Compassion fatigue in mental health nurses: A systematic review
J Psychiatr Ment Health Nurs. 2022;29:529–543. wileyonlineli
ary.com/journal/jpm | 529© 2021 John Wiley & Sons Ltd.
Received: 4 June 2021 | Revised: 24 November 2021 | Accepted: 30 November 2021
DOI: XXXXXXXXXX/jpm.12812
R E V I E W A R T I C L E
Compassion fatigue in mental health nurses: A systematic
eview
Cameron Marshman1,2 | Alison Hansen1,2 | Ian Munro1,2
1School of Nursing and Midwifery,
Monash University, Clayton, Victoria,
Australia
2Australian College of Mental Health
Nurses, Clayton, Australian Capital
Te
itory, Australia
Co
espondence
Cameron Marshman, School of Nursing
and Midwifery, Monash University,
Clayton, Vic., Australia.
Email: XXXXXXXXXX
Funding information
The authors declare nil funding sources to
e disclosed
Accessible Summary
What is known on the subject?
• Compassion fatigue is the result of the unique stressors inherent in caregiving
work, leading to a loss of compassion in clinical practice that may result in nega-
tive outcomes for mental healthcare consumers.
• Compassion fatigue has clear emotional and physical costs and significant im-
pacts on staff recruitment and retention.
What the paper adds to existing knowledge?
• This review is the first to evaluate the quantitative literature on compassion
fatigue in mental health nurses.
• Research on compassion fatigue in mental health nurses does not accurately ac-
count for the unique care relationship between nurse and consumer.
• Competency- based education, strong mental health nurse leadership, positive
organizational cultures, clinical supervision and reflection alongside individual
self- care strategies may mitigate compassion fatigue.
What are the implications for future practice?
• Resources are urgently needed for education and workforce development that
addresses compassion fatigue in mental health nurses.
• Interventions addressing the physical, cognitive and emotional demands of care
work are needed to ensure mental health nurses have the capability to provide
sustainable compassionate care to consumers.
Abstract
Introduction: Although compassionate care is an essential component of mental health
nursing, understandings of the impact of compassion fatigue is poorly understood.
Aims/Questions: To examine and synthesize available data on the prevalence of com-
passion fatigue within mental health nurses and consider what variables impact com-
passion fatigue.
Method: A search of MEDLINE, EMBASE, PsychINFO, Emcare, Web of Science,
Scopus, CINAHL and grey literature for articles published between 1992 and Fe
uary
2021 was conducted. Data were extracted from articles meeting inclusion criteria and
integrated using na
ative synthesis.
Results: Twelve articles were included. Prevalence of compassion fatigue ranged from
low to high. Variables were identified that may mitigate the risk of compassion fatigue.
Strong leadership and positive workplace cultures, clinical supervision, reflection,
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530 | MARSHMAN et Al.
1 | INTRODUC TION
Compassion is often a core value of healthcare organizations and
should underpin the delivery of high- quality mental healthcare
(Cleary et al., XXXXXXXXXXThe use of compassion by mental health (MH)
nurses may help enhance consumers feelings of safety (Cutler et al.,
2020) and has been associated with increased consumer participa-
tion and engagement (Lloyd & Carson, XXXXXXXXXXHowever, compassion
fatigue (CF) may reduce the capability of nurses to provide high-
quality compassionate care (Salyers et al., 2015, XXXXXXXXXXThe use of
empathy and compassion by MH nurses makes them particularly
susceptible to CF as they work closely with consumers on a daily
asis and are constantly exposed to the emotional pain and trauma
of others (Turgoose & Maddox, XXXXXXXXXXDespite potential negative
impacts for MH nurses, consumers and families, and healthcare or-
ganizations, our understanding of CF in MH is limited in comparison
with the
oader nursing profession and other healthcare disciplines.
The immeasurable costs of CF are something healthcare organi-
zation cannot afford to dismiss in a global environment experiencing
critical MH nursing shortages. Nurse recruitment is a global concern
(World Health Organization, 2018) and countries, such as Australia,
are predicting an undersupply of 18, 500 MH nurses by the year
2030 (Health Workforce Australia, XXXXXXXXXXMoreover, retention
data from a study in the United States found 17.5% of MH nursing
graduates left the profession after 1 year and 33.5% of MH nurs-
ing graduates departed the profession after 2 years (Pelletier et al.,
2019). Cu
ent research has linked high CF to increased staff turn-
over intention (Sung et al., 2012), and authors have argued CF has
clear implications for sustainable workforce retention (Jakimowicz
et al., XXXXXXXXXXIn a global environment suffering with the stress and
demands of COVID- 19 (Muller et al., 2020), healthcare organizations
must acknowledge the economic and psychosocial impacts of CF,
including the daily “
ain drain” that is occu
ing.
The impact of CF on MH nurses results in clear physical and emo-
tional consequences for individual nurses (Melvin, 2012; Nolte et al.,
2017; Todaro- Franceschi, 2019), including feeling physically ex-
hausted and angry (Boyle, 2011), filled with a sense of helplessness
and disconnectedness (Ha
is & Griffin, 2015) and reduces a nurses
ability to feel empathy towards consumers and their families (Jenkins
& Wa
en, XXXXXXXXXXDespite the economic, emotional and physical im-
pacts of CF, the concept has received limited attention within the
MH nursing research.
Although CF has been recognized as a global area of concern
across a variety of contexts and disciplines, the aetiology of CF is
inconsistent. It has been suggested CF is perpetuated by personal,
work- related and psychological factors (Yang & Kim, XXXXXXXXXXOther
studies have noted significant differences in the aetiology of CF
across varied areas of specialization (Branch & Klinkenberg, 2015;
Yoder, 2010).
The concept of CF was first defined as a unique form of burn-
out that is inherent in caregiving work (Joinson, XXXXXXXXXXThe term
CF was later adopted by Figley XXXXXXXXXXand described as “a state of
exhaustion and dysfunction, biologically, physiologically, and emo-
tionally, as a result of prolonged exposure to compassion stress” (p.
34). Other authors contend CF may be better understood as moral
distress (Forster, 2009), or as empathic distress fatigue (Klimecki
& Singer, XXXXXXXXXXThis review defines CF as being the end result of
prolonged, cumulative exposure to stress and trauma (Ainsworth &
Sgo
ini, 2010; Coetzee & Klopper, 2010; Figley, 1995, 2002).
Initial measures of CF focused only on the negative aspects
of care and included subscale measures of burnout (BO) and later
secondary traumatic stress (STS). These include the 40- item
Compassion Fatigue Self- Test (CFST) that consisted of CF and BO
subscales (Figley, 1995; Figley & Stamm, XXXXXXXXXXThis was later re-
vised to become the 30- item Compassion Fatigue Scale- Revised
(CFS- R) containing BO and CF subscales (Adams et al., XXXXXXXXXXThe
concepts of BO and CF have been closely related from the outset,
with the impacts of BO resulting in similar physical, emotional and
cognitive impacts (Maslach, XXXXXXXXXXHowever, the most used mea-
sure of CF today is the Professional Quality of Life scale (ProQOL)
(Stamm, XXXXXXXXXXThe ProQOL is a measure of the positive and nega-
tive aspects of care work. The cu
ent version ProQOL- V consists
of 30 items across three subscales consisting of compassion sat-
isfaction (CS), BO and secondary traumatic stress (STS) (Stamm,
self- care and personal well- being may protect mental health nurses against compas-
sion fatigue.
Discussion: Future research is needed on mental health nurses lived experience of
compassion fatigue and their understandings of compassion.
Implications for Practice: Interventions should focus on increasing awareness of com-
passion fatigue and building individual and organizational resilience. Both organiza-
tions and individuals should be aware of the role they play in maintaining the capacity
and capability for mental health nurses to provide sustainable and compassionate
mental healthcare.
K E Y W O R D S
compassion fatigue, mental health nurse, nurses, resilience, self- care, systematic review
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| 531MARSHMAN et Al.
2010). In previous versions, the STS subscale has measured CF,
however, in the cu
ent version CF is defined as consisting of two
components, BO and STS (Stamm, XXXXXXXXXXThe most substantial
change in measures of CF is the inclusion of the CS subscale. The
term CS is defined as positive feelings derived from a person's
work with others (Stamm, XXXXXXXXXXIts inclusion recognizes the po-
tential protective impact positive aspects of the helping relation-
ship may have in reducing the risk of CF.
The ProQOL measure has been instrumental in researching the
issue of CF globally and across healthcare disciplines. Studies have
een conducted in America (Hunsaker et al., 2015), New Zealand
(Severn et al., 2012), Australia (Hegney et al., 2014) and Korea
(Lee & Yom, 2013) and within emergency departments (Hamilton
et al., 2016; Hunsaker et al., 2015), intensive care units (Mason
et al., 2014), oncology (Potter et al., 2010) and paediatrics (Branch
& Klinkenberg, XXXXXXXXXXThe consequences of CF have been iden-
tified within various disciplines besides nurses including physi-
cians (Huggard & Dixon, 2011); midwives (Beaumont et al., 2016);
nursing students (Mason & Nel, 2012); and social workers (Adams
et al., 2006).
There are no consistently identified protective factors for CF
across the literature. Potentially protective factors include in-
creased age and experience (Berger et al., 2015; Sinclair et al.,
2017); post- graduate education (Jakimowicz et al., 2018; Zhang
et al., 2018); self- care (Alkema et al., 2008; Dasan et al., 2015), self-
compassion (Beaumont et al., 2016), maintaining work– life bound-
aries (Bourassa, 2012; Pe
y et al., 2011; Peters, 2018), emotional
intelligence (Zeidner et al., 2013), positive teams (Dasan et al., 2015),
and group cohesion and organizational commitment (Li et al., 2014).
While some larger studies include data from MH nurses, for example
Hegney et al. (2014), our understanding of perpetuating and protec-
tive factors that may be unique to MH nursing is limited and is an
area requiring further research.
Our cu
ent understanding of the prevalence of CF in MH
nursing is poorly understood. The prevalence of CF in healthcare
providers is also unclear (Cavanagh et al., XXXXXXXXXXAdditionally, de-
spite the amount of research on CF across health care, two re-
cent systematic reviews of interventions for CF have found limited
evidence for any strategy to address CF (Blomberg et al., 2016;
Cocker & Joss, XXXXXXXXXXIn healthcare systems already ove
ur-
dened from the COVID- 19 pandemic, the consequences of not
acknowledging and attempting to address the impacts of CF are
evident in recruitment and retention issues and have significant
economic costs for healthcare organizations. However, ultimately,
the impacts of CF fall upon MH nurses and the consumers and
families for whom they care.
1.1 | Aims and questions
This review aims to explore and describe the prevalence of CF in MH
nurses in any MH care context and to consider the variables that
influence CF.
The research questions were as follows:
1. What is the prevalence of compassion fatigue in mental health
nurses?
2. What variables affect compassion fatigue in mental health nurses?
2 | METHODS
2.1 | Search strategy
The review was conducted in MEDLINE, EMBASE, PsychINFO,
Emcare, Web of Science, Scopus, CINAHL, ProQuest dissertations
and thesis global. Additionally, a search was undertaken of Google
search engine. The search was conducted on 9 Fe
uary 2021.
Search terms included Community Mental Health Nursing/ OR
Psychiatric nursing/ OR “mental health nurs*” OR “mental health
clinician” OR “psychiatric nurs*” OR “psychiatric clinician” AND
Compassion Fatigue/ OR “secondary trauma” OR “vicarious trauma”
OR ProQOL OR “professional quality of life” OR “secondary trau-
matic stress scale.” Related terms, such as secondary trauma and
vicarious trauma, were included to ensure all relevant articles were
captured during the search. Table 1 outlines the search strategy.
2.2 | Inclusion/exclusion criteria
Studies were included if they utilized a quantitative design and a
validated measure of CF within a population of nurses working in
TA B L E 1 Review parameters
Databases searched MEDLINE, EMBASE, PsychINFO, Emcare, Web of Science, Scopus, CINAHL, ProQuest
dissertations and thesis global, and Google search engine
Search terms Community Mental Health Nursing/ OR Psychiatric nursing/ OR “mental health nurs*” OR
“mental health clinician” OR “psychiatric nurs*” OR “psychiatric clinician”
AND
Compassion Fatigue/ OR “secondary trauma” OR “vicarious trauma” OR ProQOL OR
“professional quality of