Oncology nurses are at risk for compassion fatigue (CF). Bush (2009) defines CF as an emotional state with negative psychological and physical consequences that emanate from caregiving to people experiencing intense trauma, suffering, or misfortune. CF can damage personal and professional health leading to deep emotional and physical exhaustion and loss of optimism regarding work done (Robinson, Clements, & Land, 2003).Yet CF in clinical oncology RNs is largely unexplored. This paper details a descriptive qualitative research study that investigated the experience of CF in Canadian clinical oncology registered nurses (RNs). The research question was “How do clinical oncology RNs describe their experiences of CF?”
Material and Method
The methodology is phenomenology which aims to transform the RNs experience of CF into a textual expression of the “essence” of the experience. A conceptual stress process model that considers caregivers’ stress in four domains provides the conceptual framework (Aneshensel, Pearlin, Mullan, Zarit, & Whitlatch, 1995). A purposive sample of nineteen clinical oncology RNs were recruited. Participants completed an online survey and wrote narratives describing their experiences with CF. Data were analyzed thematically.
Results and Discussion
Five themes were identified. First recognizing CF. Respondents reported having limited knowledge regarding CF. The nurses knew “something” was troubling them about their work, but they were not sure how to label what they were feeling. Second participants described causes of CF including lack of support and lack of time/ability to give high quality care. Third factors that worsen CF included incongruence between what nurses wanted to do for their patients and what they were able to do, co-existing physical and emotional stresses, and excessive emotional attachment and involvement. Fourth outcomes of CF included profound fatigue of mind and body, negative effects on personal relationships, and considering leaving the profession. Finally interventions that lessen CF included colleague support, work-life balance, connecting with others, acknowledgement and recognition, and maturity and experience.
Oncology nursing involves caring for complex and acute needs of patients with life-threatening conditions. Despite skilful interventions, there are times when the care needed by patients and their families is primarily palliative. In this presentation the author focuses on examples of ways nurses can make the palliative care they provide exemplary but focusing simple gestures.
Material and Method
This presentation is based on the findings of a phenomenological research study of outstanding Canadian oncology nurses who specialized in palliative care. A purposive sample of 8 exemplary nurses who worked on a palliative care unit in a large urban hospital participated. These nurses were nominated by their peers as those people they would choose to care for them if they were dying. The investigator spent 40 hours with each participant on the nursing unit observing their nurse-patient interactions. Data were also collected through an in-depth one to one interview with each nurse. Interviews were recorded and transcribed. Data were analyzed using van Manen’s (1997) three processes for isolating thematic statements: seeking overall meaning by holistically looking at the sentences, focusing on sentences or phrases which stand out in the text, followed by a line-by-line scrutiny of the text sentence by sentence. Data trustworthiness was address by returning themes to participants to confirm findings, provision of thick description featuring verbatim quotes, and the detailing of an audit and research process trail.
Results and Discussion
The over arching theme was simple gestures. What would seem at first to be very inconsequential nursing interventions seemed to have a large positive impact on the patient experience. Specifically, the simple gestures identified include helping people live on, individualizing care, defending human dignity, sensitive listening, sharing hope, and keeping the promise to never abandon. Discussion focuses on a secondary finding related to the positive effects providing excellent palliative care may have not only on the patient but also on the nurse. Nurses who provide exemplary palliative care may be molded into more caring and compassionate people, and more exemplary human beings.
Oncology nurses, including those who specialize in palliative care, are challenged daily to meet the multiple needs of patients and their families. Though state of the art technology, medications and advanced skills may save many lives, there are times when the care that is appropriate is palliative. It is in these instances that careful attention to the power of the simple gestures in providing exemplary nursing care is essential. Attending to the simple gestures and providing exemplary care is transformative for the nurse as patient well-being is central.||en