A wellness programme to prevent and manage compassion fatigue amongst nurses working in an anti-retroviral clinic in a public tertiary hospital

Abstract

Introduction: Compassion fatigue is an extreme state of tension and preoccupation with the suffering of those being helped and affects those who work in caring professions. Helping people in distress can traumatise the helper because of their empathetic ability. Nurses who work in ARV clinics witness the suffering of their patients when they listen to their patients' descriptions of the trauma that they have to cope with. The patients get the chance to let go of the trauma and to share their concerns. Unfortunately the nurses often absorb some of the emotional pain of their patients and not all nurses are equipped to handle the situations in such a way that they do not become secondarily affected by the trauma of their patients and therefore, become vulnerable to develop compassion fatigue. If compassion fatigue is not identified in time and addressed adequately, the affected nurses may develop feelings of hopelessness in their ability to take care of their patients with detrimental effect on the quality of nursing care to these patients. Aims: Firstly, to explore and describe the extent of the manifestation of compassion fatigue amongst nurses working in antiretroviral clinics; and secondly, to develop a wellness programme to aid in the identification and management of episodes of compassion fatigue as well as the prevention of future occurrences of such episodes of compassion fatigue amongst nurses working in antiretroviral clinics. Methodology: The researcher conducted the study in two phases. In Phase one, a single embedded case study design, with three sub-units situated within the case, namely nurses who work in the adult, ante-natal and paediatric ARV clinics in a tertiary public hospital, was used. Purposive sampling was used to select seven nurses. Data was collected using semi-structured interviews. The researcher used content analysis as described by Elo and Kyngäs (2008) to analyse the transcribed interviews. The themes identified include the risk to develop compassion fatigue, manifestation of compassion fatigue and strategies to prevent and manage compassion fatigue. For document analysis the researcher used professional and enrolled nurses' job description and the employee health and wellness programme for public service. In Phase two, the researcher developed the wellness programme to aid in the identification, prevention and management of compassion fatigue amongst nurses who work in antiretroviral clinics and the Delphi Method was used to refine the wellness programme. Findings: Nurses working in the ARV clinics are at risk of developing compassion fatigue due to work environment issues such as challenges created by the health care system, lack of support from management, and their overwhelming work load. The cost of the nurse-patient relationship also contributed to nurses being at risk of compassion fatigue. Aspects that were identified that relate to the cost of a relationship with patients who are HIV positive include caring for traumatised patients, vicarious exposure to traumatic experiences of patients, and the influence caring for patients who are HIV positive has had on nurses' personal lives and their families. Nurses can traumatise their family members by continually not being available for them through emotional withdrawal. Nurses presented with physical, psychological, spiritual symptoms and changes in their behaviour that are indicative of compassion fatigue. Various strategies to prevent and manage compassion fatigue were identified: both what nurses can do, and what they expected from management. Nurses' job description is generic and does not spell out their role and function within antiretroviral clinics. The implementation of the health and wellness programme is lacking. The findings of Phase one and related literatures formed the bases from which the researcher developed the wellness programme to aid with the identification, prevention and management of compassion fatigue. Conclusion: Nurses are at risk of developing compassion fatigue due to the cost of the nurse-patient relationship with patients who are HIV positive. The key to prevention of compassion fatigue is awareness and a number of strategies that can aid in the identification, prevention and management of compassion fatigue have been identified and included in the wellness programme. Managerial support and practicing of self-care is important to maintain the health and well-being of nurses who work in antiretroviral clinic.