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Predicting the Risk of Compassion Fatigue: A Study of Hospice Nurses
Abstract
There is a growing interest in the clinical phenomenon of compassion fatigue and its impact on healthcare providers; however, its impact on hospice nurses is basically unknown. This study investigated the prevalence and the relationships between nurse characteristics and compassion fatigue risk. It also provided a model for predicting compassion fatigue risk. A non-experimental descriptive design using cross-sectional data and descriptive and inferential statistics was used. Nurses (N = 216) from 22 hospices across the state of Florida participated in the study. Findings revealed that 78% of the sample was at moderate to high risk for compassion fatigue, with approximately 26% in the high-risk category. Trauma, anxiety, life demands, and excessive empathy (leading to blurred professional boundaries) were key determinants of compassion fatigue risk in the multiple regression model that accounted for 91% (P < .001) of the variance in compassion fatigue risk. Knowledge of these variables may help organizations identify nurses at risk and provide interventions and preventions to maintain optimal nursing care.
... Another study found that EOL professionals experience an average of seven patient deaths per month. 9 Repeatedly experiencing patients' deaths has been shown to affect healthcare providers in particular ways with increased mortality salience affecting death anxiety, 10 with occasions of moral distress, vicarious traumatisation 11 or secondary traumatic stress (STS), grief and bereavement, and post-traumatic stress. 12 While some EOL professionals have experienced great emotional and spiritual rewards in EOL care, 13 there are also perpetual experiences of grief, alienation, frustration, moral distress and helplessness, which, too often unchecked and unacknowledged, lead healthcare professionals to states of burnout, to compassion fatigue and to abandoning their work for less demanding employment. ...
... 17,18 Trauma has been linked to increased death anxiety 12 and death anxiety has been shown to negatively impact EOL staff's interactions with and care for, dying patients and their families. 10 A descriptive study 9 of 216 nurses found 78% of them at moderate to high risk of compassion fatigue. Regression analysis showed that 91% of the variance of the risk of compassion fatigue was due to trauma, anxiety, life demands, and excessive empathy that blurred professional boundaries. ...
... 13,22,23 While general health care settings have used mindfulness teaching to help staff members avoid burnout and increase compassion, 24,26 EOL interventions need also to address the unique suffering of those working with people who are dying. 2,6,9 Mindfulness, with its focus on the present, on teaching how to experience strong emotions and difficult situations without being overwhelmed by them, may be able to provide this important additional support. 7,27,28 Mindfulness is, "the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment." ...
Objectives: The potential usefulness of mindfulness-based interventions (MBIs) is being investigated for healthcare staff burnout and associated problems, but empirical research on MBI's for end-of-life (EOL) professionals is still in its infancy. The aim of this review is to describe and evaluate the body of evidence-based research on the use of MBIs to support the psychological wellbeing of professional staff in EOL care settings. Methods: A systematic review of the literature was conducted. Database records were extracted from ERIC, PsycInfo, EBSCO, PubMed Central (PMC) and Web of Science, using search terms to locate peer-reviewed studies on professional (not volunteer) staff in dedicated end-of-life settings, administering MBIs not embedded in more general therapeutic modalities (such as ACT or DBT). After removing duplicates, 8701 potential studies were identified: eliminating those that did not fit the eligibility criteria reduced the number of eligible studies to six. Results: A total of six empirical studies were identified and further evaluated. Interventions primarily focussed on reducing burnout symptoms, increasing self-care and self-compassion, and fostering mindfulness. Studies demonstrated very little overlap in treatment, methodology and measures. Only one study was a randomised control trial, which on application of the 3-item Jadad quality scoring, (evidence of randomisation, blinding of researcher to participants’ identity and accounts provided of all participants), achieved 1 out of 5 possible points. Furthermore, other concerns were identified as to the study's methodology. Conclusions: Results of this review point to significant gaps in the research on the potential of MBIs to improve the wellbeing of EOL professionals.
... Hemşirelerde merhamet yorgunluğu prevalansının, çalıştıkları birimlere göre orta ile yüksek seviyelerde ve %78-86 arasında değiştiği raporlandırılmıştır (10,11 (12). MY-KÖ, her bir katılımcıdan, mevcut deneyimlerini yansıtmalarını isteyen bir değerlendirme aracıdır. ...
... Literatür incelemelerinde; hemşirelerin %90 oranında orta ve yüksek düzeyde merhamet yorgunluğu yaşadığı kaydedilmiştir (16). Önceki yıllarda yapılmış iki çalışmada ise merhamet yorgunluğu yaşama oranının %78-86 arasında değiştiği raporlandırılmıştır (10,11). Aynı çalışmalarda cerrahi birimlerde çalışan hemşirelerin acil, yaşlı bakım ve diğer kliniklerde çalışanlara göre daha fazla merhamet yorgunluğu yaşadıkları bilgisine yer verilmiştir (10,11). ...
... Önceki yıllarda yapılmış iki çalışmada ise merhamet yorgunluğu yaşama oranının %78-86 arasında değiştiği raporlandırılmıştır (10,11). Aynı çalışmalarda cerrahi birimlerde çalışan hemşirelerin acil, yaşlı bakım ve diğer kliniklerde çalışanlara göre daha fazla merhamet yorgunluğu yaşadıkları bilgisine yer verilmiştir (10,11). Başka bir çalışmada hemşirelerin %50'den fazlasında merhamet yorgunluğunun görüldüğü belirlenmiştir (17). ...
Aim: In this study; we aimed to examine the effect of compassion fatigue of surgical nurses on patient care satisfaction. Methods: The sample groups consisted of n = 72 surgical nurses and n = 157 inpatients in surgical units. It was performed in the surgical units of a training and research hospital. Compassion Fatigue and Newcastle Nursing Care Satisfaction Scales were used for data collection. After the data were coded by the researchers, data analysis was performed with Statistical Packed for The Social Sciences 25 IBM. Descriptive statistics, Kolmogorov-Smirnov test, Independent samples t test, one-way analysis of variance (ANOVA) and correlation analysis were performed in the analysis of the data. Results: 48.6% of the surgical nurses were between the ages of 22-30, 83.3% were female and 73.6% were undergraduate. It was determined that 41.4% of the patients were 60 years old and over, 52.2% were women, 77.1% were married, and 27.4% stayed in the Brain and Nerve Surgery unit. It was found that there was a strong positive correlation between compassion fatigue and high care satisfaction scores. Conclusion: Compassion fatigue and care satisfaction were found to be high in the study. It is a form of burnout that surgical nurses have high their compassion fatigue. The burnout of surgical nurses paves the way for their psychological and physical wear. Solutions should be sought to prevent compassion fatigue.
... In contrast, the impact on professionals caring for them has received less and uneven attention. While the elevated risk of secondary trauma, compassion fatigue and burnout for 'front-line' palliative-care and oncology staff is relatively well known (Abendroth & Flannery, 2006;Breen et al., 2014;Meier, 2001;Trufelli et al., 2008), research on these topics is largely limited to professionals providing medical care, principally nurses (Hospice Friendly Hospitals Programme, 2013). In addition, while caring for critically-ill and dying patients is widely recognised as a central stressor for oncology and palliative-care nursing staff (Abendroth & Flannery, 2006;Aycock & Boyle, 2009;Vachon, 1998), the specific impact of patient death on other professionals involved in their care has received only limited attention. ...
... While the elevated risk of secondary trauma, compassion fatigue and burnout for 'front-line' palliative-care and oncology staff is relatively well known (Abendroth & Flannery, 2006;Breen et al., 2014;Meier, 2001;Trufelli et al., 2008), research on these topics is largely limited to professionals providing medical care, principally nurses (Hospice Friendly Hospitals Programme, 2013). In addition, while caring for critically-ill and dying patients is widely recognised as a central stressor for oncology and palliative-care nursing staff (Abendroth & Flannery, 2006;Aycock & Boyle, 2009;Vachon, 1998), the specific impact of patient death on other professionals involved in their care has received only limited attention. ...
... Hence client suicide was found to have a strong negative impact on those providing care (Ellis & Patel, 2012;Hendin et al., 2004Hendin et al., , 2000, and mental-health professionals appeared more vulnerable to trauma than physical-health practitioners following suicide (Ellis & Patel, 2012;Séguin et al., 2014). In addition, while client deaths in cancer-and palliative-care settings seem associated with a higher risk of burnout and increased death anxiety (Abendroth & Flannery, 2006;Breen et al., 2014;Meier, 2001;Trufelli et al., 2008), practice in gerontological settings was not linked to burnout but to personal and professional growth, and lessened death anxiety (Foster & Vacha-Haase, 2013). ...
Background and objective: Caring for critically-ill and dying patients is widely recognised as a central stressor in oncology and palliative-care staff. Past research in this area has mostly focused on medical staff, and the impact of patient deaths on other professionals has received only limited attention. This study aimed to explore how psychotherapists experience and cope with the death of the cancer patients in their care, and whether these experiences promote personal and/or professional growth. Methods: an exploratory sequential mixed-methods design was adopted. Participants were psychotherapists working with adult cancer- and palliative-care patients within UK hospices. In the qualitative phase, seven semi-structured interviews were conducted and examined using thematic analysis. In the quantitative phase, 28 participants completed an online questionnaire designed to evaluate the incidence within the target population of the themes identified in the qualitative phase. Findings: Grief appeared as hospice psychotherapists' main immediate response to client deaths. Participants used coping strategies aiming to facilitate emotional closure, and to foster emotional and cognitive processing. These strategies included conducting personal rituals, receiving support from colleagues and clinical supervision. Several factors hindering these coping strategies were identified, but the vast majority were shared by only a small minority of participants (e.g. feeling disenfranchised in their grief for clients). Repeated exposure to client death caused participants to feel emotionally and physically drained (and for some leading to greater fear of illness and dying). It also affected their outlook on life positively, leading to personal growth. Participants managed the negative long-term impact of their work using self-care strategies, which included working in cancer- and palliative-care settings on a part-time basis, and engaging in creative and future-oriented activities promoting a sense of hope, possibilities, and growth. Conclusion and implications: Although many hospice psychotherapists repeatedly experience grief following the deaths of their clients, most appear able to manage the immediate and long-term impacts of their work. Working in proximity to illness and death is seen as deeply challenging but at the same time as promoting personal growth, and to enhance and bring meaning to hospice psychotherapists' lives. Furthermore, the mixed-methods design adopted here provides evidence that while the qualitative methods employed produced rich data, the addition of a simple quantitative survey allowed to put these in perspective about the wider group of hospice psychotherapists. I argue that this finding supports the call, prevalent in the mixed-methods research literature, to question the segregation of qualitative and quantitative methods.
... In contrast, the impact on professionals caring for them has received less and uneven attention. While the elevated risk of secondary trauma, compassion fatigue and burnout for 'front-line' palliative-care and oncology staff is relatively well known (Abendroth & Flannery, 2006;Breen et al., 2014;Meier, 2001;Trufelli et al., 2008), research on these topics is largely limited to professionals providing medical care, principally nurses (Hospice Friendly Hospitals Programme, 2013). In addition, while caring for critically-ill and dying patients is widely recognised as a central stressor for oncology and palliative-care nursing staff (Abendroth & Flannery, 2006;Aycock & Boyle, 2009;Vachon, 1998), the specific impact of patient death on other professionals involved in their care has received only limited attention. ...
... While the elevated risk of secondary trauma, compassion fatigue and burnout for 'front-line' palliative-care and oncology staff is relatively well known (Abendroth & Flannery, 2006;Breen et al., 2014;Meier, 2001;Trufelli et al., 2008), research on these topics is largely limited to professionals providing medical care, principally nurses (Hospice Friendly Hospitals Programme, 2013). In addition, while caring for critically-ill and dying patients is widely recognised as a central stressor for oncology and palliative-care nursing staff (Abendroth & Flannery, 2006;Aycock & Boyle, 2009;Vachon, 1998), the specific impact of patient death on other professionals involved in their care has received only limited attention. ...
... Hence client suicide was found to have a strong negative impact on those providing care (Ellis & Patel, 2012;Hendin et al., 2004Hendin et al., , 2000, and mental-health professionals appeared more vulnerable to trauma than physical-health practitioners following suicide (Ellis & Patel, 2012;Séguin et al., 2014). In addition, while client deaths in cancer-and palliative-care settings seem associated with a higher risk of burnout and increased death anxiety (Abendroth & Flannery, 2006;Breen et al., 2014;Meier, 2001;Trufelli et al., 2008), practice in gerontological settings was not linked to burnout but to personal and professional growth, and lessened death anxiety (Foster & Vacha-Haase, 2013). ...
Background and objective: Caring for critically-ill and dying patients is widely recognised as a central stressor in oncology and palliative-care staff. Past research in this area has mostly focused on medical staff, and the impact of patient deaths on other professionals has received only limited attention. This study aimed to explore how psychotherapists experience and cope with the death of the cancer patients in their care, and whether these experiences promote personal and/or professional growth. Methods: an exploratory sequential mixed-methods design was adopted. Participants were psychotherapists working with adult cancer- and palliative-care patients within UK hospices. In the qualitative phase, seven semi-structured interviews were conducted and examined using thematic analysis. In the quantitative phase, 28 participants completed an online questionnaire designed to evaluate the incidence within the target population of the themes identified in the qualitative phase. Findings: Grief appeared as hospice psychotherapists' main immediate response to client deaths. Participants used coping strategies aiming to facilitate emotional closure, and to foster emotional and cognitive processing. These strategies included conducting personal rituals, receiving support from colleagues and clinical supervision. Several factors hindering these coping strategies were identified, but the vast majority were shared by only a small minority of participants (e.g. feeling disenfranchised in their grief for clients). Repeated exposure to client death caused participants to feel emotionally and physically drained (and for some leading to greater fear of illness and dying). It also affected their outlook on life positively, leading to personal growth. Participants managed the negative long-term impact of their work using self-care strategies, which included working in cancer- and palliative-care settings on a part-time basis, and engaging in creative and future-oriented activities promoting a sense of hope, possibilities, and growth. Conclusion and implications: Although many hospice psychotherapists repeatedly experience grief following the deaths of their clients, most appear able to manage the immediate and long-term impacts of their work. Working in proximity to illness and death is seen as deeply challenging but at the same time as promoting personal growth, and to enhance and bring meaning to hospice psychotherapists' lives. Furthermore, the mixed-methods design adopted here provides evidence that while the qualitative methods employed produced rich data, the addition of a simple quantitative survey allowed to put these in perspective about the wider group of hospice psychotherapists. I argue that this finding supports the call, prevalent in the mixed-methods research literature, to question the segregation of qualitative and quantitative methods.
... To meaningfully compare relationships across groups, metric invariance is a necessary condition, while for group mean comparisons, scalar invariance is necessary [45]. However, these requirements were not met in most research regarding the ProQOL [24,[46][47][48][49][50][51][52][53][54][55][56][57][58][59]. In our case, because the measurement invariance routine results were successful, we were able to test for mean differences. ...
... The differences in the age, sex, and distribution seen in the samples could have been because of different levels of BO and CF in relation to age, sex, or different professions of the participants. However, previous research has shown some controversy regarding differences in professionals' quality of life in relation to these variables [24,[46][47][48][49][50][51][52][53][54][55][56][57][58][59], and so future research should examine this possible explanation. Several studies have noted that sex is an important variable because women experience more BO than men [43,44]. ...
... For instance, a recent study among professional care providers at Palliative Cancer Care Centers in India showed that nurses and nursing aids had significantly higher BO than the other professionals studied (physicians, social workers, physiotherapists, and pharmacists) [55]. This also fits with previous research indicating that the presence of BO and risk of CF is higher in nurses than in other health professions [56][57][58][59]. Therefore, we concluded that the differences in CF and BO observed in our results may have been related to sex, because CF was highest in Brazilian professionals-the group which included the most women. ...
Background
This research presents a short version of the Professional Quality of Life (ProQOL) scale, one of the most frequently used questionnaires in the arena of applied healthcare investigation. It measures burnout (BO), compassion fatigue (CF), and compassion satisfaction (CS).
Methods
A 9-item version of the ProQOL was developed. In Study 1, this short version, which used items from version IV of the ProQOL, was administered to 817 palliative care professionals from Spain, Argentina, and Brazil. In Study 2, the same nine items, but this time from version V of the ProQOL, were administered to 296 Spanish palliative care professionals.
Results
Study 1: The Short ProQOL showed an adequate internal structure, and invariance across the countries studied (χ²(106) = 185.620 (p < 0.001), CFI = .929, RMSEA = 0.058 [0.044, 0.072], SRMR = 0.081). Argentinians showed higher levels of BO (mean difference = 0.172, p = 0.042, Cohen’s d = 0.168), whereas Brazilians showed higher levels of CF (Mean difference = 0.384, p = 0.002, Cohen’s d = 0.352). Study 2: the Short ProQOL again showed adequate internal structure and reliability (χ²(24) = 134.504 (p < 0.001); CFI = 0.953; RMSEA = 0.126 [0.106, 0.147]; SRMR = 0.063), and was related to coping with death, self-compassion, and self-care.
Conclusions
The Short ProQOL could help facilitate the application of harmonizing measurements and its use for cross-cultural comparisons and occupational health monitoring was satisfactory.
... While there has been much research and a continually growing interest in the compassion fatigue phenomenon, few literatures discuss its effects and impact on hospice nurses. As there are thousands of nurses working in hospice and palliative care, it is important to learn how issues such as compassion fatigue can be addressed in order to ensure that nurses remain healthy and able to provide optimal nursing care (Abendroth & Flannery, 2006). ...
... In addition, because nurses have the most contact with clients among health care providers and professionals, they become more vulnerable to work-related stress and have higher risks of suffering from compassion fatigue (Abendroth, 2011). Even more at risk for compassion fatigue are nurses who work in critical care specialty areas such as oncology departments (Aycock & Boyle, 2009;Perry, 2010), hospice and palliative care environments (Abendroth & Flannery, 2006;Ablett & Jones, 2007;Melo & Oliver, 2011;Pereira et al., 2011;Woods et al., 2008), emergency departments, surgical care departments (Gates et al., 2011;Gunther & Thomas, 2006;Scanell-Desch & Doherty, 2010;Wies & Coy, 2013), and clinics for people living with HIV/AIDS (Cruz, 2007;Uebel et al., 2007). ...
... According to the literature, nurses have the most contact with clients among health care providers and professionals, and they become more vulnerable to workrelated stress and have higher risks of suffering from CF (Abendroth, 2011). Nurses who work in critical care specialty areas such as hospice, emergency room, palliative care, and HIV/AIDS care outside of the United States are even more at risk (Abendroth & Flannery, 2006;Ablett & Jones 2007;Melo & Oliver, 2011;Pereira, Fonseca, & Carvalho, 2011;Woods,Willison, Kington, & Gavin, 2008). This chapter includes a description of the research method, questions and hypotheses, design, population and sampling, data collection, instrumentation, and data analysis. ...
... However, according to the American Association of Critical-Care Nurses (AACN, 2017), compassion fatigue (CF) has a significant impact on the emotional, psychological, and professional well-being of critical care nurses. Moreover, physical symptoms, emotional symptoms, triggering causes, and ways to avoid compassion fatigue were identified as four themes in a metasynthesis on compassion fatigue in nursing (1) . ...
... The reason behind this is that most of the study sample was from the newly appointed category and This result agreed with study carried out by (3) who found that the majority of participants had (1-3) years of experience . In addition to, study title in "The effect of education on Compassion Fatigue as Experienced by staff Nurses" conducted by (15) who reported that majority of participants (38.89%) had (1)(2)(3)(4)(5) years of experience. While the study that disagreed with this study was by (Gardner, 2015) found that the majority of participants (32.6%) had (31-35) years of experience. ...
As health problems acuity increased in health care settings particularly in critical care units, it is not surprising that effective educational approach regarding Compassion fatigue (CF) can become one of the most important aspects in nursing profession. CF among critical care nurses is a secondary response that occurs as a result of repeated trauma and heightened emotional stress. Nurses who give care and may not be known of their own levels of physical and emotional stress, which has an influence on their professional and personal health and well-being. In order to minimize the impact of CF on staff and to maximize quality staff and patient care, it is vital to be aware of the risks and techniques for preventing the beginning of CF on nurses who provide nursing care for critically-ill patients. The purpose of this study is to evaluate the effectiveness of an instructional program regarding compassion fatigue and to determine the relationship between demographic variables of participants with compassion fatigue.
... The current study results revealed that, more than half studied sample were less than 30 years with no significance relation to the level of compassion fatigue, burnout, and satisfaction this finding can be interpreted as the age has a little discriminating value for describing the prevalence of the risk for these phenomena. This result supported by Abendroth and Flannery (23) Who reported that the age has no significance relation to the compassion fatigue and satisfaction. ...
... This current result is supported by Potter et al. (24) who studied compassion fatigue and burnout among oncology nurses and proved that burnout is increased by the years of experience. Meanwhile, this current result is contradicted by Abendroth and Flannery (23) Who stated that, nurses' coping abilities may be inherent, and/or may have been learned from years of nursing experience who affect negatively on both compassion fatigue and burnout. ...
... Only Johnson (1986) reported an attitude decline toward death at 3 months follow-up. The cause of attitude decline after 1 month post-intervention could be due to nurses and nursing students' poor grief management, which could lead to compassion fatiguea common problem faced by palliative nurses (Abendroth and Flannery, 2006;Coetzee and Klopper, 2010). Compassion fatigue occurs when nurses become overly exhausted from accumulated stress and prolonged intense patient contact, resulting in their inability to alleviate their patients' sufferings (Coetzee and Klopper, 2010;Ledoux, 2015). ...
... Compassion fatigue occurs when nurses become overly exhausted from accumulated stress and prolonged intense patient contact, resulting in their inability to alleviate their patients' sufferings (Coetzee and Klopper, 2010;Ledoux, 2015). As excessive empathy is a risk factor for compassion fatigue (Abendroth and Flannery, 2006), nurses and nursing students could have inadvertently over-exerted themselves postintervention in their eagerness to provide care for dying patients hence leading to compassion fatigue. This review only had three included studies which addressed nurses' grief management (Alvaro, 2009;Conner et al., 2014;Johnson, 1986); future trials should focus more on the topic to prevent compassion fatigue. ...
Objectives
To examine the effectiveness of end-of-life educational interventions in improving nurses and nursing students' attitude toward death and care of dying patients.
Design
A systematic review and meta-analysis of randomized controlled trials and controlled clinical trials.
Data sources
English language studies were sourced from five electronic databases (PubMed, Embase, CINAHL, PsycINFO and ProQuest Dissertations & Theses Global) to November 2020.
Review methods
A meta-analysis was conducted using the random-effect model. Standardized mean differences with 95% confidence intervals were used as the effect measure under the inverse-variance method. Heterogeneity was assessed using the I² statistics and Cochran's Q chi-squared test. The Cochrane risk of bias tool conducted quality appraisal at the study level while the Grades of Recommendation, Assessment, Development, and Evaluation approach conducted quality appraisal at the outcome level.
Results
Nine studies were included. Meta-analyses showed that end-of-life educational interventions were effective in improving attitude toward death and care of dying patients among nurses and nursing students at post-intervention. The sustainability of improvement of both attitudes could not be determined due to the lack of follow-up assessments by the included studies. Subgroup analyses revealed that both nurses and nursing students showed similar attitude improvement, online educational courses were feasible and attitude toward death may require longer interventions (more than 2 months) to show improvement.
Conclusions
Future trials could be improved by organizing both group-based segments and combined sessions for nurses and nursing students. Online components could be incorporated for convenience. Topics related to spirituality and grief management should be included. Future research is needed to examine the sustainability of nurses and nursing students' improvement in attitude toward death and care of dying patients, as well as how the change in their attitude affects their clinical practices.
... This finding indicates that caring for special needs children at school could lead to a feeling of exhaustion, frustration and a sense of sharing in the challenges faced by the children. Similar findings were made among primary school educators in West Virginia (Robinson, 2005); crisis counsellors after the Oklahoma City bombing (Wee & Myers, 2003), hospice nurses (Abendroth & Flannery, 2006), emergency nurses (Hooper et al., 2010), and oncology nurses (Black, Deignan & Potter, 2014). This current finding highlights the need for timely formulation and implementation of policies and programmes targeted at creating awareness, concerning compassion fatigue among special teachers and equipping them with adequate management and coping strategies. ...
The study was carried out to assess the level of compassion fatigue and psychological well-being of special needs educators. It adopted a cross-sectional survey design. The sample for the study was 416 special needs educators. The compassion fatigue subscale of the Professional Quality of Life scale (ProQOL) was used to assess compassion fatigue in the dimensions of burnout and secondary traumatic stress. Psychological well-being was measured using Ryff's Psychological Well-being scale in the dimensions of autonomy, environmental mastery, positive relationship with others, purpose in life, personal growth and self-acceptance. Frequency and percentage were used to analyse the descriptive data while Pearson's correlation was used to determine the relationship between variables. From the result, the majority (87.7%) of the respondents were females and 81.5% were between the age of 20-40 years. The majority (97.3%) of the respondents had moderate level compassion fatigue in both dimensions of burnout and secondary traumatic stress. About a quarter (24.7%) of the respondents reported a low level of psychological well-being. Psychological well-being dimensions of positive relationships with others and purpose in life were found to negatively correlate with secondary traumatic stress, while environmental mastery and purpose in life had a positive relationship with burnout among the special educators. Therefore, the study concludes that special needs educators experience compassion fatigue at a moderate level. The study recommends that there should be an increase in the social support rendered to special needs educators as this could encourage them more in executing their duties.
... Tus, stress can negatively impact [70] professional QoL and increase attrition among the nursing workforce. Numerous studies have demonstrated that stress has direct and indirect relationships with BO, STS [31,71], and CF [19]. Surprisingly, Itzhaki et al. [68] found that work stress was not associated with STS. ...
Objective:
To examine the interrelated impacts of work-related stress, compassion satisfaction (CS), and job satisfaction on burnout (BO) and secondary traumatic stress (STS) among nurses using structural equation modelling (SEM).
Methods:
A cross-sectional design was used to survey 727 nurses at a teaching hospital in eastern Saudi Arabia. Three scales were used: the Quality of Life (ProQOL) scale, the Nursing Stress Scale (NSS), and the Job Satisfaction Survey (JSS). Data were analysed using SPSS and Analysis of Moment Structures (AMOS), and SEM analysis was conducted to confirm the interrelations among variables.
Results:
The final model had a good fit for the obtained data (X 2 = 2.726, RMSEA = 0.032). Stress is directly related to BO and STS, and the following variables were directly related to STS: job satisfaction, BO, and CS. Lastly, BO mediated the relationship between stress and STS.
Conclusion:
It is crucial to analyze the effect of stress, CS, and job satisfaction which seems to have a positive and negative impact on nurses' BO and STS. Therefore, implementing a management strategy to manage stress and satisfaction can enhance nurses' quality of life, support the maintenance of positive attitudes, and enhance the standard of patient care.
... Most of the nurses (60.1%) were found to be in an above average risk category. In a study conducted in the USA by Abendroth et al. 9 with 238 health personnel (2006), 21.3% of the participants were stated to be in the low risk category while 26.4% were found to be in the high risk category. In another study conducted in England by Gregson et al. 10 , 70% of health care workers were stated to be in either the low or high risk categories. ...
The aim of this study is to research the prevalence of compassion fatigue among intensive care nurses in a public hospital located in northwestern Turkey. The sample of the study consisted of 111 nurses who worked at adult intensive care units and volunteered for the study. In the collection of research data, demographic questionnaire which includes socio-demographic features and compassion fatigue (CF) sub-scale of Professional Quality of Life Scale (ProQOLR-IV) were used. In the examination, numbers, percentages, mean values, and standard deviations from among descriptive statistics, the Mann Whitney U test, the Kruskal Wallis test, and the Binary logistic regression model were used. In this study, 60.1% of the nurses were found to be in the high risk category with regard to compassion fatigue. Additionally, nurses with high education levels, less occupational experience, and excessive weekly working hours who were single were found to experience higher compassion fatigue risk (p < 0.05). Nurses being supported against the risk of compassion fatigue and coping strategies for this situation being taught to nurses will reflect in their life and work quality positively. Further studies in different specialist fields and areas should be performed in order to incentivize the generalisation of our results and discover other potential predictors.
... Several risk factors might be responsible for the development of CF: having a personal history of traumatic events, encountering patients who have experienced trauma, absence of a support system, lack of experience, lack of balance between work and personal life, and lack of self-awareness [15,16]. However, adequate social support, personal and occupational development, and self-awareness have been shown to protect against CF [1,7,9,11,15,[17][18][19][20]. ...
Compassion fatigue is a set of emotions and behaviors that occur as a result of assisting a person who is suffering. Compassion fatigue, burnout, and low compassion satisfaction are all hazards that professional caregivers encounter. However, in comparison to non-medical workers, psychiatrists were found to have higher levels of compassion fatigue. We conducted a cross-sectional study that targeted all psychiatrists and psychiatric trainees enlisted in Saudi Arabia at the only registering body, the Saudi Commission for Health Specialties (SCFHS). The SCFHS approved and sent an online survey consisting of a three-section questionnaire concerning sociodemographic, personal, and professional information and the Professional Quality of Life Scale (ProQOL 5). Compassion fatigue was found at an average level in 43.2% of participants, while 56.3% had a low level. An average level of burnout was found in 65.9% of participants, while 34.1% had a low level of burnout. Of all participants, 38.9% had an elevated level of compassion satisfaction. Participants who were diagnosed with psychiatric illness showed higher burnout scores (p<0.001). Divorced or separated participants had a higher compassion satisfaction score compared with single participants. A history of psychological trauma was associated with a higher compassion fatigue score (p=0.002). These findings supported the notion of trauma as a specific risk factor for compassion fatigue. They also attested to the huge burden among psychiatrists and psychiatric trainees as part of the nature of this profession. We advise developing systematic and proactive tools to screen for trauma and to support practicing and future psychiatrists, especially those at risk of compassion fatigue.
... Uygulama ile ilgili stres unsurları arasında; iş yükü, prosedürlerdeki değişiklikler, çalışan sayısı, kişiler arası ilişkiler, rol belirsizliği, sınırlı kaynaklar, iş akışında kesilmeler, travmanın sürekliliği ve destek/kontrol eksikliği sayılmaktadır. [14][15][16][17] Şefkat yorgunluğunu tetikleyebilecek kişisel faktörler; profesyonel sınırları aşarak duygusal olarak ilgilenmeye başlamak, bilgi eksikliği, deneyimsizlik, kayıplar, çatışmalar ve öz bakımın sürdürülememesi olarak belirtilmiştir. 6,18,19 Şefkat yorgunluğu olan hemşireler, fiziksel, duygusal ve zi-hinsel yorgunluk ve ayrılma semptomları yaşayabilmektedirler. 20 Bunlarla birlikte, şefkat yorgunluğuna bağlı hastalık zamanında artma, geç kalma, sağduyuda aşınma, kişiler arası sorunlar veya öfke patlamaları, verimlilikte azalma, madde bağımlılığı ve ilgisizlik gibi belirtilerin yaşandığı belirtilmiştir. ...
... Similarly, burnout and compassion fatigue, while sometimes regarded as synonyms (22,23), have been differentiated in terms of onset and time course (24)(25)(26) as well as the circumstances that lead to them (14,(27)(28)(29). Some have regarded burnout as a precursor to compassion fatigue, and others vice versa (14,24,(30)(31)(32)(33)(34)(35). Others still suggest the absence of a strong correlation between the two (21,36). ...
Background
Adverse affective experiences have been well-documented in healthcare providers. Research describes them under a variety of terms, including burnout, secondary traumatic stress (STS), and compassion fatigue (CF). The present study evaluates conflicting models of STS, CF, and burnout constructs in physicians.
Methods
Surveys were mailed to all allopathic physicians with active Rhode Island medical licenses. Three hundred and seventy-five complete responses were received. The survey included common measures of STS, CF, and burnout. Confirmatory Factor Analysis (CFA) was used to evaluate discriminant validity of the three constructs and test 5 a priori (1-, 2-, and 3-factor) theoretical models, and Exploratory Factor Analysis (EFA) was planned assess underlying factor structure in the case that CFA did not provide evidence supporting any existing model.
Results
By CFA, all five a priori models of burnout, CF, and STS fail to demonstrate adequate model fit (Standardized Root Mean Square Residual >0.10, Tucker-Lewis Index <0.90). EFA with parallel analysis extracts four factors underlying the three burnout, STS, and CF measures. The four factors describe 54.3% of variance and can be described as (1) depressive mood; (2) primary traumatic stress-like symptoms; (3) responses to patients' trauma; and (4) sleep disturbances.
Conclusion
In spite of abundant discussion surrounding burnout, CF, and STS in physicians, measures of these constructs did not uphold their theoretical factor structures in the present study. Future research might explore other constructs and measures that may describe adverse affective physician experiences.
... The results of the current study support research (Abendroth & Flannery, 2006;Figley & Roop, 2006), which suggests that difficulty separating professional and personal life may be a sign of CF or could exacerbate existing CF and therefore might be an important target for intervention. The concept of work/life boundaries is particularly pertinent for people who foster animals (Murphy & Daly, 2020). ...
Compassion fatigue, which has been conceptualized as the combination of secondary traumatic stress and burnout in a help giving context, is an important yet understudied area of psychological interest in the animal rescue and shelter sector. Most research on compassion fatigue including for animal rescue/shelter workers utilizes a measure called the Professional Quality of Life scale, a questionnaire designed for use with human care–giving professionals. The current study used a mixed-methods analysis to investigate the utility of the ProQOL in assessing levels of compassion fatigue in a sample of Australian animal rescuers (N = 342) reached via online survey. The free text responses of participants with the highest (n = 50) and lowest (n = 50) ProQOL compassion fatigue ratings were analyzed to address the question, “Does the talk match the numbers?”; that is, do the free text responses support quantitative ratings of compassion fatigue? The answers to open-ended questions about the lived experience of animal rescue were assessed for 5 overarching psychological symptoms of compassion fatigue: Arousal, intrusion, avoidance, depressive, and dissociative. A relatively high prevalence of certain compassion fatigue symptoms were found, in particular depressive and dissociative symptoms. This study provides qualified support that the Professional Quality of Life scale tool may be valid for screening for compassion fatigue within an animal rescue population. Areas
for further attention, including research and intervention considerations, are discussed.
... Several studies have reported STS symptoms in social workers [10], hospice nurses [11], nurses working in departments such as hospital emergency rooms [12], oncology departments [13], intensive care units [14] and pediatric wards [15]. Despite the prominence of STS in numerous studies and professional groups of healthcare providers, the existence of unique aspects in midwifery limits the generalizability of the results of these studies to midwives. ...
Background
The present qualitative study was conducted to explain the experiences of secondary traumatic stress (STS) and its related factors in midwives working in maternity wards.
Methods
Data were collected using semi-structured interviews with 11 midwives working in the maternity wards of hospitals in Urmia, Iran, through in-depth interviews with open-ended questions. Data were analyzed using the conventional content analysis approach.
Results
The results of data analysis led to the extraction of three themes, seven main categories, and 18 subcategories. The first theme was “STS stimuli,” with the two categories of “Discriminatory approach to midwifery” and “The nature of the midwifery profession”. The second theme was “Traumatic outcomes”, which included the subcategories of “Psychological-emotional trauma”, “Physical trauma” and “Social trauma”. The third theme was “Risk management”, which had the two subcategories of “Reactive approach” and “Proactive approach”.
Conclusions
The results showed that, in addition to the traumatic nature of events that midwives experience during work as the secondhand victims, factors such as governance-organizational structure, unbalanced distribution of power, and poor supportive laws undermine their professional role and provide conditions conducive to STS. Therefore, avoiding traumatic situations and scientific and skill self-empowerment were the most important strategies adopted by the midwives in this study to prevent risky situations and cope with the consequences of STS. The participation of midwifery stakeholders in policy-making and adopting supportive legislation in redefining the position and role of midwives can play a major role in reducing STS and sustaining their role and position in maternal care.
... For example, in a nursing study conducted by Barr [31], nurses who felt more strongly that work demands pulled them in different and sometimes opposing directions and nurses who felt more overburdened by the volume of work had higher levels of compassion fatigue. Similarly, a study among nursing midwives found that continuous exposure to distressing situations and lack of decision latitude increased susceptibility to developing compassion fatigue [48]. ...
This cross-sectional survey study examined the relationship between Canadian nurses' work environment characteristics, emotional intelligence, compassion fatigue and compassion satisfaction (n = 1271). Psychological demands, decision latitude, supervisor and coworker support, and emotional intelligence (EI) were significantly correlated with nurses' compassion satisfaction and compassion fatigue, except for two EI subscales. Furthermore, these relationships were stronger for compassion satisfaction than compassion fatigue, suggesting that they are influenced by different factors. Our results highlight the importance of creating reasonable psychological demands, empowering nurses to make decisions in their jobs, supportive relationships at work, and fostering the development of nurses' EI.
... Several studies have reported STS symptoms in social workers [10], hospice nurses [11], nurses working in departments such as hospital emergency rooms [12], oncology departments [13], intensive care units [14] and pediatric wards [15]. Despite the prominence of STS in numerous studies and professional groups of health care providers, the existence of unique aspects in midwifery limits the generalizability of the results of these studies to midwives. ...
Background: The present qualitative study was conducted to explain the experiences of secondary traumatic stress (STS) and its related factors in midwives working in maternity wards.
Methods: Data were collected using semi-structured interviews with 11 midwives working in the maternity wards of hospitals in Urmia, Iran, through in-depth interviews with open-ended questions. Data were analyzed using the conventional content analysis approach.
Results:The results of data analysis led to the extraction of three themes, seven main categories, and 18 subcategories. The first theme was “STS stimuli,” with the two categories of “Discriminatory approach to midwifery” and “The nature of the midwifery profession”. The second theme was “Traumatic outcomes”, which included the subcategories of “Psychological-emotional trauma”, “physical trauma” and “social trauma”. The third theme was “Risk management”, which had the two subcategories of “Reactive approach” and “Proactive approach”.
Conclusions:The results showed that, in addition to the traumatic nature of events that midwives experience during work as the secondhand victims, factors such as governance-organizational structure, unbalanced distribution of power, and poor supportive laws undermine their professional role and provide conditions conducive to STS. Therefore, avoiding traumatic situations and scientific and skill self-empowerment were the most important strategies adopted by the midwives in this study to prevent risky situations and cope with the consequences of STS. The participation of midwifery stakeholders in policy-making and adopting supportive legislation in redefining the position and role of midwives can play a major role in reducing STS and sustaining their role and position in maternal care.
... On the whole, there is little evidence available to show whether the relationships among them are unidirectional or bidirectional in nature (Shepherd & Newell, 2020;Voss Horrell et al., 2011). To the best of our knowledge, few longitudinal studies have examined the association between trauma-related symptoms and burnout among health care providers (Abendroth & Flannery, 2006;Collins & Long, 2003;Wang et al., 2020). However, in one such work by Shoji and colleagues (Shoji et al., 2015), a crosslagged panel design was used to investigate whether job burnout as measured at an initial time point predicted secondary trauma at 6 months follow-up or vice versa. ...
Objective:
The aim of this longitudinal study was to model the cumulative network of associations between trauma-related symptoms, professional burnout, and psychological distress in health care practitioners working in emergency settings.
Method:
The research was conducted with Palestinian health care helpers (N = 60) operating in Gaza and the West Bank. The study variables were evaluated via repeated quantitative self-report questionnaires collected in two waves and the associations among them were estimated using structural equation modeling, bootstrap methods, and Monte Carlo simulation.
Results:
The longitudinal structural model offered a good fit for the data (χ²(114) = 161.4, p = .02, NC = 1.42, nonnormed fit index [NNFI] = .950, comparative fit index [CFI] = .951, root mean square error of approximation [RMSEA] = .079), in support of the notion that trauma-related outcomes and professional burnout may be associated with mental health across different professional groups. Specifically, trauma-related symptoms wielded a direct effect on professional burnout (β = .28) and psychological distress (β = .11) at T0. Trauma-related symptoms were found to be more strongly associated with professional burnout (β = .40) than with psychological distress (β = .03) at T1.
Conclusion:
Emergency workers operating in an environment marked by instability and ongoing risk need to draw on sources of resistance and resilience to protect their mental health. We discuss both the clinical implications of these findings and future lines of inquiry. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... Insight into the factors that influence the mental health and wellbeing of nurses and midwives working in different contexts is required. For example, professional isolation appears to be a particular problem for practice nurses 115 , dealing with child protection issues for paediatric nurses 116 and compassion fatigue for hospice nurses 117 . It is also important to note that 20% of nurses and midwives in the UK do not work for the NHS (15.3% are employed in the private sector; 4.3% in another public sector; 2.2% in the charity/voluntary sector) 118 and more research is needed to understand their experiences and how they impact on wellbeing and mental health 119 . ...
... Prior research looking at burnout and compassion satisfaction among healthcare workers has shown that roughly one-quarter of providers may experience high levels of compassion fatigue and burnout, with 50% or more at moderate levels. 17,18 Inversely, only around 20 -30% of healthcare workers reported a high level of compassion satisfaction from their work. 19 During the time of our study (April 2020), national headlines contained a regular stream of developments: COVID-19 related hospitalizations and deaths in New York City, widespread deficiencies in access to personal protective equipment (PPE) for frontline healthcare workers, 20 and growing prevalence and incidence rates occurring nationally as well as locally. ...
Introduction:
Healthcare systems are being bombarded during the COVID-19 pandemic. Understanding burnout, compassion fatigue, and potential protective factors, such as compassion satisfaction, will be important in supporting the vital healthcare workforce. The goal of the current study was to understand the key factors of burnout, compassion fatigue, and compassion satisfaction among healthcare employees during the pandemic within the U.S. in April 2020.
Methods:
The authors conducted a single-center, cross-sectional online survey using the Professional Quality of Life (ProQOL) Questionnaire and three open-ended questions around stress and responses to stress during COVID-19 at a large Midwestern academic medical center with nearly 16,000 employees.
Results:
Healthcare employees (613) representing over 25 professions or roles and 30 different departments within the health system were surveyed. Participants reported low levels of compassion fatigue and burnout, but moderate levels of compassion satisfaction. Compassion satisfaction was notably higher than prior literature. Key areas of stress outside of work included family, finances and housing, childcare and homeschooling, and personal health.
Conclusions:
This was a cross-sectional survey, limiting causal analyses. Also, based on the qualitative responses, the ProQOL was somewhat insufficient in assessing the breadth of stressors, particularly outside of work, that healthcare employees faced due to the pandemic. Although compassion satisfaction was elevated during the initial phases of the pandemic, providing some possible protection against burnout, this may change as COVID-19 continues to surge. Healthcare systems are encouraged to assess and address the broad range of work and non-work-related stressors to best serve their vital workforce.
... However, as our participants declared, the emotional involvement professionals have with the people they care for can either help them to be emotionally sympathetic and empathetic or spillover in their life refraining them to escape from their personal and professional issues (Drury et al., 2014). On the one hand the level of stress is higher when professionals care for people affected by incurable disease with a short end (Abendroth & Flannery, 2006), on the other hand, the same level can be modified in several manners. One of the factors refers to the fortune to rely on peers and family's supportive help, who can provide support to overcome part of the stress. ...
Young onset dementia has become a growing challenge in national healthcare systems. Concerns about the situation have already been expressed; however, they mostly report the views of services end-users. Aimed at finding out useful further improvement, interviews documenting the working experiences of professionals addressing healthcare services to people with young onset dementia (YOD) were analysed qualitatively. The interviews resulted in four themes and twelve categories. The themes regarded services' complexity and responsiveness, the levels of education and knowledge on YOD, the impact that serving people with YOD reflects on staff working experience and quality of life, and a series of proposals aimed at improving services by giving people with YOD and families the provision of care they deserve. Although some of the themes recapped the ones reported in the previous literature, the mixture of internally and externally driven instances represented in the themes depict the complexity of care delivery in the services. Findings are discussed in the light of a pragmatical framework capable of suggesting what changes services should implement to be timely responsive.
... However, burnout and compassion fatigue may also be influenced by personal characteristics and factors arising from outside the work environment, such as coping skills, quality of personal relationships, psychological well-being, an existing diagnosis of anxiety or depression, and prior negative life events (Abendroth & Flannery, 2006;Chung & Harding, 2009;Glasberg et al., 2008) inadequate social support, challenging patients, and rural location (Matheson, Robertson, Elliott, Iversen, & Murchie, 2016). Professional experience has also been found to influence resilience, with more educated and experienced health workers displaying higher levels of resilience (Gayton & Lovell, 2012;Hsieh, Chang, & Wang, 2017). ...
... Among nurses working at specialized hospice and palliative care facilities, 78% experienced a moderate or higher level of compassion fatigue, and approximately 26% had severe compassion fatigue [5]. Higher levels of secondary traumatic stress and burnout perceived by nurses-corresponding to the subscales of compassion fatigue-were associated with more severe depression, anxiety, and sleep disturbances. ...
... Second, as Bunderson and Thompson (2009: 52) put it, calling's 'profound meaning' comes at the cost of 'profound sacrifice'. Such sacrifice can include stress disorders, workaholism (Bunderson and Thompson, 2009;Duffy et al., 2016;Hirschi et al., 2019), or compassion fatigue (Abendroth and Flannery, 2006;Cohen et al., 2019), notwithstanding the resilience that following a calling affords. Such dysfunctional work behaviours can cause decreased subjective well-being (Angrave and Charlwood, 2015). ...
This conceptual article extends the literature on the disadvantages of calling. The article makes four main contributions. First, it argues that some of the burden of calling is shouldered not by called individuals or their employers, but rather by close family members. Second, it argues that calling influences work–life ideology, limiting a called person’s ability to exercise choice and self-manage their work–life boundary. Third, it introduces the novel notion of the sacrifice-reliant organisation, which relies on calling to achieve organisational goals. Fourth, the article argues normatively that organisations with called members have an enhanced duty of care towards families of its members that is commensurate with the extent to which they rely on calling to achieve their goals. Using ethics of care, it also develops guidelines on the extent and components of such an enhanced duty of care.
... Ebelerde merhamet yorgunluğuna bakan çalışmaya rastlanmamıştır. Bakım veren mesleklerden olan hemşirelikte merhamet yorgunluğu açısından yapılan çalışmalara bakıldığında, benzer şekilde "başkalarının ihtiyaçları için öz fedakarlık" ve "aşırı empati"'nin merhamet yorgunluğu gelişmesine neden olduğu bulunmuştur (Abendroth & Flannery, 2006). Yine, hastalarla "fazla meşgul olma"'nın merhamet yorgunluğu ile ilişkili olduğu tanımlanmıştır (Maytum, Heiman & Gardic, 2004). ...
... Although the organ transplant coordinators participating in the study seemed to have low burnout levels, the fact that they had high personal burnout levels can be considered an important finding. Burnout is characterized by chronic tension caused by inconsistency and incompatibility between employees and work [27] and is triggered by various characteristics of the work or organization [28]. Therefore, the psychological and socially challenging duties of organ transplant coordinators, such as requesting organ donation, may create important dilemmas in individuals [29], which may lead to burnout, causing negative outcomes in donation interviews [30]. ...
Aim
The aim was to determine the effects of compassion fatigue, emotional intelligence levels, and communication skills of organ transplant coordinators on burnout.
Methods
This descriptive correlational study included 104 organ transplant coordinators. Data were collected via a survey that consisted of demographic information, the Copenhagen Burnout Inventory, the Emotional Intelligence Scale, and the Compassion Fatigue Scale.
Findings
A positive relationship was reported between burnout (mean, 39.42 [SD, 19.54]) and compassion fatigue (mean, 2.26 [SD, 0.86]) measurements of the organ transplant coordinators (r = 0.432) and a negative and significant relationship existed between burnout and emotional intelligence (mean, 3.53 [SD, 0.58]) measurements (r = −0.372). However, no correlation was found between communication skills (mean, 4.27 [SD, 0.52]) and burnout (r = −0.184; P > .05) except a negative correlation with client-related burnout measurements (r = −0.222; P < .05). As a result of the 2-step regression analysis, the regression-squared value predicted the joint effect of compassion fatigue and emotional intelligence on burnout (R² = .285).
Conclusions
Organ transplant coordinators reported moderate levels of burnout and compassion fatigue and high levels of emotional intelligence and communication skills. Compassion fatigue caused burnout, while emotional intelligence decreased. Additionally, transplant coordinators’ communication skills were related to client-related burnout.
... Hospis hemşirelerinde yapılan bir çalışmada hastalarına özverili davranışta bulunan hemşirelerin %34'ünde merhamet yorgunluğunun görüldüğü tespit edilmiştir (Abendroth ve Flannery, 2006). Hemşirenin özverili davranışı merhamet yorgunluğu riskini artırmaktadır. ...
z Hemşirelik mesleği merhamet yorgunluğunun en ağır yaşandığı mesleklerden biridir. Merhamet hemşirelik bakımının sunulmasını kolaylaştıran bir değerdir. Hemşireler merhamet duygusunu hasta bakımında anahtar olarak kullanmaktadır. Merhamet başkasının yaşadığı travmayı, acıyı ve ağrıyı derinden fark etmektir. Hemşireler, hastaların travma, acı, ağrılarına merhamet göstermeleri, empati kurmaları ve hastaların travmalarına uzun süre maruz kalmaları sonucunda merhamet yorgunluğu yaşarlar. Merhamet yorgunluğu bakım ilişkisinin doğal bir sonucu olarak hemşirelik bakımının bedeli şeklinde ifade edilmektedir. Merhamet yorgunluğu yaşayan hemşirenin bakım verme isteği, becerisi ve enerjisi azalmaktadır. Merhamet yorgunluğu sonucunda hemşirelerde fiziksel, duygusal/ruhsal ve sosyal tükenme belirtileri görülebilmektedir. Hemşirelik bakımının kalitesini doğrudan tehdit eden, hemşirelerin hastalarına karşı duyarsızlaşmalarına sebep olan ve hemşirelerin kurumdan ve meslekten ayrılmalarında önemli bir faktör olarak görülen merhamet yorgunluğuna karşı acil önlemler alınmalıdır. Ülkemizde hemşirelikte merhamet yorgunluğu konusunun gündeme getirilmesi, anlaşılması, konuya gereken önemin verilmesi ve merhamet yorgunluğunu önleme ve tedavi programlarının oluşturulması açısından bu yazı büyük önem taşımaktadır. Abstract Cost of Nursing Care: Compassion Fatigue Nursing is one of the professions experiencing severe compassion fatigue. Compassion is a value that facilitates the provision of nursing care. Nurses use the sense of compassion as a key in patient care. Compassion is to feel someone else's trauma, suffering and pain deeply. Nurses experience compassion fatigue as a result of having compassion for patients' trauma, suffering and pain, developing empathy, and prolonged exposure to the conditions of patients. Compassion fatigue is considered as the cost of nursing care, as a natural result of the care relationship. Caregiving willingness, skills and energy of nurses who experience a compassion fatigue decrease. Physical, emotional/psychological and social burden symptoms can be seen as a result of the compassion fatigue in nurses. Consequently, immediate measures should be taken against the compassion fatigue, which directly threatens the quality of nursing care, causes insensitivity in nurses toward their patients, and considered as an important factor in nurses who leave their institution and profession. This paper is of great importance to bring up, understand and give due consideration to the issues of compassion fatigue in nursing, and to create prevention and treatment programs for the compassion fatigue.
... Emotional exhaustion was high in Kutluturkan et al. 's (2016) sample of 140 oncology nurses, and, similarly, in a third of Guveli et al. 's (2015) Turkish sample (n = 159). A study of 216 American hospice nurses reported that around 80% of the sample were at high risk of compassion fatigue (Abendroth & Flannery, 2006). Oncology nurses have reported higher levels of burnout and compassion fatigue compared to other specialties such as emergency, intensive care, and nephrology nurses (Hooper et al., 2010;Ortega-Campos et al., 2020). ...
Oncology nurses are at risk of chronic stress. In this narrative review we provide an overview of stress management intervention studies for oncology nurses, and suggest that Acceptance and Commitment Therapy/Training (ACT) provides a better intervention framework due to the relevance of underpinning therapeutic processes (e.g. acceptance, mindfulness, values clarification) to the role and stress-related experiences of this workforce population. Current evidence for the effectiveness of stress management intervention varies, with few studies describing how theory informs intervention content, or justifying why they should benefit this population specifically. ACT lends itself to data driven intervention development, thus potentially addressing some methodological limitations in this field. Only one trial has tested ACT in this population, reporting only partial effects. Further empirical research is required given (a) the applicability of ACT for this population and context, and (b) the associated advantages of brief and/or group delivery to address known barriers to participating in stress management interventions.
... Whereas physiological resonance with a target person may facilitate accuracy of momentary empathic inference and compassion as adaptive responses, it may also trigger empathic distress and longer-term health risks, particularly for vulnerable empathizers and when occurring frequently or being sustained over extended periods of time. In an extreme case, this is illustrated by findings of healthcare providers' excessive empathy with patients being related to an increased risk of developing clinically relevant burnout and compassion fatigue syndromes (Abendroth & Flannery, 2006;O'Brien & Haaga, 2015). Also in mundane empathic exchanges, frequent and sustained physiological resonance with other persons' negative experiences (such as stress, fear, or anger) might be related to enhanced physiological morbidity risk in vulnerable empathizers. ...
Empathic accuracy is the ability to infer another person's inner states. While early findings suggested older adults to be less empathically accurate on average than younger individuals, the context dependency of such age differences was emphasized more recently. Comparable empathic accuracy was observed in older and younger empathizers when conversational topics were positive or personally relevant or when empathic judgments were solely based on prior knowledge of the target. Motivational and cognitive mechanisms are assumed to underlie this context-dependent pattern of findings. A refined future understanding of the sources of variation in empathic skills within and across age groups will require unraveling the contributions of the empathizer, the target person, and their relationship. Moreover, improved insights into the implications of empathic skills in various phases of adulthood, including older adults’ social functioning and health, will require joint consideration of cognitive and affective components of empathy and their accompanying physiological processes.
Expected final online publication date for the Annual Review of Developmental Psychology, Volume 2 is December 15, 2020. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
... However, this process often comes at a considerable cost to the worker (Newell and MacNeil, 2010). Literature has long documented that secondary traumatic stress (STS) is prevalent among frontline care workers, such as, emergency room nurses, palliative care workers, crisis workers and psychotherapists, but there is a dearth of literature studying the prevalence of STS of generalist social work practitioners (Abendroth and Flannery, 2006;Bride, 2007;Cornille and Meyers, 1999;Dominguez-Gomez and Rutledge, 2009). ...
This study examines the relationship between mindfulness and secondary traumatic stress (STS) amongst licensed social workers in New York City. The research that was conducted was a quantitative analysis. Participants consisted of 154 social workers that were employed in a variety of agency based or private practice settings. Participants were asked to complete an electronic survey that included: (1) a questionnaire of professional characteristics and demographic information; (2) Cognitive and Affective Mindfulness Scale - Revised (CAMS-R); (3) Minnesota Satisfaction Questionnaire (MSQ); (3) Secondary Traumatic Stress Scale (STSS). The data was analyzed by the use of SPSS. The multivariate linear regression analyses revealed that higher level of mindfulness is related to an increase in job satisfaction (B=1.13, SE=.09, β=.73, p.001) and lower STS for social workers (B=-.66, SE=.11, β=-.49, p.001).
... Another risk factor for compassion fatigue is porous professional boundaries (Abendroth & Flannery, 2006). Prior to the pandemic, the issue to be addressed would be the professional and physical boundaries that faculty maintain with students in order to achieve a personal satisfactory work-life balance. ...
Background: With the global pandemic, higher education has experienced unparalleled changes with abrupt transitions to remote and online learning. Faculty are working to provide continuity of teaching and support to students whose lives have been disrupted; therefore, faculty are finding themselves managing distressed students with a wide range of issues, while also managing their own intrapersonal stress. Consequently, faculty may experience feelings of being psychologically overwhelmed and emotionally exhausted.
Aim: This article informs faculty in higher education on the concept of compassion fatigue along with the symptoms, warning signs, and risk factors. In addition, protective factors, including self-care plans and coping strategies are addressed.
Methods: A comprehensive review of the literature on compassion fatigue was conducted including the application of the construct to teaching and education. The literature review illuminates the use of compassion fatigue, originating from the scientific disciplines of counseling and traumatology, within an emerging line of research findings occurring amongst educators prior to the COVID-19 pandemic.
Results: The literature demonstrates that compassion fatigue as a prospective, intrapersonal condition may potentially affect some faculty in higher education, and the proposed conceptual application of the construct to teaching and education can assist with acknowledging and understanding an important aspect of faculty mental health.
Conclusions: Given the crisis surrounding the pandemic, it's essential for faculty to be aware of compassion fatigue in order to mitigate potential intrapersonal psychological and emotional consequences. Elucidating the symptoms and implications of compassion fatigue for faculty in higher education is part of a broader, overlooked issue on faculty mental health and wellness.
... Regarding studies on compassion fatigue, Abendroth and Flannery conducted a research to determine the frequency of compassion fatigue among health-care providers in the United States and found that low, moderate, and high levels of compassion fatigue were present in 21.3%, 52.3%, and 26.6% of participants, respectively. [15] Another study by Sodeke-Gregson et al. found that low, moderate, and high levels of compassion fatigue were present in zero, 30, and 70% of UK therapists who work with adult trauma clients. [16] Health-care providers as frontline staff for communication with patients are influenced by stress related to treatment and care and they endure this stress and fatigue. ...
Introduction: The professional quality of life is a type of emotion that every person perceives to his/her job. This study aimed to evaluate the professional quality of life among health-care providers including physicians, nurses, and midwives and its related factors. Methods: This cross-sectional study was conducted in 2018. Participants were 464 doctors, nurses, and midwives working in educational hospitals of Qazvin University of Medical Sciences selected using a convenience method. Data were collected using demographic information questionnaire and Persian version of the professional quality of life questionnaire. Multivariate linear regression models were used to examine the related factors. Results: In the present study, 464 health-care providers including 150 doctors, 161 midwives, and 153 nurses participated. Their mean age was 32.29 ± 6.88 years. The majority of them (56.2%) reported a moderate job satisfaction. The mean (standard deviation) of participants' scores in the domains of compassion satisfaction, burnout, and secondary traumatic stress was 38.84 (6.23), 13.53 (4.34), and 27.05 (5.70), respectively. The regression model showed that high and medium job satisfaction, monthly income, and work shift arrangements were significant predictors for all domains of professional quality of life. Conclusion: Physicians, midwives, and nurses had a moderate professional quality of life. Factors such as high job satisfaction, monthly income, and work shift arrangements partly predicted their professional quality of life. Therefore, paying enough attention to improving job satisfaction and improving working conditions and income might improve the professional quality of life of health-care providers, and consequently, the quality of patient care.
This research examines the predictors of volunteer satisfaction in animal shelters. It assesses the relative importance of volunteer demographics, the attributes of the shelter, and the policies and procedures governing the volunteer experience. Volunteering takes place within organizational contexts creating a dynamic relationship between the individual and the organization. The study compares the importance of volunteer and organizational traits and organizational policies in volunteer satisfaction. Based on a survey of 651 animal shelter volunteers, it concludes that policies and procedures under the control of the organization are most important in contributing to volunteer satisfaction.
Bu araştırmanın amacı ruh sağlığı alanında çalışan psikolojik danışmanların şefkat yorgunluğu düzeyini ölçmek üzere bir ölçme aracı geliştirmektir. Araştırmanın çalışma grubunu toplam 725 (518 kadın ve 207 erkek) psikolojik danışman oluşturmaktadır. Araştırmada açımlayıcı faktör analizi, doğrulayıcı faktör analizi, ölçüt bağıntılı geçerliği, Cronbach alfa iç tutarlık değeri ve madde analizi hesaplanarak ölçeğin psikometrik özellikleri ortaya konmuştur. Açımlayıcı faktör analizi sonucunda toplam varyansın %53’ünü açıklayan 21 maddelik dört boyutlu bir ölçek elde edilmiştir. Ölçek faktör yükleri .504 ile .781 arasında değişmektedir. Ölçeğin dört boyutlu yapısı farklı bir örneklem grubu üzerinde doğrulayıcı faktör analizi yapılarak test edilmiştir. Yapılan analiz sonucunda model ile veri arasında uyumun kabul edilebilir düzeyde olduğu saptanmıştır (χ2= 315.43, p= .000, sd= 181, χ2/sd= 1.74, CFI= .91, TLI= .90, SRMR= .05, RMSEA= .06). Ölçeğin madde tahmin değerleri ise .39 ile .80 arasında değişmektedir. Bunun dışında, farklı bir örneklem ile yapılan ölçüt bağıntılı geçerlik çalışmasında da istatistiksel olarak anlamlı ilişkiler bulunmuştur. Güvenirlik analizleri kapsamında yapılan analizlerde ölçeğin geneli için Cronbach alfa iç tutarlık katsayısı .890 ve Guttman katsayısı .872 olarak hesaplanmıştır. Alt boyutlar için ise Cronbach alfa iç tutarlık değeri .683 ile .836 arasında değerler almıştır. Benzer şekilde alt boyutlar için Guttman katsayısı da .612 ile .837 arasında değişmektedir. Ölçeğe ilişkin madde toplam korelasyon değerleri hesaplandığında .374 ile .701 arasında değerler olduğu belirlenmiştir. Tüm bu bulgular, Psikolojik Danışmanlarda Şefkat Yorgunluğu Ölçeğinin geçerli ve güvenilir bir ölçme aracı olduğunu kanıtlar niteliktedir. Araştırmada elde edilen sonuçlar alanyazında yer alan araştırmalar dikkate alınarak tartışılmış ve yorumlanmıştır.
Purpose
To investigate compassion fatigue in nurses and the factors influencing the condition.
Design and Methods
This descriptive, comparative, and cross-sectional study was conducted in state and university hospitals in the Turkish Republic of Northern Cyprus. A purposive sampling method was used.
Findings
Almost all of the nurses have experienced low to moderate levels of compassion fatigue. Factors affecting the severity include age, years of seniority, service, marital status, children, and type of hospital.
Practice Implications
Recommendations for reducing compassion fatigue are as follows: establishing clinical practice policies that reduce the development and possible consequences of compassion fatigue in addition to education and resilience training.
This study’s purpose was to explore how palliative care nurses’ views on death and time perspectives are related to their terminal care attitudes. A questionnaire survey—consisting of the Death Attitude Inventory, Experiential Time Perspective Scale, and the Japanese version of the Frommelt Attitudes Toward Care of the Dying Scale—was administered to 300 individuals. Cluster analysis was conducted to categorize the way nurses perceive death, which revealed four types: Avoidant, middle, accepting, and indifferent. As a result of the analysis of variance on the terminal care attitudes, based on the types of views on death and time attitudes, it was found that the middle and accepting types, as well as the adaptive formation of time attitudes, were related to positive terminal care attitudes. In conclusion, more effective improvements in attitudes toward terminal care can be expected by incorporating time perspective, in addition to the conventional approaches focusing on death.
Background
Work-related mental health issues in New Zealand are increasing yearly and impact on how employees are able to cope with day-to-day pressures and work productivity. Work-related mental health issues are especially prevalent during times of great stress such as the coronavirus pandemic.
Aim
In this study, the prevalence of compassion fatigue, burnout and compassion satisfaction were assessed using the Professional Quality of Life (ProQOL) scale and a range of demographic and descriptive questions.
Methods
The ProQOL is a Likert-style survey for those in human- or animal care roles, such as veterinary nurses. It measures compassion fatigue, burnout, and compassion satisfaction, rating the scores as low, moderate, or high risk. The survey was hosted via an online survey website for 6 weeks.
Results
The survey received 166 usable responses. The average scores indicated moderate risk for most respondents for compassion fatigue, burnout, and compassion satisfaction.
Conclusion
This research indicates that New Zealand's veterinary nurses show similar levels of compassion fatigue, burnout, and compassion satisfaction to international results in veterinary nurses assessed prior to the coronavirus pandemic, indicating that New Zealand veterinary nurses coped remarkably well during the global catastrophe.
Purpose
Health-care professionals working in inpatient forensic mental health settings are exposed to a range of traumatic and distressing incidents with impacts discussed variously as “burnout”, “compassion fatigue”, “secondary trauma stress” and “vicarious traumatisation”. This study aims to explore the short- and long-term psychological and physical health effects of trauma exposure in the workplace for frontline staff in a forensic setting.
Design/methodology/approach
Semi-structured interviews were conducted with 14 nursing staff members working in the male personality disorders care stream in a Medium Secure Hospital.
Findings
Thematic analysis yielded five themes: categories of trauma; how well-being is impacted; ways of coping and managing; protective factors; and systemic factors, with sub-themes within each of the superordinate themes.
Practical implications
The findings demonstrate that some staff members were affected both physically and psychologically as a result of trauma-focused work whereas other staff members were unaffected. The psychological and physical health effects were broadly short-term; however, long-term effects on staff member’s social networks and desensitisation to working conditions were observed. A broad range of coping methods were identified that supported staff member’s well-being, which included both individual and organisational factors. Staff member’s health is impacted by exposure to workplace trauma either directly or indirectly through exposure to material, and there is a greater need to support staff members after routine organisational provisions are complete. Staff should receive education and training on the possible health effects associated with exposure to potentially traumatic material and events.
Originality/value
This research has further contributed to understanding the staff needs of nursing staff members working with the forensic personality disorder patients within a secure hospital setting. This research has identified the following service developments: the need for ongoing support particularly after organisational provisions are complete; further prospects to engage in psychological formulations; greater opportunities for informal supervision forums; staff training to understand the potential health impact associated with trauma-focused work; supervisors being appropriately trained and supported to elicit impacts of trauma-focused work on staff members; and additional opportunities to discuss well-being or monitor well-being.
Objective
To explore the emotions experienced by the nurses of a Home Hospitalization Unitas a result of their work role.
Method
A qualitative exploratory study was carried out with a phenomenology approach toexplore people’s experiences and inner-life experiences. The participants were 9 nurses workingin the home hospitalization unit. An analysis of qualitative content was undertaken. Units ofmeaning were grouped into 13 codes that, in turn, were classified into 4 categories, emotionaldimension, beneficial and distressing aspects, daily working life and personal life.
Results
Nursing professionals working in palliative care suffer continuous exposure to traumaticsituations, although they also report feeling satisfactory emotions that compensate for momentsof distress. Having resources such as training in self-care and emotional regulation, as well associal support seems to be key to providing quality care and avoiding the onset of compassionfatigue.
Conclusions
Maintaining psychosocial well-being in the workplace is crucial for palliative care nurses to be able to undertake their work in the best possible way.
Working in palliative care services has an impact on the personal and professional lives of healthcare staff. The complex practicalities of the role and additional factors such as moral distress, burnout, compassion fatigue and death anxiety all impact on the overall quality of services and patient care. This article aims to highlight what is known of the practical and emotional challenges for palliative nursing care and offers recommendations to services to support staff at an organisational as well as individual level, to help create a more supportive workplace for staff and patients alike. It follows previous research on working in palliative and end-of-life care.
Purpose
Online charitable giving is prevalent, and how to attract individuals' attention to donate is essential for charities. Little is known about the interaction effect of empathy (donor) and vulnerability (receiver) on donate intention. To bridge this gap, this study aims to investigate whether the influence of empathy on charitable giving would be moderated by receivers' vulnerability, and if yes, what is the mechanism.
Design/methodology/approach
Five experiments were conducted in the context of charitable giving with 1,303 participants to test our hypotheses.
Findings
When empathetic individuals confronted high vulnerable receivers, they were less likely to donate; otherwise, they were more likely to donate when they confronted low vulnerable receivers, and this interaction effect was mediated by concern about self.
Originality/value
The present research identifies a novel moderator of the effect of empathy on charitable giving and elucidates the underlying mechanism of concern about self. Based on these findings, the authors provide actionable implications for charities by demonstrating the interaction effect of empathy and vulnerability on donate intention.
Objective:
To explore the emotions experienced by the nurses of a Home Hospitalization Unit as a result of their work role.
Method:
A qualitative exploratory study was carried out with a phenomenology approach to explore people's experiences and inner-life experiences. The participants were 9nurses working in the home hospitalization unit. An analysis of qualitative content was undertaken. Units of meaning were grouped into 13 codes that, in turn, were classified into 4 categories, emotional dimension, beneficial and distressing aspects, daily working life and personal life.
Results:
Nursing professionals working in palliative care suffer continuous exposure to traumatic situations, although they also report feeling satisfactory emotions that compensate for moments of distress. Having resources such as training in self-care and emotional regulation, as well as social support seems to be key to providing quality care and avoiding the onset of compassion fatigue.
Conclusions:
Maintaining psychosocial well-being in the workplace is crucial for palliative care nurses to be able to undertake their work in the best possible way.
Volunteers are a critical resource for many types of organizations and efforts need to be made to ensure they are satisfied with their experience. Using data from an online survey of 651 animal shelter volunteers this research explores the role of volunteer input or “voice” in the policies and practices of organizations, and its impact on satisfaction with the volunteer experience. The findings indicate that volunteers more negative about their opportunities for voice were significantly less satisfied with their experience overall. Further, there appears to be a relationship between the nature of the animal shelter and satisfaction with voice and the volunteering experience. Indeed, internal shelter factors are more important to volunteer satisfaction than the traits of the individual volunteer. Specifically, volunteers are more satisfied with their experience and with the extent of their opportunity for voice if they are at a limited intake shelter with higher save rates. Informed by survey data, this research recommends shelters implement several policies and practices to improve satisfaction with volunteer voice.
Most health care employees experience and are bolstered by compassion satisfaction as they deal with patients in need. However, the more empathetic a health care provider is, the more likely he or she will experience compassion fatigue. Compassion fatigue is a negative syndrome that occurs when dealing with the traumatic experiences of patients, and examples of symptoms include intrusive thoughts, sleeping problems, and depression. Compassion fatigue is different from burnout. Compassion fatigue is a rapidly occurring disorder for primary health care workers who work with suffering patients, whereas burnout, a larger construct, is a slowly progressing disorder for employees who typically are working in burdensome organizational environments. Managers can mitigate problems associated with compassion fatigue with a number of interventions including patient reassignments, formal mentoring programs, employee training, and a compassionate organizational culture. With burnout, health care managers will want to focus primarily on chronic organizational problems.
Based on a detailed job analysis, job-related personality dimensions and communication skills were used as predictors of hospice nurse performance. In particular, it was predicted that communication/social competence and certain dimensions of empathy (empathic concern, perspective-taking) would be positively related to hospice nurse performance, and that another type of empathy, personal distress, and trait dogmatism would be negatively associated with performance. Ninety-two hospice nurses were administered the battery of tests, and “file drawer” assessments of their performance were obtained. Possession of communication/social competence and certain dimensions of empathy led to good prediction of job performance. Implications for personnel screening and selection are discussed.
Stressors, coping and demographic variables were examined as predictors of burnout in a sample of hospice nurses. The study aimed to investigate the level of burnout among hospice nurses; to ascertain which aspects of nursing work were positively or negatively related to burnout; to examine the relative contributions made by these different variables and to suggest individual and organizational interventions to reduce levels of burnout.
Eighty-nine female nurses from nine hospices completed a battery of questionnaires comprising the Maslach Burnout Inventory, Nursing Stress Scale, Ways of Coping Scale and a demographic information form.
In general, the level of burnout (characterized by high emotional exhaustion, high depersonalization of patients and low personal accomplishment) was found to be low. In multiple regression analyses, 'death and dying', "conflict with staff', 'accepting responsibility' and higher nursing grade contributed to emotional exhaustion. 'Conflict with staff', 'inadequate preparation', 'escape' and reduced 'planful problem-solving' contributed to depersonalization. 'Inadequate preparation', 'escape', reduced 'positive reappraisal' and fewer professional qualifications contributed to lower levels of personal accomplishment. Overall, stressors made the greatest contribution to burnout and demographic factors contributed the least.
The importance of not labelling individuals as good and bad 'copers' was discussed, as the effectiveness of a strategy may depend on the situation. It was concluded that the investigation of problem-focused and emotion-focused coping in relation to burnout, was oversimplifying the coping-burnout relationship. Suggestions for stress management included staff training in counselling skills, monitoring staff conflict, implementing stress inoculation training to teach appropriate use of coping skills and finally, monitoring particularly vulnerable groups of hospice staff such as unqualified nursing assistants and qualified nurses in management positions. It was concluded that despite the difficult nature of hospice work, the hospice is a positive environment in which to work.
Psychotherapists who work with the chronic illness tend to disregard their own self-care needs when focusing on the needs of clients. The article discusses the concept of compassion fatigue, a form of caregiver burnout among psychotherapists and contrasts it with simple burnout and countertransference. It includes a multi-factor model of compassion fatigue that emphasizes the costs of caring, empathy, and emotional investment in helping the suffering. The model suggests that psychotherapists that limiting compassion stress, dealing with traumatic memories, and more effectively managing case loads are effective ways of avoiding compassion fatigue. The model also suggests that, to limit compassion stress, psychotherapists with chronic illness need to development methods for both enhancing satisfaction and learning to separate from the work emotionally and physically in order to feel renewed. A case study illustrates how to help someone with compassion fatigue.
This study compared death anxiety and frequency and severity of job stress in 30 hospice and 40 medical-surgical nurses. Death anxiety was assessed through the Templer/McMordie Death Anxiety Scale, job stress through the Gray-Toft/Anderson Nursing Stress Scale. There were no significant group differences in the death anxiety scores nor in the total scores for the frequency segment of the nursing stress scale. The medical-surgical nurses scored a significantly higher total for the severity segment of the nursing stress scale. Death anxiety correlated significantly with frequency and severity of job stress for medical-surgical nurses but not for hospice nurses. Death anxiety correlated highly significantly with death and dying as a source of stress for the medical-surgical nurses.
A study was undertaken in the hospice unit at a large, midwestern community hospital to investigate the sources of stress experienced by hospice nurses. The case material reported in this article is based on observations, interviews with nurses, written stressful incident reports completed by nurses, and support group discussions. A number of sources of stress experienced by hospice nurses are identified. Physical characteristics of the unit as well as staffing policies designed to improve the quality of care resulted in conflict and feelings of alienation from other hospital personnel. Procedures followed in admitting patients to the hospice created stress when they were not fully supported by hospital administrators and physicians. Other policies related to the preparation of meals and open visitation increased the nurse's work load. At the same time, greater involvement with the patient and family during the dying process resulted in increased emotional demands on the nurse. Nurses experienced a sense of loss when a patient they had grown attached to died or was discharged to another institution. Stress also resulted from the nurse's exclusive involvement with terminally ill patients. Continual involvement with dying patients precipitated anxiety and superstitions concerning the nurse's own vulnerability and was particularly stressful when the nurse had experienced the death of someone close to her outside of the hospital.
Early in the hospice movement, several goals were proposed. One goal was to identify and clarify those aspects of hospice care that were successful. To accomplish this, the people providing the hospice care should be the research focus. Nurses have emerged as essential professionals on the hospice team, and they are at the center of this study.
The primary goal of understanding nurses who provide hospice care is to improve the quality of care given and thus the quality of life for the hospice patient and family. For the current study, focused ethnography was the method used to identify and describe qualities of hospice nurses. The research was conducted in a freestanding, community-based hospice agency. Twelve descriptors emerged that seemed to capture the essence of hospice nurses. The most prominent quality identified was that of “attending or being humanly present with.”
It has become clear that nursing is a high-risk occupation with regards to stress-related diseases. In this study, we were interested in nurses’ experiences of stress and the emotions arising from stress at work. Results showed that nurses experienced negative stress which was apparently related to the social environment in which they worked. Four nurses were interviewed. The method used was grounded theory. Analysis of the interviews singled out absence of response as the core category. Recurring stressful situations obviously caused problems for the nurses in their daily work. Not only did they lack responses from their supervisors, they also experienced emotions of frustration, powerlessness, hopelessness and inadequacy, which increased the general stress experienced at work. Our conclusion is that the experience of absence of response leads to negative stress in nurses.
To begin examining the nature of vicarious or indirect trauma and to discuss risk factors and prevention strategies. Despite the fact that many nurses are traumatized indirectly, few recognize the insidious development of such trauma. The dynamics of indirect trauma are relevant to nursing as are risk factors and prevention strategies.
Brief review of the literature (1974-1997) on vicarious trauma, compassion fatigue, secondary traumatic stress disorder, and traumatic countertransference using short vignettes for illustration.
Nurses who are informed about vicarious trauma and who actively maintain a balanced personal and professional life are in the best position to bring themselves and their clients through the many hazards of trauma work. The implications of vicarious or indirect trauma for nurses and clients are serious and complex requiring thoughtful analysis and research to clarify its effects.
This study compared death anxiety and frequency and severity of job stress in 30 hospice and 40 medical-surgical nurses. Death anxiety was assessed through the Templer/McMordie Death Anxiety Scale, job stress through the Gray-Toft/Anderson Nursing Stress Scale. There were no significant group differences in the death anxiety scores nor in the total scores for the frequency segment of the nursing stress scale. The medical-surgical nurses scored a significantly higher total for the severity segment of the nursing stress scale. Death anxiety correlated significantly with frequency and severity of job stress for medical-surgical nurses but not for hospice nurses. Death anxiety correlated highly significantly with death and dying as a source of stress for the medical-surgical nurses.
The present study was undertaken to compare the occupational stress, levels of burnout, death anxiety, and the social support of a national sample of 376 hospice and critical care nurses. t tests indicated that critical care nurses reported significantly more occupational stress, showed higher burnout, and experienced more death anxiety than hospice nurses. The two nursing groups differed significantly when the three components of the Maslach Burnout Inventory were compared: hospice nurses reported feeling less emotional exhaustion, utilized the technique of depersonalization less frequently, and experienced a greater sense of personal accomplishment. The two nursing groups did not differ in social support when both the quantity and quality of that construct were examined. Pearson coefficients indicated positive associations between burnout and occupational stress and between burnout and death anxiety, with a negative relationship between burnout and social support.
This article presents results from a study of all hospice programs in a western state. Personal interviews and questionnaires were utilized to collect data about hospice programs, their directors, nurses, social workers, and chaplains. Results from this study indicate the hospice programs in one state do not uniformly deliver "total care," services designed to address physical, emotional, social, and spiritual needs. Caseloads for nurses were consistent at 9-12 patients per one Full Time Equivalent (FTE) while caseloads for social workers and chaplains varied widely from less than twenty patients per FTE to more than one hundred for some chaplains. Social workers and chaplains identified lack of time as a significant challenge, while nurses were challenged by the emotional needs of patients and families. Social workers and chaplains were significantly more likely than nurses to view the medical needs of patients as the primary focus of their hospice programs. Further, results indicate that characteristics of programs and directors were related to the availability of services and staff perceptions of hospice practices.
Thirty-three nurses from three hospice services in a large Midwestern city participated in this study, which investigated responses to difficult or demanding work-related situations. Three tools (the Self Inventory of Situational Responses-TC questionnaire, the Spielberger State Anxiety Inventory questionnaire and rank-ordered listing of likely causes of difficult or demanding situations) were used to collect data. Findings indicated that anxiety is an issue for hospice workers but that difficult or demanding situations were viewed as challenges rather than threats. Management of intractable symptoms and communication issues were of primary concern. Administrative concerns were identified as the third-ranking source of difficult situations. Issues related to death and dying were of notably less concern. Strategies for staff support also are identified.
Compassion fatigue is described as the emotional burden that health care providers may experience as a result of overexposure to a traumatic event that has befallen victims. Perioperative nurses are experiencing increased exposure to major traumatic events within their practice, especially those nurses who work in level 1 trauma centers. This article helps nurses identify risks for compassion fatigue and symptoms associated with this form of stress.
Burnout is a job-related state characterized by emotional and physical exhaustion which can be caused by intense involvement over an extended period of time with people who are experiencing psychological and/or physical problems. People working in the health care professions have been identified as being particularly at risk for experiencing burnout. Based on hospice staff survey data collected as a part of the National Hospice Study (NHS), this paper describes multivariate analyses of selected demographic, occupational, and organizational predictors of burnout. Findings indicated that younger, better-educated staff are more prone to burnout, as are staff who work on a full-time basis in direct contact with patients. None of the hospice organizational factors tested were significantly related to burnout. Further research is necessary to determine whether or not such factors as staff support systems are effective in mitigating burnout among staff in the health care field.
Burnout is a word currently used in discussions about the present nursing shortage. Hospice staff, because of their work with the terminally ill, are considered a high-risk group for burnout. Too frequently, the reason behind the decision to leave or take a sabbatical from hospice work is that the staff member reached the limits of his or her capacity to care and "couldn't take it any more." It is, therefore, important to discuss the concept of burnout and how it can affect hospice staff as well as the primary caregivers for hospice patients to ascertain the reasons behind it and take steps to lessen caregiver stress.
The nursing care of the dying patient in the home setting is considered highly stressful. As the population ages, the hospice census is expected to increase and the need to attract and retain hospice nurses will be vitally important. Understanding hospice nurses' perceived stress and coping mechanisms can lead to increased retention and higher employee satisfaction. The survey presented in this article identified the perceived stressors of hospice nurses, their stress relief methods, and organizational work issues.
A cross-sectional study of 437 ambulance officers in a large state of Australia examined the long-term effects of suppressing emotion reactions to exposure to trauma. Results indicate that the use of emotion-suppressing defenses (e.g., withdrawal or acting out) have a highly significant positive relationship with physical and psychological stress symptoms. Alexithymia scores were also positively associated with stress symptoms. In addition, there was a positive association between years of ambulance service and stress symptoms. Implications of the findings are discussed for recovery from exposure to trauma of emergency services personnel and more generally to the experience of survivors of trauma.
This quantitative and qualitative longitudinal study was designed to examine the effects on caregivers working therapeutically with seriously traumatized people. The participants were 13 healthcare workers seconded into a trauma and recovery team (TRT) set up to help those traumatized by the Omagh bombing on 15 August 1998. Quantitative data were collected using the Compassion Satisfaction/Fatigue Test and the Life Status Review Questionnaire. Qualitative data regarding positive and negative aspects of working with traumatized individuals, as well as caregiver's experience leaving the TRT, were gathered using open-ended questions contained in the final data set. These questionnaires were completed at four points in time: August 1998, December 1998, August 1999 and February 2001. Ethical approval for the study was gained from the Sperrin Lakeland Trust research committee. Analysis of the quantitative data indicated that levels of compassion fatigue and burnout increased, respectively, from 18.85 to 34.46 and 22.38 to 29.69 over the first year. Levels of compassion satisfaction decreased from 87.62 to 80.15, while levels of satisfaction with life (53.85 to 40.38) and life status (11.23 to 5.62) also decreased. Findings also demonstrated that compassion satisfaction is possibly a protective factor against compassion fatigue and burnout, in that caregivers with high compassion satisfaction scores were less likely to have corresponding high compassion fatigue and burnout scores. Findings from the qualitative data generated, revealed that team spirit and camaraderie, along with the satisfaction of seeing clients recover, were the most positive aspects of working in the team. Media interest, coping with and containing anger shown by bereaved relatives and dealing with the content of client's stories were the most negative. Themes to emerge from leaving the team included lack of understanding and support from non-trauma managers and an underestimation of the impact on caregivers of finishing in the team. Strategies that were found to be beneficial in helping to alleviate the negative effects of working with trauma were also elicited. This research has implications for practice, management and education.
An increasing number of publications examine the disturbing effects on clinicians of witnessing or learning of trauma experienced by their patients. This vicarious traumatisation is described in various terms, including secondary victimisation, secondary survival, emotional contagion, counter-transference, burnout and compassion fatigue. It is generally accepted that, while they have significant similarities, there are also differences between these phenomena. Central to these processes is the use of empathy by clinicians. What is the role of empathy in the doctor)patient relationship?
It has become clear that nursing is a high-risk occupation with regards to stress-related diseases. In this study, we were interested in nurses' experiences of stress and the emotions arising from stress at work. Results showed that nurses experienced negative stress which was apparently related to the social environment in which they worked. Four nurses were interviewed. The method used was grounded theory. Analysis of the interviews singled out absence of response as the core category. Recurring stressful situations obviously caused problems for the nurses in their daily work. Not only did they lack responses from their supervisors, they also experienced emotions of frustration, powerlessness, hopelessness and inadequacy, which increased the general stress experienced at work. Our conclusion is that the experience of absence of response leads to negative stress in nurses.
To investigate (a) the effect of job-related stress on job performance among hospital nurses, and (b) the effect of social support from coworkers on the stress-performance relationship.
A correlational descriptive survey was used to investigate these relationships among a convenience sample of 263 American hospital nurses and 40 non-American nurses who were accessible via the Internet.
Data were collected using a Web-based structured questionnaire, which included the Nursing Stress Scale, the Schwirian Six Dimension Scale of Nursing Performance, the McCain and Marklin Social Integration Scale, and the demographic form. Descriptive statistics, Pearson product-moment correlations, and hierarchical regression techniques were used to analyze the data.
Perceived social support from coworkers enhanced the level of reported job performance and decreased the level of reported job stress. The analysis also indicated a curvilinear (U-shaped) relationship between job stress and job performance; nurses who reported moderate levels of job stress believed that they performed their jobs less well than did those who reported low or high levels of job stress.
Results indicted the importance of social support from coworkers, as well as the need for further research to test the U-shaped relationship between job stress and job performance.
With the current and ever-growing shortage of nurses in the United States, it is imperative that nurses find ways to prevent burnout and effectively manage compassion fatigue that can result from working with traumatized populations. The aim of this study is to identify the triggers and coping strategies that nurses who work with children with chronic conditions use to manage compassion fatigue and prevent burnout.
In this descriptive qualitative pilot project, 20 experienced nurses who work with children with chronic conditions were interviewed about their experiences with compassion fatigue and burnout.
Findings indicate that compassion fatigue is commonly and episodically experienced by nurses working with children with chronic conditions and their families. Participants reported that insight and experience helped them develop short- and long-term coping strategies to minimize and manage compassion fatigue episodes and prevent burnout.
Nurses need to be able to identify signs of compassion fatigue and develop a range of coping strategies and a support system to revitalize their compassion and minimize the risk of burnout.
Hospices as providers of total care in one western state Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those who Treat the Traumatized
- Ma Sontag
Sontag MA. Hospices as providers of total care in one western state. HospJ. 1996;ll(3):71-94. 6. Figley CR, ed. Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those who Treat the Traumatized. New York: Brunner/Mazel; 1995.
Too tired to care? The psychological effects of working with trauma 355 I'T 29. National Center for Health Workforce Analysis. Projected supply, demand and shortages of registered nurses
- S Gollins
- Long
Gollins S, Long A. Too tired to care? The psychological effects of working with trauma. / Psychiatr Ment Health Nurs. 2003;] 0:17-23. JOURNAL OF HOSPICE AND PALLIATIVE NURSING @BULLET Vol. 8, No. 6, November/December 2006 355 I'T 29. National Center for Health Workforce Analysis. Projected supply, demand and shortages of registered nurses: 2000-2020. US Department of Health and Human Services. 2002;!-22.
Research information on the ProQOL-CSF-R-III Available at: http://www.isu.edu/~bhstamm/testsProQOL_ psychometric.htm
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