Healthcare and Human Resources Development

Introduction
Compassion and caring are cornerstones of nursing. The cultivation and application of compassionate care approaches are critical for nurse satisfaction, too. Compassion satisfaction refers to the positive feelings and thoughts that arise from helping others. However, nurses can and do experience what is known as compassion fatigue, a type of emotional burnout. Sacco, Ciurzynski, Harvey & Ingersoll (2015) investigate the prevalence and explore the causes of both compassion satisfaction and compassion fatigue in “Compassion Satisfaction and Compassion Fatigue Among Critical Care Nurses.”
The term compassion fatigue was coined in the 1990s (Sacco, Ciurzynski, Harvey & Ingersoll, 2015). Nurses working with trauma patients may be especially at risk for compassion fatigue because of the unique nature of the patient population and the corresponding stressors in the work environment. Compassion fatigue is frequently framed as a type of burnout, or “a cumulative state of frustration with a person’s work environment that develops over a long time,” (Sacco, Ciurzynski, Harvey & Ingersoll, 2015, p. 33). Even nurses who do not work in trauma units can experience burnout, but nurses in trauma units may be at an especially high risk for compassion fatigue due to secondary traumatic stress. Secondary traumatic stress is defined as “a feeling of despair caused by the transfer of emotional distress from a victim to a caregiver that often develops suddenly (Sacco, Ciurzynski, Harvey & Ingersoll, 2015, p. 33). Burnout plus secondary traumatic stress equal compassion fatigue. Compassion fatigue can lower employee satisfaction rates, and even lead to ancillary effects like reduced patient satisfaction and poorer patient outcome. This research by Sacco, Ciurzynski, Harvey & Ingersoll (2015) adds to the growing body of evidence on compassion fatigue by broadening the concept and linking it with workplace safety, organizational culture, and occupational health.
Purpose and Significance
The specific purpose of the Sacco, Ciurzynski, Harvey & Ingersoll (2015) study is to determine the prevalence of compassion fatigue and compassion satisfaction among nurses working in adult, pediatric, and neonatal critical care settings. A secondary purpose of the study is stated as describing demographic and organizational variables that might contribute to either compassion satisfaction or compassion fatigue. Ideally, healthcare organizations help nurses maintain a balance between compassion satisfaction and compassion fatigue.
Sacco, Ciurzynski, Harvey & Ingersoll (2015) also help differentiate between burnout and secondary traumatic stress. Burnout is more related to environmental conditions, whereas secondary traumatic stress is unique to nurses working with specific patient populations, namely trauma patients. In the introduction to “Compassion satisfaction and compassion fatigue among critical care nurses,” Sacco, Ciurzynski, Harvey & Ingersoll (2015) also refer to professional quality of life as the balance between the positive and negative effects of caring (p. 33). The research is therefore of particular use for human resources managers and healthcare administrators.
Review of Literature
No formal review of literature is provided in the Sacco, Ciurzynski, Harvey & Ingersoll (2015) report, in spite of the existence of a substantive body of literature on the topic. For example, Conrad & Kellar-Guenther (2006) use a self-report instrument to measure compassion fatigue and burnout among child protective workers and found that while over 70% expressed compassion satisfaction, about 50% also experienced compassion fatigue. Hooper, Craig, Janvrin, et al (2010) used a cross-sectional survey to search for differences in compassion satisfaction and compassion fatigue between emergency nurses and intensive care nurses, and found that emergency nurses exhibit lower compassion satisfaction overall versus other nurses, but 86% of all nurses experienced compassion fatigue.
The lack of a literature review in the Sacco, Ciurzynski, Harvey & Ingersoll (2015) study weakens the research and diminishes its impact and credibility significantly. However, the authors do refer to a seminal study by Joinson (1992), who first described the phenomenon of compassion fatigue. The authors also mention the American Psychiatric Association’s definition of traumatic stressor, and the American Association of Critical-Care Nurses’ standards for establishing and maintaining a healthy work environment.
Theoretical Framework
The authors do not identify their theoretical framework, but do mention their predilection for the professional quality of life model (ProQOL). Therefore, the authors seem to use a theoretical framework more closely akin to human resources and organizational psychology than to nursing. Likewise, the authors mention the concept of a healthy workplace environment, and the importance of reducing stress and burnout to promote better patient outcomes as well as higher job satisfaction rates.
Methods/Research Design/Procedures
This is a cross-sectional study conducted in a tertiary care academic medical center in 2010. Although the authors do not admit it, theirs is a convenience sample. After receiving approval by the medical center’s review board, the authors used the institution’s email system to send electronic invites to hospital personnel. Anonymity was ensured and informed consent received. The authors offered a small ($2.50) financial incentive, suggesting that participation was not only voluntary but an act of kindness on the part of the participants. The medical center has 739 beds, and the authors drew the sample from 9 targeted units including three adult instensive critical care, three mixed ICUs and progressive care units, two pediatric care, and one neonatal care unit. All participants needed to be critical care nurses (registered nurses and licensed practical nurses). The response rate was 38%, with the highest number of responses coming from the neonatal and pediatric ICUs. A total of 221 participants completed the survey.
The drawbacks of the author’s research design and sampling methods are offset by their use of a credible and reliable survey instrument. The survey instrument used was the ProQOL, version 5. The ProQOL has “acceptable levels of internal consistency reliability,” (Sacco, Ciurzynski, Harvey & Ingersoll, 2015, p. 34). The ProQOL includes three separate subscales to measure compassion satisfaction and compassion fatigue. The three subscales include compassion satisfaction, burnout, and secondary traumatic stress. The authors point out that the latter two collectively measure the variable of compassion fatigue. A demographic instrument was also included in the study.
Because the research is exploratory and not experimental in nature, there are no independent or dependent variables. However, results of the ProQOL survey are treated as dependent variables in relation to independent variables such as type of critical care unit and demographics. Nursing experience, role of nurse, unit tenure, and level of education were also recorded and used for data analysis.
The authors used SPSS to analyze the data, converting raw data into t scores and computing analyses of variance. The authors admit an inadvertent omission of one item on the secondary traumatic stress inventory subscale. To remedy the omission, the authors claim to have used algebraic modifications.
Results/Data Analysis
Taken collectively, the 221 participants scored within average ranges for all ProQOL subscales. However, the purpose of this study was to see if there were ProQOL scoring differences depending on demographics and/or workplace conditions or unit type. There were statistically significant differences in the dependent variable of compassion satisfaction. The group mean scores revealed differences according to sex, age, unit acuity, and change in nursing management. Female nurses reported higher compassion satisfaction than their male counterparts. The age cohort of 40-49 also reported lower compassion satisfaction than other cohorts. On the other hand, the highest rates of compassion satisfaction were reported by nurses in the over-50 age cohort. Nurses working on single acuity units reported higher compassion satisfaction versus nurses on mixed-acuity units. Having had a recent change in management also impacted compassion satisfaction scores, with management change linked to lower compassion satisfaction. Interestingly, nurses with a Bachelor’s degree report the lowest compassion satisfaction versus either those with an Associate’s or Master’s degree.
Nurses in the 40-49 age cohort report significantly higher burnout and secondary traumatic stress than their counterparts in all other age groups. However, nurses in the 20-29 cohort do report higher secondary traumatic stress than older groups. Nurses working in mixed acuity units also report higher rates of burnout and secondary traumatic stress. Management change was also correlated with higher burnout and secondary traumatic stress. Procedural changes on the unit were also linked to higher burnout and secondary traumatic stress. Interestingly, no one unit reported significantly different rates of either compassion satisfaction or compassion fatigue.
Findings/Conclusions
The results indicate that while overall, critical care nurses have average scores of compassion fatigue and compassion satisfaction, there are differences according to organizational factors and demographic characteristics. The authors suggest that healthcare organizations promote compassion satisfaction, rather than focusing on the means by which to reduce compassion fatigue. Because of the striking demographic differences in the experiences of compassion satisfaction and compassion fatigue, the results have implications for human resources managers. Older and more experienced nurses report lower levels of compassion fatigue and higher levels of compassion satisfaction. Likewise, mixed units report higher compassion fatigue and lower rates of compassion satisfaction. Administrators interested in promoting ProQOL in their institutions should therefore aim to change the workplace environment to reduce the burdens of mixed units, while also improving the training offered to younger nurses at risk for burnout and secondary traumatic stress. Age is in fact the most important factor influencing ProQOL.
Summary Assessment
This research lacks internal and external validity and therefore has limited real world applications. However, the results of the research can be of use to human resources managers in healthcare organizations. The exploratory nature of the research does shed light on some of the possible risk factors for burnout and secondary traumatic stress. This research can be used to inform future studies, encouraging a more robust research design. Finally, future experimental research could focus on the organizational culture and managerial variables like managerial changes and unit composition.



References

Conrad, D. & Kellar-Guenther, Y. (2006). Compassion fatigue, burnout, and compassion satisfaction among Colorado child protection workers. Child Abuse & Neglect 30(10): 1071-1080.
Hooper, C., Craig, J., Janvrin, D.R., et al (2010). Compassion Satisfaction, Burnout, and Compassion Fatigue Among Emergency Nurses Compared With Nurses in Other Selected Inpatient Specialties. Journal of Emergency Nursing 36(5): 420-427.
Sacco, T.L., Ciurzynski, S.M., Harvey, M.E. & Ingersoll, G.L. (2015). Compassion satisfaction and compassion fatigue among critical care nurses. Critical Care Nurse 35(4): 32-42.