Predictors of compassion fatigue, burnout, and compassion satisfaction among emergency nurses: A cross-sectional survey

Compassion fatigue in helping professions: a scoping literature review

BACKGROUND

Generalizing the concept of compassion fatigue across healthcare settings or professions is difficult because compassion fatigue is a complex and abstract concept. Compassion fatigue is described as a result in the form of behaviors and emotions resulting from learning of another person's traumatic event. Compassion fatigue is considered a 'cost of caring.' This study was a scoping literature review that aimed to identify what is known about compassion fatigue in helping professions.

METHODS

A systematic search was conducted on electronic databases, namely ScienceDirect, PubMed, and Taylor and Francis. Data analysis was conducted using PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Study results were mapped based on the following criteria: 1) conceptual analysis; 2) predictor factors; and 3) research progress. A total of 43 articles met the inclusion and eligibility criteria for further review in this scoping literature review.

RESULTS

The results showed that it is difficult to imagine how a conceptual model of compassion fatigue could be equally relevant and applicable to various helping professions. Factors that can influence compassion fatigue are divided into personal factors (professional factors and sociodemographic factors), such as resilience, burnout, moral courage, emotional control, mindfulness, work experience, professional competence, and professional efficacy, and work-related factors such as traumatic experiences, life disorders, number of patients treated, job satisfaction, emotional support, social support, and fluctuations in interactions with suffering patients. Research on compassion fatigue has developed a lot, especially in the health sector, especially nursing using experimental, cross-sectional, and literature review research methods.

CONCLUSION

Further analysis is needed in developing a conceptual analysis of compassion fatigue that focuses on other fields of work more specifically and comprehensively by paying attention to, aspects, determinants, and validity of compassion fatigue symptoms.

Interventions for Compassion Fatigue, Burnout, and Secondary Traumatic Stress in Nurses: A Systematic Review and Network Meta-Analysis

This study uses network meta-analysis to evaluate the relative effectiveness of different interventions (behavioral, psychological, and comprehensive) in alleviating compassion fatigue, burnout, and secondary traumatic stress, as well as in improving compassion satisfaction among nurses, aiming to provide evidence-based insights for enhancing nurses' mental health and care quality. Compassion fatigue in nurses negatively affects their mental health, patient care quality, and healthcare efficiency. Various interventions (psychological, behavioral, and integrated) target this issue, but evidence on their effectiveness is inconclusive. Network meta-analysis. Randomized controlled trials on compassion fatigue interventions in nurses were reviewed, focusing on outcomes like compassion fatigue, satisfaction, burnout, and secondary traumatic stress. PRISMA guidelines were followed. Behavioral training significantly reduced compassion fatigue and improved compassion satisfaction. Comprehensive interventions were most effective in reducing burnout, while psychological interventions alleviated secondary trauma. Targeted, multifaceted interventions, especially behavioral and comprehensive strategies, effectively manage compassion fatigue, improving nurses' mental health, job satisfaction, and care quality.

Effectiveness of a Brief Mindfulness-Based Intervention on Compassion Fatigue and Compassion Satisfaction in Pediatric Nurses

BACKGROUND

Unlike other medical practitioners, nurses working in pediatric intensive care units face uniquely challenging workplace conditions because they care for preterm newborns and critically ill patients. These workplace challenges led to increased compassion fatigue (i.e., burnout and secondary traumatic stress) and decreased compassion satisfaction. Compassion fatigue and compassion satisfaction strongly influence the quality of care and patient outcomes, and these need to be addressed through effective interventions such as mindfulness-based interventions.

AIM

This study aimed to examine the impact of a brief mindfulness-based intervention on compassion fatigue and compassion satisfaction among pediatric intensive care nurses.

METHODS

A quasi experimental study with a pretest posttest design was used to recruit 204 nurses: 102 in the intervention group and 102 in the control group with randomization by hospital (n = 4). The brief mindfulness-based intervention was delivered over 6 weeks. Data were collected using a demographics questionnaire and the Professional Quality of Life Scale, Version 5.

RESULTS

The intervention group's mean scores of burnout and secondary traumatic stress were significantly lower postinterventions compared with the control group. Similarly, the mean compassion satisfaction score for the intervention group indicated a significant improvement post-intervention compared with the control group. Additional evidence for the effectiveness of the intervention was the disappearance of low compassion satisfaction, high burnout, and high secondary traumatic stress categorizations postintervention in the intervention group, contrary to the control group.

LINKING EVIDENCE TO ACTION

Implementing brief mindfulness-based interventions can improve pediatric intensive care nurses' well-being by reducing burnout and secondary traumatic stress while enhancing compassion satisfaction. By using the study's findings, nurse managers can make these practices essential for high-quality care and effective workforce management.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: ACTRN12622000389707.

Toward a Comprehensive Understanding of Nurses' Compassion Fatigue: A Meta-Integrative Qualitative Synthesis

AIMS

The study aims to conduct a thematic synthesis approach of existing qualitative research to synthesise the real experiences of nurses dealing with compassion fatigue. This integration seeks to provide a comprehensive overview, identify common themes, and offer theoretical support for developing effective intervention strategies to mitigate compassion fatigue in healthcare settings.

DESIGN

A thematic synthesis approach was utilised, synthesising qualitative studies on nurses' experiences of compassion fatigue.

DATA SOURCES

Data were collected from major academic databases, including PubMed, CINAHL, Scopus, and Web of Science. A total of 15 studies met the inclusion criteria.

REVIEW METHODS

This study systematically reviewed 11 qualitative research articles from China, the United States, Japan, Spain, Iran and Finland, involving 1076 nurses, to analyse and integrate the phenomenon of compassion fatigue among nurses and extract common themes.

RESULTS

The analysis revealed that the leading causes of compassion fatigue include insufficient time and resources, psychosocial stressors, compassion overload and organisational and environmental factors. The manifestations of compassion fatigue primarily consist of work-related difficulties and impacts on family life, emotional and physical exhaustion and a mix of positive and negative emotions. Coping strategies focus on self-care and emotional regulation, symptom recognition and response strategies and organisational interventions and training.

CONCLUSION

This study's findings provide theoretical support for healthcare institutions to develop effective intervention strategies to alleviate compassion fatigue among nurses and improve the quality of care.

IMPACT

The study contributes to the body of knowledge by systematically synthesising qualitative evidence on compassion fatigue among nurses. The results have practical implications for nursing management and policy, emphasising the need for supportive measures to protect nurses from compassion fatigue and ensure sustainable care practices.

PATIENT OR PUBLIC CONTRIBUTION

This research does not directly involve patients or public participants but focuses on synthesising the experiences of nurses as reported in existing studies, thereby indirectly contributing to improving patient care by addressing the well-being of healthcare providers.

Effort-reward imbalance and health outcomes in emergency nurses: the mediating role of work-family conflict and intrinsic effort

Background

Emergency nurses experience high stress, but the mechanisms linking effort-reward imbalance to health outcomes are unclear. Work-family conflict might mediate this relationship, and intrinsic effort could moderate it. This study aimed to explore these interactions and their impact on nurse health.

Methods

A prospective cross-sectional survey was conducted from 30 tertiary hospitals across 19 provinces in mainland China. Participants completed validated scales to measure effort-reward imbalance, work-family conflict, somatic symptoms, and mental health symptoms. Statistical analyses, including mediation and moderation, were performed using the PROCESS macro to evaluate the relationships between the variables.

Results

In this study, 1,540 emergency nurses were finally included. The analysis revealed that 80.5% of participants reported experiencing effort-reward imbalance, which was significantly associated with increased somatic symptoms and mental symptoms. Work-family conflict was identified as a significant mediator in the relationship between effort-reward imbalance and health outcomes, with a direct effect of effort-reward imbalance on overall symptoms (β = 0.554, p < 0.001). Additionally, intrinsic effort moderated the impact of effort-reward imbalance on work-family conflict; moderate levels of emotional investment provided protection against burnout, while excessive intrinsic effort heightened the risk of mental health deterioration (β = -0.104, p < 0.001).

Conclusion

These findings underscored the urgent need for targeted interventions that address both effort-reward imbalance and work-family conflict in healthcare settings. Enhancing workplace conditions and supporting emotional engagement among emergency nurses are essential strategies for improving their well-being and reducing burnout risk. Future research should focus on longitudinal studies to assess the effectiveness of these interventions over time.

Exploring the bidirectional relationship between job burnout and empathy in nurses: A longitudinal study

OBJECTIVES

This study explored the bidirectional relationship between job burnout and empathy among Chinese nurses.

METHODS

A nurse cohort was assessed longitudinally in 2020 (T1) and 2022 (T2). Participants completed the Maslach Burnout Inventory (MBI)-Human Services Survey and the Jefferson Scale of Empathy-Health Professionals.

RESULTS

Out of the 1090 nurses who participated in both assessments, 551 (50.6 %) exhibited job burnout. Nurses with no burnout, discontinued burnout, and newly developed burnout groups had higher levels of empathy than the persistent burnout group. There is a bidirectional negative association between empathy and job burnout, particularly in the depersonalization and low personal accomplishment. Notably, empathy did not predict the emotional exhaustion from burnout, but heightened emotional exhaustion predicted diminished empathy.

CONCLUSION

The findings suggest a significant bidirectional negative association between empathy and job burnout, especially in depersonalization and low personal accomplishment. Notably, nurses without burnout, discontinued burnout, and newly developed burnout exhibited higher levels of empathy, emphasizing the potential impact of addressing and mitigating burnout on fostering empathetic behavior.

PRACTICE IMPLICATIONS

Interventions targeting both burnout and empathy are vital for nurses. Recognizing and addressing burnout can positively impact fostering empathetic behavior in nursing practice.

Development and validation of a machine learning-based predictive model for compassion fatigue in Chinese nursing interns: a cross-sectional study utilizing latent profile analysis

BACKGROUND

Compassion fatigue is a significant issue in nursing, affecting both registered nurses and nursing students, potentially leading to burnout and reduced quality of care. During internships, compassion fatigue can shape nursing students' career trajectories and intent to stay in the profession. Identifying those at high risk is crucial for timely interventions, yet existing tools often fail to account for within-group variability, limiting their ability to accurately predict compassion fatigue risk.

OBJECTIVES

This study aimed to develop and validate a predictive model for detecting the risk of compassion fatigue among nursing students during their placement.

DESIGN

A cross-sectional study was used to capture the prevalence and associations of compassion fatigue among nursing interns, as it allows for timely assessment of key influencing factors without requiring long-term follow-up.

METHODS

A convenience sampling strategy was used to recruit 2256 nursing students from all ten public junior colleges in Hunan province in China between December 2021 and June 2022. Participants completed questionnaires assessing compassion fatigue, professional identity, self-efficacy, social support, psychological resilience, coping styles, and demographic characteristics. Predictors were selected based on prior literature and theoretical frameworks related to compassion fatigue in nursing. Latent profile analysis was used to classify compassion fatigue levels, and potential predictors were identified through univariate analysis and least absolute shrinkage and selection operator (LASSO) regression. Eight machine learning algorithms were applied to predict compassion fatigue, with performance assessed through cross-validation, calibration, and discrimination metrics. The best-performing model was further validated to ensure robustness.

RESULTS

A three-profile model best fits the data, identifying low (55.73%), moderate (32.17%), and severe (12.10%) profiles for compassion fatigue. Generally, an area under the curve (AUC) above 0.700 is acceptable, and above 0.800 indicates good predictive performance. The AUC values for the eight machine learning models ranged from 0.644 to 0.826 for the training set and 0.651 to 0.757 for the test set, indicating moderate to good discriminatory ability. The eXtreme Gradient Boosting (XGBoost) performed best, with AUC values of 0.840, 0.768, and 0.731 in the training, validation, and test sets, respectively. Shapley Additive Explanation (SHAP) analysis interpreted the model by quantifying the contribution of each variable to the prediction, revealing that psychological resilience, professional identity, and social support were the key contributors to the risk of compassion fatigue. A user-friendly, web-based prediction tool for calculating the risk of compassion fatigue was developed.

CONCLUSIONS

The XGBoosting classifier demonstrates excellent performance, and implementing the online tool can help nursing administrators manage compassion fatigue effectively. It holds practical value for nursing education and practice by supporting early detection and intervention. Future research should validate its use across settings, and longitudinal studies could assess its long-term impact.

The dual roles of empathy in mediating structural empowerment and compassion fatigue among Chinese nurses

BACKGROUND

Nurses in dynamic healthcare environments face escalating challenges that impact their efficacy and well-being. These challenges arise from both the increasing complexity of medical procedures and the intense emotional demands of caregiving, often leading to compassion fatigue. A global prevalence of burnout at 30.0% was observed over the past decade. This study examines the relationship between structural empowerment, empathy (cognitive and affective), and compassion fatigue among Chinese nurses. Understanding these relationships is crucial for developing strategies to mitigate compassion fatigue. It also contributes to enhancing nurses' well-being.

METHODS

Conducted at a public hospital in Shanghai, this cross-sectional study surveyed 305 nurses, with 277 valid responses. Structural empowerment was measured using the Conditions for Work Effectiveness Questionnaire-II, empathy with the Kiersma-Chen Empathy Scale, and compassion fatigue with the Compassion Fatigue Short Scale. We performed correlation and mediation analyses to explore the direct and indirect effects of structural empowerment on compassion fatigue through empathy.

RESULTS

A significant negative direct effect of structural empowerment on compassion fatigue was evidenced by a coefficient of -0.165 (confidence interval: [-0.311, -0.013]). Further analysis revealed a negative indirect effect through cognitive empathy, indicated by an effect of -0.103 (confidence interval: [-0.220, -0.008]). Increased structural empowerment was linked to higher levels of cognitive empathy, which correlated with decreased compassion fatigue. Conversely, the mediation through affective empathy showed a positive indirect effect, indicated by an effect of 0.126 (confidence interval: [0.047, 0.229]). This suggests that higher structural empowerment was associated with increased affective empathy, leading to higher levels of compassion fatigue.

CONCLUSION

The study illuminates the dual role of empathy within the framework of structural empowerment and its impact on compassion fatigue. Cognitive empathy serves as a protective factor, reducing susceptibility to compassion fatigue, while affective empathy appears to heighten vulnerability. These findings provide direct evidence supporting the dual processing pathways of empathy. It is recommended that healthcare policies integrate organizational support with targeted empathy training, such as cognitive reappraisal, emotion regulation, and peer support, to effectively counteract compassion fatigue among nurses. However, due to the cross-sectional nature and the single-hospital setting, the findings should be interpreted cautiously.

Professional quality of life profiles and its associations with turnover intention and life satisfaction among nurses: a prospective longitudinal study

BACKGROUND

Nursing shortage is a global issue. Turnover intention and life satisfaction are significant predictors of turnover. The specific nature of nursing and stressful work schedules lead to impaired professional quality of life (ProQOL), and existing studies have confirmed the effect of a dimension of ProQOL (such as secondary trauma stress, burnout and compassion satisfaction) on turnover intention and life satisfaction. Yet the heterogeneity of ProQOL across individuals is not known. A lack of research on the relationship between potential ProQOL subgroups and turnover intention and life satisfaction, and the mechanisms underlying this relationship remain understudied. The study aimed to determine different ProQOL profiles, and their cross-sectional and longitudinal effects on turnover intention and life satisfaction, while exploring the mediating roles of job satisfaction and work engagement within the relationship.

METHODS

Data were collected at a tertiary hospital in a northeastern province of China. An online questionnaire was administered twice over the course of six months. 1832 and 900 participates provided cross-sectional and longitudinal data respectively. We used latent profile analysis (LPA) and K-means clustering to identify ProQOL profiles, and used the PROCESS macro program to conduct mediation analysis.

RESULTS

The LPA results supported a 4-profile solution, including balanced protection, good quality, traumatic satisfaction and burnout problem. ProQOL profiles directly predicted nurses' current and subsequent turnover intention and life satisfaction. In addition, job satisfaction and work engagement mediated the effects of ProQOL profiles on turnover intention and life satisfaction in cross-sectional sample, and mediated the effects of ProQOL profiles on turnover intention in longitudinal sample.

CONCLUSION

The findings suggest that nurses' ProQOL has distinct categorical characteristics and is strongly associated with turnover intention and life satisfaction. Hospital administrators should implement individualized, join management and interventions according to each profile. Furthermore, more attentions should focus on improving nurses' job satisfaction and work engagement levels to promote good work and life outcomes.

The relationships among factors affecting compassion fatigue, compassion satisfaction, and burnout in Japanese nurses: A cross-sectional study

AIM

This study aimed to investigate the relationships among factors affecting compassion fatigue/secondary traumatic stress, burnout, and compassion satisfaction in Japanese nurses, focusing on self-compassion, fears of compassion, and attachment styles.

METHODS

This cross-sectional observational study enrolled 400 clinical nurses (aged ≥20 years) in Japan, registered with an online survey company, from June 6 to June 26, 2021. The subjects completed a web-based questionnaire that assessed compassion fatigue/secondary traumatic stress, burnout, compassion satisfaction, self-compassion, fears of compassion for self, anxiety, and avoidance. Additionally, descriptive statistics, correlation analysis, multiple regression analysis and path analysis were performed to examine the relationships among the influencing factors.

RESULTS

Compassion fatigue/secondary traumatic stress was influenced by anxiety and fears of compassion for self (R2 = .31). Burnout was affected by compassion fatigue/secondary traumatic stress, compassion satisfaction, self-compassion, anxiety, and avoidance (R2 = .63). Compassion satisfaction was impacted by self-compassion, anxiety, and fears of compassion for self (R2 = .31). Additionally, self-compassion (R2 = .28) and fears of compassion for self (R2 = .55) were influenced by anxiety and avoidance.

CONCLUSIONS

Compassion fatigue/secondary traumatic stress leads to burnout, whereas compassion satisfaction moderates burnout. Furthermore, there were associations among the factors leading to compassion fatigue/secondary traumatic stress and burnout and compassion satisfaction. Therefore, an approach that enhances self-compassion and promotes the development of a stable attachment style could mitigate compassion fatigue/secondary traumatic stress and fears of compassion for self while moderately maintaining and improving compassion satisfaction.

Differences in compassion satisfaction and compassion fatigue among oncology nurses in Oman: A multi-center cross-sectional study

BACKGROUND

Oncology nurses are constantly exposed to occupational exposure to the suffering of others, which can lead to vicarious traumatization, low professional quality of life (ProQOL), and inability to provide quality nursing care. The purpose of the study is to explore the ProQOL of oncology nurses working in Oman and the characteristics that lead to differences in compassion satisfaction (CS) and compassion fatigue (CF).

MATERIALS AND METHODS

A cross-sectional design was conducted between March and December 2020 using the ProQOL scale to collect data from 242 oncology nurses in Oman using a convenience sampling technique. The rates of CS and CF [(secondary traumatic stress (STS) and burnout (BO)] were summarized using descriptive statistics. The characteristics leading to differences in CS and CF were assessed using the independent-sample t-test.

RESULTS

Only 35% reported high levels of CS. Most nurses reported moderate STS (60%) and BO (65%). Nurses aged ≥36 years, ≥10 years of professional experience, ≥6 years of oncology experience, married, and desiring to work with cancer patients reported higher levels of CS.

CONCLUSION

Omani oncology nurses have low levels of CS. The nurses' desire to work with cancer patients, professional experience, and the age of cancer patients regularly affected the experience of CF. The identified characteristics can be exploited to mitigate deterioration in oncology nurses' ProQOL using targeted interventions for high-risk individuals. Beneficial interventions may focus on continuing education, stress management, coping, work environment, teamwork, and communication of oncology nurses and other members of the healthcare team.

Preventing Trauma and Grief in Emergency and Critical Care Units: A Mixed Methods Study on a Psycho-Educational Defusing Intervention

Emergency and critical care services inevitably expose their staff to potential work stressors and traumatic events, which can cause emotional, behavioral, and physical reactions. The literature presents a wide range of evidence-based knowledge on the effectiveness of interventions to promote mental health after traumatic events. However, little is known about the effectiveness of prevention programs. In this study, we sought to improve the empirical understanding of the potential of a combination of psycho-educational-defusing training for trauma prevention. We employed a mixed methods approach using statistical modeling and content/focus group analysis to describe the sample of investigation and the effectiveness of the prevention training. A retrospective quantitative chart measured and evaluated the psychological state of physicians, nurses, and registered nurses (N = 222). A retrospective qualitative chart examined staff accounts of traumas and their coping strategies via autobiographies (n = 26). Prospective focus groups examined participants of the psycho-educational defusing intervention administered (n = 61). Findings revealed different forms of experiencing grief and trauma. Prospective analysis of the training effectiveness revealed favorable perceptions by participants. Results support the formal implementation of continuous prevention, building relational support, and coping strategies as keys to recovery and preventing traumas.

Evaluating the feasibility and preliminary effects of an online compassion training program for nursing students: A pilot randomized controlled trial

Objectives

This study aimed to assess the feasibility of an online compassion training program for nursing students and preliminarily investigate its effects on mindfulness, self-compassion, and stress reduction.

Methods

This study employed a randomized controlled trial design. Second-year students from a nursing college in Guangzhou, China, were recruited as research participants in August 2023. The intervention group participated in an 8-week online compassion training program via the WeChat platform, comprising three stages: mindfulness (weeks 1-2), self-compassion (weeks 3-5), and compassion for others (weeks 6-8). Each stage included four activities: psychoeducation, mindfulness practice, weekly diary, and emotional support. Program feasibility was assessed through recruitment and retention rates, program engagement, and participant acceptability. Program effectiveness was measured with the Mindful Attention Awareness Scale, Self-Compassion Scale - Short Form, and Perceived Stress Scale.

Results

A total of 28 students completed the study (13 in the intervention group, 15 in the control group). The recruitment rate was 36.46%, with a high retention rate of 93.3%. Participants demonstrated high engagement: 69.2% accessed learning materials every 1-2 days, 93.3% practiced mindfulness at least weekly, with an average of 4.69 diary entries submitted per person and 23.30 WeChat interactions with instructors. Regarding acceptability, all participants expressed satisfaction with the program, with 92.4% finding it "very helpful" or "extremely helpful." In terms of intervention effects, the intervention group showed a significant increase in mindfulness levels from pre-intervention (51.54 ± 10.93) to post-intervention (62.46 ± 13.58) (P < 0.05), while no significant change was observed in the control group. Although there were no statistically significant differences between the two groups in post-intervention self-compassion and perceived stress levels, the intervention group showed positive trends: self-compassion levels increased (35.85 ± 8.60 vs. 40.85 ± 5.54), and perceived stress levels slightly decreased (44.77 ± 8.65 vs. 42.00 ± 5.77).

Conclusions

This pilot study demonstrated the feasibility of an online compassion training program for nursing students and suggested its potential effectiveness in enhancing mindfulness, self-compassion, and stress reduction. Despite limitations such as small sample size and lack of long-term follow-up, preliminary evidence indicates promising prospects for integrating such training into nursing education. Further research is warranted to confirm these findings and assess the sustained impact of this approach on nursing education and practice.

Development and Implementation of a Multidimensional Narrative Support System for Emergency Nurses: An Action Research

Background

Emergency nurses may experience various fatiguing duties and suffer more pressure, so it is necessary to promote their professional or work-related quality of life, especially during tough periods.

Aim

To describe the development of the multidimensional narrative support system and explore its effectiveness and feasibility among emergency nurses.

Design

An action research was conducted in Shanghai, China, from 2022 to 2023.

Methods

Two cycles of action research were adopted in the emergency departments of two tertiary general hospitals in Shanghai, China. A total of 20 and 13 emergency nurses from different posts participated in each cycle. Multiple methods and tools, such as validated instruments, self-designed questionnaires, and individual and focus group interviews, were used to collect short- and long-term data. The EQUATOR guidelines on reporting action research were used as the guideline for this study.

Results

The multidimensional narrative support system was gradually modified to promote its feasibility. Involved emergency nurses actively participated in different activities and proposed relatively positive and satisfying remarks. Quantitative data showed the significantly instant or long-lasting improvements in emergency nurses' professional and work-related quality of life, as well as their self-compassion, and perceived social support. Various categories were summarized about the participants' experiences, perceived long-term effects, and suggestions on the multidimensional narrative support system.

Conclusion

The multidimensional narrative support system integrates narrative methods and psychological activities and provides multidimensional support for emergency nurses. In spite of various challenges, the system shows good feasibility and significant influences on emergency nurses' well-being and quality of life. Implications for Nursing Management. The multidimensional narrative support system may action as a novel intervention for the overall improvements of clinical emergency nurses, which can be recommended to other populations with targeted modifications and training, so as to achieve good generalization in different departments.

Development and validation of the hospice professional coping scale among Chinese nurses

BACKGROUND

Hospice care professionals often experience trauma patient deaths and multiple patient deaths in a short period of time (more so than other nurses). This repeated exposure to the death process and the death of patients leads to greater psychological pressure on hospice care professionals. But at present, people pay more attention to the feelings and care burden of the family members of dying patients but pay less attention to medical staff. Thus, this study aimed to develop a scale on the burden of care for hospice care providers and assess the coping capacity of hospice professionals. Raising awareness of the psychological burden of hospice professionals.

METHODS

Through a literature review, research group discussion, Delphi method and a pre-survey of professional coping skills among nurses, 200 hospice professionals who had received training in hospice care from pilot institutions engaged in or providing hospice care were selected for investigation. Cronbach's α coefficient and split-half reliability were used to test the internal consistency of the scale, and content validity and explore factor analysis (EFA) were used to test the construct validity of the scale.

RESULTS

Two rounds of Delphi methods were carried out, and the effective recovery rate was 100%. The expert authority coefficients of the two rounds were 0.838 and 0.833, respectively. The Kendall's W coefficient of experts in the first round was 0.121 ~ 0.200 (P < 0.05), and the Kendall's W coefficient of the second round was 0.115-0.136 (P < 0.05), indicating a good level of expert coordination. The final survey scale for the care burden of hospice professionals included four dimensions-working environment (9 items), professional roles (8 items), clinical nursing (9 items) and psychological burden (7 items)-with a total of 33 items. The total Cronbach's α coefficient of the scale was 0.963, and the Cronbach's α coefficients of the working environment, professional roles, clinical nursing and psychological burden dimensions were 0.920, 0.889, 0.936 and 0.910, respectively. The total split-half reliability of the scale was 0.927, and the split-half reliability of each dimension was 0.846, 0.817, 0.891, and 0.832. The content validity of the scale items ranged from 0.90 to 1.00. Exploratory factor analysis revealed 5 common factors, with a total cumulative contribution rate of 68.878%. The common degree of each item in the scale was > 0.4, and the factor loading of each item was also > 0.4.

CONCLUSION

The scale is an open-access, short, easy-to-administer scale. And which for assessing hospice care burden among hospice professionals developed in this study demonstrated strong reliability and validity. This tool can serve as a dependable instrument for evaluating the burden of hospice care for terminally ill patients by professionals in the hospice setting.

Areas of work-life, psychological capital and emotional intelligence on compassion fatigue and compassion satisfaction among nurses: A cross-sectional study

AIM

To examine the impact of six areas of work-life, emotional intelligence and psychological capital on compassion fatigue and compassion satisfaction among Canadian Registered Nurses and licensed practical nurses.

DESIGN

A cross-sectional survey study.

METHODS

A convenience sample of 296 Registered Nurses and 110 licensed practical nurses answered a self-administered questionnaire measuring areas of work-life, psychological capital, emotional intelligence, compassion satisfaction and compassion fatigue in September 2019. The association between variables were analysed with descriptive and correlational analyses, while the hypothesized models were tested using multiple regression analyses.

RESULTS

This study identified several areas of work-life and intrapersonal resources that impacted compassion satisfaction and compassion fatigue. Among Registered Nurses, compassion satisfaction was predicted by psychological capital, rewards, values and workload. Compassion fatigue was predicted by psychological capital, workload, control and community. Among licensed practical nurses, compassion satisfaction was predicted by psychological capital and emotional intelligence. Compassion fatigue was predicted by workload and psychological capital. Study results also revealed significant differences in Registered Nurses' and licensed practical nurses' perceptions of workload, rewards and fairness at work, and both compassion satisfaction and compassion fatigue. Registered Nurses perceived their workload to be more manageable and perceived greater rewards and greater fairness at work than licensed practical nurses. Compassion fatigue was higher for Registered Nurses than licensed practical nurses, while compassion satisfaction was higher for licensed practical nurses than Registered Nurses. Future studies should investigate the nature and span of these differences to suggest relevant strategies to mitigate compassion fatigue and promote compassion satisfaction for each of these nursing roles.

CONCLUSION

The results of this study underscore the need to create nursing work environments that foster a manageable workload and positive social relationships, where nurses have professional autonomy, decision-making capacities and access to adequate resources to do their job effectively. The nursing work environment should also provide recognition of nurses' contributions and an alignment between personal and organizational values. Investments in the development and improvement of nurses' psychological capital and emotional intelligence should be prioritized since they are malleable and impactful intrapersonal resources on compassion satisfaction and compassion fatigue.

REPORTING METHOD

This study adhered to the STROBE guidelines.

PUBLIC CONTRIBUTION

A total of 406 nurses were involved in this study by answering a self-administered study survey.

A cross-sectional survey on the relationship between workplace psychological violence and empathy among Chinese nurses: the mediation role of resilience

BACKGROUND

Workplace violence is one of the most serious public health issues worldwide in healthcare occupations, nurse is a profession which faces the greatest risk of exposure to workplace violence among healthcare occupations.

OBJECTIVE

The present study aimed to explore the relationship between workplace psychological violence and empathy among Chinese nurses, and further examine the mediation role of resilience in this relationship.

METHOD

A cross-sectional survey was conducted among a convenience sample of clinical registered nurses in Xinjiang China from 29 September 2023 to 19 October 2023.The online questionnaire, contained the general information form, the Workplace Psychologically Violent Behaviors Instrument, the Jefferson Scale of Empathy-Healthcare Professionals Version, and the Connor-Davidson Resilience Scale, was used to collect data. The IBM SPSS statistics software version 22.0 was used to perform data analyses in forms of descriptive statistics, correlation analysis, and mediation analysis.

RESULT

This survey recruited a convenience sample of 1613 clinical registered nurses aged 22 to 55 years who come from diverse ethnicities and worked in different departments. A total of 534 nurse experienced psychological violent, which yielded a positive rate of 33.1% for psychological violent among nurses. Pearson analysis reported a negative correlation between psychological violences and empathy (r=-0.724, P < 0.01) as well as a negative correlation between psychological violences and resilience (r=-0.681, P < 0.01). Mediation analysis reported that resilience mediated the negative relationship between psychological violence and empathy, the mediation effect accounted for ab/(ab + c') = 23.40% of the total effect.

CONCLUSION

This study supported an inverse ralationship between psychological violence and empathy among Chinese nurses where resilience acted as a protective factor to mediated the negative impacts of psychological violences on empathy These results directed health policies and clinical interventions to equip nurses with resilience to copy with and recover from workplace psychological violence.

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

BACKGROUND

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

AIMS

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Workplace humour, compassion, and professional quality of life among medical staff

Background: Professional quality of life pertains to the balance between compassion fatigue and compassion satisfaction. In recent years, there was an increase in compassion fatigue among medical staff due to the pandemic, all over the world, while compassion satisfaction was reported at a moderate level.Objectives: The aim of this study was to identify the relationship between workplace humour and professional quality of life among medical staff, as well as the moderating role of compassion in this relationship.Method: The sample consisted of 189 participants (Mage = 41.01; SD = 9.58). Of the total sample, 57.1% are physicians, 32.3% are nurses and 6.9% are clinical psychologists. The participants completed scales measuring compassion, workplace humour, and professional quality of life.Results: The results showed that self-enhancing and affiliative humour were positively related, while self-defeating humour was negatively related to compassion satisfaction. Burnout and secondary traumatic stress were negatively related to self-enhancing humour and positively related to self-defeating humour. Compassion moderated the relationship between affiliative humour and secondary traumatic stress.Conclusions: Encouraging coping strategies based on adaptive humour (i.e. affiliative humour, self-enhancing) and raising awareness about negative humour strategies (i.e. self-defeating) could contribute to an increase of quality of life among healthcare providers. Another conclusion derived from the present study sustains that compassion is a valuable personal resource positively related to compassion satisfaction. Compassion also facilitates the relationship between affiliative humour and low secondary traumatic stress. Thus, encouraging compassionate skills could be beneficial for the optimal professional quality of life.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Construction and evaluation of a predictive model for compassion fatigue among emergency department nurses: A cross-sectional study

BACKGROUND

Compassion fatigue is a syndrome resulting from long-term work-related traumatic event stress exposure of medical staff. The emergency department is considered to be a high-risk, high-intensity and high-stress work environment, with a high prevalence of trauma and violence. Nurses in the emergency department are more prone to compassion fatigue than nurses in other departments. Compassion fatigue not only affects the physical and mental health, and job satisfaction of emergency department nurses, but also causes serious consequences for patients, such as poor patient outcome, medical errors, and increased patient mortality during hospitalization.

OBJECTIVES

Our study aims to develop and evaluate a predictive model for compassion fatigue among emergency department nurses.

DESIGN

A cross-sectional study.

DATA SOURCES

The emergency department nurses (N = 1014) were recruited from 21 tertiary hospitals (from Chengdu, Chongqing, Guiyang, Guangzhou and Shanghai) in central, southwestern, southern, and eastern China from July 25, 2022 to October 30, 2022.

METHODS

Univariate and multiple logistic regression analyses were used to determine the potential predictive factors associated with compassion fatigue in emergency department nurses. A nomogram was built based on the predictive factors and internally evaluated using a bootstrap resampling method (1000 bootstrap resamples). The performance of the predictive model was evaluated by measuring the Hosmer-Lemeshow goodness of fit test and calibration curve.

RESULTS

The prevalence of compassion fatigue among emergency department nurses was 75.9 %. The multiple logistic regression analysis revealed that the independent predictive factors for compassion fatigue among emergency department nurses were working position, job satisfaction, diet habit, sleep hours per day, occupational stress, physical harassment and the level of workplace violence, all of which were identified to create the nomogram. The Hosmer-Lemeshow goodness of fit test indicated that the predictive model was well calibrated (χ2 = 11.520, P = 0.174). The bootstrap-corrected concordance index of nomogram was 0.821 (95 % CI: 0.791-0.851). The calibration curve of the nomogram showed good consistency between the predicted and actual probabilities.

CONCLUSIONS

A predictive model of compassion fatigue among emergency department nurses has been developed, based on the general demographic, work-related and lifestyle characteristics, occupational stress, and workplace violence, with satisfactory predictive ability. This model can identify emergency department nurses who are at high risk of compassion fatigue. Our study provides an empirical basis for early detection, early diagnosis and early intervention of emergency department nurses at high risk of compassion fatigue.

Social support, empathy and compassion fatigue among clinical nurses: structural equation modeling

BACKGROUND

Clinical nurses are at high risk for compassion fatigue. Empathy is a prerequisite for compassion fatigue, and social support is an important variable in the process of reducing individual stress. However, the role of social support in the relationship between empathy and compassion fatigue remains unclear. This study explored whether social support mediates the relationship between empathy and compassion fatigue among clinical nurses.

METHODS

A total of 992 clinical nurses were recruited through convenience sampling for a cross-sectional study in Central China. They completed the General Information Questionnaire, Perceived Social Support Scale, Professional Quality of Life Scale, and Jefferson Scale of Empathy. SPSS was used to conduct descriptive statistical analyses. Pearson's or Spearman's correlation analyses and AMOS were employed to build a structural equation model (SEM) to verify the mediating effect of social support on the relationship between empathy and compassion fatigue.

RESULTS

The results indicated that the standardized direct effect of empathy on compassion fatigue was 0.127, and the standardized indirect effect of empathy on compassion fatigue through social support was 0.136. The mediation effect ratio between empathy and compassion fatigue was 51.7%.

CONCLUSIONS

Our findings show that social support mediates the relationship between empathy and compassion fatigue among clinical nurses. This finding suggests that increasing nurses' social support can decrease the prevalence of compassion fatigue. Nursing managers should provide training related to flexibly adjusting empathy and educating nurses to establish effective social networks with family, friends, and colleagues to prevent compassion fatigue.

Sleep Disturbance and Occupational Fatigue in Emergency Nurses of Public Hospitals in Greece: A Cross-Sectional Study

The emergency department (ED) is a stressful workplace for nurses, due to heavy workload and work shifts, which affect sleep quality, causing occupational fatigue. As a result, nurses burn out and turn over and quality of care is impaired. The aim of this study was to investigate sleep disturbance (SD) and occupational fatigue (OF) in emergency nurses of public hospitals in Greece. This descriptive cross-sectional study was conducted in the ED of tertiary public hospitals in Greece from September 2019 to October 2021, after the approval from the scientific and ethical committee of hospitals and the full informed consent of participants. The Standard Shift work Index (SSI) questionnaire was used, which includes 12 question groups about sleep habits and OF evaluation for shift workers, as nurses. Two hundred and ten ED nurses were recruited for the purpose of the study. In this research their quality of life, sleep completeness, and fatigue levels were studied. A moderate level of SD (total score = 70.54) of nurses was found that was related to marital status, presence of children, and underlying diseases (p = 0.012, p = 0.024, and p = 0.002, respectively). OF was assessed at low levels (score = 27.34) and was mainly related to age, with younger nurses reporting less fatigue compared with older nurses. The effect of work shifts in SD and OF of ED nurses was well documented. ED nurses' OF was correlated with increased SD, age, and marital status. Further research is needed for a better assessment and understanding of the factors that influence SD and OF of ED nurses to plan a strategy to optimize sleep patterns of work shift ED nurses.

Provision of Compassionate and Empathic Care as a Well-Being Preservation Tool for Emergency Physicians: A Scoping Review

Objective

Compassion and physician well-being are two key components related to quality care in health including emergency medicine. The objective of this study was to explore the impact of compassion in care on the well-being of emergency physicians. We conducted a scoping review to explore the impact of provision of compassionate care by emergency physicians on their well-being and subconcepts.

Methods

Four electronic databases and grey literature were searched to find evidence related to compassion, empathy, self-compassion, and their impact on emergency physicians' well-being. Following title and abstract review, two reviewers independently screened full-text articles, and extracted data. Data were presented using descriptive statistics and a narrative analysis.

Results

A total of 803 reports were identified in databases. Three articles met eligibility criteria for data extraction. None directly examined compassion and well-being. Included studies addressed empathy and burnout in emergency medicine professionals.

Conclusion

No high-quality evidence could be found on the topic in the population of interest. Literature related to the topic of compassion in physicians, especially in emergency physicians, a field known for its high demand and stress levels, is currently scarce and additional evidence is needed to better describe and understand the association between physicians' compassion and well-being.

Compassion fatigue and anxiety in critical care emergency nurses: In between efficiency and humanity

OBJECTIVES

To determine the emotional impact of permanent proximity to trauma and death in the Emergency and ICU's nurses establishing prevalence of Compassionate Fatigue (burnout and Secondary Traumatic Stress) and anxiety. Analyze its relationship with sociodemographic, training, workplace and psychological variables.

METHODS

Descriptive, cross-sectional and multicentre study. The validated ProQOL v. IV and STAI scales and an ad-hoc questionnaire with the variables of the second objective were used in 710 nurses from nine highly complex hospitals in Catalonia (Spain).

RESULTS

In both units, the prevalence of professionals affected with high scores of burnout was higher than 20%, on Secondary Traumatic Stress was 30% and, 12% on anxiety. Each subscale was significantly associated with the intention to leave units and the career. 97% of participants stated that they needed to be trained in emotional management.

CONCLUSION

The prevalence of burnout and Secondary Traumatic Stress were higher in our study than those offered in the reference literature in emergency and ICU nurses. The prevalence of each construct was individually related to the desire to leave work units and career. This fact, together with the participants' desire to be better trained in emotional management exposes the need to establish educational plans, as well as institutional measures to prevent and support nurses for Compassion Fatigue.

Implementing a Resilience Bundle for Emergency Nurses: An Evidence-Based Practice Project

INTRODUCTION

Resilience bundles are designed to work within and enhance existing routines. In the wake of COVID-19, nurses are reporting high levels of burnout and are leaving the field at an alarming rate. Hospital system leaders across the country are working to develop wellness programs to improve nurse morale, decrease burnout, and enhance resilience. Resilience can help mitigate nurse burnout, and using a bundle of tools to help nurses develop resilience is more effective than a single strategy.

METHODS

Using the Connor-Davidson Resilience Scale-10 and the Perceived Stress Scale 4, emergency nurses were surveyed to measure resilience and stress before and after implementation of a 3-strategy resilience bundle. We surveyed at baseline, phase 1 (6 weeks after implementation), and phase 2 (15 weeks after implementation).

RESULTS

A statistically significant increase in the Connor-Davidson Resilience Scale-10 scores was identified between the baseline and phase 1 surveys. A measurable decrease in the Perceived Stress Scale 4 was found between the baseline survey and the phase 1 and phase 2 postintervention surveys.

DISCUSSION

Although evidence suggests a multifocal approach to improving resilience, use of resilience bundles is new. To enhance nurse resilience and mitigate burnout, nurse leaders may consider resilience bundles to prioritize the mental health and wellness of their staff.

Prevalence of Compassion Fatigue and Its Association with Professional Identity in Junior College Nursing Interns: A Cross-Sectional Study

Background: The issue of compassion fatigue among clinical nurses has received considerable attention, particularly during the COVID-19 pandemic. Yet, the current status of compassion fatigue among junior college nursing interns remains unclear. Additionally, professional identity can modulate the impact of compassion fatigue or burnout on psychological well-being; however, whether professional identity still works in this group is also unclear. This study aimed to reveal the current status of compassion fatigue among nursing interns in junior colleges and also investigate the association between compassion fatigue and professional identity. Methods: This cross-sectional survey evaluated the levels of participants' compassion fatigue (The Compassion Fatigue Short Scale) and professional identity (Professional Identity Scale) in 2256 nursing interns. Results: The mean score of compassion fatigue was 44.99, and 19.5% of the participants scored above The Compassion Fatigue Short Scale median scores for compassion fatigue. A moderate negative correlation was detected between compassion fatigue and professional identity. Conclusions: The level of compassion fatigue among nursing interns is low but nearly one in five nursing students is at risk of compassion fatigue. More attention should be paid to nursing interns with a high risk of compassion fatigue. Future studies are warranted to explore which pathways could mediate the relationship between professional identify and comparison fatigue.

Characteristics of Occupational Burnout among Nurses of Various Specialties and in the Time of the COVID-19 Pandemic-Review

Occupational burnout is particularly common among nurses due to their work being associated with stress, showing understanding, compassion, and commitment, along with the simultaneous need to maintain the necessary emotional distance. The aim of this review was to assess the occurrence and characterization of burnout among nurses working within neurology, geriatric care, intensive care units and with patients infected with the novel COVID-19 virus. PRISMA guidelines were used to conduct the review. The search for literature was limited to articles meeting the inclusion criteria and published from 2017 to 2022 in PubMed, Scopus, Science Direct, Google Scholar, and Wiley. A total of 768 articles from this category have been found. Ultimately, after in-depth analysis, 20 articles were included in the study. The group of respondents ranged from 49 to 3100 participants. According to the data, the percentages of nurses suffering from burnout in the presented research ranged from 14.3% to 84.7%, with the highest value of burnout among nurses who worked in the ICU during the COVID-19 pandemic. There are certain factors among nurses that significantly affect the occurrence of burnout. These include, among others, working time, age, exposure to infection and contact with infected patients, lack of training on COVID-19 prevention, providing care to an increased number of COVID-19 patients per shift, lack of personal protective equipment, lack of support of administration, lack of pay satisfaction, intrinsic motivation and turnover intention.

Compassion fatigue and compassion satisfaction among Chinese palliative care nurses: A province-wide cross-sectional survey

AIMS

We aim to explore the prevalence and potential facilitators and inhibitors of compassion fatigue and compassion satisfaction among Chinese palliative care nurses.

BACKGROUND

Nurses with compassion fatigue may suffer from health-related problems, causing decreased work efficiency and quality of care. Palliative care nurses are especially at risk of compassion fatigue due to close contact with terminal patients.

METHODS

A province-wide cross-sectional survey using convenience sampling was conducted among 318 palliative care nurses at 25 hospitals and healthcare institutions in Sichuan Province, China. Data were collected using demographic questionnaire and five scales: Professional Quality of Life Scale, General Self-Efficacy Scale, Perceived Social Support Scale, Simplified Coping Style Questionnaire, and Connor-Davison Resilience Scale. Data analyses including descriptive statistics, t-test, one-way ANOVA, simple linear regression, and multiple linear regression.

RESULTS

Mean scores (SD) for burnout, secondary traumatic stress, and compassion satisfaction were 25.42 (4.75), 26.08 (5.72), and 35.67 (5.77), respectively. Related factors predicted 40.30%, 27.10%, and 35.4% of the variance in the model of burnout, secondary traumatic stress, and compassion satisfaction, respectively (all p < .001).

CONCLUSIONS

The levels of burnout and secondary traumatic stress among Chinese palliative care nurses were higher than those among other types of nurses. Social support, resilience, positive coping, family recognition of work, and income satisfaction are inhibitors of compassion fatigue among palliative care nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing administrators and educators should consider providing effective and targeted strategies (e.g. ongoing training and psychological interventions) to decrease compassion fatigue among palliative care nurses based on the cultural and ethical settings.

Dealing with Emotional Vulnerability and Anxiety in Nurses from High-Risk Units-A Multicenter Study

Compassion fatigue and anxiety derived from continued exposure to trauma and death greatly impact nurses’ quality of care and quality of life, increasing their desire to leave work. The aim of the study is to assess compassion fatigue and anxiety prevalence and their association with secondary variables. A multicenter, cross-sectional study in nurses from four high-risk units, Emergency, Intensive Care, Oncology, and Pediatrics, was carried out in 14 hospitals in Catalonia (Spain) between 2015 and 2016. The primary endpoints were compassion satisfaction and compassion fatigue (burnout and secondary traumatic stress), which were assessed by Professional Quality of Life (ProQOL), and anxiety, assessed with the State-Trait Anxiety Inventory (STAI). Multivariable logistic regression analyzed the association of sociodemographic, training, working, and psychological factors. Of a total of 1302 nurses, 18.6% presented low compassion satisfaction; 19.7%, high burnout; and 36.4%, high secondary traumatic stress. Trait anxiety scored high in 7.2%. Although compassion satisfaction was present, it did not protect sufficiently against the high level of compassion fatigue or anxiety present in nurses in all centers. The working conditions in the units and variables showed a strong association with nurses’ desire to leave. This corroborates the global challenge of healthcare professionals’ shortage. Participants expressed the need for better training in emotional management.

"I love the job…" Thriving in nursing: A qualitative interview study with framework analysis

BACKGROUND

Burnout is a well-known issue among nurses in critical care settings, including emergency nurses. There are decades of research indicating that emergency nurses experience burnout in their work. However, many nurses have long careers in emergency settings, which suggests that burnout is not the only outcome for nurses. Thriving may also be part of nurses' experiences. The Model of Thriving at Work includes external factors (autonomy, climate of trust and respect, and information sharing) and internal factors (knowledge, personal outlook, and relationships). Thriving is characterized by the concepts of vitality and ongoing learning. Previous researchers suggest that thriving fits with some nurses' experiences, based on validated questionnaires. However, thriving has not been investigated among nurses using interview approaches.

AIMS

This article explores nurses' experiences of thriving and assesses the fit of Spreitzer et al.'s Model of Thriving at Work with nurses' experiences.

STUDY DESIGN

Qualitative interview study, using framework analysis.

METHODS

Eleven nurses, from a single site, completed semi-structured interviews. These interviews explored nurses' workplace experiences, both positive and negative.

RESULTS

Participants reported experiences that fit with the Model of Thriving at Work, consisting of vitality, ongoing learning, and external and internal factors. Nurses hesitated to describe themselves in positive ways, referring instead to being 'not burnt out'. Nurses could, however, readily identify qualities of thriving in others, and viewed those nurses as aspirational. In addition to the Model, participants highlighted their emotional burden, workload, and ethical issues as important contributors to thriving. The Model could potentially be expanded to include these factors.

CONCLUSIONS

Thriving at work could be part of a range of emergency nurses' workplace outcomes. External and internal factors contribute to thriving. Healthcare leaders could support thriving among emergency nurses by fostering a positive work environment.

Australian Chaplains and Their Professional Quality of Life

Chaplains often express a sense of satisfaction in helping others. But their work renders them vulnerable to secondary traumatic stress and burnout. We investigated mindful self-care, comparing the experiences of chaplains and other workers. Measures used included mindful selfcare, social support, and professional quality of life. We found self-care practices did not predict the professional quality of life. Lack of supportive structures and mindful awareness predicted burnout. Compassion satisfaction might arise from other sources.

Evaluating effort-reward imbalance among nurses in emergency departments: a cross-sectional study in China

BACKGROUND

Effort-reward imbalance is an adverse psychological response to working conditions that has several negative effects on nurses. However, there is little research on effort-reward imbalance and its influencing factors among nurses in emergency departments. This study aimed to understand the current situation of effort-reward imbalance and explore its influencing factors among emergency department nurses in China.

METHODS

From July to August 2018, a structured online questionnaire survey was conducted among emergency department nurses in China. Data were collected from emergency department nurses employed in hospitals providing pre-hospital care in China. The questionnaire consisted of sociodemographic characteristics, work-related factors and effort-reward imbalance. A descriptive analysis and a binary logistic regression were conducted to explore the effort-reward imbalance and its influencing factors among emergency department nurses.

RESULTS

The study involved 17,582 emergency department nurses; notably, the prevalence of effort-reward imbalance was 59.66%. The participating nurses who were males, aged 25 to 34 years, whose educational level was a bachelor degree or above, who had a junior or above title, who had longer years of service, and who had suffered verbal or physical violence in the past year had a higher risk of effort-reward imbalance. Furthermore, the nurses with a high monthly income, who believed that the number of nurses met the department's demand had a lower risk of effort-reward imbalance.

CONCLUSIONS

Effort-reward imbalance was prevalent among emergency department nurses in China. Measures such as adjusting the night shift frequency, increasing the number of nurses, raising salaries and reducing workplace violence should be considered to reduce the level of effort-reward imbalance.