Vidette Todaro-Franceschi & Caregiver Compassion Fatigue and Burnout

Interviewed By Donna Letteresre

Professor Vidette Todaro-Franceschi teaches at Hunter College of the City University of New York, and is the author of the book “Compassion Fatigue and Burnout in Nursing.” Compassion fatigue and burnout are serious issues for the profession, and she offers nurses ways to prevent or heal from these syndromes.

What made you decide to get into the field of nursing?

Todaro-Franceschi: Initially, I wanted to be a journalist. But I was inspired by my mother, a registered nurse, to give nursing a try, and I fell in love with it. I’ve been in the field for over thirty-one years.

How has nursing changed since you began working in the field?

Todaro-Franceschi: The foundation of nursing hasn’t changed. Nurses have always worked to improve the quality of life for people. However, patient care has become far more complex. People are living longer, many times with chronic illnesses that in the past people died from. Consequently, caring for the aged and those suffering with various diseases has become more complex. The formal education nurses require has gotten harder, as well, in keeping with the greater demands placed upon healthcare professionals.

What was the impetus for your book “Compassion Fatigue and Burnout in Nursing?”

Todaro-Franceschi: When I was in practice, I suffered from compassion fatigue. It’s a very difficult job at times, and there were moments when I wanted to quit. As an educator for over a decade, I have consistently met and taught nurses who have suffered with compassion fatigue and/or burnout. Some had actually returned to school to learn how to cope with it. I’ve also seen firsthand, as a patient and family member, how professional burnout can negatively affect the care that patients receive. Thus, it was a combination of my professional and personal experiences that inspired me to write this book.

What do you see as the primary problems that contribute to compassion fatigue and burnout in nursing?

Todaro-Franceschi: Burnout is a complex syndrome that is related to many different things but basically it is a person’s negative response to their work. Lack of resources, heavy workload, and poor work environment can all contribute to burnout. Compassion fatigue can be a factor; it is when a caregiver becomes suddenly overwhelmed, co-suffering with her patient. If compassion fatigue is not recognized and steps are not taken to heal, over time burnout can develop.

Caregivers who are suffering from burnout shut down, they become disinterested, disengaged, and apathetic. They no longer seem to find any joy in going to work. This is extremely serious, as nurses are the front-line caregivers in healthcare. In addition, many nurses and other caregivers may feel forced into positions where they cannot give the best of care. This causes moral distress, which often goes hand in hand with compassion fatigue.

Do you feel that nurses are properly taught how to cope with a patient who is at the end of his or her life?

Todaro-Franceschi: There is no consistency in what nurses and indeed other health care professionals learn about end of life care. Classes in obstetrics, pediatrics, and gerontology are all required in nursing. Yet, in many programs there is no required course to help nurses learn about caring for the dying and their loved ones. When a nurse is put into a position of having to care for a dying patient, if she is unprepared, that’s a grave social injustice—to the caregiver, as well as the suffering patients and families. I believe nurses need to be strongly educated on this subject.

What do you see as the solutions for the issues facing nurses today?

Todaro-Franceschi: I believe that in every human endeavor, people need to begin with the question, “What is my purpose?” For nurses, the purpose is to enhance the quality of both living and dying for others. As we go about our work, we need to be able to put ourselves in the patients place or say, “this could be my loved ones.” All health care has to begin with compassion; for it is that which provokes purposeful actions.

Many of the issues that nurse’s face could also be lessened by educating them more about their power as the largest health care constituent. I think that there are gaps in education; we need to consistently teach advocacy, assertiveness and communication skills, as well as self-care strategies, and death education. A significant percentage of our workforce is getting ready to retire so it is more important than ever that beginning nurses know how invaluable they are. Without nurses, there would be no acute or long-term care settings.

And, the biggest thing they bring to work is their ability to care compassionately and competently.

Could you explain your ART model?

Todaro-Franceschi: “ART” is an acronym. First, the “A” is for “Acknowledging” a feeling. When things are good, it’s important to realize why you feel happy. What choices led you there? In turn, when you have a bad day, thinking back to that good day gives you perspective.

The “R” is for “Recognizing Choices.” We must recognize that we always have choices, and that we must choose with intention. People who claim to have no choice are actually choosing to do nothing.

And finally, the “T” is for “Turning Outward.” It’s necessary for nurses to turn outward towards yourself, reflecting on your situation. Yet, one must to turn outward towards others, those you are caring for, working with, and even loved ones. We have to be present in every moment that we interact with others. People who are burned out are losing their moments, and it affects everyone negatively. Everyone needs to remain aware that what each person is doing makes a difference, and the “ART” model gives nurses and other caregivers specific steps to remember that.

Can caregivers who are not in the field, but care for friends or loved ones, suffer from burnout?

Todaro-Franceschi: Absolutely. Burnout is a coping mechanism, I think, for many people. It is a way to cope with what one has come to believe is utterly impossible to cope with. Today many individuals find themselves caring for loved ones for many reasons. Children are caring for parents, grandparents and their own children. Sometimes, the caregivers are older adults with multiple health issues themselves. People become overwhelmed with the burden of caring and may feel completely alone. They may gradually, overtime burnout and are not even aware of it. Many non-professional caregivers have no idea that there are resources available to help them. They need to be educated as to their options.

What all caregivers need to remember, is that it isn’t possible to care for someone else if you neglect yourself. As we are repeatedly reminded on planes, if the oxygen mask is released due to changes in cabin pressure, you have to put the mask on your own face first!

What are the primary changes that you’d like to see implemented in the field of nursing?

Todaro-Franceschi: In nursing (as well as in all other walks of life), we need to reconnect with why we do what we do, and why we must do it well. I’d like to see nursing schools place more emphasis on the true purpose of nursing and how important we are to society. Our purpose is not simply to “provide” care. It is to actually care. Nurses need to recognize their importance, to stand up for themselves, and to always feel free to be moral. There were times in my career where I had to turn to a coworker—a nurse or a physician—and ask, “If that were your Grandmother, would you perform that task yhe way you’re doing it?” Not once, in thirty-one years, did the person not check themselves. We can teach ethics, how to face death, advocacy, assertiveness and communication skills, and perhaps most important, self-care strategies—how to identify compassion fatigue and burnout and how to prevent and/or heal from these syndromes. Some places already teach these things quite well, but it needs to be consistent across the board.

What are the main points that you would like readers to take away from your book?

Todaro-Franceschi: It’s really all about compassion. It is important to never lose sight of that. We need to be mindful that everything we do contributes to the whole and makes a difference. Yes, the workload in health care today is complex and heavy. But having a sense of communality, caring for ourselves, and each other, along with knowing the importance of our work, can provoke us to do it well and remain joyful while doing it. It becomes a win-win for all.

For more information or to contact Professor Vidette Todaro-Franceschi, please go to www.qualitycaring.org.

The publisher's website for her book “Compassion Fatigue and Burnout in Nursing,” containing Chapter One, can be found at www.springerpub.com.

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