Why compassion turns into fatigue: The need for self-care in hospice chaplaincy

Saul Ebema, D.Min.

Hospice Chaplain #2 was a minister who exhibited anxiety and job dissatisfaction on a regular basis. He was often overwhelmed with his complex, patient-care assignments and expressed much sadness about his patients’ social and emotional problems. He was often tearful and verbally acknowledged not wanting to come to work. In addition, he was sensitive to feedback and felt a lack of support from some of the hospice team. He had difficulty sleeping, worried about work on his days off, and talked openly about wanting to leave his work as a hospice chaplain. He was unable to separate his work life from his personal life. The challenges of ministering to the terminally ill were extremely overwhelming for him. This is because he often absorbed the traumatic stress of the patients he was counseling. In the process, he developed compassion fatigue.

The calling to ministry and to counseling the terminally ill is a calling to compassion. Yet our capacity for compassion, along with the intensity of counseling the terminally ill can, at times, leave us vulnerable to compassion fatigue.

Compassion fatigue has been defined as a combination of physical, emotional, and spiritual depletion associated with caring for patients in significant emotional pain and physical distress[1].

Compassion fatigue can be cumulative (from the effects helping many patients) or occur in response to a particularly challenging or traumatic individual case. This extreme state of anxiety and preoccupation with the suffering of the patient becomes traumatizing for the chaplain.

In summary, the hospice chaplain’s work thrives within the context of a caring, empathetic relationship between chaplain and patient. However, this necessary empathetic relationship can also contribute to compassion fatigue if conscious steps are not taken to avoid and/or lessen this condition.

Figley names the following “fifteen warning signs and symptoms for compassion fatigue”[2]:

  • Questioning the meaning of life
  • Loss of purpose.
  • Low morale.
  • Lack of motivation.
  • Feeling estranged from others (Having difficulty sharing or describing feelings with others).
  • Difficulty falling or staying asleep.
  • Having flashbacks connected to the patients.
  • Working too hard for your own good.
  • Loss of satisfaction.
  • Suddenly and involuntarily recalling a frightening experience while working with a client or their family.
  • Being preoccupied with a client or their family.
  • Isolation from others.
  • Losing sleep over a client and their family’s traumatic experiences.
  • Loneliness
  • Feeling trapped by your work as a helper.
  • Feeling a sense of hopelessness associated with working with clients and their families.
  • Feeling weak, tired, and rundown as a result of your work as a helper.
  • Feeling depressed as a result of your work as a helper.
  • Being unsuccessful at separating work from personal life
  • Find it difficult separating your personal life from my work life
  • A sense of worthlessness/disillusionment/resentment associated with your work.

Prevention and Treatment of Compassion Fatigue

Spend plenty of quiet time alone. Learning mindfulness meditation is an excellent way to ground yourself in the moment and keep your thoughts from pulling you in different directions. The ability to reconnect with God will also help you achieve inner balance and can produce an almost miraculous turnaround, even when your world seems its blackest.

Recharge your batteries daily. This can be as simple as committing to eat better and stopping all other activities while eating can have an exponential benefit on both your psyche and your physical body. A regular exercise regimen can reduce stress, help you achieve outer balance and re-energize you for time with family and friends.

It is vital for chaplains to become knowledgeable about compassion fatigue symptoms and intervention strategies and to develop a personal plan of care so as to avoid it and achieve a healthy work-life balance.

Unrecognized and untreated compassion fatigue causes people to leave their profession, fall into the throws of addictions or in extreme cases become self-destructive or commit suicide. It is important that hospice chaplains understand this phenomenon for their own well-being, but also for providing quality counseling to the dying and the bereaved.

Sources

[1] Patti Anewalt, “Fired up or burned out? Understanding the importance of professional boundaries in home health care hospice.” The Journal of Home Healthcare Nurse 29 (2009): 591- 597.

[2] Charles R. Figley, Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized (New York, NY: Brunner-Mazel, 1995), 42.



Categories: Research

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