Compassion Fatigue Resilency for Military Medical Personnel

Title of Work – Compassion Fatigue Resiliency for Military Medical Personnel

I have spent all of my adult life in the military and I have witnessed friends and colleagues suffer from the devastating effects of compassion fatigue. I recently conducted a study to examine the treatment effectiveness of a multi-faceted education program to decrease compassion fatigue (CF) and burnout symptoms, and also to increase compassion satisfaction (CS) of emergency nurses participating in the training. The manuscript was submitted for publication in the Advanced Emergency Nursing Journal. The goal of the CF multi-faceted intervention program was to demonstrate a statistically significant improvement in the three subscales; an increase on the compassion satisfaction subscale, a decrease on the two components of compassion fatigue subscales-secondary traumatic stress and burnout subscales in the participants’ pretest and posttest scores as measured by The Professional Quality of Life test (Stamm, 2010). In this study (n=59), the multi-faceted education program proved statistically significant in increasing CS (p= 0.004) deceasing burnout (p= < 0.001 and decreasing secondary traumatic stress symptoms (p=0.001) in this population.

Military health care professionals by the nature of their work are at risk for CF. Understanding the origins of secondary traumatic stress (a component of CF) lies in understanding post-traumatic stress disorder (PTSD). This psychiatric disorder was first recognized in soldiers as a psychological war wound (Stewart, 2009). Figley describes compassion fatigue as “nearly identical to PTSD, except that it applies to those emotionally affected by the trauma of another” (Figley, 2002, pg. 3). However, victims of PTSD can typically recall the event which gave rise to the symptoms: a gunshot wound, a traumatic amputation, a rape. Compassion fatigue is more insidious and often unrecognized but can be just as life altering. It is postulated that the repeated exposure to secondary traumatic stress has a negative cumulative effect (Gentry, 2012). Many of the symptoms identified in patients with PSTD, such as intrusive thoughts, sleep disturbances, avoidance, anxiety, distressing emotions, and hyperarousal are also present in some individuals with compassion fatigue (Figley 2002; Gentry 2010). How it works The first level of intervention is a four-hour interactive group seminar entitled, “Compassion Fatigue and Resiliency” conducted by the project investigator and colleagues. The four-hour seminar was adapted with permission from Dr. Eric Gentry’s Compassion Fatigue Prevention & Resiliency, Fitness for the Frontline course. The seminar detailed the origins of compassion fatigue, the physiological effects, signs and symptoms of CF and burnout as well as the factors associated with emergency nursing that may lead to CF and burnout. Additionally, the seminar provided conceptual information and suggestions regarding prevention and treatment for CF, including the five key elements identified by Dr. Gentry for the prevention and treatment of CF: self-regulation, intentionality, perceptual maturation/self-validated care giving, connection and self-care. The participants engaged in several exercises aimed at enhancing understanding of the material, including a guided imaging exercise. In the second level of intervention multi-media resources were given to or made available to the participants. The resources included: • Printed seminar handouts; • “Tools of Hope” DVD by Dr. Eric Gentry; • Guided imaging/music CD by Bellruth Naparstek (psychotherapist and guided imagery pioneer); • Access to an ED web based site with CF, compassion satisfaction and resiliency education resources, and publications on CF. • How does it support the readiness of our troops and medical force? Challenging care-giving experiences affect the lives of military medical personal and can also affect those who are close to them. Significant others, family members, friends and colleagues may also share in the negative effects of compassion fatigue. Studies suggest that health care providers with CF may no longer be effective with patients and that their symptoms may interfere with providing empathetic care (Dominguez-Gomez, 2009). The cost to the caregiver may be financial in terms of a loss of a position or promotion, or emotional in terms of unhappy relationships or divorce. The damage to the military may be in the form of suboptimal care or medication errors, or the loss of the member from the service.

• What would a small pilot look like? How many pilot locations would be needed? What resources would be used? Recommend either replicating the study above in a group of military members or conduct the training for military medical members before deployment. Recommend instructors be Certified Compassion Fatigue Specialists. I am currently a Colonel in the USAFR and would be willing to put on military orders to conduct training.

• Cost estimates? For instructors to attend Certified Compassion Fatigue Specialist Training, $400 for two day course plus travel/lodging/per diem. Participants would attend four hour attendance seminar if active duty or paid from another source would not have pay but perhaps travel/lodging/per diem. Estimated budget for 100 participants $12,000.

• What does the implementation timeline look like for your pilot? Depending on how large the pilot, reasonable to accomplish by June 2013.

Try it out