Workplace violence and turnover intention among Chinese nurses: the mediating role of compassion fatigue and the moderating role of psychological resilience.

BACKGROUND: Workplace violence is a global public health issue and a major occupational hazard cross borders and environments. Nurses are the primary victims of workplace violence due to their frontline roles and continuous interactions. OBJECTIVE: The present study aimed to investigate the status of workplace violence, turnover intention, compassion fatigue, and psychological resilience among Chinese nurses, and explore the mediating role of compassion fatigue and the moderating role of psychological resilience on relationship between workplace violence and turnover intention among Chinese nurses. METHOD: A cross-sectional study was conducted among a convenience sample of clinical registered nurses from public hospitals in Changsha, Hunan, China. Data was collected through an online questionnaire, which included a demographic information form, the Workplace Violence Scale (WVS), the Turnover Intention Questionnaire (TIQ), the Compassion Fatigue Scale (CF-CN), and the Connor-Davidson Resilience Scale (CD-RISC). Descriptive statistics and correlation analysis were employed to examine the relationships among the main variables. A moderated mediation analysis was further conducted using the PROCESS macro for SPSS (Model 4 and Model 8) to examine the mediating role of compassion fatigue and the moderating role of psychological resilience. RESULT: The present survey recruited a convenience sample of 1,141 clinical registered nurses, who reported experiencing multiple types of workplace violence during the past year. Correlation analysis revealed significant positive correlations between workplace violence and turnover intention (r = 0.466, P < 0.01) as well as compassion fatigue (r = 0.452, P < 0.01), while negative correlation between workplace violence and psychological resilience (r=-0.414, P < 0.01). Moderated mediation analysis revealed that compassion fatigue mediated, while psychological resilience moderated, the positive relationship between workplace violence and turnover intention (all P < 0.05). CONCLUSION: This study underscores the mediating effect of compassion fatigue and the moderating role of psychological resilience in the relationship between workplace violence and turnover intention among Chinese nurses. Future efforts should be undertaken to develop effective preventive measures and intervention strategies at individual, organizational, and national levels to mitigate workplace violence and foster supportive work environment. CLINICAL TRIAL NUMBER: Not applicable.

Professional quality of life and fear of COVID-19 among Spanish nurses: A longitudinal repeated cross-sectional study.

AIM AND OBJECTIVES: To evaluate changes in compassion fatigue (CF), burnout (BO), compassion satisfaction (CS) and fear of COVID-19 among Spanish nurses by comparing two assessment points: before and after the COVID-19 vaccination campaign. BACKGROUND: The COVID-19 pandemic has produced a great impact in healthcare worker's professional quality of life, especially among nurses. CF, BO and fear of COVID-19 decisively affect the care provided by nurses and put them at risk for mental health problems, so longitudinal studies are essential. DESIGN: A repeated cross-sectional design was carried out with a time-lapse of 12 months. METHODS: A total of 439 registered nurses in December 2020 and 410 in December 2021 participated in this study through an online survey. Data were collected using the Professional Quality of Life Questionnaire and the Fear of COVID-19 Scale. Occupational and sociodemographic variables were also analysed. This article adheres to the STROBE guidelines for the reporting of observational studies. RESULTS: The fear of COVID-19 has not been reduced among nurses. The levels of BO remain stable and continue to be high in half of the professionals. CF has been reduced with a small effect size (d = 0.30), while CS has also decreased (d = 0.30). Positive correlations were found in both assessment points between fear of COVID-19 and BO (r = .44, p ≤ .001; r = .41, p ≤ .001) and also between fear of COVID and CF (r = .57, p ≤ .001; r = .50, p ≤ .001). Negative correlations between fear and CS were also found (r = - .16, p = .001; r = - .22, p ≤ .001). RELEVANCE TO CLINICAL PRACTICE: Programmes to reduce fear of COVID-19, BO and CF are needed to improve mental health and to prevent psychological distress among nurses, as well as to increase CS and preserve the productivity and quality of nursing care. PATIENT OR PUBLIC CONTRIBUTION: The nurses collaborated by participating in the present study anonymously and disinterestedly.

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

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

Compassion fatigue and the meaning in life as predictors of secondary traumatic stress in nurses during the COVID-19 pandemic.

AIM: This study aimed to investigate the relationship among secondary traumatic stress, compassion fatigue, and meaning in life in nurses during the COVID-19 pandemic. BACKGROUND: Changes in working conditions during the pandemic also changed the needs of nurses. In addition to physical health, the COVID-19 pandemic led to many psychosocial health problems such as sleep disturbances, depression, and traumatic stress. This makes nurses vulnerable to psychological side effects of the pandemic. DESIGN: A cross-sectional study was conducted. METHODS: This study was conducted with 166 nurses. Data were collected online at May-June 2021. A Personal Information Form, the Secondary Traumatic Stress Scale, Compassion Fatigue Scale, and Meaning in Life Scale were used. The STROBE reporting checklist was followed. RESULTS: As secondary traumatic stress levels increase, compassion fatigue increases, meaning in life decreases, and the search for meaning in life increases. CONCLUSION: Predictors of secondary traumatic stress were shown to be compassion fatigue, change in sleep habits, meaning in life, marital status, and having a chronic illness. This suggested that working during the pandemic posed significant risks in terms of manifesting negative consequences on mental health in the long term.

Impact of the SARS-CoV-2 pandemic on pediatric subspecialists' well-being and perception of workplace value.

OBJECTIVE: To explore pediatric subspecialist distress and well-being during the pandemic, with a particular focus on relationships between compassion fatigue (CF), burnout (BO), and compassion satisfaction (CS), and physicians' perception of "feeling valued" by their institution. METHODS: The Compassion Fatigue and Satisfaction Self-Test and a questionnaire of personal/professional characteristics were distributed electronically to pediatric subspecialists. Content analysis was performed for responses to the question "How has your institution made you feel valued?" RESULTS: During the 16-month study period, CF and BO scores significantly increased, and CS scores decreased over time. By Epoch 3, 52% of respondents did not feel valued by their employing institution. When controlling for the effect of time, CF and BO scores remained higher, and CS scores lower, in participants who did not feel valued by their institution. Themes from the content analysis of "value" included expressions of gratitude, perks vs. penalties, safety, and leadership. The same overture from leadership provoked disparate responses in recipients, seemingly over the sincerity behind the offering, which may reflect underlying workplace culture. CONCLUSIONS: Increasingly, pediatric subspecialists are not feeling valued for their work. Institutional leadership must prioritize healthy workplace culture, and re-think emotional and mental health support within the health system. IMPACT: A total of 52% of our study population did not "feel valued" by their employing institution by late 2021, which is cause for concern. This is the first longitudinal analysis of distress and well-being in a national cohort of pediatric subspecialists during the COVID-19 pandemic. The same overture or messaging from leadership sparked disparate responses in recipients, seemingly over the sincerity behind the offering, which relates to the underlying workplace culture of the department or institution. Institutional leadership must prioritize a healthy workplace culture, and re-think and re-invent emotional and mental health support within the health system.

Compassion Fatigue, Compassion Satisfaction, Burnout and Alcohol Use Among Dental Hygienists.

AIMS: The purpose of this study was to investigate the relationship between demographics, compassion fatigue (CF), compassion satisfaction (CS), burnout (BO) and alcohol use among dental hygienists (DHs). METHODS: The web-based survey consisting of two validated instruments [Alcohol Use Disorders Identification Test (AUDIT) and Professional Quality of Life] to measure alcohol use, CF, CS and BO was conducted with a convenience sample of DHs (n = 963). RESULTS: The completion rate was 81.6% (n = 786). Nearly one in five DHs (19.1%) reported having their alcohol consumption influenced by the Coronavirus disease 2019 pandemic at least moderately. The number of hours worked per week (x) and AUDIT scores (y) were fully mediated by BO (m) (P < 0.001); the average number of hours worked per week (x) and AUDIT scores (y) were fully mediated by CF (m) (P < 0.001); the average number of patients seen per day (x) was a predictor of AUDIT scores (y) when partially mediated by BO (m) (P < 0.001); and age (x) was a predictor of AUDIT scores (y), mediated by CS (m). Results showed that one in four DHs could qualify for binge drinking (25.6%, n = 177) and 15.1% experienced blackout drinking episodes within the past year (n = 118). CONCLUSION: Mediating relationships exist between demographics, CF, CS, BO and alcohol use among DHs. More research needs to be conducted on alcohol use and CF among DHs and protective factors that may reduce the risk of BO, CF or alcohol use.

Compassion fatigue in healthcare providers: a scoping review.

The detrimental impacts of COVID-19 on healthcare providers' psychological health and well-being continue to affect their professional roles and activities, leading to compassion fatigue. The purpose of this review was to identify and summarize published literature on compassion fatigue among healthcare providers and its impact on patient care. Six databases were searched: MEDLINE (Ovid), PsycINFO (Ovid), Embase (Ovid), CINAHL, Scopus, Web of Science, for studies on compassion fatigue in healthcare providers, published in English from the peak of the pandemic in 2020 to 2023. To expand the search, reference lists of included studies were hand searched to locate additional relevant studies. The studies primarily focused on nurses, physicians, and other allied health professionals. This scoping review was registered on Open Science Framework (OSF), using the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) extension to scoping review. From 11,715 search results, 24 met the inclusion criteria. Findings are presented using four themes: prevalence of compassion fatigue; antecedents of compassion fatigue; consequences of compassion fatigue; and interventions to address compassion fatigue. The potential antecedents of compassion fatigue are grouped under individual-, organization-, and systems-level factors. Our findings suggest that healthcare providers differ in risk for developing compassion fatigue in a country-dependent manner. Interventions such as increasing available personnel helped to minimize the occurrence of compassion fatigue. This scoping review offers important insight on the common causes and potential risks for compassion fatigue among healthcare providers and identifies potential strategies to support healthcare providers' psychological health and well-being.

Compassion fatigue and burnout in Turkish pediatric emergency nurses during the COVID-19 pandemic.

PURPOSE: This study was conducted to determine compassion fatigue and burnout in nurses working in the pediatric emergency department (PED) during the COVID-19 pandemic in Turkey. DESIGN AND METHODS: This descriptive and cross-sectional study was conducted with 164 nurses working in the PED and following the social media platforms of the Emergency Nurses Association between September 1, 2020, and January 1, 2021. Data were collected using the online survey method with the Descriptive Data Form, Maslach Burnout Inventory (MBI), and Compassion Fatigue-Short Scale (CF-SS). RESULTS: Pediatric emergency nurses reported that they experienced high emotional exhaustion (28.25 ± 6.05) and depersonalization (11.89 ± 2.39), low personal accomplishment (17.98 ± 3.12), and moderate compassion fatigue (4.99 ± 1.43). CONCLUSION: Pediatric emergency nurses had high levels of burnout and moderate levels of compassion fatigue during the pandemic in Turkey. To prevent any long-term negative effects of the pandemic, addressing the physiological, psychological, and psychosocial needs of nurses should be prioritized. PRACTICAL IMPLICATIONS: Compassion fatigue and burnout can affect the quality of care provided by nurses, but also negatively affect their well-being and quality of life during the pandemic. Therefore, the development of interventions to reduce compassion fatigue and burnout can help manage these symptoms.

Compassion fatigue and compassion satisfaction in pediatric and neonatal care nurses during the COVID-19 pandemic in Sweden.

PURPOSE: Quality of care and the mental and physical health of nurses are interlinked. The COVID-19 pandemic has imposed an extremely high burden on health care. This study aimed to: 1) describe professional quality of life of registered nurses (RN) working in the pediatric and neonatal care units during the COVID-19 pandemic in Sweden, 2) compare professional quality of life between RNs with and without a Master's degree in specialist nursing pediatric care (MSc), and 3) compare differences in professional quality of life associated with the nursing experience (years). DESIGN AND METHODS: This study adopted a cross-sectional survey design. The PROQoL®-5-questionnaire was administered as a web survey to 160 RNs at four pediatric wards and two neonatal units of two hospitals in Sweden. RESULTS: Seventy-one RNs responded to the survey. Overall, they reported a sufficient professional quality of life. RNs with an MSc suffered significantly lower secondary traumatic stress levels. Experienced RNs reported significantly higher compassion satisfaction and lower occupational burnout. CONCLUSION: Higher education and longer experience are beneficial for nurses' professional quality of life when working in pediatric care units. PRACTICAL IMPLICATIONS: Results from this study highlights the importance of offering RN education in pediatric care at master level and supporting novice nurses, to prevent negative professional well-being outcomes in pediatric care, because the health of nurses is of utterly importance when crisis such as a pandemic hits the world. The findings also suggest that the conditions for professional quality of life could improve through activities such as self-care, time for reflection, better working hours, competence-adjusted salary, and educational opportunities.

Burnout, Moral Distress, and Compassion Fatigue as Correlates of Posttraumatic Stress Symptoms in Clinical and Nonclinical Healthcare Workers.

GOAL: Research has highlighted psychological distress resulting from the COVID-19 pandemic on healthcare workers (HCWs), including the development of posttraumatic stress symptoms (PTSS). However, the degree to which these conditions have endured beyond the pandemic and the extent to which they affect the entire healthcare team, including both clinical and nonclinical workers, remain unknown. This study aims to identify correlates of PTSS in the entire healthcare workforce with the goal of providing evidence to support the development of trauma-informed leadership strategies. METHODS: Data were collected from June to July 2022 using a cross-sectional anonymous survey in a large academic medical center setting. A total of 6,466 clinical and nonclinical employees completed the survey (27.3% response rate). Cases with at least one missing variable were omitted, for a total sample size of 4,806, the evaluation of which enabled us to understand individual, organizational, and work-related and nonwork-related stressors associated with PTSS. Data were analyzed using ordinal logistic regression and dominance analyses to identify predictors of PTSS specific to clinical and nonclinical workers. PRINCIPAL FINDINGS: While previous studies have shown that HCWs in different job roles experience unique stressors, our data indicate that the top correlates of PTSS among both clinical and nonclinical HCWs are the same: burnout, moral distress, and compassion fatigue. These three factors alone explained 45% and 44.4% of the variance in PTSS in clinical and nonclinical workers, respectively. PTSS was also associated with a lower sense of recognition and feeling mistreated by other employees at work in the clinical workforce. Concerningly, women and sexual minorities in the clinical sample exhibited a higher incidence of PTSS. In nonclinical workers, social isolation or loneliness and lower trust and confidence in senior leadership were associated with PTSS. Nonwork-related factors, such as exhaustion from caregiving responsibilities and financial strain, were also significantly associated with PTSS. Even after controlling for discrimination at and outside of work in both samples, we found that non-White populations were more likely to experience PTSS, highlighting a deeply concerning issue in the healthcare workforce. PRACTICAL APPLICATIONS: The primary objective of this article is to help healthcare leaders understand the correlates of PTSS across the entire healthcare team as organizations recover from the COVID-19 pandemic. Understanding which factors are associated with PTSS will help healthcare leaders develop best practices that aim to reduce HCW distress and strategies to circumvent trauma derived from future crises. Our data indicate that leaders must address the correlates of PTSS in the workforce, focusing attention on both those who work on the frontlines and those who work behind the scenes. We urge leaders to adopt a trauma-informed leadership approach to ensure that the entire healthcare workforce is recognized, supported, and cared for as each HCW plays a unique role in the care of patients.

Compassion fatigue and COVID-19: A global view from nurses.

BACKGROUND: Due to the rapid spread of COVID-19 variants, the number of people hospitalized for COVID-19 may create psychological burdens on nurses. Nurses with high levels of compassion fatigue (CF) are more likely to make work errors, deliver poor-quality care, and have greater intent to leave their position. OBJECTIVES: This study utilized the social-ecological model to examine factors associated with nurses' CF and compassion satisfaction (CS) during the COVID-19 pandemic. METHODS: Data were collected from the United States, Japan, and South Korea from July to December 2020. The Professional Quality of Life Scale was used to measure burnout (BO), secondary traumatic stress (STS), and CS. RESULTS: Data from 662 responses were used in the analysis. Mean scores were 25.04 (±6.44) for BO, 24.81 (±6.43) for STS, and 37.85 (±7.67) for CS. Multiple regression analyses indicated that resilience and intention to leave nursing were related to each study outcome (i.e., BO, STS, and CS). Greater resilience predicted lower BO and STS but greater CS, whereas intention to leave nursing indicated greater BO and STS, but lower CS. Furthermore, intrapersonal factors and organizational factors (i.e., nurses involved in developing policies to prepare for COVID-19 patients, organizational support, and personal protective equipment [PPE] provisions) were related to BO, STS, and CS. LINKING EVIDENCE TO PRACTICE: To promote nurses' psychological well-being, improvement of organizational factors such as support, PPE, and programs to enhance resilience is recommended to prepare for future emerging infectious disease crises.

Stress Work and Hopelessness in Mental Health Workers/Caregivers: an Observational Study in Pandemic and Post COVID-19 Pandemic.

BACKGROUND: WHO has decreed an end to the pandemic crisis from COVID-19. However, the consequences of stress, compassion fatigue, and healthcare workers' expectations are still evident. Also, the hope of ending the problems associated with the pandemic is still present, although the awareness of maintaining a high level of attention is current in the HCWs. METHOD: In our observational study, 102 (65 females, 37 males) mental healthcare workers were evaluated during and post-COVID-19 pandemic. They were divided into different categories of workers: nurses, physicians, psychologists, social assistants, social educators, social health workers, and psychiatric rehabilitation technicians. We used the ProQoL for compassion fatigue, compassion satisfaction, and burnout; BHS for hopelessness. RESULTS: ProQoL data showed a significant increase in compassion satisfaction in post-pandemic (p=0.002) in all professional workers. The same results in burnout and secondary stress subscales (respectively, p=0.018, p=0.000) are evident. The BHS total score indicated that the difference between T0 vs. T1 was not statistically significant (p=0.109). CONCLUSIONS: The collected data during and post-COVID-19 pandemic showed reduced burnout and compassion fatigue in the helping professions. However, in the periods analyzed, no changes in hope are observed.

The Emotional Impact on Mental Health Workers in the Care of Patients with Mental Disorders in the Pandemic and Post COVID-19 Pandemic: a Measure of "Burnout" and "Compassion Fatigue".

BACKGROUND: Emotional pressure, fear, and uncertainties affected healthcare workers (HCWs) who played a significant role during the COVID-19 pandemic. After the pandemic crisis, the consequences on the health of mental HealhCare Workers are still significant. Our work aimed to evaluate burnout and compassion fatigue in HCWs. METHOD: In our observational study, 102 (65 females, 37 males) mental HCWs were evaluated during and post-COVID-19 pandemic. We used the Compassion Fatigue-Short Scale, Balanced Emotional Empathy Scale, and Beck Depression Inventory. RESULTS: Subscale Secondary Trauma Stress of CF-SS demonstrated an increase in the rate in the post-pandemic phase (24.51% in all HCWs). The percentage reached in males was high (37.84%). Instead, the levels of Job Burnout remained constant in the two periods analyzed (during and post-COVID-19). Depressive symptoms remained constant with a prevalence in females of the post-COVID period. CONCLUSION: The results confirm increased stress secondary to the traumatic event, while the levels of job burnout are high. Closely associated with compassion fatigue are levels of empathy that were found to be unchanged.

Assessment of Compassion Fatigue and Empathy Levels in Nurses During the COVID-19 Outbreak: Turkey's Case.

This study was conducted to determine the compassion fatigue level of nurses and to review several variables believed to be associated with it; in addition, an assessment is made of empathy levels in the same group. This is a cross-sectional study conducted from December 2021 to May 2022 on nurses working at a city hospital linked to the Turkish Ministry of Health. The study group consisted of 616 nurses. A Personal Information Form, the Compassion Fatigue-Short Scale (CF-SS), and the Jefferson Scale of Empathy were used to collect data. Data were collected through face-to-face interviews. Student's t-test, One-Way Analysis of Variance, and Multiple Linear Regression Analysis were used for data analysis. The statistical significance value was accepted as p < 0.05. The study group consisted of 499 (81.0%) females and 117 (19.0%) males, and their ages ranged from 20 to 51, with a mean age of 29.2 ± 6.9 years. The scores obtained from the CF-SS ranged from 16 to 130, with a mean score of 70.96 ± 25.04. The level of compassion fatigue was found to be higher in participants with a low family income, those who work more than 40 h a week, those who chose their profession unwillingly, those who are not satisfied with their profession, and those with a history of contact with a COVID-19 patient (p < 0.05 for each group). There was a significant association between levels of compassion fatigue and empathy (r = 0.92; p = 0.220). The level of compassion fatigue was found to be moderate in the nurses observed. The factors affecting the level of compassion fatigue included gender, family income, reasons for choosing nursing as a profession, the number of patients given daily care by the nurses, satisfaction with their profession, and history of contact with a COVID-19 patient. More extensive studies focusing on the association between compassion fatigue and empathy in nurses are needed.

COVID-19 vicarious traumatization links functional connectome to general distress.

As characterized by repeated exposure of others' trauma, vicarious traumatization is a common negative psychological reaction during the COVID-19 pandemic and plays a crucial role in the development of general mental distress. This study aims to identify functional connectome that encodes individual variations of pandemic-related vicarious traumatization and reveal the underlying brain-vicarious traumatization mechanism in predicting general distress. The eligible subjects were 105 general university students (60 females, aged from 19 to 27 years) undergoing brain MRI scanning and baseline behavioral tests (October 2019 to January 2020), whom were re-contacted for COVID-related vicarious traumatization measurement (February to April 2020) and follow-up general distress evaluation (March to April 2021). We applied a connectome-based predictive modeling (CPM) approach to identify the functional connectome supporting vicarious traumatization based on a 268-region-parcellation assigned to network memberships. The CPM analyses showed that only the negative network model stably predicted individuals' vicarious traumatization scores (q2 = -0.18, MSE = 617, r [predicted, actual] = 0.18, p = 0.024), with the contributing functional connectivity primarily distributed in the fronto-parietal, default mode, medial frontal, salience, and motor network. Furthermore, mediation analysis revealed that vicarious traumatization mediated the influence of brain functional connectome on general distress. Importantly, our results were independent of baseline family socioeconomic status, other stressful life events and general mental health as well as age, sex and head motion. Our study is the first to provide evidence for the functional neural markers of vicarious traumatization and reveal an underlying neuropsychological pathway to predict distress symptoms in which brain functional connectome affects general distress via vicarious traumatization.

Secondary Traumatic Stress in Emergency Services Systems (STRESS) Project: Quantifying and Predicting Compassion Fatigue in Emergency Medical Services Personnel.

Introduction: Compassion fatigue (CF) is defined as the acute or gradual loss of benevolence that occurs after exposure to critical incident stress. Colloquially referred to as the "cost of caring," CF can affect an individual's future response to stressful situations and is unhealthy for caregivers.Objective: To identify the prevalence and predictors of CF in EMS professionals.Methods: This was a cross-sectional survey of EMS personnel using one-stage area sampling. Nine EMS agencies recruited based on location and geographic region provided data on service area and call mix. Respondents were surveyed in-person during monthly training. The survey evaluated the relationship between CF and psychosocial factors using the Professional Quality of Life Scale (ProQOL). Parametric and non-parametric tests were used where appropriate for the univariate analysis. Those factors significant in the univariate analysis were included in the multivariable analysis. A logistic regression was conducted to determine predictors of CF while controlling for potential confounders.Results: A total of 686 EMS personnel completed the survey. Altogether, 48% had CF, of which 50.8% were male and 14% were minorities. Compared to those without CF, more than 4 times as many respondents with CF (n = 28[8.6%] v. 7[2.0%]) self-reported as currently in counseling and over a third (n = 109[33.1%]) had considered suicide. Irrespective of the presence of CF, one in two knew another EMS professional who had completed suicide. African-American EMS professionals were 3 times more likely to have CF (OR:3.1;p = 0.009). Mean scores on the ProQOL CF subscale were 10 points higher in those with CF compared to those without (27.1[±4.34] v. 17.04[±2.9]). EMS personnel were 48% more likely to have CF if they knew an EMS provider who completed suicide (p = 0.047). Additionally, those with concomitant traumatic stress syndromes, such as vicarious trauma and burnout, were 4.61 and 3.35 times more likely to have CF, respectively.Conclusions: CF is a considerable concern for EMS professionals and there are several modifiable factors that may reduce the prevalence of this cumulative stress syndrome. Additional research should focus on causal factors and mitigation strategies, as well as the individual and agency impact of CF on the prehospital work environment.

Are We in Control of Our Demons?: Understanding Compassion Satisfaction, Compassion Fatigue and Burnout in an Asian Pediatric Emergency Department in a Pandemic.

BACKGROUND: The medical profession, with its remarkable physical and emotional demands, predisposes physicians to compassion fatigue (CF) and burnout (BO). Although these conditions have been studied individually, little attention has been paid to how pediatric emergency physicians experience these conditions in the context of an Asian emergency setting especially during a global pandemic In our study, we aim to understand the experiences of individual physicians and describe the potential triggers or protective factors of compassion satisfaction, BO, and compassion satisfaction among physicians in an Asian pediatric emergency department during a pandemic. METHODS: A qualitative, individual interview methodology was used. From March to April 2020, we enrolled 20 physicians involved in frontline care during the coronavirus disease 2019 (COVID-19) pandemic in the pediatric emergency department to participate. Semistructured interviews were conducted, audiotaped, and transcribed in verbatim, with identifiers removed. Themes were identified, and data were analyzed using qualitative data analysis and iterative data analysis. RESULTS: We recruited 20 physicians. Three themes emerged from data analysis. First, we showed how workplace conditions are protective, including work morale, leadership and management, and social support received. Second, workload affected participants emotionally and in terms of its heavier quantity and longer hours. Finally, intrinsic factors that were protective in developing CF or BO include having professional autonomy, experience, work-life balance, and having emotional resilience to develop self-care. Cultural influences affect emotional regulation and can lead to negative coping with negative peer pressure. In general, participants quantified their levels of satisfaction at work as average to above average. However, they highlighted experiencing greater stress during COVID-19 with the underlying fear of contagion and infection. CONCLUSIONS: Being a pediatric emergency physician puts one at greater risk of experiencing CF and BO because of work and nonwork stressors, especially during a global pandemic, influenced by sociocultural factors. A positive and supportive work environment should be created while providing culturally adapted strategies to improve individual physician resilience to maintain their well-being.

Caring for sick kids: An integrative review of the evidence about the prevalence of compassion fatigue and effects on pediatric nurse retention.

PROBLEM: Compassion Fatigue (CF) in healthcare professionals has been explored in multiple studies, but few focused on hospital-based pediatric nurses. The purpose of this integrative review is to synthesize the evidence about CF prevalence in nurses caring for pediatric patients, and to describe its effects on retention and job satisfaction. ELIGIBILITY CRITERIA: Included studies were in English from any date describing research or quality improvement studies about CF in pediatric nurses. SAMPLE: An integrative review of nine electronic databases yielded 13 articles about 1921 nurses. Data were synthesized from four qualitative and nine quantitative studies separately before integrating results. A risk of bias analysis was included for evidence level and quality. RESULTS: Overall CF prevalence was low, but 14% of nurses were at high risk of burnout and 10% were at high risk for secondary traumatic stress. Studies examining the effects of CF on retention found no significant relationship. Most studies were about critical care or oncology nurses. CONCLUSIONS: A subset of pediatric nurses is highly vulnerable to CF, but more high-quality evidence is needed to fully address this topic. Leaders should study CF prevalence, protective and exacerbating factors, relationships between CF and retention, and targeted strategies to resolve CF in high-risk nurses.

The prevalence and influencing factors for compassion fatigue among nurses in Fangcang shelter hospitals: A cross-sectional study.

AIM: We aim to investigate the prevalence and associated factors for compassion fatigue among nurses in Fangcang Shelter Hospitals in Wuhan. Studies have shown that compassion fatigue was more common among nurses than other health-care providers, and its predictors were also different. In recent years, most studies have investigated compassion fatigue in emergency and oncology nurses, whereas there is little information on compassion fatigue among nurses from the frontline of Fangcang Shelter Hospitals during the COVID-19 pandemic. METHODS: A descriptive, cross-sectional design was used in this study. An online survey was conducted among nurses (n = 972) of five Fangcang Shelter Hospitals in Wuhan, Hubei province, China, from 6 March to 10 March 2020. A self-administered questionnaire including demographic information, work-related information, General Health Questionnaire, Perceived Stress Scale and Compassion Fatigue Scale was used. RESULTS: The prevalence of compassion fatigue among nurses in Fangcang Shelter Hospitals was moderate, and most cases were mild. There was a significant relationship between compassion fatigue and work-related factors, mental health and perceived stress among nurses working in Fangcang Shelter Hospitals. CONCLUSIONS: Various factors contribute to compassion fatigue, including lower job satisfaction and job adaptability, less praise from patients, more fear of infection and more perceived stress. A good working atmosphere, organizational support and psychological consultation are essential to alleviate nurses' compassion fatigue during the anti-epidemic period.

Secondary traumatic stress and dissociative coping strategies in nurses during the COVID-19 pandemic: The protective role of resilience.

During the COVID-19 pandemic, nurses are repeatedly exposed to acute stress at their workplace, and therefore, they are at high risk for developing mental health symptoms. The prolonged exposure of healthcare professionals may lead to Secondary Traumatic Stress (STS). STS is an aspect of "cost of care", the natural consequence of providing care to people who suffer physically or psychologically. The purpose of this study was to investigate the levels of STS in nurses during the first phase of the COVID-19 pandemic in Greece and to detect aggravating and protective factors. Participants were 222 nurses (87.4 % women; mean age 42.3 years) who completed an online survey. The questionnaire comprised of the Secondary Traumatic Stress Scale, the Brief Resilience Scale, and the Brief Coping Orientation to Problems Experienced Inventory. Nurses had high levels of STS. The hierarchical regression analyses showed that STS and its dimensions Avoidance and Arousal were positively predicted mainly by denial and self-distraction coping strategies and inversely by resilience. Resilience exhibited a protective (partial mediation) effect on the strong relationship between the dissociative coping strategies (denial, self-distraction, venting and behavioral disengagement) and STS. Trauma-informed care psychosocial interventions are needed to support the already overburdened nursing staff during the coronavirus pandemic.