Solutions to Compassion Fatigue – Part I by Katie Davis, Phd
For at least the last 25 years the problem of compassion fatigue has been of mounting importance in the medical field, particularly in parts of the profession where demand outstrips supply and emotional demands of the work are high (e.g. emergency departments, trauma units, cancer centers, end of life care, etc.). As the profile of the issues inherent in emotionally-laden work environments is raised other professions have started to discuss the problems as they apply in their own industries. The veterinary medicine environment shares in many ways the same working conditions and challenges as faced in the medical industry but solutions to compassion fatigue and other on the job stress-inducers are comparatively in their infancy.
In the first in a series of three articles we will look at four different workplace solutions designed to address compassion fatigue or burnout in the medical industry (specifically nursing and oncology). In following posts we will look at how to translate those solutions from the medical to the veterinary industry and move towards industry-specific approaches that can alleviate some of the problems associated with such work that demands such a constant high emotional output of its practitioners.
Training Within Industry
This first case study looks at the Training Within Industry Approach (TWI). This is an approach that was originally developed by the US government during World War II as a method to quickly train largely agricultural workers to serve the war industrial machine. This approach has been adapted many times and applied successfully to many different industries. The TWI approach essentially standardizes training into very simple steps that can be easily and quickly implemented by anyone who takes the training and also provides a simple, conflict-free way to administer and follow-up on feedback. This approach can go a long way towards reducing stress caused by high turnover, insufficient training, and different methodologies in an industry where turnover is high and there are wide variations in the standard of care between different practices since it has specifically been designed for those types of challenges.
In this particular case the original method was applied to a small emergency department in greater LA and explores the impact this program can have on emotional exhaustion, depersonalization, and personal achievement in a real-time setting. The study ran for several weeks and monitored participants (via survey) before, during, and after the implementation of a TWI program to assess what impact it had. The study used a particular statistical approach when comparing the program period to an earlier period at the hospital to account for the abnormal distributions caused by the small number of participants.
Comparisons between the pre- and post-intervention period showed some measures of burnout such as engagement and depersonalization were improved moderately to substantially on a statistical basis (some deteriorated or could not be evaluated). However, in this study the engagement scores experienced by only a portion of the staff increased while emotional exhaustion deteriorated, possibly due to outside influences .
Compassion Fatigue Resiliency
The next approach looks at a pilot program, involving trauma nurses, designed to build compassion fatigue resiliency (CFR). Nurses and staff part pate in compassion resiliency sessions outside of normal working hours led by an outside, trained moderator. The pilot program was relatively short, but had started to modify behaviors that had an impact on compassion fatigue. One of the key recommendations coming out of the study was that the program was ineffective as a one-time intervention and would need to be implemented ongoingly to have the desired impact in the long-term and to deliverable statistically measurable results. There was some concern about conducting CFR sessions in mixed professional/non-professional groups because of the possible concerns related to retaliation and hierarchy. It was clear in the mediations sessions that removal of hierarchy and boundaries to talking was critical to the success of the program .
Internal Recovery Model
Another approach that has been tried focuses on an internal recovery model specifically to address burnout. This study looked at outpatient oncology care in Germany and proposed several different hypotheses that were tested by surveys. It was specifically looking at the differences between internal recovery (small breaks that occur during working hours) and external recovery (occurring at home on the weekends or on vacation). There are a lot of nuances to the findings but one of the findings was that there was an indirect correlation between work home conflict and internal recovery during the work day that essentially showed that internal recovery played a role in lowering emotional exhaustion impacts as measured by work home conflict.
This is potentially important when we look at the veterinary environment. There outpatient clinical oncology practice (generally with a couple of physicians only and office staff) is more similar to the standard veterinary practice than is a hospital trauma ward or really any part of the hospital and so the findings may be more immediately applicable to a vet clinic. The internal recovery actions cited in the oncology study were not large interventions but rather changes in customary ways of operating. Clinics where lower burnout measures were seen are ones that built small breaks into appointment scheduling and possibly scheduled deliberate downtime during the day. In the study here, oncology practices that employed those kinds of systems reported lower levels of burnout (emotional exhaustion, detachment, satisfaction) .
Schwartz rounds are essentially moderated discussions that support clinicians and staff to discuss the non-clinical aspects of care. Sessions are supposed to occur monthly, during work hours (commonly a provided lunch) and will discuss one case per session used as a way to guide the discussion to talk about general themes and emotions. It is important to note that these discussions are led by a staff member themselves, but the staff member serving as moderator will have been trained specifically on how to run a schwartz session (by the Schwarz Center). This particular paper simply looked at the model itself, without presenting any of the case studies although numerous case studies have demonstrated that the Schwarz model is effective in reducing burnout in participants and this reduction is long-term and increases over time.
 Pascual, A.A., Training within industry in the emergency department: team development to improve patient care and alleviate staff burnout,
 Pfaff, K.A., Freeman-Gibb, L., Patrick, L.J., DiBiase, R., Moretti, O., Reducing the “cost of caring” in cancer care: evaluation of a pilot interprefessional compassion fatigue resiliency programme, Journal of Interprefessional Care, 31 (4), 512-519, 2017.
 Nitzsche, A., Neumann, M., Grob, S.E., Ansmann, L., Pfaff, H., Baumann, W., Wirtz, M., Schmitz, S, Ernstamann, N., Recovery opportunities, work-home conflict, and emotional exhaustion among hematologists and oncologists in private practice, Psychology, Health & Medicine, 22 (4), 462-473, 2017
 Goodrich, J., Compassionate care and Schwartz Rounds: The nature of the work – Acknowledging it is hard, Nurse Education Today, 34, 1185-1187, 2014.