Because of the demanding nature of working in long-term care, primary care givers, and many professionals including nurses, run the risk of suffering from burnout and compassion fatigue. By adopting healthy lifestyle choices and focusing on burnout and compassion fatigue prevention, you can minimize work stresses and their toll. The author is a leading social gerontology expert in the caregiving industry and he provides insight for both the caregiver and the recipient in this wonderful article. 

“To work out this plan, you need the support of your husband”, I told Krishnaprabha explaining the care plan of her mother in law. “If not better to place her in a care facility” I gave the second option.

“No sir, he will not understand and he always says that it is my duty, as if he has no stake in this”, Krishnaprabha complains about her plight of singlehandedly (mis)managing a rheumatoid patient with slight dementia.

“Three years of caring for my mother in law with dementia, I’m exhausted! What hurts worse is when a clueless husband tells you that the reason my mother in law is so bad is because I had neglected her. That was very ignorant. I worked, like a donkey, hard at home doing my family’s chores, and also worked years at jobs myself.. I’m worn out, no more it is possible. But now-a-days, the sleepless nights really gang up on me. I can’t do this kind of work any more …. I can’t care anymore”  Prabha decided to call off her ‘caregiving assignment’.

You’ve heard of burnout, but may not have heard of compassion fatigue. As more and more family members like Krishnaprabha become caregivers, it is important to be learning about this term. A heavy workload and never-ending tasks may make you wonder if you’ve developed compassion fatigue. What is it and what can you do about it?

Krishna Prabha is a typical case of Compassion Fatigue. Caring too much can hurt. When primary caregivers focus on their infirm loved ones without practicing self-care, destructive behaviors can surface. Apathy, isolation, bottled up emotions and substance abuse head a long list of symptoms associated with the secondary traumatic stress disorder now labelled: Compassion Fatigue.

In general, Compassion Fatigue is a state experienced by those helping people or animals in distress; it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic stress for the helper.

My experience with ‘long term caregiving’ suggests that caregivers play host to a high level of compassion fatigue. Day in, day out, primary caregivers struggle to function in care giving environments that constantly present heart wrenching, emotional challenges. Eventually, negative attitudes prevail.

Compassion fatigue is caused by empathy.  But when there is involvement, it is the natural consequence of stress resulting from caring for and helping traumatized or suffering people. The more commonly used term, ‘burnout’ and compassion fatigue may overlap. The American Institute of Stress, defines this acute stress as “vicarious traumatization” because it’s caused by working with those who are suffering from the consequences of a traumatic event.

When you detach from the scenario, there will not be any empathy. Very few people can do this and most care providers have overwhelming feelings and thoughts when they witness the suffering of another and the desire to alleviate the suffering knowing very well that they are in a helpless situation. Often we confuse compassion with attachment, which is our own personal investment in the outcome of the situation.  In other words, when we think we feel compassion we are actually wrapped up in our own emotional needs rather than the needs of the other person. Mostly it’s attachment that leads to compassion fatigue, not compassion itself.

It is not only the family members who have compassion fatigue.  A perfect illustration involves Milan, Nurse Manager working in our care facility. She describes walking into the room of 87 year old, Muniratnamma, a new admission, and feeling stunned by what she saw—  an extremely thin, emaciated woman with severe bruising and discoloration on her arms and legs sitting in her wheelchair. The bruises were the result of severe abuse by her son and daughter in law. Milan described her first reaction as fear which turned to sadness for this woman’s condition and knowing that she really couldn’t do anything to change it. 

As part of preparing this article, I discussed this topic with two nurse managers from our care facilities. Both expressed a sense of being overwhelmed, mostly by the feeling that what stresses them most is beyond their control. “Typically, we entered nursing to make a difference in the lives of others, not realizing the extraordinary range of job duties this entails. In addition, we often have to face illness, decline, and the death of the very people we care so deeply about, and for whom we strive so hard to provide high-quality care. Residents and families need support, staff have their coping struggles, bosses can be demanding, and we are expected to step in and know just what to do. Sometimes we wonder what we do, why we do?”, Milan was open about her negative feelings.

“Nurses and care providers have demanding jobs, and at times it may feel like you are carrying the weight of the world on your shoulders. Given the pressures of care home life, we are susceptible to emotional, mental, and physical exhaustion brought on by continuous demands that include the needs of residents and families, staffing issues, reporting compliances, and surprise visits by management representatives”, Swetha adds.

As a social gerontologist, I suggest the family care providers, to consider the following before the compassion fatigue sets in:

• Don’t pause your life.
• Practice self care including, yoga, exercise, small breaks and socialising.
• Consider placing the ‘patient’ in a care facility for ‘Respite Care’.
• Consider a vacation.
• Ask the other siblings or relatives to provide care for a fixed period in every year.
• Get additional support, in the form of  home nursing.
• If nothing works, then opt for institutionalisation.
• Place interest of the patient as utmost important, rather your conveniences.
• Above all, come to terms with the helpless situation you are in and be pragmatic when it come to long term care.

Prevention steps

Prevention steps I would list out to help professionals get life back under control include the following. Few of this are applicable to family care providers. 

• Start each day with a relaxing ritual such as 15 minutes for meditating, journaling, stretching, or reading something inspirational or interesting.
• Adopt healthy eating, exercising, and sleeping habits.
• Set boundaries to avoid overextending yourself at work.
• Take a daily break and set aside time to completely disconnect.
• Nourish self-creativity by choosing fun activities that have nothing to do with work.
• Learn to manage stress.
• Add vacation time to your life.
• Care for your spiritual self.

Accepting the presence of compassion fatigue in your life only serves to validate the fact that you are a deeply caring individual. If you sense that you are suffering from compassion fatigue, your path to wellness begins with one small step: awareness. Appropriate awareness can lead to insights regarding past traumas and painful situations that are being relived over and over within the confines of your symptoms and behaviors. Healing begins by employing such simple practices as regular exercise, healthy eating habits, enjoyable social activities, journaling, and restful sleep. Somewhere along your healing path, the truth will present itself: You don’t have to make a choice like I mentioned above the likes of Krishnaprabha. It is possible to practice healthy, ongoing self-care while successfully continuing to care for others.