s relationship with self is a core concept in
managing compassion fatigue. Nurses need to be
assertive, to express personal needs and values, and
to view work-life balance as an achievable outcome.
This relationship with self is essential for optimizing
one’s health, for being empathic with others, and for
being a productive member of a work group within a
EMPOWERING OUR THOUGHTS
Our thoughts create our reality and impact our
health. What we believe about our environment
becomes the reality.
Do we process or vent?
What beliefs do we hold that keep stress stuck?
Kelly McGonigal Ted Talk
The Greater Good Science Center-
-University of California Berkeley
BUILDING A COMMUNITY OF HEALTH
Build relationships that are open and require
Practice having the “real conversation”
Focus on strengths
The people around u