Is Compassion Fatigue a growing freight for physiotherapists in COVID-19?
“Fatigue” the expression of feeling exhausted or tired (Evans WJ et al., 2007) has now been reported as one of the commonest symptoms or problems faced by hospitalized COVID-19 affected individuals. Its long-lasting presence has been felt even after being discharged from the hospital irrespective of the virus’s severity and infectivity (Townsend L et al., 2020).
The debilitating effects of fatigue have been observed previously among a multitude of chronic medical conditions and eventually coined as “Chronic Fatigue Syndrome” (Swartz MN et a., 1988).
The impact of COVID-19 will persists for several months impacting our health (Islam MF et al., 2020).
The pre-requisite at the present hour is to identify and implement effective strategies that may help to alleviate the hazardous effects imposed by fatigue on the health of those affected and those delivering the services to the affected individuals (especially the healthcare team).
Physiotherapists play a critical role in the early mobilization of COVID-19 hospitalized individuals and beyond. It is necessary to understand the impact of fatigue experienced by them during these challenging times of delivering quality care to patients.
It has been found that the “Cost of caring” for individuals under very high risk and high-pressure scenarios such as the critical care setting puts voluminous emotional distress which impacts the psychological health of all frontline healthcare workers (Craigie M et al., 2016).
The evidence from studies done in China (Tenz Z et al. 2020) and Turkey (Morgul E et al., 2020) highlight a large percentage such as 73.7% and 64.1% of fatigue being reported among its study participants, who were all healthcare staff. Thus a strong link exists between the increasing number of healthcare workers being fatigued and a decrease in the quality of care being delivered by them to the affected individuals (Alharbi et al., 2020; O’Connor CM et al., 2020).
Physiotherapists in the ICUs are involved in a series of activities that require tremendous manual strength in them. Even though they are routinely scheduled or allocated for their duties ensuring they have adequate time to rest and return to work, looking at the present scenario with an upsurge of growing number of cases, it is a clear indication of the physiotherapy workforce being over-burdened in times ahead (Carmassi C et al., 2020; Devi DT et al.,2020). This brings up the concept of “Compassion Fatigue” to delve into.
Let’s understand what is Compassion Fatigue?
Compassion Fatigue is also called as “vicarious traumatization” or “secondary traumatization” (Figley et al., 1995). It refers to repeatedly being exposed to stressful environments or dealing with individuals who are suffering from the consequences of any traumatic event. In our scenario, the event is the long-standing pandemic and its implications on our health. Compassion fatigue and burnout have some similarities in their presentations but they are however very different concepts and should not be used interchangeably.
The American Institute of Stress identifies compassion fatigue to have a rapid onset but a rapid recovery rate if it has been identified and managed at the beginning itself, while burnout on the other hand takes much longer to set it in and even longer to go. Feeling physically, emotionally, and mentally exhausted, with a sense of isolation from others and being disconnected can be common with compassion fatigue.
Physiotherapists caring for critically ill individuals who need to be frequently positioned, or given different chest care maneuvers for improving their ventilation-perfusion or gas exchange in the lungs, or early mobilization are constantly under the threat of being influenced by compassion fatigue. Moreover, even after returning home, maintenance of social distancing, practicing self-isolation for prevention of family members from contracting any virus transmission and infection can make it very challenging to deal with.
This can influence our mind, making us feel hopeless, or in despair or anxious or demotivated with our life. Thus keeping our mind and thoughts healthy can be very essential in preventing the development of compassion fatigue. The mechanisms in which fatigue originates can be classified as either neuromuscular or central. As a considerable amount of change occurs within our brain we call this “Central fatigue”. Thus even the slightest form of verbal encouragement, or engaging in activities of interests like playing music, singing, dancing, painting, reading can be rightly stimulating to change our perception which can eventually contribute to better mental health and thereby reduce the chances of developing compassion fatigue in the long run.
So here are some Do’s & Don’ts to help my physiotherapists-
Do’s
1. Always talk to a dear one
2. Take some time off from your work life
3. Eat healthily and follow a nutritious diet
4. Stay adequately hydrated
5. Sleep adequately
6. Exercise and practice mindfulness
Dont’s
1. Don’t blame your colleagues or yourself as each one is working very hard to save their patients and themselves.
2. Don’t over-react in an already stressful environment like a hospital setting.
3. Don’t over-burden yourself with responsibilities, STOP when you need to.
Remind yourself daily, that only if you are in “Good Physical & Mental Health” you can provide help to others.
Lastly,
Stay Healthy & Stay Safe!
