Compassion fatigue often unavoidable; adapting critical

April 1, 2004

There's a hidden "occupational hazard" new graduates aren't likely to find in any OSHA manual, according to one expert.

There's a hidden "occupational hazard" new graduates aren't likely to find in any OSHA manual, according to one expert.

Tracy Zaparanick, Ph.D., a student of the College of Social Work at the University of Tennessee, who has studied the "hazard" at length, says the unlikely culprit is compassion fatigue, or the stress of caring too much.

"Whenever you put yourself in the role of taking care of others that are people or animals, then you are susceptible," says Zaparanick. "But it doesn't mean it's an automatic sentence. There are things you can do to minimize its impact and become more resilient in the future."

Syndrome defined

Compassion fatigue syndrome, according to research conducted in 1997, is specifically the combination of primary traumatic stress plus secondary traumatic stress, plus burnout.

Primary traumatic stress means a person experienced or was confronted with an event that involved actual or threatened death or serious injury. A common example in veterinary circles is the effect of euthanizing an animal. Secondary stress occurs when a person witnesses an event that involved death or serious injury. An example might include witnessing euthanasia.

Add burnout, or the chronic conditions of perceived demands outweighing perceived resources, to the mix and there's a ripe opportunity for compassion fatigue to take over.

High risk factors for the syndrome include the frequency and intensity of euthanasia, animal cruelty, distressed clients, limited financial resources of clientele, volume of animals treated and conflict within the workplace.

How to recognize

Zaparanick says that individuals afflicted with compassion fatigue typically go through four phases: zealot or idealistic phase; withdrawal phase; irritability phase and zombie phase.

Compassion fatigue project in full swing

Zealot phase. In this stage a veterinarian or veterinary staff feels committed, available, ready to make a difference. Staffers willingly work long hours. Enthusiasm is unending.

Withdrawal phase. The second stage sees enthusiasm turn sour and the bubble burst. Complaints about work begin to surface. The individual is tired all the time and avoids talking about work. He or she begins neglecting family, coworkers, clients and him or herself.

Irritability phase. The person starts avoiding patient/client contact. Use of humor is strained. Lapses of concentration begin occurring. People distance themselves even further from family and friends.

Zombie phase. All hopelessness turns to rage. The person begins to loathe any and all people, including coworkers. Others become incompetent. There's a disdain for patients and clients. Patience is minimal.

Contrary to popular opinion that compassion fatigue is directly tied to work, symptoms of the condition can pervade all areas of a person's life: psychological, emotional, behavioral, work-related and interpersonal.

"Compassion fatigue will impact many dimensions of our lives — not just our professional relationships with our clients," Zaparanick says. "It will bleed into every area of our life."

Some common symptoms include: sleep disturbances and sudden uninvited thoughts and unpleasant images. Others will intensify their addictions to alcohol or drugs to deal with problems at hand.

Another common response to compassion fatigue is withdrawal.

"You've met people who appear cold. That's another result of compassion fatigue. People have to figure out another way of surviving in the job. People either give of themselves completely, or they give nothing," she says.

When load is heavy

To prevent falling victim to compassion fatigue in your first job out of school, Zaparanick recommends that students learn to develop what is called a non-anxious presence while still in school.

"Essentially this is the ability someone has to maintain a peacefulness within themselves. Rather than being really anxious, angry, frustrated or confused, you're able to self-regulate so at a moment's notice you can be calm."

She says the development of a peaceful existence is critical to overcoming compassion fatigue-related stress. Active ways to foster peace include meditation, prayer, yoga or relaxation exercises.

The key to overcoming the weight of compassion fatigue is to learn to become resilient to it, she adds. While you may not prevent its occurrence, resilience can lessen the blow.

Grief factor

The expectation of grief and loss in the workplace, due to the responsibilities of the veterinary professional, increase the risk of compassion fatigue.

Types of grief include normal; anticipatory, where animal caregivers expect the loss of an animal; discrepant, in which each animal caregiver grieves differently; complicated, where the person had no previous experience with loss; unresolved and problematic.

"Because death and loss is such an integral part of the workplace, attention must be given to maneuvering and accommodating all this loss," she says. To that end, Zaparanick and others are working largely with shelters in helping them to better handle the volume of euthanasia.

Action plan

To prepare individuals for future loss and setbacks in the workplace, Zaparanick and researchers have compiled what's called the Professional Compassion Fatigue Resiliency Plan. This plan involves being able to create a mission statement stating your intentions in stressful situations.

"When you enter a situation, you want to be able to respond the way you want to rather than getting upset; you want to be able to go in and say my job is to help the client and patient through this difficult time. The mission statement really creates a boundary for yourself: what's OK and not OK to do," she says.

In the end, Zaparanick says that if you face a potential compassion fatigue breakdown, change your perspective.

"People have to see the world differently. Realize the work you do is good enough."