Psychiatric registered nurses (RNs) and licensed practice nurses (LPNs) beginning their careers in inpatient psychiatric facilities face increased risks of developing compassion fatigue (CF) symptoms due to extensive engagement in emotionally and psychologically demanding patient communication endeavors. In mental health nursing, CF is explained as a type of stress that has a more rapid onset compared to occupational burnout and involves a “gradual decrease in compassion over time,” which makes CF a crucial challenge for care activities (Pehlivan & Guner, 2018, p. 130). As a multidimensional condition, CF might involve excessive and verbalized anger, mood swings, accusatory language, and sleep abnormalities (Peters, 2018). CF in the nursing staff has devastating consequences, resulting in elevated turnover rates, reductions in employee morale, slower reactions to patients’ requests, and various care-related mistakes that affect patient outcomes (Peters, 2018). Literature review studies suggest that clinical supervision and self-care support the prevention of CF in mental health nursing professionals, so staff education to increase nurses’ awareness of CF and promote practicing self-care might be crucial (Marshman et al., 2021). Therefore, CF is widely recognized as a problem affecting behavioral health nurses disproportionately.
The project will address the practice gap in an inpatient behavioral health facility in the Southern District of Baltimore, such as the lack of CF prevention education targeted at behavioral health nurses working their first year in this specialty. The facility provides extensive training and learning opportunities, but high workloads and new nurses’ unpreparedness for the specialty’s emotional demands result in imperfect new nurse retention rates. From private conversations with nurses at the practicum site, some of them experience anxiety and helplessness after repeated interactions with clients who develop complex mental health issues due to trauma, abuse, or unbearable losses. Despite recognizing psychological changes linked with working with these patient populations, the nurses do not receive knowledge on CF, warning signs, and self-help to prevent the condition’s development and exacerbation. There are potentially viable CF prevention strategies for behavioral health facilities, such as self-care promotion, ethical dilemma education, reflective journaling, or anti-anxiety rituals (Adimando, 2018; Perregrini, 2019; Peters, 2018). The facility’s new nurse education programs do not emphasize CF, and this staff education project will seek to address the gap and prevent further increases in employee turnover.
- Will staff education for first-year behavioral health nurses about CF (warning signs, evidence-based CF prevention techniques, and self-help) improve nurses’ knowledge and eventually reduce the facility’s employee turnover rates for new nurses?
The intended practice-focused staff education project will support positive change by increasing first-year behavioral health nurses’ awareness of CF and easy-to-use self-help techniques to reduce the risks of developing this condition. Research shows that CF can contribute to situations in which psychiatric RNs and LPNs have no internal psychological resource and motivation to engage in meaningful, respectful, and recovery-promoting communication with hospitalized patients (Maila et al., 2020; Pehlivan & Güner, 2018). CF also increases the risks of job leaving intentions, thus adding to nursing shortages (Peters, 2018). With that in mind, staff education focused on CF prevention will have a variety of beneficial effects.
The project’s positive influences on nurses, the nursing profession, and the facility will be all-encompassing. The nurses participating in the staff education program will develop a greater awareness of their own mental health, learn the techniques they can use for CF prevention, and comprehend the behavioral manifestations of CF typical for nursing specialists, which will support their overall professional and self-care knowledge. Next, the nursing profession will benefit from the project since participants will delve into psychological self-care and self-monitoring. This would enable them to uphold the profession’s values and remain compassionate without engaging in exhaustive emotional labor or developing traumatizing boundaryless relationships with patients. Finally, for the facility, the staff teaching program’s advantageous outcomes are both professional and reputational. For professional ones, since compassion satisfaction is inversely related to employee turnover rates, the program’s effectiveness would mean success in new nurse retention and the opportunity to maintain safe nurse-to-patient ratios for the practicum site. Potentially, through caring for its employees’ psychological well-being, the inpatient behavioral health unit could also develop a better reputation in the professional community.
The project can also help patients, families, and the community by promoting care safety indirectly. CF-focused staff education will seek to enable nurses to demonstrate healthy empathy and have the energy to support patients while also reducing the risks of clinical mistakes stemming from psychological discomfort. Combined with the possibility of promoting better nurse staffing ratios by reducing turnover, these effects can boost patient outcomes by preventing clinical errors and maintaining the high quality of nurse-patient communication. The possible impacts on turnover rates and safety can also benefit families. For instance, patients’ families will trust the facility more, becoming less concerned about care quality and their relatives’ hypothetical prognoses. Finally, by promoting better new nurse retention rates, the project will increase the South Baltimore community’s access to high-quality mental health nursing care.
Context for the Doctoral Project
The setting for the staff education project is an inpatient behavioral health facility located in the Southern District of Baltimore, MD. The practicum setting offers rehabilitation and health improvement programs for adult patients with diverse mental health needs and diagnoses. These include substance use disorders and non-life-threatening psychological conditions that require attention, supervision, and assistance in structuring daily activities to promote mental health restoration and reintegration into society.
The practicum setting is a 50-bed facility with 23 private and double rooms selected based on the patient’s needs and ability to socialize. The facility’s interprofessional team currently consists of 6 psychiatrists, 7 occupational therapy professionals and psychologists, 6 close-to-community specialists with degrees in social work, 40 LPNs, and 30 RNs. The facility has recently expanded its services and hired recent graduates to replace retiring and leaving nurses, so the current nursing workforce includes 18 employees in their first year in the behavioral health profession (8 RNs and 10 LPNs). Regarding educational levels, 10 participants have earned practical nursing diplomas, 3 have ADN degrees, and 5 have BSN degrees. The age range for the abovementioned group is 19-33 years old.
Sources of Evidence
The high prevalence of CF among nurses signifies the need for educational interventions to reduce the incidence of secondary traumatic stress and its effects on well-being and workforce retention. Gustafsson and Hemberg (2021) argue that treatments for CF are poorly explored, whereas prevention, including organization-level actions, such as “direct/indirect peer support” and “increased awareness and knowledge” of CF, is a more effective way of battling CF (p. 3). The finding is relevant to the project since it highlights CF awareness-building efforts’ potential for promoting nurses’ well-being. In their correlational study in pediatric nurses, Walden et al. (2018) apply the ABC (awareness, balance, connections) CF prevention framework, with resilience education and staff training on self-care as the key measures of promoting awareness. This finding illustrates CF education’s role in reducing nurses’ self-care knowledge deficits, making it relevant to the planned staff teaching project. In their meta-analysis of 20 trials, Zhang et al. (2018) state that more than 52% of hospital nurses develop CF, and lower educational attainment is directly related to CF’s severity. Considering the practicum setting’s education-related statistics, this finding highlights the need for staff teaching in this particular group.
CF education has been shown to produce meaningful impacts on care facilities. Dreher et al. (2019) report that a 90-minute staff teaching program focused on CF awareness and self-care skills increases the retention of certified nursing assistants by more than 40% while also improving average compassion satisfaction scores. Adimando (2018) reports that educational workshops covering CF, its symptoms, and self-care strategies improve nurses’ CF-related knowledge, which is crucial to decreasing the issue’s incidence. Both studies support the need for the project by illustrating the benefits of CF education linked with staff retention and CF prevention.
The steps below will benefit the community by promoting compassionate care in the facility and supporting new nurses’ well-being:
- Ensure the facility’s support and obtain approval from the practicum site to complete the project.
- Create a 15-question CF knowledge assessment tool to be used before and after the staff education session.
- Applying the ADDIE model, create a brief staff training program on CF delivered in the form of a PowerPoint Presentation and handouts for participants (Kim et al., 2020).
- Measure participants’ CF knowledge and conduct the staff education session for first-year nurses.
- Reassess the participants’ CF knowledge after delivering the teaching session.
- Using descriptive statistics, analyze changes to CF knowledge levels using the t-test approach, thus addressing the practice-focused question.
The staff teaching program will promote self-care, thus posing no risks affecting behavioral nurses. All participants will be instructed on constructing unique identification codes to be entered during all data collection events. Approval from the site and the IRB will be obtained to proceed with the project, and no patient information will be included in educational materials. The project will meet the IRB’s requirements by utilizing data sources falling under the IRB pre-approval. These include literature as data and anonymous questionnaires for staff members. The pre-test/post-test data will be kept on the USB flash and the student’s personal computer. The student will be capable of accessing raw data, whereas the facility’s management will have access to the teaching program and the generalized descriptions of the project’s results without any deanonymizing details. The results will be used to consider making CF education a typical intervention. The staff education program will be kept by the facility for as long as needed, whereas raw data (questionnaires with detailed answer reports) will be kept during the entire project completion process and destroyed only after defending the final paper.
The project will align with Walden University’s staff education guidelines and the mission of promoting positive social change. The problem statement section details the lack of CF education for new nurses as a practice gap and informs the practice-focused question linked with education and quantifying the participants’ knowledge improvement. The context section confirms the question’s applicability to the practicum setting, and the sources of evidence explain the benefits of CF awareness programs for staff retention and well-being. The procedural approach and ethical considerations outline the process for addressing the question. The project will close the gap between new nurses’ insufficient CF knowledge and the existing personal self-care practices for CF prevention.
Adimando, A. (2018). Preventing and alleviating compassion fatigue through self-care: An educational workshop for nurses. Journal of Holistic Nursing, 36(4), 304-317.
Dreher, M. M., Hughes, R. G., Handley, P. A., & Tavakoli, A. S. (2019). Improving retention among certified nursing assistants through compassion fatigue awareness and self-care skills education. Journal of Holistic Nursing, 37(3), 296-308.
Gustafsson, T., & Hemberg, J. (2021). Compassion fatigue as bruises in the soul: A qualitative study on nurses. Nursing Ethics, 1-14.
Kim, S., Choi, S., Seo, M., Kim, D. R., & Lee, K. (2020). Designing a clinical ethics education program for nurses based on the ADDIE model. Research and Theory for Nursing Practice, 34(3), 205-222.
Maila, S., Martin, P. D., & Chipps, J. (2020). Professional quality of life amongst nurses in psychiatric observation units. South African Journal of Psychiatry, 26(1), 1-7.
Marshman, C., Hansen, A., & Munro, I. (2021). Compassion fatigue in mental health nurses: A systematic review. Journal of Psychiatric and Mental Health Nursing, 1-2.
Pehlivan, T., & Guner, P. (2018). Compassion fatigue: The known and unknown. Journal of Psychiatric Nursing/Psikiyatri Hemsireleri Dernegi, 9(2), 129-134.
Perregrini, M. (2019). Combating compassion fatigue. Nursing2019, 49(2), 50-54.
Peters, E. (2018). Compassion fatigue in nursing: A concept analysis. Nursing Forum, 53(4), 466-480.
Walden, M., Adams, G., Annesley-Dewinter, E., Bai, S., Belknap, N., Eichenlaub, A., Green, A., Huett, A., Lea, K., Lovenstein, A., Ramick, A., Salassi-Scotter, M., Webb, T., & Wessel, V. (2018). The emotional cost of caring for others: One pediatric hospital’s journey to reduce compassion fatigue. JONA: The Journal of Nursing Administration, 48(11), 545-552.
Zhang, Y. Y., Han, W. L., Qin, W., Yin, H. X., Zhang, C. F., Kong, C., & Wang, Y. L. (2018). Extent of compassion satisfaction, compassion fatigue and burnout in nursing: A meta-analysis. Journal of Nursing Management, 26(7), 810-819.