DNA Reporter - November 2018

November, December 2018, January 2019 DNA Reporter • Page 9
Self-Care While Providing Spiritual Care to Patients!
Avoiding Compassion Fatigue: Put Your Oxygen Mask on First!
Maryellen Sparks MSN, APRN, CBN
See Guest Editor for complete bio on page 1
Health Care Chaplaincy Network (HCCN) and the
Spiritual Care Association (SCA) published a White
Paper in 2017 titled Spiritual Care and Nursing: A
Nurses Contribution and Practice which acknowledged
in great detail “The close ties between spiritual
motivations and the nursing field which have been
demonstrated thought the history of nursing” (Hughes
et al., 2017, p.3). Hughes et al. (2017) addressed
the issue of compassion fatigue affecting nurses
constantly providing spiritual care and the positive
impact that creating constructive coping strategies
for self-care would have mitigating their distress.
Compassion fatigue (CF) was coined in the early
1990’s and has been defined as “a state of physical or
psychological distress in caregivers, which occurs as
a consequence of an ongoing and snowballing process
in a demanding relationship with needy individuals”
(Van Mol, Kompanje, Benoit, Bakker, & Nijkamp, 2015,
p. 3). Van Mol et al. (2015) further explained that there
are two parts to compassion fatigue:
The first part contains issues such as
exhaustion, frustration, and depression, typical
associated with Burnout (BO). The second
part is the negative feeling driven by concerns
such as hyper-vigilance, avoidance, fear and
intrusion, which are also characteristics of
secondary post-traumatic stress (S/PTS). (p. 3)
Compassion fatigue is pervasive and
unpredictable in healthcare providers especially
nurses. At greatest risk are nurses that routinely
form intimate caring, compassionate relationships
above and beyond the call of duty with patients and/
or their families, particularly if nurse’s individual
boundaries aren’t enforced. Sheppard (2016)
reported specialties requiring high intensity longer
term care such as oncology; critical care; dialysis;
gerontology; etc. areas which typically experience
frequent death outcomes escalate the possibility
of compassion fatigue. The emotional distress
resulting from the exposure to a patient’s traumatic
experiences further intensifies compassion fatigue.
Often patients and/or their family members remind
nurses of someone significant to them resulting in
extreme empathy and/or sympathy. Sheppard (2016)
noted risk factors for CF include the following:
Nurses, who skip breaks, take extra shifts, or
come in on their days off out of a sense of duty
may be more at risk for compassion fatigue.
One of the greatest risks for compassion fatigue
comes when nurses forgo their own self-care.
Sheppard (2016) identified the initial indicators of
compassion fatigue are emotional often exhibited as
extreme irritation, volatility, boredom, disinterest,
and aloofness towards patients, families, and
colleagues. If these behaviors are not confronted
they can result in psychological distress. This
distress is frequently manifested as insomnia,
excess anxiety, rumination, and forgetfulness,
which may result in an overwhelming sense physical
and mental exhaustion. Exhaustion coupled with
extreme tension may be expressed as somatic
complaints like nausea, headaches or backaches.
Sheppard (2016) cited compassion fatigues’ long-term
impact on work performance potentially increasing
the risk for errors, call outs, inattentiveness,
crankiness, counter to caring and compassion
necessary for healing. Sadly prompting some “nurses
(to) self-medicate with alcohol or drug use/abuse,
(while) others abandon nursing” (Sheppard, 2016).
Sheppard (2016) reviewed potential strategies to
reduce compassion fatigue. Awareness is critical to
identify the discomfort and psychological distress.
This can be accomplished by practicing self-reflection
and mindfulness, as well as expressing self-kindness
and caring. It is essential for individuals to routinely
enforce personal boundaries in their life or risk
disintegration! Sheppard (2016) encouraged that
nurses should maintain personal integration by
making self-care and self-compassion priorities, if
mental or physical symptoms arise such as insomnia,
nightmares, depression, and/or anxiety she
recommended requesting assistance from employee
assistance program (EAP) or a mental health.
Hughes et al. (2017) discussed the necessity of a
spiritual reservoir of resilience for nurses versus a
state of depletion noting that difficulties arise when
nurse is providing a higher level of care for others
than he or she is caring for their own selves. Many
sources recommended meditation, prayer, and
maintaining relationships in a faith community
as ways to develop a reservoir of resilience. One
example cited in the White Paper was St. Bernard
of Claivaux, a 12th century Christian monk, in his
Sermon of Songs stated the following as an example:
The man who is wise, therefore, will see his life
more like a reservoir than a canal. The canal
simultaneously pours out what it receives; the
reservoir retains the water until it is filled, then
discharges the overflow without loss to itself.
(Hughes et al., 2017, p.17)
Developing strategies to intentionally replenish
reserves will help nurses to work from a locus of
abundance versus lack.
Nurses need to be given the tools and resources
not only to care for patients’ spiritual well-being but
to enhance their own! Ideally nurses need a Tool Box
they can access to refill their own reservoirs. A couple
of examples mentioned in the literature are: Tea for
the Soul and Blessing of Hands (BOH) for nurses as
a means of supporting nurses’ reconnection with the
meaning and purpose of nursing. “Tea for the Soul”
healthcare staff are served tea and other treats by
chaplains or spiritual care departments along with
an open invitation to discuss issues they face caring
for patients with goal of reducing healthcare providers
stress. Supportive resources such as inspirational
readings or resource materials are available upon
request. Creation of a nurturing environment by the
chaplains encourages and fosters staff to practice
“collaborative decision-making and reflection…
enhances coping and resiliency giving a deeper
meaning of their work” (“Nurturing Caregivers with
‘Tea for the Soul’,” 2017). Saint Francis Healthcare
in Wilmington, Delaware, much like the rest of the
country, celebrates the beginning of Nurses Week
with the Blessing of Hands (BOH). There is a plethora
of descriptions of the nuances of the BOH ceremony
Join a New Way of Healthcare!
using water and essential oils; however, Wolpert
(2010) has a bullet point summary of the process for
individuals interested in instituting the BOH at a
healthcare facility. Often nurse prayer cards are given
to each nurse as a memento of the blessing of the
sacred work of nursing.
Another approach to Care for Caregivers used
by a number of hospitals nationwide is a Code
Lavender which according to Hamilton (2014)
is similar to a Code Blue for “integrative healing”.
“Code Lavender services consist of a rapid
response team of specialists, which are called
upon when an individual – patient, family, health
care worker, or employee – has reached his or her
emotional limit” (Hamilton, 2014). Hamilton (2014)
reported that Dr. Brenda Duffy of Cleveland Clinic
was the first to adopt the Code Lavender a concept
created by Earl Bakken, CEO of North Hawaii
Community Hospital in 2008. Dr. Duffy wanted
to insure that providers focused on the mission of
healing. “Don’t lose the connection to the reason you
entered healthcare in the first place. This is sacred
work. We are here to heal” (Hamilton, 2014, slide 4).
The purpose of a Code Lavender is to serve
as “Care for the Caregivers…A circuit breaker on
stressful days…. this allows any caregiver to trigger
its holistic pressure relief valve for a particular staff”
(Hamilton, 2014). Code Lavender is initiated by the
Administrative Coordinator who notifies Spiritual Care
Services to direct the care as needed. Hamilton (2014)
provided a description of an actual code cart containing
support information on grief, coping with stress,
inspiration quotes, water, guided meditations, quiet
music, aromatherapy, and massage on site or massage
gift certificates; often comfort food and beverages
are provided to staff as well. Hospital “leadership is
present and involved with continuous rounding for 24-
NOW HIRING Registered Nurses
Opportunities throughout all of Patient Care, including Specialty Areas
Self-Care While Providing Spiritual Care to Patients!
continued on page 11
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