Program aims to combat 'compassion fatigue'

Stressed providers cannot offer optimal care, leaders say

The Woman's Hospital of Texas, based in Houston, is offering caregivers in several units a "compassion fatigue" program, designed to target a little-known stress disorder that its proponents say prevents providers from giving their patients optimal care.

"Compassion fatigue [CF] is a stress disorder that was first identified in the 1950s, primarily among vocations that provide care for people in crisis," says Bruce G. Coe, MDiv, chaplain, quality resource management at the hospital. "When I came here three years ago, I quickly determined a goodly number of our staff was under the disorder. I tried to get some interest at the time and did not get what I hoped for, but due to recent situations and circumstances in the country, hospital leadership began to pick up on it — and this program is something you can offer."

Exactly what is compassion fatigue? "Compassion fatigue is the gradual lessening of a person's ability to provide compassion," Coe explains. "Each nurse, doctor, or other caregiver only has so much compassion. The textbook definition says it comes on gradually, but one crisis can drain the will, and providers can find themselves unable or unwilling to provide care."

When a provider suffers from compassion fatigue, "quality of care suffers," says April Spreeman, LMSW, a social worker involved in the program. "We have to have a lot of compassion to build rapport with patients and make connections."

Coe agrees, "HCAHPS [the Hospital Consumer Assessment of Healthcare Providers and Systems — a publicly reported survey of patients' perspectives of care] not only demands that we provide good clinical care, but we know that people want those warm, fuzzy feelings," he notes. "If we do not have them, that will reflect on our scores and cause even more stress."

The condition, he says, not only affects the ability to show compassion, but also begins to show up in clinical care. "I had unit managers come to me several times telling me that nurses who never had issues or events are having them," Coe shares. "We believe it's directly related to stress levels in their lives at work and at home. If it goes unchecked, it shows up in clinical care; they begin to not do some things or do things they've not done before."

Lack of compassion, he observes, is an attitude. "These people are tired, unmotivated, not giving prompt care," says Coe. "They may not be making clinical mistakes, but they are not providing normal, effective care."

Accordingly, adds Spreeman, staff compassion fatigue was beginning to affect HCAHPS scores. "I talked with our patient advocate, and said if you want to improve those scores you need to look at CF," she recalls. "She did not know about the condition; very few people in the medical profession are aware of it," says Spreeman, who notes that she learned about it in a previous position in hospice. Ultimately, its HCAHPS scores became a selling point for the program.

How the program works

The program itself is, by and large, a "self-care" program, explains Coe. "We provide a lecture for nursing units consisting of a plan for them to develop; we provide a framework," he shares. The lectures, he adds, are built into their monthly meetings.

"We run a PowerPoint presentation and go through a definition of CF, and we also talk about symptoms; one of the biggest steps is self-awareness," says Spreeman. For example, she says, staff members may avoid a particular patient on purpose because they know he or she is difficult. "Another is irritability with patients and with co-workers," she says. Additional symptoms, she notes, include extreme nervousness or anxiety, and even physical symptoms such as constipation."

"The point is for them to first acknowledge they have the condition," says Coe. "Then, we ask them to make a promise to care for themselves; our responsibility is to ask them if they are keeping their promise."

The promise, he continues, is that staff members will do something for themselves once a day. "I wrap up the session by sharing how my day is spent hearing stories about death, disease, discouragement, and despair — imagine what I'd be like at the end of day if I did not decompress?" he says. "It might be as simple as meeting a buddy at a restaurant and having a cup of coffee, or taking a long walk when I get home. Once a week I plan something big so I can look forward to it; that's how simple it is."

The program has been offered in nine different units over a couple of months, and "it could not have been better received," says Coe. "Our administration is trying to build this in as a more regular part of our lecture series and orientation for employees. We've even had another hospital make inquiries about what we're doing."

[For more information, contact: Bruce G. Coe, MDiv, Chaplain, Quality Resource Management, The Woman's Hospital of Texas, 7600 Fannin, Houston, TX 77054. Phone: (713) 791-7138. April Spreeman, LMSW. Phone: (713) 791-7149; E-mail:]