Compassion amidst Contagion: The Emotional Consequences on Caregivers during the Pandemic
Caregivers battling on the frontlines of the COVID-19 pandemic are susceptible to burnout and compassion fatigue. But there have been too, stories of meaning and compassion satisfaction amidst the bleakness and pessimism.
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Efforts towards Containing the Contagion have become a Cold Comfort
Close to two years after alarms and emergency responses were raised around the world, we find ourselves – at the time of writing, still battling the COVID-19 pandemic. The emergence of the rapidly transmissible Delta variant of the virus has prolonged the battle that countries, organizations, and individuals around the world are still waging. Lives have been upended and lost; livelihoods have been hampered and, in some cases, halted entirely by the pandemic. Countries have ramped up vaccination efforts, but in many cases, primarily because of the virulence of the new strain, it feels like we are playing catch-up to the pandemic. The pandemic is, unfortunately, likely here to stay. A survey conducted by Nature, sampling immunologists and virologists from around the world showed 60% of respondents projecting that the virus will continue to spread in pockets and clusters globally. Half of the experts surveyed think it is unlikely to be eliminated; a total of 89% of respondents – all experts in this field, predict that the SARS-CoV-2 will be endemic [1]. Even with the knowledge that effective vaccines are being developed and approved around the world, along with the optimism that we might someday reach a sufficient level of herd immunity, the news comes as cold comfort to many of us who have heard of or even known someone who has lost their lives to the virus. Several countries have started loosening restrictions, and some have also allowed for a return to some semblance of normalcy. But even so, the lingering threat of new cases and “breakthrough” infections, continue to cast a long shadow over our lives.
The Consequences and of Caregiving: Compassion Fatigue, but also, Compassion Satisfaction
This prolonged uncertainty exacts an incredible toll on our mental health and well-being. But perhaps the emotional costs are particularly evident among those who are at the frontlines of this global battle. Medical frontliners – first responders, emergency service workers, and those in intensive care are all confronted with the physical and psychological risks from treating the endless stream of COVID-19 patients. Hospitals around the world are overwhelmed; the imagery of a medical worker, still in their personal protection equipment, sitting slumped over on the floor as the ambulance sirens blare in the distance has become a psychological emblem for these tumultuous times. The lack of necessary medical resources, support – and even clear, ethical leadership at this time has led to many healthcare professionals experiencing burnout, anxiety, and depression [2].
The medical and narrative medicine literature has established that those in caregiving professions experience a specific form of fatigue. Compassion fatigue – the secondary fatigue that comes from working with traumatized patients, is borne out of work from secondary traumatic stress [3]. This stress results from helping, or wanting to help suffering persons, but the need and expectation to constantly empathize with patients exact an emotional toll on caregivers. Indeed, one study shows that compassion fatigue predicted levels of burnout among Spanish physicians [4]. Interestingly, however, the same study showed that among Spanish nurses, compassion satisfaction increased. Compassion satisfaction here relates to the positive experiences associated with connecting with and assisting another empathetically. The authors explain these findings by suggesting that the nurses derived personal significance and meaning in helping relieve the suffering of patients. Similarly, another study of funeral directors in Belgium showed that burnout, but not compassion fatigue, increased during periods of intense and demanding work [5]. Yet another study showed that healthcare workers do report comparatively lower levels of burnout and secondary traumatic stress – but moderate to high levels of compassion satisfaction while working during the pandemic. This study was especially notable in that it sampled healthcare workers from Wuhan, China and in showing that compassion satisfaction was associated with higher hand hygiene behaviours [6]. Put another way, when healthcare workers derive meaning and satisfaction from their caregiving, they were also more likely to engage in behaviours that helped constructively manage the outbreak and as a result, report lower levels of burnout.
Supporting Healthcare Professionals in Finding Meaning amidst Melancholy
It is a testament to the human spirit that medical frontliners continue to fend off the virus in a seemingly never-ending war. Despite being battle-weary, burnt out and demoralized, we see the continued and courageous efforts of caregivers doing their utmost in responding to the infections. Common across the remarkable and inspiring stories is that these healthcare professionals see their roles as something greater than themselves. One study, also sampling physicians and nurses from Wuhan, suggests that when front-line medical professionals reappraise their work demands as contributing to a collective, group good instead of their personal, individual impact, they were more likely to report lower levels of burnout and greater levels of compassion satisfaction [7]. Finding meaning – but knowing that one’s work is not just important – but essential for others, seems to be one way in which medical professionals find purpose amidst the pain; when the situation appears profoundly bleak.
The effective management of medical professionals’ and caregivers’ well-being, however, should not rest in the workers themselves. Burnout is an occupational phenomenon – effective interventions cannot target the employees alone. Indeed, the additional demands placed on healthcare professionals and caregivers during this time amplifies inadequacies and inefficiencies of the organization and has nothing to do with employees’ training or skills [8]. It is thus essential for healthcare institutions and organizations to enhance their systems and policies to ensure that their healthcare professionals can render the essential care needed by their patients. Clear communication of guidelines, establishing standards of care for self and patients, along with the provision of necessary material and mental health support initiatives should complement self-care interventions to help the essential work that medical professionals are doing during the pandemic [9]. There is arguably no more noble and important profession in the age of contagion than those who serve at the frontlines against the pandemic. The imperative for enhancing medical professionals’ well-being has – and will continue to have long-term implications. Not just for the patients they treat, but for all of humanity.
Reference:
[1] Phillips, N. (2021). The coronavirus is here to stay-here’s what that means. Nature, 590(7846), 382-384.
[2] Azoulay, E., De Waele, J., Ferrer, R., Staudinger, T., Borkowska, M., Povoa, P., ... & Cecconi, M. (2020). Symptoms of burnout in intensive care unit specialists facing the COVID-19 outbreak. Annals of Intensive Care, 10(1), 1-8.
[3] Bride, B. E., Radey, M., & Figley, C. R. (2007). Measuring compassion fatigue. Clinical Social Work Journal, 35(3), 155-163.
[4] Ruiz‐Fernández, M. D., Ramos‐Pichardo, J. D., Ibáñez‐Masero, O., Cabrera‐Troya, J., Carmona‐Rega, M. I., & Ortega‐Galán, Á. M. (2020). Compassion fatigue, burnout, compassion satisfaction and perceived stress in healthcare professionals during the COVID‐19 health crisis in Spain. Journal of Clinical Nursing, 29(21-22), 4321-4330.
[5] Van Overmeire, R., Van Keer, R. L., Cocquyt, M., & Bilsen, J. (2021). Compassion fatigue of funeral directors during and after the first wave of COVID-19. Journal of Public Health (Oxford, England).
[6] Zhou, Q., Lai, X., Wan, Z., Zhang, X., & Tan, L. (2021). Impact of burnout, secondary traumatic stress and compassion satisfaction on hand hygiene of healthcare workers during the COVID‐19 pandemic. Nursing Open, 8(5), 2551-2557.
[7] Wu, Y., Wang, J., Luo, C., Hu, S., Lin, X., Anderson, A. E., ... & Qian, Y. (2020). A comparison of burnout frequency among oncology physicians and nurses working on the frontline and usual wards during the COVID-19 epidemic in Wuhan, China. Journal of Pain and Symptom Management, 60(1), e60-e65.
[8] Montgomery, A., Panagopoulou, E., Esmail, A., Richards, T., & Maslach, C. (2019). Burnout in healthcare: the case for organisational change. BMJ, 366.
[9] Alharbi, J., Jackson, D., & Usher, K. (2020). The potential for COVID‐19 to contribute to compassion fatigue in critical care nurses. Journal of Clinical Nursing, 2020 May 18.
