Opinion

Compassion fatigue, burnout, PTSD: Health-care professionals need protection

As vaccination rates increase and restrictions relax, the opening of public services suggests that we will see a rebound in the mental health of the general population. Many longitudinal studies are currently underway to study the impact of COVID-19 on the mental health of different demographics, including children and post-secondary students affected by online education and seniors residing in long-term-care.

However, the data and literature surrounding pandemic-related “compassion fatigue,” “burnout,” and the mental health of health-care providers are minimal and underreported, posing risks not only for the providers themselves but for their patients as well. Numerous studies indicate that a clinician’s judgment can be impaired by prolonged compassion fatigue and symptoms of burnout, which have been linked to decreased quality of patient care and satisfaction. For instance, studies in clinical nursing settings show that increased rates of burnout are correlated to increased rates of self-reported medical errors.

The term “compassion fatigue” illustrates the idea of individuals in helping professions struggling to cope with the emotional toll of their occupations, often leading to emotional and physical exhaustion, vicarious trauma and burnout. Amidst the pandemic, mental health experts in North America have reported considerable increases in the demand for psychotherapeutic services by the general public and health-care providers.

Compassion fatigue is caused by long-term exposure to occupational stress at higher than normal levels, due to factors such as increased workload, decreased clinical autonomy, and decreased funding for resources and staffing. Burnout is a subsequent cause of compassion fatigue, resulting in decreased motivation and overall emotional and physical exhaustion from occupational stressors.

Studies on the psychological distress of front-line responders following traumatic events (e.g., 9/11) present the idea of a “communal disaster,” which “may adversely impact those who witness suffering as a part of an occupational responsibility.” Current research on the COVID-19 pandemic suggests that health-care providers treating patients on the front lines are susceptible to this same phenomenon, resulting in a higher risk for developing post-traumatic stress disorder (PTSD). COVID-19 has caused a number of occupational stressors, including shortages in PPE, vaccines and drugs, adapting to virtual care, working outside areas of specialization and exposure to higher rates of death and dying.

A clinician’s judgment can be impaired by prolonged compassion fatigue and burnout.

Ultimately, many health-care providers’ psychological distress is rooted in the limited capacity to deliver sufficient care, which is beyond their control. This is a form of moral injury, a type of psychological distress following traumatic events that causes individuals to contradict their own values or moral ethics with their actions or lack thereof, often leading to an overwhelming sense of guilt.

The solutions to reduce compassion fatigue and increase safety in the mental health-care system for both patients and health-care providers are the responsibility of many. System-based interventions promote active involvement of health-care administrators to engage with clinical staff and implement adequate training and check-in protocols to prevent severe burnout and introduce early intervention strategies. Individual interventions include a broad range of micro-practices, such as engaging in cognitive behavioural therapy and creating safe workplace environments. Workplaces must promote open conversations about compassion fatigue and burnout, helping to decrease the internalized stigma of health-care providers seeking mental health supports.

Some organizations are already doing this work. The Centre for Addiction and Mental Health provides resources and training to all allied health professionals on how to navigate compassion fatigue. Anxiety Canada also offers some helpful strategies, such as reaching out for social support, making time for self-care and setting boundaries to avoid unnecessary unplanned exposure to occupational stressors.

To improve health-care professionals’ mental health in the long-term, greater emphasis must be placed on how to practice self-care while at work. The causes, consequences, prevention and management of compassion fatigue ought to be a part of health-care education.

Compassion fatigue can be experienced by clinicians in all settings (e.g., acute care, rehab, community), and as the prevalence of mental health disorders increases, it is imperative that patients, clinicians and health-care administrations consider how compassion fatigue and increased risk of moral injury fit into the big picture of providing quality patient care while protecting clinician well-being.

As we work through a pivotal time in both mental and public health, unravelling the disparities in equity and ethical care from all perspectives, it is essential to protect the mental health of health-care professionals to protect the public health of our communities at large.

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Author

Zahra Hasan

Contributor

Zahra Hasan, BSc, is a master’s student at the University of Toronto Dalla Lana School of Public Health and the Joint Centre for Bioethics.

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