Regarding the Pain of Others

Hong Kongers have survived through waves and waves of the pandemic together. Particularly service providers, including health care providers, social workers, psychologists, and counselors, are still clenching their jaws to serve the public in the midst of adversities. While supporting others to heal their trauma and relieve their distress, what about their own mental health? In this interview, we invited two frontline nurses, YY and Sylvia, to share how their workplace environment, instructions at work, and job satisfaction affected their mental health and the depletion of their compassion during the fifth wave of the pandemic.

Anger, Anxiety, and Fear among Health Care Providers

YY, who has been working as a nurse for about four years, said she was not mentally prepared for the fifth wave of the pandemic at the very beginning of the year. "All of a sudden, the whole ward had to be emptied in a day to receive patients from the Accident & Emergency Department. The following days, we had to figure out what to do; should we transfer the patients to the temporary hospital in Asia World Expo, to another hospital, or should they stay? It was all up to us." 

“The situation was disorienting. 

We could only have it shoved down our throat and listen to our seniors' orders.”

‘‘I don’t know what to say.’’ YY pointed out that the hospital lacked the most essential medical support, equipment and was short-staffed, which aggravated their workload. ‘‘We risked going to work every day - the wards were temporary, transitional and many of the facilities were not up to standard. For example, we didn't have a formal infection ward with double doors to prevent the spread of the virus, our staff couldn't wear full gear to work, and we didn't even have enough air sanitizers to filter out the virus.’’

"Our minds were full of doubts and fears: 

is it really OK?"

(Photo by PETER PARKS/AFP via Getty Images)

Witnessing Patients Bearing the Brunt

"We had no time to recognize the needs of patients, we could only provide basic care, such as feeding meals and changing their diapers. Some of the older adults entered the hospital and did not know what was happening so they insisted on getting out of bed. We had to follow the hospital rules and use safety vests or bed restraining straps to prevent them from falling.’’

YY recalled that at the peak of the fifth wave, one side of the ward was packed with eight beds, and two-thirds of the patients were older adults with hands and legs tied and could not move. "I was more upset than furious about having to restrain patients due to shortage of staff. Patients were passing away at every shift. It was something I have never encountered before, and I still look back with great distress. So my belief was to do as much as I could, to save as many lives as I could. Getting them out of the hospital in good health was my only wish at that time. I always reminded myself to be in the best condition at work. It's only when I got off work that I suddenly felt so exhausted and worn out.’’

Witnessing Patients' Trauma with Nothing They Could Do About It

Unlike YY, Sylvia took the initiative to join the Hong Kong Infection Control Center (HKICC) at the North Lantau Hospital. Why did she take the bull by the horns? "After working for a long time in the same position, I wanted to start a new adventure and step out of my comfort zone.’’ Sylvia said.

After eight years being a nurse, Sylvia is convinced that the fifth wave would be the worst scenario she has ever experienced in her life. The temporary transitional hospital was designed for patients who are capable of taking care of themselves in isolation. Initially, every two nurses were in charge of 72 imported cases, such as immigrants, airline crews, maids, and patients with the ability to take care of themselves. However, in the fifth wave, the hospital was transformed within a day, taking in the residents of an entire nursing home, every two nurses had to take care of nearly 100 older adults without the ability to take care of themselves.

（Photo by PETER PARKS/AFP via Getty Images）

Sylvia describes the situation as "hellish" - severely understaffed, and the service quality has taken a nosedive. "If the patient survived and didn't pass away that day, it was already a success. There were not enough diapers and oxygen face masks, so we had to make our own, cutting holes in paper cups and using them as masks.’’

 "Some older adults who couldn't take care of themselves cried and 

begged nurses to change their diapers, saying that they had not been changed all day, 

their excrement was overflowing, 

and their skin was rankled."

Sylvia said that they crumbled: "There was no time to eat at work, going to the toilet was a big luxury, and I didn't dare to take a day off. Everyday I didn't want to go to work, I called colleagues and my family to cry after work, and shared how overwhelmed and despondent I was."

（Photo by Marc Fernandes / NurPhoto via Getty Images）

What is Compassion Fatigue?

For those who provide support services, prolonged use of their own resources (including physical and psychological resources) to support others or to carry the emotions and sufferings of others can cause emotional overload and lead to compassion fatigue.

"People who experience compassion fatigue may demonstrate a diminished ability or interest to care for others, as well as mental or physical exhaustion.’’

Signs of compassion fatigue are similar to those of work burnout, including feeling exhausted, anxious or numb, emotionally detached, and losing a sense of fulfillment. The difference is that compassion fatigue is caused by chronic experience of feeling and understanding the emotions of others.

Research summarized stressful events that are often experienced by health care professionals, including frequent encounters with:

• death and dying, observing extreme physical pain in patients
  
• grieving families 
  
• traumatic stories
  
• personal grief
  
• emotional and physical exhaustion
  
• strong emotional states such as anger and depression
  

Studies also highlighted workplace administrative factors as critical to reducing compassion fatigue:

• An ideal work environment with organizational resources and support (clear communication, adequate professional autonomy, psychological and daily support can all enhance nurse morale)
  
• Appropriate workload
  
• Improving job satisfaction

In the face of patients' suffering, Sylvia's approach is "To do as much as I can. I'm sorry if I can't make it, but there's nothing I can do further.’’ Sylvia shared, "I have witnessed compassion fatigue more or less, such as colleagues turning a blind eye to patients' requests.’’ She believes that the overwhelming workload and personal mentality are the sources of compassion fatigue.

‘‘With so many tasks and so limited human resources, what can we do? 

As long as the patient is alive, it's alright. 

Other concerns such as whether they are comfortable and whether the food is acceptable don’t matter.’’

The intense shift arrangement is also the main reason for the fatigue among nurses. For example, if the shift schedule is 0700-1500 today, the next shift is 2100 on the same day, to 0700 the next morning. It severely affects their quality of sleep and state of mind.

‘‘We call it ‘‘shift-chasing’’. 

It's like spending all the time in the hospital and not being away from work. 

I don't know who came up with this idea.’’

According to a study, all respondents agreed that there were signs of compassion fatigue, which began with a loss of energy during leisure time and evolved into a loss of energy at work, resulting in only physical rather than emotional care for patients.

Compassion fatigue not only makes nurses exhausted physically and mentally at work, this numbness may unconsciously carry over to personal life and other aspects such as self-worth. In addition to indifference towards patients, impatience, fear, self-criticism, and anger may also be carried over into personal life, such as when communicating with family members and partners. 

As Susan Sontag wrote in Regarding the Pain of Others, “Compassion is an unstable emotion. It needs to be translated into action, or it withers.’’ Yet, when feeling and relieving the suffering of others is a part of your job, how to avoid numbness and not wither over the years?

In the midst of the crisis, compassion fatigue can also be transformed into a valuable opportunity for self-awareness, reminding service providers to take care of their own needs. If you are interested in exploring more ways to address and relieve compassion fatigue, please keep an eye on our articles and webinars to learn more about self compassion and other ways to support yourself. 

Taking care of yourself is the most powerful way to begin to take care of others. May all service providers have space to soothe their spirits while taking care of others.

References:

Strauss, C., Lever Taylor, B., Gu, J., Kuyken, W., Baer, R., Jones, F., & Cavanagh, K. (2016). What is compassion and how can we measure it? A review of definitions and measures. Clinical psychology review, 47, 15–27. https://doi.org/10.1016/j.cpr.2016.05.004

Turgoose, D., & Maddox, L. (2017). Predictors of compassion fatigue in mental health professionals: A narrative review. Traumatology, 23(2), 172. https://psycnet.apa.org/record/2017-09426-001

Gustafsson, T., & Hemberg, J. (2022). Compassion fatigue as bruises in the soul: A qualitative study on nurses. Nursing ethics, 29(1), 157–170. https://doi.org/10.1177/09697330211003215