N302 Test II Lecture Notes DEATH AND DYING Objectives: Discuss communication goals with dying patients and their families, Describe stages ofGrief/Bereavement, Discuss Patient Self Determination Act/ Advanced Directives, Define Palliative Care Death is often referred to as “the final stage of growth.” Life is a moving process, it begins at birth, but when does it end? The style in w hich a person dies is very individual; just as their life was. Death is individual. A Cultural Perspective : It is unfamiliar, causes great fear in many people, the younger you are the more abstract the concept of death, it is hard to imagine oneself not being pa rt of this world. A Nursing Perspective: As nurses we are committed to life and health. • Dying is a contradiction to a nurse’s commitment. This can be seen by some nurses as a failure in theircare, or their skills. Your feelings will provide the foundation, driving the way you deliver care. Comfort at End of life: The nurse helps or soothes the dying patient. The key is respecting the dying person’s wishes. What is a good death?Is it peaceful, quick, slow, etc.? The Dying person may be uncomfortable because of: Pain, Breathing problems, Skin irritation, Digestive problems, Temperature sensitivity, Fatigue, etc. Focus on how these states can impact the nurse’s communication with the patient. Loss: A universal experience, Part of the life process, Involves emotional pain, Requires adjustment, *May result in personal growth End of Life Losses - Multiple Losses (for the patient): • Loss of physical functioning • Loss of social functioning • Loss of role • Loss of cognitive acuity What patient’s fear • Patients fear the dying process more than they fear death itself. • Fear being in pain, being left alone, being avoided by others who are uncomfortable with the idea ofdying. Stages of Death and Dying (70’s) • Denial-”no, not me.” • Anger-”why me?” • Bargaining-”yes, but…” • Depression-”yes me”
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Objectives: Discuss communication goals with dying patients and their families, Describe stages of Grief/Bereavement, Discuss Patient Self Determination Act/ Advanced Directives, Define Palliative Care
Death is often referred to as “the final stage of growth.” Life is a moving process, it begins at birth, but whendoes it end? The style in which a person dies is very individual; just as their life was. Death is individual.
A Cultural Perspective: It is unfamiliar, causes great fear in many people, the younger you are the moreabstract the concept of death, it is hard to imagine oneself not being part of this world.
A Nursing Perspective: As nurses we are committed to life and health.
• Dying is a contradiction to a nurse’s commitment. This can be seen by some nurses as a failure in their
care, or their skills. Your feelings will provide the foundation, driving the way you deliver care.
Comfort at End of life: The nurse helps or soothes the dying patient. The key is respecting the dying person’swishes.
What is a good death? Is it peaceful, quick, slow, etc.?
The Dying person may be uncomfortable because of: Pain, Breathing problems, Skin irritation, Digestive problems, Temperature sensitivity, Fatigue, etc. Focus on how these states can impact the nurse’scommunication with the patient.
Loss: A universal experience, Part of the life process, Involves emotional pain, Requires adjustment, *Mayresult in personal growth
End of Life Losses - Multiple Losses (for the patient):
• Loss of physical functioning
• Loss of social functioning
• Loss of role
• Loss of cognitive acuity
What patient’s fear
• Patients fear the dying process more than they fear death itself.
• Fear being in pain, being left alone, being avoided by others who are uncomfortable with the idea of
• Bereave – Be deprived of a loved one through a profound absence.
Dr. Eric Lindemann in the 1940’s studied grief over time:
Dr. Eric Lindemann, a Boston psychiatrist, studied survivors and their relatives and published what has becomea classic paper, “Symptomatology and Management of Acute Grief,” May 1944 considered to have laid thefoundation for research in this area.
Objectives: Discuss the connection between communication and medical errors. Describe standards of effectivecommunication. Identify the steps in using the SBAR method of information exchange.
Importance of Communication Among the Healthcare Team:
• Ineffective communication is a root cause for greater than two-thirds of all sentinel events reported.
Source: The Joint Commission’s Root Causes and Percentages for Sentinel Events (All Categories)January1995−December 2008
• 44,000-98,000 people die each year due to medical errors (IOM, 2000)
Health care involves complex interdependencies of personnel
Teams that do not communicate effectively are merely groups of people working side by side.
Examples of Interdependence: Multiple Care Transitions:
For every 1,000 persons aged 65:
• 400 ambulance rides
• 300 visits to Emergency Rooms
• 200 hospital admissions
• 46 SNF admits
• 106 home care visits
• Multiple patient Hand-offs
Factors Impacting Communication:
Multiple variables influence how the healthcare team communicates. Mistakes occur because peopleabuse their authority.
Audience – How might your interaction about a medication with a pharmacy tech differ from your interactionabout the same issue with a physician?
Mode of Communication – How might your face to face request to a physician for more pain medication for your patient differ from the same request over email?
Standards for communication:
• Avoiding “do not use abbreviations”.
• Verbal clarification for non-verbal responses: non-verbal communication can be a powerful tool for
therapeutic communication, but is not acceptable for transmitting patient care information.
• http://www.youtube.com/watch?v=Z8g_fkQb2F8 (Summary: Disruptive behavior breaks down the
dynamics of teamwork)
• Disruptive behavior: Any inappropriate behavior, confrontation, or conflict, ranging from verbal abuse
to physical or sexual harassment.
Silence Kills (2005 study AACN/VitalSmarts)
• Surveyed 1700 nurses, doctors, administrators
• 84% observed colleagues making dangerous shortcuts
• Less than 10% confronted their colleagues about it
Silent Treatment- follow-up study in 2010
• Dangerous shortcuts: unchanged from previous study
• Incompetence: 82% say that 10% of their colleagues are missing basic skills
• Disrespect: 85% say 10% of their colleagues undermine their ability to share concerns or speak up by
being disrespectful
The Joint Commission (Sentinel Event Alert #40)
• Disruptive behavior that intimidates others and affects morale or staff turnover can be harmful to patient
care. Leaders must address disruptive behavior of individuals working at all levels of the organization,including management, clinical and administrative staff, licensed independent practitioners, and
governing body members.Disruptive Behavior (Nadzam, 2009):
• Fosters medical errors
• Results in patient dissatisfaction
• Increases cost of care
• Leads to staff turnover
• Causes preventable adverse outcomes
Code of Conduct:
• Zero tolerance policy for disruptive behavior
• 60% of nurses new to the nursing practice, leave their first position in 6 months because of some form of
hostility directed to them by another nurse.
AACN Standards for Establishing and Sustaining a Healthy Work Environment (2005)
Anticipate what information the receiving person needs.
Have all of the relevant information in front of you.
Have the medical record and electronic record open to that patient.
Using SBAR notepad, write down all information.
Practice conversation if uncomfortable with the situation.
A- Assessement
• An assessment of the situation is made.
o What you think is going on with the patient.
o What you think the problem is.
• At times, you may not be able to make an interpretation of the problem. If so, it is OK to report this. For
example:
o “I am not sure what the problem is, but the patient is deteriorating.”
o “The patient seems to be unstable and may get worse, I think we need to do something.”
R- Recommendation
• Based on the situation, background, and assessment of the case, state what you think needs to be done.
• Some staff find this step of SBAR is intimidating. Staff may feel that they are not qualified to make arecommendation or worry that their recommendation is incorrect.
• It is important to remember that you are not making the final decision
• The purpose of the recommendation is to outline your thoughts.
• If you are not sure what needs to be done, simply stating, “It is important for you to check on the patient
now,” is an appropriate recommendation.
• Recommendation Tips:
o Using “critical” words can increase the intensity of your message (it conveys a sense of urgency)
o Ex: “The patient needs meds now.” “I need you to check on the patient immediately.”
• C.U.S.
• C.U.S. is an assertion tool to help formulation tool to help formulate your recommendation.
o “I am Concerned for my patients condition.”
o “I am Uncomfortable with my patients condition.”
• Get back to people (tell them it was nice meeting them or give them what you might have promised)
• If you find something the people you meet may need send it.
Networking at conferences: Don’t:
• Don’t hang around with your friends.
• Don’t be overly negative or critical.
• Don’t get discouraged.
Intercultural Communication
Objectives: Define culture and related terminology. Discuss the concept of intercultural communication. Applythe nursing process to the care of culturally diverse clients.
Demographic Breakdown San Diego
SANDAG, 2009
By 2050, more than half of U.S. population will be minorities
Indigenous Peoples of California
In California, we have over one hundred recognized American Indian Tribes. With this number, we have thelargest Native American population and the largest number of distinct tribes than any other US state.
Cultural Competency
• Practice cultural, humility, which consists of recognizing the differences and limitations of one’s own
culture when working with people of other cultures.
o Overcome cultural biases and barriers.
o Reduce authoritative communication.
Cultural Competence
• Requires that you understand your own world views and those of the patient.
• It is about cultural awareness, so you can see the entire picture and improve the quality of care and
health outcomes.
• The attitudes, knowledge and skills necessary for providing quality care to diverse populations
• Not letting one’s personal beliefs have an “undo” influence on those whose worldview is different from
one’s own.
Cultural Competence Means:
• Obtaining cultural information and then applying that knowledge.
• To provide culturally appropriate care means you need to know and understand culturally influenced
health behaviors.
Transcultural Nursing
Transcultural Nursing: A humanistic and scientific area of formal study and practice in nursing, which isfocused upon differences and similarities among cultures with respect to human care, health, and illness. This is based upon the peoples cultural values, beliefs, and practices, and the fact that nurses should use this knowledgeto provide cultural specific or culturally congruent nursing care to people... (Leininger)
Culture: “The norms of behavior and shared values among a particular group of people.”
• The nurse needs to be non-judgmental and open to different practices.
• Elephant Dung Tea – Thailand drinks it as a medicinal drink.
•
All of us like to eat! But some like to drink poo and eat bugs.
Where is culture learned
• Family
• Geographic context
• Religious institutions
• Schools
•
Community
Illness is culture bound
• The culture defines what is considered illness
o Example: there is no word for “Depression” in Chinese
• Illness trends vary by culture
o Example: Eating disorders are a western phenomena
• Some illnesses have a genetic component and therefore tend to run in closed cultural groups
What people do when they are sick
• For example, chicken noodle soup vs. seeing a medicine man
Who do you seek care from?
• Traditional Healer Services
o Traditional Healers play a significant role in a health care system.
o They are usually informal, unrecognized by government, and do not interact with the rest of the
health care system.
o Traditional healer services: the application of knowledge skills, and practices based on the
experiences indigenous to different cultures.
o These services are directed towards the maintenance of health, as well as the prevention,
diagnosis, and improvement of physical and mental illness.
• Western Medicine
o Prescription medications and diagnosis by a doctor.
o The MAGIC PILL! A Pill for Everything: the American Way.
o Over the last 10 years, the percentage of Americans who took at least one prescription drug in
the past month increased from 44% to 48%. The use of two or more drugs increased from 25% to31%. The use of five or more drugs increased from 6% to 11%.
Herbs
• Herb Cautions:
May be contaminated with heavy metals. i.e. lead & arsenic.
Hard to calculate dosage.
Not much research focus on herbs.
Who would not want us to know more about herbs as an option? Big pharma.
WHO: Traditional Medicine (2003)
• Traditional Healers are significant providers in developing countries because they are more accessible and
affordable. They are also seen as more socially accepted.
In Africa, up to 80% of the population uses traditional medicine.
In China, traditional medicine accounts for about 40% of all health care delivered.
In USA, the number who use traditional medicine is unknown.
• These providers are especially influential in reaching and changing behavior of low-status, stigmatized
patients who often avoid public providers or those who are neglected.
How to focus your communication on traditional treatment modalities?
• Do you or your family members use anything to stay healthy or things to prevent you from becoming
ill? Don’t ridicule or discount the patient’s use of traditional medicine.
Hospital Room and Hospital Chapel (I forgot what he was getting at with this example)
Acculturation/Assimilation
• A socialization process in which a person from a different cultural group learns the dominant culture.
• Language is a good indicator of acculturation
(Immigrants should speak English vs. Racism, conversation)
Ethnicity vs. Race
• Ethnicity refers to shared racial, religious, and historical culture
• Race is a biological concept
Ethnocentrism: Belief that one’s own culture is superior to others
Why is all of this important to nurses?
• Minorities are more likely to be diagnosed with late-stage breast cancer and colorectal cancer compared
with whites.
• Patients of lower socioeconomic position are less likely to receive recommended diabetic services and
more likely to be hospitalized for diabetes and its complications.
• When hospitalized for acute myocardial infarction, Hispanics are less likely to receive optimal care.
• Many racial and ethnic minorities and persons of lower socioeconomic position are more likely to die
from HIV.
• Minorities also account for a disproportionate share of new AIDS cases.
• The use of physical restraints in nursing homes is higher among Hispanics and Asian/Pacific Islanders
compared with non-Hispanic whites.
• Blacks and poorer patients have higher rates of avoidable hospital admission (i.e. hospitalizations for
heath conditions that in the presence of comprehensive primary care, rarely require hospitalization).
Health Disparities: Differences in the incidence, prevalence, mortality, and burden of disease and other adverse health conditions that exist among specific population groups in the U.S.
How do we best communicate with people from another culture?
A communication deficit: simply means insufficient communication, often combined with misunderstandings.
Effective communication is the cornerstone of a strong, healthy nurse patient relationship. It involves talking,listening and understanding.
General Strategies for Effective Communication:
• Say the person’s name before beginning a conversation (this lets them focus their attention).
• Acquaint the listener with the general topic of the conversation. (avoid sudden changes in topic).
• Have the person repeat specifics back to you.
• Provide pertinent information in writing.
Hearing Loss Demographics
• According to the Centers for Disease Control and Prevention, more than 34 million Americans were
hearing impaired as of 1997.
• About 50% are men and 33% of women 65 years of age and older have some degree of hearing loss.
• Hearing loss is more common in men than in women, and in whites more than African-Americans or
Hispanics.
Three Major Types of Hearing Impairment:
Conductive Hearing Loss: A reduction in the ability of sound to be transmitted (conducted) to the middle ear.(It can be caused by ear wax and infection)
Sensorineural Hearing Loss: results from damage to any part of the inner ear or the neural pathway to the brain. (It can result from genetic causes or from systemic disease and things like-prolonged loud noise andmedications.)
Mixed Hearing Loss: A combination of conductive and sensorineural impairment.
Presbycusis
• A form of sensorineural hearing loss associated with aging.
• Most common type of hearing loss in the USA.
• Typically progressive, gradual, bilateral, and characterized by high-frequency hearing loss.
o Consonants such as T, P and S are high frequency.
o Every seven minutes someone in America becomes visually impaired.
Causes of Vision Loss:
• Glaucoma
• Cataracts
• Diabetic retinopathy
• Macular degeneration
Presbyopia – Diminished ability to focus on near objects with age.
• Presbyopia's exact mechanisms are believed to be caused by a loss of elasticity of the crystalline lens.
• The only treatment is corrective lenses which need to be re-checked every 2 years.
Macular Degeneration – Age related macular degeneration is a medical condition which usually affects older adults that results in a loss of vision in the center of the visual field (the macula) because of damage to theretina.
• Macular degeneration develops as part of the body's natural aging process.
• Etiology is unknown
• No treatment has been uniformly effective.
• It occurs in “dry” and “wet” forms. Extra info: Wet is most severe, but more treatable.
• It is a major cause of visual impairment in older adults (>50 years).
• Macular degeneration can make it difficult or impossible to read or recognize faces, although enough
peripheral vision remains to allow other activities of daily life.
• Leading Cause of Vision Loss in Caucasians >65
What can you do?
• When you work with a patient who’s visually impaired, it’s important that the patient feels involved in
their care and that you feel comfortable caring for them.
Suggestions:
• Knock on the door and enter the room addressing him by name.
• Introduce yourself each time you enter the room.
• At your initial assessment, ask the patient how he performs activities living at home and how he is
functioning in the hospital.
Strategies to Improve Communication with Vision Loss
• Read instructions out loud to patient and ask for repeat back
Communicating Effectively with someone Blind or Vision Impaired:
• Identify yourself: don’t assume the person will recognize you by your voice.
• Tone of your voice is very important.
• Never channel conversation through a third person.
• Never leave a conversation without saying so.
• Relax and be yourself.
Assistive devices for the visually impaired
• Magnifying glasses.
• Large print devices
• Pre-filled syringes
How can you communicate with the patient with Aphasia?
• Aphasia: any neurological linguistic deficit.
• There may be no cognitive impairment, but the client may need more “think time” for cognitive
processing during a conversation.
• Aphasia: Expressive, Receptive, Global
o Expressive aphasia (Broca’s aphasia): Patient can usually understand what you say, but can’t
form sentences to respond. Also called non-fluent aphasia.
o Receptive Aphasia (Wernicke’s aphasia): AKA Fluent Aphasia: Patient cannot understand what
you are saying. Patient may be able to speak, but sentences and words are gibberish. Sometimes patients can sing fine, but not generate coherent sentences.
o Global Aphasia: Patient cannot understand what is being said and cannot form words. Patient
may also not be able to write or understand writing. Global aphasia is usually caused by stroke.Global aphasia usually gets better after cerebral edema has decreased.
Communication Strategies with Aphasic Patients
• Don’t pretend you understand what they are saying when you don’t.
Communication Boards: Examples of communication boards on slides
Sensory Loss, Depression, and Isolation
• People with sensory loss are often depressed and isolated.
• New Technologies (computers, PDA’s, etc) are helping patients with communication deficits live more
independently.
• These devices are not used much in hospitals.
• Nurses are the communication partners for these patients.
Patients on Ventilators
• Many report being very frightened.
• Don’t say anything you wouldn’t want to hear your patient repeat.
• Use communication boards.
• Explain all procedures to patient.
Interpersonal Conflict
Objectives: Discriminate among passive, assertive, and aggressive responses to conflict situations. Specify thecharacteristics of assertive communication. Identify different approaches to conflict management.
Conflict is like the Air we Breathe!
• As we lead busy and challenging lives, we experience conflict daily if not hourly.
o We need to understand sources of conflict and how to manage it when it occurs.
Conflict is neither GOOD nor BAD, it just IS!
• Dispute, Arguments and Disagreements are a normal and necessary part of life.
• Listen to the patient’s complaint completely without interrupting or reacting.
• Don’t tell patient to calm down, model calmness
• Don’t avoid the patient even if you might want to.
• Use disarming statements: agree with something the patient says:
o Ex: “You are right. You shouldn’t have had to wait this long.” “I hear you and agree with you,
we have got to find a better way to manage this pain.”
o Pause for the patient to be able to react.
Anger
• Ask the patient what they really want. “What do you see as the best outcome for this situation?”
• Be alert to the potential for violence
o Most common in emergency rooms and mental health units
o Emergency Nurses Association reports over half of all Emergency Room nurses surveyed
reported having experienced violence from patients
Conflict is Inevitable and Can Enhance Learning
• Conflict is a natural consequence of human diversity.
• Conflict can result in:
o Interpersonal gain
o Incentive for creativity
o Motivation for change
o Scholarly discussion
Generational Differences
We all know the person who is always happy, the greedy person, the loud mouth, the busy body, the expert.
Astrological Sign: Do you remember when the question was to ask when meeting someone new: “What is yourSign?” What Characteristics are associated with Zodiac Signs?
In the News: The “Bad Cheerleaders” AKA The “Fab Five”
A nurse, who had been practicing as an RN for 27 years, committed suicide after she had given an unintendedoverdose to an infant heart patient. The medical error was said to have contributed to the child’s death dayslater. She had given this drug hundreds of times in her career.
This life-changing error caused the death of her patient, she was suspended, then fired from a profession sheloved, and then she committed suicide.
The Institute of Medicine (IOM): considers patient safety “indistinguishable from the delivery of qualityhealthcare.” Many view quality health care as the overarching umbrella under which the patient safety resides.
Quality care is: safe, effective, patient centered, timely, efficient, and equitable.
People make errors for a variety of reasons that have little to do with lack of good intention or knowledge.Humans have many intellectual strengths (e.g., large memory capacity and an ability to react creatively andeffectively to the unexpected).
Improving safety requires respecting human abilities by designing processes that recognize human strengths andweaknesses.
What is Quality?
• The IOM has attempted to define quality of health care in terms of standards.
• The IOM definition of Quality: “The degree to which health services for individuals and populations
increase the likelihood of desired health outcomes and are consistent with current professionalknowledge.”
• Quality has been defined according to quality indicators which are expressed as outcomes.
To Err Is Human (1999) Safety In Healthcare Delivery: The IOM report on safety opened the door toacknowledge that there is a healthcare safety crisis. Data indicated in 1999: Approximately 44,000 to nearly100,000 patients die annually in U.S. hospitals due to error.
What is Patient Safety?
• The IOM definition of Patient Safety: “The prevention of harm to patients.”
• Emphasis is placed on the system of care delivery that:
1) Prevents errors
2) Learns from the errors that do occur and patients.
3) Is built on a culture of safety that involves health care professionals, organizations, and patients.
Technology and Safety
• There are many patient safety practices that utilize technology such as: use of simulators, bar coding,
computerized physician order entry, etc.
• A MAJOR GOAL is to “Standardize a Patient Safety Taxonomy”
What are the Risks in Reporting an Error? The problem is that “We ALL want to be PERFECT!”
FEARS if you Report an Error:
1) As a student, failing a course or being dismissed from the program for “unsafe practice”.
The IOM report caused health care agencies to be put on the defensive.
Why is so difficult for us to accept responsibility for our actions?
• Two children who attended 5 schools before 10th grade all within 20 mile radius because the parents
claimed the schools were horrible and the teachers showed favoritism.
• At what point would these parents accept responsibility for their children’s involvement in the problems
they experienced?
Taking Responsibility for Your Own Actions!
• The inability to accept responsibility for our actions and behaviors is a result of insecurity. If you accept
responsibility you are admitting to being weak, powerless and you may lose the respect of others. Youmay feel you lose your sense of value and importance.
• Accepting responsibility is a sign of personal growth and maturity. It is definitely not a sign of
weakness.
Difficulty in Taking Responsibility
1) You may frequently feel insecure.
2) Triggers doubt about your own abilities.
3) Undermines your self-confidence.
4) You may become defensive about every action “right” or “wrong”.
2) An error occurs and the person making it did not know, but others found it.
3) The person making the error and knows they made it and didn’t report the error.
4) The person making the error knows and reports it.
Key Concepts:
• Safety: Freedom from accidental injury.
• Error: Failure of a planned action to be completed as intended or the use of a wrong plan to achieve an
aim.
Types of Errors:
• Diagnostic
• Treatment
• Preventive
• Other
• Many errors go undocumented or are not reported due to:
• Staff fear of reprisal, lack of adequate systems to report the error, limited staff education
about safety and report process, and lack of computerized surveillance systems.
“Near-Misses” or “Good Catches”
• Errors of commission or omission that could harm or adverse consequences a patient but did not.
• Think about the times that you almost made an error. We all have these experiences. What do you do to
learn from these experiences?
Provision 4: ANA Code of Ethics for Nurses With Interpretive Statements
The nurse is responsible and accountable for individual nursing practice and determines the appropriatedelegation of tasks consistent with the nurse’s obligation to provide optimum patient care.
• 4.1 Acceptance of accountability and responsibility The nurse bears primary responsibility for the
nursing care that their patients receive and individually responsible for their own practice. Nursing practice includes direct care activities, acts of delegation, and other responsibilities such as teaching,research, and administration.4.2 Accountability for nursing judgment and action. Accountability means answerable to oneself andothers for one’s own actions. Your actions are grounded in the moral principles of fidelity and respectfor the dignity, worth, and self-determination of patients.
4.3 Responsibility for nursing judgment and action4.4 Delegation of nursing activities
Communication during Stressful Situations
Today is about the need to take care of yourself if you are committed to take care of others.
Objectives: Define stress. Identify coping mechanisms used by clients and family members in stress situations.Identify communication strategies clients and families in crisis. Describe the diversion Program for Nurses
Stress as a Concept:
•
Stress is an unavoidable part of our everyday lives. Stress affects our bodies, behaviors, and minds inmany different ways!
• Stress is a personalized physical, psychological, and spiritual response to the presence of a stressor.
Stress in America
• More than half of all Americans report feelings of “high stress” in a typical day.
• Up to 75% to 90% of all visits to the doctor are stress-related. (Harvard’s Mind/Body Medical Institute)
• 40% of worker turnover is due to job stress.
What Causes One to be Stressed?
• One can put themselves into circumstances that can cause stress.
• Some people like a life of crisis and stress.
• A little stress is good for learning.
Stressors
• A Stressor is any demand, situation, internal stimulus or circumstance that threatens a person’s personal
• Vigorous schedule (12 hour shifts and working a schedule with different shifts).
• Unhealthy hospital cultures.
• Overwhelming technology.
• Potential for making errors.
• The nursing shortage.
• Lack of confidence and respect for nursing leadership.
Compassion Fatigue Syndrome: “A physical, emotional and spiritual fatigue or exhaustion that takes over a person and causes a decline in their ability to experience joy or feel and care for others”.
The emotional residual (side effect) from exposure to working with individuals suffering from the consequencesof traumatic events in their lives.
Compassion Fatigue Syndrome is a form of Burnout, a kind “of secondary victimization” that is transmitted byclients to workers through empathetic listening.