Compassion" is defined by Webster as "the sympathetic consciousness of others' distress with a desire to alleviate it," and "fatigue" as "weariness or exhaustion from labor, exertion, or stress." As wound, ostomy, and continence (WOC) nurses, we realize that these feelings are an essential truth and fundamental component of our nursing care. Because we practice with empathy, the danger arises that we may begin to absorb the fear, pain, and trauma of others until we become mentally, physically, and spiritually exhausted. With constant exposure over long periods of time, we may begin to suffer from "compassion fatigue." The concept of compassion fatigue is not identical to "burnout." Burnout may be experienced by individuals in any job or profession and is associated with distress and aggravation experienced in the workplace. It is cumulative, relatively predictable, and frequently alleviated by a vacation or a job change. Unlike burnout, compassion fatigue mainly affects people in caregiving professions such as nursing. It involves a state of tension and preoccupation with our patients' medical and emotional needs. Compression Fatigue is insidious in its onset and may take weeks or years to develop. Although the patient suffers from critical incident stress (being traumatized by something that is experienced or seen), WOC nurses absorb the trauma on second-hand basis owing to the empathy we have for our patients. For this reason, compassion fatigue can be described as a secondary posttraumatic syndrome.

Why Are WOC Nurses at Risk?

Although nurses have undoubtedly been experiencing "compassion fatigue" throughout the history of their profession, it has emerged only recently in the professional literature. Joinson1 was the first nurse to identify compassion fatigue in 1992. In her article, she points out that nurses are susceptible to compassion fatigue and should learn to recognize the signs to minimize negative effects on their jobs and their quality of life.

Because we are constantly exposed to people who are dealing with altered body appearances, profound changes in bodily functions, and even the ultimate loss, death, WOC nurses are especially vulnerable to compassion fatigue. Our constant pouring out of compassion and concern without taking time to renew ourselves makes it increasingly difficult to maintain a hopeful outlook. Over time, this demand to express empathy can overpower, dominate, and interfere with our ability to function.

Recognizing Symptoms and Seeking Relief

The signs of compassion fatigue are similar to classic stress symptoms: somatic illness, insomnia, depression, and workaholism. The hallmark signs seem to be increased irritability and anger that are frequently too intense for the situation. If we realize that we are exhibiting any of these signs, then we must begin to take stock of how we can replenish and recharge our energy everyday. Because compassion fatigue affects mind, body, and spirit, relief will only come as each of those areas is recharged. We have all heard and attended stress-relief programs, but how much have we learned and changed our behavior and lifestyle choices? By not practicing stress-relief methods regularly, we are literally jeopardizing our families, our careers, and ourselves. Realizing this fact may make stress reduction a higher priority rather than a luxury for which we have not the time or energy.

Perhaps our greatest weapon against compassion fatigue is having each other. In general, stress can be alleviated by talking to someone and "debriefing." Further, as WOC nurses often practice alone, and as only a WOC nurse knows what the other faces every day, local, regional, and national conferences provide excellent opportunities to debrief with colleagues who are familiar with the daily stresses we face in order to defuse the negative consequences of compassion fatigue. These meetings also offer an opportunity to form friendships that can be depended upon when we need someone to understand that our spirit needs replenished. If we are lucky enough to be a part of a friendship like this, we should also try when necessary to lift up our friends and refill their spirit.

Conclusion

As professionals who care for patients facing significant losses, WOC nurses are at risk of compassion fatigue. Our specialty choice is such that each of us will probably experience it at some point in our career. Despite its frequency, compassion fatigue is difficult to recognize and act upon without heightened awareness. Therefore, we should take the time to look for signs of compassion fatigue both in ourselves and in our peers. In my experience as a WOC nurse for more than 20 years, I have watched too many gifted, caring nurses just walk away. Would they have walked away if we had been aware of their needs? Could we have helped them to recharge and renew their passion for nursing? With the support of each other, we can empathize with our patients without risking ourselves.

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