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Originally, as shown in the protocol, the trial was to have used bimodal scoring, specifying that a positive outcome would be a 50% reduction in fatigue score, or a score of 3 or less. In a relatively small study, looking at cortisol levels in CFS, the Likert scale was used to assess fatigue levels in 40 patients and 40 controls. In this article I will provide an overview of the concepts of burnout, compassion fatigue, and vicarious traumatisation (see Table ). Research is needed to fully explore the role of self-sacrificing behavior as a contributing factor for increased risk of compassion fatigue, as well as the role of individual characteristics and organizational factors. As a reader you may have recognized that some signs or characteristic of depression are present in compassion fatigue.
Direct and indirect relationships between emotional intelligence and subjective fatigue in university students. The low yield of physical examinations and laboratory investigations of patients with chronic fatigue. The association between anemia and fatigue in patients with advanced cancer receiving palliative care. Iron supplementation for unexplained fatigue in non-anaemic women: double blind randomised placebo controlled trial.
Patient-controlled methylphenidate for cancer fatigue: a double-blind, randomized, placebo-controlled trial. Cognitive behaviour therapy for adolescents with chronic fatigue syndrome: randomised controlled trial [published correction appears in BMJ. Shiftwork locus of control, situational and behavioural effects on sleepiness and fatigue in shiftworkers. Physiological, biochemical and psychological markers of strenuous training-induced fatigue. Depressive mood symptoms and fatigue after exercise withdrawal: the potential role of decreased fitness. Job characteristics and off-job activities as predictors of need for recovery, well-being, and fatigue. Stress, fatigue, health, and risk of road traffic accidents among professional drivers: the contribution of physical inactivity. Chronic debilitating fatigue in Irish general practice: a survey of general practitioners' experience.
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Several types of occupational stress have been identified, including burnout, compassion fatigue, and vicarious traumatization. While emphasis is placed on compassion fatigue and its underlying theory, an overview of the other two types of occupational stress, namely burnout and vicarious traumatisation, are also provided. An offshoot of burnout, the term compassion fatigue first reflected the adverse psychosocial consequences experienced by emergency room nurses in a study exploring burnout (Joinson, 1992). It also fails to adequately account for the benefits that nurses may derive from their relationships with patients or for how the therapeutic relationship may potentially serve to protect the nurse from experiencing compassion fatigue (Sabo, 2009, 2010). Approximately 34% (N=47) of the 170 nurses who exhibited this behavior were in the high risk category for compassion fatigue.
Exposure to traumatic stressors does not guarantee that an individual will manifest symptoms of compassion fatigue (Valent, 2002).
For example, nurses may respond to questions on one of several instruments used to indicate the presence or absence of occupational stress, yet the responses do little to explain how nurses perceive the nature of their work and what factors affect compassion fatigue or other types of occupational stress. In a recently completed study conducted by myself and colleagues (unpublished as of this writing) the researchers did observe a statistically significant correlation between the presence of clinical depression and compassion fatigue among caregivers of hematological stem cell transplant recipients. The differential diagnosis of fatigue includes lifestyle issues, physical conditions, mental disorders, and treatment side effects.
While the emphasis of this article is on compassion fatigue and its theoretical conceptualization, the concepts of burnout and vicarious traumatization are also discussed. Research has yet to provide clarity and understanding as to whether empathy and engagement have a role in contributing to, or protecting the nurse from compassion fatigue and vicarious traumatisation. In contrast, nurses experiencing compassion fatigue exhibit an intensified level of emotional distress leading to interpersonal withdrawal and changes in their beliefs, expectations, and assumptions.
Over the past ten years compassion fatigue has received considerable attention as a potential form of occupational stress experienced by nurses. Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized.
Compassion fatigue and burnout in nurses who work with children with chronic conditions and their families. Issues and controversies in the understanding and diagnosis of compassion fatigue, vicarious traumatization and secondary traumatic stress disorder. Fatigue can be classified as secondary to other medical conditions, physiologic, or chronic. These factors may include resilience and hope, which may thwart the development of compassion fatigue allowing the nurse to experience positive effects from caring work. While the findings supported the notion that hospice care nursing was stressful, what remained unclear was the nature of the relationship among nurses, patients, and families and the role of relationships in either increasing or decreasing the risk for compassion fatigue. Nor is the continuum on which burnout, compassion fatigue, and vicarious traumatization may exist.
At the same time, the lack of theoretical clarity underlying compassion fatigue has led to a number of questions ranging from the role of empathy and empathic response in the development of compassion fatigue to the possibility of a continuum of stress.

At this point in time, it is unclear whether or not burnout is a precondition for compassion fatigue. It is possible that ongoing exposure to these factors may lead nurses to experience compassion fatigue, one form of occupational stress. Taking this perspective into consideration, it would appear that a different concept may be at work in influencing compassion fatigue, a concept separate from empathy.
It is also worth noting that a clear distinction between compassion fatigue and vicarious traumatization lies in the permanency of change to the individual. It may well be that initially the lines are blurred between burnout and compassion fatigue because of overlap in the signs of both burnout and compassion fatigue. We do not currently have evidence to support a continuum of occupational stress ranging from burnout to compassion fatigue to vicarious traumatization. Treatment of all types of fatigue should include a structured plan for regular physical activity that consists of stretching and aerobic exercise, such as walking.
Patients whose symptoms worsen for longer than 24 hours after physical exertion have a poor prognosis.36,37EVALUATIONDetailed psychiatric and sleep histories may help determine possible psychosocial contributors to fatigue. Hence it would not appear unreasonable to suggest that burnout may be a pre-condition for the other types of occupational stress, namely compassion fatigue and vicarious traumatisation, by creating the fertile ground for these types of stress to develop.
Yet as the situation continues to deteriorate, more signs of compassion fatigue may appear. She has published in the areas of occupational stress, compassion fatigue, and finding cancer meaning through art. In contrast, compassion fatigue is amenable to treatment intervention and individuals may continue to work successfully in their chosen field. With this in mind, it would seem plausible to suggest that compassion fatigue precedes vicarious traumatization if one chooses to envision a stress continuum. It is also reasonable to assume that burnout can exist concurrently with either compassion fatigue or vicarious traumatization.
For example, an individual may not have compassion fatigue, yet may be slightly, moderately, or severely affected by a given interaction with a patient. Persons who are sleepy are temporarily aroused by activity, whereas fatigue is intensified by activity, at least in the short-term.4 Patients with sleepiness feel better after a nap, but patients with fatigue report a lack of energy, mental exhaustion, poor muscle endurance, delayed recovery after physical exertion, and nonrestorative sleep. Secondary fatigue is caused by an underlying medical condition and may last one month or longer, but it generally lasts less than six months.

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