Compassion fatigue: A meta-narrative review of the healthcare literature.

BACKGROUND: Compassion fatigue describes a work-related stress response in healthcare providers that is considered a 'cost of caring' and a key contributor to the loss of compassion in healthcare. OBJECTIVE: The purpose of this review was to critically examine the construct of compassion fatigue and to determine if it is an accurate descriptor of work-related stress in healthcare providers and a valid target variable for intervention. DESIGN: Meta-narrative review. DATA SOURCES: PubMed, Medline, CINAHL, PsycINFO, and Web of Science databases, Google Scholar, the grey literature, and manual searches of bibliographies. REVIEW METHODS: Seminal articles and theoretical and empirical studies on compassion fatigue in the healthcare literature were identified and appraised for their validity and relevance to our review. Sources were mapped according to the following criteria: 1) definitions; 2) conceptual analyses; 3) signs and symptoms; 4) measures; 5) prevalence and associated risk factors; and 6) interventions. A narrative account of included studies that critically examines the concept of compassion fatigue in healthcare was employed, and recommendations for practice, policy and further research were made. RESULTS: 90 studies from the nursing literature and healthcare in general were included in the review. Findings emphasized that the physical, emotional, social and spiritual health of healthcare providers is impaired by cumulative stress related to their work, which can impact the delivery of healthcare services; however, the precise nature of compassion fatigue and that it is predicated on the provision of compassionate care is associated with significant limitations. The conceptualization of compassion fatigue was expropriated from crisis counseling and psychotherapy and focuses on limited facets of compassion. Empirical studies primarily measure compassion fatigue using the Professional Quality of Life Scale, which does not assess any of the elements of compassion. Reported risk factors for compassion fatigue include job-related factors, fewer healthcare qualifications and less years experience; however, there is no research demonstrating that exemplary compassionate carers are more susceptible to 'compassion fatigue'. CONCLUSION: In the last two decades, compassion fatigue has become a contemporary and iconic euphemism that should be critically reexamined in favour of a new discourse on healthcare provider work-related stress.

Canada's pregnancy-related mortality rates: doing well but room for improvement.

PURPOSE: Canada's perinatal, infant and maternal mortality rates were examined and compared with other Organization for Economic Cooperation and Development (OECD) countries. The type and the quality of the available data and best practices in several OECD countries were evaluated. SOURCE: A literature search was performed in PubMed and the Cochrane Library. Vital statistics data were obtained from the OECD Health Database and Statistics Canada and subjected to secondary analysis. PRINCIPAL FINDINGS: Overall, Canadian pregnancy mortality rates have fallen dramatically since the early 1960's. Perinatal and infant mortality rates remain low and stable, but the maternal mortality rate has increased slightly and both mortality rates have declined in their relative OECD rankings over the last 20 years. Data quality and coverage across Canada and internationally, especially for Indigenous peoples, is inconsistent and registration practices differ greatly, making comparisons difficult. Available data do show that Indigenous people's perinatal and infant mortality rates are nearly twice those of the general population. Best practices in other OECD countries include Australia's National Maternity Services plan to improve Aboriginal perinatal health, the Netherlands' midwifery services and National Perinatal Registry and Japan's national pregnancy registration and Maternal Handbook. CONCLUSION: To diminish Canadian disparities in perinatal health rates and improve health outcomes we recommend a) uniform registration practices across Canada, b) better data quality and coverage especially among Indigenous communities, c) adoption of a national pregnancy registration and a maternal handbook along with d) improved midwifery and primary practice services to rural and remote communities. At a time when Canada is focusing upon improving pregnancy health in developing nations, it also needs to address its own challenges in improving pregnancy outcomes.