WASHINGTON, DC—Health care providers who work with traumatized patients are at risk for their own type of mental condition with symptoms that closely parallel post-traumatic stress disorder (PTSD). The malady, known as “compassion fatigue” can lead to emotional burnout and a range of physical symptoms, according to a recent webinar held by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE)

“Many if not all providers struggle with this at some point in their careers. It is a natural reaction to working long hours with many patients,” said James Bender, PhD a psychologist at DCoE. “Unfortunately, it can also impair clinical performance and needs to be addressed, not just swept under the rug with the hopes that it will all go away.”

Providers can be vulnerable to experiencing compassion fatigue when they are indirectly traumatized by their patient’s trauma. Compassion fatigue may also be triggered when a provider who cares for traumatized patients has unresolved personal issues themselves or a lack of social support. That eventually can lead to burnout, a state in which cumulative stressors lead to physical, emotional and mental exhaustion.

Military health providers can be particularly vulnerable to compassion fatigue, especially in the current situation with ongoing war and multiple deployments common.

“If we look at military health care providers we know that this has been a very long war,” said Victoria Bruner, RN, director of clinical education at the Deployment Health Clinical Center. “We’ve had multiple deployments and redeployments. There has been an indefiniteness to the length of war, sometimes even to the number of deployments, and a high volume of those who are needing our care both down range and back here at home.”

The Mental Health Advisory Team’s 2005 survey showed that 33% of behavioral health personnel reported high burnout, 22% low morale, and 15% agreed stressors of deployment impaired their job, Bruner pointed out. Using different measurements from the 2005 survey, the team’s 2006 survey found that burnout was an issue for behavioral health providers with 21% reporting high or very high burnout levels

At Risk for Compassion Fatigue

Paradoxically, the most empathetic caregivers are also the most at risk for compassion fatigue, Bruner said. “Workaholics” also are at high risk, she said, because providers who are more dependent on their work for their self worth and identity may be less resilient to it.

“They are very, very at risk because they don’t have a fallback if something happens, which it is going to happen in terms of not being perfect,” Bruner said.

Behavioral symptoms of compassion fatigue can include impatience, withdrawing from others, hypervigilance, a lack of self-care, and moodiness. Sufferers may experience conflict in their close relationships and a dread of working with clients or patients, Bruner said.

Somatic symptoms may include breathing difficulties, dizziness and aches and pains while, cognitively, sufferers may have reductions in memory and concentration which can adversely affect their work

Compassion fatigue also may cause health care providers to question their own spiritual beliefs. “There is a lot of questioning, especially when you bear witness to suffering in numerous settings,” said Bruner. “There is a questioning of the meaning of life, even perhaps shattering our worldview.”

Fortunately, she noted, tools are available to help providers determine if they need help. Self-monitoring is available through the Pro QOL, Professional Quality of Life Scale, which measure levels of burnout, compassion fatigue and compassion satisfaction, she said.

Yet, even if they know they are suffering from compassion fatigue, care providers may be reluctant to let colleagues or superiors know they are having a difficult time. “There is stigma,” Bruner said. “How many of us really want to say, ‘I am burnt out, I am tired, I need a break. I don’t know if I can hear one more story.’ So there is a fear of being perceived as weak or not strong enough.”

Strategies To Overcome Compassion Fatigue

Several strategies can help providers build resilience against compassion fatigue and burnout, said Jeffrey Rhodes, D. Min, senior manager consultant at DCoE in the area of combat operational stress control and performance enhancement. He said those strategies include:

• Maintaining physical exercise,
• Finding meaning and purpose in work,
• Practicing religion and
  spirituality,
• Developing coping skills,
• Sustaining social support,
• Practicing mind-body techniques, and
• Practicing sound sleep routines.

Rhodes also recommended changes in DoD policy to ensure a better balance of workload and deployments with time off for rest and recovery for military care providers.

“We could develop joint DoD measurement standards to assess for and monitor for healthcare provider compassion fatigue and burnout.” he said, adding that the Pro QOL Scale could be used across the services.

Providers also can tap into resources such as provider resiliency training on the DoD as well as the VA and DCoE websites, he said.

The Army Center for Enhanced Performance is also a strong resource and available to all military personnel, regardless of service, he said. ‘There are 11 centers across the US and they have a module for care providers,” he said. “They will take you through a module that will help you strengthen, and (then) come back if you have had some stress-related problems.”

Bruner noted that leaders also can play a role in preventing care provider burnout. “The commands themselves need to be very aware of the ways they are self caring, and serve as a very good model for their troops and units,” she said.

Resources For Providers

DoD Civilian Personnel Management System (CPMS)
www.cpms.osd.mil/wellness

Veterans Affairs
www.va.gov/health

Provider Resiliency Training DoD Web Site
www.pdhealth.mil

DCoE’s Afterdeployment.org
www.afterdeployment.org

Army Center for Enhanced Performance
www.acep.army.mil

Source: Understanding and Overcoming Compassion
Fatigue presentation given by Jeffrey Rhodes, D. Min

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