Compassion Fatigue

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After completion of this Compassion Fatigue course you will receive 2 Continuing Education Units/Contact Hour
Is this course for me? This course is for RNs, LVNs, Psych Techs, Administrators & Workers for Adult Residential Facilities, Residential Facilities for the Elderly & Group Homes

Course Synopsis:

Most healthcare and human services workers dealing with the effects of this black hole called Compassion Fatigue usually resort to doing what they’ve always done: Work harder and give more until they are completely tapped out.

Compassion Fatigue is not just a “fluffy” term for burnout. It depletes not just your mind and your body, but the very core of who you are as a human being—the seat of your emotions, your soul. Oftentimes taking the form of disdain for the frailty of humanity, this psychological foe can lead a person, who at one time entered the field of healthcare out of compassion, to walk away cynical, jaded, and convinced that all human beings are hell-bent on destroying themselves. Doe-eyed nursing students become jaded chain smokers who spend their breaks railing against their latest lousy patient and the broken healthcare system with other cynical coworkers.

Whether you’re caring for a friend or family member with a terminal illness or you’re a trained medical professional, compassion fatigue is one of the deadliest adversaries any healthcare personnel can face.

The key to overcoming and preventing Compassion Fatigue is taking personal responsibility for yourself and recognizing your own limitations as a caregiver. You need to take care of yourself first before you can effectively take care of someone else.

Course Objectives:

Upon completion of this course you will be able to:

  • Understand the history and importance of care and compassion
  • Define and understand Compassion Fatigue
  • Understand the ramifications of Compassion Fatigue on health and wellness
  • Gain knowledge about how to recognize, cope and overcome Compassion Fatigue
  • Learn how to create and sustain a culture of care and compassion

About Your Instructor:

 Donn Kropp founded CLiCKPLAY Continuing Education University out of a desire to bring others to greater levels of health and wellness. With over ten years of emergency and trauma room experience, Donn brings a seasoned, yet fresh approach to continuing education.

Course Approvals

This course is approved by the following governing boards & organizations:

  • CA Board of Registered Nursing: CA Provider # CEP 15849
  • District of Columbia Board of Nursing: CE Provider #50-14108
  • California Board of Vocational Nursing Provider # V10810
  • Psychiatric Technicians Provider # V10806
  • DSS/CCL Division for Adult Residential Facilities (ARF) Vendor Approval # 2000149-735-2: Course Approval #149-0212-24235
  • DSS/CCL Division for Residential Facilities for the Elderly (RCFE) Vendor Approval # 2000149-740-2: Course Approval #149-0212-24239
  • DSS/CCL Division for Group Homes (GH) Vendor Approval # 2000149-730-2: Course Approval #149-0212-24231
  • Far Northern Regional Center

Course Videos Transcript

Compassion Fatigue

1. Introduction

Imagine yourself slipping into a black hole, slowly and steadily drawn deeper and deeper without handholds or footholds to stop your descent. Some have described their battle with compassion fatigue as being “sucked into a vortex that pulls them slowly downward.”  Most caregivers dealing with the effects of this black hole called, compassion fatigue, usually resort to doing what they’ve always done: Work harder and give more until they are completely tapped out. Compassion fatigue is not just a “fluffy” term for burnout. It depletes not just your mind and your body, but the very core of who you are as a human being—the seat of your emotions, your soul. It also makes you feel like not shaving. Sorry I am kind of scruffy. Oftentimes taking the form of disdain for the frailty of humanity, this psychological foe can lead a person who at one time entered the field of healthcare out of compassion- to walk away cynical, jaded, and convinced that all human beings are hellbent on destroying themselves. Doe-eyed nursing students become jaded chain smokers who spend their breaks railing against their latest lousy patient and the broken healthcare system with other cynical coworkers. Whether you’re caring for a friend or family member with a terminal illness or you’re a trained medical professional, compassion fatigue is one of the deadliest adversaries any caregiver can face.

2. Objectives

The key to overcoming and preventing compassion fatigue is taking personal responsibility for yourself and recognizing your own limitations as a caregiver. You need to take care of yourself first before you can effectively take care of someone else. What do they tell you to do in an airplane in the event of cabin pressure loss? The oxygen masks come down and who do you put it on first.  In this module, we’ll take you on a flight through the history of this psychological issue. Hopefully a better flight then what we just witnessed.  Once we reach our destination, you’ll have a good understanding of compassion fatigue, including how it happens. You’ll be well-versed in how to recognize, cope with, and overcome the signs, symptoms, and effects of compassion fatigue, and you will learn how to develop a self-care plan, including rehabilitative and prevention strategies. You will also be able to identify the stages of The Care and Compassion Cycle and what to do if you or someone you know is suffering from a severe case of compassion fatigue. Finally, learn how an organization can create and sustain a culture of care and compassion in your organization. Whether you are in higher management or a medical staff member, you can take a stand against the siege of compassion fatigue.

3. True Life Moment

I couldn’t believe I went from an excited idealistic nurse to cynical and jaded. It was hard for me to believe that I had become so mean. My story of how I got into the health care field is probably similar to a lot of medical professionals. I wanted to help people in their greatest time of need. I wanted to contribute to humanity and comfort the sick. As a brand new graduate from nursing school, I got a job in a really busy ER. The hours were long, the paper work was overwhelming, and the patient load was barely manageable. The stress and anxiety of the environment began to chip away at the foundation of my core values of care and compassion. It didn’t really hit me until about a year into my new job, when a patient was brought into one of my rooms from an ambulance. I remember the day clearly. It was really stressful. Car accidents, heart attacks, and other serious issues were the norm, so as the ambulance crew dropped off this patient I began to ask him the routine triage questions. I got his name and age, and then I started asking about his sickness. The man said he wasn’t going to tell me anymore until I got him something to drink. I told the guy, “I will get you a drink a little later after I get you checked in and the doctor sees you.” The man kept asking for something to drink and I kept telling him, “No we need to get you checked out first.” This volley went back and forth for awhile and I finally said, “You know what, I will get you your drinks.” At that point I went to the hospital fridge and got about thirty little drinks and dropped them on his bed and said, “Here are your drinks. Now, will you tell me what is going on with you?” At that point the man cussed me out and threatened to kill me and then left the ER. Maybe you’re thinking I may have had good reason to do what I did and that it wasn’t so bad. At the time I felt justified in my reaction. However, my boss did not agree with me, and in retrospect I’ve come to agree that it wasn’t a good move on my part. It was, however, a very telling reaction. I realized that my heart had grown bitter and that bitterness was manifesting itself outwardly, infecting myself and directly on to the patients. Unfortunately, this reaction to that man wasn’t the last time my compassion fatigue manifested itself. Over the course of my ten plus years in the nursing field I have treated patients and those closest to me in less than honorable ways because I had a serious case of COMPASSION FATIGUE.

4. Compassion Fatigue

Before we delve into the course and uncover the mysteries of compassion fatigue we need to define a few terms first, so that we are all on the same page.  Our first term is Health Care Worker: Clinical and other staff, including those in primary care, who have regular, clinical contact with patients. CaregiverA broad term used to refer to an individual who provides care to another individual who cannot care for him or herself due to a disability or functional limitation.Care:  The services rendered by members of the health professions for the benefit of a patient. CompassionA feeling of deep sympathy and sorrow for another who is stricken by suffering or misfortune, accompanied by a strong desire to alleviate the pain or remove its cause. Fatigueextreme tiredness, typically resulting from mental or physical exertion. Empathy: the ability to understand and share the feelings of another. Sympathy: feelings of pity and sorrow for someone else’s misfortune. Now that you have some definitions of important terms you can move on in this course with a good knowledge base. So, let’s move on. It is natural when faced with your own limitations to become frustrated with someone who is leaning on you to help them solve their problems, give them hope, or make them feel better.

As healthcare workers and caregivers, there is a constant pull to do the impossible. For some, this constant pull can find us unexpectedly walking down the dark path toward compassion fatigue. Also called “secondary traumatic stress disorder” or “the cost of caring”, compassion fatigue is an advanced form of burnout characterized by deep physical, emotional, and spiritual exhaustion, which manifests as a decline in a healthcare worker’s ability to experience joy or to feel compassion and concern for others. Common among healthcare professionals who work with the traumatized or chronically ill, compassion fatigue is the result of the daily onslaught of hearing about and dealing with trauma or caring long term for someone whose suffering is chronic and incurable. A daily flood of the pain of others can wash away every ounce of your compassion, energy, and sympathy, leaving you a hollow shell filled only with guilt and shame. Though most commonly found among emergency room personnel, firefighters, paramedics, therapists, and child welfare workers, compassion fatigue can also affect people in any setting where they are expending high levels of physical and emotional energy on a daily basis. Hospice workers, oncologists, palliative care professionals, and even stay-at-home parents, those caring for chronically ill relatives, and spouses of addicts or alcoholics are all at risk for developing compassion fatigue. Developing slowly over time, compassion fatigue is a quiet and slow erosion of your ability to feel and care for others caused by the overtaxation of your empathy, sympathy, energy, and ministrations.

First diagnosed among nurses in the 1950’s, secondary trauma was later discussed in the realm of immigration policy during the 1980s. Resurfacing in the 1990s during the “homeless problem”, the term made its first debut in the media to describe the public’s lack of empathy toward down-and-outers. It was in 1992, that a writer named Carla Joinson first used the term compassion fatigue to describe a particular type of burnout affecting trauma and ER nurses. Compassion fatigue has been most thoroughly studied and researched in the area of traumatology, particularly for its effects and how to manage and prevent it among ER personnel, firefighters, and police officers, where its effects are most noticeable. In more recent years, this life-sucking enemy has hopped the fence and is cropping up with greater prevalence among staff members of long-term care facilities and even in managed care facilities as a result of increasing external pressures brought about by longer hours, lower pay, and increased workloads. Caregivers are required to see more patients, do more paperwork, and negotiate more with insurance companies and CEOs, leaving less time to build the one-to-one connection many family physicians and nursing staff shared with their patients in years gone by. This give-and-take between caregivers and patients once served as a buffer against the onset of detachment, numb feelings, and a “Next” mentality. It is evidenced in patients, as well, with more patients disregarding professional recommendations and continuing self-destructive behaviors which perpetuate the symptoms of their chronic disorders.

We’ve talked about the what and the when of compassion fatigue. Now let’s move to the why and the how. It all starts with TIME, “T”-”I”-”M”-”E”! “T”- TEDIOUS and tiresome tasks take up more and more of our time, leaving less room for connecting in positive ways with patients and coworkers. We spend hours on the phone or making chart notes, and we have less time to sit and talk with our patients—to connect on a human level with them.“I”- INDIVIDUAL EXPOSURE to stories of the traumatized day in and day out makes what can become a lasting imprint on our psyches. All the stories begin to blend into one big tragic story. This is especially true for ER and trauma workers,like myself, where time with the patient is often spent swiftly patching them up for transfer to a different floor. This leaves the medical worker with little to no closure. There isn’t time to follow up on every patient, and a large number of your patients leave in such bad shape it would be hard to imagine a best-case scenario even if you’re an optimist. “M”- MUMS THE WORD. Confidentiality is the cornerstone of the medical community, and it must be maintained. However, there has to be an avenue for drawing on our experiences to connect with our patients and also a safe place within the confines of an organization to debrief. Lack of time and resources, as well as a “buck up” or “grin and bear it” mentality in many medical organizations reinforces a “code of silence”, forcing most to bottle up their emotions and keep on trucking without dealing with unresolved feelings, frustrations, and heart wrenching stories.“E”- EMOTION STUFFING. Aside from the possibility that your organization may not provide a safe environment for sharing feelings, there is a certain amount of “turning off” a healthcare worker/caregiver has to do in order to move from one crisis to another without melting down, or refusing to work the next day. Day after day, the rush and grind of the job can eliminate all possibilities for personal or professional debriefing. Without this time to debrief, the water in the well of stuffed pain begins to rise, and will eventually leak out in irritability or anger.

In addition to this fun and informative acronym-TIME, the actual passing of time also plays a role in opening the doors for compassion fatigue to sneak in. When pressed for time, most medical professionals compensate by multi-tasking.They eat lunch while they dictate, or they do chart notes while on hold with insurance companies, or they read medical journals while sitting at stop lights in their cars. The constant message of “there isn’t enough of you to go around,” fortifies the practice of cutting out the very things that make a person feel human…exercise, relaxed meals with family and friends, prayer/meditation, sports, and hobbies. It takes a very strong inner core to withstand the onslaught of external pressures to do more, be more, and have more than any one human being was ever meant to do, be, or have. In addition to the TIME factor, there is another factor at play in the vulnerability of those in the healing professions toward compassion fatigue. It was what traumatologist, Eric Gentry, calls “Other-directed care giving.” Gentry asserts that many of those drawn to the helping professions were taught from a young age to care for others at the expense of caring for themselves, and many have not learned to practice faithful, customary habits of self-nurturing.There is nothing wrong with wanting to help or even putting yourself out for others. Most of us in this profession have a core value of caring for others, and that is a good thing. The danger comes when our gift of empathy (being able to put ourselves in another’s shoes) becomes a snare, and we find that we can’t extricate ourselves from their shoes. It is very easy for those of us with strong empathy gifts to forget to take oxygen for ourselves before giving it away to others, and we end up passed out on the ground needing someone to rescue us. It is simply vital, though, to recognize that these very wonderful gifts and resources you have to draw upon can leave you vulnerable to the destructive forces of compassion fatigue.

You’ve been working as a charge nurse on the floor of an ICU in a busy hospital in the inner city. On a daily basis, you see between 50 and 100 patients, a large percentage having been transferred from surgery after trauma, and another large percentage brought in for complications of chronic disorders such as liver disease, cancer, or heart disease. Your job is to administer palliative care and hope that they will rest comfortably and peacefully until they are able to return home for extensive rehabilitation, or worse, to die as comfortably as possible. After several months of your first year, you begin to wake up wishing you could sleep for another five hours. You find yourself taking anti-inflammatories in the evening and turning on the tube with your feet up and a hot pad on your back. After a few more months, you begin to experience difficulty falling asleep, with questions plaguing you about whether you remembered to fill in the chart on that one patient or whether your supervisor is going to harass you about your chart notes again. You begin to turn more frequently to Ben & Jerry’s at night and Pepsi for your afternoon snack, and your personal life begins to take a backseat to resting on the couch at the end of the day.

Soon you find yourself snapping at your spouse, your dog, or the phone solicitor who dared to rattle your pounding head with his ringing call. You begin to succumb to the inevitability of having more to do than you can humanly accomplish in one day, and you know your supervisor is just about to call you into her office for a talk about it all.  You can never find your keys, and you’re beginning to spend all your free time surfing the net or watching TV just to make it through the night. You forgot the last time you went out dancing, skiing, or strolling through the park. You’ve lost touch with activities that bring you pleasure, and you don’t even enjoy running to the store or grabbing an espresso with a friend anymore. No one wants to hear you complain about your job anymore, and you’re beginning to read about your friends’ grand adventures on Facebook, and they never invited you to come along.At this point, you can be sure that you’ve fallen deep into the abyss of compassion fatigue. This is just one scenario highlighting a few of the signs and symptoms that accompany the battle with compassion fatigue. Please be assured, if this is you I will not leave you hanging here in this miry pit. At the end of this module, you will be well armed and ready to begin a frontal assault on this common and vicious foe. Compassion fatigue affects all aspects of your being and life which includes your physical body, emotions, cognition, behaviors and interpersonal relationships. Some physical signs and symptoms you may experience if suffering from compassion fatigue are: Exhaustion/Lethargy, Frequent headaches, Gastrointestinal complaints, Sleep disturbances and others. Some emotional manifestations are: Apathy, Stuffing feelings, Depression, Anxiety, negativity and hopelessness. There are many others as well. Our brains rely on a sensitive balance to function properly. When compassion fatigue strikes that balance can be disrupted causing cognitive and behavioral changes such as being: suspicious of others, compulsive thinking & behaviors, having mood swings and others. Finally Compassion fatigue can affect your interpersonal relationships. Humans are highly relational. When you are affected by Compassion fatigue these relationships become stressed and often times fractured. Some signs and symptoms of interpersonal disturbances include, isolation from others, irritability, withdrawal, distrust, increasing and paralyzing fear of social situations, sabotaging relationships and many others.  We’ve covered quite a bit of material so far, I think you are ready for a rapid review.

5. Care & Compassion Cycle

How did you do on the rapid review? We’ve talked about  a lot of interesting material so far. Compassion Fatigue is such an important topic to understand because it can be such a destructive force.  Are you walking the dark corridors of compassion fatigue even now? How can you stay alert to the pitfalls and traps inherent in working in healthcare? One of the keys to longevity in the health care field is to be sure you understand the care and compassion cycle. Once you determine what stage you’re in, you can determine the actions you need to take to apply the three “A’s” of self-care, which we will discuss a little bit later in the course. Let’s take a look at the care and compassion cycle, shall we. Our first stage is the incubation/honeymoon stage. This is the stage most of us start out in as newbies. We’re excited about helping others in need, and we’re proud to serve humanity. We effervesce with ideas, hopes, and dreams of reforming the system and seeing patients returned home in better condition than when they arrived in our facility. What? You don’t know what effervesce means? You know effervescent, bubblie, like alka-seltzer. Effervesce, no. It means bubbley. The second stage of the care and compassion cycle is Disillusionment. If you are at stage two you notice the excitement has worn off in direct proportion to the realities of the “job” setting in. Ideals of making a difference have been squashed a bit by the hard manual labor, the constant emotional toil of seeing death and sickness day in and day out. There is a sense of futility that comes when many of your patients leave your facility in need of further care, or worse, on a gurney covered by a sheet. Already in stage two, compassion fatigue has set in. If you remain at this stage, you will destroy yourself and others. Stage 3 is called transition. During labor and delivery of a newborn, transition is the most difficult and intense stage of the process. Change is on the horizon, and the laboring mother recognizes that the baby is coming soon. Naturally, her focus shifts inward, and she typically loses focus on what is going on around here. It is during this stage that her nurses and support team are the most critical. In order for labor to progress, her support team needs to be intentional in redirecting her inward focus toward the goal of outward action; in this case, pushing the baby forth into the world. Similarly, in order for healing to take place in one who is struggling against the downward spiral of compassion fatigue, the transition phase in the care and compassion cycle also must include an inward focus. However, it will serve no good purpose if there is not a support team in place to help the burned out caregiver direct that inward energy of evaluating the reasons, feelings, and resentments they have toward their job into outward change. The transition phase concludes when the health care worker or caregiver is ready to begin those outward changes by implementing the tools and skills necessary for healthy self-care. The next stage we will talk about is reconstruction. Here the health care personnell starts to make personal and professional decisions moving toward greater levels of hope and fulfillment. It is in this stage that disgruntled workers have asked the right questions, have developed principles of practice, and determined whether they are prepared to get back in the race or whether they are ready to change careers, departments, or family dynamics. This is the longest part of the cycle, mainly because it requires constant self-evaluation and adjustment. To be most successful in this stage, a person must have a team of people around them, both on and off the job, who will ask the hard questions and even poke and prod a little to be sure the worker is living out of a purpose-driven model and not reverting to a needs-oriented or an externally-governed paradigm. Our final stage is hope. It is at this stage that the health care worker or caregiver has come full circle. It will seem as though the honeymoon stage is beginning all over again, but this time there is wisdom, understanding, and self-awareness informing the enthusiasm and excitement. Having become “in touch” with their feelings and having identified core values and goals, they have realized their limitations and have made conscious decisions to make changes and place “safety nets” in their life. To have hope is to know and understand how one fell into disillusionment in the first place so that shame, guilt, and feelings of inadequacy can no longer gain the upper hand. Hope is also knowing and having the skills to pull out of compassion fatigue when disillusionment comes knocking on the door again. It is when hope abounds that you know this will spread to others, and care and compassion can flourish in life and the environment around you. Depending on where you’re at in this cycle, there are several different avenues to take to move toward health and wholeness. In the next few segments, we will address how you can move from the very depths of compassion fatigue to preventing its onset in the future.

6. Guidelines to Help

In this segment we’ll discuss five very important guidelines to follow if you find yourself in either the disillusionment or transition stage of The Care & Compassion Cycle. In addition to adhering to these guidelines, I strongly recommend seeking professional help from either a counselor, therapist, or other mental health professional. Our first guideline is this-Save big decisions until you have transitioned safely from disillusionment to the reconstruction stage. Making major decisions like quitting your job, getting a divorce, having an affair, or spending your large amounts of money on trips or “toys” while you are discouraged, depressed, and disheartened will feel better for a little while, but will later bring shame, guilt, or regret. These negative feelings will only further your spiral downward. Be careful not to succumb to the temptation to quit your job or take an adversarial stance against your employer while you’re in the depths of the disillusionment or transition stages. Give yourself time to move into the reconstruction phase before taking legal action or making a career move. You will have far more clarity, and you will be able to make a more informed decision about what type of organization you want to work for. Our second guideline is to express your feelings.Research shows that expressing your feelings through writing, verbal processing, or artistic expression does wonders for moving toward personal power and freedom. Spend time journaling your feelings and chose one or two very close friends or colleagues to share your struggles with. Knowing that you will have an outlet for expressing your negative feelings will enable you to go through your work day without blowing up at a coworker or client. If you are an artist, spending time intentionally expressing your feelings through free-flow use of your particular area of artistic expression will decrease the pressure inside of you and bring you focus and clarity on your day. The third guideline to follow if you are feeling Compassion Fatigue creeping upon you is to spend your energy looking for solutions rather than complaining. Choose positive coworkers to take your breaks with, or go on a walk or to your car rather than sharing free time with those who gossip and complain. Fight against the old adage, “Misery loves company,” by reminding yourself that complaining and negativity will only increase your guilt, shame, and feelings of inadequacy and powerlessness. Instead of using your precious energy to blame others, focus on areas where you can make changes and allow the rest to roll off your back. Look for areas where you can take personal responsibility and make changes to the way you make decisions and care for clients. Learn to see yourself as a leader rather than a follower and become the change you want to see. Rather than depleting your energy reserves with negativity, begin to seek positive solutions to the problems you face in your workplace. The forth guideline is to 4. ‘“Face your pain head on.” This is another area where journaling or talking with a trusted friend or counselor will be helpful. Attempt to get to the core of your restlessness, anger, or feelings of sadness or apathy.  When you feel a vague sense of unease, irritability, or disillusionment, begin digging for the root of that feeling. Once you find it, take hold of it and follow it to its direct cause. You may find that it goes way back into your upbringing. This is normal. The road to wholeness and health usually includes looking at the past to unravel the wrong assumptions. Wounds tend to inform our present until they’re cleaned out and allowed opportunity to fully heal. This may take some time especially if you’ve been stuffing your emotions for a long time, and in some cases you may need professional help to get to these core assumptions, but your journey out of the vortex begins with reconnecting with yourself and listening to your emotions and your body. If you must take a break from the pain for a brief period here and there, choose vigorous exercise or a life-giving hobby you enjoy rather than picking up a drink, a smoke, or a toke.

Our final guideline or recommendation for you if you’re stuck in the disillusionment or transition stages of the care and compassion cycle is to draw clear boundaries for work. Take regular breaks and do something completely different to get your mind off work. Go to your car and practice silence, go on a walk and pay attention to the details around you. Read a humorous book or magazine. Don’t allow yourself or others (even supervisors) pressure you into picking up extra shifts or taking on extra projects. These critical stages of The Care & Compassion Cycle require scaling back to the bare minimum in terms of work and home responsibilities. You need as much time and energy to direct toward reconstruction as you can get. Do the job you were hired for and use any extra time to do something that will nourish your soul and spirit. This might be a good time to review to find the areas where you have been working above and beyond the call of duty. You may be able to go to your supervisor and explain what you’ve learned about your battle with compassion fatigue and request that a few of your extraneous duties be reassigned to others for a time. If you do not have a good working relationship with your supervisor, it might be a good time to meet with a counselor or even a skilled life coach to learn positive and proactive ways to make the necessary changes to your work load. Do all you can to avoid nasty confrontations or power struggles with those around you. Try to stick things out as you learn new skills. Again, quitting your job during this stage of recovery may actually set you back in the journey toward wholeness. The material we have covered so far is so good I want it to stick in your brains and heart-so let’s do a rapid review!

7. Self Care Practices I

So far in this module you have learned that compassion fatigue strikes those of us in the health care field. We have also taken an in-depth look at the care and compassion cycle. Were you able to identify where you are on the cycle? We also just examined some guidelines to help if you have become disillusioned or are in the transition cycle of our care and compassion model. At this point, you may recognize that you are well on your way to succumbing to this psychological foe, compassion fatigue. In fact, you may realize that you’re in deep. I want to assure you that it is possible to turn the tables. We will now focus our attention on self-care practices so that you can get healthy and whole and be able to take care of yourself and the individuals you serve with excellence. Every atom has a nucleus with a ring of electrons, neutrons, and positrons. If imbalance occurs in just one of the outer rings, the atom is susceptible to collapsing in on itself. Just as with an atom, your soul has three layers of protection against compassion fatigue, and they must remain in balance in order to prevent collapse. The first ring is awareness, knowing the signs and symptoms. The second ring is acknowledgement, coming to terms with the pitfalls of your personality, your personal history, and your particular job. The final ring is adjustment, making the changes necessary to live out of your core rather than being driven by the needs and pressures from the outside. It is inevitable that imbalance will come at one time or another in your life. The beauty of these rings is that as you work in one area, the other areas naturally come more and more into alignment. Let’s dive into the first ring of our atom, AWARENESS.

The key to walking tall and strong, confident of your own place in the world of healthcare is this outer ring… Awareness. It is important to become aware of who you are, why you do what you do, and how to govern your own actions rather than being governed by the external pressures of circumstances, emotions, or the needs of others. One step in becoming aware is to look into your past and see what traumatic triggers lay within your history. Look out for particular patient histories that trigger your deepest emotions of anger, fear, or self-doubt. Professionals agree that most of us struggle with cases involving children. Perhaps your struggle, though, is with the elderly or with cardiac cases or brain traumas. Knowing your triggers gives you the opportunity to choose when and how you will deal with these particular cases in the future.Once you know your triggers, you can either choose a line of work that will protect you from these particular triggers, or you can create a strategy for coping that involves staying present to your feelings and your patient, with a healthy dose of your favorite self-care activity within a day or two of your exposure to the trigger. This self-rejuvenating activity is something you should be able to promise to do for yourself even if you only have an hour to do it. Keep in mind that in the beginning of becoming aware of your triggers, you may need professional help from a counselor, pastor, or other mental health professional; someone with the knowledge and skills to help you move out of the past into the present, to ensure that your past trauma no longer informs your experience of the trauma you are hearing about from others.

A second way to become aware is to check in with your emotions throughout the day. This is a step many of us have been taught to skip in our lives, some of us even from a young age. It takes time and practice to begin checking in, but after awhile you’ll grow more adept at doing it. Remember, all new things take time to learn. You’ve learned not to feel, and now you’ll need to learn to feel again. One thing that will help you get in touch with your deeper emotions is to understand that there are only four basic emotions from which stem all other feelings. They are MAD, SAD, GLAD, and AFRAID. Perhaps you notice yourself growing irritable with a patient. Take a minute to break away. Go to the sink to wash your hands or do something mindless for a few minutes, so you can ask yourself a series of questions. Did a coworker or patient say something that bothered me just before I came in to see this patient? Am I sad about something that happened between me and a friend? Am I feeling powerless in this situation? Am I frustrated or angry about something a supervisor or coworker told me earlier? These are just a few examples of the kinds of questions you can ask yourself to help you identify why you want to pull all the plugs on your patient. Though there is the possibility that your patient did something to make you mad, there is just as much possibility that you were worn thin by something that happened before you even went into his room. Identifying the core feeling and the source of that feeling will help you separate the emotions you’re experiencing from the patient you are working with in the moment. A third step towards awareness is to begin to recognize when your compassion is eroding before it gets to a crisis point. As you begin to make connections between your core feelings and your physical responses and behaviors, you will begin to see that there are cords tying them all together. This third step involves beginning to untie the knots in some of these cords so they remain separate from your patients and your workplace as much as possible. This step requires that you form a self-care plan, which we’ll talk about a little bit later in the moduleA fourth step is determining what you personally have control and influence over, both at work and in your private life. Whereas, you can influence your workplace, finances, health, and family members, the truth is that you have control only over your own thoughts, feelings, attitudes, and actions as well. This may not feel true if you’re in the throes of compassion fatigue, as the nature of this issue is seated in the loss of personal power and control by way of giving and giving until there is nothing left to give. However, as you begin to implement a self-care plan and begin learning healthier coping skills, this feeling of powerlessness will begin to decrease. It is important during this stage to be patient with yourself. This is just the beginning step in the war against compassion fatigue.

Once you find that your stamina and sense of personal power begin to increase, you’re ready to move from the first to the second ring, acknowledgement. There are a few critical concepts to grasp during this phase. First, that everyone is vulnerable and compassion fatigue may already be setting in. Secondly, that your personal experiences with unresolved trauma leave you prone to this psychological affliction. Finally, you may have internal factors that make you more susceptible to the pull of compassion fatigue. Since compassion fatigue is a cycle, you can be somewhere in the midst of it without having the more severe signs such as sleep disturbance, substance abuse, physical disorders, or severe depression. It’s important to realize and accept that every one of us is vulnerable to crashing and burning. Acknowledging our weak points and the stressors that are unique to us will help in the fight to remain healthy and whole. In our culture, all of us have multiple draws on our energy. These pulls on our attention and time can be positive, negative, or somewhere in between. Whether it’s raising small children, working several jobs, serving on civic or work-related committees, or juggling an active social life with a busy work schedule, these pulls on our energy require a tremendous amount of conscious attention. Add to this a career in the medical field, and there is no way around the fact that compassion fatigue is always lurking in the background waiting for a chance to pounce. Working in the field of medicine on any level requires living life at a higher pace. If you work in a clinic or a medical care facility, there can be an atmosphere of low-level stress, hurry, and anxiety throughout your entire shift. If you work in a hospital or large care facility, this low-level pressure often ratchets up to mid-level or even high-level and if you work in an ER or trauma center, you can be assured that there will be shifts that have you running in high gear for a full eight to twelve hours. It is important to recognize the emotional and physical toll this constant external pressure takes on your soul day in and day out. As you begin to acknowledge the demand on yourself, you can begin to counter that demand with some important self-care habits, which we’ll cover as we discuss the next ring, Adjustment.

The second type of vulnerability we need understand is trauma-related vulnerabilities. We just talked about internal vulnerabilities and they are important to acknowledge and understand but an equally vital piece to acknowledgement is to recognize whether or not you have a history of abuse or other unresolved trauma. Examples of this type of trauma may include early loss and deaths of caregivers, friends or family. If there has not been resolution or healing in these areas of your heart you may be more susceptible to compassion fatigue. Without intimate knowledge of triggers, you may inadvertently be reliving past trauma, thereby setting off unconscious patterns of self-protection which you’ve operated from since you were a child. Psychologists recommend that those who have suffered trauma become aware of the ways their current personal and work situations activate self-defense modes, and they recommend a thorough understanding of trauma theory. In short, “psychic trauma occurs when a sudden, unexpected, overwhelming intense emotional blow or a series of blows assaults the person from outside.” There is agreement among clinicians that it is not necessarily the trauma that does the damage, rather it is a combination of the unique physical and emotional responses of the victim and the victim’s social group that determines whether a traumatic experience remains unresolved. In children, perception is key, meaning that even a perceived threat to themselves or a loved one can open the door for experiencing trauma. Trauma impacts the way a person thinks, learns, feels about others, views the world, and how they make decisions and behave. These coping patterns emerge quickly after trauma and will remain firmly established until the psychological impact of that traumatic experience is healed and new coping methods are mastered.As healthcare workers/caregivers and professionals working with the victimized, it is crucial to identify and refute beliefs and fears that are based on outdated threats from the past, including traumatic experiences and abuse or neglect. Living out of the past increases stress, undermines self-care habits, and increases the likelihood that compassion fatigue will creep in and overtake you.

The final piece in the acknowledgement ring is to determine if your core identity is susceptible to the wiles of compassion fatigue. Core identities are formed in early childhood and are undergirded by internal factors such as beliefs, character traits, and core assumptions. These underpinnings are formed over time in the early years of childhood as a result of the atmosphere, expectations, verbal and nonverbal messages, modeled behaviors, and beliefs constructed by your primary caregivers. Depending on the role you played in your family, your core identity can include a structure for healthy boundaries and positive interactions, a structure for unhealthy boundaries and negative interactions, or a structure that includes a combination of both. Your core identity is how you define yourself, which in turn determines how easy you find it to express your needs, care for yourself, and work with your limitations. There are four core identities that lend themselves to increased susceptibility to compassion fatigue. People who find themselves in one of these groups typically maintain habits and coping skills that have outlived their usefulness. Many who struggle with core identity issues as adults have actually learned and even mastered many healthy coping strategies, but when triggered they fall back onto these old patterns and habits that have never been completely eradicated.

It is vital in the fight against compassion fatigue to understand these four categories and the core assumptions and habits associated with them. It is possible for these core identities to transform over time, though it requires perseverance, a good support team, and often the professional help of a therapist, counselor or trusted friend. At this point, though, acknowledging that you may fit into one of these groups is sufficient to move forward in developing an effective self-care strategy. Before we look at the four identities, here are some general characteristics commonly found among those who have internal factors that will place them at risk for developing compassion fatigue:

  • Being helpful, attentive and accommodating to the point of ignoring your limits and desires.
  • Deriving your self-worth from others needing you.
  • Defining yourself by the good you do for others.
  • Being drawn to rescuing/fixing people’s problems.
  • Focusing a lot of your attention on other people’s reactions, moods, and needs.
  • Focusing on pleasing others or getting their approval.
  • Feeling responsible for another person’s mood or happiness.
  • Emphasizing self-reliance to the point that needing others is not allowed.
  • Attempting to adapt and please others to ensure harmony.

The first of the four core identities is the helper. Remember core identities are how you define yourself, which in turn determines how easy you find it to express your needs, care for yourself, and work with your limitations. Let’s examine, “The Helper” Helpers give too much and often feel responsible when others are disappointed. As a result, they find it difficult to set limits with others who depend on them for help. Helpers often feel responsible for the happiness and well-being of those in their care, and they tend to overextend themselves to make things better. Enabling and codependency are common among Helpers, who often shield others from the consequences of their actions by helping too much. Helpers often grow up in homes where responsibility for younger siblings is placed upon their shoulders when they’re young. These folks may have had a mom or a dad who confided in them and leaned upon them to help solve their problems or make decisions, often leaving them swimming in guilt for whatever negative consequences befell their parents. The three most prevalent habits associated with The Helper core identity are defining themselves based on the things they do for others, having an exaggerated sense of responsibility, and absorbing the problems and emotional states of others.

The core assumptions associated with Helpers are:

  • I’m worthless unless I’m helping someone.
  • I have to be in a relationship.
  • I must honor the requests of others.
  • I should be able to do all the work assigned to me.

Our next core identity is The Strong One. Strong Ones define themselves by their self-reliance and their ability to be someone others can lean on in a crisis. As a result Strong Ones may look for crises to get involved in, and they may attract needy, draining people to themselves. Since Strong Ones value themselves only when they are strong, they may not be plugged into their own needs and vulnerabilities. They find it hard to ask for help, and may find it difficult to hear correction. These folks likely grew up in homes with rigid rules and high expectations for competence and productivity. Rewards and punishments were likely offered routinely, perhaps with intimidation or threats. The three most prevalent habits of Strong Ones are defining themselves by being there for others, doing everything for themselves even to the point of martyrdom, and not being able to admit weakness, fear, or need.

The core assumptions associated with Strong Ones are:

  • It’s my fault if I can’t bring order and harmony to the situation.
  • I’m worthless if I can’t fulfill a commitment I’ve made.
  • I will be rejected if I allow my weaknesses to show.
  • Chaos will ensue if I don’t maintain control.
  • I’m worthless if I’m not producing results.
  • I should always get things right.

Our third core identity is The Responsible One. Responsible Ones derive their self-worth from their character strengths, such as competence, dependability, loyalty, and good work ethic. They have a near-insatiable need to maintain control of their environment at all times. They tend to take on more than they can handle and find it difficult to delegate to others, not trusting that things will be done right unless they do it themselves. Responsible Ones find it far easier to give than to receive. In living out of sheer willpower and strength of character, Responsible Ones often find it hard to acknowledge mistakes and limitations, and it’s near impossible for them to ask for help. Responsible Ones may have grown up in homes where helpfulness and compliance were rewarded by their primary caregivers. They are likely the firstborn or only child in homes where the parents were busy, sometimes to the point of neglect, and where sternness or fear were used to control behavior and actions. Their primary caregivers may have withheld emotionally when disappointed in them. The three most prevalent habits of Responsible Ones are defining themselves by their accomplishments or their career, holding grudges or micromanaging situations, and being unaware and unapproachable when it comes to vulnerabilities and weaknesses.

The core assumptions associated with Responsible Ones are:

  • If I’m not on top of everything, things around me will fall apart and I’ll be alone.
  • I won’t survive if I don’t do things myself.
  • If someone feels let down by me, I’m wrong and must make things right.
  • [Must Be Prepared] I should always be prepared.


Have you identified with any of the core identities so far? Are you the helper, the strong one, or the responsible one? If you aren’t any of those maybe you are our final core identity, the Absorber. Absorbers are empathic to the point of over-identifying with the pain and trauma of others. They will take on another’s story to the point of weakening their own boundaries and even losing track of where they begin and the other person ends. Absorbers often neglect their own needs and push themselves past their limits. They feel an exaggerated sense of responsibility for others, and they are racked by guilt when they let others down. Absorbers often grew up with neglectful, self-absorbed, disengaged, or overly burdened caregivers. There may have been a lot of family pain and helplessness, which led these folks to overidentify with the family and take everyone’s pain on as their own. The three most prevalent habits of Absorbers are defining themselves by how others react to them, believing their needs are a burden to others, and frequently going above and beyond the call of duty.

The core assumptions associated with Absorbers are:

  • I should never hurt someone’s feelings.
  • should always set aside what I’m doing if someone else needs me.
  • It’s wrong for me to disappoint others.
  • I’m to blame when others are sad or upset around me.

Now that we understand a little more about the different ways we can be vulnerable based on our childhood experiences and our personality traits, it will be of some help to understand how these core assumptions and identities form in the first place. The following are just a few of the ways the foundations for these four vulnerable core identities are formed:

  • Families with rigid rules of good and bad behavior with the threat of punishment for being bad.
  • Emotional, social, or economic deficiencies may make a child feel ashamed at school or in public.
  • Families where verbal or physical rewards are given for attending to their parents’ need, such as listening to problems or helping make decisions.
  • Exposure to arguing and tension can cause children to tread lightly to avoid stirring the pot. Hyper-vigilance can sometimes set in with these children.

This is just a basic understanding of the pitfalls of these core identities. However, acknowledging your unique weaknesses and limitations, as well as the limitations and pitfalls inherent in your particular work environment, will enable you to develop a stronger and more effective self-care plan. Wow, we’ve covered a lot.

7. Self Care Practices II

Welcome Back. Did you ace the rapid review? So far on our journey we have uncovered the the history, causes, signs/symptoms, and vulnerabilities of compassion fatigue. We just covered the first part of self care practices. We will now continue deeper into those practices. Before the rapid review we were talking about the rings of awareness and acknowledgement. Our next ring is adjustment. Moving to the outer ring of adjustment will require putting the information you’ve gleaned from the first two rings, awareness and acknowledgement, into action. The goal during this phase of the process is to take a long inhalation of oxygen before returning to care for your clients. Though you may not be able to take time off work, you can still begin making adjustments to your lifestyle that will bring health and wholeness over time. Here are strategies of how to develop your principles of practice, build your support network, and create a self-care plan to support healthy boundaries between work and home. Principles of practice serve as a personal mission statement that clearly defines your values and states the boundaries out of which you will interact with supervisors, coworkers, and clients. The key to developing your principles is asking the right questions. Once you have answers to these questions, you can create “I messages” or “declarations” that can be written down on a piece of paper to post in your locker or desk for easy reference. Once you’ve developed your principles, commit to reaffirming them at least once a month. Ask yourself where you’ve been, where you are, and where you’re trying to get to. Verify that you are making decisions and responding to situations from the foundation of these governing values. If you find yourself off track, it will be much easier to make adjustments if you’re regularly checking in with yourself. Here are some questions you can ask yourself to begin developing precepts. Allow these questions to serve as a guideline to help you get started. Feel free to add your own and ask others for input on how to develop your declarations further.

  • “What gives my life joy and meaning?”
  • “Why did I choose this profession?”
  • “What impact do I hope to have on my patients?”
  • “What impact do I hope to have on my coworkers?”
  • “What is my life’s mission?”
  • “What is the first priority in my life?” (Hint: It may not be work-related.)
  • “What are my other priorities, and in what order do I value them?”
  • “What kind of person do I want to be?”
  • “What do I want to be known for?”

Again, these are just a few questions to get you started. Your principles of practice should be a series of “I” statements/declarations that reflect your core values. They should motivate you and keep you moving toward your personal and professional goals. Review them regularly to be sure you are living from them instead of from your emotions or the external pressures in your life. This will ensure that you gain enough personal power to change the driving forces behind your actions. You will slowly become proactive rather than reactive, and you will know which battles to fight and which ones to allow others to fight. As you commit to live and work with these principles governing your life, you will begin to attract those around you that will further enhance your efforts to make real and positive changes.

Our first strategy in creating healthy boundaries between home and work was to develop principles of practice. The second strategy is to build support systems. Research shows there is great value in holding one meaningful conversation every day. This conversation can be with anyone you trust, from a coworker to a close friend or family member. This conversation should move beyond the details of your day and into the realm of your soul and spirit. These life-giving conversations will help guard against monotony and depression, both precursors to compassion fatigue. It is vital to surround yourself with people who understand and share your core values, who are committed to facing conflict rather than glossing over it, and who are good listeners. In building a healthy support system, it is important to surround yourself with people who accept and support your new boundaries. If you are just starting out in the process of setting boundaries, you may find it causes a strain on personal relationships for a time. In fact, you may even lose friends in the process. Hang in there and allow the friends who will respect the changes you’re making in your life to remain. If you are low on friends, now would be the time to start learning to make new ones. It may be hard at first to open up to new people. The long hours and all-consuming nature of working in the healthcare field can make it hard to find time and energy to go out after work. If you’re finding it a struggle, just start by talking with someone where you work who seems to be living above the negativity and drag of compassion fatigue. Find the courage to step out of your normal patterns and talk about what you’ve learned and let them know that you’ve noticed they stand out as someone who is maintaining a positive attitude at work. Ask questions about how they cope and find out if they would be interested in learning more with you about compassion fatigue and how to prevent and recover from its effects.

In addition to coworkers, it’s good to have other friends who work in different arenas with different pressures. It also might be of some help to seek a professional counselor who understands compassion fatigue and can offer skills and ways to practice new skills at home and on the job. Whoever you choose to talk with, it is vital that you find people who listen well and are not quick to offer advice. Choose people who ask penetrating questions to help you discover your own core feelings and their resulting behaviors. People with these qualities are more interested in helping you solve your own problems rather than rushing in to fix things temporarily for you. Find people who will validate your feelings, your desire to change, and the slow and steady adjustments that will be required to overhaul your approach to handling the demands of your life and work. A person who fits this bill will say things like, “No, you’re not crazy to be angry at that helpless victim you worked on all day today.” Or they might say, “Well, it’s not okay to hit your dog or throw things around, but I totally understand why you would go home and want to hurt things. You had to change diapers and bedpans all day long for people who do nothing but grump and complain.” Our third and last strategy to ensure that the boundaries between life and work are healthy is to Create a Self-Care Plan. Once you’ve developed your principles of practice and have a strong and healthy support team, it’s time to create and implement a self-care plan. The first step in creating a self-care plan is to learn to be kind to yourself. Remind yourself regularly that the demands on you are superhero demands, even though you’re a mere human being. Since even superheroes have to recharge, you definitely need to learn to recharge your batteries.

Part of being gentle with yourself is to recognize that the pain you experience in the struggle against compassion fatigue is normal. Feeling badly about the way you cope is only going to increase your chances of succumbing to the downward spiral. As you work through the steps in assessment and acknowledgement, you will begin to find that you have more and more power to implement your self-care plan by exchanging negative coping methods for positive ones. As you progress, take time to celebrate your progress and continue learning new techniques for combatting the stresses of your work. Most importantly, start by making one change at a time. As you meet with success, your energy will increase and you’ll grow in your ability to tackle more than one thing at a time. I know you’ve heard the stories of people who’ve given up alcohol, cigarettes, and negative talk all in one fell swoop, but there are far more who have to keep their cigarette habit while they’re quitting the drink. Please don’t beat yourself up over this. Self-empowerment is cumulative, and if you’re just beginning on this journey you may even need to think about making a change for several months before actually making it. In fact, this is a brilliant idea! Think about the changes you want to make…think about them long and hard until you’re inspired. Inspiration is a far more potent motivator for sticking to new habits than willpower. This may be a good time to take a vacation or even a personal day. Go somewhere that takes you away from it all, even if it’s to the mall or the neighborhood basketball court. It would be advisable to stay away from bars or nightclubs. However, you could take a friend to the mall, go hit balls on the driving range or jog. Recreation means to re-create. Go re-create yourself and have a fun time doing it. Here are few other simple ideas to get you started in choosing new habits to replace the old ones: Medicate with exercise, hobbies, or sports. Start out by spending 10 or 15 minutes a day doing something active that makes you smile…dance, run, walk, spin, do cartwheels or jumping jacks. Make a few changes during the tedious tasks at work. When you’re on hold, take a few deep breaths and use the time to relax rather than to write notes. If you have dictation or chart notes to complete after hours, take a 30-to-45-minute break. Go home or go out to dinner with a friend before returning to the office. You will get more done and get it done faster if you take a little time to recharge after the end of your shift. Focus on one task at a time, learn to trust others will get done in their time. Practice the art of believing that if you give something your full attention, it will be done better and more efficiently than if you’re thinking about a million other things at the same time. Nourish your spirit and soul with spiritual practices such as the practice of silence, prayer, meditation, dancing, yoga, singing, taking nature walks, listening to quiet music with no other activity, guided imagery, guided relaxation techniques. Nourish your body with massage, physical therapy, or therapeutic touch. Make healthy eating choices and replace at least half of your caloric beverage intake with clean, pure water. Cutting out or replacing just one low-nutrient food with high-nutrient food can increase your energy exponentially over the course of a few weeks. Visit a nutritionist to discuss healing products that will reverse the hormonal and changes in your body. Healthy foods, supplements, as well as herbal tinctures can counteract adrenaline overload, thyroid toxicity, and other stress-related chemical changes in your body. Make appointments with you to take care of you. Keep your word to yourself. These appointments for physical and spiritual nourishment do not have to take hours a day. Fifteen to thirty minutes will add up to a good balance over the course of a few weeks or months. To bring our self care practices section to a close let’s do a rapid review to reinforce the material. Ready, GO!!!

8. A Culture of Care & Compassion

What if a person has done everything he or she can to overcome the effects of compassion fatigue, but after returning to the workplace, the environment itself is toxic. In many medical facilities it is evident that compassion fatigue has become a “tribal” issue and not just an isolated case of one or two doctors or nurses who can’t cope with the stresses of their jobs. When compassion fatigue has gone viral, it manifests in increasing Worker’s Comp costs, high turnover rates, friction between employees, friction between house staff and management, decreased morale, and decreased quality of patient care. To survive in the potentially hostile health care field environment you must carry a culture of Care and Compassion. You must be the agent of change. Unfortunately, I can’t teach you this part. It is more caught then taught. All the information that we covered in this course will set you on the right path, but only you can make the decision to stay on that path. Unfortunately the pursuit of  “care and compassion longevity” is not simple. It is complex and requires you to constantly affirm and remind yourself that having core values of care and compassion is absolutely essential to your job. It is a relentless pursuit. My own journey to maintain a tender heart has been challenging and filled with failures. But I have had many successes as well. I remember a few years back when I went to my ER job. At the beginning of the shift one of the doctor’s came up to me and said, “I am glad when you are on duty. It feels better here in the ER when you work.” That made me feel good because the doctor confirmed to me that I was successful in carrying a positive “culture” of care and compassion around me. If you cultivate a heart of care and compassion it emanates out of you and leaks into the atmosphere affecting your coworkers, supervisors and most importantly your patients or clients. Whatever you do- don’t lose hope. The poet, Percy Shelley,  said it best. Man can live about forty days without food, about three days without water, a few minutes without air, but only for one second without hope.

9. Conclusion

I promised you that by the end of this training module you would not only have a clear understanding of compassion fatigue and its effects on the individual, but also that you would be well armed and ready to begin a frontal assault on this common and vicious foe. In conclusion of this module, I would like to highlight the arsenal you now have in your tool belt. Understanding compassion fatigue will act as a helmet in the fight against compassion fatigue. Understanding the inner workings of your enemy and what makes an individual and organization vulnerable to its effects is the first step in fighting this foe. Recognizing how you approach TIME plays a huge role in vanquishing this enemy. Learning healthy skills for coping with the Tedious Tasks associated with your job, understanding how to gird yourself against the Individual Exposure to the trauma of others, and learning to navigate the tricky waters of confidentiality (Mums the Word) without resorting to Emotion Stuffing will serve as your armor plating against the onset of compassion fatigue. Recognizing the physical, emotional, and interpersonal signs and symptoms of compassion fatigue and being able to determine where you’re at in the Care & Compassion Cycle will serve as your informant, helping you know when to fight, when to seek help, and when to step in and help a coworker or friends who may be slipping into the grasp of this vicious enemy. Learning and implementing healthy self-care practices will serve as a machine gun in this war. Making changes in any of the rings of awareness, acknowledgement, and adjustment, will be another shot fired at your adversary. Now that you are well-armed, we have reached the end of our journey together. It is up to you now to make the changes in your life. The power to cultivate a life of hope is in your hands. Will you fight to keep your heart full of compassion and care for your fellow man? Will you fight when you feel the assault of Compassion Fatigue? I hope you will because the battle is worth it. You are health care workers and caregivers. You take care of the most important commodity on this planet–a human-being.

Writers and References

Writer(s): Angela Magnotti Andrews & Donn Kropp, RN, BSN


  • Pfifferling & Gilley. AAFP. Retrieved 9/10/11 from
Assisted Guide Information Services. Retrieved 7/4/11from
  • Farlax Dictionary. Retrieved 7/1/11 from, compassion fatigue.
  • Lenore Terr,. Retrieved 6/30/11 from
  • Figley, Charles. What is Compassion Fatigue? Retrieved 3/1/11 from
  • Jarvis, Tim. (2009). Do You Have Compassion Fatigue? Retrieved 5/10/11 from
  • Portnoy, Dennis. (2010). Are You Caring or Caretaking? Retrieved 6/1/11 from



Length: 2 minutes

Compassion Fatigue can be detrimental to anyone who provides care to others. Learning to cope and manage Compassion Fatigue is essential for your well-being and those around you.

True Life Moment

Length: 3 minutes

Take a look at a true life Compassion Fatigue moment. Don’t do what Donn does!

Care & Compassion Cycle

Length: 6 minutes

Explore the care and compassion cycle. Understanding where you are on the cycle can help you overcome Compassion Fatigue.

Conclusion & Final Quiz

Length: 4 minutes

This lesson concludes our course on Compassion Fatigue and you are left with some encouragement to keep going! You are important to the people you serve and the world needs…