How to Use ART to Combat Compassion Fatigue

You don’t have to accept compassion fatigue and/or burnout as the costs of caring for your patients.

Compassion Fatigue and Burnout in Nursing: Enhancing Professional Quality of Life by Vidette Todaro-Franceschi

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Vidette Todaro-Franceschi tells us that, “We do not have to accept compassion fatigue and/or burnout as the costs of caring; with intention, we can make choices that help us to reaffirm our purpose and actively sidestep feeling dissatisfied and disenchanted with our work.”

In her book, Compassion Fatigue and Burnout in Nursing: Enhancing Professional Quality of Life, she teaches a concept called ART: Acknowledge, Recognize, and Turn Outward, which she describes as reaffirming purpose as a healing model for our wounded workforce.

In her book, Todaro-Franceschi discusses ways to use ART for many different situations or purposes, which we’ll look at closer. In every case, she states that “when applying ART, you focus on awareness of turning points, connection to others (and the environment), and one’s place (individually and collectively) in the unfolding present.”

The first application of ART is compassion contentment, or job satisfaction in a manner of speaking. This is the positive side of professional quality of life, the reasons we put on scrubs every morning and clock in at our practices. When you remain aware or mindful of the positive things in life, we can look to repeat those things and experience joy and happiness when they occur. Here is a brief explanation of applying ART to compassion contentment:

  • Acknowledge a time when you felt good doing the work you do, a specific example of a task or interaction or case that made you remember why you became an animal caregiver. How did it make you feel in the moment? How did you feel when you left work that day? When you arrived at work the next morning, were you hoping and even looking for that same kind of moment so you could relive the feeling? Specifically, write down what you were doing in that moment and how it made you feel at the time it happened.
  • Recognize that the choice is yours, to act in ways that will recreate happiness and reaffirm your purpose in caring for animals. What choices did you make that day when you experienced a good feeling? Do these moments happen often enough, and if not, why not? What obstacles stand in your way of having more positive feelings? Specifically, what can you choose to do this day to create that positive feeling again?
  • Turn outward toward yourself and others. Reconnect with that positive feeling described above and grab onto that sense of well-being. Can you reproduce that moment? Will you be able to connect with your patients, loved ones and coworkers?
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ART can also be applied to stave off compassion fatigue. For example, seven oncology nurses were identified as exemplary by their coworkers, and were interviewed about their work. There were three main characteristics shared by these seven nurses: moments of connection, making moments matter and energizing moments. (Perry, 2008) These nurses looked at these peak moments and made them count; even on a bad day, you have to admit, there are good moments. Unfortunately, the negative energy of the bad moments easily clouds over the good moments, UNLESS we refuse to let them! Here is a discussion of applying ART to compassion fatigue:

  • Acknowledge feelings, or a wound that needs healing. It is important to examine our own suffering, with the intent to identify and disempower those things causing our suffering. How do you feel each morning you go to work? What is on your mind (or feelings in your body) as you enter the practice? When did you begin to feel this way; was there an event or change that may have contributed? Too often we try to run from the pain or suffering, but you must move toward it to free yourself of its power. Recognize choices and take purposeful actions. Take some time to figure out what is at the root of your negative feelings, and generate a list of actions that might be applicable. Let a friend or close coworker take a look at the list, and see if they have an approach that may have not occurred to you. Do not settle for compassion fatigue, but instead learn how to work through those obstacles causing it. For example: 

    A coworker or manager is bullying you; what are your choices? Perhaps you could reach out to this person and try to find the reason for the behavior. If there are others being bullied by this person, perhaps you could talk and come up with possible actions to take. By yourself or with these others, you could go to your supervisor for advice; if the problem IS your supervisor, then you take it one step higher on the hierarchy. You can do nothing but “grin and bear it,” recognizing that this doesn’t solve anything … or you could quit your job and find another place to work. You may need to try several of these options to find resolution. If you do nothing, you have still made a choice. The choice is yours, but you have to choose.‚Äč

  • Turn outward toward self and others. In this case, this means to step outside of yourself, and examine how well you’re caring for yourself. What is important to you, and do you make the time or create the energy to do those things? How are you interacting with others in your life, not just at work, but at home as well? Seek connection with the people close to you, discuss your feelings. 

Using this concept of ART, an individual can begin to look closer at their professional life and develop ways to bring back the compassion that led us to the veterinary profession in the first place. Yet no matter how healthy a person becomes, if they walk into a toxic environment every day when they show up for work, compassion doesn’t stand a chance. If we are surrounded by people who have compassion fatigue and have lost the compassion to care – about patients, coworkers, and themselves—then the next step is to apply ART to the collective awareness of compassion fatigue.

  • Acknowledge feelings: Once you acknowledge your own personal feelings, it’s time to start opening up the door to healing for the practice team. Start with just a small opening, rather than bursting through all at once. Remember, your coworkers have been battling the same negative feelings about their work, and some may have become apathetic or fallen into denial, a very easy place to rest. The way you approach the subject will also depend upon your position on the team. If you are a supervisor or manager, you may start by talking to peers at the same level to see if they feel it’s a problem for their teams. If you aren’t in management, and in fact, if management is the level that is apathetic or in denial, you might start with your close teammates, opening up a little about how you feel, mentioning the concept, talking to them about this presentation, finding an article to share, to just get the conversation started. It is true that sometimes the people who need it the most, will be the ones who are the toughest to reach, but go forward anyway with people who do care and will listen, and everyone may get caught up in the wave of healing.
  • Recognize choices and take purposeful action: There are many choices when it comes to addressing compassion fatigue in the workplace. Perhaps small focus groups can meet to discuss feelings and ways to cope. Perhaps you have a Buddy System where people simply pair up with someone who cares and can be a sounding board for each other. As a team, in staff meetings there may be time set aside to discuss difficult cases (both clients and/or patients) and how the team either survived well, or could do better in the future. Just the act of brainstorming what action TO take can help the team unite in this fight against compassion fatigue, and positive results have already begun!
  • Turn outward toward self and others: Together, find ways to increase job satisfaction, i.e. professional quality of life. Examine these six key areas for employee happiness: (1) a manageable workload, (2) a sense of control, (3) the opportunity for rewards, (4) a feeling of community, (5) faith in the fairness of the workplace, and (6) shared values. (Maslach and Leiter, 1999) What areas need work, and who should be involved in the task? What areas are already good, and should be appreciated?  What will it take to eradicate and minimize compassion fatigue in the organization?

We all have the ability to imagine a better future, for us, our team, and our profession. Healing won’t always be easy, but it may be a more comfortable ride than the one we took to get where we are now if we are submerged in compassion fatigue. Here are some capabilities that will help us to get to where we imagine we could be:

  • Noticing deeply – identifying and articulating layers of detail through continuous interaction with an object of study
  • Embodying – experiencing a work through your senses and emotions, and physically representing that experience
  • Questioning – asking “Why” and “What if?” throughout your explorations
  • Identifying patterns – finding relationships among the details you notice, and grouping them into patterns
  • Making connections – linking the patterns you notice to prior knowledge and experience (both your own and others)
  • Exhibiting empathy – understanding and respected the experiences of others
  • Creating meaning – creating interpretations of what you encounter, and synthesizing them with the perspectives of others
  • Taking action – acting on the synthesis through a project or an action that expresses your learning
  • Reflecting and assessing – looking back on your learning to identify what challenges remain and to begin learning anew  (Liu and Noppe-Brandon, 2009)

Next time, we’ll explore moral distress, and how to be true to yourself by being true to your patients.

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