Emergency Room Nurses

Compassion Fatigue

 

            Nursing are the frontline of care in practically every healthcare setting. It is the nurse’s goal to provide the best care possible. However, with the increasing numbers of patient load and increased expectations, nurses’ job is becoming tougher than ever. Resulting in increased levels of stress and burnout affecting nurses mentally, physically and emotionally (Hunsaker, 2014). Utilizing Watson Caritas Process this study will determine indications of compassion fatigue in emergency room nurses.

Purpose

The purpose of this research is to explore key factors contributing to compassion fatigue among nurses in the emergency room setting.

Problem

            In the ER, nurses are expected to treat every individual that comes seeking for help. The increased number of federally Impacted uninsured individuals, along with the current uninsured populations, nurses are more overworked than ever. Nurse’s expectations have drastically increased. Nurses in the frontline of the ER, not only must keep patient safe, but also must keep hospitals scores high for reimbursement purposes.

Research Questions

            What are the factors contributing to the compassion fatigue among emergency room nurses.

Significance to Nursing

            Compassion fatigue has tremendous significance in nursing.  It not only affects nurses’ professional and personal lives, but also affects adversely patient care. Patients are directly affected during interactions with a nurse experiencing compassion fatigue; nurses can easily unintentionally ignore important assessment by trying to work faster. Medication errors are more prone to occur due to nurse’s lack of attention due to the effects of compassion fatigue. Moreover, because of nurses increased compassion fatigue, nurses are leaving the profession and are more vulnerable emotionally and physically (Chase, 2005, p.5).  This study aims to investigate the contributing factors of compassion fatigue among emergency room nurses.

Theoretical Framework

            Jean Watson’s Theory of Human Caring will be utilized in the study. The theory places the nurse as the mediator of care. For Watson, care is a practice of loving from self to another individual. It includes caring for not only the patient but also the family and overall circumstances (Watson, 1985). The Caritas of Watson has ten Factors redefined as Caritas Processes:

1. “Practice loving kindness with self and others.
2. Impart faith and hope and honor others.
3. Be sensitive to self and others by nurturing individual beliefs and practices.
4. Develop helping trusting- caring relationships.
5. Promote and accept positive and negative feelings authentically listen to another’s story

6.Use creative scientific problem-solving methods.

7. Share teaching and learning that addresses the individual needs and comprehension styles.
8. Create a healing environment for the physical and spiritual self which respects human dignity.
9. Assist with basic physical, emotional, and spiritual human needs.
10. Open to mystery and Allow miracles to enter” (Watson, 1985).

            The caritas process is a guideline for nurse-patient relationship. When a nurse is given a guideline to follow, such as the Caritas of Watson, nurses has the opportunity to take a second and think about the proper way to treat a patient.

Literature Review

Compassion fatigue is defined as mix of burn-out and secondary stress (Kelly, Runge, Spencer, 2015), where empathy is the root cause. In an emergency room (ER) setting, nurses are trained to work quickly under high levels of stress as they start implement the initial plan of care for most patients who enter the hospital setting. Most commonly, patients arrive hospital’s ER not only physically ailing, but they are also in a stage state of panic, and are worried about the next course of treatment. The ER nurse’s first response is to establish rapport to obtain the best care possible to the patient. ER nurses frequently report ‘feeling the pain’ of their patients as she or he is the one addressing the problem for the first time.  Furthermore, this constant contact with patients with acute emergencies accompanied with their often unrealistic expectations adversely definitely affect the ER nurses in their personal and professional life.  Emotional draining can interfere with the way a nurse performs his or her duties on a day to day basis. The quantitative study used a total of 491 direct care registered nurses. The nurses completed a survey measuring their professional quality of life. The study showed factors related to CF that can help with nurse’s retention rates and quality of care (p.522). Survey data was protected from recognizing or storing participant’s email, so names would not be linked. Furthermore, the study reflected favorable outcome and low levels of CF in nurses that were recognized often.

A quantitative convenient sample was implement in the study. In this research complete by Farity, 60% of the nurses showed CF in the past 30 days.  Limitation of the study relied on a small sample that could not reflect the general ER nurses’ population (Farity, 2013, p.255).

Hunsaker, Chen, Maughan (2014) quantitative study reflected low levels of compassion fatigue from a small sample size of 278 nurses. The research was mailed to 1,000 nurses, but only 24% of the surveys where returned. The need for a new study was mention by the researches due to the lack of participation. Researchers attributed the low response rate to a lack of interest filling the survey. Also, prospective subjects feeling that compassion fatigue was not pertinent to them (p.192). The study agreed having inconsistency, and it was compared to previous studies completed by Domingues-Gomez & Ruledge (2009) were CF was on a rise among ER nurses.

According to Hegney, Craigie, Hemsworth, Osseiran-Moisson, Aoun, Francis, and Drury (2014), nurses with lower levels of experience, working longer hours and lower educational levels experienced the highest levels of compassion fatigue (p. 515). New graduates are expected to perform just as an experienced nurse. The new study explores the effects novice nurses encounters during stressful situation. Often, graduate nurses “absorb” the feelings of patients. Frequently, new nurses work longer hours, and are at risk of burnout. For most ER nurse, the work week is three days a week. Novice nurses work more than that; some work four and five days a week. The high levels of work stress obtained by working in excess impairs nurse’s judgement during medication administration and perhaps can result in triaging a patient incorrectly. The quantitative study utilizes a self-report exploratory cross sectional survey of 132 nurses working in a tertiary hospital. Results of the study show a relationship between work related stress and the development of CF. The percentage of nurses with stress was 11.4%, 15% suffer from anxiety and 13,6% suffer from depression. A need of a new study was address. A future study measuring the development of anxiety as indicated (p.11).

Mazzota (2013) reported that ER nurses are affected psychologically; so much so that they carry their work home into their dreams. In the study, one ER nurse reported having dreams about being at work and infusing blood on an active bleeding patient with hemoglobin of 3.0g/dl. Mazzota (2015 further reported almost post-traumatic stress disorder (PTSD) symptoms among ER nurses in the form of flashback.  Mazzota (2015) noted one nurse had a flashback about a patient that was alert, had an established rapport with, then later coded.  This led to the patient being, sedated and intubate.  ER nurse’s experiences at high risk for developing compassion fatigue, possibly more than at a higher level than nurses from other units. The quantitative study surveyed 67 nurses. The 57% of the nurses expressed avoidance to patients, 43% expressed decreased activity levels, and 46% would stress about past patients.

Ethical Implications

Approval for implementation was obtained from College of Central Florida through the Institutional Review Board (IRB). Potential risk and benefits of the research has been explained to the participants. Informed consent was signed prior the interview. Interview was done in a private conference room away from others, and admission to the room to others while conducting the interview was not permitted. Withdraw from the study was allowed, and participant names were not used in the study. Data was luck in a researcher computer and data will be kept for five years.

 

 

Conclusions

            The study concludes that compassion fatigue affects the quality of care provide to the patients. Nurse are the front line of care, and it is nurse’s responsibilities to give the best care possible. Constant exposure to critical unstable patients in fast pace environment along with unrealistic expectation can affect nurses emotional and personal life’s and ultimately vacate from the nursing profession.  Lastly, the study result of a new study regarding steps that can contribute to overcoming compassion fatigue in emergency room nurses.

 

 References

Flarity, K., Gentry, E., Mesnikoff, N. (2013). The effectiveness of an educational program on preventing and treating compassion fatigue in emergency nurses. Advanced Emergency Nursing Journal, 35(3), 247-258.

Hegney, D. G., Craigie, M., Hemsworth, D., Osseiran-Moisson, R., Aoun, S., Francis, K., & Drury, V. (2014). Compassion satisfaction, compassion fatigue, anxiety, depression and stress in registered nurses in Australia: study 1 results. Journal of Nursing Management, 22(4), 506-518. doi:10.1111/jonm.12160.

Hunsaker, S., Chen, H., Maughan, D., & Heaston, S. (2015). Factors that influence the development of compassion fatigue, burnout, and compassion satisfaction in emergency department nurses. Journal Of Nursing Scholarship, 47(2), 186-194. doi:10.1111/jnu.12122.

Kelly, L., Runge, J., & Spencer, C. (2015). Predictors of compassion fatigue and compassion satisfaction in acute care nurses. Journal Of Nursing Scholarship, 47(6), 522-528. doi:10.1111/jnu.12162

Mazzotta, C. P. (2015). Paying attention to compassion fatigue in emergency nurses. American Journal of Nursing, 115(12), 13. doi:10.1097/01.naj.0000475268.60265.00

Watson, J. (1985). Nursing: The philosophy and science of caring. Colorado: University Press of Colorado.