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    Burnout and Compassion Fatigue Literature Review

    Barbara J. Henry

    Northern Kentucky University

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    Burnout and compassion fatigue are conditions that occur in many professionals,

    particularly nurses working in high trauma specialties such as oncology. The purpose of this

    paper is to review the literature and briefly describe the conceptual framework for burnout and

    compassion fatigue in oncology nurses. The literature search was conducted using CINAHL,

    MEDLINE, and PSYCHInfo databases along with articles obtained from Really Simple

    Syndication (RSS) feeds and hand selection using the search terms of burnout. compassion

    fatigue, burnout and compassion fatigue in nurses, and burnout and compassion fatigue in

    oncology. Findings were grounded in the literature from nursing, medicine, psychology, social

    work, and palliative care professions. The literature review was limited to the past 10 years

    except for older original works on burnout and compassion fatigue. Articles on related topics

    were also reviewed. Articles selected for the literature review are directly urelated to the

    research question: how does a therapeutic retreat effect burnout and compassion fatigue in

    oncology nurses?

    Background and Conceptual Framework

    In Boyles review of literature, antecedents to burnout and compassion fatigue included

    the following: 1.) exposure to traumatic care of cancer patients, 2.) vulnerable individual

    personality traits and lack of coping skills, or 3.) lateral violence from others (2011). Bush, like

    Boyle, is a nursing author who has written extensively on burnout and compassion fatigue in

    oncology nurses. Bush noted that burnout and compassion fatigue occur when emotional

    boundaries are blurred and the nurse absorbs distress, anxiety, fears, and trauma of the patient, (a

    concept called countertransference in psychiatry), (2009). Collins & Long reported a

    consequence of compassion fatigue and burnout is unresolved emotional pain that caregivers

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    store away (2003 p 18). Difficulty balancing work and life outside work may be an

    antecedent to or consequence of burnout and compassion fatigue as well.

    Many articles define and describe the concepts of burnout and compassion fatigue. The

    concept of burnout was first conceptualized by Christina Maslach who developed the Maslach

    Burnout Inventory (MBI) tool to measure burnout in healthcare and other professional workers

    (Maslach,& Schaufeli, 1993). Compassion fatigue was first introduced by Joinson in 1992

    during an investigation of burnout in emergency nurses. Joinson never formally defined

    compassion fatigue and in 1995, it was adopted by psychologist Charles Figley as a term for

    secondary traumatic stress disorder (Figley, 1995).

    Pilkington suggested a conceptualization of burnout and compassion fatigue from the

    perspective of the Neuman systems model (2008). Jean Watsons seven assumptions of nurse

    caring provide the theoretical underpinnings of potential for burnout and compassion fatigue

    (Current Nursing, 2012).

    Burnout, compassion fatigue, and related concepts have been topics of interest in nursing

    literature, particularly in the past five years (Knobloch Coutzee & Klopper, 2005). The concept

    of lateral violence has emerged in the literature as both an antecedent and consequence of

    burnout and compassion fatigue (Sheridan-Leos, 2008).

    Description and Critique of Scholarly Literature

    There are very few randomized clinically controlled trials (RCTs) examining burnout and

    compassion fatigue in oncology nurses or healthcare professionals. Most articles are reviews of

    RCTs, review of literature, and qualitative studies.

    A 2010 study utilized a two arm randomized controlled mixed methods trial using 65

    medical personnel with direct patient contact as participants (Brooks, Bradt, Eyre, Hunt, &

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    Dileo, 2010). Results showed no statistically significant difference in change scores between the

    control and experimental groups for self-reported burnout, sense of coherence, and job

    satisfaction (Brooks, et al., 2010). Qualitative findings indicated that music imagery and creative

    mandala drawings helped participants relax, rejuvenate, and refocus enabling them to complete

    their shifts with renewed energy (Brooks, et al., 2010). A limitation of this study was the sample

    size and that shortly after the study began a major restructuring at one of the hospitals resulted in

    layoffs, increased shifts, and fear of termination for open admission of feeling burned-out during

    the process, and many planned music-imagery sessions were cancelled affecting study findings

    (Brooks, et al., 2010).

    16 participants in a brief mindfulness intervention for nurses and nurse aids experienced

    significant improvements in burnout symptoms, relaxation, and life satisfaction compared to 15

    wait list control participants (Mackenzie, Poulin, & Seidman-Carlson, 2006). Each week,

    participants from large urban geriatric teaching hospital attended one of 6 sessions held during

    the day and evening shifts and received a CD of guided mindfulness exercises, which they were

    instructed to practice for at least 10 minutes per day 5 days per week along with a manual

    summarizing key points from the sessions and homework assignments (Mackenzie, et al., 2006).

    Mackenzie and colleagues utilized the MBI, Smith Relaxation Dispositions Inventory, and

    Intrinsic Job Satisfaction subscale from the Job Satisfaction Scale, Satisfaction with Life scale,

    and 13 item version of the Orientation to Life Questionnaire to measure quantitative data (2006).

    An obvious limitation of this study was the sample size, but results of the study support the

    feasibility and potential effectiveness of brief mindfulness training in reducing burnout and

    improving morale in nurses (Mackenzie, et al, 2006.)

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    Marine, Ruotsalainen, Serra, & Verbeek conducted a review of RCTs on interventions

    aimed at prevention of psychological stress and burnout in healthcare workers (2009). Authors

    presented a meta-analysis and qualitative synthesis of 14 RCTs, 3 cluster randomized trials, and

    2 crossover trials with a total of 1,564 participants in intervention groups and 1,248 participants

    in control groups (Marine, et al., 2009). The main limitation of these studies were that only two

    of the trials were of high quality. Interventions were grouped into person-directed and work-

    directed. One trial showed stress remained low a month after the intervention, another showed a

    reduction in emotional exhaustion and in lack of personal accomplishment maintained up to two

    years post-intervention with refresher sessions (Marine, et al., 2009). Two studies showed a

    reduction in anxiety maintained up to a month post-intervention (Marine, et al., 2009). The

    authors recommended larger and better quality trials and concluded that person-directed

    interventions including cognitive behavioral approaches like coping skills training combined

    with relaxation techniques can be effective in reducing burnout in healthcare workers compared

    to no intervention (Marine, et al., 2009).

    Najjar and colleagues reviewed 57 studies with healthcare workers and found a variety of

    terminology used to describe burnout and compassion fatigue (Najjar, Davis, Beck-Coon, &

    Carney Doebbling, 2009). The authors described 14 studies on compassion fatigue with various

    healthcare professionals, the largest sample being 336 county child protection staff and one

    clinical trial examining the treatment effectiveness of the Certified Compassion Fatigue

    Specialists Training (CCFST) for mental health professionals (Najjar, et al., 2009). The authors

    acknowledged that conceptual and methodological research on the problem is lacking, and

    summarized personal, professional, and organizational strategies to manage and treat compassion

    fatigue (Najjar, et al., 2009).

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    In a study on nurse practice environments and patient outcomes, Friese (2005) used a

    large sample of 1956 registered nurses including 305 oncology nurses. The study was a

    secondary analysis of survey data collected in 1998 using statistical analysis instruments

    including logistic regression (Friese, 2005). Though the data was old, a limitation of the study,

    the author found that oncology nurses had superior patient outcomes compared to non-oncology

    nurses and that emotional exhaustion was significantly lower for nurses working in magnet

    hospitals compared to those working in non-magnet hospitals (Friese, 2005). Frieses key points

    were that nurse concern with practice environments was reflected by their job dissatisfaction,

    burnout, and perceived quality of care, and to improve outcomes, practice environments should

    be assessed routinely t


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