Compassion Fatigue

The compassion displayed by the healthcare, emergency, and community service experts can be demonstrated physically, mentally, and financially costly. Briefly, the revelation to the patients or clients experiencing trauma or distress can adversely affect professional’s mental and physical health, safety and well-being, as well as for their families, the people they care for, and their employing organizations.

The term Compassion Fatigue (CF) was conceived to explain the occurrence of stress resulting from exposure to a traumatized individual rather than disclose to the trauma itself.

An often extreme state of tension and absorption with the emotional pain or the physical trouble of those being helped create second traumatic stress (STS) for the health professional, and when gathered with collective Burnout (BO), a state of physical and mental fatigue caused by a depleted ability to deal with one’s everyday environment, CF results.

CF is marked by exhaustion, anger, and petulance, negative dealing behaviours including alcohol and drug abuse, capacity reduction to feel sympathy and empathy, a lessened sense of enjoyment or satisfaction with work, enhanced truancy, and a damaged ability to make up your mind and care for the patients and the clients.

The negative consequences of providing care are provoked by the intensity of the traumatic material to which the health care provider is exposed, such as direct connection with the victims, especially when the disclosure is of a graphic nature.

This ranks certain works, such as health care, emergency, and the social service workers, at a raised risk of evolving CF and possibly more exhausting conditions such as depression and anxiety, and Post-Traumatic Stress Disorder (PTSD).

These conditions are known to increase the absence through illness, acute stress disorder claims, job overturn, and adversely affect productiveness.

Compassion Fatigue (CF) has been diversely defined, and the associated theories of BO, STS, and Vicarious Traumatization (VT) are frequently used reciprocally and mistakenly to describe the phenomenon.

BO and STS are also linked with CF, but as defined by Stamm, they are two different issues of discovery. BO and STS be caused by separate failed coping strategies.

BO come up from an assertiveness-goal achievement response and takes place when an individual cannot achieve his/her goals and give rises to “frustration, a sense of absence of control, raised deliberate efforts, and lessening morale.”

As an alternative, STS arises from a rescue-caretaking response and takes place when an individual is not able to save someone from getting harm and who results in blame, guilt, and trouble.

After that, STS and BO lead to CF if the previously mentioned symptoms are not intervened by the third, as important as the concept of Compassion Satisfaction (CS). CF and CS can be understood as the positive and negative consequences of working with individuals who have experienced or are experiencing trauma or suffering at the moment.

For that reason, a significant amount of evidence implies that the CS is a vital part of the whole union, thus increasing the importance of building elasticity and the transformation from the negative to the positive appearances.

Most often than the not used definition of CF describes the concept as “a state of exhaustion and dysfunction organically, psychologically, biologically, and socially as a consequence of extended revelation to sympathy stress and all it conjures.

This definition, in the more superior way, comprises the complicated dimensions of CF, the characteristics of CF are defined as a conventional relationship between the health care provider and the patient/client all is connected with the caregiving role and the psychological and physical responses it raises.

The triggering events established on the nurses taking care of patients who were experiencing life-threatening situations and cases with the involvement of useless or soothing care.

The arrangement issues or organizational factors, such as physically and emotionally exacting assignments and extra workdays as a risk factor for CF. While, it was also identified that empathy is essential to the progress of CF, as the health care provider must be capable to perceive and understand what their patient/client is experiencing and be able to make known of this understanding.


Search Strategy:

The following search strategy was conducted using the relevant database browsers (EMBASE, CINHAL, Psych Info, Web of Science, PubMed, and Scopus). Search terms were divided into four groups.

Group 1 related to CF, related concepts, and versions or by-products such as VT or STS.

Group 2 included endangered occupation types commonly exposed to known risk factors for CF such as battlefront health, emergency, and community service workers.

Group 3 included the terms related to the study design, for which we used the Cochrane search terms for the identification of interventions and trials (e.g. intervention, training, program, efficacy, and randomized control group).

Group 4 is related to the form of employment or derivatives of related words such as employees, workers, and professionals.

Inclusion and Exclusion Criteria:

The incorporative standards prescribed that the studies included a quantifiable evaluation of interference that stated consequences on a standardized and certified measure for Compassion Fatigue (CF).

This evaluation could be any of the endorsed versions of the most often than not used Professional Quality of Life (Pro-QoL) or a less common, but equally valid measure of CF. Instead, the results could be one of the sub-scales of the Pro-QoL; CS, a protective factor, or STS or BO, in respect of both of which are known risk factors for CF.

Eventually, the outcome could be endorse of a general health measure that has evidence of validity as a CF, BO, STS, or CS analytical tool (e.g. Maslach Burnout Scale, or the Resilience Scale).

The interposition has to target CF directly or indirectly through a known risk component for CF, such as those considered in the introduction (lack of significant gratitude, years of experience, higher job satisfaction, and poor functional work climate).

The mediation settings could be in work or non-work settings. Studies were excluded if they did not report on CF, focused on the prevalence of CF only, or used a qualitative methodology.

Data Extraction:

The volatiles removed cover intervention captions, sample characteristics, exceptional characteristics, quality of the research design (use of control group, random allocation), and the indicators of achievement.

The quality is rating score should not be used in the analysis, as it presents individuality and is liable to the incomplete data. The first and the second author developed the cryptography instructions and guidelines in order to reduce the perspicacity of the made decisions.

On completion of the coding, the first author independently checked the coding of each of the papers. Cases in which disagreement with the initial coding decisions occurred has resulted from consensus between both authors (Fiona Cocker and Nerida Joss).


The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) flowchart briefing the incorporation and exclusion decisions made by both the authors previously mentioned.

Due to the small number of huts generated (229), all articles were very carefully checked to determine whether they met the criteria for inclusion, contrary to making exceptional decisions solely on the basis of the initial title screening.

With the help of this review, two duplicate articles were removed, and 216 articles were eliminated. The majority of the study were included as well, as they focused solely on the incidence of CF. or a CF risk factor, within a particular optional group.

The rest of the articles were excluded, as they did not assess the efficacy of a CF prevention or intervention program, their primary focus was not CF, or they did not have a specific, certified measure of CF or factors which contribute to CF.

For example, studies were excluded if they had a PTSD or the stress-related outcome measure, measures of general psychosocial functioning, or well-being scales that have not been conventional in the literature as valid indicators of CF. The demand of these integration criteria resulted in a total of 13 studies being considered suitable for the detailed, systematic review and data extraction.

Characteristics of Included Studies:

Of the included studies (84.6%) were held in the USA, one in Australia, and one in Israel. About ten of the thirteen studies included nurses (76.9%), with three studies which are bein focused especially on oncology, one on the pediatric nurse, and one on emergency nurses.

Other employment groups represented were social workers (15.4%), chaplains (7.7%), hospice workers (7.7%), disability sector workers (7.7%), and miscellaneous medical staff (23.1%). The studies which were targeting the emergency service workers were not identified.

Outcome Measurements:

Ten (16.9%) of the covered research used a model of the Professional Quality of Life Scale (ProQoL) to degree CF, in addition to its subscales CS, BO, and STS. Other measures of the CF used had been the Compassion Fatigue Scale (CFS), each original and revised versions, designed to evaluate each secondary trauma and process burnout, and the Compassion Satisfaction and Fatigue Test (CSFT).

Three (23.1% of the protected studies measured best one form of outcome (e.g. ProQoL, Version 5, Manufacturer, City, Country). The closing ten protected articles measured the subsequent consequences similarly to CF: (i) Burnout (ii) Group building (iii) Effect of demanding events (iv)Pride with paintings or life (v) Empathy (vi) Resilience 

 (vii) Depression, anxiety, stress, or perceived stress (viii) Self-efficacy, self-esteem; mastery and hope; mindfulness, health care patron assessment, fashionable health; grief; paintings environment; and coping.


This systematic overview diagnosed the proof on interventions designed to lessen CF in fitness, emergency and network provider employees to decide the handiest place of business primarily based totally techniques for lowering CF immediately or through enhancing its regarded person and organizational danger factors.

Despite the full-size interest given to measuring the superiority of CF on this cohort of employees, there’s a loss of records and proof of approximately powerful interventions designed to lessen CF in those occupational groups.

We have located that, notwithstanding the popularity of the danger publicity to secondary trauma poses to the intellectual fitness and wellbeing of sure at-danger occupational groups, and the hooked up life of well-being packages to fight CF and associated concepts, rigorous, educational assessment of proof in this subject matter has most effective lately emerged withinside the previous few years, with the earlier observed posted in 2011 with a set of eighty pediatric nurses in Israel, as a result indicating the relative novelty of interventional studies on this vicinity.

By consolidating the small quantity of proof to be had we were capable of becoming aware of promising interventions in this vicinity in addition to the proof gaps and regions in want of studies interest withinside the future.

In doing so, the following proof-primarily based totally place of business-primarily based totally interventions have the capacity to lessen CF and extra serious, persistent and economically high priced intellectual disorders, to the gain of person employees, employers and the wider society and financial system via the retention of healthy, effective employees who provide the ones in want of health care and social assistance.

Study Population Characteristics:

The majority of research recognized in our-seek had been generated from the US, with nurses because of the occupation organization of interest.

As such, nurses have been disproportionally represented, proscribing the generalizability of findings to different similarly at-danger occupations inclusive of police, hearth place fighters, paramedics and different fitness and network provider employees.

Further, the bulk of topics represented withinside the covered research have been female (58.8%-100%), which, at the same time as reflective of the healthcare and social help enterprise to which most of the at-danger populations belong, as soon as again, reduces the extent of generalizability as different occupational organizations at-danger of CF, inclusive of the male-ruled emergency services aren’t covered.

Older employees have been additionally disproportionally represented, with averages starting from 45 years to 49 years, therefore, proscribing applicability of the findings to more youthful employees who can be vulnerable to growing CF.

More specifically, proof has recognized that each age and years of expert revel in have been defensive elements for STS, CF, or BO.

In addition to the over-illustration of numerous demographic characteristics 

 (e.g. instructional attainment) and organizational elements (e.g. lengthy paintings hours and caseloads with excessive probabilities of trauma patients) that have been related to an extended prevalence of STS and CF, have been now no longer considered.

Study Design and Methodological Quality:

Comparison among research became tough given the heterogeneity of the interventions themselves and the decrease degree of methodological nice for almost all of the research. The majority of research has been of low to mild nice, with the handiest RCT research covered in our review.

The majority of research hired a pre-put up layout, maximum of which did now no longer consist of a long-time period comply with-up (eight weeks). Additionally, the period of the intervention duration numerous substantially from an unmarried 4-hour session to six, one-hour classes as soon as every week for 12 weeks.

This is a concern, as vast behavioural and private ordinary change is needed in a few cases, with no complimentary adjustments being made to the work-associated chance elements including decreased publicity to traumatized sufferers or accelerated relaxation among shifts.

Change is likewise not likely inside this brief time duration, hence making vast development in CS or a vast lower in BO and/or STS in addition improbable. Finally, further to notably variable methodological layout and nice, maximum research covered have small pattern sizes with much less than a hundred subjects, which lessen statistical power, growth the opportunity of kind II error, and decrease the cap potential for statistical checks to locate vast variations among values.


While an intensive seek method turned into designed to adopt this systematic review, boundaries ought to be taken into considerations withinside the interpretation of results. As with any seek, in spite of looking at six predominant databases, a few research may also have been missed. Ours seek turned into confined to most effective seek English language journals, and, therefore, research posted in a language aside from English may have missed.


For your knowledge, this is the first review to attempt to appraise the evidence of the efficacy of CF interventions in hazard-prone health, emergency and social care professions. Results revealed that, despite an awareness of the prevalence of CF in these endangered workers, there is a lack of information and evidence about effective workplace-based strategies to reduce CF in these employment groups through modifying its acknowledged individual and organizational causative factors.

Therefore, the research is recommended more to determine how best to protect susceptible workers in order to prevent CF, as well as the potentially more important health and economic consequences related to the succeeding physical and mental health outcomes.

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