Background Compassion fatigue is described as the phenomenon of exhaustion and dysfunction in healthcare workers resulting from prolonged exposure to work-related stress and compassion stress. Oncology nurses are at high risk for compassion fatigue. Aims Our study aims to estimate the levels, prevalence and related factors of compassion fatigue dimension in oncology nurses. Design Systematic review and meta-analysis. Method Ten electronic databases were conducted in the systematic review and meta-analysis. Time frame of the searches is from inception up to 31 January 2020. The research team independently conducted study selection, quality assessments, data extractions and analysis of all included studies. The means, standard deviations and prevalence of three dimensions of compassion fatigue were pooled using random-effects meta-analysis. The PRISMA guideline was used to report the systematic review and meta-analysis. PROSPERO registration number: CRD42020205521. Results The systematic review included 21 studies, involving 6533 oncology nurses across 6 different countries. In our studies, the pooled mean scores of compassion satisfaction (CS), burnout (BO) and secondary traumatic stress (STS) were 35.47 (95% CI: 33.54-37.41), 24.94 (95% CI: 23.47-26.41) and 24.48 (95% CI: 23.36-25.60), respectively; the pooled prevalence of "low" rates of CS, "high" rates of BO and STS were 20% (CI 13%-28%), 22% (CI 18%-26%) and 22% (CI 17%-28%), respectively; furthermore, geographical regions (Asia) significantly affect the prevalence of compassion fatigue among oncology nurses. The compassion fatigue variables considered were demographic (age, marital status, education background, health condition and gender), work-related (job satisfaction, income satisfaction, years of working experience, professional title, position and work environment) and other variables (social support, coping strategy, self-compassion, professional cognition and psychological training). Conclusion Oncology nurses were at "moderate" level of compassion satisfaction, burnout and secondary traumatic stress, and 22% of oncology nurses suffered from "high" risk of compassion fatigue. Hospital administrators should develop interventions to address compassion fatigue phenomenon, and enhance the mental health of oncology nurses and nursing care results. Relevance to clinical practice Oncology unit warrants special attention, and oncology nurses are at high risk for compassion fatigue. However, the reported prevalence rates and oncology nurses with different characteristics vary considerably. The review provides a preliminary framework for nursing administrators to develop interventions to address compassion fatigue phenomenon, and enhance the psychological health of oncology nurses.

The levels, prevalence and related factors of compassion fatigue among oncology nurses: a systematic review and meta-analysis

Compassion is one of the core elements of nursing care. Continued exposure to patient pain and suffering puts nurses at risk of developing compassion fatigue. The aim of this study was to understand the causes and consequences of compassion fatigue from the perspective of nurses. To this end, a qualitative design based on the hermeneutic phenomenology paradigm was used. Five focus group sessions were held with 43 nursing professionals. Two themes and six sub-themes emerged from the analysis of their discourses in relation to the impact of compassion fatigue on nurses. Based on the results obtained, the causes perceived as generating compassion fatigue are the lack of time and resources to provide comprehensive nursing care. The consequences identified were difficulties in carrying out their work, repercussions on family and private life, anxiety, stress, and, in some cases, the desire to quit the profession. This study concluded that healthcare organizations are key to fostering compassionate care and that cultivating compassion is necessary to prevent compassion fatigue.

Qualitative study on the causes and consequences of compassion fatigue from the perspective of nurses.

Aims This study aimed to conduct a short- and long-term Compassion Fatigue Resiliency Program and compare its impact on nurses' professional quality of life, perceived stress, and resilience. Design The research was conducted between January 2017 January 2019 as a randomized controlled trial. Methods The sample comprised 125 oncology-haematology nurses randomly assigned to a Experimental I, Experimental II, or control group. The Compassion Fatigue Resiliency Program was conducted with the nurses as an intervention. Experimental I received a short-term program (5 hr per day for 2 days, 10 hr in total) while Experimental II received a long-term one (5 weeks, 2 hr per week, 10 hr in total). Measurements were obtained during pre- and post-test and at 3-, 6-, and 12-month follow-ups. Research hypotheses were analysed using multilevel models. Results The results of multilevel model analyses showed there was no statistically significant difference between mean scores for compassion fatigue, burnout, perceived stress, and resilience of nurses in the short- or long-term groups or of those in the control group. Mean compassion satisfaction scores of nurses in the short- or long-term groups were significantly higher than those in the control group. Mean compassion satisfaction scores of nurses in the short- or long-term groups were significantly higher than the control group's pre-test mean after 6 and 12 months. Conclusion This study concluded that short- or long-term programs had no influence on compassion fatigue, burnout, perceived stress, and resilience; however, both programs positively affected compassion satisfaction. We recommend that further studies be conducted, which will help determine the effectiveness of new programs. Impact Caring for patients with cancer can generate work-related stress that can negatively affect oncology nurses' physical and emotional health, which could lead to compassion fatigue. The program provided nurses with an opportunity to improve their compassion satisfaction. Because there was no difference between both programs regarding mean compassion satisfaction scores, a short-term program may be preferred to encourage more participation among nurses. We also recommend further studies should be conducted that include environmental improvements along with the training programs. Trial registered at ClinicalTrials.gov (The name of the trial register: Effect of a Compassion Fatigue Resiliency Program; the clinical trial registration number: NCT04372303).

Effect of a compassion fatigue resiliency program on nurses' professional quality of life, perceived stress, resilience: A randomized controlled trial.

Oncology nurses are at high risk of developing compassion fatigue (CF) because of the persistent exposure to patients' suffering and death. Empathy is a prerequisite cognitive reaction for CF. Nurses with greater empathy levels are more prone to develop an emotional connection with patients. However, it is this kind of close bonds that led nurses to experience a deep sense of grief. Cumulative grief may eventually develop into CF. This study examined the levels of grief, empathy and CF, evaluated the correlation among empathy, grief and CF, and verified the role grief as a mediator of the relationship between empathy and CF.

Grief as a mediator of the relationship between empathy and compassion fatigue

Interventions to foster resilience in nursing staff: A systematic review and meta-analyses of pre-pandemic evidence.

http://diposit.ub.edu/dspace/bitstream/2445/146583/1/693005.pdf

Emotional impact and compassion fatigue in oncology nurses: Results of a multicentre study

Compassion fatigue and anxiety derived from continued exposure to trauma and death greatly impact nurses’ quality of care and quality of life, increasing their desire to leave work. The aim of the study is to assess compassion fatigue and anxiety prevalence and their association with secondary variables. A multicenter, cross-sectional study in nurses from four high-risk units, Emergency, Intensive Care, Oncology, and Pediatrics, was carried out in 14 hospitals in Catalonia (Spain) between 2015 and 2016. The primary endpoints were compassion satisfaction and compassion fatigue (burnout and secondary traumatic stress), which were assessed by Professional Quality of Life (ProQOL), and anxiety, assessed with the State-Trait Anxiety Inventory (STAI). Multivariable logistic regression analyzed the association of sociodemographic, training, working, and psychological factors. Of a total of 1302 nurses, 18.6% presented low compassion satisfaction; 19.7%, high burnout; and 36.4%, high secondary traumatic stress. Trait anxiety scored high in 7.2%. Although compassion satisfaction was present, it did not protect sufficiently against the high level of compassion fatigue or anxiety present in nurses in all centers. The working conditions in the units and variables showed a strong association with nurses’ desire to leave. This corroborates the global challenge of healthcare professionals’ shortage. Participants expressed the need for better training in emotional management.

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Esther Arimon-Pagès

Papers

Emotional impact and compassion fatigue in oncology nurses: Results of a multicentre study

Dealing with Emotional Vulnerability and Anxiety in Nurses from High-Risk Units—A Multicenter Study

Compassion fatigue and anxiety in critical care emergency nurses: In between efficiency and humanity.