Academic journal article Journal of Nursing Scholarship

Understanding Compassion Fatigue in Healthcare Providers: A Review of Current Literature

Academic journal article Journal of Nursing Scholarship

Understanding Compassion Fatigue in Healthcare Providers: A Review of Current Literature

Article excerpt

Compassion fatigue (CF) is often thought of as the caregiver's cost of caring and results when caregivers are exposed to repeated interactions requiring high-levels of empathic engagement with distressed clients; it can be a significant contributing factor in caregiver burnout (Figley, 2002). CF leads to an acute onset of physical, emotional, and work-related symptoms that affect patient care and relationships (Lombardo & Eyre, 2010).

CF is often conflated with burnout, secondary traumatic stress (STS), and compassion stress. While the terms are used interchangeably in the literature, it is unclear whether they are in fact synonymous. Some of this overlap occurred due to the evolution of the concept of CF. CF originated from the understanding that post-traumatic stress disorder could also affect individuals who know about a traumatic event that impacted someone close to them; this was also known as secondary catastrophic stress reaction (American Psychiatric Association, 1980; Figley, 1993). This understanding led to Figley's further research and conceptualization of STS to explain the costs of caring many supportive parties experienced when they learned of someone else's trauma (Figley, 1993). Joinson renamed the cost of caring phenomenon compassion fatigue, and both parties conceded that the terms could be used interchangeably, with STS offering a better clinical description and CF providing a more user-friendly term for the experience (Figley, 1995; Joinson, 1992).

CF and burnout have similarities and are closely correlated (r = 0.769, p < .001), yet they have unique symptomology, with CF occurring more abruptly than burnout and as a direct result of exposure to another person's trauma (El-bar, Levy, Wald, & Biderman, 2013; Todaro-Franceschi, 2013). While both result in mental, physical, and psychological exhaustion, CF mirrors post-traumatic stress disorder in that most of the symptoms and distress are related to traumatic memories, hyperarousal or numbness, avoidance of same or similar situations, and exhaustion (El-bar et al., 2013). Conversely, burnout is the result of powerlessness and low job satisfaction, and leads to gradual worker disengagement (El-bar et al., 2013). However, continued overlapping and interchanging of these terms in recent research suggests the need to differentiate them in the form of a thorough concept analysis (Coetzee & Klopper, 2010; Figley, 2002; Jenkins & Warren, 2012; Sabo, 2011). Until such time, CF and related concepts (CF and RCs) will be used as an overarching term in the discussion to present a comprehensive analysis of the literature.

Aims and Research Questions

The aim of this literature review was to analyze published research in the past 10 years that addressed CF and RCs in healthcare providers (HCPs) with attention to provider role and practice area. To do this, the current literature for CF in all HCPs was reviewed. Ultimately, this review aims to answer (a) What does the recent literature report regarding CF and RCs in HCPs, and (b) Are there any gaps in the current literature related to specific HCP roles?


This literature review employed Whittemore and Knafl's (2005) integrative review methodology. It deviated slightly as no official data evaluation stage was included due to lack of clearly defined concepts in the literature. While recommended, Whittemore and Knafl (2005) acknowledged that quality data evaluation is complex and more helpful when the sample of literature is small and includes similar or identical research designs. The use of a quality scoring system would not have been particularly beneficial because this review covered an extensive sample and a wide variety of research designs.

The literature search spanned 2005-2015 and was conducted using the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed. While restricting the search to online databases can be selflimiting, as detailed by Whittemore and Knafl (2005), including databases that are inclusive of all healthcare professionals minimized this limitation. …

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