Understanding compassion fatigue among social workers: a scoping review

Abstract

Exposure to significant sources of trauma and stress among social workers is increasingly identified as an important issue that can impact the quality of professional services, and the social worker’s well-being. There is more and more literature focusing on this phenomenon and related concepts. However, to our knowledge, there has been no published systematic review of the literature on compassion fatigue (CF) among social workers. Therefore, we performed a systematic scoping review by searching five electronic databases for studies published from 2001 to 2021, with the aim of identifying relevant literature. A total of twenty-nine studies were selected in the review following the systematic search strategy. Five themes were identified through the use of a narrative approach to synthesizing the literature by a Five-step framework of scoping review, including the prevalence, factors related, attributes and characteristics, consequences and strategies or interventions to reduce compassion fatigue among social workers. Findings revealed that few studies had examined the consequences and tested the effectiveness of specific interventions. Furthermore, future research involving concept analysis and related theoretical model was required in the field of social work.

Highlights

Introduction

As a practice based profession, the main task of clinical social workers is to establish professional relationships and empathize with people who have experienced or are currently facing multiple traumas. Consequently, social workers in various roles are highly susceptible to experiencing emotional and psychological distress, such as vicarious traumatization (VT), secondary traumatic stress (STS), compassion fatigue (CF) or job burnout (BO), due to prolonged exposure to various types of traumatic realities (Armes et al., 2020; Hamid and Musa, 2017). Research on social workers in a range of settings reported that they were almost at risk of developing compassion fatigue, such as child welfare caseworkers (Rienks, 2020), hospice social workers (Fox, 2019) and social workers in the community settings (Brown et al., 2019). These literatures suggested that compassion fatigue can have multiple negative effects on social workers and even have the negative implications for organizations and service users (Ledoux, 2015). The negative psychological and physical impacts of CF involved hopelessness; deep physical, emotional, and spiritual exhaustion; disconnection from others; and affected the personal and professional well-being of care providers (Figley, 1995). Meanwhile the social workers in high-risk situations will encounter employee absenteeism, turnover, poor morale, and impaired professional judgment (Denne et al., 2019; Kim et al., 2021). Better understanding of social workers’ experiences of compassion fatigue can improve their wellbeing and optimize the efficiency and quality of social services delivered to those in need (Bride et al., 2016; Decker et al., 2002).

Compared to secondary traumatic stress (Sorenson et al., 2016), the term compassion fatigue, which was considered as a user-friendly alternative for the outcome of work-related stress, had been widely adopted after its publication by Joinson in 1992 (Coetzee and Laschinger, 2018). As two different conditions with similar features, secondary traumatic stress and vicarious traumatization located different areas of symptoms, respectively. The former emphasized outward behavioral symptoms and the later focused on intrinsic cognitive changes (Newell and MacNeil, 2010). Since then, significant advancements had been made in the field of compassion fatigue research, particularly in terms of conceptual and methodological domains. These advancements focused on establishing conceptual clarity, conducting empirical research and developing theoretical and measurement models (Bride et al., 2007; Cross, 2019; Sorenson et al., 2017). The existing measurement tools used to assess CF among social workers included the professional quality of life scale (ProQOL) and compassion fatigue scale (CFS).

However, compared with these studies in health care, there was a limited number of studies reviewing the compassion fatigue related concepts in social work (Letson et al., 2020). While Molnar et al. (2020) conducted a review on vicarious traumatic stress in early childhood professionals through the analysis of 39 articles, as far as we know, there has been a lack of systematic review focusing on compassion fatigue specifically among the social workers. This gap in the literature research made it challenging to identify the prevalence of compassion fatigue among social workers and to develop prevention and intervention strategies (Méndez-Fernández et al., 2022).

As a type of knowledge synthesis for literature reviews that has received little attention, scoping reviews are particularly effective in mapping evidence on broader topics (Arksey and O'Malley, 2005; Harms and Goodwin, 2019). Therefore, we conducted a scoping review by utilizing a systematic approach, analyzing and summarizing the scope of findings in current literatures.

The purpose of this scoping review was to

• Identify the quantity and scope of current literature.

• Provide a summary and synthesis of significant research findings.

• Explore the gaps in the available literature to guide future research.

Methods

In contrast to systematic reviews, scoping reviews preliminary assess the potential scope and extent of available literature through a broad approach to uncover the current knowledge gaps (Arksey and O'Malley, 2005; Grant and Booth, 2009; Harms and Goodwin, 2019). The selection of a scoping review methodology for this study was appropriate to achieve the goals of mapping the current literature and informing the findings for social work practice (Molnar et al., 2020). We employed the scoping review following the framework proposed by Arksey and O'Malley (2005), and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework as a systematic approach (Tricco et al., 2018). The review process consisted of the following five stages.

Stage 1: identifying the research question

What research in English and Chinese language had been undertaken on compassion fatigue among social workers?

Stage 2: identification of relevant studies

The two-pronged search strategy was utilized. The first strategy involved a systematic literature search of five electronic databases, namely PubMed, ERIC, Web of Science, EBSCO (Psychology and Behavioral Sciences Collection, APA PsycArticles, APA PsyInfo, and Open Dissertations), CNKI, and Airiti (two electronic databases in Chinese), spanning from January 2001 to December 2021. One set of search terms describing participants (“social work” OR “social workers” *) was combined with a second set of keywords describing CF (“compassion fatigue” OR “compassion satisfaction” OR “secondary traumatic stress” OR “burnout”*) in all possible permutations. In addition, to avoid the risk of omitting relevant studies, a hand-search of the reference lists of located studies was also conducted and identified five additional publications.

Stage 3: selecting studies

A systematic selection process was utilized to determine the final set of articles that reflected the international trends. For inclusion in the review, articles were (a) empirical article published in a peer-reviewed journal, (b) written in English or Chinese, with (c) primary focus on social workers or related professionals, and (d) studied the compassion fatigue. The reasons why certain articles were not considered for this scoping review were as follows: (a) they focused on other professions and did not include information about social workers; or (b) they focused on the related concept other than compassion fatigue (i.e., Secondary Traumatic Stress, Burnout, Professional Resilience). In addition, as a revised version of the compassion fatigue scale (CFS), the professional quality of life scale (ProQOL) was the most commonly used assessment tool, which consisted of three subscales—compassion satisfaction, burnout, and secondary traumatic stress—where compassion fatigue was defined as a combination of burnout, and secondary traumatic stress. Therefore, if the article involved multiple concepts and used the Pro-QOL scale as the main measurement concept, they were included.

Two authors conducted the process independently and then checked agreement. The reliability of the searching was determined by comparing the number of articles identified by the two reviewers. Five articles with different opinions were discussed in more depth between the two reviewers and resolved through reconsidering inclusion to reach a consensus. Figure 1 provided a summary of our search process and results as presented in the PRISMA chart (Tricco et al., 2018).

Figure 1

Stage 4: data graphics

Two reviewers collaborated to extract descriptive characteristics from the articles, and developed a standardized data extraction form that facilitated the gathering of vital theoretical and methodological elements, including: (a) author (s) and publication year, (b) study location: country and setting, (c) study populations (e.g., child protection social work), (d) purpose of the study, (e) research design and methodology, and (f) instrument. In addition, to illuminate the dominant areas of research, the reviewers identified the outcomes from the included papers. These detailed data extractions can be found in Table 1, which were collated by the reviewers using a customized data extraction sheet.

Stage 5: summarizing and reporting the results

The results were presented by examining, comparing, synthesizing, and discussing the study characteristics and primary findings of the included articles. A narrative synthesis format was utilized, in which the themes were organized into an inductive conceptual structures to facilitate the discussion of the results.

Results

Initially, a total of 326 articles were identified through electronic database searching and manual searching. After the removal of duplicates, 178 articles remained and the titles and abstracts of them were screened. 139 articles were excluded in accordance with the inclusion criteria (interrater reliability 96%). Finally, the full texts of the remaining 39 articles were examined to reach a final decision. 10 articles were excluded at full-text review due to the excluded standard (interrater reliability 94%). Figure 1 shows the PRISMA flowchart of the study selection process.

Table 1 presented the general characteristics of these studies. All included articles were in English (n = 29). Most of the studies were conducted in the USA (n = 16), and followed by Australia (n = 4), Canada (n = 3), Korea (n = 3), Norway (n = 1), Spain (n = 1) and Israel (n = 1). The majority of studies were published between 2013 and 2021 (n = 24), reflecting the emerging research status of this field (see Figure 2). Most of the studies employed quantitative methods (n = 21) and eight papers used qualitative methods. Two main measurement tools with potential use for CF among social workers across the quantitative studies were identified, including the Compassion Fatigue Scale (n = 5) and Professional Quality of Life (ProQOL) scale (n = 16). Table 1 listed the characteristics of the methodologies used in all the included studies.

Figure 2

Theme 1: prevalence of CF among social workers

The existing instruments used to assess compassion fatigue among social workers included the professional quality of life scale (ProQOL) and compassion fatigue scale (CFS) (Keesler and Fukui, 2020). Sixteen of the studies in this review employed the Pro-QOL (III, IV, V) and five used the CFS. Ten studies reported data on the level and prevalence. Overall, most studies (n = 7) reported that more than half of the participants scored in the medium range of compassion fatigue. However, Letson et al. (2020) found child welfare workers scored high category for burnout scale (68th percentile) and the top quartile for STS scale (94th percentile). Baugerud et al. (2018) found none of the respondents scoring in the high range of burnout (BO) and secondary traumatic stress (STS), meanwhile some of the participants (32.6%) scored high. (Cuartero and Campos-Vidal, 2019). There was no data available in the Chinese literature.

Theme 2: factors related to CF in social workers

We coded the factors that correlated with compassion fatigue across the reviewed studies, including the demographic differences (i.e., age, gender, marital status, education), the traits of personality (i.e., empathy, self-care, mindfulness, personal distress) and the work-related factors (i.e., employment status, length of employment, job position, peer Support). Baugerud et al. (2018) reported that the positive challenges at work, a sense of mastery of the work and commitment to their organizations were associated with improved levels of compassion satisfaction. Yi et al. (2018) and Wagaman et al. (2015) both focused on the role of empathy and reported negative correlation with compassion fatigue.

Theme 3: attributes and characteristics of CF in social workers

To understand the attributes and characteristics of compassion fatigue among social workers, the voices from themselves was very important. Kapoulitsas and Corcoran (2014) identified the emotional responses and difficulties from the interviews involving six social workers who working with distressed clients and Yi et al. (2016) described when compassion fatigue was experienced and how it was dealt with within the oncology social workers. There were two key defining attributes were identified from the relevant literature, including the cumulative process and emotional and behavioral symptoms.

Theme 4: consequences of CF in social workers

Compared to the studies focusing on the predictors of compassion fatigue, there was limited research on the consequences of compassion fatigue, with only two studies identified in this scoping review. Kim et al. (2021) explored the negative consequences of compassion fatigue on the oncology social workers’ well-being, including the personal wellbeing and transforming the impact of compassion fatigue. Denne et al. (2019) found that compassion fatigue could change the perspective of social workers when dealing with cases of child abuse and Kapoulitsas and Corcoran (2014) provided another insight into the participants’ experiences, like the resilience as the growth factors.

Theme 5: strategies or interventions to reduce CF among social workers

Among the studies reviewed, two focused on interventions aimed at reducing compassion fatigue in social workers, such as yoga and mindfulness programs and pre-recorded guided imagery (GI). Kiley et al. (2018) provided an evaluation of the effects on compassion fatigue and anxiety among the mental health, while Brown et al. (2017) confirmed that compassion fatigue and mindfulness were inversely correlated. However, there was no formal intervention in these two studies. There were no relevant reports in Chinese language.

Discussion

This scoping review sought to examine and map a broad spectrum of published literature concerning social workers’ experiences with compassion fatigue. There had been a growing focus on the population of social workers (ex., compared to the nurses), with almost 82.8% of the literature published between 2013 and 2021.

Almost all peer-reviewed papers came from high-income countries, showing that there are regional differences in this research, which was also closely related to the development of the social work profession. Future research needed to obtain research data from more countries and regions around the world, including comparisons evidence between different countries, in order to capture the CF level of social workers around the world in a more comprehensive way. Additionally, five themes of the included literature were identified through the thematic analysis. These themes were also documented in previous reviews that centered on other professionals (Najjar et al., 2009; Ortega-Campos et al., 2019; Zhang et al., 2018). Baqeas et al., 2021 reported the themes emerged from synthesis, including consequences, associated factors and strategies to support palliative care health providers. To some extent, it was similar with this current review. However, our findings revealed that most of the studies investigated the prevalence and related factors, which indicated the gap in the literature that needed more examination.

Firstly, a concept analysis and related attributes or theoretical model needed to be discussed and a more suitable measurement tool for social workers needed to be developed. Based on our review, the findings indicated that there was no existing work provided a concept analysis of compassion fatigue among the social workers. However, there were some researches that focused on the concept analysis of compassion fatigue among the healthcare providers or the family caregivers in the healthcare setting (Cross, 2019; Lynch and Lobo, 2012). A concept definition of compassion fatigue in the context of social work could provide more insight for this profession and facilitate the identification of symptoms and risk factors among social workers (Coetzee and Laschinger, 2018). Most of the included studies used the ProQOL scale, which is widely used among the nurses and medical staff (Ortega-Campos et al., 2019). Future research should aim to enhance theoretical understanding of compassion fatigue and develop a more suitable measurement tool for social workers.

Second, this scoping review revealed the CF-related risk and protective factors in social workers across the reviewed studies. The main factor that affected social workers in terms of compassion fatigue was related to the work-based conditions, which was in line with studies that explored the well-being of social workers (Hitchcock et al., 2021).

The studies included in this scoping review recruited from many of the settings (i.e. hospital (Yi et al., 2019)) in which social work is practiced, making it representative of the social work profession.

However, our findings suggested that there were still some working units not included in existing research (e.g., school). To our knowledge, there was no existing research that compared findings across settings or examined the different affect compassion fatigue among social workers in various settings. Future research should explore the incidence across settings and how work settings impacted on the development of compassion fatigue.

Finally, there was a lack of evidence that conducted and tested the effectiveness of interventions that could mitigate compassion fatigue among social workers, who had the unique experiences. Receiving the training or education programs was found to prevent and reduce the increasing symptoms of compassion fatigue among various populations. In contrast to the considerable research dedicated to examining the factors that contributed to compassion fatigue, there were relatively few intervention studies conducted to provide effective interventions and assess their efficacy specifically among social workers, particularly in implementation to other professionals (Delaney, 2018; Slatyer et al., 2017). Instead of focusing on the implement and effectiveness of strategies that reduced compassion fatigue among social workers, some studies only explored strategies themselves through self-reported data and correlational analysis. Therefore, future research should explore more details of the strategies or programs that were applicable to mitigate compassion fatigue among social workers using the quasi-experimental design.

Limitations

While a systematic process was followed, it was essential to acknowledge that this scoping review might miss certain elements of the literature, especially the missing of relevant articles not included in databases searched. This was a result of limiting the search to English and Chinese literature published within the last two decades. Consequently, the following types of literature were excluded: unpublished (grey literature); published in a language other than English and Chinese; and published as early as 2001. This might introduce some bias, including publication and language.

Conclusion

In this scoping review, we comprehensively examined the literature on the experiences of CF among social workers and identified five themes, including the prevalence of CF, factors related to CF, attributes and characteristics of CF, consequences of CF, and strategies or interventions to reduce CF among social workers. Although our review provided valuable insights into the CF among social workers, several research gaps remained to be addressed. First of all, the concept analysis and related attributes or theoretical model of CF should to be discussed. And then a more suitable measurement tool for social workers’ experience of CF needed to be developed. Finally, there was a lack of evidence that conducted and tested the effectiveness of interventions that could mitigate compassion fatigue among social workers.

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