Compassion In EMS, Fighting Fatigue Or Seeking Satisfaction?
Can we cut a little compassion fatigue and burnout by seeking compassion satisfaction instead?
Two of the most widely accepted consequences in the emergency medical services arena are compassion fatigue and burnout, with causes just as diverse as their negative effects. Definitions of each may be complicated and conflicting, best left to qualified psychology professionals, but from a care provider’s point of view, narrowing down the basics can lead to some obvious and positive conclusions.
There are well-known repercussions to compassion fatigue and burnout, such as high staff turnover, decline in mental health and negative attitudes towards patients. In addition, the risk of poor communication and misjudgement leading to clinical errors, safety issues and professional compromise increases.
Maslach’s theory explains the progression through a series of steps, starting with the emotional burnout that erodes our initial bank of resources. In an attempt to alleviate its effects, we begin to distance ourselves from patients and colleagues by depersonalising thoughts and interactions. By doing so, we then reduce feelings of personal accomplishment, any sense of achievement and ultimately, self-esteem. Before we know it, physical, emotional and mental exhaustion sets in.
Compassion fatigue, arising from repetitive and extended contact time with patients, compounds to replace a natural ability to nurture, with newfound cynicism and apathy. Negative emotional, cognitive, physical, professional and social consequences will also lead us to experience exhaustion, anger, frustration, depression, sadness and feelings of inadequacy.
By the time we add reduced empathy levels, increased judgmental responses and less overall joy in life to the mix, it becomes clear to see that a negative spiral can occur, either gradually or suddenly, with every aspect further impacting on each other. In today’s climate of prehospital pressure, these are understandable negative reactions to excessive demand.
So why would we want to do this to ourselves?
Paramedics and first responders are drawn to their roles for various reasons. For some, it may be a desire for excitement and personal challenge. But that desire may be infrequently fulfilled when the reality of repetition kicks in.
Many are highly perceptive to the needs of others and gain satisfaction through helping people and feeling needed or appreciated. Any ongoing lack of appreciation or inability to make a positive difference may then fail to satisfy at all.
With common natural traits such as flexibility, resilience, strong-mindedness, motivation, detail orientation, decision making capability, action focus and high stress tolerance, paramedics are ideally suited to the prehospital environment. We also get to develop personal and professional attributes through emotionally demanding work and stressful situations that strengthen us over time. Unfortunately, our downfall may also stem from these characteristics.
The ability to keep pain, hurt, frustration, pressure and stress to ourselves is just as common and, culturally, a lack of discussion around feelings or open reflection on life and work challenges looms large.
Add to this an accumulation of high workload, mundane tasks, infrequent use of hard-earned skills and education, long travel times, extended ramping in confined spaces and being relatively isolated with the same colleague over weeks, months or years. Patient and bystander behaviours such as hostility, aggression, frequent callers, regular attendance to challenging mental health and social crises. Unavoidable overtime, varied or lack of meal breaks, key performance indicator pressures, organisational frustration, disturbed sleep cycles, work/life imbalance and limited family contact over several shifts or rotations.
Not to mention repeat exposure to trauma, neglect and poverty. Feelings that the world is not a good place, and shame or guilt at not being able to make things better. So how can we avoid what may seem like a slippery slope downwards?
A major key lies in compassion satisfaction. Rarely discussed, less widely revered but just as valid as its counterparts, there exists a more positive feature of long-term patient contact.
It encourages strengthened self-esteem from feeling useful, increased growth in personal development through connecting with others and a notion of bettering society by making a difference. A sense of achievement, success and value can be attained by creating stronger patient rapport and more rewarding interactions. Precepting, mentoring, training and leadership may feel more worthwhile when shaping a culture that seeks out compassion satisfaction into the future.
The benefits derived from helping others and directly contributing in this way are not only useful in the moment, they are cited as a valid way of combating compassion fatigue and burnout. Along with conscientiousness as a personality trait, for its well-known moderating factors.
Rather than trying to avoid what may feel like the inevitable adverse effects of EMS, there are steps that we can take to shift the focus more towards seeking out satisfaction instead.
Download and complete the ProQOL Professional Quality Of Life tool and use this as a benchmark moving forward.
Schedule some time for compassion satisfaction reflective practice in upcoming CPD hours.
Start the conversation with a trusted circle of peers to focus on it together and form a support system.
Find out which positive and proactive resources exist in the workplace and consider offering constructive suggestions if options seem limited.
Come up with education and training goals that help to create feelings of success and satisfaction regularly, rather than focusing heavily on areas rarely used.
Create a satisfaction journal in an app or diary then add those “feel good” moments every time they occur, no matter how small.
Ask loved ones to look out for signs of impending burnout or fatigue and explain that satisfaction is the new goal.
Engage psychological support in maintaining proactive behaviours now, rather than having to implement it as a reactive measure later.
In most cases, we pride ourselves on enhancing skills and knowledge, so that we feel successful and satisfied. The only way to increase how often we get to experience that satisfaction is to seek it out more often. Priding ourselves on the benefits we can bring and how much of a difference we can make only serves to enhance satisfaction overall.
Whichever approach we choose, the balance will always tip one way or the other. High levels of compassion fatigue and burnout make high levels of satisfaction impossible. In the same way, growing compassion satisfaction will likely soothe away some of that burnout and make work a better place to be.
If the personality traits of paramedics trend towards enthusiastic, problem-solving, solution-seeking, resilient people with a desire to help others, let’s put them to good use. Rather than settling for and suffering the cost of caring for others in emotional and physical distress, we can use those motivating characteristics to actively seek out compassion satisfaction for ourselves.
Thanks for reading or listening.
Tammie
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First Published
Australian Emergency Services Magazine Vol 21 (5) 2020
References
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From Hõ Huy Hoàng at Pixabay
