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Creatively Confronting Compassion Fatigue: Meet MSN Alumna Caroline Pauline Cárdenas

A simple hula hoop helped one woman start a self-care revolution for caregivers.

A personal tragedy inspired Caroline P. Cárdenas ’14, Master of Science in Nursing (MSN), to dedicate herself to women’s health, with the goal of becoming an oncology nurse. But it was a need to protect her own well-being that eventually led her to advocate for the well-being of all nurses. Today Cárdenas says, “I’m using my education for good to help nurses prevent and decrease compassion fatigue through play.”

When Cárdenas was 21, her mother, Grace, died from breast cancer. Grace was only 47 and had been diagnosed just three months before. Cárdenas decided that she wanted to care for cancer patients and their family members, and she set her sights on becoming an oncology nurse. She earned her associate degree in nursing and eventually went to work at Moores Cancer Center at UC San Diego Health. There, she met her nurse mentor, Lori Johnson ’12, MSN.

Caroline P. Cárdenas demonstrating hula hoop at graduation.
Photo taken by: Miguel A. Cárdenas, Ph.D.

“I was curious about furthering my education,” Cárdenas says. She knew that in order to advance in her career, she would need to earn a bachelor’s degree in nursing. Johnson was pursuing an MSN at Walden University at the time. Cárdenas noted that Walden’s program afforded Johnson the flexibility to continue working while earning her MSN degree. “I saw how Lori was growing professionally and personally, and it was really inspiring,” Cárdenas says.

Cárdenas decided to enroll at Walden, too. She originally intended to pursue a Bachelor of Science in Nursing (BSN), but her Walden Enrollment Specialist encouraged her to follow the RN to MSN track. At the time, Cárdenas worked as an infusion nurse, administering chemotherapy and biotherapy agents to cancer patients at Moores Cancer Center during the day, while completing her nursing coursework in the evenings and on weekends. “Because I was able to work full time, I was able to pay for my degree program while I was attending school,” Cárdenas says. “I didn’t have to take on student loans. That was really important to me.”

Cárdenas and Johnson weren’t the only ones attending nursing school online. Several of their colleagues were attending other online schools. But there was a big difference. “I noticed that the kind of education I was receiving from Walden University was of higher quality—period,” she says. “Walden helped me see the world in a broader way, empowering me to bring my own unique gifts forward, along with my education, to foster positive social change.”

Additionally, she says, “The faculty was excellent.” Dr. Anna Valdez, who taught Cárdenas’ capstone courses, “was professional, caring, and kind, and saw more in me than I saw in myself. That allowed me to soar to new heights and develop something unique with my master’s thesis. She really encouraged me to do my thesis on what I was most passionate about,” Cárdenas says.

And what Cárdenas was most passionate about were the multifaceted benefits of a simple hula hoop.

“It wasn’t hard for me to choose to focus on both hoop dancing and compassion fatigue in my thesis,” shares Cárdenas, “because I was experiencing both.”

Years earlier, not long after starting her nursing career, she had begun to experience compassion fatigue and burnout. Cárdenas says that at the time, she didn’t have language to describe what she was feeling. Burnout and compassion fatigue were terms that weren’t even addressed in her associate nursing degree curriculum. She remembers feeling joyless, anxious, and hopeless. Here she was working in the profession she had felt called to join, but she was uncertain she’d be able to continue. Compassion fatigue affects up to 39% of nurses.1 According to nursing professor and author Dr. Vidette Todaro-Franceschi, compassion fatigue is defined as the emotional cost of caring related to caring for those suffering individuals over time and, as a result, cause emotional, physical, and spiritual exhaustion.2

Compassion fatigue is experienced when a helping professional suffers with another human being and internalizes their pain, which manifests itself in ways that can be physically and psychologically harmful.2 According to Dr. Charles Figley, founder of the Tulane University Traumatology Institute, those most at risk for experiencing this occupational hazard are healthcare professionals who consider themselves as able to display high levels of empathy and empathic response to a patient’s suffering.3

Symptoms of compassion fatigue include feelings of a heavy heart, diminished sense of personal accomplishment, decreased sense of purpose, joylessness, helplessness, hopelessness, disillusionment, numbness, and apathy.1 Ultimately, compassion fatigue left untreated can lead to mistakes on the job, physical and psychological symptoms and illnesses, joylessness, and healthcare professionals leaving their profession.4

At the time that Cárdenas was experiencing compassion fatigue, she was working as a nurse at Memorial Sloan-Kettering Cancer Center in New York City. One day she took a walk in Central Park and encountered a man who had laid out hula hoops on the concrete. He played the bongos and sang while random people picked up the hoops and danced with joy. She observed for a while, seeing how much fun these strangers were having, and eventually Cárdenas herself joined in. “I remember feeling a profound sense of joy throughout my body,” she says. “I couldn’t get enough of it!”

She bought her own hula hoop that very weekend, which set in motion her daily practice of body and movement play through hoop dancing. And she began to experience changes. “I noticed that my symptoms of burnout and compassion fatigue were improving. I was feeling more joyful. I was feeling more hopeful. I was feeling renewed.”

So, Cárdenas provided nursing care, pursued her MSN degree, and hoop danced. Once she graduated with her master’s in nursing, she was offered a new job with UC San Diego Health, this time in the surgical oncology department of the Comprehensive Breast Health Center. She soon realized that there was a need to develop evidence-based patient education material to support women diagnosed with breast cancer as they prepared for their surgeries and recommended treatments.

Bolstered by her positive master’s thesis experience at Walden, Cárdenas knew she could create a patient education program that would benefit the patients, the nurses, and the rest of the healthcare team. That patient education program is still used at the center today. Cárdenas also developed an onboarding program for newly hired nurses and served as a nurse educator and mentor.

While she achieved professional success, Cárdenas continued her daily practice of hoop dancing. “I worked as a nurse, but I had to hula hoop at some point in the day. Ultimately hula hooping was evoking my joy. And joy is restorative. It cultivates well-being,” she says.

She saw her fellow nurses experiencing the compassion fatigue that she had been able to overcome. “Nurses walk alongside the path with people when they are experiencing a change in their health and when they are experiencing fear, when they most need care and compassion,” Cárdenas says. “Nurses help patients understand their diagnosis, disease process, and treatments, while helping to alleviate their suffering. When we can empathically support people in need, it creates a healthier, more compassionate community.”

But when nurses are experiencing compassion fatigue and burnout, their ability to provide compassionate care to patients can be compromised. “I wanted to address this. I wanted to figure out ways to prevent and decrease compassion fatigue so we can keep nurses inspired and motivated to remain in their roles: happy, joyful, feeling good! I wanted to come up with a solution. And I knew what was working for me,” she says.

Cárdenas developed evidence-based programs to help those who care for others to understand the value of play and how to apply it in their lives. In her play workshops and seminars, she first guides her attendees to experience play through hula hooping. She then shares a presentation that is grounded in science and research explaining the phenomenon and benefits of play, the basic affect of joy, and the value of empathy and compassion, ultimately drawing a connection to personal and collective well-being. Play, Cárdenas says, is intrinsic to who we are. It evokes joy, which fosters relaxation and restoration and promotes emotional and psychological well-being.

“Participants’ reactions range from realizing how much fun they had, feeling more joyful and hopeful, recognizing how little they engage in play in their life, noticing how accessible play is, to a more broadened awareness of play’s transformative function,” she says. Cárdenas then encourages participants to feel empowered to take this newfound knowledge and apply it within their own lives.

Today, Cárdenas, who is now a doctoral candidate in psychology, is determined to help fellow nurses and caregivers prevent and decrease compassion fatigue through body and movement play. In her seminars and play workshops, she helps those who care for others learn to embrace self-care and experience joy. In celebration of Nurses Month, Walden’s Mobilize for Good initiative is donating resources to bring Cárdenas’ play workshops and seminars to nurses and healthcare professionals across the country.

“Another word for compassion is grace. And my mother’s name was Grace. The reason I became an oncology nurse is because I am first the daughter of a woman diagnosed with breast cancer,” Cárdenas says. Her commitment to compassionate care for people in times of need is not only a tribute to her mother but also an opportunity for people to see the strong, joyful, and caring woman her mother raised.

“Can you imagine a world without play?” Cárdenas asks. “Can you imagine a world that lacks empathy and compassion?”

Imagining this is distressing; experiencing it would be much worse.

Cárdenas is creating a world where play is valued instead of marginalized, and sustained joy is the result. After all, she explains, “When we evoke joy, we foster the social bond and promote well-being. Ultimately, it’s about helping not just ourselves but one another.”

Walden University is an accredited institution offering a suite of nursing degree programs online, including a Master of Science in Nursing (MSN). Expand your career options and earn your degree using a convenient, flexible learning platform that fits your busy life.


Walden University is accredited by The Higher Learning Commission,