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Compassionate practice in a ‘compassion fatigued’ climate.

Compassionate practice requires health and social care professionals to have, and use, emotions that prompt them to reach out to those in distress. It is about making connections with people, human to human, in a bid to alleviate others’ pain in some way. I have been giving some serious thought to how practitioners develop, and maintain, compassionate responses without being overwhelmed by the emotional cost to themselves. How do they connect emotionally, show empathy, and give of themselves, without succumbing to ‘compassion fatigue’ or ‘burnout’? What difference does the context in which they practice make? And why does any of this matter?

Let’s start by thinking about why compassionate practice matters. Who does it matter to? 

When we receive health and social care services we are likely to want to be treated compassionately. If we pause and reflect on our own health appointments, and think about what made us feel we had safe treatment, my guess is we want more than competency and efficiency. We want to feel our presenting difficulty has been understood. We want to feel a sense of safety and trust. A little bit of ‘bedside manner’ goes a long way in reassuring us! 

Study after study finds that the quality of the helping relationship is key. Children in the care system describe wanting social workers who are warm and demonstrate they care. Mental health studies highlight that many different therapies are effective but the 'therapeutic relationship' is the most important ingredient in healing. I could go on... 

Compassionate practice matters to the practitioners in the health and social care sector. They frequently cite wanting to ‘make a difference’ as a motivator for choosing their professions. They generally set out with a desire to care for others. I can relate to that. This leaves practitioners vulnerable. I can relate to that too! Giving of themselves can be emotionally demanding. The ‘burnout’ rates of social workers, teachers and nurses is shockingly high. The average professional lives of social workers is estimated at somewhere between five and eight years. Community Care reported that four out of five social workers find their caseloads ‘unmanageable’ and some link this to thoughts of leaving the profession (Stevenson, April 11th 2018). Shocking. What a waste of good intentions. Not to mention the costs of training etc. And as for the impact on service-users who have frequent changes of social workers... 

Perhaps even more shocking is the way organisations and professional bodies respond. There are retention problems across the board in the helping professions. The reasons for this are complex. However the ‘solutions’ we see offered seem overly simplistic to me and centre around two key themes: 

-Train more. More quickly. Keep the recruits coming. It reminds me of sending young soldiers to the World War One trenches...and then they were sent over the top...

-Blame the practitioner. This one takes many forms. Judgements made about practitioners who show ‘emotional leakage’, or signs of secondary trauma, arising from their passion, empathy and compassion. Criticisms of practitioners who fail to work quicker, ‘smarter’,  or take on more cases (or even worse complain!). More insidious is the move to build ‘professional resilience’ of the workforce. In other words toughen them up to withstand the emotional demands. 

A recent thread on Twitter caused me to reflect on my own part in building the professional resilience of student social workers and practitioners. I have embraced the concept and devised innovative ways of helping people develop emotional insight, strength and coping strategies. Its a good thing. Or is it? Could it be that I am perpetuating the idea that resilience (which is so necessary in maintaining a compassionate stance without being overwhelmed) is the personal responsibility of practitioners? Am I absolving the systems from their duty of care to employees?

The Social, Emotional and Behavioural Difficulties Association tweeted -

“There is a ‘dark side’ to the term resilience. Resilience is not for individuals to develop, in isolation, in order to cope with unreasonable, dehumanising demands. resilience is supported socially and organisations have a responsibility to facilitate staff wellbeing and positive mental health” (@SebdaOrg, Twitter, 28/04/2018).

I think it was the phrase ‘dehumanising demands’ that really got me thinking... if compassion is about human connection then a lack of compassion can lead to de-humanising of others.

Now I could go down a ‘blame the management’ route. But in my experience through the years I recognise that managers are often in impossible positions. How do they square the circle, of improving services, meeting demand and targets, and responding to continual government-led policy change, with decreasing resources? 

The lack of resources links to the way as a society we seem to becoming increasingly immune to the distress of others. I may be wrong but things like the increases in street homelessness, food bank use and children with mental health issues are rapidly becoming ‘normalised’. These are the symptoms of austerity cuts and of a society under pressure. I really struggle with the rise in hatred towards those perceived as ‘different’ or other. There seems to be a societal lack of compassion. I wonder how these attitudes comes from communities that are in survival mode and traumatised by the difficulties they face? Could it be that there is ‘organisational burnout’ in our services fuelled by a societal climate of ‘compassion fatigue’? 

Now before we all fall into a pit of despair over the way the world is going I want to bring my thoughts on compassionate practice back to a positive note. Although being compassionate can “involve sadness and grief” it can also be “conducive to our own health and well-being” (Gilbert, 2010). After all when we are kind and caring towards others, and we see we have lightened someone’s burdens, it feels good. 

There have been recent examples of public compassion that offer hope that people do care about each other. One example is the support for the family of Alfie Evans. I am not convinced that this has been entirely helpful or that the ‘helpers’ have always acted in Alfie and his family’s best interests. But the greater majority seem to be demonstrating a sense of empathy and a desire to show they care.These are positive human traits. 

I was very impressed by the compassion, wisdom and sensitivity shown by Mr Justice Hayden in his judgement on the case (judicary.gov.uk, Case No: FD17P00694). He offered a balanced and clear account of the dilemmas and a depth of understanding of parental distress and their raw pain. However he also offers insight into the compassionate and dedicated practice of the medical team at Alder Hey Hospital. It is heartening to hear that under such extreme pressure they maintained their compassion.

This demonstrates that even in a climate of seeming ‘compassion fatigue’ at organisational, or even a societal, level compassionate practice is possible. Whether we like it or not professionals probably need to embrace the ‘dark side’ and take personal responsibility for bolstering their resilience and emotional wellbeing so they have the best hope of being compassionate.

Alistair Hewson and Yvonne Sawbridge’s book ‘Compassion in Nursing: Theory, Evidence and Practice’ is a great read if you are wanting to explore ideas about compassion more. It is applicable across the health and social care professions.

It is easy to lose sight of good practice and compassionate practice often goes unnoticed. I want to pay tribute to the practitioners who show their compassion to service users a daily basis. 

As always these are my thoughts I am sharing for discussion. I welcome your thoughts and feedback. Why not ‘chat’ to me on Twitter? @CarolineAldrid5

United Kingdom

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