Emergency Department Nurses' Lived Experience with Compassion Fatigue

144 Pages·2015·1.39 MB·English

by  Michelle Marie Chase

Florida State University Libraries
Electronic Theses, Treatises and Dissertations The Graduate School
2005
Emergency Department Nurses' Lived
Experience with Compassion Fatigue
Michelle M. Chase
Follow this and additional works at the FSU Digital Library. For more information, please contact
THE FLORIDA STATE UNIVERSITY
SCHOOL OF NURSING
EMERGENCY DEPARTMENT NURSES’ LIVED EXPERIENCE WITH
COMPASSION FATIGUE
By
MICHELLE M. CHASE
A Thesis submitted to the
School of Nursing
in partial fulfillment of the
requirements for the degree
of Master of Science in Nursing
Degree Awarded:
Fall Semester, 2005
Copyright 2005
Michelle Chase
All Rights Reserved
The members of the Committee approve the thesis of Michelle M. Chase defended on
October 26, 2005.
__
Sandra Faria
Professor Directing Thesis
________
Denise Tucker
Committee Member

__________________________
Charles Figley
Committee Member
Approved:
___________________________________________________________
Linda Sullivan, Director, School of Nursing Graduate Program
___________________________________________________________
Katherine P. Mason, Dean, School of Nursing
The Office of Graduate Studies has verified and approved the above named committee
members.
ii
This manuscript is dedicated to Darryl Jordan. Your love, support, and understanding
have fostered the achievement of my academic goals. I am grateful for your desire to
assist me in the accomplishment of my dreams.
iii
ACKNOWLEGEMENTS
A special thanks to those extraordinary individuals who have helped me in the
achievement of my academic endeavors.
To Dr. Sandra Faria for your knowledge, wisdom, and encouragement which
provided me with strength and direction in facing the daunting task of analyzing my data
as well as completing my research.
To Dr. Jeanne Flannery for your guidance and support which was very valuable in
the early phases of the research process. You gave me the power and motivation to
pursue my research interest as well to persevere when I felt that I could no longer keep
going.
To Dr. Denise Tucker for your positive attitude and words of encouragement
which were a tremendous help throughout the research process.
To Dr. Charles Figley for your strong support of my research focus and
willingness to assist me in my research endeavors.
To Darlene Prickett for your assistance and eagerness in promoting my research.
To Jamie Marsh for your technical assistance which was extremely valuable as I
completed my research.
iv
TABLE OF CONTENTS
List of Tables …….………………………………….………………………………. vii
List of Figures …….…..……………………….………………………….………… viii
Abstract ….…….…………………………………….……………………………… ix
CHAPTER 1
Introduction ………….……………………………………………...................... 1
Statement of the Problem ……..………………………………………………… 3
Significance of the Problem ……..……………………………………………… 5
Statement of Purpose ……...…………………………………………………….. 7
Research Questions ……………………………………………………………... 7
Definition of Terms ……………………………………………………………... 7
Assumptions …………………………………………………………………….. 7
Limitations ……………………………………………………………………… 8
Conceptual Framework …………………………………………………………. 8
Watson’s Theory of Human Caring ……………………………………… 8
Selye’s Stress Theory …………………………………………………….. 9
Figley’s Compassion Stress and Fatigue Model …………………………. 10
Summary …..……………………………………………………………………. 12
CHAPTER 2
Review of Literature …...….…………………………………………………….. 14
Theory …..………………………………………………………………………. 14
Compassion Fatigue ……………………………………………………… 14
Secondary Traumatic Stress ……………………………………………… 15
Burnout …………………………………………………………………… 16
Vicarious Traumatization ………………………………………………… 17
Empathy ………………………………………………………………….. 18
Watson’s Theory of Human Caring ……………………………………… 18
Selye’s Stress Theory …………………………………………………….. 21
Figley’s Compassion Stress and Fatigue Model …………………………. 25
Empirical Studies ……………………………………………………………….. 27
Compassion Fatigue ……………………………………………………… 27
Secondary Traumatic Stress ……………………………………………… 34
Burnout …………………………………………………………………… 38
Vicarious Traumatization ………………………………………………… 41
Empathy ………………………………………………………………….. 42
Work-related Stress ………………………………………………………. 44
Watson’s Theory of Human Caring ……………………………………… 49
v
Selye’s Stress Theory …………………………………………………….. 54
Figley’s Compassion Stress and Fatigue Model …………………………. 55
Summary …..……………………………………………………………………. 56
CHAPTER 3
Methodology ….………..……………………………………………………….. 58
Design …………………………………….…………………………………….. 58
Sample ………………………………………………………………………….. 59
Instrumentation ..………………………………………………………………... 59
Protection of Human Subjects ...………………………………………………… 60
Procedure …………………………...…………………………………………… 61
Data Analysis …..……………………………………………………………….. 63
Summary …..……………………………………………………………………. 64
CHAPTER 4
Results ...….…………………………………………………………………… 65
Description of the Sample ……..………………………………………………... 65
Research Question 1 …………………………………………………………….. 68
Research Question 2 …………………………………………………………….. 84
Research Question 3 …………………………………………………………….. 88
Conclusions ….………………………………………………………………….. 91
Summary …..……………………………………………………………………. 92
CHAPTER 5
Discussion of the Findings ..…………………………………………………….. 93
Relationship to Literature ……………………………………………………….. 97
Conceptual Framework …………..……………………………………………... 99
Limitations of the Study ..……………………………………………………….. 104
Strengths of the Study ……..…………………………………………………..... 104
Implications for Nursing …..……………………………………………………. 105
Recommendations for Future Research ………..……………………………….. 107
Summary …..……………………………………………………………………. 108
APPENDICES ………………………………………………………………………. 109
REFERENCES ...…………………………...………………………...……………... 128
BIOGRAPHICAL SKETCH …………..……………………………………………. 134
vi
LIST OF TABLES
4.1 Description of the Study Sample ……………………………….……….…… 66
4.2 Results of the Compassion Satisfaction/Fatigue Self-Test for Helpers ……... 90
vii
LIST OF FIGURES
1.1 Figley’s Compassion Stress and Fatigue Model ……..…….…….…………… 12
5.1 Emergency Department Nurses Compassion Fatigue Lived Experience
Model …………………………. ……………………………………..………. 103
viii
ABSTRACT
The profession of nursing is in the midst of a crisis brought on by a nursing
shortage. Many are choosing to leave the profession of nursing coupled with fewer
numbers choosing nursing as a profession. As a result, nurses are challenged with
increased acuity of patient care in the face of short staffing. Compassion fatigue can
result from these highly stressful situations. Much has been written in the healthcare
literature about the negative effects of compassion fatigue and work-related stress on
healthcare workers. However, the population of Emergency Department nurses has been
virtually ignored.
This inquiry utilized a qualitative approach with a phenomenological design in
order to capture and describe the lived experience of Emergency Department nurses with
compassion fatigue and work-related stress. The study revealed that the work-related
stressors in which Emergency Department nurses encounter are numerous as a result of
the hectic and chaotic environment in which they work. The main work stressors
included the large number and continuous influx of patients, the increased patient acuity,
and the lack of skilled nursing staff. Those nurses included in the study were resourceful
in coping with work-related stressors by relying on support systems, using internal
coping measures, or simply trying to persevere or overcome through firm resolve. When
these nurses were successful in coping with their work stress, they often felt a sense of
accomplishment in terms of the patient care delivered. If the encounters with work stress
were especially negative, many often felt abandoned and exhausted. However, by
witnessing improvements in patient status or by feeling that their care giving efforts were
effective in relieving the pain and suffering of those in their care, these nurses were often
able to overcome their negative feelings caused by the chaotic work environment.
Generally speaking, the encounters with work stress had a negative impact on the
nurses’ ability to provide care. They described feeling angry and displaying uncaring
attitudes toward the patients. However, many described feeling a sense of
ix