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Compassion Fatigue in EMS: How to Empathize While Avoiding Burnout

Kati Kleber, BSN, RN, CCRN, author of several healthcare books and Charlotte Business Journal’s “2015 Nurse of the Year,” hosted a webinar on May 10, 2017, titled “Empathy 101 For Nurses,” in which she discusses how to be empathetic toward patients without burning out emotionally.

While the webinar was geared toward nurses, this is a pervasive topic in emergency medical services, and EMS personnel can greatly benefit from the knowledge and insight Kleber provides.

It’s important for EMS providers to first gain a true understanding of what empathy is. Empathy and sympathy are different from each other, despite the common misconception that they are synonymous. This video provides a simple illustration of the difference between the two terms. Essentially, sympathy is the ability to feel bad for someone’s suffering, while empathy is the ability to share the emotions of someone who is suffering, says Kleber.

A step further than empathy is compassion, which is “more engaged than simple empathy, and is associated with an active desire to alleviate the suffering of its object,” says Oxford University professor Neel Burton, MD, as quoted by Kleber. She warns against responses that might seem empathetic but are more sympathetic in nature and thus unhelpful. For example, don’t try to “silver-line” someone’s problem—there doesn’t have to be a positive aspect of the situation. This may feel like you’re undermining their pain.

There are four main components of empathy Kleber discusses, which can help strengthen your compassion:

  1. Perspective-taking: 
    This is the act of viewing the world from another person’s perspective. Avoid viewing the situation through your own lens. Don’t assume you can imagine the pain they are going through. Take into consideration that their feelings and life experiences are different than yours, so they will likely have very different reactions and coping skills.
  2. Staying out of Judgment: 
    It’s important to remain non-judgmental. It can be easy to judge someone’s actions if you don’t attempt to look at the situation through their eyes. Set aside your presumptions because you don’t know (and may not understand) the full scope of their situation. Recognizing this leaves no room for judgment.
  3. Understand Their Emotions:
    Reflecting on your own experiences, make an effort to recognize and identify with their emotions to better understand them. Name their feelings. However, keep in mind that this is not the time to bring your own experiences into the conversation. This will make them feel obligated to talk about you when you should be the one supporting them.
  4. Communicate Your Understanding of Their Emotions:
    Tell the person you understand their pain. You can even thank them for sharing their feelings with you, but don’t feel pressured to know the right things to say. Simply acknowledging that they are dealing with a difficult situation validates their emotions and lets them know it’s okay to struggle.

“If you’re doing it right, it hurts,” says Kleber. While being empathetic toward patients is significantly beneficial to their mental well-being, it can be detrimental to yours if you don’t properly care for yourself.

“You can’t keep filling their cup if you’re not filling your own,” Kleber says. In other words, extending empathy and compassion to other people must be balanced with compassion for yourself.

This is what Kleber refers to as self-compassion. Due to the nature of the EMS profession, in which providers frequently witness trauma, self-care is critical. Directing most of your energy into empathizing with patients can lead to severe mental distress and, ultimately, compassion fatigue. Kleber quotes a source defining compassion fatigue as a “reduced capacity for compassion as a consequence of being exhausted from dealing with the suffering of others.”

Kleber notes that self-compassion can be a protective measure against compassion fatigue. She lists three practices of self-compassion.

  1. Self-kindness: Instead of being harshly self-critical during times of failure or pain, be kind and understanding to yourself.
  1. Common Humanity: Rather than viewing traumatic experiences as isolated events that negatively affect you, perceive them simply as smaller parts to the whole of the human experience.
  1. Mindfulness: Maintain a balanced awareness of painful emotions rather than allowing them to define you. Acknowledge the emotions and allow yourself to feel them, but don’t wallow in them.

Kleber references Dr. Irene Kraegel, clinical psychologist of Calvin College, who explains that lacking self-compassion can make you believe that your life is hard due to your own fault. However, with self-compassion, you realize this is not the truth and you can move forward to experience healing.

“Through self-compassion, we change this response to ourselves and notice that life isn’t hard because we’re doing something wrong—life is hard for everyone,” says Kraegel.

When you come to terms with this, you can begin treating yourself like a friend when you are suffering, rather than beating yourself up, she says. “We stop comparing and experience gratitude for whatever abundance (in whatever form) we have.”

Kleber offers some practical tips to keep in mind when learning self-compassion. “Directing compassion toward yourself may stir up pain as you realize ways you did not receive compassion in life,” she says. Achieving self-compassion is not based on how well you’re feeling, but knowing you need to feel well and continuing to strive for it.

It’s OK to experience painful moments in this process. Kleber says this is not a sign of failure, but one of progression. Accept that it’s painful and don’t try to extinguish the pain, as this will only exacerbate it and delay the healing process.

Even if you struggle through these developments, know that it’s normal. Kleber quotes Dr. Kristin Neff, psychology professor at the University of Texas, noting it’s essential to “embrace ourselves and care in response, remembering that imperfection is part of the shared human experience.”

Remember, to properly care for patients, you must care for yourself first. Kleber says self-compassion and gratitude must be your first priority. Only then can you offer effective empathy and compassion to others.

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