Skip to main content

Reflections on Compassion, Suffering and Occupational Stress

  • Chapter
  • First Online:
Perspectives on Human Suffering

Abstract

In dealing with people with life threatening illness, whether in the context of early diagnosis, palliative or end of life care, professional caregivers are witness to considerable suffering. Such suffering can lead to distress in caregivers, which may be manifest in burnout, compassion fatigue, moral distress or vicarious traumatization. It is proposed that through understanding the concepts of suffering and compassion and practicing self-awareness, self-care, mindfulness and other reflective practices, self-compassion, exquisite empathy, and a sense of meaning and connectedness, caregivers may be better able to care both for patients and themselves.

Live with compassion Work with compassion Die with compassionMeditate with compassion Enjoy with compassion When problems come, Experience them with compassion

Lama Zopa Rinpoche, A View on Buddhism: Compassion and Bodhicitta

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Notes

  1. 1.

    Remen (1996, p. 52), from Vachon (2006).

  2. 2.

    Puchalski et al. (2009), from Vachon (2011).

  3. 3.

    For a discussion of the research in stress and burnout in oncology and palliative care over the past 30 years, see Vachon and Sherwood (2007), Vachon (2010).

  4. 4.

    For reviews of the topic, see Vachon (1987), Vachon (1995), Vachon and Sherwood (2007), Vachon and Müeller (2009), Sabo and Vachon (2011).

  5. 5.

    Vaillant (2008), from Vachon and Huggard (2010). Emphasis was in the original.

  6. 6.

    It is worth noting that Mount has himself been living with a serious, life-threatening illness for years while he has simultaneously been studying how others cope with their illnesses. See also Kearney et al. (2009).

  7. 7.

    Perry (1998b), from Vachon and Huggard (2010).

  8. 8.

    This section adapted from Sabo and Vachon (2011).

Bibliography

  • Ablett, Janice, and R. S. P. Jones. 2007. Resilience and well-being in palliative care staff: A qualitative study of hospice nurses’ experience of work. Psycho-Oncology 16:733–740.

    Article  Google Scholar 

  • Alkema, Karen, Jeremy M. Linton, and Randal Davies. 2008. A study of the relationship between self-care, compassion satisfaction, compassion fatigue, and burnout among hospice workers. Journal of Social Work in End-of-Life & Palliative Care 4:101–119.

    Article  Google Scholar 

  • American Association of Critical-Care Nurses, Ethics Work Group. 2008. The 4As to rise above moral distress, American Association of Critical-Care Nurses. www.aacn.org/WD/Practice/Docs/4As_to_Rise_Above_Moral_Distress.pdf. Accessed 6 Sept 2010.

    Google Scholar 

  • Back, Anthony L., Susan M. Bauer-Wu, Cynda H. Rushton, and Joan Halifax. 2009. Compassionate silence in the patient-clinician encounter: A contemplative approach. Journal of Palliative Medicine 12:13–17.

    Article  Google Scholar 

  • Boston, Patricia A., Anna Towers, and David Barnard. 2001. Embracing vulnerability: Risk and empathy in palliative care. Journal of Palliative Care 17:248–253.

    Google Scholar 

  • Boston, Patricia A., and Balfour M. Mount. 2006. The caregiver’s perspective on existential and spiritual distress in palliative care. Journal of Pain and Symptom Management 32:13–26.

    Article  Google Scholar 

  • Brady, Donald W., Giselle Corbie-Smith, and William Branch. 2002. “What’s important to you?”: The use of narratives to promote self-reflection and to understand the experiences of medical residents. Annals of Internal Medicine 137 (3): 220–223.

    Article  Google Scholar 

  • Cassell, E. J. 1982. The nature of suffering and the goals of medicine. New England Journal of Medicine 306:639–645.

    Article  Google Scholar 

  • Cepeda, Soledad M., Richard Chapman, and Nelcy Miranda. 2008. Emotional disclosure through patient narrative may improve pain and well-being: Results of a randomized controlled trial in patients with cancer pain. Journal of Pain and Symptom Management 35 (6): 623–631.

    Article  Google Scholar 

  • Charon, Rita. 2001. Narrative medicine. A model for empathy, reflection, profession, and trust. Journal of the American Medical Association 286 (15): 1897–1902.

    Google Scholar 

  • Chochinov, Harvey M. 2007. Dignity and the essence of medicine: The A, B, C & D of dignity-conserving Care. British Medical Journal 334:184–187.

    Article  Google Scholar 

  • Cohen-Katz, Joanne, Susan D. Wiley, Terry Capuano, Debra Baker, and Shauna Shapiro. 2004. The effects of mindfulness-based stress reduction on nurse stress and burnout: A quantitative and qualitative study. Holistic Nursing Practice 18:302–308.

    Google Scholar 

  • Farsides, Bobbie. 2006. Ethical issues in multi-disciplinary team work in palliative care. In Teamwork in palliative care: Fulfilling or frustrating?, ed. Peter Speck. Oxford: Oxford University Press.

    Google Scholar 

  • Figley, Charles R. ed. 1995. Compassion fatigue: Coping with secondary traumatic stress disorder. In Those who treat the traumatized. New York: Brunner.

    Google Scholar 

  • Figley, Charles R. ed. 2002. Treating compassion fatigue. New York: Brunner-Routledge.

    Google Scholar 

  • Georges, Jean-Jacques, Mieke Grypdonck, and Bernadette D. De Casterle. 2002. ʻBeing a palliative care nurse in an academic hospital: A qualitative study about nurses’ perceptions of palliative care nursing. Journal of Clinical Nursing 11:785–793.

    Article  Google Scholar 

  • Gonzalez, Maria, and Graham Byron. 2010. The mindful investor. Ontario: Wiley.

    Google Scholar 

  • Grossman, Paul, Ludger Niemann, Stefan Schmidt, and Harald Walach. 2004. Mindfulness-based stress reduction and health benefits: A meta-analysis. Journal of Psychosomatic Research 57 (1): 35–43.

    Article  Google Scholar 

  • Halbesleben, Jonathan R. B., and Cheryl Rathert. 2008. Linking physician burnout and patient outcomes: Exploring the dyadic relationship between physicians and patients. Health Care Management Review 33:29–39.

    Article  Google Scholar 

  • Harrison, Richard L., and Marvin J. Westwood. 2009. Preventing vicarious traumatization of mental health therapists: Identifying protective practices. Psychotherapy Theory, Research, Practice, Training 46:203–219.

    Article  Google Scholar 

  • Hawkins, Andrew C., Ruth A. Howard, and Jan R. Oyebode. 2007. Stress and coping in hospice nursing staff. The impact of attachment styles. Psycho-oncology 16:563–572.

    Article  Google Scholar 

  • James, Nicky, and David Field. 1992. The routinization of hospice: Charisma and bureaucracy. Social Science and Medicine 34:1363–1375.

    Article  Google Scholar 

  • Jameton, Andrew. 1984. Nursing practice: The ethical issues. Englewood Cliffs: Prentice Hall.

    Google Scholar 

  • Kabat-Zinn, Jon. 2005. Coming to our senses: Healing ourselves and the world through mindfulness. New York: Hyperion.

    Google Scholar 

  • Kash, Kathleen M., Jimmie C. Holland, William Breitbart, Susan Berenson, James Dougherty, Suzanne Ouelette-Kobasa, and Lynna Lesko. 2000. Stress and burnout in oncology. Oncology 14:1621–1637.

    Google Scholar 

  • Katz, Renee S. 2006. When our personal selves influence our professional work: An introduction to emotions and countertransference in end-of-life care. In When professionals weep: Emotional and countertransference responses in end-of-life care, eds. R. Katz and T. Johnson. New York: Routledge.

    Google Scholar 

  • Kearney, Michael K. 2000. A place of healing: Working with suffering in living and dying. Oxford: Oxford University Press.

    Google Scholar 

  • Kearney, Michael K., Radhule B. Weininger, Mary L. S. Vachon, Balfour M. Mount, and Richard L. Harrison. 2009. Self-care of physicians caring for patients at the end of life: “Being connected… a key to my survival”. Journal of the American Medical Association 301:1155–1164.

    Article  Google Scholar 

  • Keeton, Kristie, Dee E. Fenner, Timothy R. B. Johnson, and Rodney A. Hayward. 2007. Predictors of physician career satisfaction, work-life balance, and burnout. Obstetrics & Gynecology 109:949–955.

    Article  Google Scholar 

  • Keidel, Gladys Catkins. 2002. Burnout and compassion fatigue among hospice caregivers. American Journal of Hospice and Palliative Care 19:200–205.

    Article  Google Scholar 

  • Kuerer, Henry M., Timothy J. Eberlein, Raphael E. Pollock, Mashele Huschka, Walter F. Baile, Monica Morrow, Fabrizio Michelassi, S. Eva Singletary, Paul Novotny, Jeff Sloan, and Tait D. Shanafelt. 2007. Career satisfaction, practice patterns and burnout among surgical oncologists: Report on the quality of life of members of the society of surgical oncology. Annals of Surgical Oncology 14:3043–3053.

    Article  Google Scholar 

  • Liaschenko, Peter E., and Joan Liaschenko. 2004. Perils of proximity: A spatiotemporal analysis of moral distress and moral ambiguity. Nursing Inquiry 11:218–225.

    Article  Google Scholar 

  • Maslach, Christina. 2003. Job burnout: New directions in research and intervention. Current Directions in Psychological Science 12:189–192.

    Article  Google Scholar 

  • Maslach, Christina, and Michael P. Leiter. 2008. Early predictors of job burnout and engagement. Journal of Applied Psychology 93:498–512.

    Article  Google Scholar 

  • Maslach, Christina, Wilmar B. Schaufeli, and Michael P. Leiter. 2001. Job burnout. Annual Review of Psychology 52:397–422.

    Article  Google Scholar 

  • McCann, I. Lisa, and Laurie Ann Pearlman. 1990. Vicarious traumatization: A contextual model for understanding the effects of trauma on helpers. Journal of Traumatic Stress 3:131–149.

    Article  Google Scholar 

  • Meier, Diane, Anthony L. Back, and R. Sean Morrison. 2001. The inner life of physicians and care of the seriously Ill. Journal of the American Medical Association 286:3007–3014.

    Article  Google Scholar 

  • Monroe, Barbara, and David Oliviere, eds. 2007. Resilience in palliative care: Achievement in adversity. Oxford: Oxford University Press.

    Book  Google Scholar 

  • Morgan, Nancy, Kristi Graves, Elizabeth Poggi, and Bruce Cheson. 2008. Implementing an expressive writing study in a cancer clinic. Oncologist 13 (2): 196–204.

    Article  Google Scholar 

  • Mount, Balfour M., Patricia H. Boston, and S. Robin Cohen. 2007. Healing connections: On moving from suffering to a sense of well-being. Journal of Pain and Symptom Management 33:372–388.

    Article  Google Scholar 

  • Myss, Caroline. 2001. Advanced energy anatomy, CD-ROM. Boulder: Sounds True.

    Google Scholar 

  • Myss, Caroline. 2002. Fundamentals of spiritual alchemy. New York: HayHouse Audio.

    Google Scholar 

  • Novack, Dennis H., Anthony L. Suchman, William Clark, Ronald M. Epstein, Eva Najberg, and Craig Kaplan. 1997. Calibrating the physician: Personal awareness and effective patient care. Journal of the American Medical Association 278:502–509.

    Article  Google Scholar 

  • Novack, Dennis H., Roland M. Epstein, and Randall H. Paulsen. 1999. Toward creating physician-healers: Fostering medical student’s self-awareness, personal growth, and well-being. Academic Medicine 74:516–520.

    Article  Google Scholar 

  • Oberle, Kathleen, and Dorothy Hughes. 2001. Doctors’ and nurses’ perceptions of ethical problems in end-of-life decisions. Journal of Advanced Nursing 33:707–715.

    Article  Google Scholar 

  • Perry, Beth. 1998a. Beliefs of eight exemplary oncology nurses related to Watson’s Nursing Theory. Canadian Oncology Nursing Journal 8:97–101.

    Google Scholar 

  • Perry Beth. 1998b. Moments in time: Images of exemplary nursing care. Ottawa: Canadian Nurses Association.

    Google Scholar 

  • Perry, Beth. 2008. Why exemplary oncology nurses seem to avoid compassion fatigue. Canadian Oncology Nursing Journal 18:87–92.

    Google Scholar 

  • Pipe, Terri Britt, Jennifer J. Bortz, Amylou Dueck, Debra Pendergast, Vicki Buchda, and Jay Summers. 2009. Nurse leader mindfulness meditation program for stress management: A randomized controlled trial. Journal of Nursing Administration 39:130–137.

    Article  Google Scholar 

  • Puchalski, Christine, Betty Ferrell, Rose Virani, et al. 2009. Improving the quality of spiritual care as a dimension of palliative care: The report of the consensus conference. Journal of Palliative Medicine 12:885–904.

    Article  Google Scholar 

  • Radley, Melissa, and Charles R. Figley. 2007. The social psychology of compassion. Clinical Social Work Journal 35:207–214.

    Article  Google Scholar 

  • Remen, Rachael Naomi. 1996. Kitchen table wisdom. New York: Riverhead Books.

    Google Scholar 

  • Remen, Rachael Naomi. 2000. My grandfather’s blessings. New York: Riverhead Books.

    Google Scholar 

  • Rice, Elizabeth M., Mohamed Y. Rady, Arreta Hamrick, Joseph. L. Verheijde, and Debra K. Pendergast. 2008. Determinants of moral distress in medical and surgical nurses at an adult acute tertiary care hospital. Journal of Nursing Management 16:360–373.

    Article  Google Scholar 

  • Rinpoche, Lama Zopa. 2010. A View on Buddhism: Compassion and Bodhicitta. www.viewonbuddhism.org. Accessed 27 Feb 2010.

    Google Scholar 

  • Rosenzweig, Steven, Diane K. Reibel, Jeffrey M. Greeson, George C. Brainard, and Mohammadreza Hojat. 2003. Mindfulness-based stress reduction lowers psychological distress in medical students. Teaching and Learning in Medicine 15 (2): 88–92.

    Article  Google Scholar 

  • Sabo, Brenda, and Mary L. S. Vachon. 2011. Care of professional caregivers. In Supportive oncology, eds. Mellar P. Davis, Camilla Zimmermann, Petra Feyer and Petra Ortner. Philadelphia: Elsevier.

    Chapter  Google Scholar 

  • Shanafelt, Tait D., Paul Novotny, Mary E. Johnson, David P. Steensmaa, Martha Q. Lacy, Joseph Rubina, and Jeff Sloan. 2005a. The well-being and personal wellness promotion strategies of medical oncologists in the North Central Cancer Treatment Group. Oncology 68:23–32.

    Article  Google Scholar 

  • Shanafelt, Tait D., Colin West, Xinghua Zhao, Paul Novotny, Joseph Kolars, Thomas Habermann, and Jeff Sloan. 2005b. Relationship between increased personal well-being and enhanced empathy among internal medicine residents. Journal of General Internal Medicine 20:559–564.

    Article  Google Scholar 

  • Shapiro, Shauna L., Roger Walsh, and Willoughby B. Britton. 2003. An analysis of recent meditation research and suggestions for future directions. Journal for Meditation and Meditation Research 3:69–90.

    Google Scholar 

  • Shapiro, Shauna L., J. Astin, S. Bishop, and M. Cordova. 2005. Mindfulness-based stress reduction for health care professionals: Results from a randomized trial. International Journal of Stress Management 12 (2): 164–176.

    Article  Google Scholar 

  • Shapiro, Shauna L., Kirk W. Brown, and Gina M. Biegel. 2007. Teaching self-care to caregivers: Effects of mindfulness-based stress reduction on the mental health of therapists in training. Training, Education and Prof Psychology 1 (2): 105–118.

    Article  Google Scholar 

  • Spickard, Anderson, Steven Gabbe, and John F. Christensen. 2002. Mid-career burnout in generalist and specialist physicians. Journal of the American Medical Association 288:1447–1450.

    Article  Google Scholar 

  • Stamm, Beth H. 2002. Measuring compassion satisfaction as well as fatigue: Developmental history of the compassion satisfaction and fatigue test. In Treating compassion fatigue, ed. C. F. Figley, 107–119. New York: Brunner-Routledge.

    Google Scholar 

  • Stamm, Beth H. 2009. The concise manual for the professional quality of life scale: The ProQOL. Pocatello: ProQOL.org.

    Google Scholar 

  • Vachon, Mary L. S. 1987. Occupational stress in the care of the critically ill, dying and bereaved. Washington: Hemisphere.

    Google Scholar 

  • Vachon, Mary L. S. 1995. Staff stress in hospice/palliative care: A review. Palliative Medicine 9:91–122.

    Article  Google Scholar 

  • Vachon, Mary L. S. 2006. The experience of the nurse in end-of-life care in the 21st century. In Textbook of palliative nursing, eds. Betty R. Ferrell and Nessa Coyle, 2nd ed. Oxford: Oxford University Press.

    Google Scholar 

  • Vachon, Mary L. S. 2010. Oncology staff stress and related interventions. In Psycho-oncology, eds. Jimmie C. Holland, William S. Breitbart, Paul B. Jacobsen, Marguerite S. Lederberg, Mathew J. Loscalzo and Ruth McCorkle, 2nd ed. New York: Oxford University Press.

    Chapter  Google Scholar 

  • Vachon, Mary L. S., and Christopher Sherwood. 2007. Staff stress and burnout. In Principles and practice of palliative care and supportive oncology, eds. Ann M. Berger, John L. Shuster and Jamie H. Von Roenn. Philadelphia: Lippincott.

    Google Scholar 

  • Vachon, Mary L. S., and Monika Müeller. 2009. Burnout and symptoms of stress. In Handbook of psychiatry in palliative medicine, eds. William Breitbart and Harvey M. Chochinov. New York: Oxford University Press.

    Google Scholar 

  • Vachon, Mary L. S., and Jayne Huggard. 2010. The experience of the nurse in-end-of-life care in the 21st century: Stressors, personal, professional, and organizational responsibilities. In The Oxford textbook of palliative nursing, eds. Betty Ferrell and Nessa Coyle. Oxford: Oxford University Press.

    Google Scholar 

  • Vaillant, George E. 2008. Spiritual evolution. New York: Broadway Books.

    Google Scholar 

  • Watson, Jean. 1989. Human caring and suffering: A subjective model for health sciences. In They shall not hurt: Human suffering and human caring, eds. R. L. Taylor and J. Watson. Boulder: Colorado Associated University Press.

    Google Scholar 

  • Webster, George C., and Francoise E. Baylis. 2000. Moral residue. In Margin of error: The ethics of mistakes in the practice of medicine, eds. Susan B. Rubin and Laurie Zoloth. Hagerstown: University Publishing Group.

    Google Scholar 

  • Weissman, David E. 2009. Moral distress in palliative care. Journal of Palliative Medicine 12:865–866.

    Article  Google Scholar 

  • West, Colin P., Mashele M. Huschka, Paul J. Novotny, Jeff A Sloan, Joseph C. Kolars, Thomas M. Habermann, and Tait D. Shanafelt. 2006. Association of perceived medical errors with resident distress and empathy: A prospective longitudinal study. Journal of the American Medical Association 296:1071–1078.

    Article  Google Scholar 

  • Wright, Bob. 2004. Compassion fatigue: How to avoid it. Palliative Medicine 18:4–5.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mary L. S. Vachon .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media B.V.

About this chapter

Cite this chapter

Vachon, M.L. (2012). Reflections on Compassion, Suffering and Occupational Stress. In: Malpas, J., Lickiss, N. (eds) Perspectives on Human Suffering. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-2795-3_24

Download citation

Publish with us

Policies and ethics