Compassion for the Compassionate

Importance of Compassion in Health-Care

The word “compassion” is derived from the Latin words “pati” and “cum,” which together mean “to suffer with.”[16, 27] While synonymous with sympathy, empathy, and concern, compassion goes one step further and involves not only a feeling we have towards another in a state of pain, anguish, or misfortune, but also includes an additional desire to act in order to alleviate this distress. When it comes to health care and compassion, it could be said that the two are different words describing the same act, and for those working in a medical care role, the importance of compassionate treatment comes as no surprise. The very act of caring for one in need necessitates compassion, and it has been suggested that those working in health care who utilize and express this important action are the most effective in their work.[27] Compassionate treatment is a benchmark for quality medical care, empathized in patient rights and best-practice guidelines, and for good reason, as compassionate treatment improves the health outcomes of those at its receiving end.[8, 26, 27] Research has shown that patientcentred, compassion-based care in primary-care visits are associated with better recovery from discomfort and concern, and foster better emotional health.[26] Ask any patient or their family member, and they will consistently identify compassionate caring that is person-centred, responsive, and communicative, as indicative of quality medical care that helps to strengthen and comfort the patient in need.[18, 26]

The Medical Professional and Compassion Fatigue

The importance of compassion in health care is without a doubt imperative to the health of those seeking its services, but what of those who are providing this care? For all those working in clinics, hospitals, mental health facilities, EMS, social work, and other corners of health care, including naturopathic medicine, the need to regularly provide compassionate care can prove to be at times debilitating. Routinization, an increase in exposure to traumatic events, target-driven medical care, and even exposure to the mundane can decrease the expression of compassion, diminishing the effectiveness of this important health-care tool.[26]

Compassion fatigue (CF) refers to a syndrome seen in individuals who deal with traumatic or sensitive events, such as those working in health care, that can negatively influence the professional’s mental and physical health, safety, and wellbeing, as well as the health and wellbeing of their families and the people they care for.[9, 25] Considered an occupational hazard, those working in health-care are at an increased risk of developing CF, and it has been suggested that the more empathetic a health-care provider is, the more likely he or she will experience CF.[9, 25, 28] Studies have shown that the prevalence of CF can be as high as 40% among those working in certain medical fields,[31] and similar findings have been found among other helping professionals such as child-protection workers, law enforcement, and counselors.[1, 6, 14] Those employed as psychiatrists and social workers have been shown to have the highest levels of CF, with significant increases in this parameter detected for each extra year spent working in these fields.[28]

The symptoms associated with CF are many and commonly include intrusive thoughts, sleeping problems, exhaustion, anger and irritability, negative coping behaviours including alcohol and drug abuse, reduced ability to feel sympathy and empathy, a diminished sense of enjoyment or satisfaction with work, as well as increased absenteeism.[9, 25] Perhaps of most concern, however, is the effect that CF has on the health outcomes of those under the care of CF sufferers, as this syndrome is associated with less effective delivery of care.[27] Research has shown that CF and stress can impair the practitioner’s ability to make decisions and care for patients as well as reduce attention and concentration.[9, 15, 27] Burnout, a component of CF, has also been associated with decreased patient satisfaction, suboptimal patient care, and longer recovery times.[24, 27, 30] Thus, combating the pervasive nature of CF is of utmost importance not only for the practitioner in question, but also for those in the susceptible patient role.

Self-Compassion as Treatment for Compassion Fatigue

Addressing CF in the health-care professional is essential and while there are different methods of tackling this syndrome—including work initiatives, identification strategies, training and education, social support, and self-awareness—one treatment gaining recognition may be as simple as taking your own medicine.[29] Self-compassion (SC)— described as including the three attributes of kindness, a sense of common humanity, and mindfulness—is an effective mindset that can protect the health-care professional from the development of this syndrome.[4] Dr. Kristen Neff, PhD, at the forefront of research regarding the influence of SC, describes this inward treatment of the self as “really no different than having compassion for others and entails being warm and understanding toward ourselves when we suffer, fail, or feel inadequate, rather than ignoring our pain or flagellating ourselves with self-criticism. Self-compassionate people recognize that being imperfect, failing, and experiencing life difficulties is inevitable, so they tend to be gentle with themselves when confronted with painful experiences rather than getting angry when life falls short of set ideals.”[23]

When we look to the research regarding the protective effects of SC, we see the influence that this important behaviour has. A study looking at the influence of SC surveyed student midwives on their professional quality of life, self-compassion, mental wellbeing, as well as compassion for others, and found that those students who engaged in more negative self-judgement were less compassionate towards both themselves and others and had reduced wellbeing, as well as reported greater burnout and CF.[3] Alternatively, student midwives who reported high on measures of self-compassion and wellbeing reported less CF and burnout.[3] This research demonstrates that having compassion and kindness for the self can infer protection against CF.

According to Neff, the reasoning behind SC’s ability to protect against CF is due to the fact that SC builds resiliency against depression and anxiety, while increasing life satisfaction, optimism, social connectedness, and happiness—something we all could probably use a little more of in our lives.[20] This resiliency, in turn, allows for moderation of the health-care worker’s reactions to negative events.[20] Research conducted by Tate et al (2007) found that individuals who were higher in self-compassion demonstrated less extreme reactions and less negative emotions, had more accepting thoughts, and had a greater tendency to put their problems into perspective while at the same time acknowledging their own responsibility.[13] Furthermore, self-compassionate people are less likely to ruminate on or suppress negative thoughts and emotions.[21] In addition, self-compassion is directly associated with psychological strengths such as happiness, optimism, wisdom, personal initiative, and emotional intelligence.[2, 11, 12] In other words, self-compassion may be the scaffolding on which to support the health-care practitioner that better prepares them to effectively carry out their role in this demanding field.

Going beyond simple kindness for the self into more practical applications of SC, research suggests that mindfulness interventions, particularly those with an added lovingkindness component, have the potential to increase SC among health-care workers.[27] Neff and her colleagues, based on their research, have developed an effective program to teach SC, known as Mindful Self-Compassion, which emphasizes a number of different meditations (loving kindness, affectionate breathing) and informal practices for use in daily life (e.g. soothing touch, self-compassionate letter writing).[2] The hope is that enhancing a focus on developing self-compassion using these interventions for health-care workers will hold promise for reducing stress and increasing clinical-care effectiveness.[27]

Conclusion

Compassion is of necessity in health-care. Those who receive care that is delivered with humanity and empathy have improved outcomes and greater satisfaction with their care, a standard any health team hopes to achieve. Delivering this care, however, is sometimes easier said than done, as those on the front lines of health care are at risk of developing CF due to the demanding and sensitive nature of their important roles. While the issue is multifactorial, research shows that he development of SC may be vital in the prevention of CF as well as in the promotion of compassionate care, and “meeting one’s own needs for relief, empathetic understanding, and support is an important prerequisite for continuing to serve as an attachment figure for needy others.”[10] Whether treating other health-care providers, or acknowledging the development of CF in the self, SC, as well as mindfulness mediations aimed at building kindness for the self, are excellent recommendations for the medical provider to help the afflicted establish better coping ability in the integral role they play in others lives.

“We are taught in medicine to be brave and to be strong, but there should also be a time and place for emotional expression, and perhaps even for crying. Doctors, nurses and other members of the health-care team must be steady sources of support for the patient. But when the patient encounter is over, at the end of the day, the doctor or nurse or social worker or clerk needs to be able to process everything they have seen and experienced. We need to support people who work with the sickest of the sick” and that support may just need to begin with the self.[7]