523 Qualitativeresearchstudyfinalpaper

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Running head: THE EFFECT OF TRAUMATIC EXPERIENCE LEADING TO A HELPING

CAREER CHOICE IN TUN OT15 STUDENTS

The Effect of Traumatic Experience Leading to a Helping Career Choice in TUN OT15 Students
Shantel Bishoff, Kamrie Fryer, Jaclyn Jerse & Sotheavy Moeung
Touro University Nevada

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Introduction

Clinicians who choose helping professions are often extremely empathetic people: they
are able to step into another persons shoes and understand what that person is feeling. These
qualities make therapists drawn to assist individuals who are suffering, while increasing their
vulnerability to compassion fatigue. In the 1990s the term compassion fatigue appeared and was
often associated with the stress and burnout experienced by nurses. The American Institute of
Stress defines compassion fatigue as the emotional residue or strain of exposure to working
with those suffering from the consequences of traumatic events. It is also defined by Charles
Figley as a state of tension and preoccupation with the traumatized patients by re-experiencing
the traumatic events, avoidance/numbing of reminders [and] persistent arousal (e.g., anxiety,
hyper-vigilance) associated with the patient (Figley, p.1434). It is thought that some people are
more vulnerable than others to compassion fatigue, particularly people who may have
experienced unresolved trauma in their own lives.
This study needs to be conducted because people who experience compassion fatigue
usually direct attention to others rather than themselves, which leads to psychological distress.
Our research team would like to promote greater self-awareness with self-reflection, which in
turn will allow for success in a helping profession, such as occupational therapy. Compassion
fatigue affects numerous individuals within many professions, but still is highly unrecognized.
This study is being conducted with the intentions of comparing and contrasting similar aspects
and traits amongst individuals seeking a career in the helping field of occupational therapy.

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Purpose
Studies confirm that caregivers play host to a high level of compassion fatigue. Often
times workers struggle to function in care giving environments that constantly present heart
wrenching, emotional challenges. Affecting positive change in society is a mission so vital to
those passionate about caring for others and is perceived as elusive, if not impossible.
Most students enter the occupational therapy career field out of a strong desire to help
others. Numerous research studies have reported that a large percentage of people who enter the
helping professions may have experienced one or more episodes of trauma in their lives (Costa,
p. 14). It is of notably high occurrence that clinicians in a helping career will hear of traumatic
stress, suffering, or pain, that may easily transfer over into a relation of the clinicians past
trauma, causing them to distance themselves from their clients. Authentic, ongoing self-care
practices are also absent from their lives. Empathy is a key characteristic involved in
occupational therapy as well as many other helping professions. Being able to provide a client-
centered approach entails building therapeutic rapport with the client; this cannot be achieved
without empathy. Although it is important to take into consideration that the greater empathy we
feel and express for our clients, the greater the risk becomes of developing compassion fatigue.
Rationale
Compassion fatigue was discovered by conversing with each other and discussing our
reasons for selecting occupational therapy as our career of choice. When we acknowledged that
all members of the team experienced some type of traumatic event, we decided to begin
questioning classmates to find out if this was a commonality amongst the 2015 occupational
therapy class. Due to similar aspects of trauma experienced by numerous class members we
decided to research the effects of these events on life choices. Thorough research of this topic led
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to compassion fatigue, allowing us to understand the effects of traumatic experience on selection
of a helping career choice.
Being a helper can be immensely rewarding, however, for many it can also come with
hidden costs, significant emotional and physical exhaustion. This exhaustion, depletion of
compassion and energy, is an occupational hazard, which is the cost that comes from doing
important work. Compassion fatigue experts such as Charles Figley have described it as a normal
and treatable consequence of the work we do, that affects those who do their work well: in
essence, we develop compassion fatigue because we care (Figley, 1995).
Helpers often become negative and increasingly cynical at work, they may make clinical
errors, violate client boundaries, lose a respectful stance towards their clients and contribute to a
toxic work environment. Or, conversely, they may remain very competent at work but have
nothing left to give when they get home to their families and their own needs continue to be put
aside for later. Its very common for helpers to develop hopelessness as well as tremendous
exhaustion. This study will help us to understand the effect of traumatic experience leading to a
helping career choice, as well as the similar traits amongst many who may be prone to
experiencing compassion fatigue. Recognizing the signs of compassion fatigue will lead to
prevention, following the appropriate steps and recognizing precautions.
Grand tour question and sub-questions
Is a traumatic event the greatest influence on a persons choice in a helping career, which in turn
may lead to compassion fatigue? Is compassion fatigue more prominent in a helping career?

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Definitions:
Burnout: An emotional condition marked by tiredness, loss of interest, or frustration that
interferes with job performance. Burnout is usually regarded as the result of prolonged
stress
Compassion fatigue: emotional drain experienced by caregivers usually after caring for
another with a progressive illness; gradual lessening of compassion overtime.
Occupational stress: a disorder associated with a job or work. The anxiety may be
expressed in the form of extreme tension and anxiety and the development of physical
symptoms such as headache or cramps.
Vicarious traumatization: Transformation in the self of a trauma worker or helper that
results from empathic engagement with traumatized clients and their reports of traumatic
experiences.
Depletion: The state of being depleted; exhaustion.
Compassion satisfaction: The pleasure one derives from being able to do their work well.
Self-awareness: Having a clear perception of your personality, including strengths,
weaknesses, thoughts, beliefs, motivation, and emotions. Self-Awareness allows you to
understand other people, how they perceive you, your attitude and your responses to them
in the moment.
Empathy: The feeling that you understand and share another persons experiences and
emotions: the ability to share someone elses feelings.
Delimitations and Limitations
Our team is limiting the focus group of this study to the occupational therapy program at
Touro University and eliminating the other student programs on campus. Articles were chosen
primarily focusing on helping professionals within the healthcare setting, deterring our search
away from careers outside of the medical field. In order to minimize intrusiveness and/or
influence on the interviewee, we will not use structured or group interviews. Interviews were
conducted before distributing the Compassion Fatigue Questionnaire to our interviewees, in an
effort to prevent bias in given answers during the interview process.
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Time constraints of the semester require less time than may be ideal for a
phenomenological study. Our topic can be very personal and questions may probe at emotions
that the interviewee may feel guarded about sharing, which may easily limit the depth of
information revealed during the interviews and data collection. The team is collecting data using
scribes to document, which may produce a slight false interpretation if not recorded exactly. The
sample size is small amongst a group of people pursuing the same career within a limited age
range, which may present bias on the topic. The interviewee may feel more vulnerable due to the
fact that we all know one another, which may deter the reliability of the study as well.
Review of Related Literature
Organization of our review was based upon common trends found in articles related to
compassion fatigue. Key words were utilized throughout our database search and highlighted
consistently within our article reviews. These terms consist of; burnout, compassion fatigue,
occupational stress, vicarious traumatization, depletion, compassion satisfaction, self-awareness,
and empathy. These terms suggested a high prevalence of compassion through selfless acts of
kindness and minimal reflection of self. Major themes were discovered within our literature
review, indicating a high correspondence between a helping profession and compassion fatigue
personality traits.
Articles focus on the selfless beliefs and actions through the overarching patterns that
professionals experience on a daily basis. One article in particular focuses on a nurse showing
symptoms of compassion fatigue. Relationships with patients, families, and colleagues
overshadowed the relationship with self, which is a core concept in managing compassion
fatigue. Personal needs and values need to be addressed with perspectives directed towards
achieving a balance between work and life. The relationship with self is essential for optimizing
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ones health, for displaying empathy with others, and for being a productive team member within
a healthcare facility.
Compassion fatigue also affects individuals outside of healthcare facilities, primarily
being caregivers. This entails caregiving for family members as well as for employment.
Overwhelmed by continuous empathic engagement with clients suffering trauma, reflects the
caregivers persona psychologically and physiologically. Emotions, disturbances, withdrawals,
and avoidance hinder personalities as the increased exposure to clients continue. One article
explains a wife caregiving for her husband who was diagnosed with amyotrophic lateral sclerosis
and had been gradually declining for the last 3 years. When her husband was hospitalized after
going into respiratory arrest at home, she remained by his side, directing nurses away to take full
responsibility of his care. This led her to exhaustion and she distanced herself from friends and
family. She became selfless in the midst of caring for her husband, forgetting her need to take
care of herself which reflected in her demeanor.
Literature Findings

Compassion fatigue is prevalent amongst helping professionals including healthcare and
non-healthcare professionals. Often times helping professionals become victims of frequent
stress and trauma due to attempts of seeking to meet the needs of their patients and families;
subsequently this leads to compassion fatigue (Lombardo, 2011). Occupational therapists often
experience compassion fatigue due to working with patients that are suffering from a devastating
disability or prolonged illness accompanied by pain and trauma. The mental, emotional, spiritual,
and physical demands placed on health care providers will cause them to experience compassion
fatigue at some point in their career (Costa, 2008).
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A case study included in our literature review examined a young female who had
experienced compassion fatigue early on in her life due to her mothers cardiac
complications. This led her to admire the kind nursing staff that took such good care of her
mother during this difficult time. She formed close relationships with the nursing staff due to her
mothers frequent medical visits and became inspired by them, making the decision to attend
nursing school. After graduation, she began working in a telemetry unit that was very demanding
and consisted of multiple patients. After experiencing deaths of patients, she began to suffer from
compassion fatigue. This nurse was unable to balance her personal life demands and stress of her
occupation due to the impact of these traumatic events. The nursing profession as well as many
other caregiver roles is centered on compassionate, supportive relationships between caregiver
and patient with a consistent need to emotionally experience the pain of others. These are all
significant factors which if experienced, will almost always lead to compassion fatigue
(Lombardo, 2011).
In a study conducted on compassion fatigue exploring the occurrence with family
caregivers who assisted staff with caring for older relatives in long-term facility, family
caregivers were very empathic and showed their desire and devotion through caring for the
family member in an effort to relieve their suffering. These sympathetic caregivers lost their
balance of self-care and well-being while caring for their family members. Shelley who cared
for her 82-year-old mother stated, I guess I will resume my other life when this is all over. I'll
try to pick up the pieces of relationships that I have put on hold. Maybe my friends will still be
there, or maybe they won't. She was engulfed by the obligation and responsibility she felt
towards taking care of her older relatives. Sympathy was expressed by caregivers in feelings of
despair, loss, and hopelessness as well (Perry, Dalton, & Edwards 2010).
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While the aspiration of most helping professionals and occupational therapists are to
assist others, studies show that considerable percentages of these professionals have experienced
one or more incidences of trauma in their lives. These professionals often may identify more
with patients that are in need of someone who will listen to their traumatic experiences, or relate
to their pain and suffering. While in contrast, when helping professionals can assist patients with
the desired outcomes and progression of health, professionals become enriched by what is called
compassion satisfaction. When compassion satisfaction is achieved, the damaging effects of
compassion fatigue decline and feelings of power and self-assurance lead professionals to push
forward in difficult times (Costa, 2008).
Professionals experiencing compassion fatigue demonstrated inadequate self-care and
increased detriment of self needs while assisting in the role of a caregiver. Typical symptoms
discovered with professionals who suffered from compassion fatigue consisted of a variety of
categories (Lombardo, 2011). One of the domains is behavioral which included the following
symptoms: mood swings, irritable, sleep disturbances, inability to sleep, and insomnia. The
emotional domain included the following symptoms: anxiety, anger, depression, and
oversensitivity. The physical domain involved increased medical concerns, cardiac symptoms,
and muscle aches. Avoidance of work, low morale, staff conflicts, frequently absent, and
reduced work quality fell within the work domain (Costa, 2008).
Compassion fatigue has also been termed as secondary traumatic stress from caring for
others that are experiencing emotional, stress, and physical pain. Secondary post-traumatic stress
has been defined as damaging bio psychosocial effects of emotionally traumatic events. While
the caregiver may experience the traumatic event themselves, more commonly they take upon
the accompanied emotional burden of being affectionate and caring towards others involved.
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Compassion fatigue symptoms have been closely related to burnout, but it is important to
differentiate between the two. Burnout is defined as what individuals are obligated to do, which
leads to symptoms associated with loss of personal standards, determination, and self-respect
(Costa, 2008). It is described by physical, emotional, mental tiredness from a persistent long
term engagement in emotionally exhausting circumstances. The inception of symptoms
regarding burnout are more gradual and progressively get worse, while compassion fatigue is
more severe at the beginning, but can get better over time if acknowledged by the individual
affected.
Literature Design and Methods
Two studies within the literature review focused on grounded theory approaches, while
one used the phenomenological approach to investigate compassion fatigue. Lombardo used
Watsons Theory that focused on human caring which was grounded on the empathic
relationship of the nurse and patient. Relationship based nursing (RBN) focuses on empathy and
commutation with the patient and family. This also included the nurses relationship to self
which is the central concept in managing compassion fatigue.
Sabo refers to a theoretical model and the occurrence of compassion fatigue and stress-
process framework. This model is grounded on the theory that emotional energy and empathy
are necessary in forming therapeutic connections and relationships. This model comprises a
sequence of occurring events such as exposure to suffering, pain, and traumatic events. Nurses
can feel empathic to a specific patient which results in compassion stress and loss of emotional
energy. Increased exposure to suffering, memories that trigger emotional response, and
unexpected life events may increase the risk of compassion fatigue.
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According to Perry, Dalton, and Edwards, their methodology was based on a
phenomenology study that aimed to describe and understand a participants perspective in the
context of what is being explored. This study sought to recreate lived experience of participants
into a textual expression. Understanding human experience in an intricate and elusive way in
connection with compassion fatigue occurring amongst family caregivers was the main focus of
this study.
Major gaps in the research included lack of longitudinal studies that are needed to
investigate factors contributing to compassion fatigue symptoms. Such factors include the
nurses years of experience, level of education, and institutional support. Also, studies should
focus not only on the effectiveness of interventions on compassion fatigue, but combating
compassion fatigue in a variety of work settings. Lombardo suggested in her article that a pre-
and post-intervention questionnaire asking nurses to describe, for example, the effects of weekly
patient care conferences on their stress and compassion levels might help lessen the gap and
contribute to further studies. An interdisciplinary approach to future study may also help to see
common themes amongst all healthcare disciplines so that together, healthcare workers can work
to find the answers so as to lessen compassion fatigue (Lombardo, 2011). It is evident that
additional research is needed to fully explore the role of self-sacrificing behavior amongst
various professions, rather than limiting study participants to healthcare professionals.
Procedure
The approach used for conducting this research study involves interest in the topic of
compassion fatigue and the impact on career choice through a qualitative study. This allows the
team to analyze the informants and their environments in their naturalistic setting through
personal experience, life story, interview, and interaction that describes routine and problematic
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moments and meaning in individuals lives (Stein, Rice, & Cutter, 2013). We used this method
to explore perceptions and experiences, as well as to understand the phenomena in context and
from the individuals point of view, in terms of the meanings attributed to them. Specifically, the
team seeks to understand if individuals who have experienced a traumatic event or know
someone who has gone through a traumatic event, may have a greater tendency to seek a career
in a field that focuses on helping others. By using the qualitative research method, the team
plays an active role in participatory and holistic knowing, focus on critical subjectivity by
fully acknowledging the primary subjects experiences, and concede that knowledge is formed
in and for action with action in its natural occurrence. With this in mind, the team becomes part
of the research instrument (Stein, Rice, & Cutter, 2013).
The first step is to seek participants who are entering a helping field who have
experienced such event or have known individuals who have and to hear their story. Participants
should be willing to share their stories and have it scribed by the team members. A semi-
structured interview approach will allow the client to answer fundamental questions relating to
compassion fatigue. This also allows the participants and interviewer to add additional
information that might pertain to the study. This flexibility gives participants an opportunity to
share as much information as they are comfortable with by not limiting the research to concrete
questions.
Features of the Design
Articles addressing compassion fatigue and burnout on health care providers in
combination with the convenience nature of the population heading into a helping career
prompted selected questions used in the semi-structured interview process. The team placed
great emphasis on the emotions and experiences of past traumatic experience in an effort to find
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a correlation between experiences of compassion fatigue, the participants empathetic nature, and
choice to pursue a helping career. Participants were encouraged to answer the questions and
further elaborate on their experiences.
The questions selected pose for both positive and negative feedback which is inherently
different for each participant through each question. Certain questions inquire about the
emotional impact that compassion fatigue plays on the individuals. Depending on the individual,
some might feel a burnout or frustration, while others regarded it as a challenge or motivation.
Thus, most questions offer a diverse range of possible answers. Additionally, most questions
prompt for further elaboration from the participants as well as portray a natural progression of
answers leading into the next question. The fluid structure of the interview questions allow for
participants to feel at ease throughout the entirety of the interview process. The chosen topic
encourages the participants to evaluate and reflect on their experiences, and to understand the
impact compassion fatigue has had on their lives.
Assumptions
It is assumed that most, if not all of the participants are empathetic individuals who
emotionally invest in those around them. Thus, some answers are expected because of the nature
of the population. All participants are graduate level students who have faced a traumatic event
at least once in their lifetimes and are in school to become occupational therapists. There are
certain expectancies that come with this knowledge, such as, majority of the participants want to
help others in need and/or they want to be or have already taken the steps to be part of a career
that helps those in need. Additionally, due to bias with the researchers and the participants being
classmates, this can hinder or promote willingness to answer certain questions.
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The semi-structured interview format is used in an effort to provide a guide for the
interview, but allow for a broad range of answers or details during the process. This technique
assists in obtaining needed information, while giving freedom to the participants to respond and
illustrate concepts. The interviewer can use conversational tone that encourages participants to
talk, share stories, and describe incidents in rich descriptive context. The semi-structured format
also allows the interviewer to probe if further information is needed. The open-ended questions
elicit more of a discussion versus the use of close-ended questions. This format also encourages
participants to think out loud, giving the transcribers more information to collect. For some
informants, the semi-structured interview can pose as a cathartic experience in which they feel
comfortable discussing all accompanying emotions to the topic. Using this qualitative interview
allows the process to be more of a therapeutic experience prompting more experiences
exchanged, which in turn, yields more useful results (Morse & Field, 1995).
Role of the Researcher
It is interesting to determine the reasons colleagues chose a similar career path. As we
conversed over the importance of occupational therapy, all members stated, Ive always wanted
to have a career in which I could lose myself in the service of others. I am happiest when I know
my efforts have contributed to others happiness. Once we noticed these similar attributes we
started looking into caring for others and the effects encompassing one self. There were many
articles acknowledging compassion satisfaction and self-fulfillment, which are both
commonalities that come out of helping others. However, once these traits are taken to another
level, it eventually starts to drain the person in numerous ways. These findings are what sparked
our interest in compassion fatigue. Compassion fatigue is a prevalent characteristic of those who
tend to spread themselves too thin when helping. It is often common for these people to lose
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themselves in their work, leaving a void in their own health and wellness. Although all of our
team has experienced some form of this, we have never taken the time to look into the topic in
depth, review the detrimental characteristics involved or understand the full meaning of caring
for oneself in order to better serve others as well. These affirmations provoked an interest of
curiosity guiding our research towards compassion fatigue, its characteristics, effects on the
person, family and others involved, and the best ways to prevent this form of burnout. One team
member shares her story and experience with compassion fatigue and the positive and negative
effects presented during her childhood.
Ive had a lot of experiences with compassion fatigue but one that stands out the most
was my experience growing up with a big brother who had bipolar disorder (BPD). He
was diagnosed at the age of 19 and I believe it was almost harder having a brother who
was normal majority of our childhood, turn into a completely different person later on
in life. When I was 14, my brother checked himself into a psychiatric institution for BPD.
When he got out and came back into society was when we started seeing the obvious
symptoms associated with this disease. My brother truly was a different person.
Before being diagnosed, he was enrolled in a community college and graduated with an
Associates degree in Economics while maintaining a job at banana republic. After the
diagnosis, all of these qualities disappeared one by one. He had manic episodes for about
a month long, followed by depressive episodes for three to six months long and this
became a cycle for the following years to come.
One of the hardest moments of my life was going to a psychiatric ward and seeing him
completely gone with his eyes glazed over amongst many others who were in a similar
state and no matter what I said to him, I knew that he was not registering.
When I turned eighteen years old and became an adult, taking more of the
responsibilities of my brother, I felt that no longer was I the younger sibling. It started
impacting my own life. I felt like I wasnt allowed to fully experience my young adulthood
because of my responsibilities. It started to affect my education, job, and overall life. I
felt a withdrawal and sought an escape. It started to eat me up inside and I knew that if I
couldnt help myself, I surely couldnt help someone else.
Ethical Issues
The first step taken in the research study was obtaining approval of the topic and what the
study would entail. In order to begin the interview process, a private study room was secured.
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Once in this secluded area, the team was able to conduct interviews while ensuring privacy of the
participant and accuracy during transcribing. As the team did not have IRB approval, request for
interview participation was strictly amongst classmates via a handout asking for volunteers to
participate in a research study involving career choice and experiences of traumatic events.
Informed consent from persons capable of such consent should be obtained as in all other
research. This requires informing participants about the overall purpose of the research and its
main features, as well as of the risks and benefits of participation. Consent to interview was
given via written approval or verbally conversed between the interviewer and interviewee. The
team will ensure anonymity by coding each individual interviewees name during the research
process as well as in presentation of the information. Information provided to the researcher will
be treated in a confidential manner and not dispersed to any person other than the research team
at any time. Developing rapport with the interviewee to assure that data collection and the
interview process will not exceed overly intrusive expectations is pertinent to influence a
comfortable and trustworthy environment. Analyzing data in a way that will prevent
misinterpretations, misstatements, and/or fraudulent analysis will not only benefit the validity of
our study, but is also important to preserve the interviewees thoughts and feelings as best as
possible.
Data Analysis
Qualitative data was collected from 7 members of the Touro University Nevada
Occupational Therapy students class of 2015 during their second semester of
school. Individual interviews were conducted with each member of the focus group
participants. Participants were asked a series of fourteen semi-structured questions relating to a
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traumatic experience they had experienced in the past and how this has affected their helping
career choice in occupational therapy.
The phenomenological data collected from the semi-structured interviews provided the
research team with increased insight into the personal life experiences of the participants and
how it related to their daily patterns, meanings, and beliefs. The team was not only able to listen
to the participants stories narratively, but was able to see the emotions connected to the
experiences. The data collected provided us with information to explore the beliefs and
motivations of the participants that related to the phenomenon of compassion fatigue in
correlation with helping career choice (Law & MacDermid, 2008).
The setting selected by the team was Touro University Nevada occupational therapy study
rooms. This setting was chosen for the convenience of the participants as well as to allow them
to feel as comfortable as possible during the interview process. The participants were selected
by criterion sampling. All participants had to meet the criteria of experiencing a traumatic event
and/or know someone who had experienced a traumatic event, which in turn, impacted their
future career choice.
The research team consisted of four members including: one interviewer and three
scribers. The questions were formulated on a computer prior to interviews in which two scribers
typed the answers below the corresponding questions. The third scriber hand wrote received
data.
The procedure designed for collecting information from the participants included
selecting semi-structured questions that were associated with the traumatic event experienced by
the participants. Once the interview process was complete, the interviewee participated in
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completion of a compassion fatigue questionnaire which assessed the intensity and occurrence of
behaviors related to compassion fatigue. Guided questions and probes were utilized in
conjunction with semi-structured questions. For example, some guided questions resembled the
following: Can you elaborate on your answer, how does it make you feel, is there anything
else you can tell me, and if you feel comfortable answering this question. Tactful wording
and sentencing of questions and probes, structuring of body language, tone of voice, and verbal
cues were used by interviewer to elicit descriptive answers.
After conducting interviews and gathering relevant information, we will evaluate each
interviewees answers and note keywords as well as similarities amongst participants. This will
indicate major themes and trends that will be categorized into specific regions.

Subject Age Gender Marital Status Experience (personal/family/other)
1 23 M X Family
2 23 F X Family
3 25 F X Other
4 27 F Married Personal
5 29 M X Family
6 30 M X Personal
7 37 F Married Personal

Methods
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Methodological triangulation involves the use of multiple qualitative and/or quantitative
methods to study the identified research question. Results from questionnaires, information from
articles, and focus group interviews correlate and establish results that will present simulations
within the findings. Validity is proven upon conclusion from the chosen methods through
analyzing and interpretation of strong parallel patterns within each source.
For example, a qualitative approach will be used when interviewing each member of the
focus group. This will include interviewing, observation, and document analysis to assess the
likelihood of having compassion fatigue. The team will also have the participant fill out a
questionnaire based off a quantitative strategy. Articles related to compassion fatigue and
helping professions will familiarize researchers with an idea of results that most likely will be
presented. If the findings from all of the methods draw the same or similar conclusions, then
validity has been proven. This method requires several resources and time to analyze the
information yielded by the different methods.
Findings
Our findings suggest that healthcare professionals are primarily affected by compassion
fatigue due to the need for consistent empathetic performance. Healthcare professionals
practicing other areas in medicine may yield different results in comparison to our research study
focusing primarily on occupational therapy students. Not only was our primary focus directed
towards occupational therapy students, but through literature reviews involving similar
professionals such as nurse practitioners. Replication of this study may yield different results if
our research team proposed a randomized blind study using occupational therapy students. This
would not allow our research team to engage in conversation with specific individuals that noted
they chose occupational therapy due to a traumatic event. Various perspectives may be presented
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on why they chose a helping profession without experiencing the havoc of a traumatic event.
Students may have found occupational therapy through undergraduate advisors, family members,
or volunteer experience, which would skew our overall results and conclusion.
Unique findings propose that healthcare professionals are not the only career at risk in
developing compassion fatigue, but lawyers experience compassion fatigue as well. This was
surprising to our team, imagining lawyers have a different dynamic within their profession as
well as competitive personality characteristics and civil demeanor. Practice areas that involve
criminal, family or juvenile law may be especially susceptible to compassion fatigue, as they are
regularly exposed to human-induced trauma. These lawyers are entitled to empathetically listen
to victims stories, read reports and descriptions of traumatic events, view crime or accident
scenes, and view graphic evidence of traumatic victimization. This places lawyers at risk for
experiencing compassion fatigue, due to large caseloads and empathic tendencies.
Coding and Themes
Findings were organized into major themes coding the commonalities of experiences
related to compassion fatigue. These included traumatic experience, helping career choice,
emotional balance, and self-awareness with specific parts in relation to each theme. Cohesive
data of our detailed findings were articulated throughout the study to present high reliability and
validity.
Traumatic Experience
Traumatic Experience was our first theme determining the relational aspect of how we
chose our subjects and the foundational imagery that led them to a helping career. 7 subjects
expressed traumatic connections by sharing either a personal experience, a family experience, or
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other experience. Our findings showed that 3 out of 7 subjects associated stories to a personal
traumatic experience as well as 3 out 7 subjects associated stories to a family traumatic
experience. 1 individual associated their traumatic experience to a family acquaintance. This
shows all participants were affected by a traumatic experience influencing their career choice in
becoming an occupational therapist.
Helping Career Choice
Occupational therapy is one of the most prevalent helping professions within the medical
field. Both personal and situational factors strongly influence the development of compassion
fatigue amongst caregivers. When determining if the traumatic experience was the greatest
influence on career choice, each participant was asked how the experience affected their choice
of career, if at all. These open-ended questions helped lead to the conclusion of 5 out of 7
participants choosing the career choice of occupational therapy due to their experience within the
traumatic event. As stated in much of the literature review, certain life events in the family may
exert a compelling influence on why a specific career choice is more intriguing than another.
Seeing the struggles my grandfather went through as far as not being able to
speak, learn how to write, walk, and losing the ability to participate in all ADLs
was hard. It made me interested in therapy and also influenced me to become a
better occupational therapist so I could help others who experience this same
thing.
Although most of the time influences and choices on a helping career come with good
intentions and a genuine care and concern for others, its important to acknowledge the empathic
response that may follow as well. Often times helpers may go to dramatic lengths to reduce the
suffering of others through therapeutic use of self. Although putting ones self in their shoes is a
very client-centered approach to take, it can also put the helper at risk of experiencing the same
emotions which consequently could lead to compassion fatigue. The importance of detachment
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must be emphasized in order to be able to express concern and empathy without retaining
residual compassion stress.
Our findings also helped portray that although traumatic events were experienced, 6 out
of 7 participants have accepted the experiences with a mindset of wanting to advocate, care for,
encourage and uplift others who may have experienced a similar event. These findings are
relatable when understanding why the career choice was one of helping versus avoidance and
deterrence from any field of related experiences. Ive been able to see the extreme need for
therapy and how much of a difference it has made in my own life. It has influenced me to learn
as much about it as possible. Several studies have presented data acknowledging 34%-69% of
health care professionals choosing the profession as a result of having experienced a previous
traumatic life event and wanting to help others because of it (Costa, p. 16). But it is also
important to address that previous traumatic experiences may often be triggered by working with
clients experiencing a similar event, which in turn may lead to posttraumatic stress disorder.
These findings are important in acknowledging that life experiences are good to have and may
help tremendously in the healthcare profession, but its also important to take care of ones self
and manage stress appropriately in an effort to reach compassion satisfaction in a rewarding
career.
Emotional Balance
Emotional Balance being our third major theme categorized our findings into 3 tiers
consisting of positive and negative emotions, prioritizing others feelings over their own, and
taking pain away from others through fixing.
23

Subjects expressed both positive and negative emotions throughout the interview,
visualizing their feelings narratively as if it happened yesterday. Positive emotions were
conveyed with an optimistic outlook upon the traumatic experience stating I try to think about
the happy memories. This redirects feelings of negativity to rectifiable memories that helped
them grow. Common negative emotions were shown using words such as sadness, guilt, grief,
fear, frustration, doubt, envy, shame, and depression when sharing their story. One individual
stated, I felt loss of control in that I wasnt able to control my emotions, demeanor, and
attitude. I felt ashamed, guilt for my actions. I felt like I wasnt very good at my job, I didnt help
her like I shouldve when she needed it the most. The role of negative emotions illustrates their
feelings of empathy and attitude towards others. These individuals become very involved in
other peoples problems and feel the need to fix every situation they encounter. Forgetting to
balance their own lives by becoming selfless in the midst of fixing others lives reflects our third
tier of this theme.
Within the emotional balance theme was prioritizing others feelings over ones self. 6
out of 7 of our subjects felt that they would sacrifice their time and needs to meet the needs of
others. This is a very common aspect in individuals suffering from compassion fatigue. Often,
family and friends come to loved ones for advice as well as for comfort. These subjects
acknowledged that they may not have the time to help cope with everyones issues, but put
themselves second when comforting was needed. This falls into our next category within our
emotional balance theme.
6 out of 7 of our subjects fell into the third tier of taking away pain from others by fixing
the situation. One subject stated,
24

I find myself trying to take away pain from others a lot. I get very involved and go all in.
I want to be there to help. I dont like to listen to them and just excuse their problem. If I
see that someone wants or needs my help I take on the caretaker role. Its something Ive
noticed I do in my relationship as well.
Another subject said, Im really comfortable with people telling me their problems. I feel good
that they trust me enough to tell me their problems. I look at it as an opportunity to help others.
We touched upon this tier previously showing that each category correlates with one another.
Emotional balance is a key component for everyones life to manage stability throughout
positive and negative times. Self-reflecting on emotional balance can help analyze ones
priorities, realizing they need to focus on themselves.
Self-Awareness
There are many different ways that individuals may choose to cope with traumatic life
events and stressful situations. We cope with stressors every day, often without even realizing it.
When we cope with traumatic events, it is vitally important that we use healthy, effective coping
skills. When asked about coping strategies and if this was something they had utilized, 5 out of 7
of our participants stated that they had implemented many coping strategies along the way in an
effort to grow and learn from their experience in a positive way. The remaining 2 did not feel as
though they had developed any coping strategies regarding their experienced traumatic event.
Many of our participants were able to acknowledge positive coping mechanisms that guided their
acceptance of the traumatic event in their lives. Talking to someone that could relate to me and
understand exactly what I was going through was my biggest coping strategy.
Compassion fatigue is very real and it is necessary to acknowledge the importance of
developing coping strategies in order to reflect positive outcomes within ones lifestyle. When
people feel overwhelmed and unable to manage situations, it can undermine their ability to do
their jobs and be an active participant in their own life. There are a number of common strategies
25

that individuals utilize when coping with extraordinary stress in their lives. These strategies,
while effective at manageable levels of stress, can become unproductive or detrimental when
stress reaches overwhelming or traumatic levels. Often times individual coping skills may be the
trigger to compassion fatigue; the result of interactions and situations left unresolved, traumatic
experience not dealt with properly, or detrimental coping strategies such as trying to prevent
others from experiencing a similar painful experience, may all be commonalities. If ones coping
skills are not able to effectively address the event, there can be an increase in impaired
functioning such as affecting the health and well-being of the individual. It is important to
remember that individuals have their own way and pace for processing traumatic events, and
each individual must listen to and honor this at their own speed (Kearney, Weininger, Vachon,
Harrison, & Mount, 2009).
Self-reflection
When functioning with less self-awareness, individuals are more likely to lose
perspective, experience more stress in interactions with loved ones or people they are trying to
take care of, experience empathy as a liability, and have a greater likelihood of compassion
fatigue and burnout. The ability to function with greater self-awareness will offer individuals an
experience of greater engagement with less stress in interactions within the work environment as
well as the home environment.
Self-reflection can help an individual to experience empathy as a mutually healing
connection, as well as derive compassion satisfaction and vicarious posttraumatic growth in
order to enhance self-care (Kearney, Weininger, Vachon, Harrison, & Mount, 2009). Often
times, especially in stressful times, it is easy for self-awareness to collapse into a constricted
26

view of reality and more reactive patterns of behavior. In an effort to avoid the negative effects
of compassion fatigue, its important to regard ones own well-being.
One of the greatest methods of enhancing self-awareness that has empirical data to
support effectiveness is self-reflection. Our team was not surprised to find out that most of our
participants, 6 out of 7, participated in some aspect of self-reflection. I often reflect on my life
and look back at it wondering if I did something wrong to deserve this. But I also see how far
Ive come. I do more reflecting than I care to admit. It is easy to get caught up in the negative
aspects of what we did, or why we chose to do something, but more importantly this study has
helped us to recognize and understand the immense effect positive self-reflection can have on an
individuals outlook on life. This is an important trait regarding the self-awareness theme due to
the fact that as healthcare professionals, it is imperative to manage the cognitive, affective and
behavioral self in order to engage effectively in therapeutic relationships.
Self-fulfillment
Self-fulfillment is acknowledged as being the realization of ones deepest desires and
capacities. When coding for this sub-theme, three main words or phrases were in unanimity
throughout each individual interview; happiness, contribution to society, and satisfaction.
Doing something with my life to feel I contributed to the world. When Im on my
death bed I want to look back and know that I contributed and lived a life worth
living.
It is a bringing of oneself to completion, an unfolding of what is strongest or best in the
individual, so that it represents the successful culmination of ones potential and aspirations.
Self-fulllment is determined in regards to a life well lived, a life that is deeply satisfying,
rewarding, and worthwhile.
Helping others and having a rewarding career where I can go home and feel
good about myself is what self-fulfillment is to me.
27

During participant interviews it was mentioned numerous times that choosing
occupational therapy as a career was due to an instinctive desire for happiness within a
rewarding career. Fully understanding the concept of self-fulfillment in regards to being
independent and putting oneself before others is not selfish, rather it is finding who you truly are,
what inspires you, what makes you feel whole. In turn, this will benefit those around you
needing an emotional uplifting or encouragement to make progress in a positive direction.
When I can make others around me smile is when Im truly the most happy.
Conclusions and Recommendations
Being graduate students and experiencing compassion fatigue in the past or present,
represents the importance of our qualitative research study. Our study solidifies specific
personality traits such as empathy, compassion, and kindness, which are essential as a healthcare
professional. Awareness of self is of utmost importance when coping with compassion fatigue
through self-reflection, work-life balance, and attitudes toward self-fulfillment. A traumatic
experience triggers compassion fatigue as all of our interviewees proved when answering the
questions. Our study also showed the commonality of choosing a helping profession in regards to
feelings of selflessness and empathy.
Further studies on compassion fatigue and health care providers should be conducted on a
larger scale considering other areas of practice rather than focusing directly on nursing. This may
yield different results and create new questions for future qualitative studies. Research related to
our findings involving graduate students that may be at risk or experiencing compassion fatigue
would be fascinating studies to better understand the impact on both educational and vocational
endeavors.

28

References
Costa, D. (2005). Compassion Fatigue: Self-Care Skills for Practitioners. OT Practice, 13-18.Retrieved
from https://www.uwhealth.org/files/uwhealth/docs/pdf/Compassion%20Fatigue%20Article.pdf
Figley, C. R. (Ed.). (2002). Treating compassion fatigue. New York: Brunner-Rutledge.
Figley, C.R. (1995). Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder an
overview. Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in those for
those who treat the traumatized (pg.1-12). London: Library congress catalogue.

Kearney, M., Weininger, R.B., Vachon, M. L.S, Harrison, R.L., Mount, B.M, (2009). Being Connected;
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Lynch, S., & Lobo, M. (2012). Compassion fatigue in family caregivers: a Wilsonian concept
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Community Care Medicine. 1-6. Retrieved from
http://www.compassionfatigue.org/pages/RunningOnEmpty.pdf
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259-280.
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Occupational Therapy (pp.146-155). New York: Delmar

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Appendices
COMPASSION FATIGUE SELF-TEST: AN ASSESSMENT
Answer the questions below to the best of your knowledge. There is no right or wrong answer.
Assign one of these numbers to each one of the questions below:
Responses: 1 = Very True 2 = Somewhat True 3 = Rarely True
You will find summation directions at the end of the test.
1. _____ When people get upset, I try to smooth things out.
2. _____ I am able to listen to other's problems without trying to "fix" them and/or take away
their pain.
3. _____ My self-worth is determined by how others perceive me.
4. _____ When I am exposed to conflict, I feel it is my fault.
5. _____ I feel guilty when others are disappointed by my actions.
6. _____ When I make a mistake, I tend to be extremely critical of myself. I have difficulty
forgiving myself.
7. _____ I usually know how I want other people to treat me.
8. _____ I tell people how I prefer to be treated.
9. _____ My achievements define my self-worth.
10. ____ I feel anxious in most situations involving confrontation.
11.____ In relationships, it is easier for me to "give" than to "receive".
12. ____ I can be so focused on someone I am helping that I lose sight of my own perceptions,
interests and desires.
13. ____ It is hard for me to express sadness.
14. ____ To make mistakes means that I am weak.
15. ____ It is best to not "rock the boat" or "make waves."
16. ____ It is important to put people at ease.
17. ____ It is best not to need others.
18. ____ If I cannot solve a problem, I feel like a failure.
30

19. ____ I often feel "used up" at the end of the day.
20. ____ I take work home frequently.
21. ____ I can ask for help but only if the situation is serious.
22. ____ I am willing to sacrifice my needs in order to please others.
23. ____ When faced with uncertainty, I feel that things will get totally out of control.
24. ____ I am uncomfortable when others do not see me as being strong and self-sufficient.
25. ____ In intimate relationships, I am drawn to people who are needy or need me.
26. ____ I have difficulty expressing my differing opinion in the face of an opposing viewpoint.
27. ____ When I say "no," I feel guilty.
28. ____ When others distance from me, I feel anxious.
29. ____ When listening to someone's problems, I am more aware of their feelings than I am of
my own feelings.
30. ____ I find it difficult to stand up for myself and express my feelings when someone treats
me in an insensitive manner.
31. ____ I feel anxious when I am not busy.
32. ____ I believe that expressing resentments is wrong.
33. ____ I am more comfortable giving than receiving.
34. ____ I become anxious when I think I've disappointed someone.
35. ____ Work dominates much of my life.
36. ____ I seem to be working harder and accomplishing less.
37.____ I feel most worthwhile and alive in crisis situations.
38. ____ I have difficulty saying "no" and setting limits.
39. ____ My interests and values reflect what others expect of me rather than my own interests
and values.
40. ____ People rely on me for support.
It is important for you to periodically review your self-care, along with your needs and action
plans to meet those needs. If you find that you responded with a 1 (Very True) to more
than 15 of these items, it's definitely time to take a close and careful look at self-care issues.
31

Questions for Participants:
1. Have you known someone who has suffered from a traumatic experience that has affected you
personally?
2. Can you tell us about this traumatic experience?
3. How has this influenced your career choice?
4. What are some of the emotions youve faced accompanying this traumatic event (burnout,
experiences slowly developing frustration, a loss of control, and generally low morale?)
5. What were some coping mechanisms youve used along the way?
6. What feelings are presented when faced with a similar traumatic event or with individuals that
were associated with this event?
7. Do you avoid certain activities or situations that remind you of the traumatic experience?
8. Do you lose sleep over it?
9. Do you often try to fix or take away pain from others?
10. Do you tend to prioritize others feelings and listen to their problems over your own?
11. Have you ever participated into self-reflection? Explain?
12. How did you discover occupational therapy?
13. What are some of your qualities that you feel has carried over into your choice of
occupational therapy?
14. What comes to your mind in terms of self-fulfillment?

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Running head: THE EFFECT OF TRAUMATIC EXPERIENCE LEADING TO A HELPING

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