Relationships Between Burnout, Secondary Traumatic Stress, Mindfulness, and Self-Compassion in Victim Advocates.

Victim advocates experience burnout and secondary traumatic stress (STS) in response to their exposure to trauma at work. Mindful awareness may serve as a protective factor against these negative outcomes. The current study examined a sample of 133 victim advocates from across the country to better understand and predict STS and burnout. Higher mindful awareness was found to be associated with lower STS and burnout, even when controlling for other best-known predictors. Self-compassion partially mediated these relationships. These findings support further research exploring the effects of mindful awareness training for victim advocates to reduce STS and burnout.

Labor and Delivery Clinician Perspectives on Impact of Traumatic Clinical Experiences and Need for Systemic Supports.

OBJECTIVES: Few studies have elucidated the impact of work-related trauma on labor and delivery clinician or considered whether it may be a cause of burnout. This study aims to elicit labor and delivery clinician perspectives on the impact of exposure to traumatic births on their professional quality of life. METHODS: Labor and delivery clinicians (physicians, midwives, nurse practitioners, and nurses; n = 165) were recruited to complete an online questionnaire on experiences with traumatic births. The questionnaire contained measures from the Maslach Burnout Inventory and the professional quality of life scale version 5. Some participants completed an optional free-text prompt to recommend ways to support clinicians after traumatic births (n = 115). Others opted into a semi-structured phone interview (n = 8). Qualitative data was analyzed using a modified grounded theory approach. RESULTS: Self-reported adequate institutional support for clinicians after a traumatic birth was positively correlated with compassion satisfaction (r = 0.21, p < 0.01) and negatively correlated with secondary traumatic stress (r = - 0.27, p < 0.01), and burnout (r = - 0.26, p < 0.01). Qualitative themes included lack of system-wide and leadership support, lack of access to mental health resources, and suboptimal workplace culture as contributors toward secondary traumatic stress and burnout. Participants recommended proactive leadership, consistent debriefing protocols, trauma education, and improved access to counseling. CONCLUSIONS FOR PRACTICE: Multi-level barriers prevented labor and delivery clinicians from accessing needed mental health support after exposure to traumatic births. Proactive investment in healthcare system supports for clinicians may improve clinician professional quality of life.

Assessing the impact of the COVID-19 pandemic on nurse practitioners' professional quality of life.

BACKGROUND: The COVID-19 global pandemic has put health care professionals under immense pressure and hindered their ability to provide quality services. PURPOSE: This study aimed to examine the professional quality of life (ProQOL) among Georgia nurse practitioners during the COVID-19 global pandemic. METHODOLOGY: The ProQOL survey was distributed to nurse practitioners in Georgia by the professional organization's listserv. Multiple analysis of variance (ANOVA) analyses were performed to assess differences between employment settings, geographic location, and other relevant demographic qualifiers and levels of compassion satisfaction, burnout, and secondary traumatic stress. RESULTS: Hundred nurse practitioners (NPs) (n = 100) responded to the survey. Ninety-one percent were female and ages 25-35 years. Male NPs showed higher rates of compassion fatigue and secondary traumatic stress. CONCLUSIONS: A ProQOL survey demonstrated increased burnout and secondary traumatic stress among frontline practitioners in Georgia due to increased workloads, feelings of inadequacy, fear of being infected by the virus, and prolonged exposure to deaths. IMPLICATIONS: Ensuring effective communication, team collaboration, emotional, adequate staffing, and psychological support can help reduce compassion fatigue among NPs.

Association between coping strategies and professional quality of life in nurses and physicians during COVID-19: A cross-sectional study.

AIM: To explore the associations between coping strategies (social support, avoidance strategies, positive attitude, problem orientation, and transcendent orientation) and professional quality of life (compassion satisfaction, burnout, and secondary traumatic stress) of nurses and physicians during COVID-19. BACKGROUND: Little is known about the association between the way health care workers cope with stress and their professional quality of life during the unusual circumstances that the COVID-19 pandemic imposed. METHODS: A single-centre cross-sectional observational study was conducted with health care professionals (n = 143). The Professional Quality of Life scale Version 5 and the Italian Version of the Coping Orientations to the Problems Experienced measured the professional quality of life and coping strategies, respectively. RESULTS: Avoidance, problem orientation and social support coping worsened professional quality of life, whereas a positive attitude improved it. CONCLUSIONS: This study on the relationship between coping strategies and the professional quality of life during health emergencies like the COVID-19 pandemic can inform interventions aiming to foster functional coping strategies in health care personnel to sustain their professional quality of life. IMPLICATIONS FOR NURSING MANAGEMENT: Identifying people at greater risk of burnout and secondary traumatic stress can guide tailored interventions to improve health care workers' wellbeing. Increased professional quality of life might turn in improved quality of care and reduced absenteeism and intention to leave.

A Mixed Methods Investigation of the Prevalence and Influencing Factors of Compassion Fatigue among Midwives in Different Areas of China.

Objective: Exploring the influencing factors of compassion fatigue among midwives to prevent compassion fatigue from occurring and improve their mental health. Methods: A method integrating the quantitative research method and qualitative research method is used. For the quantitative research, a cross-sectional study was carried out. State-run hospitals from three economic areas in China were selected as investigation scope from June 2018 to May 2021. A total of 515 midwives were chosen randomly from three economic areas. SPSS 22.0 was used for data cleaning and statistical description and analysis. The influencing factors of compassion fatigue among midwives were analyzed by fitting these two-level logistic models. For qualitative research, purposive sampling and maximum variation strategy were used to select midwives with mild or above compassion fatigue in the questionnaire survey. Field study and interviews were used to collect data. Results: The results in the quantitative research showed that 515 valid questionnaires were received with 82.14% of midwives whose compassion fatigue were moderate or above. Multilevel statistical model analysis demonstrated that hospital level, children situation, area, working atmosphere, experiences of traumatic delivery, sleep quality, and social support level had impacts on the degree of midwives' compassion fatigue (p < 0.05). The result in the qualitative research showed that 34 midwives were interviewed, and 7 topic ideas were refined. Conclusion: Overall, the incidence of compassion fatigue among midwives is high. Risk factors influencing the degree of midwives' compassion fatigue include lower social support, disharmonious working atmosphere, toddler situation, huge workload, experiences of traumatic delivery, and poor quality of sleep.

Compassion satisfaction and compassion fatigue in frontline nurses during the COVID-19 pandemic in Wuhan, China.

AIM: The aim of this study is to investigate the compassion satisfaction and compassion fatigue among Chinese frontline nurses during the COVID-19 pandemic in Wuhan, China and to explore the related factors. BACKGROUND: Frontline nurses undertake a huge nursing workload with a risk of infection, causing great pressure on them and making them face a risk of compassion fatigue during the pandemic. METHODS: A cross-sectional online survey was conducted from 9 March to 15 March 2020. A total of 1582 nurses caring for critical patients with COVID-19 participated. Compassion satisfaction and compassion fatigue (comprising burnout and secondary traumatic stress) were assessed with the Professional Quality of Life Scale, and resilience was measured with the Chinese 10-item Connor-Davidson Resilience Scale. RESULTS: Moderate levels of compassion satisfaction (36.99 ± 6.71), burnout (24.14 ± 5.33) and secondary traumatic stress (24.53 ± 5.24) were experienced by frontline nurses. Resilience and perceived work pressure were the main predictors. CONCLUSIONS: Frontline nurses demonstrated a moderate level of compassion satisfaction and compassion fatigue. IMPLICATIONS FOR NURSING MANAGEMENT: The compassion fatigue of frontline nurses should be considered. Strategies aiming to reduce stress and enhance resilience, such as training about psychological adjustment, developing professional skills and creating a supportive workplace environment, are several options. The trial is not registered. This study is a cross-sectional study, and according to China's clinical trial registration standards, such studies are not required to be registered. So the trial is not registered. However, oral consent was obtained from the ethics committee of the hospital before this study was conducted.

Vicarious trauma in nursing professionals: A concept analysis.

AIM: To explore the concept of vicarious trauma (VT) and clarify its fundamental meaning and distinctiveness as a psychological phenomenon experienced by nurses. BACKGROUND: The current coronavirus disease 2019 (COVID-19) pandemic has incited significant psychological distress on nursing professionals worldwide. There is growing knowledge of the negative outcomes of this distress including the manifestation of nursing burnout syndrome, compassion fatigue, and vicarious traumatization (VT). These concepts have often been used interchangeably throughout nursing discourse creating confusion surrounding their uses and unique attributes. DESIGN: Walker and Avant's method of concept analysis. RESULTS: VT is a psychological phenomenon that causes a permanent cognitive shift in the inner experience and world views of nurses after prolonged empathetic engagement with a patient's trauma. VT manifests as physical and emotional symptoms of distress, which can disrupt a nurses ability to provide competent care. Contradictions within the literature exist when defining VT, burnout syndrome, and compassion fatigue, creating difficulty identifying attributes and consequences unique to VT. CONCLUSION: More empiric rigor is needed to adequately operationalize VT. Given the traumatic nature of the COVID-19 pandemic, immediate policy and education attention should be directed towards understanding the relationship between nurses working during the COVID-19 pandemic and the prevalence of VT.

Prevalence and influencing factors of posttraumatic growth among nurses suffering from workplace violence: A cross-sectional study.

The purpose of this study was to (i) identify the level of posttraumatic growth among nurses suffering from workplace violence, (ii) clarify the relationship between nurses' posttraumatic growth and compassion satisfaction, burnout, secondary traumatic stress, and (iii) determine the influencing factors for posttraumatic growth among nurses suffering from workplace violence. A cross-sectional study was conducted to investigate 726 nurses suffering from workplace violence in 10 tertiary hospitals by using demographic, work-related information, lifestyle questionnaire, simplified Chinese version of the Posttraumatic Growth Inventory, and professional quality of life scale. In the findings, (i) the participants' posttraumatic growth scores were 57.29 ± 21.56, while the compassion satisfaction, burnout, and secondary traumatic stress scores were 32.82 ± 6.80, 27.17 ± 5.53, and 26.67 ± 5.29, respectively, (ii) posttraumatic growth was positively correlated with compassion satisfaction and secondary traumatic stress, and negatively correlated with burnout, and (iii) compassion satisfaction, sleep hours per day, department, scheduling, alcohol, secondary traumatic stress, children, and work hours per day were influencing factors of posttraumatic growth, which explained 36.3% of the total variance. Our study indicates that Chinese nurses may experience moderate levels of compassionate satisfaction, burnout, secondary traumatic stress, and low levels of posttraumatic growth after suffering from workplace violence, while the posttraumatic growth of nurses suffering from workplace violence is more affected by work-related variables and lifestyle-related variables, but less affected by other sociodemographic variables. Therefore, it is necessary to strengthen the psychological evaluation of nurses and adopt targeted strategies to promote nurses' posttraumatic growth.

A structural equation model analysis of the association between work-related stress, burnout and job-related affective well-being among nurses in Saudi Arabia during the COVID-19 pandemic.

AIM: To test a model that examines the direct and indirect effects of work-related stress on job-related affective well-being through compassion fatigue. BACKGROUND: Despite the danger of infection, nurses' dedication to their work appears to be an innate desire to provide care for patients with COVID-19. Nonetheless, the universal effort to control the outbreak has led to extended work hours and workload, which has been defined as the primary contributor to work-related stress among nurses and might impact their job-related affective well-being. METHOD: We used a cross-sectional exploratory design. Data were collected using an online survey from 161 nurses working in the Saudi health care system. The survey included obtaining information on demographics and work-related stress using Professional Quality of Life Scale version 5 to measure compassion fatigue as well as a job-related affective well-being scale. RESULTS: Work-related stress had significant negative direct effects on job-related affective well-being and positive effects on compassion fatigue. Compassion fatigue had significantly negative direct effects on job-related affective well-being. Work-related stress exerted negative indirect effects on job-related affective well-being through compassion fatigue, which partially mediated the relationship. CONCLUSION: The findings supported the model and added to our understanding regarding the impact of work-related stress on nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Stress reduction is an important element in improving staff outcomes as well as job-related affective well-being.

Empathy and Cognitive Processing as Factors Determining the Consequences of Secondary Exposure to Trauma Among Roman Catholic Clergymen.

By helping individuals after traumatic experiences, the helper is also exposed to the consequences of trauma. The aim of this study was to determine the predictors of consequences of secondary exposure to trauma among clergymen and therapists (N = 140) helping victims of trauma in Poland. Symptoms of secondary traumatic stress (STS) were identified in 22.9% of the clergymen and 8.6% of therapists, and secondary posttraumatic growth (SPTG) in 61.4% of the clergymen and 42.9% of therapists. STS and SPTG predictors were identified based on regression models. In the case of clergymen, regret is a determinant of STS, and positive cognitive restructuring of SPTG. Research findings highlight the need to increase awareness of exposure to secondary trauma among the clergy, and for them to acquire greater skills for coping with stress.

Beyond workplace violence: Direct and vicarious trauma among psychiatric hospital workers. A qualitative study.

AIM: We aimed to explore psychiatric nurses' and other psychiatric workers' understanding of trauma in the context of their relationships with the people they care for and the effects on their mental health. BACKGROUND: Workplace violence in psychiatric hospitals can lead to mental health problems, including posttraumatic stress disorder. Professional relationships with the people they care for may complicate psychiatric workers' experiences of trauma. METHODS: We qualitatively analysed responses of 30 psychiatric workers who answered relevant open-ended questions in a survey of workplace violence and posttraumatic stress disorder symptoms. RESULTS: We found that respondents were profoundly affected by violence and vicarious trauma through the current and previous suffering of people in their care. The effects of vicarious exposure and other potentially psychologically traumatic events were often made worse by lack of organizational support. CONCLUSION: Not only direct exposure to violent events but also indirect exposure, vicarious traumatic stress and perceived lack of organizational support affect staff's well-being. IMPLICATIONS FOR NURSING MANAGEMENT: Management should ensure that mental health supports are not limited to workers directly affected by workplace violence but should extend to those who witnessed the event and to those regularly exposed to vicarious trauma.

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.

Secondary traumatic stress, anxiety, and depression among emergency healthcare workers in the middle of the COVID-19 outbreak: A cross-sectional study.

BACKGROUND: This study aims to determine the secondary traumatic stress (STS), anxiety, and depression levels of the emergency healthcare workers (HCWs) and to identify the factors associated with the mental health of the emergency HCWs. METHODS: This prospective cross-sectional study was performed between April 1 and May 1, 2021. Emergency nurses and auxiliary staff who gave informed consent were included in the study. Participants who answered the questions incompletely were excluded from the study. Demographic information, working and living conditions, STS, anxiety, depression scores, and coping strategies were recorded. RESULTS: A total of 363 HCWs were included in the study. STS was detected in 261 (71.9%) of the participants, anxiety in 148 (40.8%), and depression in 203 (55.9%) participants. Vaccination against COVID-19 was not associated with STS, anxiety, and depression among emergency HCWs (p > 0.05). Having financial difficulties was the most important factor in the development of anxiety, depression, and STS (OR: 3.68 (95% CI 1.96-6.90), p < 0.001; OR: 4.36 (95% CI 2.52-7.53), p < 0.001; OR: 5.35 (95% CI 3.06-9.37), p < 0.001, respectively). We found significantly reduced levels of STS, anxiety, and depression among participants reporting coping strategies that engaging in hobbies, healthy nutrition, and reading books. CONCLUSION: High levels of STS, anxiety, and depression were determined among emergency nurses and auxiliary staff during the pandemic. Poor job satisfaction and financial difficulties were associated with the mental health of emergency HCWs. The mental health of the emergency HCWs should be evaluated regularly. In addition to professional psychological support, social and financial support should be provided as well.

Prevalence and contextual factors associated with compassion fatigue among nurses in northern Uganda.

BACKGROUND: Compassion fatigue is associated with negative consequences that undermine workplace performance. However, literature is scarce on compassion fatigue among nurses in the context of Uganda who are at higher risk of compassion fatigue owed to the nature of their occupation and the unfavorable work environment. We aimed to assess the prevalence and predictors of compassion fatigue among nurses in Northern Uganda. METHODS: We conducted a cross-sectional survey among 395 randomly selected nurses from two referral and four general hospitals in Northern Uganda. Data was collected using a self-administered questionnaire. Data analysis consisted of descriptive statistics, cross-tabulations, and logistic regression at a 95% level of significance in SPSS version 25. RESULTS: Of 395 nurses who took part in the study, 58.2% were female, 39.8% had a diploma, 47.1% were single, and 32.4% had worked for between 11-15 years. Close to 50% of the nurses experienced compassion fatigue. The predictors of compassion fatigue among the participants were; workplace bullying (AOR: 3.83; 95% CI: 1.99-7.36; p = <0.001) career enhancement opportunities (AOR: 9.16; 95% CI: 2.32-36.22; p = 0.002; and remuneration (AOR: 7.30; 95% CI: 2.73-19.49; p = <0.001). CONCLUSION: More than 3 in 4 nurses in Northern Uganda experience compassion fatigue. The Ministry of Health together with other stakeholders should strive to increase career enhancement opportunities for nurses, improve nurses' remuneration and improve the overall workplace environment to prevent compassion fatigue among nurses in the country.

Second Victim Experience among OBGYN Trainees: What Is Their Desired Form of Support?

OBJECTIVES: Physician trainees in obstetrics and gynecology (OBGYN) experience unexpected outcomes similar to those of supervising physicians. A relative lack of experience and perspective may make them more vulnerable to second victim experience (SVE), however. The objectives of our study were to contrast the prevalence of SVE between supervising physicians and trainees and to identify their preferred methods of support. METHODS: In 2019, the Second Victim Experience and Support Tool, a validated survey with supplemental questions, was administered to healthcare workers caring for OBGYN patients at a large academic center in the midwestern United States. RESULTS: The survey was sent to 571 healthcare workers working in OBGYN. A total of 205 healthcare workers completed the survey, including 18 (43.9% of 41) supervising physicians and 12 (48.0% of 25) resident/fellow physicians. The mean scores for the Second Victim Experience and Support Tool dimensions and outcomes were similar between the two groups. Seven (58.3%) trainees reported feeling like a second victim after an adverse patient safety event at some point in their work experience compared with 10 (55.6%) of the supervising physicians. Five (41.7%) trainees identified as a second victim in the previous 12 months compared with 3 (16.7%) supervising physicians (P = 0.21). The most common form of desired support for both groups was conversations with their peers. CONCLUSIONS: Trainees and supervising physicians are both at risk of SVE after an unexpected medical event and prefer conversations with peers as a desired form of support. Because trainees commonly encounter SVEs early in their careers, program directors should consider implementing a program for peer support after an unexpected event.

Prevalence and predictors of secondary traumatic stress symptoms in health care professionals working with trauma victims: A cross-sectional study.

INTRODUCTION: Medical personnel is an occupational group that is especially prone to secondary traumatic stress. The factors conditioning its occurrence include organizational and work-related factors, as well as personal features and traits. The aim of this study was to determine Secondary Traumatic Stress (STS) indicators in a group of medical personnel, considering occupational load, job satisfaction, social support, and cognitive processing of trauma. MATERIAL AND METHODS: Results obtained from 419 medical professionals, paramedics and nurses, were analyzed. The age of study participants ranged from 19 to 65 (M = 39.60, SD = 11.03). A questionnaire developed for this research including questions about occupational indicators as well as four standard evaluation tools: Secondary Traumatic Stress Inventory, Job Satisfaction Scale, Social Support Scale which measures four support sources (supervisors, coworkers, family, friends) and Cognitive Processing of Trauma Scale which allows to evaluate cognitive coping strategies (positive cognitive restructuring, downward comparison, resolution/acceptance, denial, regret) were used in the study. RESULTS: The results showed that the main predictor of STS symptoms in the studied group of medical personnel is job satisfaction. Two cognitive strategies also turned out to be predictors of STS, that is regret (positive relation) and resolution/acceptance (negative relation). The contribution of other analyzed variables, i.e., denial, workload and social support to explaining the dependent variable is rather small. CONCLUSIONS: Paramedics and nurses are at the high risk of indirect traumatic exposure and thus may be more prone to secondary traumatic stress symptoms development. It is important to include the medical personnel in the actions aiming at prevention and reduction of STS symptoms.

Stressors, Job Resources, Fear of Contagion, and Secondary Traumatic Stress Among Nursing Home Workers in Face of the COVID-19: The Case of Spain.

This study aimed to analyze the psychological consequences of the COVID-19 pandemic on nursing home workers, as well as the influence of certain related stressors and job resources. Two-hundred twenty-eight nursing home workers in Spain participated in this cross-sectional study. High levels of workload, social pressure from work, contact with suffering, and fear of contagion were found. In nursing homes where cases of COVID-19 had been detected, workers experienced higher levels of secondary traumatic stress. Social pressure from work, high doses of exposure to suffering, lack of personnel and personal protective equipment, and minimal supervisor support were significant in explaining traumatic stress. Supervisor and coworker support moderated some of these relationships. The results are discussed in terms of the need to implement urgent psychosocial protection strategies and to provide personal protective equipment (PPE) to help prevent future psychological disorders in this worker population.

Secondary Traumatic Stress Among Labor and Delivery Nurses.

PURPOSE: To describe the prevalence and severity of secondary traumatic stress (STS) among labor and delivery nurses within a Northeastern United States academic health system. STUDY DESIGN AND METHODS: Using a cross-sectional, descriptive correlational design, a convenience sample of labor and delivery nurses (288 nurses) were invited to complete Secondary Traumatic Stress Scale (STSS), a 17-item Likert-type instrument, that measures intrusion, avoidance, and the arousal symptoms associated with indirect exposure to traumatic events. Five additional questions about potential consequences of STS were also asked. RESULTS: N = 144 completed the survey (50% response rate). Average STSS score was 33.74 (SD, 11.8), with 35% of respondents meeting symptom severity scores associated with STS. STSS Scores ≥ 38 were significantly correlated with nurses considering leaving their jobs, calling out sick, or requesting an assignment change after witnessing a traumatic birth (p < 0.001). The majority of respondents (84.7%) reported witnessing a traumatic birth. After witnessing a traumatic birth, respondents used co-workers, family, and friends as sources of support. CLINICAL IMPLICATIONS: This study offers insight into the frequency and severity of STS among labor and delivery nurses, as well as the potential workforce-related consequences and provides a foundation for future work aimed at developing interventions to prevent or alleviate STS.