From Effort to Exhaustion: A Qualitative Study of Compassion Fatigue in elderly healthcare aides based on the Effort-Recovery Theory

Aim This qualitative study, guided by the Effort-Recovery Theory (ERT), examines how compassion fatigue (CF) develops in elderly healthcare aides (HCAs) in China. The study focuses on the developmental mechanisms and dynamic trajectory of CF. Background With global population aging, especially in China, where adults aged over 60 reached 310 million (22% of the population) by the end of 2024, HCAs face increasing physical and emotional burdens. Their physical labor includes daily care and emergency response, while their emotional labor involves managing empathy and nonverbal communication with residents who have cognitive impairments. However, existing research on CF has primarily focused on hospital nurses, with limited attention to HCAs’ unique experiences, particularly the dynamic process of CF under China’s sociocultural context. Methods A qualitative descriptive design was adopted, with 13 HCAs recruited from a large long-term care facility in Shanghai through purposive sampling. Data were collected via semi-participant observation and in-depth interviews, and analyzed using directed content analysis. The study adhered to the COREQ checklist to ensure methodological rigor. Results The analysis revealed a four-stage development process of CF. Stage one is Work Demand Overload. This stage involves physical burden, such as intensive labor and fragmented sleep. It also involves psychological burden, such as high cognitive demands and emotional entanglement. Stage two is Compensatory Effort Strategies. These strategies include emotional detachment through surface acting. They also include physiological compensation, for example, caffeine dependence. Another strategy is culturally specific cognitive reframing, such as believing in "karmic merit". Stage three is Insufficient Recovery. Stage three is Insufficient Recovery. Divergent recovery awareness influences this stage, which encompasses active micro-recovery, passive adaptation, and awareness-action disconnection. Structural barriers also contribute, which include institutional resource exclusion and cultural stigma. Stage four is Negative Effects, where CF emerges, which manifests as occupational burnout, secondary traumatization, and declining empathy satisfaction. Conclusion This study confirms that ERT effectively explains CF in HCAs. An imbalance between resource consumption and recovery drives the development of CF. Cultural norms, like the expectation of "family-like care", and institutional constraints make this imbalance worse. The findings address a gap in CF research about HCAs. They also provide a theory base for interventions. These could include optimizing workloads and improving recovery resources. Such steps could support the well-being of HCAs and enhance the quality of care.