NR 501 A Concept Analysis

NR 501 A Concept Analysis

NR 501 A Concept Analysis

Any theory provides the framework towards understanding the professional practices. The same applies to nursing. Nursing theories are meant to guide the nurses towards providing right services. By developing and referring to the right nursing theories, nurses can add a lot of value to the healthcare environment as well as the society. When working towards the development of any theory, the theorist explores and explains the concept in detail and identifies the triggers that can enable the necessary intervention. By the very nature, a theory could be difficult to interpret, as it is abstract. Therefore, concept analysis is important to develop the right understanding. Every theory is a culmination of a variety of concepts that help in make the theory easy to interpret and apply in the right conditions.

In this paper, we will evaluate and analyze the concept of compassion fatigue its correlation with the environment that is provided to nurses for learning and practice. Watson’s theory of human caring talks about the relationship between patients- nurses. This relationship is nurtured with the compassion, empathy, and skills of nurses. The nurses need to be completely available physically, mentally, and spiritually while connecting with patients or their families. According to Watson’s theory, compassion is a very important part of developing a caring environment for patients and nurses are responsible for this development. Each nurse has her own as well as group responsibility towards this environment. They fulfill these responsibilities based on the ten caritas processes that are part of their routine. Each caritas explores a unique facet of nurse-patient relationship in details. This emphasizes the importance of a compassionate interpersonal connection between these stakeholders. Both, nurses as well as patients are an important part of these caritas. Watson strongly believes that a nurse needs to be salubrious in respect to contribute to the wellbeing of a patient (Clerico et al, 2013). Walker and Avant’s opinion is used in this concept analysis of compassion fatigue. The key steps involve describing the concept, literature review, describing the characteristics, recognition of precedent and antecedents, recognition of two verifiable referent, marginal case, exploration of reference case, and a contradictory case to further understand the concept (Jenkins & Warren, 2012).

Compassion Fatigue

Due to its connect with nursing profession and the performance of caregivers, there arises a need for the complete understanding of the concept of compassion fatigue. In Taber’s Cyclopedia Medical Dictionary compassion, fatigue has been denoted as a stupendous succor fondness of enervation with reduced capacity for manual and cognitive functioning. Compassion fatigue can be showcased by variety of features including: Suspicion, psychological enervation, Cynicism, emotional exhaustion, self-concentration, and emotional dissociative disorder, of patients or conditions (Compassion fatigue, 2014). According to Harris and Griffin, compassion fatigue is the manual, psychological and divine outcome of chronic self-immolation. It could be due to the extended submission to tiring conditions that lead a person drained of affection, nourishment, attention or sympathy (2015, p. 82). Compassion fatigue often takes place when an individual goes through disturbing phenomenon, hardships, and destructive sickness, persistently with no outlet for psychological pronouncement or recreation (Boyle, 2015).  In the last few decades, compassion fatigue has been incorrectly labelled as exhaustion. Exhaustion takes place as a reaction to continuous work without rest, high expectations, financial crunch, interpersonal aggravation, and social pressures– these measures lead to reduced attentiveness, mistrust, and worthlessness” (Harris & Griffin, 2015, p. 82).

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Watson’s theory is all about caring for caregivers so that the nurses remain present and able for providing the best care to their patients. The patient-nurse relationship is at the core of human care, which encompasses the nurses’ capability to be available in every attentive communication (Clerico et al, 2013). Significantly, an attentive, and available, nurse will be capable of bestowing sympathetic, secure and standard attentiveness to every patient, which leads to healthy patients conclusions and ameliorate patients gratification. Nurses who encounter compassion fatigue are deprived of the capability to honestly relate with their patients, thereby inhibiting the foundation of attentive surrounding.

Literature Review

Literature review is an important step for concept analysis. Compassion fatigue is an abstract concept, which is

NR 501 A Concept Analysis
NR 501 A Concept Analysis

especially relevant for emergency response professionals like police, firefighters, and paramedics; however very less research has been done about how compassion fatigue influence nurses and their capability to provide the right care to patients. Like other initial health care professionals, nurses are distinctive, as they can’t refuse for their responsibility once the accountability of patients has been taken. Nurses are not supposed to share all the work related information with their partner. They are expected to hold their feelings and experiences back with themselves and continue to perform their duties (Boyle, 2015). Due to this, recent research has highlighted that about 16%-39% nurses face compassion fatigue, while only about 8%-38% feel exhausted. According to Kelly, Rung, and Spencer (2015), more “Millennial Generation” (ages 21-33 years) face compassion fatigue as compared to the previous generation “Baby Boomer” (ages 50-65 years) or the “Generation X” (ages 34-49 years).

Moreover, about 20% nurses quit their profession within the first year. Out of this, a large number of junior nurses completely leave the industry right at the start of their career (Kelly, Rung & Spencer, 2015, p. 526).  In Hong Kong, a multi-hospital research has presented that some personality attributes have greater threats with respect to compassion fatigue. These characteristics are: high conscious, quest for perfection, and excessively volunteering for work (Yu, Jiang & Shen, 2015). Excitingly, researches, which evaluate variety of nursing professions, discover that hospice nurses had not showcased any positive interrelationship to succeed compassion fatigue. The truth is that hospice nurses possess more information of dealing contrivance, (Melvin, 2012).

Defining Attributes

It is hard for a nurse who is experiencing compassion fatigue to determine it instantly. The describing characteristics of compassion fatigue are:- Loss of personal identity of patients, lack of sympathy, indigent discernment, minimized toleration, declined functioning (Jenkins & Warren, 2012). The nurse might display some or all of these characteristics, which is much frequent in loss of identity of patients and in lack of recognition (Harris & Griffin, 2015).

 

Antecedent and Consequence

We should investigate in respect of concept analysis, that what arrives prior to abstract, or arouse abstract, or what are the predecessor of the abstract. In supplementation, we must scrutinize what happens succeeding the abstract, or what are the outcomes of the abstract happening. In connection, to compassion fatigue, there are reiterate compassion stressors, which took place before the advancement of compassion fatigue. In consideration, it is correspondingly new abstract and undetermined also as which stressor is much impactful, it aims at recording all recognized compassion stressors or predecessor. The determined compassion fatigue predecessor are: Reappearing submission of the caretaker to hardship, reiterate upheaval phenomenon, everlasting and extreme relationship with patient, greater-stress and  extreme upheaval submission, greater self-concentration within one’s function of  surrounding or character, and the advancement of deep connection with families and patients which aroused to extended psychological prostration. (Boyle, 2015).

If nurse has initiated encountering compassion fatigue, she may pronounce that we stand at zero ground of the abstract, this is the notion at its foundation and now the conclusion of the idea either will begin to obvious or get mould into pervasive. Furthermore, considering compassion fatigue as correspondingly a current idea, it carries enumeration in multiple results. It could lead to lack of sympathy, loss of personal identity of patients, suspicion, enlargement in dropping of work days owing to physical objection, enlargement in psychosomatic sickness such as body aches, sudden loss or gain of weight, trauma,  and psychological exhaustion etc. (Boyle, 2015). See Appendix A.

Empirical Referents

Empirical referents confirm or deny the presence of a concept exists and its scalability. It also suggests if the data can be put to other implementations as well (Boyle, 2015). Compassion fatigue is measurable on a scale that identifies the vulnerability level of an individual with respect to the condition. This scale is known as the Professional Quality of Life Scale (ProQOL 5). It has been upgraded five times since it was first introduced. This scale is comprised of a record of thirty questions, which the respondent respond on a scale of 0 to 5. 0 here indicates that the instance never took place while 5 means that it has happened more than once. Once the responses are compiled, the analysis reveals the potential of an individual to catch compassion fatigue (Boyle, 2015).

There are many other self-tests as well to identify the threat of compassion fatigue. This test is entirely undesignated and free of cost. Whereas it fails to recognize various modes to obstruct compassion fatigue, but can assist to determine someone at danger. Supplementing to these scales, there is an impression of Event Scale – Revised (IES-R) and the Nursing Job Satisfaction Scale.  Thus, these scales also provide assistance in fostering the remedial surrounding if the recognized employees are bestowed with additional stuff to deal and to obstruct the entire elaboration of compassion fatigue. Furthermore, salubrious caretakers who possess capability of completely remain in abidance to patient and to flourish the distinct interrelated connection between caretaker and patient which is the vital component of Watson’s caring theory (Clerico et al, 2015).Other empirical referents are: partitioned from relationship, consciousness regarding fatigue, personal and professional frustration, and absence of incitement (Harris & Griffin, 2015). View Appendix ‘A’ with additional details.

Model Case

Below is the recommended model that can be used for grooming of hospice nurse so that they may stay away from compassion fatigue. The model is explained with the help of a couple of case studies.

“Jackie” is working as nurses since the last ten years or so. She has given her services at several healthcare setups such as emergency care, operational theatres, general care ward, intensive care units (ICU), and long-term care etc. As of now, she is part of a hospice care center as a nurse. Jackie has worked with a large number of patients facing different health issues. These patients come from a variety of demographics, culture, and economic backgrounds. Due to her skills and exposure, Jackie is regarded as a skilled, experienced, and compassionate nurse. She shares her knowledge and experience with her colleagues to even enhance their skills. While she moved to hospice care, Jackie had a new and pleasant experience of providing her services to the patients and their families. She is a good communicator and loves to share her knowledge of healthcare as well as general experience with them. Due to her love for the patients, she is able to connect with their easily. Jackie is thoroughly enjoying this phase of her life and invests a lot of time and effort to personally connect with her patients. She believes that this connect goes a long way in providing the right care and support to the patients during their tough times.  The hospital administration, relatives, and patients often hear that patients have good things to say about Jackie. They enjoy the care provided by her and the time spent by her. However, there is something different in the recent times. Jackie’s manager often sees her staying back even after completing her duty. In this time, she talks to the patients and their family members, tries to do things that would make them feel good, and even volunteers for extended hours of shift. There is no negative impact upon Jackie’s work due to these added new responsibilities. However, her manager still notices the change carefully and thinks of stepping in if needed. Something changes again when Jackie reaches the center after a long weekend to find out that all the patients that were under her special care have passed away. Her manager also informs her that a new patient will come under her care the same day. This patient is a girl who is as young as Jackie’s own daughter. She is suffering from uncontrolled pain due to chronic cancer.Jackie makes all the possible efforts to save the girl from this horrible pain, but is not able to do so. Eventually the girl passes away. Jackie continuously feels the guilt. While she is not out of it, she is assigned a couple of new patients who are facing tremendous dyspnea, pain and anxiety.  Jackie once again provides them with the best possible care, invests hours even after her shift, and stays in touch with doctors continuously. About a week down the first instance, Jackie comes to the hospice center with a different, unusual, cynical attitude. He commoditizes her new lung cancer patient as “my smoker in room 2”. She also disrespects the family members of a young patient by saying “those needy parents.” Without a blink, all her colleagues notice this change in her tonality. However, none takes it as a permanent change and there is no reaction from the external environment. Few days later, Jackie seeks a half-day leave due to reported migraine. She comes back next day with the same problem.

Jackie has spent about a quarter now at the hospice care center. Her probation is about to get over and her manager needs to confirm her. She notes that Jackie started her job with a desire to do something uncommon, completely devoted to her service and always available for duty without any notification. In last couple of weeks before the recapitulation the Jackie has been delayed three times and was absent for 2 days of at workplace. Furthermore, Jackie’s workmates have stated to her manager that she has not been completely focused on her job these days. Jackie’s nurse administrator is bothered about her, that she might be experiencing compassion fatigue and make efforts to do counseling with her. Enduring to this counseling she confessed that unexpectedly she begins to experience exhaustion every time. She also confesses that she often feels tired all the time, even after a good sleep. She fails to lift up her spirits, as she should; she experience disappointment regarding her selection of giving priority of changing over to hospice and develops the perception of quitting the duty. Thus, Jackie’s manager examined Jackie for compassion fatigue by performing online self-test, in which she scores highly. Therefore, Jackie’s manager recommends her Employee Health due to surmised compassion fatigue.

Considering this replicated case, Nurse “Jackie” reveal number of describing characteristics of compassion fatigue incorporating loss of personal identity, minimized presentation, and loss of sympathy. The background of Jackie encompasses her especial and extraordinary relation with patients, her great utilization of self, reiterate submission to hardship (working with seriously ill people), and a high-trauma surrounding (nursing). The outcome of the concluding compassion fatigue for Jackie was her loss of sympathy, her loss of identity for patients (referring to them as a disease or stigma), and absenteeism (migraines) (Jenkins & Warren, 2012).

Alternative Cases

This segment is comprised of a reference case which is either at the edge or the contradictory examples of the nursing abstract called as compassion fatigue.  A borderline replicated case will reveal entire characteristics of nursing abstract rather than one or two, whereas the abstract is still in the run. On the other side a contrary case does not have the characteristics that confirm the presence of compassion fatigue and will be in full disapproval regarding the nursing concept (Jenkins & Warren, 2012).

Borderline Model Case

Beneath borderline case of compassion fatigue with a description is given:

A nurse named Paul is working in the emergency care ward at an extremely busy hospital in the city. Since the last 5 years, Paul has been working as a nurse and invested a big part of his career in similar healthcare environment. Currently, Paul is associated with the responsibility of a patient who is brought through medivac. He was injured in a motor vehicle misadventure. When Paul’s patient arrives through medivac, the flight unit reveals that alcohol was found in patient’s car. Paul is speedy in bestowing magnificent attentiveness to his patient, whereas he refers to the patient “the drunk” or “the MVA” rather than using patient’s name. Paul remains in abidance to his patients and attains number of patients in whole day. Though he dispenses a standard care, he used to address them by their sarcastic nickname or by their sickness but not mention them as patients.  When Paul reports at the end of his duty, he does not prepare the complete report for his replacement Sandy. Moreover, Sandy clutches more time to search the information, but she works as required. She shrugs off the difficulties as “Paul being Paul” and he cannot be changed. Paul attains the duty at the very first morning and is in hurry to refuse the duty as he discloses that he is aged now and owing to this, he used to feel exhausted latterly. Then, he disregards his duty and sustains his day in the E.R.

Paul is encountering compassion fatigue. Thus, he has initiated losing of identity in respect of patients and eluding sympathy (The MVA or The Drunk); and he is presenting his work miserably (inadequate handoff/report).  He has an objection on his hardship due to exhaustion (fatigue even with sleep).  Hence, we can say that Paul’s case is a borderline case in which he is not revealing the describing features of compassion fatigue; and yet he possess a robust discernment and still have the capability to issue high standard of attentiveness towards his patient.

Contrary Model Case

Becky is a nurse since prolonged time span. She adores her profession since last 25 years and enjoys interacting with her patients. Every day, Becky attains her duty with enthusiastic approach, a smile on her face, and giving preference to others requirement. As soon as her day comes to an end, Becky provides complete details to the upcoming nurse in an executive method bestowing uncomplicated and compact info to nurture uninterrupted care. Becky becomes conscious about the alterations appearing in health care and only performing in the way in which she can ensure to her patients and colleagues that though alterations are arriving but we will investigate it completely together as a troupe. She assimilates that though alterations are disagreeable and result into extended shifts periodically, which might leads to more trauma level in a day, thus, her performance in the attentive surrounding as a nurse enables her to avoid such disagreeable aspects. All her workmate and member of the interdisciplinary array, doctor, and associate adore working with Becky as they are aware that she will do everything possible to the best of her skills and capabilities to ensure the well-being of her patient. Becky is a vigorous patient upholder and always wishes to hear every patient, to assimilate their preferences in respect of betterment of health, and then to scrutinize their needs and to see whether the needs are accomplished or not. Furthermore, Becky enables every patient to feel like a healthy individual by addressing them with their correct names and exchanging words with them above nursing mediation. As Becky has seen a number of diseases, drawbacks, and stresses in her whole nursing profession, she enjoys satisfaction in realizing her reciprocal action with her patient, and she performs with all her strength to shower humbleness, solicitude, and sympathy during her reciprocal action.

In this contrary model case, Becky fails to encounter any characteristics of compassion toally fatigue. Truthfully, she is compassion content, which is totally opposite of compassion fatigue (Harris & Quinn, 2015).

Conclusion

In the end, we can say that compassion fatigue is not a much-explored concept. However, the foundation of several theories like Watson’s theory of human caring is on abstract values such as care and compassionate of nurses. This makes it mandatory to further explore the field and identify valid concepts and application. Going by the academic references discussed in this paper, compassion fatigue negatively affects the overall skills and capability of nurses. Therefore, it has direct bearings on the availability and quality of healthcare services present in the society. Watson’s theory advises that the nurses need to be given the right environment to keep their motivation intact. Without this motivation, the nurses may not be inclined to provide the compassionate, skilled, personalized care to the patients who are in need of this. Therefore, theories play an important role towards making the society a healthy and safe place. We can also see the interrelation between theory and practice through this discussion. Nursing practice can be tremendously benefitted from the understanding of theories and putting these into practice framework.

 

References

Boyle, D. A. (2015). Compassion fatigue: The cost of caring. Nursing, 45(7), 48-51 4p. doi:10.1097/01.NURSE.0000461857.48809.a1

Clerico, E., Lott, T. F., Harley, C., Walker, R. ‘.,Kosak, E., Michel, Y., & Hulsey, T. (2013). Caring for the nurse in the hospital environment. International Journal for Human Caring, 17 (1), 56-63 8p. Retrieved from http://internationaljournalforhumancaring.org/

Compassion fatigue. (2014). In D. Venes (Ed.), Taber’s cyclopedic medical dictionary (22nd ed.). Retrieved from http://www.tabers.com/tabersonline/view/Tabers-Dictionary/757231/all/fatigue

Compassion Fatigue Awareness Project (Ed.). (2013). Compassion fatigue self-test. Retrieved from  http://www.compassionfatigue.org/pages/cfassessment.html

Harris, C., & Griffin, T. Q. (2015). Nursing on empty: Compassion fatigue signs, symptoms, and system interventions. Journal of Christian Nursing, 32(2), 80-87 8p. doi:10.1097/CNJ.0000000000000155

Jenkins, B., & Warren, N. A. (2012). Concept analysis: compassion fatigue and effects upon critical care nurses. Critical Care Nursing Quarterly, 35(4), 388-395 8p. Retrieved from http://journals.lww.com/ccnq/Pages/default.aspx

Kelly, L., Runge, J., & Spencer, C. (2015). Predictors of compassion fatigue and compassion satisfaction in acute care nurses. Journal of Nursing Scholarship, 47(6), 522-528 7p. doi:10.1111/jnu.12162

Melvin, C. S. (2012). Professional compassion fatigue: what is the true cost of nurses caring for the dying?.International Journal of Palliative Nursing, 18(12), 606-611 6p. Retrieved from http://www.magonlinelibrary.com/toc/ijpn/current

Potter, P., Deshields, T., Berger, J. A., Clarke, M., Olsen, S., & Chen, L. (2013). Evaluation of a compassion fatigue resiliency program for oncology nurses. Oncology Nursing Forum, 40(2), 180-187 8p. doi:10.1188/13.ONF.180-187

Sacco, T. L., Ciurzynski, S. M., Harvey, M. E., & Ingersoll, G. L. (2015). Compassion satisfaction and compassion fatigue among critical care nurses. Critical Care Nurse, 35(4), 32-44 13p. doi:10.4037/ccn2015392

Yu, H., Jiang, A., & Shen, J. (2016). Prevalence and predictors of compassion fatigue, burnout and compassion satisfaction among oncology nurses: A cross-sectional survey. International Journal of Nursing Studies, 5728-38 11p. doi:10.1016/j.ijnurstu.2016.01.012