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  1. Demonstrate an appreciation of the relationship between human flourishing in the nursing workforce and positive patient outcomes.
  2. Demonstrate an ability to integrate contemporary nursing care in the development of an evidence based clinical practice.

Students are required to analyse the level of compassion satisfaction and / or compassion fatigue within your specialty area of practice and in a care environment you have practiced, (this can be past or present workplace). From this analysis you need to propose a potential project that will have a positive impact on improving the compassion satisfaction and human flourishing within this practice environment.

Your report should include:

  • An overview of your specialty area of nursing practice that highlights practice changes that have influenced nursing care from a compassion satisfaction or compassion fatigue perspective.
  • Evidence of analysis of the findings from observation and / or the stories from people receiving care and / or their carers
  • Analysis of the current compassionate culture in terms of the attributes, enabling factors and consequences using the effective workplace culture framework (Manley et al., 2011).
  • A synthesis of the information above to develop recommendations for improvements to compassion satisfaction and human flourishing in current workplace cultures.

Overview of Nursing Practitioner

The report is developed with an aim to analyze the compassion fatigue level in the care environment of nursing practitioner. For this purpose, an overview of the nursing practitioner is provided in the report which highlights the changes in the practice of nursing practitioner in the perspective of compassion fatigue.  The analysis is supported by the finding of the observation of care provided by the carers and received by the people. In addition to this, the characteristics, enabling factors, and use of effective cultural framework at workplace leading to prevailing compassionate culture are also analyzed in the report. Moreover, effective recommendations are provided on the basis of the observations in the report so that the compassion satisfaction can be improved in the prevailing culture of the workplace.

Nursing practitioner in the present times is a vital component in the medicine office of most of the families. The professional practice of nursing practitioner includes working under the surveillance of a doctor for examining the patients, diagnosing their different types of illness and prescribing medicine on the basis of diagnosed problem (Butcher, Buelchek, Dochterman, and Warner, 2018). Nursing practitioner provides high quality and safe care in assessing and managing the patients. The academic and clinical education prepares nursing practitioners to assess the patients and diagnose the problems related to their health so that complete care can be provided to them. There are number of duties which are performed by the nursing practitioner and are different from traditional care model such as performing advanced assessments of health, initiating and interpreting investigations related to diagnosis such as diagnostic imaging and pathology as well as diagnosing of problems related to health, designing, implementation, and monitoring of regimes which are therapeutic and collaborate with families, patients, and other professional in the healthcare industry, prescription of medicines, and initiating and receiving appropriate referrals from them. A nursing practitioner often works with individuals, families, and communities among different settings if health care which includes community health settings, hospitals as well as private practice (Stuart, 2014). The services of nursing practitioners are not limited to the ones established by NSW. Nursing practitioners are even working in areas such as emergency, private practice, aged care, medical, drugs and alcohol, surgical, women’s health, rural and remote, community, paediatrics, mental health, and complex and chronic care.    

With the increasing number of patients and decreasing number of doctors, the demand for nursing practitioner has been increased in the present scenario. Most of the nurses join the nursing field with an intention of helping others and emphatically providing care to patients with spiritual, emotional, mental, and physical needs (Chachula, Myrick, and Yonge, 2015). However, a toll is taken on nurses for emphatically providing care to patients as they move within their profession. Due to heavy workload for patient care, increasing acuity among patients, and high psychological as well as physical demands, the nursing practice for patient care may sometimes result in lower satisfaction of job and decrease in productivity for individual nurses. Due to increasing demand for the job and additional emotional and psychological stress from patient care suffering from emotional or physical pain potentially develops compassion fatigue among the nurses (Decker, Brown, Ong, Stiney-Ziskind, 2015). In addition to this, the increased acuity among patients and comorbidities which is complex in nature, the stay of patients in the medical units have increased to long periods of time and therefore nurses are developing professional relationship with the patients for longer time. It is known that due to increasing emotional giving over a long period of time to patients by the nurses has lead to disable the nurses in attaining a significant balance between the objectivity and empathy and is resulting in compassion fatigue. However, structural workplace empowerment can alter the relationship context between the patients and care providers. It is also possible that compassion fatigue is associated with the lack of workplace empowerment structures. The phenomenon of compassion fatigue conceptualizes and emphasizes a feeling and sense of sleeplessness, hopelessness, and explains the emotional and physical fatigue which is faced by many of the caring professionals (Newell, 2017). It is the physical, emotional, spiritual and social exhaustion which overtakes a person and due to which a persuasive decline is caused in the person’s ability, energy, and desire to care and feel for others. Another definition for compassion fatigue states that it is a resultant of intense, continuous, and prolonged contact with the patients and using the self and exposing to stress. Thus, it can be clearly stated that in the earlier times the nursing practitioners were not much in demand but due to increasing health problem the numbers of patients have increased overtime. This has resulted in the increment of workload on nursing practitioners as they have to spend extra time with the patients dealing with the emotional, mental, and physical problems. The spending of extra hours on the care has lead to decreasing performance in terms of caring for others, which is eventually resulting in the compassion fatigue (Corey, Muratori, Austin, and Austin, 2017). It can also be said that compassion fatigue is the resultant of ‘burnout’ due to which the work of care professional is affected. Burnout is known to be a syndrome of depersonalization, emotional exhaustion, and reduction in the personal accomplishment occurring among the individuals engaged in care related work. Burnout is a resultant of overload from work, powerlessness feelings, community deficit, lack of reward and fairness, and conflict of personal value (Chirico, 2016).

Compassion Fatigue among Nursing Practitioners

Several concepts have been withdrawn from the stories related to the concept of compassion fatigue observed by the people received care form nursing practitioners. Following is the discussion of explored knowledge in context of compassion fatigue:

It was observed form the analysis the cases of different care receivers that compassion fatigue is a hazard which is occupational in nature which suggest that 9 out of 10 carers develops compassion fatigue to a certain amount although the severity of degree varies among different individuals. It was found that one-fifth of the nurses reported to have compassion fatigue only in the first month of their service as they were new to the field of nursing and they were mentally not strong enough to handle such a huge amount of workload (Hunsaker, Chen, Maughan, and Heaston, 2015). This mental breakdown ultimately leads to compassion fatigue. Some nurses fell prey to compassion fatigue due to the lack of physical strength required for performing long hours of cares to the patients. Therefore, lack of physical fitness can also be considered as a cause of compassion fatigue. It was also observed that job violence is faced by many of the nurses and number is higher than any other profession. It was observed that one third of the nursing practitioners who assist in the oncology i.e. cancer care were highly exhausted emotionally and faced personal accomplishments at low levels.

It was found that 16% to 39% of the registered nurses seem to be affected by the compassionate fatigue.  Irrespective of the place of their practice the nurses which are observed to be at high risk include the ones who are working in oncology, emergency, paediatric and hospice setting (Delgado, Upton, Ranse, Furness, and Foster, 2017). The setting of mix model is often followed in the inpatient units of oncology. Under this course, care is provided to the patients by the nurses who are receiving curative active treatment in one shift. At the same time, they are required to aid the patients receiving end-of life care or palliative care which is dependent on the patient load assigned to them. The continuous movement form one situation to another is what becomes exhausting form them. One of the common stories from most of the nurses working in oncology department is that they see patients dyeing in front of them but at the next door they aging have to assist the doctor in chemo for patients who are newly diagnosed with the lymphoma and have to put on a smile on their face while practicing. This sudden switch to a new patient is emotionally retarding and is really very hard in this fast moving environment (Birkland, 2015).

Workplace Culture and Compassion Fatigue

The nurses who experience compassion fatigue usually fear to persist their work. They also face difficulties in concentrating, feeling nervous, pessimistic or anxious and face low self-esteem.

Workplace culture consists of values, behavioral norms, attitudes, and shared expectation by the member of the workplace. The modern environment is competitive and therefore a better understanding of workplace culture is required. The workplace culture has a strong influence on compassion fatigue or compassion satisfaction. The person-centered delivery of care is influenced by culture within the healthcare workplace. The consequences of cultures which are ineffective results in compassion fatigue. On the other hand, effective workplace culture enables effective care delivery with compassion satisfaction. Working environment, client environment, and personal environment all three contributes in forming a working culture and consequently leads to compassion fatigue or compassion satisfaction (Coetzee and Laschinger, 2018).

In the present time, if the working environment provides personal support to the nursing practitioner then results in compassion satisfaction but if the practitioner is undergoing interpersonal isolation then it results in compassion fatigue. This is because when personal support is provided to an individual then it boost the morale as well as strengthen the person emotionally. On the contrary, the person become interpersonally isolated if there is personal support is not provided and it may lead to depression which eventually turns into compassion fatigue (Marek, Schaufeli, and Maslach, 2017). Likewise, if the arrangement of work is flexible then it will result in compassion satisfaction but if there is rapid change in the procedures and program including the target of performance then it leads to compassion fatigue. This is because when the work arrangements are flexible then it enables the nursing practitioners to adjust their routine according to their preference. On the contrary, if the schedule of working is changing rapidly then the routine is disturbed which cause anxiety and stress. Moreover, the changes in the performance targets also disturbs the pattern of their working due to which consistency is also disturbed and which eventually leads into pressure situation thereby causing compassion fatigue (Krause, Simon, Mander, Greer, Saletin, Goldstein-Piekarski, and Walker, 2017). Positive culture also contributes significantly in the compassion satisfaction as it provides an optimistic environment to the nursing practitioner which leads to more working satisfaction.

In terms of client environment, when the practitioner can successfully provides care to the patients then it gives boost to their confidence which effectively contributes in compassion satisfaction. Whereas, in case of complexity and acuity, even after providing adequate care, the patient may collapse. Moreover, the practitioners undergo trauma stories many times. These things lead to emotional and mental imbalance and it becomes hard for the practitioners to overcome from such metal state. Due to these reason, the productivity of the practitioners become low ultimately causing compassion fatigue (Herman, 2015).

Compassion Satisfaction

In terms of personal environment, healthy behavior, awareness towards self, setting of impersonal boundaries, and access to social support is what leads to compassion satisfaction. This is so because when the practitioner is in a healthy state of mind then he becomes optimistic and performance improves. Moreover, when he or she is more aware towards the future goals in context of their nursing practice then it keeps them motivated for long run. The presence of support from seniors, colleagues, and family members also enable them to perform more efficiently and increase their performance thereby leading to compassion satisfaction (Goleman, McKee, George, and Ibarra, 2018). On the contrary, poor care of self, limited awareness, lack of social support leads to compassion fatigue. This is because poor care towards self results in physical and mental illness due to which the practitioner becomes incompetent to provide effective care to the patients. Moreover, when the practitioner is unaware of the future scope in the practice area then it may lead to work dissatisfaction towards their work. In addition to this, when the practitioner lack social support then it may lead to mental downturn which cause work inefficiency and lower productivity thereby causing compassion fatigue.

Nurses are liable to themselves as well as their patients for ensuring that adequate support will be provided by them along with the compassionate and high quality possible care. Multiple stressors are faced by them along with the demand to fulfill the complex needs of the patient as well as their homes. An effective workplace culture can positively impact the ability of the nurse to cope with the stress related to the detriment of overall safety of nurse and patients (Hockenberry, Wilson, and Rodgers, 2016). The consequences can involve the following:

  • Ability to react compassionately in case of a disaster or crises in the nursing practice.
  • Manage extreme tension states and aids in overcoming the trauma faced by the practitioner.
  • Optimism, emotional balance, self-centeredness and dedication towards the clients and work.

 Compassion satisfaction can be improved in the current cultures of workplace by recognizing the symptoms and signs of intervention level and compassion fatigue level of the nursing practitioner. There are solution and strategies which can be used at both organizational and personal level for improving the compassion satisfaction. The compassion fatigue and compassion satisfaction are reverse of each other. Therefore, if the compassion fatigue is reduced then the compassion satisfaction will be increase.  

Organizational strategies

There are strategies which are both effective and simple at the same time and can aid the nursing practitioner in improving compassion satisfaction. An open discussion and recognition of the area of compassion fatigue in the workplace can aid in normalizing the problems of each other. The nursing practitioners can also work together in order to develop a supportive environment of work. When an individual is surrounded by a supportive environment then he is encouraged to put the best efforts which results in increased optimism and is contrary to the compassion fatigue (Bartz, Bartz, and Doctor, 2017). Moreover, the supportive environment also encourages regular breaks, proper debriefing, supporting peers, changing and assessing workloads, accessing further developments related to the profession, and regularity in time of check-in. The open discussion on the impact of work on personal and professional lives also relieves stress of the individual which reduces the compassion fatigue and aids in improving the compassion satisfaction. In addition to this, the nursing practitioners can also be allowed to work part time or partially do other clinical works along with providing part time care to the patients (Butcher, Bulechek, and Dochterman, 2018). This is considered to be an effective method to for prevention of compassion fatigue and improving compassion satisfaction.

Improving Compassion Satisfaction and Human Flourishing

Another way of improving compassion satisfaction is by providing opportunities to the staff member to reflect their work and share their response in context to the stories of the client with different colleagues as well as supervisors. The sharing of success stories can aid the staff in optimal thinking which will eventually improve the compassion satisfaction.

Identification of milestones and encounter them in the course of working which will be looked by the staff as a challenging task (Thompson, 2015). Providing guidance and support in assisting staff for transforming the experiences for enhancement of staff resilience and eventually improving compassion satisfaction. Moreover, new staff can be assisted by team mates, supervisors, and mentors to enhance their working experience. It is recognized by the mentor that the self-aware individuals can personally evaluate when the support is required and what are the best people from it can be received.

Personal

Improvement in the care of self is the cornerstone of prevention from compassion fatigue and a great move for improvement of compassion satisfaction. This is obvious but in real life it is totally opposite as almost all the nursing practitioners give preference to their work first and put their needs in the end. This often makes them feel guilty later that they don’t even take out time for themselves from their busy schedule to meditate, exercise and other health related things. The life situations of the helpers shall be assessed with honesty to determine if there is a balance between their personal and professional lives or have they maintained a balance between the depleting and nourishing activities in their lives (Corey, Muratori, and Austin 2017). The individuals shall focus in themselves and give importance to healthy habits such as personal debriefing, non-work interest, and regular exercise. The caregivers shall not only focus on providing care at the organization but shall also provide care to their families. It is significant to understand whether the caregivers are relying on anti-social activities like gambling or alcohol to de-stress or they are relying on social activities only like food, exercise, and shopping etc. A balance between the personal and professional life is the most significant factor to reduce compassion fatigue and enhance compassion satisfaction at the individual level (Sacco, Ciurzynski, Harvey, and Ingersoll, 2015).

Conclusion

From the above observation it can be concluded that compassionate fatigue is becoming a common problem with the nursing practitioners. The reason behind the increasing compassion fatigue within the nursing practitioners is the increasing number of patients in the Australia which eventually increase the workload on them. The increased workload results in the anxiety, stress, and mismanagement between the personal and professional life of the nursing practitioners. It is also observed that the organizational culture play a vital role in compassion fatigue or compassion satisfaction. Moreover, the workplace culture in the healthcare also influence care delivery which is clinically effective, person centric, and improving continually in response to the changing environment. There are certain factors present at the workplace which are responsible for compassion fatigue or compassion satisfaction. Personal support, flexibility in the working hours and shifts, physical environment of the workplace, optimistic working culture are some factors which are positive in nature and results in the compassion satisfaction. On the other hand, interpersonal isolation, frequently changing work timings, shifts, and performance targets as well as lower accessibility to resources for providing care to the client are some of the factors which are negative in nature and are responsible for compassion fatigue. In order to improve compassion satisfaction, different strategies can be opted at organizational and personal level. Strategies such as creation of supportive environment, proper shift timings for accessible workload, and improved plans for professional development, self care, and a balance between personal and professional life can lead to improvements in compassion satisfaction and lower the level of compassion fatigue.

References     

Bartz, D.E., Bartz, D.T. and Doctor, J. (2017). Confidence, vulnerability, and empathy: Friends to managers. International Journal of Business and Social Science, 8(10), 1-6.

Birkland, T.A. (2015). An introduction to the policy process: Theories, concepts, and models of public policy making. UK: Routledge.

Butcher, H.K., Bulechek, G.M., Dochterman, J.M.M. and Wagner, C. (2018). Nursing Interventions classification (NIC)-E-Book. USA: Elsevier Health Sciences.

Chachula, K.M., Myrick, F. and Yonge, O. (2015). Letting go: how newly graduated registered nurses in Western Canada decide to exit the nursing profession. Nurse education today, 35(7), 912-918.

Chirico, F. (2016). Job stress models for predicting burnout syndrome: a review. Annali dell'Istituto superiore di sanita, 52(3), 443-456.

Coetzee, S.K. and Laschinger, H.K. (2018). Toward a comprehensive, theoretical model of compassion fatigue: A n integrative literature review. Nursing & health sciences, 20(1), 4-15.

Corey, G., Muratori, M., Austin, J.T. and Austin, J.A. (2017). Counselor self-care. USA: John Wiley & Sons.

Decker, J.T., Brown, J.L.C., Ong, J. and Stiney-Ziskind, C.A. (2015). Mindfulness, compassion fatigue, and compassion satisfaction among social work interns. Social Work and Christianity, 42(1), 28.

Delgado, C., Upton, D., Ranse, K., Furness, T. and Foster, K. (2017). Nurses’ resilience and the emotional labour of nursing work: An integrative review of empirical literature. International journal of nursing studies, 70, 71-88.

Goleman, D., McKee, A., George, B. and Ibarra, H. (2018). HBR Emotional Intelligence Boxed Set (6 Books)(HBR Emotional Intelligence Series). USA: Harvard Business Press.

Herman, J.L. (2015). Trauma and recovery: The aftermath of violence--from domestic abuse to political terror. UK: Hachette.

Hockenberry, M.J., Wilson, D. and Rodgers, C.C. (2016). Wong's Essentials of Pediatric Nursing-E-Book. USA: Elsevier Health Sciences.

Hunsaker, S., Chen, H.C., Maughan, D. and Heaston, S. (2015). Factors that influence the development of compassion fatigue, burnout, and compassion satisfaction in emergency department nurses. Journal of Nursing Scholarship, 47(2), 186-194.

Krause, A.J., Simon, E.B., Mander, B.A., Greer, S.M., Saletin, J.M., Goldstein-Piekarski, A.N. and Walker, M.P. (2017). The sleep-deprived human brain. Nature Reviews Neuroscience, 18(7), 404.

Marek, T., Schaufeli, W.B. and Maslach, C. (2017). Professional burnout: Recent developments in theory and research. UK: Routledge.

Newell, J.M. (2017). Cultivating Professional Resilience in Direct Practice: A Guide for Human Service Professionals. USA: Columbia University Press.

Sacco, T.L., Ciurzynski, S.M., Harvey, M.E. and Ingersoll, G.L. (2015). Compassion satisfaction and compassion fatigue among critical care nurses. Critical care nurse, 35(4), 32-42.

Stuart, G.W. (2014). Principles and Practice of Psychiatric Nursing-E-Book. USA: Elsevier Health Sciences.

Thompson, N. (2015). Understanding social work: Preparing for practice. UK: Macmillan International Higher Education.

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