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JOURNAL OF ADVANCED NURSING

CONCEPT ANALYSIS

Compassion fatigue in family caregivers: a Wilsonian concept analysis


Susan H. Lynch & Marie L. Lobo
Accepted 19 February 2012

Correspondence to S. Lynch:
e-mail: sulynch@salud.unm.edu
Susan H. Lynch MSN RN CNE
Doctoral Student
College of Nursing,
University of New Mexico,
Albuquerque, NM, USA
and Lecturer
RN BSN Coordinator
School of Nursing,
University of North Carolina-Charlotte,
Charlotte, NC, USA
Marie L. Lobo PhD RN FAAN
Professor
College of Nursing
University of New Mexico
Albuquerque, NM, USA

L Y N C H S . H . & L O B O M . L . ( 2 0 1 2 ) Compassion fatigue in family caregivers: a


Wilsonian concept analysis. Journal of Advanced Nursing 68(9), 21252134.
doi: 10.1111/j.1365-2648.2012.05985.x

Abstract
Aim. An analysis of the concept of compassion fatigue in family caregivers.
Background. The term compassion fatigue is predominantly used with professional caregivers, such as nurses, doctors and social workers. Secondary traumatic
stress, burnout, and other related terms are often cited in the literature in conjunction with compassion fatigue. Although compassion fatigue is linked to professional caregivers as a result of exposure to traumatizing events, minimal
knowledge has been developed regarding its presence in family caregivers.
Data sources. Literature published between 19802010 from the humanities,
nursing and the social sciences, including psychology, sociology, social work, and
religion, was reviewed. Data sources included dictionaries, newspapers and multiple
academic databases, such as Academic Search Complete, Atla, CINAHL, PsychInfo,
and PubMed.
Review methods. Wilsons concept analysis strategy was employed to frame the
analysis of compassion fatigue, using model, contrary, related, and borderline cases
to illustrate the concepts meaning in relation to family caregivers.
Results. Analysis revealed that the concept is predominantly used in relation to
healthcare providers. Parallels are drawn between the role of healthcare providers
and family caregivers. Compassion fatigue occurs when a care-giving relationship
founded on empathy potentially results in a deep psychological response to stress
that progresses to physical, psychological, spiritual, and social exhaustion in the
family caregiver.
Conclusion. This concept analysis clarified the definition and revealed that the
concept of compassion fatigue has potential use with family caregivers. Implications
for practice and research are identified.
Keywords: caregivers, compassion fatigue, concept analysis, family, nurses, nurisng

Introduction
Families worldwide provide extensive nursing care to family
members with a multitude of chronic and acute health
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conditions that previously were treated in hospitals. As


healthcare costs rise, the responsibility of patient care more
frequently resides with families. This changed relationship is
often long term and places the caregiver at risk physically,
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emotionally, and spiritually. Compassion fatigue has been


studied predominantly in regard to professional caregivers.
However, family care giving can be considered similar to
professional care giving. In families, a limited number of
individuals have the responsibility of providing 24-hour
care. This intense experience may exceed that of the
professional and lead family caregivers to experience
compassion fatigue.

Background
The term compassion fatigue was first used in the 1980s;
confusion about its meaning exists, however. Multiple
related concepts have been used in the literature and
compassion fatigue is often cited as an additional term for
secondary traumatic stress. Additional terms associated
with compassion fatigue include vicarious traumatization,
countertransference, and burnout (Figley 1995, Gentry
2002).
The focus of this concept analysis was to explore
compassion fatigue in family caregivers and to establish
the current conceptual use to determine the relevancy to
family caregivers. The concept analysis was conducted
according to Wilsons (1963) method to provide conceptual
clarity. Wilson introduced the technique of concept analysis
and asserted that questions of concept, not fact or value,
require analysis, with the definition and meaning of a
concept dependent on circumstance. Therefore, the aim of
concept analysis is to determine how the concept is
presently used and how it may be used in the future
(Wilson 1963).

Data sources
To analyse compassion fatigue in family caregivers, Englishlanguage dictionaries, newspapers, relevant websites and
academic databases, including Academic Search Complete,
Atla, CINAHL, PsychInfo, and PubMed, were searched.
Search terms included compassion fatigue, secondary
traumatic stress, vicarious traumatization, countertransference, and burnout. In addition, these terms were
searched in conjunction with family caregivers and caregiving. Literature published between 19802010 from
the humanities, nursing and social sciences, including
psychology, sociology, social work, and religion, was
reviewed. Inclusion of articles was based on relevancy of
content regarding background, definition, use, defining
attributes, and consequences of compassion fatigue. Articles
that did not make reference to compassion fatigue were
excluded.
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Results
Develop the right answers
According to Wilson (1963), right answers referred the best
use of the concept in the context of inquiry. Prior to 1992, the
term compassion fatigue was generally used to describe
Americans lack of charitable giving. The term was first used
in 1983 by Charles Sternberg, former director of the
International Rescue Committee, to describe the lack of
public interest in helping refugees after the Soviet Union
invasion of Afghanistan and other world events that resulted
in a high number of refugees (Compassion fatigue 1983).
More recently, Fry (2005) noted that the news medias
prolonged focus on such negative events may eventually lead
to a decline in timely response or any response to similar
occurrences (p. 1020), resulting in compassion fatigue.
However, compassion fatigue continues to be primarily
associated with the experience of professional caregivers,
such as nurses, doctors, chaplains, social workers, counsellors
and psychologists. Joinson (1992) is often cited as the first to
use the term in reference to healthcare providers in an effort
to describe the burnout of emergency room nurses. The
concept was used to describe nurses feelings related to caring
for patients who had experienced trauma. Dictionaries now
define the term in relation to these two major uses of the
concept.
The Oxford English Online Dictionary (Compassion
fatigue 2002b) defines compassion fatigue as apathy or
indifference towards the suffering of others or to charitable
causes acting on their behalf, typically attributed to numbingly frequent appeals for assistance, esp. donations; (hence)
a diminishing public response to frequent charitable appeals.
Chambers 21st Century Dictionary (Compassion fatigue
2001) defines it as progressive disinclination to show
compassion because of continued or excessive exposure to
deserving cases. Other dictionaries, including The Penguin
English Dictionary (Compassion fatigue 2007), Dictionary of
Media Studies (Compassion fatigue 2006), and Brewers
Dictionary of Modern Phrase and Fable (Compassion fatigue
2002a), define compassion fatigue similarly.
Medical dictionaries define the concept in relation to
caregivers. Some references specifically state the application
to healthcare professionals, whereas others do not. Tabers
Cyclopedic Medical dictionary (Compassion fatigue 2009),
for example, defines compassion fatigue as cynicism, emotional exhaustion, or self-centeredness occurring in a healthcare professional previously dedicated to his or her work and
clients. Mosbys Dictionary of Complementary and Alternative Medicine (Compassion fatigue 2005b) defines it as
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emotional drain experienced by caregivers, usually after


caring for another with a progressive illness. Finally, the
Macquarie Dictionary (Compassion fatigue 2005a) defines
compassion fatigue as a physical, emotional and spiritual
exhaustion that reduces ones ability to care for others, as
caused by long periods of demanding caregiving.
The most often cited author related to compassion fatigue
is Charles Figley (1995), who said, Compassion fatigue is
defined as a state of exhaustion and dysfunction biologically, psychologically, and socially as a result of prolonged
exposure to compassion stress and all that it evokes (p. 253).
Figley (2002) also noted that Compassion fatigue, like any
other kind of fatigue, reduces our capacity or our interest in
bearing the suffering of others (p. 1434). McHolm (2006)
added a spiritual component to the definition, stating that
compassion fatigue describes the emotional, physical, social,
and spiritual exhaustion that overtakes a person and causes a
pervasive decline in his or her desire, ability, and energy to
feel and care for others (p. 14).
Figley (1995) described compassion fatigue as being
synonymous with secondary traumatic stress, which is
defined as the natural consequent behaviours and emotions
resulting from knowing about a traumatizing event experienced by a significant other; the stress resulting from helping
or wanting to help a traumatized or suffering person (p. 7).
Similarly, Abendroth and Flannery (2006), Yoder (2010),
Maytum et al. (2004) and Burtson and Stichler (2010)
referred to compassion fatigue as a secondary traumatic
stress reaction. Meadors and Lamson (2008) defined compassion fatigue as a natural consequence of working with
those who have experienced a trauma or another stressful
event (p. 26).
In 2006, Adams et al. defined compassion fatigue as the
formal caregivers reduced capacity or interest in being
empathic or bearing the suffering of clients and is the natural
consequent behaviours and emotions resulting from knowing about a traumatizing event experienced or suffered by a
person (p. 2). Aycock and Boyle (2009) simply defined
compassion fatigue as severe malaise as a result of caring
for patients who are in pain or suffering (p. 184). Bush
(2009) referred to compassion fatigue as a complex
phenomenon that escalates gradually as a product of
cumulative stress over time (p. 25). Similarly, Udipi et al.
(2008) considered empathic exposure to patients in addition
to caregivers life circumstances as contributors to compassion fatigue. Coetzee and Klopper (2010) defined compassion fatigue as the final result of a progressive and
cumulative process that is caused by prolonged, continuous
and intense contact with patients, the use of self and
exposure to stress (p. 237).
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Compassion fatigue

Spirituality is a dimension of compassion fatigue that has


had limited exploration. Flannelly et al. (2005) found that
chaplains responding after the 11 September terrorist attacks
reported low levels of compassion fatigue and burnout and
high levels of compassion satisfaction. Taylor et al. (2006)
found similar results with rabbis working as chaplains. These
results point to the possible protective quality of faith or
spirituality.

Related terms
Many authors have used multiple terms when describing
compassion fatigue. Thus, there is confusion about the
definitions of compassion fatigue and its related terms,
including secondary traumatic stress, vicarious traumatization, countertransference, and burnout. Differentiation of
these related terms is needed to clearly understand the
concept of compassion fatigue. Naijar et al. (2009) believe
that all of the related terms can be a result of patient
engagement and can negatively affect the caregiver; however,
there are significant differences among them.
Secondary traumatic stress and compassion fatigue are the
two concepts most closely linked. Naijar et al. (2009) stated
that secondary traumatic stress refers to a set of psychological
symptoms that occur as a result of exposure to patients
suffering a trauma, whereas compassion fatigue is a unique
form of burnout in which the cause is not work related
stressors but the empathic responses caregivers provide in
response to patients suffering. Meadors et al. (2009) pointed
out that compassion fatigue has a different meaning than
secondary traumatic stress because of the role of empathy
and the desire to help the suffering person.
Burnout and compassion fatigue have also been discussed
in similar terms. Keidel (2002) referred to compassion fatigue
as a less abrasive term for burnout and used the two terms
interchangeably. Sabo (2006) described burnout as a gradual
process resulting from responses to the work environment,
whereas compassion fatigue has an acute onset that results
from caring for people who are suffering. Rourke (2007)
further explained that burnout is a global long-term consequence of working in stressful environments, whereas compassion fatigue is a more immediate reaction to the stressful
care-giving experience. Therefore, the primary difference
between the two lies in the factors that lead to the primary
stress.
McHolm (2006) distinguished compassion fatigue from
burnout by describing them as distinct levels: burnout,
compassion fatigue level 1 (CF-1), and compassion fatigue
level 2 (CF-2). Burnout is associated with intense nursing
work with response to the environment, whereas CF-1 is
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characterized by close identification with and absorption of


the patients trauma or pain. CF-2 progressed towards the
potential reexperience of events described by the patient.
Thus, anyone in a stressful work environment is at risk for
burnout; however, those who care for patients and repeatedly
observe and listen to experiences of pain and fear are at risk
for compassion fatigue (McHolm 2006).
Differing opinions exist regarding the relationships among
compassion fatigue, secondary traumatic stress, and burnout.
Maytum et al. (2004) noted that prevention of compassion
fatigue reduces burnout. Conversely, Udipi et al. (2008)
found that burnout was the strongest predictor of compassion fatigue and thus suggested that burnout was a precursor
of compassion fatigue. Sabo (2006) asserted that the presence
of burnout increases the chance of compassion fatigue.
Similarly, Abendroth and Flannery (2006) stated that caregiving stress can lead to burnout and eventually compassion
fatigue. Collins and Long (2003) also suggested that burnout
is a risk factor for compassion fatigue. Meadors et al. (2009),
however, found that burnout had only a weak correlation
with compassion fatigue. In addition, they found that
secondary traumatic stress and compassion fatigue may be
uniquely different concepts and that secondary traumatic
stress is a stronger predictor of compassion fatigue than
burnout.
Vicarious traumatization has been related to compassion
fatigue. Bush (2009) described vicarious traumatization as
the process by which professional caregivers begin to
integrate the patients experiences and emotions into their
own and this changes the caregivers perspective on life
issues. Sabo (2006) stated that the major difference between
compassion fatigue and vicarious traumatization was that in
vicarious traumatization, the professional caregiver undergoes a transformation in their personal and professional
belief systems (p. 138). Naijar et al. (2009) also noted that
vicarious traumatization was a cumulative process through
which professionals views of themselves and the world were
altered. This transformation was permanent and unconscious, unlike compassion fatigue, in which the caregiver has
greater awareness of symptoms, making it more manageable
(Benoit et al. 2007).
An additional related term is countertransference. Sabo
(2006) defined transference as an unconscious attunement to
and absorption of a clients trauma (p. 138). Figley (1995)
further explained that countertransference appears to be an
emotional reaction by the therapist. Figley (1995) cited
Freuds work, stating that countertransference in the context
of psychotherapy is the distortion on the part of the therapist
resulting from the life experiences and associated with her or
his unconscious, neurotic reaction to the clients transference
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(p. 9). Figley (2002) further asserted that countertransference


is related more to chronic attachment than to empathy with a
patients trauma. Berzoff and Kita (2010) differentiated the
two concepts by noting that countertransference is a
purposeful tool that can be used in clinical encounters to
gain access to the patients experiences. Conversely, compassion fatigue is based on caring experiences, develops over
time, and results in emotional exhaustion, depletion, and
work avoidance. Although Berzoff and Kita (2010) referred
to the professional therapist in describing compassion fatigue,
they acknowledged its existence with family caregivers.

Definition of compassion fatigue


As noted, multiple definitions have been proposed for
compassion fatigue. However, the relationship and parallels
drawn to secondary traumatic stress leave the concept of
compassion fatigue unclear. Figleys (1995) definition, a
state of exhaustion and dysfunction biologically, psychologically, and socially as a result of prolonged exposure to
compassion stress and all it evokes (p. 253), seems to be the
most comprehensive. This definition better encompasses the
multiple dimensions of the concept, whereas the secondary
traumatic stress definition has a central focus related to the
knowledge of a patients traumatic event, not the impact the
event or prolonged stress has on the caregiver.
After analysis, compassion fatigue in family caregivers is a
resultant condition experienced by caregivers who provide
daily care to seriously ill or dying family members and are
simultaneously exposed to the patients pain while experiencing their own emotional pain. In addition, compassion
fatigue occurs when a care-giving relationship founded on
empathy potentially results in a deep psychological response
to stress that ultimately progresses to physical, psychological,
spiritual, and social exhaustion.

Defining attributes
The defining attributes of compassion fatigue include an
established relationship between caregiver and patient,
empathy, stress, shared experiences, and a psychological
response. An established relationship, stress, and shared
experiences are all linked to the care-giving role and the
psychological and physical responses that it evokes. Yoder
(2010) found that triggering events for nurses revolved
around taking care of patients who were experiencing serious
life-threatening situations. Cases involving futile care also led
to compassion fatigue. Finally, Yoder (2010) found that both
personal and system issues triggered compassion fatigue.
Personal issues included inexperience and inadequate energy.
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System issues included heavy assignments, acuity, and extra


work days. Yoder (2010) offered this statement from one
study participant who identified what contributes to compassion fatigue: constant prioritizing, juggling, 100 things at
a time, emergency life, and death situations (p. 194).
Shared experiences and stress capture the uniqueness of
care-giving relationships, including both positive and negative components. Coetzee and Klopper (2010) recognized
a sequence of events leading up to compassion fatigue,
including the progressive elements of compassion discomfort, compassion stress, and finally compassion fatigue.
This sequence of events is reasonable; however, Figley
(1995) reported that compassion fatigue occurs with one
encounter and one interaction in the context of many,
indicating the acute potential of the concept. Figley (1995)
and Coetzee and Klopper (2010) acknowledge that progressive and cumulative stress brings the risk of compassion
fatigue.
For compassion fatigue to result, empathy must be present
in the caregiver. The caregiver must have the ability to
perceive and focus on what the patient is feeling and be able
to comprehend and communicate this understanding (Naijar
et al. 2009). Figley (2002) reported that empathy and
emotional energy are the driving forces for working with
suffering patients. Robins et al. (2009) noted that there was a
positive predictive relationship between affective empathy,
including personal distress measures and secondary traumatic
stress and compassion fatigue. They also found that higher
cognitive empathy scores were associated with lower compassion fatigue scores. Finally, Figley (2002) suggested that
the ability to empathize is the critical component in both
caring for those who are suffering and being susceptible to
the costs of caring.
The psychological response to the conflicting elements of
empathy and suffering is foundational to continued progression of stress and resulting compassion fatigue. Perry
et al. (2010) found that caregivers were unable to disengage
from the care-giving role and seek respite. Figley (2002)
proposed that 10 variables empathetic ability, empathetic
concern, exposure to the client, empathic response, compassion stress, sense of achievement, disengagement, prolonged exposure, traumatic recollections, and life disruption
interact to contribute to the development of compassion
fatigue.
The defining attributes of compassion fatigue as discussed
paint a picture of the care-giving relationship that results in
compassion fatigue. Ultimately, compassion fatigue results
from the change in empathetic ability of the caregiver
in reaction to the continual overwhelming stress of
care-giving.
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Compassion fatigue

Consequences
The consequences of compassion fatigue include psychological,
physical, spiritual, and social symptoms. Psychological effects
include being critical of others and apathetic, depersonalizing
patients, having a diminished sense of accomplishment, depression, anxiety, and feelings of isolation (McHolm 2006).
Showalter (2010) further described the costs of caring to
include fatigue, depression, withdrawal from family and
friends, loss of interest in things that were once enjoyed and
recurrent thoughts and images related to the problems of others.
Psychological overload may cause caregivers to lose objectivity
and the ability to be helpful (Conrad & Kellar-Guenther 2006).
Physical symptoms include fatigue, exhaustion, weight
changes, muscle tightness, gastrointestinal complaints, rapid
pulse, hypertension, headache, and sleep disturbances
(McHolm 2006, Showalter 2010). Socially, symptoms
included abuse of chemicals or food, spending less time with
patients or friends, sarcasm, cynicism, and feeling others are
incompetent (McHolm 2006). Spiritual symptoms involve
doubts of values and beliefs and an inability to feel joy.
Finally, professional symptoms involve job dissatisfaction,
inappropriate judgment, overworking, and inability to maintain a balance of empathy and objectivity (McHolm 2006).
It is evident that physical and psychological symptoms are
commonly reported among those at high risk for compassion
fatigue. In a qualitative study of compassion fatigue in family
caregivers, Perry et al. (2010) found that two themes, role
engulfment and enveloping sadness, emerged. Specific symptoms reported in the role engulfment theme included sacrifice
of self, poor self-care and depleted energy. The enveloping
sadness theme included symptoms of despair, loss, hopelessness, and grief. Additionally, Hooper et al. (2010) found in
their study of emergency room nurses that those who scored
in the high-risk category (28%) for compassion fatigue
exhibited symptoms of frustration, depression, disengagement, impatience, hopelessness, and loss of sympathy.
In summary, the literature reports a variety of symptoms
associated with compassion fatigue. An exhaustive list of
symptoms is difficult to construct because they are uniquely
and individually experienced. As supported by Figley (2002),
consequences of compassion fatigue include any symptom
that occurs from the state of physical and psychological
exhaustion and dysfunction.

Cases
Model case
A model case is an example of use of the concept that clearly
describes the concept in the correct context. Wilson (1963)

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refers to this as an instance which we are absolutely sure is


an instance of the concept (p. 28).
Lisa had been taking care of her husband Jim, who was
diagnosed with amyotrophic lateral sclerosis, for the last
5 years. Jim had gradually declined and had been in a
wheelchair for the last 3 years. Lisa was his only caregiver
and often held his hand, massaged his legs, and read his
favourite books to him. Without warning, Jim went into
respiratory arrest at home and was resuscitated, transported
to the hospital and placed on a ventilator. Lisa was present at
the time of his arrest and remained at his bedside. She slept
fitfully in the recliner at his bedside, often waking from
dreams of his arrest. Lisa directed the nurses in his care,
telling them all his preferences and often ended up taking care
of him herself. She busied herself in his room and rarely
looked Jim in the eye. Lisa appeared to be exhausted and
distant. Lisa and Jims friends and family visited; however,
Lisa rarely engaged in conversation.
Contrary case
Wilson (1963) described contrary cases as those that are the
direct opposite of the model case. For the concept of compassion fatigue, a sense of achievement and compassion satisfaction are terms used to denote the fulfilment derived from
the care-giving experience and are considered preventive
factors (Figley 2002).
Dan had cared for his mother with Alzheimers disease for
the past 3 years. He was committed to caring for her himself
for as long as he possibly could. His mothers memory had
declined steadily and he was unable to leave her alone. Each
day, he felt rejuvenated by the simple things he and his
mother accomplished. The memory of a soccer game when he
was 10 or his mothers ability to find her way to the
bathroom after breakfast always put a smile on his face. Even
though it was stressful, day after day, Dan felt satisfied that
he was doing his best and his mother was happy.
Related case
Related cases are those that are based on concepts that are
similar or related to the analysed concept (Hupcey et al.
1997, Wilson 1963). Burnout, for example, is a concept often
associated with compassion fatigue. However, burnout has
been described as a gradual process that is progressive and is
related to job strain (Figley 1995, Sabo 2006). Some authors
have indicated that burnout is a result of compassion fatigue
(Maytum et al. 2004) and others (Collins & Long 2003, Sabo
2006, Udipi et al. 2008) have stated that it is a precursor.
Jane had cared for her daughter Mary, who has cystic
fibrosis, for the last 20 years. Mary needed constant care to
prevent respiratory complications. Jane had a system and
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routine for the tasks related to her daughters respiratory


medications and breathing treatments. Jane felt frustrated
with the daily struggle with transportation, insurance companies, and maintaining the services she needed to provide
the best care possible for Mary. Jane found herself angry at
the bureaucracy she constantly faced. She cried herself to
sleep every night when alone in her bed, fearing what would
happen next.
Borderline case
Borderline cases are those in which it is not clear whether
they represent the concept or not. These cases help the researcher analyse fully the concepts central idea (Wilson
1963). Secondary traumatic stress is a concept in the literature that has been associated with compassion fatigue. Figley
(1995), for example, stated that compassion fatigue and
secondary traumatic stress can be used interchangeably,
whereas others have attempted to differentiate the two concepts (Naijar et al. 2009).
John and Jill had been married for 30 years. Jill was
diagnosed with breast cancer and underwent chemotherapy
and surgery; she now has brain and liver metastases.
Together they decided on home based hospice care. During
the past 6 months, Jill had become more withdrawn as the
pain and nausea intensified. John reacted to every cry from
Jill. John felt helpless and was also withdrawing to escape the
pain. He consulted with the hospice staff to discuss Jills
current symptoms and treatment plan. He then revealed his
own feelings and symptoms related to fear, disinterest, pain,
and nausea that had accompanied him the past 6 months and
had increased over the last month.

Application to family caregivers


McHolm (2006) believed that compassion fatigue can be
experienced not only by healthcare professionals but by
family caregivers who are simultaneously exposed to the
patients pain while experiencing their own emotional pain.
However, questions remain about whether it is the number of
exposures related to suffering or the magnitude of the
experience that is significant. It is true that a family caregiver
has limited exposure to multiple patients; however, it could
be argued that the intensity and frequency of the exposure, in
addition to the strong emotional attachment, are equivalent
to or heightened compared with the experiences of professional caregivers. Figley (1995) reported that compassion
fatigue can occur acutely from only one exposure to a
traumatic event. This is often dependent on the relationship
between the caregiver and patient, however. Furthermore,
Meadors et al. (2009) found that the number of hours
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worked, number of traumatized patients and exposure to


patient death contributed no predictive value to compassion
fatigue in professional caregivers working with paediatric
populations.
Finally, Perry et al. (2010) concluded that family caregiving is comparable to professional care-giving because both
are founded on compassion. They suggested that the symptoms described by families are not just related to emotional
exhaustion, but are a deeper response related to the
caregivers exposure to the suffering of people with whom
they have strong emotional bonds.

Social context
Compassion fatigue can occur in any care-giving relationship
in which empathy occurs while caring for another. When the
caregiver is exposed to individuals who are suffering,
overexposure, and stress are potential stimuli for development of compassion fatigue. Figley (1995) stated that
compassion fatigue and secondary traumatic stress are
normal behaviours and emotions that occur in response to
another persons suffering. Thus, compassion fatigue needs to
be characterized as a normal reaction so that caregivers are
comfortable with acknowledging these feelings, which are
often perceived as negative.
Furthermore, the ability to anticipate and identify compassion fatigue is essential. The goal is not only to provide
relief for those in care-giving roles, but to provide support so
that patients receive the highest quality of care from
individuals who are psychologically and physically healthy.

Reanalyse
The concept, compassion fatigue, has not been developed by
theory and research for family caregivers, however, is
recognized as a potential negative outcome for caregivers.
In family caregiver research, caregiver stress, strain, and
burden emerged as concepts of interest. However, these
concepts do not specifically address the change in empathetic
ability due to the enormous stress of family care-giving.
Conceptual frameworks such as nurse caring (Burtson &
Stichler 2010, Hooper et al. 2010), stress models (Aycock &
Boyle 2009, Hooper et al. 2010), and systems theory (Keidel
2002) have been used as theoretical foundations for compassion fatigue research in nursing. Figley (1995, 2002) developed a conceptual model of compassion fatigue that
illustrates progression of the concept. As previously discussed, 10 variables interact to form a causal model with
supportive interventions potentially interrupting the progression for those suffering from compassion fatigue.
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Compassion fatigue

Reliability and validity


Reliability and validity of instruments used to measure
compassion fatigue are reported in studies examining compassion fatigue in healthcare providers. Presently, tools used
to measure compassion fatigue risk include the revised
Compassion Fatigue Self Test, now called the Professional
Quality of Life Scale, the Compassion Satisfaction and
Fatigue Test, and the Compassion Fatigue Scale. These tools
have subscales consisting of satisfaction, burnout, and
compassion fatigue and can be examined to determine
whether they can be utilized or adapted to family caregivers.
The reliability estimates on all the tools range from 0.86
0.94, with the exception of the subscale of burnout (0.72) on
the Professional Quality of Life Scale. Positive factor validity
is reported for the Compassion Fatigue Self Test and validity
is claimed but not reported for the Professional Quality of
Life Scale (Bride et al. 2007). Therefore, investigation should
be conducted on whether current measurement tools are
appropriate for the family caregiver population including
validation of the reliability and validity of current compassion fatigue measurement tools with family caregivers.

Discussion
Although the presence of compassion fatigue is evident
related to professional healthcare providers, its existence in
family caregivers is unknown. The analysis suggests that
compassion fatigue in family caregivers is possible. However,
limited research is available to substantiate this finding.
Therefore, the analysis focused on the present use of
compassion fatigue in healthcare providers. This translation
to family caregivers could be seen as a limitation. However,
with minimal research conducted on compassion fatigue in
family caregivers, an analysis specific to family caregivers was
not possible.
The selection of Wilsons (1963) technique of concept
analysis is based on aims to identify the meaning from present
and potential future use (Wilson 1963). Critics of Wilson
(1963) state that his method was to provide classroom
guidelines for analysis for high school students; not provide a
structured research method of concept analysis. However,
other methods of concept analysis in nursing including
Walker and Avant, Chinn and Kramer and Rodgers utilize
Wilsons approach for their foundation (Hupcey et al. 1997).
It is clear that compassion fatigue is an important concept
in the caregiver experience. Care-giving, whether provided by
the professional or a family member, creates stressful
situations that, if left unacknowledged and untreated, result
in a greater risk of compassion fatigue. Figley (1995) noted

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What is already known about this topic


The incidence and defining characteristics of
compassion fatigue in healthcare professionals have
been established.
Families provide extensive care to family members with
chronic and acute health conditions that previously
were treated in hospitals, which places the caregiver at
risk physically, emotionally, and spiritually.
Tools to measure the risk of compassion fatigue in
professional caregivers have established reliability and
validity.

What this paper adds


Compassion fatigue occurs when a care-giving
relationship founded on empathy potentially results in a
deep psychological response to stress that progresses to
physical, psychological, spiritual, and social exhaustion
in the family caregiver.
The defining attributes of compassion fatigue in family
caregivers include an established relationship between
the caregiver and patient, empathy, stress, shared
experiences, and a psychological response.
The consequences of compassion fatigue in family
caregivers include psychological, physical, spiritual, and
social symptoms.

Implications for practice and/or policy


This analysis can assist the nursing profession in using
the concept of compassion fatigue in family caregivers
for research, education, practice, and policy making.
Opportunities to explore the existence of compassion
fatigue in family caregivers exist.
Further research should explore the incidence and
experience of compassion fatigue in family caregivers to
support interventions to reduce risk and adverse effects.

Research on compassion fatigue has been mostly limited to


persons in the helping professions; thus, further exploration
of the concept to include family care-giving is needed.
Specifically, research could determine whether risks, causes,
predictors, and treatment strategies are similar for family
caregivers and professional caregivers.

Conclusion
In the family care-giving literature, the concept of caregiver
burden is commonly reported. However, no studies to date
have explored the potential relationship between compassion
fatigue and caregiver burden. Questions arise as to whether
these are similar and related concepts or unique and
individual concepts. Currently, tools to assess both compassion fatigue and caregiver burden focus on risk. Comparison
of the tools could uncover a potential relationship between
the concepts when analysing items to draw parallels,
contrasts, and conclusions about compassion fatigue and
caregiver burden. This comparison would provide insight
into the family caregivers experience to clarify the presence
and direction for future research.
This concept analysis clarifies the definition of compassion
fatigue in relation to related terms and supports the application to family care-giving. Compassion fatigue in caregivers
remains relevant for researchers to examine in regard to
causes, risk factors, symptoms, and treatment options to
ensure high-quality, compassionate care for patients. Further
research may result in identification of and support for
caregivers at risk for compassion fatigue.

Funding statement
This research received no specific grant from any funding
agency in the public, commercial, or not-for-profit sectors.

Conflict of interest
No conflict of interest has been declared by the authors.

that the difference between compassion fatigue and burnout


lies in the ability to treat the problem. Compassion fatigue
can be eliminated if the condition is acknowledged and
interventions, including rest from the care-giving situation,
occur. In contrast, burnout usually results in the need to
remove oneself from the occupation or setting in which the
care-giving takes place. Recognition and treatment are
pivotal in not only addressing the needs of the caregiver,
but also in ensuring that patients receive the best possible
care.
2132

Author contributions
All authors meet at least one of the following criteria
[recommended by the ICMJE(http://www.icmje.org/ethical_1author.html)] and have agreed on the final version:
substantial contributions to conception and design,
acquisition of data, or analysis and interpretation of
data;
drafting the article or revising it critically for important
intellectual content.
 2012 Blackwell Publishing Ltd

JAN: CONCEPT ANALYSIS

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