Burnout and Compassion Fatigue Terminology and Assessment Tools
Burnout
Herbert
J. Freudenberger conceived the term “burnout” and first used it as a
medical term in 1974 to describe a syndrome of “exhaustion, disillusionment,
and withdrawal resulting from intense devotion to a cause that failed to
produce the expected result.”1,2 The German born, New York
psychologist wrote from personal experience. He described the symptoms he
had at the time. Although he was in a thriving practice, he suffered
from perfectionism and had a self-imposed missionary zeal to help
addicts. He worked from 8 AM to 7 PM in a ritzy area on the Upper East
Side and then went to a free clinic in the Bowery and worked with the
indigent until 2 AM.3
The Maslach
Burnout Inventory (MBI) was constructed to measure the syndrome.4 The MBI was designed to assess
three components of burnout: emotional exhaustion, depersonalization, and
reduced personal achievement. Burnout was found to be the result
of mismatches in at least one of six areas: workload, control, reward,
community, fairness, or values.5 The MBI is not free,
but is available online.
Compassion Fatigue
The
term “compassion fatigue” (CF) was first coined as a medical term in 1992
when Joinson described a unique form of burnout that affected caregivers
and resulted in a, “loss of the ability to nurture.”6,7 This form of burnout: a) was
related to a variety of stressors including long hours, heavy workload,
and needing to respond to complex patient needs such as pain, trauma, and
emotional distress, b) resulted in nurses feeling tired, depressed, angry,
and detached, and c) was associated with ineffective performance.7 Over time the terminology describing
CF has not been precise. It is common for authors to define terms to
clarify what they mean within specific studies.
In an
extensively researched 2015 graduate
thesis on CF, Amanda Depippo states the term secondary traumatic
stress (STS) was originally used by Charles Figley to describe CF.8,9 Figley states compassion stress, CF,
STS, and secondary traumatic stress disorder (STSD) are equivalent
terms.9 He considers the condition that CF,
STS, and STSD describe to be nearly equivalent to posttraumatic stress
disorder (PTSD), “except that exposure to a traumatizing event by one
person becomes a traumatizing event for the second person.”9
Figley
suggests that, “perhaps PTSD should stand for Primary Traumatic Stress
Disorder, rather than Post Traumatic Stress Disorder since every
stress reaction is ‘post’ by definition.”9
“Caring
people sometimes experience pain as a direct result of their exposure to
other’s traumatic material… This situation -- call it Compassion Fatigue,
Compassion Stress, or Secondary Traumatic Stress – is the
natural, predictable, treatable, and preventable unwanted consequence
of working with suffering people,” Figley wrote.9
ProQOL
The
most common measurement tool for compassion fatigue, the Professional
Quality of Life (ProQOL), was developed by Beth Stamm.10,11 The ProQOL describes CF as
being comprised of burnout and secondary trauma and gives scores for each along
with a score for compassion satisfaction.
Ownership
of the ProQOL was transferred to the Center for Victims of Torture
(CVT) in 2017. CVT is a mental health and human rights nongovernmental
organization operating in several countries around the world. The CVT
plans on keeping the ProQOL free and available for use.
Provider Resilience App
The
ProQOL is also available as part of an interesting, useful, free phone
application, Provider Resilience,
which was developed by the National Center for Telehealth & Technology to
help healthcare providers guard against burnout and compassion fatigue when
helping veterans. The app has many features that apply to any healthcare
professional. The ProQOL is a 5-minute test on the app. It also has quick
surveys that provide data displayed on a dashboard to show one's resilience
rating and time since last vacation. The dashboard's Resilience Rating gauge is
based on completion of a Resilience Builders/Killers quiz that is recommended
daily, a Burnout toggle chart recommended weekly, and the ProQOL test that is
recommended monthly. For an in-depth YouTube review of the app view the bottom of my website resources page.
References
1. Freudenberger HJ, Richelson G. Burn-out :
the high cost of high achievement. Toronto : Bantam Books,; 1980.
2. Coles TB.
The solution to burnout. Vet Forum 2003;20:26–31.
3. Anon.
Planet Money Episode 740: Burnout, Dec 7, 2016. Available at:
http://www.npr.org/sections/money/2016/12/07/504734219/episode-740-burnout.
Accessed March 22, 2017.
4. Maslach C,
Jackson SE. The measurement of experienced burnout. J Occup Behav
1981;2:99–113.
5. Maslach C,
Jackson SE, Leiter M. The Maslach Burnout Inventory Manual: Third Edition. In:
Zalaquett CP, Wood RJ, eds. Evaluating Stress: A Book of Resources. The
Scarecrow Press; 1997:191–218.
6. Joinson C.
Coping with compassion fatigue. Nursing (Lond) 1992;22:116, 118–119, 120.
7. Boyle DA.
Countering compassion fatigue: a requisite nursing agenda. Online J Issues Nurs
2011;16.
8. Depippo A.
Compassion Fatigue and Self-Care Strategies among Addiction Professionals: A
Qualitative Study. 2015. Available at:
http://scholarcommons.usf.edu/cgi/viewcontent.cgi?article=6875&context=etd.
Accessed June 16, 2016.
9. Figley CR.
Compassion Fatigue: Toward a New Understanding of the Costs of Caring. In:
Stamm BH, ed. Secondary Traumatic Stress: Self-Care Issues for Clinicians,
Researchers, and Educators. Lutherville, MD: Sidran Press; 1995.
10. Stamm BH.
Professional Quality of Life Scale (proQOL): Compassion Satisfaction and
Compassion Fatigue. 2009. Available at: http://proqol.org/uploads/ProQOL_5_English_Self-Score_3-2012.pdf.
Accessed January 11, 2016.
11. Stamm BH.
The Concise ProQOL Manual. 2nd ed. Pocatello, ID: ProQOL.org; 2010. Available
at: http://www.proqol.org/uploads/ProQOL_Concise_2ndEd_12-2010.pdf.
