The Cost of Caring: Compassion Fatigue in Hospice Nursing

Compassion fatigue is a concept that is often referred to as the “cost of caring.” Hospice nurses, who regularly care for patients at the end of life, are most susceptible to this sense of helplessness, isolation, and confusion, as each day they are faced with bearing witness to the tragic loss of their patients. Compassion fatigue has detrimental effects on the health and wellbeing of nurses, and impacts on the safety and dignity preservation of patients. The purpose of this project was to explore the concept of compassion fatigue in Hospice nursing practice. Kim and Schwartz-Barcott’s Hybrid Model is a research methodology for concept development that was utilized to complete fieldwork at a local Hospice facility and conduct a concept analysis to determine factors that impact on compassion fatigue for Hospice nurses. The Hybrid Model consists of three phases: (1) Theoretical Phase, (2) Fieldwork Phase, and (3) Final Analytic Phase. In the Theoretical Phase, a literature review was conducted to gain insight on the greatest contributing factors to and coping mechanisms for compassion fatigue in Hospice nurses. Common themes in the literature suggested that causes of compassion fatigue in Hospice nurses were directly related to repeated ongoing loss, families with intense emotional strain, problematic family dynamics, and the nurse’s attachment to the patient. Engagement in self-care activities was identified as the most effective strategy for Hospice nurses to utilize in preventing compassion fatigue. During the Fieldwork Phase, a shadowing experience at a Hospice facility in Rhode Island was completed. Nurses at this facility identified many of the same factors that contribute to compassion fatigue as were found in the literature. The “business mentality” phenomenon associated with the operation of a Hospice facility was a unique factor identified by the nurses that was not evident in the literature. When asked about interventions to prevent compassion fatigue, nurses requested more validation of the stress associated with daily exposure to loss and suffering and additional recognition for their commitment to providing quality patient care. In the Final Analytic Phase, comparison of findings from the literature and from the fieldwork experience regarding the concept of compassion fatigue facilitated development and implementation of a staff appreciation event for the Hospice nurses. Providing activities or experiences that demonstrate recognition and support are vital strategies for Hospice nursing leadership to implement that can decrease compassion fatigue and lower nurse-turnover rates. Recommendations for future nursing research include exploring the impact of the “business of death” versus the “dignity of death” phenomenon in Hospice nursing. Understanding the impact that the business mentality has on Hospice nurses’ clinical practice may provide greater insight into factors that contribute to compassion fatigue. Hospice facilities can then utilize this information to develop interventions that acknowledge the challenges associated with Hospice nursing care and minimize the risk of compassion fatigue