Source: University of Auckland (UoA)
‘Compassion fatigue’ is widely regarded as the personal cost of caring, but new research from Waipapa Taumata Rau, University of Auckland questions that narrative
‘Compassion fatigue’ is widely regarded as the personal cost of caring, but new research from Waipapa Taumata Rau, University of Auckland questions that narrative and suggests that compassion fatigue could in fact be a self-fulfilling prophecy.
| Professor Nathan Consedine, a health psychologist in the School of Medicine says the research his group has conducted raises questions about the idea that compassion is inherently exhausting. “Burnout in the health system is real, no doubt about it. But the experience of being too fried to care for other people is bundled up with the idea of ‘compassion fatigue’,” Consedine says. The notion of ‘compassion fatigue’ has its basis in the work of Carla Joinson in the early 1990s, suggesting emergency nurses experienced a particular type of burnout where they had exhausted their ability to nurture. “The idea is that compassion is like a muscle or an energy reserve that gets depleted over time,” says Consedine. “However, if it were a reservoir, you would expect compassion fatigue to get worse over time, but it does not. “More experienced practitioners, people who have been doing it ten, 15, 20 years, report lower levels of compassion fatigue,” Consedine says. “So, according to the theory, either they have found a way to give compassion without draining the reservoir, or they have found a way to fill up the reservoir. “But my interpretation is there is no reservoir, and it is not inherently fatiguing to care for other people. “If you look at fMRI data, brain activation during compassionate states overlaps strongly with pleasure. It doesn’t look like effort – it looks like it feels good.” Consedine’s latest study suggests that the very idea of ‘compassion fatigue’ may actually be a self-fulfilling prophecy. In the new study, Consedine and lead author Dr Rachel Rosqvist, a GP, Senior Lecturer in General Practice, and then masters student, randomised around 150 doctors and medical students to view one of three videos, where an expert, Consedine, described compassion as tiring, energising, or neutral. Afterwards, the doctors and students described their experiences of care in line with the particular video they had just watched. See British Journal of Health Psychology. “It shows that a simple five-minute video can push people’s expectations quite significantly in terms of whether compassion is seen as tiring or rewarding,” says Consedine. Now just imagine the effect of consistently having experts, educators, and researchers tell you that compassion is tiring. “I think what we are doing is, by constantly telling people that it is tiring to care, we are creating an expectation. And we know in health psychology research that expectations have a massive impact on the way people experience things,” Consedine says. This is like a ‘nocebo effect’, where expecting something to have harmful effects makes it so – a self-fulfilling prophecy. Making matters worse, describing the serious problems confronting healthcare in terms of ‘compassion fatigue’ focuses research on the person providing care, distracting us from the health system and the preposterous workloads doctors and nurses are expected to carry. “Given that they are tired, they start thinking, ‘Oh, I’m tired because of giving compassion to other people.’ It’s simply not true. They’re tired because their jobs are phenomenally demanding” Consedine says. The question of whether compassion fatigue is a “real thing” and whether it’s different from burnout is important because compassion is expected from health professionals, with documented links to provider job satisfaction and better patient outcomes. Compassion may in fact be protective against burnout, says Consedine. “For providers, it’s a good predictor of job satisfaction and meaning. “They could earn better money doing something else, but they choose to become a doctor or a nurse, because they get a sense of meaning from the process of alleviating suffering.” Compassion exists where someone recognises another person is suffering and does something about it, says Consedine. “It is important because every patient who comes through the door is suffering. It may be psychological, physical, or existential but orienting to the suffering of the other is the absolute crux of delivering compassionate care.” Consedine believes changing our narratives about compassion would be helpful for clinicians, patients and the health system. “Providers often think ‘I haven’t got enough time to be compassionate.’ But it is more about the way in which things are done, and what you see as the purpose of what you are doing.” Consedine says the focus should be, not on ‘compassion fatigue’, but rather on increasing the net amount of compassion in the healthcare system, with the ultimate metric being the patient’s experience of care. |
