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Compassion Fatigue: How Nurses Can Care for Themselves

The Professional Quality of Life Measurement (ProQoL) tool was developed and made available for free from, to help professionals analyze their feelings, and measure how they rate on scales for burnout and secondary traumatic stress.6 This measurement has been in use since 1995, and has been used extensively in CF research. Any person or facility may download and use the tool, which can be used as a starting point determining CF.

“If the Oxygen Masks Drop …”

Before every plane takes off, passengers are reminded of emergency procedures, which include instructions regarding the oxygen masks. If passengers are traveling with a child or someone who needs assistance, they are instructed to put on their own oxygen mask first, so they are able to help their companion. Nurses must take that same approach. They must take care of themselves, so they can take care of their patients and the others who need them. In her research into CF, Patricia Potter, RN, PhD, FAAN, and her colleagues determined that there were five approaches or strategies to self-care that nurses could employ, which they named compassion fatigue “antibodies.”5
  1. Self-regulation
    Learning how to relax or achieve a feeling of peace
  2. Perceptual maturation
    Learning how to regulate thinking and perception
  3. Intentionality
    Writing a covenant and choosing how to live and work
  4. Connection and support
    Developing and using a support network
  5. Self-care and revitalization
    Healthy living, participating in hobbies, etc
Self-care approaches provide nurses with a variety of options, from keeping gratitude journals to taking regularly scheduled vacations. Becca Hawkins, MSN, ARNP, ACHPCN, the Director of Compassionate Care at Providence Health & Services in Pendleton, Oregon, likes to promote mindfulness as a part of self-care. She has done extensive research and teaching about mindfulness and meditation for nurses. She uses this approach as self-care because it can be done anywhere any time—literally in the moment.

Jon Kabat-Zinn, founder of the Mindfulness-Base Stress Reduction (MBSR) program described mindfulness as an “awareness that arises through paying attention, on purpose, in the present moment, nonjudgmentally.”7

“We’ve been working a lot throughout our healthcare system with mindfulness. We’ve been starting with self-compassion, and paying attention to when you’re really hard on yourself, and beating yourself up over a situation or just being negative,” Hawkins said. “When this happens, you’re not able to see the positive things.”

A good place to start with mindfulness is when nurses are washing their hands. After all, how many times a shift do nurses wash their hands, Hawkins asked. “As you’re using the hand sanitizer, you just really feel your hands, listen to your heart, feel your breath, feel whatever practices you do and it brings you back here, instead of thinking, “I’m walking into this room and I’m going to have to break bad news,” she explained.

With mindfulness, there is no looking back at what happened or forward at what might happen.  

Most nurses do already know what they should do in order to prevent CF, but knowing what to do and actually doing it are two different things.

Kenney and Jakel learned of an app that would help nurses remember to use these strategies. They initiated a study to evaluate the use of the Provider Resilience Mobile App among oncology nurses. Originally designed by the Department of Defense for those who cared for Iraqi war veterans, the app was adapted for nurses for the study. Kenney described the app as something that would remind nurses to do the small pieces of daily self-care.
Becca Hawkins, MSN, ARNP, ACHPCN

Becca Hawkins, MSN, ARNP, ACHPCN

“From there, it offers various resilience builders, and also helps you with your resilience killers,” Kenney explained. “It helps you see some of the negative coping strategies that you might be using and not realize you’re using. It also offers very simple resilience builders that you can do throughout the day.” The app asks when the provider last did a positive act, but it also asks things like when was the last time the user ate junk food, sat for too long, and so on, to help identify unhealthy behaviors as well.

Also included in the app is a version of the ProQoL so users can do an initial assessment, and it measures compassion satisfaction and possible levels of burnout or potential secondary traumatic stress.

Jakel pointed out that there is no one-size-fits-all approach to preventing or dealing with CF. “I think it’s a combination, be it self-care, or meditation,” she said. “I really liked that the app had daily affirmations that you could read through. The app was easy because it was there, and it was one measurement, one thing, one intervention that people could do to build their resilience.”

Talk about this article with nurses and others in the oncology community in the General Discussions Oncology Nursing News discussion group.
External Resources

MJH Associates
American Journal of Managed Care
MD Magazine
Pharmacy Times
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Specialty Pharmacy Times
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