Carolyn Phillips, PhD, RN, ACNP-BC, AOCNP, said she loved the meaningful work she did as an oncology nurse and nurse practitioner.
But that love and devotion came at a cost to Phillips' well-being. She, like many other nurses, had no time or way to process the grief she felt. She was emotionally numb and in a perpetual state of grief.
"I needed to experience a form of expression that would resonate deep enough that I could start to feel again. I needed to 'sing it out,'" Phillips wrote on her Songs for the Soul website, a nonprofit organization she co-founded to help those experiencing similar struggles with compassion fatigue in nursing.
[caption id="attachment_56155" align="alignleft" width="300"] Carolyn Phillips, PhD, RN, ACNP-BC, AOCNP[/caption] Some describe compassion fatigue, also known as secondary traumatic stress, as the cost of caring. It can lead to emotional pain, exhaustion and burnout, according to Phillips. Healthcare professionals -- nurses, in particular -- don't have a way to process the emotions they experience when caring for others, Phillips said. "It's something we really don't talk about. We're not taught much about it in our formal education and once we get in the workplace, there's really no time or space or even programs available that help us reflect on the impact that caregiving has on nurses and their well-being," she said. The grief can build, especially in specialties such as oncology, where nurses often experience loss with patients and families they have known for years. Phillips co-authored a study looking at oncology nurses' roller coaster ride of emotional experiences in caring for patients and families.
In the study published July 29, 2019, in the journal Cancer Nursing, the authors found "new nurses are underprepared for the emotional experience of being an oncology nurse. Further, they define their emotional boundaries in isolation and without guidance on how to develop healthy coping skills. Changing the culture of silence around mental health and well-being among healthcare professionals can provide space for important conversations to occur."
Songs for the Soul aims to provide nurses with an outlet and opportunity for expression by giving them a platform to write about the people for whom they have cared. The program helps nurses put their emotions into words. Then, Phillips pairs nurses in the intervention with songwriters, who put their stories into songs. Nurses share their stories as part of the intervention and begin to realize they are not alone in the struggle to come to terms with emotions they feel from providing care, according to Phillips, who knows the power of music well. She is a member of a band called Hardened and Tempered.
Research on interventions for compassion fatigue in nursing
Phillips, a Robert Wood Johnson Foundation Future of Nursing Scholar from 2016 to 2019, set out three years ago to study whether combining writing and music would help nurses. She did a pilot study of seven nurses. They met weekly for six weeks, learning how to write about their experiences and crafting personal short stories. Phillips brought in a team of songwriters who met with the nurses to transform those stories into songs. The intervention ended when the nurses read the stories and songwriters performed the healing songs for colleagues, family and friends. More recently, Phillips studied 43 nurses who were part of two groups. About half went through the intervention while another group completed surveys about their emotions and caregiving, but didn't go through the intervention. She found the intervention is feasible and acceptable for nurses, and it works to help them through their grief.
"The No. 1 finding in both the qualitative and quantitative data was that the nurses felt less alone," she said. "They talked routinely in the groups and then talked about it in the qualitative data that they didn't realize other nurses felt the way they felt. Their loneliness decreased over time significantly compared to the comparison group."
According to the research, feeling alone often leads to burnout and compassion fatigue in nursing. "I think what happens is you start feeling burned out, you start hiding it and you start feeling isolated and alone," she said. "This intervention kind of gave nurses a place to talk about their experiences. They talked about the emotional load they were carrying but almost saw it as a weakness in themselves. What I learned is that there is a level of loneliness that we're not addressing among healthcare professionals, and this intervention gave them a setting to start having these conversations." Phillips also co-authored a perspective article on Songs for the Soul that was published in the April 1, 2017, edition of the Clinical Journal of Oncology Nursing.
"The use of storytelling through music portrays an expression of grief that matches the intensity of their caregiving experience," Phillips wrote.
Phillips will continue to research the intervention on compassion fatigue in nursing when she starts as a post-doctoral research fellow at the Dana-Farber Cancer Institute in Boston this fall. "I'm looking at implementing it on a larger scale, at multiple different institutions, to really hone in on the intervention effect, as well as the best way to deliver it," she said. "In September, I'm trying the intervention ... with a team of oncology nurses in a retreat setting. We're going to work with them over a couple of days to help write a team song about their shared experience."
Molding your words into songs
Nurses participating in the intervention receive a recording of their songs, according to Phillips. While most of the songs aren't made public because of confidentiality, Phillips shared an example of a Songs for the Soul creation called "Pecosita," by songwriter Mandy Rowden and oncology nurse Marsha Padilla. Phillips said nurses don't have to consider themselves good writers to participate. The intervention provides them with what they need to create their songs to address their compassion fatigue in nursing. Nurses who want to explore having the intervention at their institutions should email Phillips at [email protected]. For nurses struggling with compassion fatigue who don't have access to this or another intervention to address their emotions, simply journaling for as little as 5 minutes at the end of a shift about their experiences can help, according to Phillips.
"The other thing I recommend is finding some sort of practice that helps you connect to your physical and emotional self," she said. "The literature states that nurses and physicians disconnect from their emotions in their caregiving jobs."
Practices like meditation, mindfulness and breathing exercises, according to Phillips, can help nurses tune in to how they are feeling.
Take these courses related to compassion fatigue in nursing:
Research Reveals the Benefits of Meditation (1 contact hr) Healthcare practitioners in various disciplines and their patients use meditation. Meditation training has proved an effective adjunct therapy for many conditions and can be discussed as an option among healthcare providers. Meditation and relaxation techniques are part of a program to help patients reverse heart disease, for example. Healthcare programs are incorporating meditation into many clinical practices. A healthcare provider's relationship with patients can influence the outcome of clinical problems as well as the satisfaction of provider and patient. A healthcare provider's physical, emotional and mental health can influence the provider-patient relationship. By reducing stress and developing concentration, meditation cannot only increase concentration but also may help prevent job burnout. The result is a better relationship with patients and perhaps a method for self-healing. This course discusses meditation and the research supporting its use when caring for patients with a variety of conditions. Compassion Fatigue: Don't Forget to Care for Yourself While Caring for Others (1 contact hr) Compassion fatigue in nursing occurs when a caregiver experiences what experts call "secondary traumatic stress" in reaction to caring for those who are themselves suffering from traumatic events. Although caregivers don't actually experience the event (as is the case with post-traumatic stress disorder), they experience the event emotionally by caring for the patient. Compassion fatigue in has become more widely recognized as a problem that many nurses face. In a study of 1,100 bedside nurses at a major tertiary care center, compassion fatigue was found to be associated with a number of factors and to be significantly prevalent among the nurses. Compassion fatigue in nursing creates physical and emotional distress, but it's not just a personal issue -- it's a patient safety issue as well. Research has shown that compassion fatigue in nursing may increase the risk of medical errors. This module will help nurses prevent, identify and manage compassion fatigue. Nurse, Take Care of Thy Self (1 contact hr) Nursing is a stressful profession! Nurses are known for taking care of others at the cost of their own well-being. Lack of self-care can lead to compassion fatigue, personal health issues, and a lack of work-life balance. When a nurse takes the time to care for themselves, both their colleagues and patients will reap the benefit. As easy as it sounds, it can be hard to create a work life balance, exercise, and be a nurse role model. When pursuing continuing education or a new professional role, self-care and time management are key to helping yourself be successful.