Extent of compassion satisfaction, compassion fatigue and burnout in nursing: A meta-analysis

A Mixed-Method Study on the Assessment of Factors Influencing Nurses' Provision of Spiritual Care

The purpose of this study was to explore factors that influence nurses' beliefs about offering spiritual care.

STUDY DESIGN

A mixed-method study design, incorporating both quantitative (questionnaire) and qualitative research, was used for this study (focus group discussion).

METHODS

The questionnaires were completed by a convenience sample of nurses and their assistants working in two public hospitals. These questionnaires included the Greek versions of the FACIT-Sp-12, SCIPS, NEO-FFI, and the Spiritual Climate Scale, as well as a specially designed questionnaire to gather demographic, socioeconomic, and professional information about the study population (SCS). Three nurses and two nursing assistants who worked in public hospitals and were chosen through purposive sampling made up the sample for the qualitative study. In utilizing inductive content analysis methodology, a qualitative analysis was carried out.

RESULTS

Greek nurses frequently offer spiritual care to their patients, primarily existential spiritual care. It was discovered that the spiritual climate, the nurses' positive coherence, and their educational level all exert a favorable effect on total spiritual care. Three categories and seven subcategories were used to describe the participants' prior experiences with spiritual care.

CONCLUSIONS

Greek nurses frequently offer spiritual care to their patients, and both internal and external factors influence their attitudes in this regard.

Insights into the Impact of Organizational Factors and Burnout on the Employees of a For-Profit Psychiatric Hospital during the Third Wave of the COVID-19 Pandemic

In this paper, we provide insights into the interplay among the organizational, job, and attitudinal factors and employees' intentions to resign during the third wave of the COVID-19 pandemic at a mental health hospital. We point out shortcomings in the relationship dynamics between executive administration and operational staff and propose a pathway to develop more effective leadership frameworks to increase job satisfaction. We integrate qualitative data from case information and open-ended questions posed to employees at a mental health hospital and quantitative data from a small-scale survey (n = 19). We highlight that the ability to achieve objectives, work autonomy, burnout, affective commitment, distributive and procedural justice, and job satisfaction are critical in determining individuals' intentions to resign. Individuals identified disconnectedness and moral distress as critical aspects, while highlighting empathy, compassion, satisfaction, and confidence as pivotal elements. Mental healthcare settings could benefit from enhancing the staff's ability to achieve objectives, work autonomy, affective commitment, and both distributive and procedural justice. Addressing burnout and implementing measures to increase job satisfaction are equally vital. Efficiently restructuring dynamics between various leadership levels and staff can significantly improve employee retention.

Effect of compassion fatigue on emotional labor in female nurses: Moderating effect of self-compassion

Emotional labor is common in nursing but may be affected by the mental state of nurses. This study explored the effect of compassion fatigue on emotional labor and whether self-compassion moderates this effect of compassion fatigue.

METHODS

A two-stage survey design with a convenience sample. Participants were female nursing staff recruited from emergency departments, intensive care units, ward nursing units, and outpatient departments of medical centers, regional hospitals, and district hospitals in Taiwan. A total of 300 questionnaire copies in each of the first and second stages were distributed, and 272 pairs of responses were retrieved (valid response rate = 91%). The reliability and validity of the questionnaire were tested, and confirmatory factor analysis was conducted with AMOS 21. The proposed hypotheses were verified using hierarchical regression conducted with SPSS version 25.0.

RESULTS

This study revealed that compassion fatigue positively predicted surface acting (β = 0.12, p < 0.05) and negatively predicted deep acting (β = -0.18, p < 0.01) and expression of genuine emotions (β = -0.31, p < 0.01). In addition, self-compassion negatively moderates the relationships between compassion fatigue and surface acting (β = -0.12, p < 0.05), and positively moderates the relationships between compassion fatigue and expression of genuine emotions (β = 0.15, p < 0.01).

CONCLUSIONS

To avoid excessive consumption of emotional resources, nurses with high compassion fatigue may employ surface acting by engaging in emotional labor without making an effort to adjust their feelings. Nurses need also be sympathized with, and such sympathy can come from hospitals, supervisors, colleagues, and, most crucially, the nurses themselves. Hospital executives should propose improvement strategies that can prevent the compassion fatigue on nurses, such as improving nurses' self-compassion.

Can the Reboot coaching programme support critical care nurses in coping with stressful clinical events? A mixed-methods evaluation assessing resilience, burnout, depression and turnover intentions

BACKGROUND

Critical care nurses (CCNs) are routinely exposed to highly stressful situations, and at high-risk of suffering from work-related stress and developing burnout. Thus, supporting CCN wellbeing is crucial. One approach for delivering this support is by preparing CCNs for situations they may encounter, drawing on evidence-based techniques to strengthen psychological coping strategies. The current study tailored a Resilience-boosting psychological coaching programme [Reboot] to CCNs. Other healthcare staff receiving Reboot have reported improvements in confidence in coping with stressful clinical events and increased psychological resilience. The current study tailored Reboot for online, remote delivery to CCNs (as it had not previously been delivered to nurses, or in remote format), to (1) assess the feasibility of delivering Reboot remotely, and to (2) provide a preliminary assessment of whether Reboot could increase resilience, confidence in coping with adverse events and burnout.

METHODS

A single-arm mixed-methods (questionnaires, interviews) before-after feasibility study design was used. Feasibility was measured via demand, recruitment, and retention (recruitment goal: 80 CCNs, retention goal: 70% of recruited CCNs). Potential efficacy was measured via questionnaires at five timepoints; measures included confidence in coping with adverse events (Confidence scale), Resilience (Brief Resilience Scale), depression (PHQ-9) and burnout (Oldenburg-Burnout-Inventory). Intention to leave (current role, nursing more generally) was measured post-intervention. Interviews were analysed using Reflexive Thematic Analysis.

RESULTS

Results suggest that delivering Reboot remotely is feasible and acceptable. Seventy-seven nurses were recruited, 81% of whom completed the 8-week intervention. Thus, the retention rate was over 10% higher than the target. Regarding preliminary efficacy, follow-up measures showed significant increases in resilience, confidence in coping with adverse events and reductions in depression, burnout, and intention to leave. Qualitative analysis suggested that CCNs found the psychological techniques helpful and particularly valued practical exercises that could be translated into everyday practice.

CONCLUSION

This study demonstrates the feasibility of remote delivery of Reboot and potential efficacy for CCNs. Results are limited due to the single-arm feasibility design; thus, a larger trial with a control group is needed.

Structural Factors Contributing to Compassion Fatigue, Burnout, and Secondary Traumatic Stress Among Hospital-Based Healthcare Professionals During the COVID-19 Pandemic

High levels of burnout among healthcare providers (HCPs) have been a widely documented phenomenon, which have been exacerbated during the COVID-19 pandemic. In the United States, qualitative studies that are inclusive of HCPs in diverse professional roles have been limited. Therefore, we utilized a qualitative-quantitative design to examine professional quality of life in terms of compassion fatigue, burnout, and secondary traumatic stress among hospital-based HCPs, including social workers, hospitalists, residents, and palliative care team members during COVID-19. HCPs (n = 26) participated in virtual semi-structured focus groups or individual interviews and online surveys (n = 30) including the Professional Quality of Life (ProQOL) Scale. While ProQOL scores indicated low levels of compassion fatigue, burnout, and secondary traumatic stress, thematic analysis of our qualitative data included rich descriptions of compassion fatigue, burnout, and secondary traumatic stress. Safety concerns and value misalignment characterized structural stressors perceived to contribute to HCP compassion fatigue, burnout, and secondary traumatic stress. The discrepancy between our qualitative and quantitative findings may be indication that modifications to current screenings are warranted. These findings also suggest a need to identify and implement structural and policy changes that increase HCPs' physical and emotional safety and promote better alignment of institutional interests with HCP values.

Unveiling the burden of compassion fatigue in nurses

BACKGROUND

The COVID-19 pandemic has placed an unprecedented burden on nurses who have been at the forefront of patient care. The continuous exposure to suffering, death, and overwhelming demands has the potential to lead to compassion fatigue, a state of emotional, physical, and cognitive exhaustion.

RESEARCH AIM

The study aimed to explore and understand the phenomenon of compassion fatigue in nurses as the effect of the COVID-19 pandemic.

RESEARCH DESIGN

A constructivist grounded theory design was used.

PARTICIPANTS AND RESEARCH CONTEXT

The research data were collected from 20 nurses who had been employed in pandemic clinics in Turkey for a minimum of 6 months. Data were collected using a two-step approach: purposeful sample selection followed by theoretical sample selection. Individual interviews were conducted via an online platform with participants who consented to participate in the study from January 16th to April 28th, 2022. The collected data underwent initial, focused, and theoretical coding for analysis. The research findings were reported following the Consolidated Criteria for Reporting Qualitative Research guidelines.

ETHICAL CONSIDERATIONS

Ethical approval for the study was received from Non-Interventional Clinical Research Ethics Committee. The study was conducted following the Declaration of Helsinki.

FINDINGS

The study identified a core category, namely the desire to provide the best care, which was accompanied by five main categories: causes, symptoms, consequences, coping methods, and the benefits of coping methods.

CONCLUSION

During the pandemic process, nurses have experienced compassion fatigue due to various factors and have seen its symptoms. Nurses have developed various coping mechanisms individually. However, they have not indicated any institutional-level support. It has become necessary to plan nurse-centered comprehensive interventions that will reduce compassion fatigue.

Level of professional quality of life and coping with death competence in healthcare professionals exposed to perinatal loss: A cross-sectional study

Perinatal loss is a traumatic and stressful experience with a significant emotional toll on the physical and psychological wellbeing of the healthcare professionals. We included 216 healthcare professionals working in an obstetrics-gynecology service or neonatal intensive care unit in a cross-sectional study and aimed to analyze the possible association between the healthcare professionals' level of professional quality of life, their coping with death competence, and their personal and work-related characteristics. Compassion fatigue and burnout did not correlate significantly with healthcare professionals' personal and work-related characteristics. Formal training was strongly associated with high levels of compassion satisfaction and coping with death competence. A low level of coping with death competence was found in women and in younger healthcare professionals, those who are single, and with little professional experience. Self-care activities and hospital support systems can be effective resources in coping with death.

Providing Gender Sensitive and Responsive Trauma-Informed Psychiatric Nursing Care. How Hard Can It Be?

This paper addresses the challenge of providing gender sensitive and responsive trauma-informed care (TIC) in psychiatric nursing practice. Gender identity, gender subordination, and gender-related trauma history are examined as three key individual-level factors that affect nurses' capacity to engage therapeutically to provide gender sensitive and responsive TIC. Using Peplau's Interpersonal Theory and building on a shared trauma and resilience model, gender-sensitive and responsive TIC is situated within interpersonal science and the ability of the psychiatric nurse to attune to her own and her patient's gender ideologies. Strategies for transforming practice including self-reflection, self-compassion, and peer and supervisor support are reviewed. Noting the import of the practice environment, several observations of changes needed at the level of the unit, organization, and society to effect gender equitable policies that enable the implementation of gender-sensitive and responsive TIC are made.

The role of self-compassion and compassion toward others in burnout syndrome in a sample of medical students

Burnout produces negative effects on academic performance, and, in turn, feelings of inefficiency that are detrimental to students' psychosocial well-being. The aim of this research is to determine the effects that self-compassion and compassion toward others have on various burnout dimensions in a sample of medical students. A total of 235 medical students (61.7% women) aged between 16 and 32 years old (M = 19.82; SD = 2.37) belonging to a Colombian university participated. A cluster analysis to segment the population according to burnout was carried out along with nonparametric contrasts to identify differences in the levels of self-compassion and compassion toward others between each profile. A series of regression analyses was designed to find out how each type of compassion was associated with burnout on each profile. The cluster analysis allowed us to identify three profiles. The low-involvement profile (n = 51) is characterized by low depersonalization, intermediate levels of emotional exhaustion and personal accomplishment and exhibits low levels of self-compassion and compassion fatigue compared with the other profiles. The positive-adaptation profile (n = 104) is characterized by low depersonalization levels, intermediate degrees of emotional exhaustion and high levels of personal accomplishment and exhibits the highest levels of self-compassion and compassion fatigue compared with the other profiles. The high-demand profile (n = 104) is characterized by intermediate depersonalization levels, medium-high levels of emotional exhaustion and high levels of personal accomplishment and exhibits intermediate levels of self-compassion and low levels of compassion fatigue. Establishing profiles based on burnout allows students to be segmented and for precise knowledge to be acquired about the effects that both types of compassion have on the dimensions of burnout.

Non-linear association of years of experience and burnout among nursing staff: a restricted cubic spline analysis

Background

Occupational burnout is intricately linked to a spectrum of physical disorders encompassing respiratory, cardiovascular, and gastrointestinal conditions, as well as manifestations such as headaches, type 2 diabetes, elevated cholesterol levels, chronic fatigue, and muscle pain. Despite this association, there remains a paucity of research on the specific risk factors contributing to burnout among nurses in China.

Methods

This cross-sectional study utilized convenience sampling to recruit participants, with data analyzed from 1,774 nurse staffs. Psychosocial traits were assessed using the Three-Item Loneliness Scale for loneliness, the Generalized Anxiety Disorder 7-item scale (GAD-7) for anxiety symptoms, the 9-item Patient Health Questionnaire (PHQ-9) for depressive symptoms, the Connor Davidson Resilience Scale-10 item (CDRISC-10) for resilience, and the Maslach Burnout Inventory-Human Service Survey (MBI-HSS) for burn out. Restrictive cubic spline analysis to investigate the dose-response relationship between years of experience and burn out. Multivariate linear regression was employed to investigate the relationship between burnout and various risk factors.

Results

After controlling for basic demographic variables, good sleep quality was associated with a reduction in emotional exhaustion (β = -0.307, p < 0.001), while loneliness (β = 1.334, p < 0.001), depressive symptoms (β = 0.896, p < 0.001), and anxiety symptoms (β = 0.504, p < 0.001) were significantly associated with increased emotional exhaustion. Moreover, higher levels of resilience were positively associated with personal accomplishment (β = 0.635, p < 0.001). Regarding depersonalization, loneliness (β = 0.577, p < 0.001), depressive symptoms (β = 0.429, p < 0.001), and anxiety symptoms (β = 0.152, p < 0.01) were found to increase its level. Conversely, good resilience was associated with a decrease in depersonalization (β = -0.069, p < 0.001). The non-liner association between year of experience and emotional exhaustion was significantly (p < 0.05).

Conclusion

Our findings revealed that significant risk factors contributing to burnout among nursing staff including bad sleep quality, loneliness, lower level of resilience, anxiety symptoms, depressive symptoms. Moreover, a nonlinear correlation between years of experience and the likelihood of experiencing emotional exhaustion was exist.

"A Life Slips Through Our Fingers" Experiences of Nurses Working in Pediatric Intensive Care Units About Children's Death: A Qualitative Study

Caring for a dying child can be an experience full of all kinds of negative emotions, pain and stress for the pediatric nurse. In this study, which was carried out in Turkey, we aimed to determine how nurses working in a pediatric intensive care unit remembered and made sense of their experiences regarding children's deaths. In-depth interviews were held with 13 nurses. The data were analyzed using the content analysis method. Three themes were identified. These were (1) Personal effects of death, (2) Difficulties in care, and (3) Coping with death. It was clear that the nurses were traumatised by their exposure to infant deaths. The findings showed that nurses experienced regret, fatigue and posttraumatic stress disorder. In addition, it was determined that nurses should be supported to cope with child deaths, which is a complicated process involving the child and the family, especially emotionally. Moreover, providing institutional support to nurses and referring them to cognitive-behavioral therapies may make it easier for them to cope with the emotional burden they carry, as well as the burnout they experience.

Compassion Satisfaction, Burnout, and Secondary Traumatic Stress Among Nursing Staff at an Academic Medical Center: A Cross-Sectional Analysis

BACKGROUND

Although several studies have recently described compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS) in nurses, few to date have examined these issues across nursing specialties. Such examination is needed to inform future nursing-subspecialty tailored interventions.

AIMS

To examine (1) differences in CS, BO, and STS across nursing specialties and (2) differences associated with demographic, work-related, and behavioral factors among nurses.

METHOD

A secondary analysis of survey responses from nurses (N = 350) at an academic medical center. Demographic, behavioral, work-related, and professional quality of life variables were analyzed using hierarchical regression analyses.

RESULTS

CS, BO, and STS scores significantly varied across specialties with emergency nurses experiencing significantly elevated rates of BO and STS, and lowest rates of CS; scores were also differentially associated with demographic, work-related, behavioral, and workplace violence variables.

CONCLUSIONS

Key differences in CS, BO, and STS by nursing specialty suggests the importance of tailoring BO and STS mitigative interventions. BO and STS risk factors should be assessed in nurses (e.g., behavioral health problems and poor sleep quality) and specialty-specific interventions (e.g., reducing workplace violence exposure in emergency settings) may be considered to improve CS while reducing BO and STS among nurses.

Secondary traumatic stress among pediatric nurses: Relationship to peer-organizational support and emotional labor strategies

BACKGROUND

Even though the cost of caring is acknowledged in multiple helping professions, research into secondary traumatic stress in pediatric nursing remains limited. This study aimed to determine the prevalence of secondary traumatic stress among pediatric nurses and examine its correlation with demographics, perceived organizational support, peer support, and emotional labor strategies.

DESIGN AND METHODS

A total of 186 nurses working in a pediatric hospital completed questionnaires addressing secondary traumatic stress, perceived organizational support, peer support, and emotional labor strategies. Through correlational and mediation analyses, we explored the relationships between the study variables.

RESULTS

Approximately 77.8% of the pediatric nurses surveyed exhibited moderate to severe secondary traumatic stress. Notably, the level of secondary traumatic stress did not correlate with demographic variables. Increased peer support was significantly associated with a heightened use of all emotional labor strategies (surface acting, deep acting, and natural expression) and with elevated levels of secondary traumatic stress. However, surface acting was the sole mediator of this relationship. Conversely, greater perceived organizational support correlated with decreased levels of surface acting and secondary traumatic stress, with surface acting serving as the mediator.

CONCLUSIONS

Pediatric nurses are greatly impacted by secondary traumatic stress. Enhancing organizational support and carefully assessing peer support can reduce this, by decreasing nurses' need to suppress or feign genuine emotions.

PRACTICE IMPLICATIONS

To enhance nurses' psychological well-being, healthcare institutions should raise awareness of secondary traumatization and foster a supportive organizational environment that prioritizes effective team emotional support and evaluates collegial emotional labor.

Predictors of professional burnout and fulfilment in a longitudinal analysis on nurses and healthcare workers in the COVID-19 pandemic

AIMS AND OBJECTIVES

(1) To investigate the vulnerability of nurses to experiencing professional burnout and low fulfilment across 5 months of the COVID-19 pandemic. (2) To identify modifiable variables in hospital leadership and individual vulnerabilities that may mitigate these effects.

BACKGROUND

Nurses were at increased risk for burnout and low fulfilment prior to the COVID-19 pandemic. Hospital leadership factors such as organisational structure and open communication and consideration of employee opinions are known to have positive impacts on work attitudes. Personal risk factors for burnout include symptoms of depression and anxiety.

METHODS

Healthcare workers (n = 406 at baseline, n = 234 longitudinal), including doctors (n = 102), nurses (n = 94), technicians (n = 90) and non-clinical administrative staff (n = 120), completed 5 online questionnaires, once per month, for 5 months. Participants completed self-report questionnaires on professional fulfilment and burnout, perceptions of healthcare leadership, and symptoms of anxiety and depression. Participants were recruited from various healthcare settings in the southeastern United States. The STROBE checklist was used to report the present study.

RESULTS

Both at baseline and across the 5 months, nurses working during the COVID-19 pandemic reported increased burnout and decreased fulfilment relative to doctors. For all participants, burnout remained largely steady and fulfilment decreased slightly. The strongest predictors of both burnout and fulfilment were organisational structure and depressive symptoms. Leadership consideration and anxiety symptoms had smaller, yet significant, relationships to burnout and fulfilment in longitudinal analyses.

CONCLUSIONS

Burnout and reduced fulfilment remain a problem for healthcare workers, especially nurses. Leadership styles and employee symptoms of depression and anxiety are appropriate targets for intervention.

RELEVANCE TO CLINICAL PRACTICE

Leadership wishing to reduce burnout and increase fulfilment among employees should increase levels of organisational support and consideration and expand supports to employees seeking treatment for depression and anxiety.

The effect of the compassion levels of healthcare workers on their psychological well-being

BACKGROUND

A sense of compassion has a core importance in health service delivery. Research on the psychological impact of being compassionate on healthcare workers is limited.

OBJECTIVE

This research aims to examine the effect of compassion levels of healthcare workers on their psychological well-being.

METHODS

This was a cross-sectional and descriptive study. The population of the research consists of health personnel working throughout Ankara, the capital. The study was carried out with 414 healthcare workers. A personal information form, compassion scale and psychological well-being scale were used in the research questionnaire.

RESULTS

A positive and significant relationship was found between compassion and psychological well-being scores. It was determined that compassion positively affected psychological well-being levels. The level of compassion showed that there was a significant difference between the groups according to the variables of gender, family structure, job satisfaction and whether they would choose the same profession again. The level of psychological well-being was found to be significantly different between the groups in education, job satisfaction and making the same profession choice again.

CONCLUSION

It is a professional requirement that health professionals in patient care have a sense of compassion and reflect this feeling in their conduct. Research shows that the greater the compassion, the higher the psychological well-being. Therefore, undertaking training initiatives to make healthcare workers more compassionate can contribute to patient care and at the same time to the psychological well-being of healthcare workers.

Factors Associated With Healthcare Clinician Stress and Resilience: A Scoping Review

GOAL

Clinician stress and resilience have been the subjects of significant research and interest in the past several decades. We aimed to understand the factors that contribute to clinician stress and resilience in order to appropriately guide potential interventions.

METHODS

We conducted a scoping review (n = 42) of published reviews of research on clinician distress and resilience using the methodology of Peters and colleagues (2020). Our team examined these reviews using the National Academy of Medicine's framework for clinician well-being and resilience.

PRINCIPAL FINDINGS

We found that organizational factors, learning/practice environment, and healthcare responsibilities were three of the top four factors identified in the reviews as contributing to clinician distress. Learning/practice environment and organizational factors were two of the top four factors identified in the reviews as contributing to their resilience.

PRACTICAL APPLICATIONS

Clinicians continue to face numerous external challenges that complicate their work. Further research, practice, and policy changes are indicated to improve practice environments for healthcare clinicians. Healthcare leaders need to promote resources for organizational and system-level changes to improve clinician well-being.

The Associations among Destructive Leadership, Job Demands and Resources, and Burnout among Nurses: A Cross-Sectional Survey Study

Background

Nurses demonstrate high burnout prevalence. Moreover, destructive leadership, as well as job demands and resources, are associated with burnout. However, these associations, particularly in the context of nursing, warrant further investigation.

Objective

To explore the associations of destructive leadership, as well as job demands and resources, with burnout in registered nurses.

Design

A cross-sectional survey. Participants. 2115 registered nurses in Finland.

Methods

The self-administered questionnaire survey was distributed nationwide to 106,000 members of the Finnish trade union for health and social care professionals via an online newsletter in February 2023. Nurses' burnout was measured with the Burnout Assessment Tool (BAT). The data were analysed through descriptive statistics and linear regression analysis.

Results

Destructive leadership and job demands were positively associated with burnout (β = 0.39 and 0.32, respectively; both p < 0.001), whereas job resources and burnout were negatively associated (β = -0.41, p < 0.001). The associations of destructive leadership and job demands with burnout became less positive when job resources were added to the regression model (β = 0.21 and 0.14, respectively; both p < 0.001).

Conclusions

Job resources led to the greatest reduction in burnout among registered nurses. Moreover, job resources reduced burnout by diminishing the negative effects of destructive leadership and job demands. Providing a sufficient amount of job resources might reduce burnout and diminish the negative effects of destructive leadership and job demands among nurses. These relationships warrant examination in other cultural settings.

Clinical nurses' compassion fatigue psychological experience process: a constructivist grounded theory study

BACKGROUND

Clinical nurses are susceptible to compassion fatigue when exposed to various types of traumatic events in patients for extended periods of time. However, the developmental process, staging, and psychological responses distinct to each stage of compassion fatigue in nurses are not fully clarified. This study aimed to explore the processes of compassion fatigue and the psychological experiences specific to each phase of compassion fatigue among clinical nurses.

METHODS

Charmaz's Constructivist Grounded Theory methodology was used in this qualitative research. Semi-structured interviews were conducted with 13 clinical nurses with varying degrees of compassion fatigue from December 2020 to January 2021. Interview data were analyzed using grounded theory processes.

RESULTS

The data were categorized into five separate categories and 22 sub-categories. This study found that the process of compassion fatigue is dynamic and cumulative, which was classified into five phases: compassion experience period, compassion decrement period, compassion discomfort period, compassion distress period, and compassion fatigue period.

CONCLUSION

Clinical nurses who experience compassion fatigue may go through five stages that are stage-specific and predictable. The findings can shed light on local and global applications to better understand the problem of nurses' compassion fatigue. The interventions for addressing compassion fatigue in clinical nurses should be stage-specific, targeted, and individualized.

The Prevalence and Predictors of Compassion Satisfaction, Burnout and Secondary Traumatic Stress in Registered Nurses in an Eastern Canadian Province: A Cross-Sectional Study

BACKGROUND

The quality of Registered Nurses' worklife is impacting nurses' mental health, and the standard of care received by clients. Contributing factors to nurses' stress are the trauma of continuous caring for those in great suffering, and adverse working conditions.

OBJECTIVES

i) to explore the prevalence of work-related stress in a provincial sample of Registered Nurses; ii) to compare the levels of compassion satisfaction, burnout and secondary traumatic stress reported by nurses in hospital, community, non-direct care settings, and, iii) to identify factors that predict levels of nursing work stress.

METHODS

A descriptive, predictive study with a self-report survey containing demographic questions and the Professional Quality of Life Scale was emailed to over 3,300 Registered Nurses. The scale measured the prevalence of three worklife indicators, compassion satisfaction, burnout and secondary traumatic stress. Multiple linear regression identified factors that predicted the levels of the three indicators. A subgroup analysis explored the quality of worklife based on three practice environments.

FINDINGS

Nurses (n  =  661) reported moderate compassion satisfaction, burnout, and secondary traumatic stress. The strongest predictor, satisfaction with one's current job, predicted high compassion satisfaction and lower burnout and secondary stress. The subgroup analysis identified hospital nurses as having the most work-related stress and the lowest level of compassion satisfaction.

CONCLUSION

Innovative, collaborative action can transform nurses' practice environments. Organizational support is essential to bring about needed improvements.

Nurse managers' experience during the COVID-19 pandemic in China: A qualitative study

AIMS

The aim of the study was to explore the experiences of female new nurse managers during the COVID-19 pandemic.

DESIGN

This was a phenomenological study, and qualitative descriptive analysis was used.

METHODS

New nurse managers were defined as new nurse managers with less than 3 years of management experience in this study. During November and December of 2021, 18 female new nurse managers were interviewed face-to-face with a semi-structured interview guide in three municipal hospitals. The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for evaluating qualitative research reports. Data analysis was performed using Colaizzi's seven-step method.

RESULTS

Four main themes and 10 sub-themes were extracted from the collected data. The four major themes were as follows: (1) a shift in stress; (2) work-related physical and psychological discomfort; (3) reflection on the cause; (4) coping and struggles.

CONCLUSIONS

New nurse managers were experiencing great stress and exhaustion in their roles. It is important that they are helped to handle situations. Providing them with readily accessible support, addressing their psychosocial needs and addressing exhaustion is necessary. Considering their short management time, the hospital should provide adequate support in human, financial and material areas and provide training to help new nurse managers better adapt to their new roles. In addition, nurse directors should create a culture of mutual respect, identify workplace bullying and create a harmonious and cooperation-oriented work environment for new nurse managers.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

The Gratitude Campaign: A Multihospital Evidence-Based Practice Project

Nurse well-being and optimism were tested in the midst of COVID-19 patient surges and staffing challenges. Using the American Nurses Foundation Gratitude Toolkit, a health system implemented monthly gratitude practices at 4 hospitals. Validated survey measures indicated that nurses' scores of self-perceived gratitude, flourishing behaviors, and mindfulness were maintained during this challenging time but did not statistically increase. Although statistical significance increases were not demonstrated, the gratitude campaign offered clinical significance through positive feedback and was sustained through the distribution of a toolkit disseminated across the health system.

The mediating role of empathy in the impact of compassion fatigue on burnout among nurses

Background

The burnout levels of nurses, who have an important place in the delivery of health services, are increasing day by day. As the burnout levels of nurses increase, there may be undesirable situations such as compassion fatigue specific to them, their patients and their institutions.

Purpose

The aim of this study is to determine the effect of compassion fatigue seen in nurses on burnout and the mediating role of empathy in this effect.

Methods

The research was conducted on nurses working in three public hospitals operating in Sakarya, Turkey, between 2 January and 16 April 2019. Since the research was conducted in more than one hospital, the minimum number of participants was determined for each hospital using the stratified sampling method in the first stage. In the second stage, the participants were selected by convenience sampling method. Descriptive statistics, linear regression and process macro regression analysis were used to analyse the data.

Results

The results showed the effect of nurses' compassion fatigue on burnout and empathy (β = 0.673). In addition, empathy has a mediating role in the effect of compassion fatigue on burnout (β = 0.251).

Conclusions/implications for practice

Reducing the burnout levels of nurses, who have a very important place in the delivery of health services, is important for both themselves and patients. It is recommended that the results of this study, which may contribute to the development of the awareness of nurse managers, should be made with the ability to understand the symptoms of compassion fatigue and burnout, teaching coping methods and providing support by experts when necessary.

The relationship between empowerment and compassion satisfaction, compassion fatigue, and burnout in nurses during COVID-19 outbreak

BACKGROUND

The quality of nurses' professional life is at stake in crises such as COVID-19. Empowerment helps employees perform better and advance the goals of the organization. This study aimed to investigate the relationship between empowerment and the quality of nurses' professional life during the outbreak of COVID-19.

MATERIALS AND METHODS

The current cross-sectional study was conducted in 2021 in the hospitals of Babol University of Medical Sciences with the participation of 200 nurses providing care for COVID-19 patients who were included in the study by convenience sampling method. Data collection tools included the Empowerment Questionnaire (Leader Empowerment Behaviors Scale, Structural Empowerment, and Psychological Empowerment) and the Professional Quality of Life Questionnaire. SPSS software version 23 was used to analyze the data. Multiple linear regressions were used to investigate the relationship between empowerment and quality of professional life.

RESULTS

In the majority of nurses, compassion satisfaction 140 (70%), burnout 172 (86%), and compassion fatigue 126 (63%) were at moderate level. A significant relationship was found between compassion satisfaction and Leader Empowerment (R = 0.54, P =. 001), Psychological Empowerment (R = 0.55, P =. 001), and Structural Empowerment (R = 0.42, P =. 001) and Compassion Fatigue and Leader Empowerment (R = 0.35, P =. 001), psychological empowerment (R = 0.42, P =. 001), and structural empowerment (R = 0.49, P =. 001).

CONCLUSION

Nursing managers' attention to empowerment strategies in crises such as COVID-19 can improve compassion satisfaction and reduce compassion fatigue in nurses. It is also necessary to implement policies and guidelines for the development of psychosocial support to health promotion of the workplace, education, informing, and empowering nurses.

Mobile Mindfulness for Psychological Distress and Burnout among Frontline COVID-19 Nurses: A Pilot Randomized Trial

Rationale: The coronavirus disease (COVID-19) pandemic exacerbated psychological distress and burnout in frontline healthcare workers. Interventions addressing psychological distress and burnout among these workers are lacking. Objectives: To determine the feasibility and explore the impact of mobile mindfulness to treat psychological distress and burnout among nurses in frontline COVID-19 units. Methods: We conducted a pilot randomized trial of 102 nurses working in COVID-19 units at a single hospital between May 2021 and January 2022. Participants were randomized to mobile mindfulness (intervention) or waiting list (control). The primary outcome was feasibility, assessed by comparing rates of randomization, retention, and intervention completion to predefined targets. Secondary outcomes were changes in psychological distress (Patient Health Questionnaire-9, General Anxiety Disorder-7, Perceived Stress Scale-4) and burnout symptoms (Maslach Burnout Inventory) after 1 month. Results: We randomized 102 of 113 consented individuals (90%, target 80%), and 88 completed follow-up (86%, target 80%). Among 69 intervention participants, 19 completed ⩾1 mindfulness session per week (28%, target 60%), and 13 completed ⩾75% of mindfulness sessions (19%, target 50%). Intervention participants had greater decreases in Patient Health Questionnaire-9 scores than control subjects (difference in differences, -2.21; 95% confidence interval, -3.99, -0.42; P = 0.016), but the Maslach Burnout Inventory depersonalization scores decreased more in the control arm than in the intervention arm (difference in differences, 1.60; 95% confidence interval, 0.18, 3.02; P = 0.027). There were no other changes in emotional distress or burnout symptoms. Conclusions: This trial of mobile mindfulness in frontline nurses met feasibility targets for randomization and retention, but participants had modest intervention use. Intervention participants had a reduction in depression symptoms, but not in burnout. Clinical trial registered with www.clinicaltrials.gov (NCT04816708).

Correlation between professional quality of life and alarm fatigue symptoms among intensive care unit nurses

Introduction

Medical devices and equipment are necessary for accurate and continuous monitoring of the patients admitted to intensive care units, one of which is alarm systems. Frequent sounds of alarms can affect nurses' concentration and accuracy when providing care. Complications such as headache, fatigue, and stress occur after repeated alarms, leading to poor quality of professional life among nurses. This study aimed to determine the relationship between quality of professional life and alarm fatigue syndrome among intensive care unit nurses.

Methods

This cross-sectional study used convenience sampling to select nurses working in intensive care units from three hospitals in southern Iran in 2021 (n = 201). Data were collected using three questionnaires, including sociodemographic form, the professional quality of life questionnaire (ProQOL), and the alarm fatigue symptom (AFS) scale.

Results

The mean scores of compassion satisfaction (CS), burnout, secondary traumatic stress (STS) (subscales of the ProQOL), and AFS were 34.66 ± 7.54, 28.98 ± 7.59, 27.69 ± 5.87, and 13.48 ± 7.32, respectively. The majority of them had no or mild AFS, moderate CS, burnout, and STS. Among the study variables, only AFS were a significant predictor of CS and STS among ICU nurses. In addition, work experience in ICU, AFS, and a second job were significant predictors of burnout among ICU nurses.

Conclusions

The study results showed a significant relationship between alarm fatigue syndrome, burnout, STS, and CS. Given that more than half of the nurses in the intensive care unit in the present study experienced some degree of alarm fatigue syndrome, it is necessary to plan and implement interventions to better manage the alarms in the intensive care unit.

Empathy, sympathy, and altruism-An evident triad based on compassion. A theoretical model for caring

BACKGROUND

Based on existing confusion and a suggested contradiction regarding empathy and compassion in relation to caring science as well as in clinical health care.

AIM

The aim of the study was to find a knowledge base for the development of clinical caring science for, empathy, sympathy altruism, and compassion and their mutual relationship.

DESIGN

A theoretical paper.

RESULTS

The text discusses the different concepts separately, considering their history, research, obstacles, and bias and then brings them together in a concept model. The conclusion shows that empathy, sympathy, and altruism have no contradictions. Instead, they together form an evident triad based on compassion. Compassion is a prerequisite and a basis for the others to work. In clinical application, empathy is metaphorically a quality coming from the head, sympathy from the heart and altruism from the hand, merged in an attitude of compassion as a motif to care. The paper also reflects on the possibilities to increase and develop a compassionate mood and capacity by education and training.

A multi-method quasi-experimental study to assess compassion satisfaction/fatigue in nurses, midwives and allied health professionals receiving a narrative medicine intervention

AIMS

To: (1) measure the impact of a narrative medicine intervention on compassion fatigue and compassion satisfaction of nurses, midwives and allied health professionals; (2) explore participants' working experiences and (3) their impressions of the intervention.

DESIGN

Multi-methods, quasi-experimental before-after intervention design.

METHODS

The intervention consisted of 20 narrative medicine sessions (60 h). Healthcare providers (N = 48) from a mother-and-child hospital in Italy completed the 'Professional quality of life' questionnaire before and after the intervention (January 2020-April 2021). Baseline scores served as internal controls. Open-ended questions explored participants' touching experiences at work and their evaluation of the intervention. A thematic content analysis was performed. Reporting followed the TREND and SRQR guidelines.

RESULTS

The differences before-after intervention in compassion satisfaction or fatigue scores were not statistically significant. Three themes emerged from participants' touching experiences: "Witnessing death and sufferance"; "Witnessing violence" and "Organizational stressors during COVID-19". A statistically significantly higher median score for post-intervention compassion satisfaction was found among participants who reported at least one touching experience compared to those who had no touching experience. Four themes emerged from the reported strengths of the program: "Learning to exteriorize feelings"; "Team building"; "Useful to rework personal/professional journey" and "Develops professional empowerment". Two themes emerged from reported weaknesses: "Programme organization" and "Participants' difficulties in sharing experiences".

CONCLUSION

A time-limited narrative medicine intervention is not sufficient to produce significant changes in satisfaction or compassion fatigue, especially if implemented during a pandemic. However, such an intervention holds promise for supporting nurses and midwives' professional empowerment and promoting continuity of compassionate care.

IMPACT

For those at risk of compassion fatigue, policymakers need to invest in training in narrative medicine, which promotes team building, and employee well-being and thus favours compassionate care. Such programmes should be offered to undergraduate students to nurture compassion and attention to self.

PATIENT OR PUBLIC CONTRIBUTION

Does not apply as the study only includes health care providers.

Global prevalence of nursing burnout syndrome and temporal trends for the last 10 years: A meta-analysis of 94 studies covering over 30 countries

AIMS AND OBJECTIVES

To determine the global prevalence of nursing burnout syndrome and time trends for the last 10 years.

BACKGROUND

The prevalence of burnout syndrome varied greatly in different regions in the last 10 years, so the average prevalence and time trends of nursing burnout syndrome for the last 10 years were not completely clear.

DESIGN

A meta-analysis conducted in the PRISMA guidelines.

METHODS

CINAHL, Web of Science, and PubMed were searched for trials on the prevalence of nursing burnout syndrome from 2012 to 2022 systematically. Hoy's quality assessment tool was used to evaluate the risk of bias. The global prevalence of nursing burnout syndrome was estimated, and subgroup analysis was used to explore what caused heterogeneity. Time trends for the last 10 years were evaluated by meta-regression using Stata 11.0.

RESULTS

Ninety-four studies reporting the prevalence of nursing burnout were included. The global prevalence of nursing burnout was 30.0% [95% CI: 26.0%-34.0%]. Subgroup analysis indicated that the specialty (p < .001) and the region (p < .001) and the year (p < .001) were sources of the high heterogeneity. Meta-regression indicated that it tended to increase gradually for the last 10 years (t = 3.71, p = .006). The trends increased in Europe (t = 4.23, p = .006), Africa (t = 3.75, p = .006) and obstetrics (t = 3.66, p = .015). However, no statistical significance was found in ICU (t = -.14, p = .893), oncology (t = -0.44, p = .691) and emergency department (t = -0.30, p = .783).

CONCLUSIONS

A significant number of nurses were found to have moderate-high levels of burnout syndrome for the last 10 years. The meta-analysis also indicated an increased trend over time. Therefore, more attention to the prevalence of nursing burnout syndrome is urgently required.

RELEVANCE TO CLINICAL PRACTICE

High prevalence of nursing burnout may attract more attention from the public. This analysis may serve as an impetus for relevant policy to change nurses' working conditions and reduce the occurrence of burnout.

Secondary traumatic stress and posttraumatic growth in newly graduated nurses: the mediating role of compassion satisfaction

BACKGROUND

Nurses' secondary traumatic stress, compassion satisfaction and posttraumatic growth are closely related, but for newly graduated nurses, there are few reports to evaluate the specific path between these three. The aim of this study was to investigate examine the mediating role of compassion satisfaction in secondary traumatic stress and posttraumatic growth among newly graduated nurses.

METHODS

From March 2021 to May 2021, a total of 330 newly graduated nurses from five tertiary hospitals in China were enrolled, and asked to complete questionnaires regarding secondary traumatic stress, compassion satisfaction and posttraumatic growth. Descriptive statistics, independent-samples T-test, one-way analysis of variance (ANOVA), Pearson correlation analysis and structural equation model were used in this study. A STROBE checklist was used to report findings.

RESULTS

The scores of secondary traumatic stress, compassion satisfaction and posttraumatic growth of newly graduated nurses were 27.11 ± 4.94 (score range: 10-50), 31.89 ± 6.22 (score range: 10-50) and 56.47 ± 20.41 (score range: 0-100), respectively. Additionally, structural equation modeling showed that compassion satisfaction mediated the relationship between secondary traumatic stress and posttraumatic growth with the partial mediating effect of 0.089.

CONCLUSIONS

Newly graduated nurses may experience moderate secondary traumatic stress, but their posttraumatic growth is at a low level, and compassion satisfaction significantly affects the relationship between the two. Nursing managers should strengthen psychological evaluation, and promote their posttraumatic growth by improving their level of compassion satisfaction.

Professional quality of life and its associated factors among Vietnamese doctors and nurses

BACKGROUND

Prevalence of health workers with occupational health issues ranked fourth among all careers resulting in a reduction in quality of life. However, tools to measure professional quality of life (ProQoL) are unavailable in Vietnamese. This study aims to develop a Vietnamese version of the ProQoL, and examine ProQoL and its associated factors among doctors and nurses.

METHODS

The ProQoL is comprised of 30 items measures compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS). The tool was translated into Vietnamese following the Guideline by Guillemin et. al (1993), reviewed by expert panels, and validated for internal consistency and test-retest reliability among 38 health workers working at hospitals in HCMC. The validated tool was then used in a cross-sectional study to measure the ProQoL of full-time doctors and nurses working in clinical departments at the University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam. In addition to the ProQoL, self-reported data about demographic and occupational characteristics were collected.

RESULTS

The Vietnamese version of ProQoL achieved high internal consistency (alphas between 0.85 and 0.91) and Intra-class Correlation Coefficients (ICCs between 0.71 and 0.89) for all subscales. Among 316 health workers, mean scores of CS, BO, STS were 36.4 (SD = 5.4), 24.9 (SD = 5.1), 25.9 (SD = 5.3), respectively, indicating moderate levels of CS, BO and STS. Participants who were older (b = 0.17, 95%CI = 0.08, 0.26), had sufficient perceived income (b = 2.59, 95%CI = 0.93, 4.24), and > 10 years of working experience (b = 2.15, 95%CI = 0.68, 3.62), had higher CS scores. Those who were older (b=-0.15, 95%CI=-0.23, -0.07), had sufficient perceived income (b=-2.64, 95%CI=-4.18, -1.09), > 10 years of experience (b=-1.38, 95%CI=-2.76, -0.01), worked in surgical department (b=-1.46, 95%CI=-2.54, -0.38) and 8 hours/day (b=-1.52, 95%CI=-2.61, -0.44), had lower BO scores. Moreover, those in a relationship (b=-2.27, 95%CI=-3.53, -1.01) and had sufficient perceived income (b=-1.98, 95%CI=-3.64, -0.32) had lower STS scores.

CONCLUSIONS

The Vietnamese version of ProQoL is valid and reliable for use among Vietnamese health workers. Age, marital status, perceived income status, years of working experience, daily working hours, and specialty was associated with at least one component of ProQoL but gender, religion, education level, and monthly income were not.

Factors triggering the progressive detachment of nurses toward the fundamental needs of patients: findings from a qualitative study

The progressive desensitization of nurses in relation to fundamental needs (FNs) has been documented in anecdotical, scientific, and policy literature with nurses spending limited time at the bedside, thus affecting the quality of care and clinical outcomes. A potential reason that has been recognized is the limited nursing staff available in the units. However, other cultural, social, and psychological factors which have not been investigated to date may have a role in triggering the phenomenon. To investigate nurses' perceptions of the reasons that progressively detach clinical nurses from the FNs of patients, was the main intent of the study. In 2020, a qualitative study based on grounded theory following the Standards for Reporting Qualitative Research guidelines was performed. Purposeful sampling was adopted, by including 22 clinical nurses designated as 'good nurses' according to the perception of nurses working in executive and academic position. All agreed to be interviewed face-to-face. The detachment of nurses from the patients' FNs has been explained by three main factors that are interconnected: namely 'Being personally and professionally convinced regarding the role of FNs', 'Being progressively detached from the FNs', and 'Being forced to be detached from FNs'. Nurses also identified a category including strategies aimed at preventing detachment and 'Rediscovering the FNs as the core of nursing'. Nurses are personally and professionally convinced about the relevance of the FNs. However, they distance themselves from the FNs due to: (a) factors mainly attributable to internal personal and professional forces, such as the emotional fatigue that daily work entails; and (b) external forces related to the work environment where nurses work. To prevent this detrimental process that may result in negative outcomes for patients and their relatives, several strategies at the individual, organizational, and educational levels should be implemented.

A comparative study on patient safety culture among high-risk hospital staff in the context of the COVID-19 and non-COVID-19 pandemic: a cross-sectional study in Taiwan

The study aimed to compare the evolution of patient safety culture perceived by high-risk hospital staff in the context of the COVID-19 pandemic and non-COVID-19 pandemic and to examine the variations in patient safety culture across demographic variables. The study found that the COVID-19 pandemic has significantly impacted patient safety culture in healthcare settings, with an increased focus on safety climate, job satisfaction, teamwork climate, stress recognition, and emotional exhaustion. Safety culture and work stress vary among medical professionals of different age groups. To reduce stress, workload should be minimized, work efficiency improved, and physical and mental health promoted. Strengthening safety culture can reduce work-related stress, improve job satisfaction, and increase dedication towards work. The study recommends interventions such as psychological and social support, along with emotional management training, to reduce emotional exhaustion. Healthcare institutions can set up psychological counseling hotlines or support groups to help medical professionals reduce stress and emotional burden.

The Impact of Loving-Kindness Meditation on Compassion Fatigue of Nurses Working in the Neonatal Intensive Care Unit: A Randomized Clinical Trial Study

Compassion fatigue is a common complication in nurses, which can lead to burnout, job dissatisfaction, and a decline in the quality of patient care. This study aimed to investigate the impact of loving-kindness meditation on compassion fatigue of nurses working in the neonatal intensive care unit (NICU). This cluster-blinded randomized clinical trial study was conducted on 66 NICU nurses in 2 educational hospitals selected. The intervention group received a 1-month online program for daily training and practice of loving-kindness meditation. The control group received miscellaneous files on mental health during the COVID-19 pandemic period. The Nursing Compassion Fatigue Inventory (NCFI) was filled out by the 2 groups, before and after the intervention. The results showed that the mean scores of the NCFI in the intervention group decreased significantly compared with before the intervention (P = .002). In comparison with the control group, there was a significant difference between the mean scores of the 2 groups after the intervention (P = .034). Among nurses working in NICU, loving-kindness meditation significantly reduces compassion fatigue after 1 month. These findings support the use of this intervention for nurses.

The relationship between psychological resilience and professional quality of life among mental health nurses: a cross-sectional study

BACKGROUND

Mental health nursing is a demanding and stressful profession that impacts nurses' professional quality of life. Psychological resilience can be a protective factor. However, the relationship has not been extensively studied. This study aims to examine the relationship between psychological resilience and professional quality of life and identify potential predictors of ProQOL subscales among mental health nurses.

METHODS

The study employed a cross-sectional design to collect data from 179 mental health nurses. Data was collected using two standardized questionnaires: the Connor-Davidson resilience scale and the professional quality of life scale. Participants were recruited through convenient sampling during a 3-month period from April to June 2022, and the data were collected using an online survey tool called QuestionPro.

RESULTS

The study found a strong positive correlation between psychological resilience and compassion satisfaction (r = 0.632, P < 0.001). However, there was a negative significant correlation between resilience with burnout (r = -0.470, P < 0.001) and secondary traumatic stress (r = -0.210, P = 0.005). The study also found that higher resilience levels were associated with higher levels of compassion satisfaction and lower levels of secondary traumatic stress. Additionally, higher burnout scores were associated with higher levels of secondary traumatic stress. The study also identified that age and the number of children had weak associations with compassion satisfaction, while workplace was a significant predictor of burnout and secondary traumatic stress.

CONCLUSION

The study emphasizes the importance of resilience, burnout, and secondary traumatic stress in the well-being of healthcare professionals, especially nurses. The findings suggest that assessing nurses' resilience and professional quality of life can raise psychological resilience awareness and help managers create the necessary working conditions to improve nurses' professional quality of life.

Overlap between birth trauma and mistreatment: a qualitative analysis exploring American clinician perspectives on patient birth experiences

INTRODUCTION

Research exploring the mistreatment of birthing people in the United States is emerging rapidly within the context of increasingly poor maternal health outcomes that include unacceptable racial disparities. Previous research has explored overlap between psychological birth trauma and mistreatment using patient descriptions of birth experiences, but no previous studies have explored these issues from the perspectives of clinicians. The aim of this study was to explore whether maternity care providers' descriptions of patient birth trauma overlap with categories of mistreatment from a globally accepted typology.

METHODS

Content analysis was performed on a qualitative data set of 28 semi-structured interviews about patient birth trauma, completed in 2018-2019 with U.S. maternity care clinicians, including obstetricians, family physicians, midwives and labor/delivery nurses. The interviews were part of a larger study exploring maternity clinician perspectives and experiences of patient birth trauma. For this analysis Krippendorff's method of categoric distinction was used, with categories from a globally recognized typology of maternity patient mistreatment.

RESULTS

Clinicians' descriptions of their experiences with patient birth trauma mapped onto all seven mistreatment categories, although no interview questions specifically asked about mistreatment. In more than 30 hours of interviews, transcribed to more than 800 pages, the word mistreatment appears only once, suggesting that some healthcare providers may use the phrase "birth trauma" as a euphemism to describe mistreatment. Eighteen of 28 interviews included at least one description that fit into a mistreatment category. "Failure to meet professional standards of care" was the category with the most mapped clinician statements, followed by "Stigma and discrimination" and "Poor rapport between women and providers."

CONCLUSIONS

This study contributes new insight into maternity clinicians' conceptualization of patient trauma and how their descriptions of birth trauma overlap with mistreatment. Clinicians implicitly connected mistreatment with some patient experiences of birth trauma, even when they were not specifically asked about mistreatment. Findings point to a need for further research into mistreatment, including routinized "everyday care" that may include mistreatment, particularly for marginalized and historically excluded birthing people. Future research also must explore the potential role of mistreatment in poor and inequitable U.S. birth outcomes.

The impact of positive reinforcement on teamwork climate, resiliency, and burnout during the COVID-19 pandemic: The TEAM-ICU (Transforming Employee Attitudes via Messaging strengthens Interconnection, Communication, and Unity) pilot study

Burnout is an internationally recognized occupational phenomenon that negatively impacts the healthcare workforce and its recipients. The aim of this pilot study was to test whether positive reinforcement and integrating a language of support among co-workers can enhance resiliency, facilitate psychological wellness, and encourage hope. This embedded mixed methods prospective, behavioral, interventional study evaluated the effects of positive feedback on wellness among intensive care unit clinicians during the COVID-19 pandemic in a single center, quaternary care medical center. The deliberate positive feedback paradigm has the potential to augment resiliency and improve attitudes toward a teamwork climate. The routine use of deliberate positivity may represent a scalable, low-cost initiative to enhance wellness in a healthcare organization.

Compassion fatigue in nurses caring for chronic diseases

Objectives. The purpose of this study was to determine the level of compassion fatigue in nurses caring for chronic diseases and the factors that affect it. Nurses who provide continuous care for chronic diseases are under the risk of facing compassion fatigue. Methods. The descriptive and cross-sectional study took place during January-March 2019. The nurse identification form and the 'compassion fatigue' sub-dimension of the professional quality of life scale were used to determine compassion fatigue. Results. Nurses experience compassion fatigue at a moderate level. Female nurses, those who experience a decrease in their willingness to provide care and those who intend to leave work experience compassion fatigue more. Decrease in the willingness to provide care plays a determinant role on compassion fatigue. Nurses who experience compassion fatigue are unwilling to provide care to their patients. Conclusion. This study indicates the importance of the necessity for development of a compassion fatigue prevention program in the clinical area. Nurses should be trained on compassion fatigue within the scope of in-service training. This subject should be included in the school curriculum to increase the awareness of nursing students' about compassion fatigue.

Effects of work-family conflict and anxiety in the relationship between work-related stress and job burnout in Chinese female nurses: A chained mediation modeling analysis

BACKGROUND

Job burnout among nurses has been a challenging problem in recent years globally and in China. Work-related stress, work-life interference and mental health have been shown to be associated with nurse job burnout. However, the underlying mechanisms remain not fully understood. This study aims to examine the complex relationships linking work-related stress to nurse burnout among Chinese nurses.

METHODS

Study data were collected from female nurses (n = 2172) in cities of Wuhan, Shiyan and Jingzhou, Hubei Province of China. Job burnout was used as outcome variable, work-related stress was the predictor, work-life interference and anxiety symptoms were mediators. Mediation and chained mediation modeling analysis were used for data analysis.

RESULTS

The association between work-related stress and job burnout was significantly mediated by work-family conflict (indirect effect[95%CI] = 0.05[0.05,0.06]) and anxiety symptoms (indirect effect = 0.42[0.36,0.49]), respectively. Further, a chained mediation mechanism was observed with work-family conflict and anxiety symptoms consecutively mediated the relationship between work-related stress and job burnout (indirect effect = 0.02[0.01,0.02]).

LIMITATIONS

The data were collected in one province in central China, so it needs caution when generalizing the study findings to other regions within or outside of China.

CONCLUSION

Work-related stress exerts effects on job burnout through work-family conflict and anxiety symptoms among female nurses in China. Work-related stress-based burnout prevention must consider both work-family conflict and mental health problems.

Mediating effect of resilience between social support and compassion fatigue among intern nursing and midwifery students during COVID-19: a cross-sectional study

AIMS

To examine the mediating effect of resilience between social support and compassion fatigue among intern nursing and midwifery students during COVID-19.

BACKGROUND

Compassion fatigue has become exceedingly common among intern nursing and midwifery students, especially during the COVID-19 pandemic. Social support and resilience can help intern nursing and midwifery students control their negative emotions, reduce compassion fatigue, and increase their well-being. However, the mediating effect of resilience between social support and compassion fatigue remains unclear.

DESIGN

A multicentre cross-sectional survey.

METHODS

A total of 307 intern nursing and midwifery students were recruited from November 2020 to February 2021 in tertiary grade A hospitals in China. Structural equation modelling was applied to analyse the mediating effects of resilience between social support and compassion fatigue. The Social Support Rating Scale, the 10-item Connor-Davidson Resilience Scale, and the Chinese version of the Compassion Fatigue Short Scale were used to collect data. The hypothetical path model was tested by using IBM SPSS version 26.0 and AMOS version 26.0 software.

RESULTS

Intern nursing and midwifery students had moderate compassion fatigue. Social support positively affected resilience (β = 0.514, p < 0.01). Social support negatively affected compassion fatigue (β = - 0.310, p < 0.01), while resilience negatively affected compassion fatigue (β = - 0.283, p < 0.01). Resilience played a mediating role between social support and compassion fatigue.

CONCLUSION

Social support can directly affect the compassion fatigue of intern nursing and midwifery students during COVID-19 and indirectly through resilience. Stronger resilience can reduce compassion fatigue. Accordingly, resilience-based interventions should be developed to reduce compassion fatigue.

Mindfulness and compassion training for health professionals: A qualitative study

Background

Compassion is a key component of quality care. Encouraging Health Care Professionals (HCPs) to develop a patient-centered care relationship through mindfulness and compassion training may be beneficial for both patients and HCPs.

Method

We assessed the impact of a compassion-centered mindfulness program [i.e., the Mindfulness Based (MB) CARE program] on healthcare practice conducting 10 phone interviews with HCPs who experienced the program.

Results

The training had an overall positive impact on the HCPs ability to feel compassion toward their patients and themselves, helped them develop kindness toward themselves and their patients, and enhanced their attention to their patient's needs and theirs. Participants were better able to accept the difficult work experiences or those their patients experienced, with more perceived equanimity and less reactivity.

Conclusion

Professional mindfulness and compassion training programs could be operational levers for institutions aiming at fostering more compassionate HCPs-patients relationships.

The Relationship Between Coping Strategies, Compassion Satisfaction, and Compassion Fatigue During the COVID-19 Pandemic

Introduction

The rapid spread of COVID-19 poses a significant threat to nurses' lives and health, resulting in varying degrees of mental distress. Nurses may experience compassion fatigue, and their professional quality of life and satisfaction may suffer as a result. Their coping mechanisms may vary as well, influencing their compassionate and safe care.

Objectives

The study's objectives are to explore levels of compassion satisfaction and fatigue among nurses and identify their coping strategies. Further, to investigate the relationship between coping strategies, compassion satisfaction, and compassion fatigue during the COVID-19 pandemic.

Methods

Using a descriptive correlational design, this study was conducted with a convenience sample of 443 nurses working in an Egyptian university hospital. Nurses completed the coping strategy indicator scale and the professional quality of life (compassion satisfaction and compassion fatigue) scale. The data were analyzed using descriptive statistics, Pearson correlation, and regression analysis.

Results

Nurses' professional quality of life was average in terms of compassion satisfaction (2.95 ± 0.92) and compassion fatigue (2.38 ± 0.35). Nurses have a moderate use of coping strategies (2.13 ± 0.35). Problem-solving was rated as the highest coping strategy, while avoidance was rated as the lowest. Coping strategies showed a positive correlation with compassion satisfaction (r = 0.503, p < .001) and a negative correlation with compassion fatigue (r = -0.352, p < .001). In addition, coping strategies could predict 25.4% and 12.4% of compassion satisfaction and compassion fatigue, respectively (p < .001).

Conclusion

Compassion satisfaction and fatigue are key determinants of nurses' quality of work life. Coping strategies, especially problem-solving and support systems, are vital to increase compassion satisfaction and mitigate burnout and secondary stress syndrome. Nurse managers should establish supportive work environments that promote nurses' well-being. Resilience-building programs and coping strategies' training are recommended to enhance the nurses' quality of work life and positive work attitudes.

Impact of COVID-19 pandemic on the mental health of healthcare workers during the first wave in Portugal: a cross-sectional and correlational study

OBJECTIVES

The COVID-19 pandemic has had a negative impact on the mental health of healthcare workers (HCWs) worldwide. This study aims to identify the degree to which sociodemographic variables and indicators of subjective well-being and psychological resilience are associated, positively and negatively, with the outcomes of burnout, stress, depression and anxiety among Portuguese HCWs observed during the first wave. It also aims to evaluate the strength of association of these variables and indicators with each outcome.

DESIGN

Cross-sectional quantitative study. The statistical methods used are simple logistic model, multiple logistic regression model and -2*log-likelihood statistic.

SETTING

Portuguese HCWs living in Portugal and working in the Portuguese healthcare system.

PARTICIPANTS

The study included 1535 professionals, with a mean age of 38 years.

PRIMARY AND SECONDARY OUTCOMES MEASURES

Psychological variables were measured by Copenhagen Burnout Inventory, the Resilience Scale, the Depression, Anxiety and Stress Scales and the Satisfaction with Life Scale.

RESULTS

High levels of personal (55%; n=844), work-related (55.1%; n=846) and client-related burnout (35.4%; n=543) were found. Additionally, participants expressed substantial levels of depression (28.7%; n=441), stress (36.4%; n=558) and anxiety (33.1%; n=508). About 1202 participants (78.3%) demonstrated moderate-to-high levels of resilience. Profession, work regime during the pandemic, having a health problem, resilience and satisfaction with life are independent variables significantly associated with the outcomes of burnout, stress, depression and anxiety. Satisfaction with life was the independent variable that had a major association with all outcomes.

CONCLUSIONS

Governments and hospital administrations should take action to promote resilience and satisfaction with life as these variables are protective relating to mental health problems. Interventions as educational sessions, psychological support at work, programmes promoting resilience and coping mechanisms and better work conditions may improve mental health. The implementation of measures to protect healthcare students from developing prejudicial outcomes seams very adequate and important.

Determination of Workload, Work Stress and Related Factors in Nursing Home Workers during the COVID-19 Pandemic in Turkey

COVID-19 has caused a major crisis all over the world. To manage this crisis, a fixed shift system was applied to nursing home staff in Turkey to protect nursing home residents from the COVID-19 pandemic. Staff were not allowed to leave the institution during fixed shifts. It is thought that this practice for the COVID-19 outbreak, while protecting nursing home residents on the one hand, increased the workload and related stress of nursing home staff on the other hand. To the best of our knowledge, there is no study examining the workload and stress caused by the COVID-19 pandemic for nursing home staff in Turkey. The aim of this study was to examine the level of workload and work stress experienced by staff working in nursing homes during the COVID-19 pandemic in Turkey.

METHODS

A cross-sectional research design was used in the study. The sample of the study consisted of nursing home personnel working in nursing homes in the provinces of Istanbul, Ankara, Izmir and Antalya between October 2021 and January 2022. A personal information form and a workload and stress scale were used for collecting the data. Cluster analysis was performed with SPSS software.

RESULTS

In total, 154 nursing home personnel participated in the study. A statistically significant difference was found between the mean age of the two clusters. The first cluster was described as "old" and the second as "young". Statistically significant and high values were found in the quantitative workload, qualitative workload, job organization, social work area and fatigue factors in the nursing home staff in the older participant cluster.

CONCLUSION

The results of this study provide new information about the concepts of workload and work stress experienced during the COVID-19 pandemic in Turkey, which will serve as a guide for the management of future pandemics. Therefore, this study will contribute to the strategies to be followed in future pandemics in Turkey.

The language of healthcare worker emotional exhaustion: A linguistic analysis of longitudinal survey

Importance

Emotional exhaustion (EE) rates in healthcare workers (HCWs) have reached alarming levels and been linked to worse quality of care. Prior research has shown linguistic characteristics of writing samples can predict mental health disorders. Understanding whether linguistic characteristics are associated with EE could help identify and predict EE.

Objectives

To examine whether linguistic characteristics of HCW writing associate with prior, current, and future EE.

Design setting and participants

A large hospital system in the Mid-West had 11,336 HCWs complete annual quality improvement surveys in 2019, and 10,564 HCWs in 2020. Surveys included a measure of EE, an open-ended comment box, and an anonymous identifier enabling HCW responses to be linked across years. Linguistic Inquiry and Word Count (LIWC) software assessed the frequency of one exploratory and eight a priori hypothesized linguistic categories in written comments. Analysis of covariance (ANCOVA) assessed associations between these categories and past, present, and future HCW EE adjusting for the word count of comments. Comments with <20 words were excluded.

Main outcomes and measures

The frequency of the linguistic categories (word count, first person singular, first person plural, present focus, past focus, positive emotion, negative emotion, social, power) in HCW comments were examined across EE quartiles.

Results

For the 2019 and 2020 surveys, respondents wrote 3,529 and 3,246 comments, respectively, of which 2,101 and 1,418 comments (103,474 and 85,335 words) contained ≥20 words. Comments using more negative emotion (p < 0.001), power (i.e., references relevant to status, dominance, and social hierarchies, e.g., own, order, and allow) words (p < 0.0001), and words overall (p < 0.001) were associated with higher current and future EE. Using positive emotion words (p < 0.001) was associated with lower EE in 2019 (but not 2020). Contrary to hypotheses, using more first person singular (p < 0.001) predicted lower current and future EE. Past and present focus, first person plural, and social words did not predict EE. Current EE did not predict future language use.

Conclusion

Five linguistic categories predicted current and subsequent HCW EE. Notably, EE did not predict future language. These linguistic markers suggest a language of EE, offering insights into EE's etiology, consequences, measurement, and intervention. Future use of these findings could include the ability to identify and support individuals and units at high risk of EE based on their linguistic characteristics.

Impact of COVID-19 Pandemic on Stress and Burnout Levels amongst Emergency Medical Technicians: A Cross-Sectional Study in Spain

BACKGROUND

Emergency medical technicians (EMTs) are essential health care workers (HCWs). Although they play an extraordinary role during the COVID-19 pandemic, they are mostly exposed to various occupational health and safety risks that have significantly impacted their mental health, giving rise to symptoms, such as stress and burnout.

AIM

This study aimed to assess the perceived levels of stress and burnout amongst EMTs in relation to their socio-demographic characteristics and to explore the associations between their stress and burnout levels during the COVID-19 pandemic.

METHODS

This work is an observational cross-sectional design study conducted between 29 March and 30 April 2021, with a convenience sample of 280 Spanish EMTs yielding a response rate of 28%. The online survey had 42 items that aimed to determine participants' socio-demographic characteristics, the Perceived Stress Scale (PSS) and the Maslach Burnout Inventory (MBI).

RESULTS

The results showed that more than half of the EMTs (53%) perceived a moderate stress level, 37% perceived moderate levels of emotional exhaustion (EE) and 40% had moderate levels of depersonalization (DP). Furthermore, 48% had low levels of personal accomplishment (PA). Gender, age, having personal protective equipment (PPE) and experiencing fear of infection were statistically significant areas where participants experienced greater stress (p < 0.05). A positive correlation between stress, EE and DP and a negative correlation between stress and the PA subdimension of burnout were found.

CONCLUSIONS

The COVID-19 pandemic had a tremendous impact on the mental health of ambulance EMTs. Further studies building on this study and others on the psychological status of EMTs before the pandemic and follow-up during the pandemic, as well as deeper investigations on their work conditions, are needed to facilitate the implementation of various interventions. Such efforts can mitigate the negative impacts of the pandemic on their mental health, and prepare them for future disasters.KEY MESSAGEThe COVID-19 pandemic has affected the lives of the majority of the world's population. In particular, it has impacted the mental health of various communities, including HCWs. Highly stressful and insecure work conditions have placed frontline HCWs at a high risk of psychological distress, making them victims and service providers simultaneously.

Compassion Fatigue and Coping Mechanisms of Laboratory Animal Professionals from Europe, China, and Japan

Laboratory animal professionals (LAP) may experience situations that contribute to compassion fatigue (CF). The goal of this research was to better understand CF in LAP in and across employment categories. Surveys were distributed through LAP organizational listservs in the European Union (EU), China, and Japan, and results were analyzed to identify CF prevalence, personal and work-related factors, coping mechanisms, and beneficial work-support programs. Independent χ²-tests compared personal and work-related factors and feelings of CF. Feelings of CF and coping mechanisms were compared with personality scores using independent sample t tests. There were 302 respondents from the EU, 39 from China, and 77 from Japan. Over half of respondents from the EU (52%) and China (56%) reported experiencing CF (52%), with fewer (32%) reporting CF in Japan. No major differences were found based on employer type. Personality scores were significantly related to feelings of CF and preferred coping mechanisms. Work-related factors that contributed to feelings of CF in over half of respondents included staffing levels, workplace relationships, and availability of programs geared to address CF. Across regions, talking to someone, physical activity, getting away from work, and self-care were effective coping mechanisms in over 50% of respondents. Fewer than 30% of respondents indicated that their place of employment had CF support programs, and even fewer (8% to 28%) indicated that these programs were helpful. The study results suggest that to be effective, employer CF programs for LAP should consider providing quiet places at work and programs for self-care, promoting physical and mental health and social support systems, and establishing opportunities to memorialize animals.

Compassion fatigue, compassion satisfaction, and burnout: A study of nurses in a large Texas health-care system

PURPOSE

The purpose of this study is to examine compassion satisfaction, compassion fatigue, and burnout in nurses at a large nonprofit, Catholic-based health-care system in southern Texas.

DESIGN AND METHODS

This is a cross-sectional, exploratory study using a self-report survey. The survey included a demographic questionnaire and the Professional Quality of Life Scale version 5 (ProQOL 5). It was emailed to 1000 nurses at a large health-care system in Texas, USA. Three hundred and eighteen nurses completed the survey for a response rate of 31.8%.

FINDINGS

The results find low mean levels of compassion fatigue (CF) and burnout and high mean levels of compassion satisfaction (CS) among the nurses. Hours worked and nursing specialty emerged as factors in whether the nurses experienced CF or CS. The nurses with less than 10 years of experience have lower levels of CS and higher levels of burnout than those with over 10 years of experience. Finally, nurses who hold professional certification have statistically significant higher CF scores than those who do not.

CONCLUSIONS

Health-care settings may need to take into consideration the number of hours worked and nursing specialty as significant factors in whether nurses experience CF or CS.

CLINICAL RELEVANCE

Three key elements in CF prevention are education, awareness, and self-care. Often the climate in health-care settings discourages medical professionals from practicing effective self-care. The strategies for combating burnout are linked to changing health-care systems so that nurses are supported. Hospitals may explore alternative work schedules and lower patient loads to prevent CF and burnout.

Compassionate Work Environments and Their Role in Teachers' Life Satisfaction: The Contribution of Perceived Collective School Performance and Burnout

Several studies on helping professionals showed the protective role of compassion among colleagues and leaders. Despite this, studies on well-being factors at school, both preventive and protective, usually focus on teachers' personal resources and study compassion in the teacher-student relationship. This study explores the role of received compassion at work on teachers' life satisfaction while considering perceived school collective performance and burnout conditions as mediators in this link. One hundred and eighty-six Italian teachers (female = 85.4%, mean age = 48.5, SD = 9.46) completed a questionnaire on received compassion at work, perceived school collective performance, burnout, and life satisfaction. Through a structural equation model (χ²(21) = 30.716, p = 0.08, CFI = 0.989, TLI = 0.981, RMSEA = 0.050 (90% CI = 0.000-0.080, p = 0.465), SRMR = 0.038), it emerged that only perceived school collective performance mediated the association between received compassion and life satisfaction. To the best of our knowledge, few studies have addressed the role of compassion received from colleagues and supervisors at school and its effect on teachers' work-related beliefs and personal well-being.