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Emergency Department Nurses' Lived Experience with Compassion Fatigue Michelle M

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Emergency Department Nurses' Lived Experience with Compassion Fatigue Michelle M Florida State University Libraries Electronic Theses, Treatises and Dissertations The Graduate School 2005 Emergency Department Nurses' Lived Experience with Compassion Fatigue Michelle M. Chase Follow this and additional works at the FSU Digital Library. For more information, please contact [email protected] THE FLORIDA STATE UNIVERSITY SCHOOL OF NURSING EMERGENCY DEPARTMENT NURSES’ LIVED EXPERIENCE WITH COMPASSION FATIGUE By MICHELLE M. CHASE A Thesis submitted to the School of Nursing in partial fulfillment of the requirements for the degree of Master of Science in Nursing Degree Awarded: Fall Semester, 2005 Copyright 2005 Michelle Chase All Rights Reserved The members of the Committee approve the thesis of Michelle M. Chase defended on October 26, 2005. __ Sandra Faria Professor Directing Thesis ________ Denise Tucker Committee Member __________________________ Charles Figley Committee Member Approved: ___________________________________________________________ Linda Sullivan, Director, School of Nursing Graduate Program ___________________________________________________________ Katherine P. Mason, Dean, School of Nursing The Office of Graduate Studies has verified and approved the above named committee members. ii This manuscript is dedicated to Darryl Jordan. Your love, support, and understanding have fostered the achievement of my academic goals. I am grateful for your desire to assist me in the accomplishment of my dreams. iii ACKNOWLEGEMENTS A special thanks to those extraordinary individuals who have helped me in the achievement of my academic endeavors. To Dr. Sandra Faria for your knowledge, wisdom, and encouragement which provided me with strength and direction in facing the daunting task of analyzing my data as well as completing my research. To Dr. Jeanne Flannery for your guidance and support which was very valuable in the early phases of the research process. You gave me the power and motivation to pursue my research interest as well to persevere when I felt that I could no longer keep going. To Dr. Denise Tucker for your positive attitude and words of encouragement which were a tremendous help throughout the research process. To Dr. Charles Figley for your strong support of my research focus and willingness to assist me in my research endeavors. To Darlene Prickett for your assistance and eagerness in promoting my research. To Jamie Marsh for your technical assistance which was extremely valuable as I completed my research. iv TABLE OF CONTENTS List of Tables …….………………………………….………………………………. vii List of Figures …….…..……………………….………………………….………… viii Abstract ….…….…………………………………….……………………………… ix CHAPTER 1 Introduction ………….……………………………………………...................... 1 Statement of the Problem ……..………………………………………………… 3 Significance of the Problem ……..……………………………………………… 5 Statement of Purpose ……...…………………………………………………….. 7 Research Questions ……………………………………………………………... 7 Definition of Terms ……………………………………………………………... 7 Assumptions …………………………………………………………………….. 7 Limitations ……………………………………………………………………… 8 Conceptual Framework …………………………………………………………. 8 Watson’s Theory of Human Caring ……………………………………… 8 Selye’s Stress Theory …………………………………………………….. 9 Figley’s Compassion Stress and Fatigue Model …………………………. 10 Summary …..……………………………………………………………………. 12 CHAPTER 2 Review of Literature …...….…………………………………………………….. 14 Theory …..………………………………………………………………………. 14 Compassion Fatigue ……………………………………………………… 14 Secondary Traumatic Stress ……………………………………………… 15 Burnout …………………………………………………………………… 16 Vicarious Traumatization ………………………………………………… 17 Empathy ………………………………………………………………….. 18 Watson’s Theory of Human Caring ……………………………………… 18 Selye’s Stress Theory …………………………………………………….. 21 Figley’s Compassion Stress and Fatigue Model …………………………. 25 Empirical Studies ……………………………………………………………….. 27 Compassion Fatigue ……………………………………………………… 27 Secondary Traumatic Stress ……………………………………………… 34 Burnout …………………………………………………………………… 38 Vicarious Traumatization ………………………………………………… 41 Empathy ………………………………………………………………….. 42 Work-related Stress ………………………………………………………. 44 Watson’s Theory of Human Caring ……………………………………… 49 v Selye’s Stress Theory …………………………………………………….. 54 Figley’s Compassion Stress and Fatigue Model …………………………. 55 Summary …..……………………………………………………………………. 56 CHAPTER 3 Methodology ….………..……………………………………………………….. 58 Design …………………………………….…………………………………….. 58 Sample ………………………………………………………………………….. 59 Instrumentation ..………………………………………………………………... 59 Protection of Human Subjects ...………………………………………………… 60 Procedure …………………………...…………………………………………… 61 Data Analysis …..……………………………………………………………….. 63 Summary …..……………………………………………………………………. 64 CHAPTER 4 Results ...….…………………………………………………………………… 65 Description of the Sample ……..………………………………………………... 65 Research Question 1 …………………………………………………………….. 68 Research Question 2 …………………………………………………………….. 84 Research Question 3 …………………………………………………………….. 88 Conclusions ….………………………………………………………………….. 91 Summary …..……………………………………………………………………. 92 CHAPTER 5 Discussion of the Findings ..…………………………………………………….. 93 Relationship to Literature ……………………………………………………….. 97 Conceptual Framework …………..……………………………………………... 99 Limitations of the Study ..……………………………………………………….. 104 Strengths of the Study ……..…………………………………………………..... 104 Implications for Nursing …..……………………………………………………. 105 Recommendations for Future Research ………..……………………………….. 107 Summary …..……………………………………………………………………. 108 APPENDICES ………………………………………………………………………. 109 REFERENCES ...…………………………...………………………...……………... 128 BIOGRAPHICAL SKETCH …………..……………………………………………. 134 vi LIST OF TABLES 4.1 Description of the Study Sample ……………………………….……….…… 66 4.2 Results of the Compassion Satisfaction/Fatigue Self-Test for Helpers ……... 90 vii LIST OF FIGURES 1.1 Figley’s Compassion Stress and Fatigue Model ……..…….…….…………… 12 5.1 Emergency Department Nurses Compassion Fatigue Lived Experience Model …………………………. ……………………………………..………. 103 viii ABSTRACT The profession of nursing is in the midst of a crisis brought on by a nursing shortage. Many are choosing to leave the profession of nursing coupled with fewer numbers choosing nursing as a profession. As a result, nurses are challenged with increased acuity of patient care in the face of short staffing. Compassion fatigue can result from these highly stressful situations. Much has been written in the healthcare literature about the negative effects of compassion fatigue and work-related stress on healthcare workers. However, the population of Emergency Department nurses has been virtually ignored. This inquiry utilized a qualitative approach with a phenomenological design in order to capture and describe the lived experience of Emergency Department nurses with compassion fatigue and work-related stress. The study revealed that the work-related stressors in which Emergency Department nurses encounter are numerous as a result of the hectic and chaotic environment in which they work. The main work stressors included the large number and continuous influx of patients, the increased patient acuity, and the lack of skilled nursing staff. Those nurses included in the study were resourceful in coping with work-related stressors by relying on support systems, using internal coping measures, or simply trying to persevere or overcome through firm resolve. When these nurses were successful in coping with their work stress, they often felt a sense of accomplishment in terms of the patient care delivered. If the encounters with work stress were especially negative, many often felt abandoned and exhausted. However, by witnessing improvements in patient status or by feeling that their care giving efforts were effective in relieving the pain and suffering of those in their care, these nurses were often able to overcome their negative feelings caused by the chaotic work environment. Generally speaking, the encounters with work stress had a negative impact on the nurses’ ability to provide care. They described feeling angry and displaying uncaring attitudes toward the patients. However, many described feeling a sense of ix accomplishment if they had been successful in coping with the work stress or if they felt that the nursing care provided had a positive impact on patient outcomes. This study provided a glimpse into the experience of Emergency Department nurses with compassion fatigue and work-related stress. However, gaps within the literature still exist. Other areas need to be investigated including the prevalence and risk of compassion fatigue as well as the comparison of larger groups of Emergency Department nurses’ experiences with compassion fatigue. x CHAPTER 1 INTRODUCTION Nurses are constantly exposed to the pain and suffering of those in their care. With each patient interaction, the nurse is faced with the patient’s distress and isolation. For a number of nurses, the loss of compassion is an inevitable outcome of these exposures (Lamendola, 1996). Such interactions and exposures can be stressful to the nurse over a long period of time. Compassion fatigue, or secondary traumatization, is the final stage in a long period of stress. Secondary traumatization, also known as compassion fatigue, can occur in those who work closely with or study victims of traumatic events (McCann & Pearlman, 1990). According to Figley (1995), secondary traumatization is also an occupational risk to professionals who provide direct or indirect patient care. Compassion involves recognizing the patient’s difficulties and responding with a desire and commitment to help regardless of the outcome
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