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Feature Article
Compassion Fatigue in Palliative Care Nursing
A Concept Analysis
Lisa A. Cross, MSN, BA, CRRN, CHPN
The purpose of this review was to define compassion
fatigue in the context of palliative care nursing.
Compassion fatigue was first introduced as a description
for nursing burnout; however, it was not fully described.
An initial concept analysis within nursing placed it in terms
of a psychological model for secondary traumatic stress
disorder, with continual revisions of this application.
Palliative care nurses are routinely exposed to pain, trauma,
and the suffering they witness by nature of ongoing
symptom management and end-of-life care delivery;
however, the focus of care is on healthy end-of-life
management rather than preservation of life. The
literature was reviewed to provide clarification of
compassion fatigue for palliative care nurses to assist in
future identification and direction in the profession.
CINAHL, EBSCO, Journals@Ovid, MEDLINE, PsycINFO,
PubMed, and ScienceDirect databases were queried for
peer-reviewed literature, and dictionaries were examined
for subject-specific definitions. The method that was used
was a concept analysis in the tradition of Walker and
Avant. A concept definition was proposed for the
discipline of palliative care nursing. Identification of
compassion fatigue for this profession helps facilitate the
recognition of symptoms for a group that deals with
patient suffering on a regular basis.
KEY WORDS
compassion fatigue, compassion satisfaction, concept
analysis, hospice, palliative care nursing
urses are challenged with maintaining the balance
between everyday stressors and work stressors.
Palliative care nursing is a demanding nursing
subspecialty, requiring time and continual contact with
N
Lisa A. Cross, MSN, BA, CRRN, CHPN, is doctoral nursing student,
University of Massachusetts, Lowell; and is clinical nursing instructor,
North Shore Community College, Danvers, MA.
Address correspondence to Lisa A. Cross, MSN, BA, CRRN, CHPN, 10
Silas Meriam Way, Middleton, MA 01949 ([email protected]).
The author has no conflicts of interest to disclose.
This is an open-access article distributed under the terms of the Creative
Commons Attribution-Non Commercial-No Derivatives License 4.0
(CCBY-NC-ND), where it is permissible to download and share the work
provided it is properly cited. The work cannot be changed in any way or
used commercially without permission from the journal.
Copyright B 2018 The Author. Published by Wolters Kluwer Health, Inc.
DOI: 10.1097/NJH.0000000000000477
Journal of Hospice & Palliative Nursing
patients and caregivers who are suffering. The prolonged
contact with these individuals during times that they are at
end stages of serious illnesses predisposes palliative care
nurses to physical, emotional, spiritual, and psychological
distress, possibly limiting their ability to provide compassionate care.1 Compassion fatigue has been used to describe
the distress that results from work-related stressors and has
been defined as ‘‘a state of exhaustion and dysfunctionV
biologically, physically, and sociallyVas a result of prolonged
exposure to compassion stress and all that it evokes.’’2
Compassion fatigue in nurses can impact job satisfaction
and patient outcomes and can lead to nurses leaving a profession already plagued by staffing shortages.3-5 Of significance,
compassion fatigue has been seen in diverse nursing settings
and has been associated with stemming from caring, a foundational component to nursing.6 Identification of symptoms
is important for reducing occurrences of compassion fatigue, improving patient care, and retaining nurses.3 Palliative care nurses are predisposed to distress, because they are
surrounded by seriously ill or dying patients on a regular basis.1,7 The focus of this concept analysis is to define compassion fatigue for palliative care nursing to assist in recognition
of occurrences and future implications for this discipline.
BACKGROUND
Compassion fatigue emerged as a concept in health care
by Joinson8 in 1992, when it was introduced as a synonym for burnout. Figley,9 a psychologist, originally introduced the new concept of secondary catastrophic stress
reactions as synonymous with the phenomena of secondary traumatic stress disorder (STSD) and later clarified STSD as compassion fatigue in 1995.2 After years
when compassion fatigue, STSD, and burnout became interchangeable terms, Coetzee and Klopper10 defined compassion fatigue in terms of nursing practice in 2010.
Compassion fatigue is complex, because its consequences affect nurses, organizations, and patients. The
multiple levels of stress that are experienced place nurses
who have symptoms in a state of vulnerability.11 These
nurses may find the duties of their jobs in direct competition with their distress and find difficulties in providing
compassionate care.11,12 This places patients at risk for
circumstances that include low staffing, errors, abuse,
and neglect, as well as poor caring relationships.11 Health
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care organizations face the challenges of retaining nurses
and maintaining safety outcomes by preventing, identifying, and relieving the symptoms of compassion fatigue.11
Palliative nurses care for sick and suffering patients on
a continuum. Palliative care is a type of care that encompasses
the patients and the caregivers through a holistic approach
to manage the symptoms of serious illnesses, while addressing pain, symptoms, psychosocial issues, spirituality, and
quality of life.13 The World Health Organization identifies
palliative care as ‘‘an approach that improves quality of life
of patients and their families facing the problem associated
with life-threatening illness.’’14 Because the focus of care is
comprehensive, palliative nurses bear witness to patient and
caregiver suffering on multiple levels that include physical,
psychological, social, emotional, and spiritual.
Hospice and palliative nursing are frequently used as interchangeable terms, programs, or types of nursing care.
However, hospice care is a type of palliative care where the
care delivery is intensified, because the disease is identified as
terminal or end-stage, with a prognosis of 6 months or less.13
The movement for end-of-life care and bereavement services
began with Dame Cicely Saunders, a registered nurse from the
United Kingdom.15 She saw the need for extended support
during the dying process and opened the first hospice in England in 1967.15 As recognition for services spread, the hospice
philosophy eventually came to the United States, with hospice
also becoming a Medicare benefit during the 1980s.15 In the
United States, the terminology may be confusing, because
the hospice Medicare benefit provides coverage that includes
nursing care, medications, equipment, and psychosocial support for patients who are determined eligible by physicians.15
Hospice and palliative care nurses are focused on delivering quality health care to their patients and caregivers as
they approach the end of life, and it is imperative that they
maintain quality and health in their own lives.16 Palliative
care nurses may experience three stressors unique to this
discipline.17 The first stressor arises from personal factors
from the palliative nurse and includes the nurse’s discomfort with the patient’s illness or treatment plan, inadequate
preparation or training to manage the illness, or external
distractions from outside life. The second stressor is derived
from the patient or caregiver and includes patient health decline or noncompliance with the treatment plan. The third
stressor is related to the work environment and includes practice issues such as poor staffing and resources. These stressors
are distinct to the palliative care discipline and are associated
with the struggles in finding a balance between intimacy and
empathy in the working relationship.7,18 The identification
of predisposing stressors has become critical to providing
future support for palliative care nurses. As palliative care
nurses experience an intense relationship with their patients
and their caregivers, there is a greater risk for compassion
fatigue, placing emphasis on the need to define compassion fatigue for the discipline of palliative care nursing.
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Data Sources
English-language dictionaries and nursing and medical
dictionaries were reviewed for the terms ‘‘compassion fatigue,’’
‘‘compassion,’’ ‘‘fatigue,’’ ‘‘palliative,’’ and ‘‘hospice.’’ Compassion fatigue was a newer term; however, it appeared in
nursing and medical dictionaries as well as in the online
dictionaries reviewed. The databases that were searched
were CINAHL, EBSCO, Journals@Ovid, MEDLINE, PsycINFO,
PubMed, and ScienceDirect for the time frame of 2010 to 2018
and were limited to those items that were in the English
language. ‘‘Compassion fatigue,’’ ‘‘palliative care,’’ and ‘‘hospice’’ were used as search terms or keywords and then
were narrowed down to subject-specific terms to eliminate
nonrelevant data. A second search was conducted with the
search terms ‘‘concept analysis’’ and ‘‘compassion fatigue’’
in the same manner. Abstracts, reviews, and commentaries
were excluded from this search. Studies that involved compassion fatigue outside nursing or helping professions
were excluded. Duplicate results were eliminated.
Seventy-one articles within the identified time frame
were found. Six concept analyses related to compassion
fatigue were found. There were two analyses for other
nursing subspecialties other than palliative care; however,
the search did not yield one for palliative care nursing.
Twenty-eight studies were identified, with four specifically
related to palliative care or hospice nurses and compassion
fatigue. The other disciplines that were studied were oncology
nurses, student nurses, intensive care nurses, critical care
nurses, general nurses, pediatric nurses, military nurses, mental
health nurses, social workers, and genetic counselors.
Two dissertations in palliative care nursing were found.
Three recent literature reviews within the search years were
found, reviewing compassion fatigue across all nursing care.
Articles that were used outside the search parameters were
those by the original developers,2,8,9 as several other articles
referenced preliminary work in the area of compassion
fatigue concept development. Two books were found to
be relevant to the time frame and to the search terms.13,15,16
RESULTS
Concept Selection
This concept analysis was guided by the method of Walker
and Avant.19 The method included eight stages: choose the
concept, outline the purpose, determine uses of the concept, describe its attributes, examine a model case, illustrate any additional situations, identify antecedents and
consequences, and establish empirical indicators.19 The
stages are described hereinafter.
Aim of the Analysis
This analysis will separate compassion fatigue from the
similar terms ‘‘burnout,’’ ‘‘secondary traumatic stress,’’
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Feature Article
and ‘‘vicarious traumatization’’ and define the concept on
its own. The purpose of this concept analysis was to further
define compassion fatigue within the discipline of palliative care nursing to make it relevant for those nursing caregivers who have routine exposure to the suffering of their
patients and their caregivers while providing quality endof-life care. Past research has defined the concept as STSD,
burnout, or vicarious traumatization. However, palliative
care is delivered over a continuum, focusing on compassionate care delivery rather than preservation of life as in
other nursing disciplines.13 This analysis will provide a
separate identity for compassion fatigue and place it within
the context of palliative care nursing.
Use of the Concept
The terms for the concept were identified in and out of the
nursing literature to explore other uses of concept language.19 Palliative is identified as relieving care without
curing or an individual who relieves an uncomfortable condition.20 The word hospice has origins in Latin that means
‘‘guests’’ or ‘‘hosts,’’ and its current use is as a care model or
a location for care.15 Taber’s Cyclopedic Medical Dictionary
defined it slightly differently than other sources; here, it was
described as a program derived from palliative and supportive services, interdisciplinary in nature, that focused on the
‘‘physical, spiritual, social, and economic needs’’ of terminally ill patients and their caregivers.20
Compassion is defined as having pity or the urgent
desire to help or aid someone.21 It is also identified as
a synonym for sympathy.20 Fatigue is defined in different
contexts that include manual work; an exhaustion from
labor, stress, or exertion; or a ‘‘loss of power induced by
a sensory receptor.’’22 It can also be defined in military
terms as a unit or a uniform worn.22 The medical definition of fatigue placed it in the context of a diminished
capacity for work in the mental and physical domains
and also identified acute, alert, chronic, muscle, and volitional fatigue in addition to compassion fatigue.20
Compassion fatigue is medically defined as ‘‘cynicism,
emotional exhaustion, or self-centeredness occurring in
a health care professional previously dedicated to his
or her work and clients.’’20 Compassion fatigue is described
as a form of exhaustion resulting from prolonged exposure
to caring for sick or traumatized patients.23 Compassion
fatigue is also defined as ‘‘fatigue, emotional distress, or
apathy resulting from the constant demands of caring for
others or from constant appeals from charities.’’24 This definition of disinterest is fairly consistent with a 1983 public
policy application by The New York Times25 that described
the United States’ detachment in helping refugees after the
Soviet occupation of Afghanistan.
Almost a decade later, Joinson8 was the first to refer to
compassion fatigue in nursing literature as a type of
burnout, specifically linking it to caring professions such
Journal of Hospice & Palliative Nursing
as nursing, ministry, and counseling. Nurses were identified as prone to the phenomena because of the nature
of their work. Later work by Figley2 portrayed compassion
fatigue as a state of exhaustion and biological, psychological, and social dysfunction that resulted from prolonged
exposure to compassion stress. Burnout was identified
as a process that existed simultaneously with compassion fatigue or its synonymous concept, STSD, that developed gradually as physical, emotional, behavioral,
professional, and interpersonal symptoms progressively
worsened.2 Although Figley2 applied compassion fatigue
and STSD to nurses, he used the same concepts and definitions for psychotherapists and other disciplines. He
continues to develop his work with STSD in formulating
a theory with resilience, stress, and trauma victims.26
Coetzee and Klopper’s10 development of a compassion
fatigue concept analysis in 2010 was heavily influenced by
Figley’s work with STSD. This was the first concept analysis
in relation to nursing care, and despite numerous nursing
articles and nursing studies examining compassion fatigue,
several years had passed before this analysis clarified what
was a relatively new concept during that time.10 Their concept analysis indicated that compassion fatigue resulted
from a cumulative process where compassion discomfort
led to compassion stress and, if not managed, led to compassion fatigue through prolonged and intense contact
with patients, exposure to stress, and self-involvement in
care.10 The authors differentiated the concept of compassion fatigue as separate from STSD, with compassion fatigue resulting specifically from exposure to direct care of
patients and STSD resulting from exposure to traumatic
events or stories of traumatic events of others.10 However,
the definition that was used was slightly different from that
proposed in a previous work by Figley2 in that it did not
identify distress in the psychological domain. Psychological responses could be a causative or resulting factor associated with stress and are important elements for compassion
fatigue concept definition.6,17
Sorenson et al27 provided an updated concept analysis
of compassion fatigue using Rodgers’ evolutionary model
to guide the analysis in relation to nursing care. The definition was identified as interchangeable with STSD and indicated that compassion fatigue was the emotional cost of
caring related to caring for those suffering individuals
and, as a result, emotional, physical, and spiritual exhaustion occurred.27 Effects in the social and professional domains
were not addressed in this definition. This analysis also identified a similar concept, vicarious traumatization, or results
from caring for those with STSD.27
Defining Attributes
Walker and Avant19 indicated that attributes were those
characteristics that were frequently associated with the concept. Compassion fatigue develops over time. There are five
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domains identified as elements of compassion fatigue
upon pertinent literature review: emotional and psychological, intellectual and professional, physical, social, and
spiritual. These are listed in the Table and will be reviewed
in this section.
Empathy Imbalance
Palliative care nurses are involved in the end-of-life process
for all of their patients. Some have indicated that they ‘‘compartmentalize’’ their feelings from their everyday life to avoid
feeling the stress of multiple deaths.28 However, as they separate their feelings, these feelings can become inappropriate, leading to excessive empathy. Empathy is present
when nurses are actively aware of feeling or experiencing
the concerns of patients without having the thoughts or feelings described or communicated to them.29 Excessive empathy can create role confusion or blurred boundaries, just as
not enough empathy can create a poor connection between
the nurse and the patient. When nurses dwell on their feelings and roles, other emotions such as self-doubt set in and
they become overwhelmed. Anxiety, depression, and irritation with patients can result from this process.
Diminished Performance
The nurse experiencing compassion fatigue has difficulty
concentrating on his/her job. There is diminished performance as compared with the previous level of ability. As
this becomes out of control, it may be evidenced by behavior that is out of character for the nurse such as disorderly
appearance, making mistakes, or calling out.
Increased Complaints
Palliative care nurses often neglect their own physical needs
as they attend to the needs of their chronically suffering patients.28 This poor self-care manifests as exhaustion, lack of
sleep, increased physical complaints, and poor endurance.
Nurses have described physical exhaustion as being
‘‘sucked in’’ or ‘‘wrung out.’’11 Physical symptoms vary from
each person but may include headaches, gastrointestinal
symptoms, chest pain, and malaise.27
Inability to Share in Suffering
The palliative care nurse with compassion fatigue experiences greater difficulty enjoying outside life as exposure
to stress and suffering at work combined with the energy
expenditure to maintain productivity makes it difficult to
maintain personal relationships. Family members or
loved ones may have unrealistic expectations, finding it
difficult to identify with the nurse’s feelings of suffering
or inability to share or acknowledge pain or feelings.11
This contributes to the nurse’s difficulties in working
through his/her feelings and further exacerbates feelings
of anxiety and self-doubt.
Poor Judgment
A normal function of the palliative care nurse is to provide
spiritual assistance to his/her patient and caregiver.15 However, the nurse feeling the pressures of compassion fatigue
has a spiritual disconnect and lacks the ability to provide
judgment on a spiritual level.10 This also makes it difficult
to perform normal duties.
TABLE Compassion Fatigue in Palliative Care Nursing
Antecedentsa
Consequencesb
Attributesc
Empirical Referentsd
Ability to experience
compassion and empathy
Loss of ability to feel
compassion and empathy
Emotional/psychological:
empathy imbalance
Emotional/psychological:
irritation, depression, anxiety,
and self-doubt
Exposure to suffering
Burnout
Intellectual/professional:
diminished performance
Intellectual/professional: poor
performance, calling out,
mistakes, and inability to
concentrate
Repeated exposure to stressors Breakdown
Physical: increased complaints Physical: headache, nausea,
chest pain, exhaustion,
sleep loss, malaise, and
poor endurance
Disinterest
Social: inability to share in
suffering
Social: difficulty in maintaining
interpersonal relationships
Moral distress
Spiritual: poor judgment
Spiritual: inability to provide
judgment, lacks awareness
a
The events that exist before the compassion fatigue.19
The outcomes of the compassion fatigue.19
c
Those characteristics that were frequently associated with the compassion fatigue.19
d
The real-world instances that help determine the existence of the compassion fatigue.19
b
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Volume 21 & Number 1 & February 2019
Feature Article
Cases
Model Case
A model case is a use of the concept as a pure example.19
The following is a model case with the defining attributes
identified.
M.D. is a 27-year-old man who has been a home palliative and hospice nurse for 3 years. He loved his job and the
connection he had with his patients, being able to identify
with them on a personal level. Having lost his sister during
his teens to a congenital heart defect, he always wanted to
be a hospice nurse. He has recently experienced an increase in his caseload due to covering another nurse’s maternity leave. Not long ago, his wife had their second child.
He has found himself becoming anxious about the number
of death pronouncements he has had recently, having experienced incredible loss in a short amount of time, and has
been afraid to get close to his new patients. He has not
been sleeping and has been arguing with his wife about
child care. The other day, he drew up the wrong amount
of morphine for a patient, and the week before, he went to
the wrong house on the wrong day. It was okay, as neither
patient really noticed, so he did not mention it to his supervisor, J.S. He stopped going to the bereavement groups after interdisciplinary team meetings to save time to schedule
his nursing visits. He is frustrated and is starting to resent
the drive to work and to the homes of the patients who live
in the area that he is covering. ‘‘Why do I have to go to
those towns, anyway?’’, he wonders. ‘‘They aren’t even
my patients.’’
Borderline Case
A borderline case is one that has most of the defining
characteristics of the concept, but not all of them.19 The following case is of STSD. Secondary traumatic stress disorder
is a situation that develops when the caregiver experiences
stress from providing support to a traumatized individual
and usually occurs when the caregiver imagines himself/
herself as integral to the individual’s support system.27 It
is similar to compassion fatigue, but it occurs from caring
for patients who have experienced trauma and is usually
observed in different settings.
T.F. is a 38-year-old critical care nurse who has been
practicing for 13 years. For the past week, she has been caring for two young boys who were brought in as shooting
victims of a homicide-suicide committed by their father
with their mother as the homicide victim. Before their
mother was killed, they were held hostage in their apartment with her for 3 hours before being rescued. Their father killed himself before law enforcement came in. Social
service members have been in to see the boys on the unit.
T.F. has become very protective of them and has trouble
leaving her shift in the evening. She has been calling on
her off-hours to check on their progress and is concerned
Journal of Hospice & Palliative Nursing
about what will happen to them when they are ready to
discharge. She has found herself unable to stop thinking
about the shock on their young faces when they were
brought in and has been crying at night. She is starting to
have difficulty sleeping and does not want to go to work
but is worried if she does not go in, ‘‘Who will take care
of the boys?’’
Related Case
A related case is a scenario that is close to the concept but
does not have all of the defining attributes.19 The following
related case is that of vicarious traumatization. Vicarious
traumatization is similar to compassion fatigue, but it is
the stress that results from caring for traumatized patients
who are experiencing STSD.27 It can occur from hearing
about the trauma that patients have experienced and
empathizing with those experiences and usually occurs
in settings different than palliative care.
R.T. is a 58-year-old woman working on an inpatient
rehabilitation floor treating military veterans with complex injuries. She has been at her nursing job for 6 years
and initially enjoyed coming to work because of the longerterm relationships she established with her patients. She recently has been caring for a young man of similar age to her
son, and she has developed a special bond with him. She
began to spend longer time on the unit to stay and talk to
him about his injuries, and gave him her number so that he
could call her when he had bad thoughts. She has become
so preoccupied with caring for him and thinking about his
war experiences that she has been having nightmares and
making mistakes at work. She cannot reach out to her
husband and son, who do not understand her work, and
she has been thinking about talking to another colleague
to discuss these frustrations.
Contrary Case
A contrary case demonstrates the opposite of the model
case.19 The opposite of compassion fatigue is compassion satisfaction. Compassion satisfaction was presented
in a concept analysis by Sacco and Copel,29 where it was
defined as occurring when empathy drives altruism and
results in alleviation of suffering, which further results in
a positive work experience for the nurse. The following
is based on this concept.
J.D. is a 34-year-old nurse with 8 years of experience
in an inpatient hospice unit. She has always wanted to be
a hospice nurse, finding joy in her connection with patients and families. Although she is sad at losing patients,
she finds support through colleagues and through formal
and informal meetings with the interdisciplinary team.
She leads the unit bereavement group and is a mentor to
new nurses at the unit, helping them cope with their stress
management skills. During her recreation time from work,
she enjoys being part of a book club, cooking, volunteering
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at her children’s school, hiking, and vacationing with her
family. When her friends and acquaintances ask, ‘‘Why hospice nursing?’’, she tells them that she likes what she does
and finds it satisfying, still looking forward to her work.
Antecedents and Consequences
Antecedents are events that exist before the concept development.19 Antecedents for compassion fatigue are the
ability to experience compassion and empathy, exposure
to suffering, and repeated exposure to stressors. To lose
something, one must first have it. The ability to feel empathy and compassion is a requisite to compassion fatigue. If
the nurse does not have the ability to feel these two emotions, there will not be a loss. The nurse who is continually
exposed to stress will react with a change in ability to empathize.27 With exposure to suffering combined with the
stress and empathy for the patient, the nurse does not have
the ability to focus on himself/herself, creating a risk for
compassion fatigue.
Consequences are the outcomes of the concept.19 The
consequences of compassion fatigue are the loss of ability
to feel compassion and empathy, burnout, breakdown, disinterest, and moral distress. The loss of the ability to feel
compassion and empathy results from prolonged exposure to the stressors and suffering. One of the most important roles of the palliative care nurse is that of care facilitator
as well as case manager of the interdisciplinary team.13
When the nurse is disinterested and no longer able to be
concerned, he/she is no longer able to care, which is the
basic function of nursing.6 Moral distress occurs when
the palliative care nurse conducts himself/herself in ways
that contradict his/her personal values and beliefs.30 This is
a result of not performing professional nursing duties as to
normal capabilities, including disinterest or poor performance. The nurse no longer has control over the situation,
and burnout can occur. This has been described as similar
to compassion fatigue; however, burnout has been identified as occurring over a longer period.12 It can occur from
similar stressors as compassion fatigue, and it can emerge
before compassion fatigue symptoms and may also be a
contributing stressor. Emotional and physical breakdown
is a consequence of compassion fatigue occurring when
other consequences exist unattended by the palliative care
nurse’s loved ones, peers, or managers.10
Empirical Referents
Empirical referents are the real-world instances that help
determine the existence of the concept.19 It is important
that managers and coworkers recognize these situations
for the safety of the palliative care nurse and the patients
under care.
Examples for the emotional and psychological realm
include outward irritation, verbalizations that indicate lack
of empathy or excessive empathy, indications that the
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nurse is having doubt of ability, or anxiety regarding work.
Callouts due to illness, visualization or verbalization of exhaustion by the nurse, poor endurance, poor hygiene or
professional appearance, and frequent mistakes in paperwork, medication administration, or skills are examples for
the professional or intellectual domain.
Physical complaints of nausea, chest pain, headache, poor
sleeping habits, and overall exhaustion may be signs of
compassion fatigue. The nurse who closes himself/herself
off from coworkers and family, refuses to assist others, or is
having relationship issues may be demonstrating signs of
compassion fatigue. The palliative care nurse who previously was willing to participate spiritually and now is
unable to focus or demonstrate judgment or clarity in this
realm may be at risk for compassion fatigue.
Proposed Definition of Compassion Fatigue
The proposed definition of compassion fatigue in the context of palliative care nursing is the result of compassion
and empathy in the palliative care provider with chronic
professional exposure to suffering and repeated exposure
to stressors. It is the state where compassion and empathy
are lost, demonstrated by emotional and psychological,
intellectual and professional, physical, social, and spiritual
characteristics that, if left unattended, result in disinterest,
moral distress, burnout, and breakdown.
DISCUSSION
Strengths
This analysis separates compassion fatigue from its similar
concepts of vicarious traumatization, STSD, and burnout,
providing a definition for palliative care nursing. Compassion fatigue has not been defined in the context of palliative
care nursing in previous literature. Palliative care nurses are
routinely exposed to suffering and death of the patient
population they care for, and the caring leads to compassion fatigue.1
Limitations
One limitation of the data search was its restriction to the
English language. Compassion fatigue is a concept that has
not been limited to English-speaking countries, so there
may have been relevant data excluded.11,31,32 Another limitation is that, by not exploring dictionaries outside the traditional, medical, or nursing dictionaries, ideas may have
been excluded through definitions that could have impacted
this concept. Sources were obtained primarily from helping
profession databases, including nursing, medicine, social
work, and psychology, and the literature search was refined
based on the search terms. However, using these databases and not expanding the initial search may have been
a limitation.
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Implications for Nursing
Future implications include recognition of compassion
fatigue with the goal of promoting strategies for compassion satisfaction. The concept analysis of compassion satisfaction by Sacco and Copel29 identified three antecedents
similar to this model: empathy connection, negative impact
of exposure to suffering, and influence of stressors in t
