Compassion fatigue : pastoral care to HIV and AIDS caregivers within the realm of the healing professions

Solomons, Daniel Peter (2014-04)

Thesis (MTh)--Stellenbosch University, 2014.

Thesis

ENGLISH ABSTRACT: This dissertation aims to address the phenomenon of compassion fatigue within the scenario - of the HIV and AIDS pandemic in South Africa where an estimated 5-6 million people are living with HIV and AIDS. One in every three patients is hospitalised at some stage of their sickness and sufferers of the pandemic come into contact with someone that gives care to HIV and AIDS infected persons, whether in a hospital, a clinic, in counselling or a hospice. Professional stress and emotional fatigue is an inherent feature of the life of caregivers, and there is growing evidence is that it is on the increase. Caregivers are generally compassionate people and the compassion that they have and share with suffering people can be depleted . Caregivers become fatigued by the plight and the situation that never lets up hence the concept compassion fatigue. In this regard, the meaning of this concept as applied to HIV and AIDS caregivers in the healing and helping professions in hospital care (chaplaincy) and different clinical settings was the focus of the research. Compassion fatigue relates to professional stress and can impair professional competency and performance within pastoral caregiving. The phenomenon was studied to distinguish between compassion fatigue burnout/burn up and vicarious traumatisation. A more comprehensive understanding of these concepts will help to clarify current misconceptions. Aspects that necessitate a closer look are whether compassion fatigue is fundamentally stress related or a kind of depletion within the self of the pastoral helper. Could it be some kind of affective exhaustion, or is it related fundamentally to the overexposure to human suffering? Is compassion fatigue then suffering related? The study focuses on the challenges that confront caregivers in the HIV and AIDS field. How can these challenges pose an existential threat to their being-function and human identity? The study also explores how the theology of the cross (from a pastoral approach) can assist caregivers to deal with the question of meaning in the suffering that their patients (and they) may experience. Research questions included how the phenomenon of compassion fatigue should be understood as an inherent feature of the life of caregivers to HIV and AIDS sufferers, and what caregiving should imply to the caregivers (“wounded healers”). What is clear is that those caregivers very definitely also need care. A viable possibility to render meaningful help to depleted caregivers is to take them out of the working place and give them time, space and means to become whole again. A retreat environment is indicated as a form of recuperation for caregivers. At this stage the study amounts to only first steps in that direction and emphasises the need to investigate the subject further.

AFRIKAANSE OPSOMMING: Hierdie verhandeling beoog om die fenomeen van medelye-moegheid te verstaan vanuit die agtergrond van die HIV en VIGS pandemie in Suid-Afrika waar daar 'n beraamde 5-6 miljoen mense met HIV en VIGS lewe. Dit word geskat dat 1 uit elke 3 pasiënte in 'n stadium of stadia van die siekte gehospitaliseer word en derhalwe kom die meeste lyers in aanraking met iemand wat sorg verleen aan MIV/VIGS geïnfekteerde persone, hetsy in 'n hospitaal, 'n kliniek, in berading of 'n hospice. Professionele stres en emosionele moegheid is 'n inherente kenmerk van die lewe van versorgers en daar is toenemende bewys dat dit vanweë die erns van die situasie toeneem. Versorgers is oor die algemeen deernisvolle mense en die deernis wat hulle het en deel met mense wat ly, kan uitgeput raak. Te wyte aan ʼn situasie wat toenemend versleg en nie in die afsienbare toekoms sal weggaan nie ervaar versorgers dat die blootstelling aan menslike lyding en ellende hulle vermoë om lydendes pastoraal te troos en by te staan, drasties opgebruik vandaar die begrip medelye-uitputting. In hierdie verband fokus die navorsing op die betekenis van die konsep medelye-uitputting, soos toegepas op MIV- en VIGS- sorggewers binne die kader van die genesing- en hulpverleningprofessies in die hospitaal (kapelaansdienste) en kliniese instellings. Die verskynsel van medelye-uitputting met betrekking tot professionele stres raak die professionele bevoegdheid en prestasie van versorgers in pastorale hulpverlening. In hierdie verband is die doel om te onderskei tussen medelye-uitputting, uitbranding en plaasvervangende traumatisering. Dit is aanvaarbaar dat 'n meer omvattende begrip van hierdie konsepte huidige wanopvattings daaroor beter kan toelig. 'n Aspek wat 'n nader beskouing noodsaak, is of medelye-moegheid fundamenteel stresverwant is of 'n soort uitputting van die pastorale helper self, of 'n soort affektiewe uitputting, en of dit verband hou met te veel blootstelling binne die sfeer van menslike lyding. Die studie fokus op die uitdagings wat deur versorgers in die HIV en VIGSversorgingsveld die hoof gebied moet word, en hoe hierdie uitdaging ’n eksistensiële bedreiging vir hulle kan inhou wat hulle menswees en identiteit negatief kan beïnvloed. Die studie verken hoe daar vanuit die verstaan van die kruis-teologie pastorale ondersteuning gebied kan word met die hantering/verstaan van lyding en die doel en betekenis daarvan. Navorsingsvrae sluit o.a. in hoe ons die fenomeen van medelye-moegheid as ʼn ontwikkelende verskynsel in die lewe van versorgers wat met MIV- en VIGS-lyers werk, behoort te verstaan en wat pastorale sorg aan uitgeputte versorgers sou impliseer. Wat duidelik na vore gekom het, is dat die helpende hande baie beslis self ook helpende hande benodig. ʼn Haalbare moontlikheid om betekenisvolle hulp aan uitgeputte versorgers te verleen, is aan die hand gedoen, naamlik om hulle uit die werkomgewing weg te neem. By ʼn rusplek (“retreat”) kan aan hulle die kans gegun word om te herstel, self ook weer heel te word. Hierdie vorm van herstel vir uitgeputte versorgers is kortliks hanteer en word voorgestel, maar dit is maar die eerste treë in so ’n navorsingsrigting, wat die noodsaaklikheid van verdere navorsing beklemtoon.

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