During the year, I have heard it said many times and have seen several memes, making it clear that no one would be sad to say goodbye to 2020. We have been working in unprecedented times, and much of the world's attention has been focused on health care professionals. We all face stress, be it at work, home, or both. Coronavirus disease-2019 (COVID-19) changed many things: how we approach patients; manage their care during trauma resuscitations, intubations, and cardiopulmonary resuscitation; how we interface with patients, their families, our colleagues, emergency medical services agencies, and people at the grocery store. The stress is compounded by staffing burdens produced by COVID-19 that pulled individuals into different job functions, changes in patient volumes, and staffing demands for the patients with COVID-19 in the most critical conditions. These challenges added to the fear and concern for our safety, our loved ones' safety, and the psychological distress and emotional burden, beyond the typical stressors that accompany being a trauma nurse. These issues impact us, our staff and colleagues, our loved ones, and our community. It is difficult to estimate the emotional toll that COVID-19 has had and will continue to have as individuals grieve for lost positions, lost opportunities, lost loved ones, and changes due to the financial impact (J. Klein, personal communication, September 23, 2020).
It has been well documented and addressed in the literature since the mid-1990s, the emotional, cognitive, and physical consequences of providing professional services to trauma victims and survivors (Cocker & Nerida, 2016). Merriam-Webster (n.d.) defines compassion fatigue as the physical and mental exhaustion and emotional withdrawal experienced by those who care for sick or traumatized people over an extended period of time. So it goes without saying that health care professionals who care for the injured and are already particularly susceptible to developing compassion fatigue could be more vulnerable in a health care climate of uncertainty. Compassion fatigue can affect patient care standards, relationships with colleagues, and lead to more serious mental health conditions such as posttraumatic stress disorder, anxiety, or depression (Cocker & Nerida, 2016). In other words, compassion fatigue is the “cost of caring” that can impact the trauma service provider cognitively, emotionally, behaviorally, spiritually, interpersonally, and physically (Burnett & Wahl, 2015).
What can we, as professionals, mentors, colleagues, and friends do to support the healthy caregiver—someone who can bounce back quickly after traumatic experiences, maintain high-functioning behaviors at work, at home, and in the community? Psychologists define resilience as “the process of adapting well in the face of adversity, trauma, tragedy, threats or even significant sources of stress” (American Psychological Association [APA], 2020). Being resilient does not mean that bad situations, episodes of distress, or feelings of being overwhelmed will not happen. Although factors can contribute to why someone may be more susceptible to compassion fatigue, research findings suggest that resilience plays an important role in adapting in the face of adversity. Being resilient doesn't mean that people won't encounter difficult or stressful circumstances, but it does impact how they deal with them and how they grow and learn from these experiences. Becoming more resilient not only helps someone get through difficult circumstances, but it also empowers them (APA, 2020).
How can we promote resilience? Promoting resilience is done by exploring strategies to reduce stress and anxiety through mindfulness practice and self-reflection; to promote connections, share experiences, and build resilience (Good Therapy, 2020). This can be done in many ways, such as surrounding yourself with individuals, family, or friends, to forming connections with members of an organization such as the Society of Trauma Nurses (STN). Whether it's a one-on-one relationship or being part of a group, the social support of like-minded people supports resilience. Taking care of yourself by eating healthy, exercising, practicing mindfulness, and avoiding negative outlets are examples of what we can do for ourselves and others to cultivate resilience. An important focus for nurse leaders to build nurse resilience is through formal education, social support, and meaningful recognition, which fosters a healthy work environment and maintains a stable nurse workforce (Kester & Wei 2018).
Many things challenge a trauma nurse's ability to stay engaged, compassionate, and motivated. Whether it's a constant stream of devastating injuries requiring high-level critical care, one too many resuscitations that have a poor outcome, or the challenges of a pandemic, we need to learn the techniques that will help us spring back, be able to take care of the next injured patient in the best possible way, and learn and grow from those experiences. Throughout my career and even in my personal life, I've looked back on challenging times, ones I was all too happy to say goodbye to, and think of the things I've learned or grown from during that time. The important thing to remember is that we aren't able to control all of the events or circumstances that come our way, but we can change our response. Increasing resilience takes time, but with the available tools, strategies, resources, and support systems, we can increase our capacity for resilience.
American Psychological Association. (2020, February 1). Building your resilience. Retrieved from http://www.apa.org/topics/resilience
Burnett H. J., Wahl K. (2015). The compassion fatigue and resilience connection: A survey of resilience, compassion fatigue, burnout, and compassion satisfaction among trauma responders. International Journal of Emergency Mental Health, 17(1), 318–326.
Cocker F., Nerida J. (2016). Compassion fatigue among healthcare, emergency and community service workers: A systematic review. International Journal of Environmental Research and Public Health, 13(6), 618.
Kester K., Wei H. (2018). Building nurse resilience. Nursing Management, 49(6), 42–45. doi:10.1097/01.NUMA.0000533768.28005.36
Merriam-Webster. (n.d.) Compassion fatigue. Retrieved September 2, 2020, from https://www.merriamwebster.com/dictionary/compassion%20fatigue