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Aims and objectives To interpret the body of qualitative work focusing on compassion fatigue to distil a common understanding that could then be applied to nursing care. Background Complex demands place extraordinary stress on nurses struggling to work in overburdened healthcare systems. The result can be the inability to care well for others, leading to compassion fatigue, burnout and increased numbers leaving the profession. Metasynthesis offers a means of more fully illuminating compassion fatigue and further understanding of practices which might reduce its negative consequences. Design Metasynthesis. Method As a method designed to facilitate knowledge development, metasynthesis allowed for integration of qualitative study findings conducted between 1992-2016 using defined search terms. Six databases were searched for articles published in English. Nine papers met the criteria for review and metasynthesis was conducted using the meta-ethnographic approach detailed by Noblit and Hare. Results Four themes related to compassion fatigue were found by consensus discussion. The themes included: physical ('just plain worn out') and emotional symptoms ('walking on a tightrope'), triggering factors ('an unbearable weight on shoulders' and 'alone in a crowded room'), and measures to overcome/prevent ('who has my back?'). Conclusions Compassion fatigue is a concept of documented relevance to those in nursing and represents a basic inability to nurture others and engenders a temporal component. Synthesis of studies provides evidence of the veracity of the concept for application to clinical practice and research related to nursing care. Relevance to clinical practice Findings provide insight into the clinical milieu needed to prevent compassion fatigue. A theoretical model is presented which can be used to guide future research, as well as the creation of clinical practice policies which might mitigate the development of compassion fatigue and its potential consequences. [ABSTRACT FROM AUTHOR]