Resilience as a mediator between compassion fatigue, nurses' work outcomes, and quality of care during the COVID-19 pandemic

Leodoro J Labrague, Janet Alexis A de Los Santos, Leodoro J Labrague, Janet Alexis A de Los Santos

Abstract

Background: Nurses in the frontline of the battle against COVID-19 are highly vulnerable to compassion fatigue (CF), which may affect their mental health, work effectiveness, and patient safety outcomes. However, no studies have investigated nurses' CF in relation to job outcomes and care quality during the pandemic.

Aims: This study aims to examine the mediating role of resilience in the relationship between CF and frontline nurses' job outcomes (job satisfaction and turnover intention) and care quality.

Design: An online, cross-sectional survey containing five self-report scales was used to collect data from 270 frontline nurses in selected hospitals in the Philippines.

Results: Overall, 38.5% of frontline nurses experienced medium to high CF during the second wave of the pandemic. Increased CF was associated with poorer nurse-reported quality of care (β = -0.145, p = 0.019), lower job satisfaction (β = -0.317, p = 0.001), and higher organizational turnover intention (β = 0.301, p = 0.001). Moreover, resilience fully mediated the relationship between CF and quality of care (β = -0.088, p = 0.169), and partially mediated the relationship between CF and job satisfaction (β = -0.259, p = 0.001), and CF fatigue and organizational turnover intention (β = 0.272, p = 0.001).

Conclusion: Frontline nurses are at risk of developing CF during the pandemic. Psychological resilience reduces the negative impact of CF on frontline nurses' job satisfaction, turnover intention, and the quality of care in their assigned unit. Proactive measures to reduce CF should be prioritized by nursing administrators. Resilience-promoting interventions could foster job satisfaction and retention in nurses and, hence, the quality of care delivered in their units.

Keywords: COVID-19 pandemic; Compassion fatigue; Job satisfaction; Nursing; Quality of care; Resilience; Turnover intention.

Conflict of interest statement

All authors declare no conflict of interest.

Copyright © 2021 Elsevier Inc. All rights reserved.

Figures

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Fig. 1
Hypothesized models.
Fig. 2
Fig. 2
Final models.

References

    1. Adams R.E., Figley C.R., Boscarino J.A. The compassion fatigue scale: Its use with social workers following urban disaster. Research on Social Work Practice. 2008;18(3):238–250.
    1. Adimando A. Preventing and alleviating compassion fatigue through self-care: An educational workshop for nurses. Journal of Holistic Nursing. 2018;36(4):304–317.
    1. Alharbi J., Jackson D., Usher K. 2020. The potential for COVID-19 to contribute to compassion fatigue in critical care nurses.
    1. Alharbi J., Jackson D., Usher K. Personal characteristics, coping strategies, and resilience impact on compassion fatigue in critical care nurses: A cross-sectional study. Nursing & Health Sciences. 2020;22(1):20–27.
    1. Alharbi J., Jackson D., Usher K. Compassion fatigue in critical care nurses and its impact on nurse-sensitive indicators in Saudi Arabian hospitals. Australian Critical Care. 2020;33(6):553–559.
    1. Arnetz J.E., Goetz C.M., Arnetz B.B., Arble E. Nurse reports of stressful situations during the COVID-19 pandemic: Qualitative analysis of survey responses. International Journal of Environmental Research and Public Health. 2020;17(21):8126.
    1. Azizoddin D.R., Vella Gray K., Dundin A., Szyld D. Bolstering clinician resilience through an interprofessional, web-based nightly debriefing program for emergency departments during the COVID-19 pandemic. Journal of Interprofessional Care. 2020;34(5):711–715.
    1. Barnett M.D., Flores J. Narcissus, exhausted: Self-compassion mediates the relationship between narcissism and school burnout. Personality and Individual Differences. 2016;97:102–108.
    1. Baron R.M., Kenny D.A. The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology. 1986;51(6):1173.
    1. Cao X., Chen L. The impact of empathy on work engagement in hemodialysis nurses: The mediating role of resilience. Japan Journal of Nursing Science. 2020;17(1)
    1. Cavanagh N., Cockett G., Heinrich C., Doig L., Fiest K., Guichon J.R.…Doig C.J. Compassion fatigue in healthcare providers: A systematic review and meta-analysis. Nursing Ethics. 2020;27(3):639–665.
    1. Cho H.J., Jung M.S. Effect of empathy, resilience, self-care on compassion fatigue in oncology nurses. Journal of Korean Academy of Nursing Administration. 2014;20(4):373–382.
    1. Coetzee S.K., Laschinger H.K. Toward a comprehensive, theoretical model of compassion fatigue: An integrative literature review. Nursing & Health Sciences. 2018;20(1):4–15.
    1. Cooper A.L., Brown J.A., Rees C.S., Leslie G.D. Nurse resilience: A concept analysis. International Journal of Mental Health Nursing. 2020;29(4):553–575.
    1. Cooper A.L., Brown J.A., Leslie G.D. Nurse resilience for clinical practice: An integrative review. Journal of Advanced Nursing. 2021;77(6):2623–2640.
    1. Dong Z.Q., Ma J., Hao Y.N., Shen X.L., Liu F., Gao Y., Zhang L. The social psychological impact of the COVID-19 pan- demic on medical staff in China: A cross-sectional study. European Psychiatry. 2020;63(1)
    1. Dreher M.M., Hughes R.G., Handley P.A., Tavakoli A.S. Improving retention among certified nursing assistants through compassion fatigue awareness and self-care skills education. Journal of Holistic Nursing. 2019;37(3):296–308.
    1. Duarte J., Pinto-Gouveia J. Effectiveness of a mindfulness-based intervention on oncology nurses’ burnout and compassion fatigue symptoms: A non-randomized study. International Journal of Nursing Studies. 2016;64:98–107.
    1. Erkin Ö., Konakçı G., Duran S. Secondary traumatic stress in nurses working with patients with suspected/confirmed COVID-19 in Turkey. Perspectives in Psychiatric Care. 2021
    1. García-Martín M., Roman P., Rodriguez-Arrastia M., Diaz-Cortes M.D.M., Soriano-Martin P.J., Ropero-Padilla C. Novice nurse’s transitioning to emergency nurse during COVID-19 pandemic: A qualitative study. Journal of Nursing Management. 2021;29(2):258–267.
    1. Hart P.L., Brannan J.D., De Chesnay M. Resilience in nurses: An integrative review. Journal of Nursing Management. 2014;22(6):720–734.
    1. Huffman E.M., Athanasiadis D.I., Anton N.E., Haskett L.A., Doster D.L., Stefanidis D., Lee N.K. How resilient is your team? Exploring healthcare providers’ well-being during the COVID-19 pandemic. The American Journal of Surgery. 2021;221(2):277–284.
    1. Irshad M., Khattak S.A., Hassan M.M., Majeed M., Bashir S. How perceived threat of Covid-19 causes turnover intention among Pakistani nurses: A moderation and mediation analysis. International Journal of Mental Health Nursing. 2020
    1. Jo M., Na H., Jung Y.E. Mediation effects of compassion satisfaction and compassion fatigue in the relationships between resilience and anxiety or depression among hospice volunteers. Journal of Hospice & Palliative Nursing. 2020;22(3):246–253.
    1. Khattak S.R., Saeed I., Rehman S.U., Fayaz M. Impact of fear of COVID-19 pandemic on the mental health of nurses in Pakistan. Journal of Loss and Trauma. 2021;26(5):421–435.
    1. Kim Y.H., Kim S.R., Kim Y.O., Kim J.Y., Kim H.K., Kim H.Y. Influence of type D personality on job stress and job satisfaction in clinical nurses: The mediating effects of compassion fatigue, burnout, and compassion satisfaction. Journal of Advanced Nursing. 2017;73(4):905–916.
    1. Labrague L. Psychological resilience, coping behaviors, and social support among healthcare workers during the COVID-19 pandemic: A systematic review of quantitative studies. Journal of Nursing Management. 2021 Ahead of print.
    1. Labrague L.J., de los Santos J.A.A. COVID-19 anxiety among front-line nurses: Predictive role of organisational support, personal resilience and social support. Journal of Nursing Management. 2020;28(7):1653–1661.
    1. Labrague L.J., de los Santos J.A.A. Prevalence and predictors of coronaphobia among frontline hospital and public health nurses. Public Health Nursing. 2021;38(3):382–389.
    1. Labrague L.J., de los Santos J.A.A. Fear of Covid-19, psychological distress, work satisfaction and turnover intention among frontline nurses. Journal of Nursing Management. 2021;29(3):395–403.
    1. Maiorano T., Vagni M., Giostra V., Pajardi D. COVID-19: Risk factors and protective role of resilience and coping strategies for emergency stress and secondary trauma in medical staff and emergency workers—An online-based inquiry. Sustainability. 2020;12(21):9004.
    1. O’Callaghan E.L., Lam L., Cant R., Moss C. Compassion satisfaction and compassion fatigue in Australian emergency nurses: A descriptive cross-sectional study. International Emergency Nursing. 2020;48:100785.
    1. Ortega-Campos E., Vargas-Román K., Velando-Soriano A., Suleiman-Martos N., Cañadas-de la Fuente G.A., Albendín-García L., Gómez-Urquiza J.L. Compassion fatigue, compassion satisfaction, and burnout in oncology nurses: A systematic review and meta-analysis. Sustainability. 2020;12(1):72.
    1. Pang Y., Dan H., Jung H., Bae N., Kim O. Depressive symptoms, professional quality of life and turnover intention in Korean nurses. International Nursing Review. 2020;67(3):387–394.
    1. Pérez-García E., Ortega-Galán Á.M., Ibáñez-Masero O., Ramos-Pichardo J.D., Fernández-Leyva A., Ruiz-Fernández M.D. Qualitative study on the causes and consequences of compassion fatigue from the perspective of nurses. International Journal of Mental Health Nursing. 2021;30(2):469–478.
    1. Peters E. Compassion fatigue in nursing: A concept analysis. Nursing Forum. 2018;53(4):466–480.
    1. Pollock A., Campbell P., Cheyne J., Cowie J., Davis B., McCallum J.…Maxwell M. Interventions to support the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic: A mixed methods systematic review. Cochrane Database of Systematic Reviews. 2020 Ahead of Print.
    1. Rangachari P., Woods L.J. Preserving organizational resilience, patient safety, and staff retention during COVID-19 requires a holistic consideration of the psychological safety of healthcare workers. International Journal of Environmental Research and Public Health. 2020;17(12):1–12.
    1. Roberts N.J., McAloney-Kocaman K., Lippiett K., Ray E., Welch L., Kelly C. Levels of resilience, anxiety and depression in nurses working in respiratory clinical areas during the COVID pandemic. Respiratory Medicine. 2021;176:106219.
    1. Ruiz-Fernández M.D., Ramos-Pichardo J.D., Ibáñez-Masero O., Cabrera-Troya J., Carmona-Rega M.I., Ortega-Galán Á.M. Compassion fatigue, burnout, compassion satisfaction and perceived stress in healthcare professionals during the COVID-19 health crisis in Spain. Journal of Clinical Nursing. 2020;29(21−22):4321–4330.
    1. Sabo B. Reflecting on the concept of compassion fatigue. Online Journal of Issues in Nursing. 2011;16(1)
    1. Sacco T.L., Ciurzynski S.M., Harvey M.E., Ingersoll G.L. Compassion satisfaction and compassion fatigue among critical care nurses. Critical Care Nurse. 2015;35(4):32–42.
    1. Saintsing D., Gibson L.M., Pennington A.W. The novice nurse and clinical decision-making: How to avoid errors. Journal of Nursing Management. 2011;19(3):354–359.
    1. Slatyer S., Craigie M., Heritage B., Davis S., Rees C. Evaluating the effectiveness of a brief mindful self-care and resiliency (MSCR) intervention for nurses: A controlled trial. Mindfulness. 2018;9(2):534–546.
    1. Smith B.W., Dalen J., Wiggins K., Tooley E., Christopher P., Bernard J. The brief resilience scale: Assessing the ability to bounce back. International Journal of Behavioral Medicine. 2008;15(3):194–200.
    1. Soper D. A‐priori sample size calculator for multiple regression. 2021. Retrieved from.
    1. Sorenson C., Bolick B., Wright K., Hamilton R. An evolutionary concept analysis of compassion fatigue. Journal of Nursing Scholarship. 2017;49(5):557–563.
    1. Taunton R.L., Bott M.J., Koehn M.L., Miller P., Rindner E., Pace K.…Dunton N. The NDNQI-adapted index of work satisfaction. Journal of Nursing Measurement. 2004;12(2):101–122.
    1. Tseng H.M., Shih W.M., Shen Y.C., Ho L.H., Wu C.F. Work stress, resilience, and professional quality of life among nurses caring for mass burn casualty patients after Formosa color dust explosion. Journal of Burn Care & Research. 2018;39(5):798–804.
    1. Weiner L., Berna F., Nourry N., Severac F., Vidailhet P., Mengin A.C. Efficacy of an online cognitive behavioral therapy program developed for healthcare workers during the COVID-19 pandemic: The REduction of STress (REST) study protocol for a randomized controlled trial. Trials. 2020;21(1):1–10.
    1. Wells-English D., Giese J., Price J. Compassion fatigue and satisfaction: Influence on turnover among oncology nurses at an urban cancer center. Clinical Journal of Oncology Nursing. 2019;23(5):487–493.
    1. Xie W., Wang J., Zhang Y., Zuo M., Kang H., Tang P.…Ma C. The levels, prevalence and related factors of compassion fatigue among oncology nurses: A systematic review and meta-analysis. Journal of Clinical Nursing. 2021;30(5–6):615–632.
    1. Yörük S., Güler D. The relationship between psychological resilience, burnout, stress, and sociodemographic factors with depression in nurses and midwives during the COVID-19 pandemic: A cross-sectional study in Turkey. Perspectives in Psychiatric Care. 2021;57(1):390–398.
    1. Zhang S.X., Chen J., Jahanshahi A.A., Alvarez-Risco A., Dai H., Li J., Patty-Tito R.M. Succumbing to the COVID-19 pandemic—Healthcare workers not satisfied and intend to leave their jobs. International Journal of Mental Health and Addiction. 2021:1–10.
    1. Zhang Y.Y., Han W.L., Qin W., Yin H.X., Zhang C.F., Kong C., Wang Y.L. Extent of compassion satisfaction, compassion fatigue and burnout in nursing: A meta-analysis. Journal of Nursing Management. 2018;26(7):810–819.

Source: PubMed

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