Prevalence and predictors of compassion fatigue, burnout and compassion satisfaction among oncology nurses: A cross-sectional survey

https://doi.org/10.1016/j.ijnurstu.2016.01.012Get rights and content

Abstract

Background

Cancer is a leading cause of death worldwide. Given the complexity of caring work, recent studies have focused on the professional quality of life of oncology nurses. China, the world's largest developing country, faces heavy burdens of care for cancer patients. Chinese oncology nurses may be encountering the negative side of their professional life. However, studies in this field are scarce, and little is known about the prevalence and predictors of oncology nurses’ professional quality of life.

Objectives

To describe and explore the prevalence of predictors of professional quality of life (compassion fatigue, burnout and compassion satisfaction) among Chinese oncology nurses under the guidance of two theoretical models.

Design

A cross-sectional design with a survey.

Settings

Ten tertiary hospitals and five secondary hospitals in Shanghai, China.

Participants

A convenience and cluster sample of 669 oncology nurses was used. All of the nurses worked in oncology departments and had over 1 year of oncology nursing experience. Of the selected nurses, 650 returned valid questionnaires that were used for statistical analyses.

Methods

The participants completed the demographic and work-related questionnaire, the Chinese version of the Professional Quality of Life Scale for Nurses, the Chinese version of the Jefferson Scales of Empathy, the Simplified Coping Style Questionnaire, the Perceived Social Support Scale, and the Chinese Big Five Personality Inventory brief version. Descriptive statistics, t-tests, one-way analysis of variance, simple and multiple linear regressions were used to determine the predictors of the main research variables.

Results

Higher compassion fatigue and burnout were found among oncology nurses who had more years of nursing experience, worked in secondary hospitals and adopted passive coping styles. Cognitive empathy, training and support from organizations were identified as significant protectors, and ‘perspective taking’ was the strongest predictor of compassion satisfaction, explaining 23.0% of the variance. Personality traits of openness and conscientiousness were positively associated with compassion satisfaction, while neuroticism was a negative predictor, accounting for 24.2% and 19.8% of the variance in compassion fatigue and burnout, respectively.

Conclusions

Oncology care has unique features, and oncology nurses may suffer from more work-related stressors compared with other types of nurses. Various predictors can influence the professional quality of life, and some of these should be considered in the Chinese nursing context. The results may provide clues to help nurse administrators identify oncology nurses’ vulnerability to compassion fatigue and burnout and develop comprehensive strategies to improve their professional quality of life.

Introduction

Cancer is a leading cause of death around the globe, accounting for 22% of all non-communicable disease deaths in 2012 (World Health Organization, 2013). In China, approximately 3.5 million people are diagnosed with cancer every year (Chinese Center for Disease Control and Prevention, 2013). The increased incidence clearly requires a greater number of experienced oncology nurses, but a growing staff shortage is a serious problem in Chinese nursing (Yun et al., 2010).

Cancer patients experience long-term suffering and manifest diverse symptoms (Quinal et al., 2009). The deterioration of their health and repeated hospital admissions usually cause physical and psychological agony for the patients (Bush, 2009). Therefore, it is inevitable that oncology nurses witness all of this suffering and offer necessary nursing care and psychological supports. Moreover, the loss of a patient may be an emotional shock for the nurses, because a mutual caring relationship is gradually established (Fetter, 2012). All these factors can greatly affect incumbent oncology nurses.

The term “professional quality of life” refers to “the quality one feels in relation to their work as a helper” (Stamm, 2010) and covers both positive and negative aspects. It can reflect the comprehensive quality of caring work that oncology nurses experience. However, most studies in China have focused on the subjects of burnout, turnover rate, and similar issues among oncology nurses, and few studies have examined the professional quality of life in this population. Given the significance of this topic, the aim of this study is to investigate the prevalence and potential predictors of the three aspects of professional quality of life among Chinese oncology nurses to deepen our knowledge of work-related stress and help nursing administrators focus on the well-being of the individuals within this special group.

Section snippets

Current situation of oncology nursing in China

Chinese cancer patients and their relatives usually try their best to seek positive treatments upon receiving a cancer diagnosis. Because of the current medical system and less-developed hospice care situation in China, many cancer patients in terminal stages choose tertiary or secondary hospitals for medical services. Both choices lead to a high demand for oncology nursing care. In this context, institutions have begun to train oncology clinical nurse specialists; however, there is still a

Sample and setting

A cross-sectional survey was conducted in Shanghai, China, from March to June 2013. Convenience and cluster sampling was used to select study participants, who were clinical oncology nurses from five secondary hospitals and ten tertiary hospitals. To be eligible, they needed to work in the oncology department, directly care for cancer patients and have more than 1 year of nursing experience in oncology. Head nurses or nurse educators responsible for nursing management/teaching and nurses who

Demographic and work-related characteristics of the participants

Table 1 shows the demographic and work-related data of all 650 subjects. The age of the participants ranged from 19 to 55 (29.8 ± 6.0) years. The participants practiced an average of 8.6 (±6.7) years, including 6.7 (±5.3) years of oncology nursing.

Prevalence of compassion satisfaction, compassion fatigue and burnout

The mean (SD) scores for the dimensions of compassion satisfaction, compassion fatigue and burnout were 31.81 (6.49), 21.39 (4.84), and 21.14 (4.95), respectively. The median scores (interquartile range) were 32.00 (28.00–36.00), 21.00 (18.00–24.00),

Discussion

The Chinese version of the Professional Quality of Life Scale for Nurses was used to measure professional quality of life in our study. When compared with Shen et al.’s study (2015), which used the same scale and focused on Chinese clinical nurses in Shanghai from different specialties, our findings showed that oncology nurses reported lower compassion satisfaction, but higher compassion fatigue and burnout. In addition to the heavy workload and long-term mutual relationships, these

Conclusions

With the guidance of two theories, our study explored the prevalence and possible predictors of the three constructs of professional quality of life among Chinese oncology nurses. Work-related factors, such as the work hospitals and years of clinical nursing experience may have predictive value. Cognitive empathy, support and training from organizations acted as protective predictors, while passive coping and neuroticism appeared to place nurses at higher risk of compassion fatigue and burnout.

Acknowledgements

The authors gratefully acknowledge the funding from the Graduate School, Second Military Medical University; the nursing administrators in the enrolled hospitals for permitting and facilitating the investigation; and all 650 participants for responding to the survey.
Conflict of interest: None declared.
Funding: This study was supported by the Doctorate Innovative Fund from the Graduate School, Second Military Medical University.
Ethical approval: The ethical approval was given by the Ethics

References (52)

  • E.H. Elpern et al.

    Moral distress of staff nurses in a medical intensive care unit

    Am. J. Crit. Care

    (2005)
  • K.L. Fetter

    We grieve too: one inpatient oncology unit's interventions for recognizing and combating compassion fatigue

    Clin. J. Oncol. Nurs.

    (2012)
  • C.R. Figley

    Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized

    (1995)
  • C.R. Figley

    Compassion fatigue: psychotherapists’ chronic lack of self-care

    J. Clin. Psychol.

    (2002)
  • K. Flarity et al.

    The effectiveness of an educational program on preventing and treating compassion fatigue in emergency nurses

    Adv. Emerg. Nurs. J.

    (2013)
  • E. Gleichgerrcht et al.

    Empathy in clinical practice: how individual dispositions, gender, and experience moderate empathic concern, burnout, and emotional distress in physicians

    PLOS ONE

    (2013)
  • Y. Haber et al.

    Predictors of professional quality of life among physicians in a conflict setting: the role of risk and protective factors

    Isr. J. Psychiatry Relat. Sci.

    (2013)
  • M. Hojat et al.

    Physician empathy: definition, components, measurement, and relationship to gender and specialty

    Am. J. Psychiatry

    (2002)
  • M. Höing et al.

    Volunteers in circles of support and accountability job demands, job resources, and outcome

    Sex. Abuse

    (2015)
  • L. Huang et al.

    Coping style, social support and psychosomatic symptoms in the patients with cancer

    Chin. Ment. Health J.

    (1996)
  • M.C. Injeyan et al.

    Personality traits associated with genetic counselor compassion fatigue: the roles of dispositional optimism and locus of control

    J. Genet. Couns.

    (2011)
  • M. Jasperse et al.

    Evaluating stress, burnout and job satisfaction in New Zealand radiation oncology departments

    Eur. J. Cancer Care (Engl.)

    (2014)
  • Q.J. Jiang

    Medical Psychology

    (2010)
  • C. Joinson

    Coping with compassion fatigue

    Nursing (London)

    (1992)
  • G.C. Keidel

    Burnout and compassion fatigue among hospice caregivers

    Am. J. Hosp. Palliat. Care

    (2002)
  • K. Kim et al.

    Korean nurses’ ethical dilemmas, professional values and professional quality of life

    Nurs. Ethics

    (2015)
  • Cited by (0)

    View full text