Experiences of compassion fatigue in direct care nurses: a qualitative systematic review protocol Erin Salmond 1  Margaret Ames 1  Mary Kamienski 1,2  Ann V. Watkins 3  Cheryl Holly 1,2 1 School of Nursing, Rutgers, The State University of New Jersey, Newark, USA, 2 The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Center of Excellence, Newark, USA, and 3 Life and Health Sciences Librarian, John Cotton Dana Library, Rutgers University, Newark, USA Review question/objectives: The objective of this qualitative systematic review is to examine available evidence on the experiences of direct care nurses of compassion fatigue (CF) within any nursing specialty or care setting. Specifically, this review will identify evidence on the following:  Direct care nurses’ perceptions of factors that contribute to or mediate CF.  Direct care nurses’ ability to recognize CF and care for themselves when experiencing the phenomenon.  Direct care nurses’ experiences of strategies that have assisted them to cope with CF. Keywords Compassion fatigue; compassionate care; nurses; resilience; secondary traumatic stress JBI Database System Rev Implement Rep 2017; 15(7):1805–1811. Background N ursing is an extremely demanding yet reward- ing profession that requires physical, emotional and spiritual strength. Nurses enter into the lives of their patients during periods of physio- logical, emotional or spiritual vulnerability and are witness to the stress, pain and suffering accompany- ing these events. They are present at immediate and concrete levels to care for the physical and emotional/spiritual wellbeing of both the patient and the family. Having an impact on a person’s life during this vulnerable period, whether it is assisting in delivering a healthy baby, alleviating one’s pain after major surgery, comforting and counseling a person having received a catastrophic diagnosis, or enhancing one’s sense of esteem in coaching them to manage the demands of a chronic illness can be extremely rewarding and bring about a sense of compassion satisfaction. Compassion satisfaction is ‘‘the positive feelings derived from helping others through traumatic events’’. 1(p.33) Compassion satisfaction creates a sense of worth that has been described as the most rewarding part of what nurses do. 2 Those experiencing compassion satisfaction derive gratifi- cation from their work and feel positive about the patient/family, the care team, and their ability to contribute to better care and therefore, better patient outcomes. 3 Compassion satisfaction is not a static pheno- menon, rather, it is challenged by the cumulative demands of experiencing and helping others through suffering. 4 These demands, sometimes referred to as the ‘‘cost of caring’’, 5 can have negative con- sequences. The emotional demands of constant exposure to human suffering, no matter how satisfy- ing the outcome, can lead to compassion fatigue (CF). Compassion fatigue may emerge as nurses continually connect with patients who are suffering and absorbing the patients’ trauma or pain or when nurses care for traumatized patients and re-experi- ence traumatic events. 6 Sabo equates CF with secondary traumatic stress wherein caregiver’s experiencing CF do not physically experience the traumatic events but do experience the event emotionally while caring for the patient. 7 Coetzee and Klopper’s 8 definition goes beyond the experi- ence of secondary traumatic stress and ‘‘is the final result of a progressive and cumulative process that is caused by the prolonged continuous and intense contact with patients, the use of self, and the exposure to stress’’. 8(p.237) The authors note that the absence of a definition within nursing has led Correspondence: Erin Salmond, salmonee@sn.rutgers.edu There is no conflict of interest in this project. DOI: 10.11124/JBISRIR-2016-003143 JBI Database of Systematic Reviews and Implementation Reports ß 2017 THE JOANNA BRIGGS INSTITUTE 1805 SYSTEMATIC REVIEW PROTOCOL ©2017 Joanna Briggs Institute. Unauthorized reproduction of this article is prohibited.