Compassion Fatigue in Intensive Care Nurses in the COVID-19 Pandemic

Abstract

Objective: This research was conducted to determine the level of compassion fatigue in intensive care nurses working under severe working conditions and intense stress in the COVID-19 pandemic. Method: The cross-sectional and descriptive study was carried out with the voluntary participation of all 363 intensive care nurses working between 01.02.2021-01.03.2021 in Adult Anesthesia Intensive Care Units of a Pandemic Hospital in Istanbul during the pandemic period. Sample selection was not made. The data were collected using the Compassion Fatigue - Short Scale (MY-CD) form consisting of 13 items and 5-question personal information prepared by the researchers. The collected data were analyzed using the SPSS 25.0 (Statistical Packages for the Social Sciences) statistical package program. Compassion fatigue short scale sub-dimensions of secondary trauma, occupational burnout and total score were not found to show normal distribution by Shapiro-Wilk Test (p <0.05). For this reason, all analyzes were made with non-parametric methods. Mann-Whitney and Kruskal-Wallis Tests were used for comparing the means; Spearman's rho Correlation was used to determine the relationship between variables. Results: Of the 363 nurses participating in the study, 286 were female (78.8%), 268 (73.8%) were in the 18-25 age range, 279 (76.9%) were undergraduate, 265 (73%) were) between 0-1 years of professional experience, and 103 (28.4%) were diagnosed with Covid-19 positive. Compassion fatigue short scale mean score was determined as 65.01 ± 25.56. When sociodemographic data were compared with the compassion fatigue score and the scores of the sub-dimensions, no significant difference was found. A statistically significant difference was found between the nurses infected with the Covid-19 virus and those who did not have the disease, between the compassion fatigue short scale sub-dimensions of secondary trauma, occupational burnout and total score averages. Secondary trauma score (p= 0.0199), occupational burnout score (p= 0.0482) and total score (p= 0.0264), which are among the compassion fatigue short scale sub-dimensions, are higher in nurses with Covid-19. Conclusion: The compassion fatigue of those who were infected with the Covid-19 virus and had the disease was found to be higher in nurses, most of whom were young, newly graduates and who had only 0-1 years of experience in the intensive care unit. In order not to decrease the quality of nursing care, not to feel inadequate in the first years of the profession, and not to leave the profession, it is recommended by the hospital management to take measures on this issue, to make motivational interviews with all nurses about this risky situation and to support individuals with in-service training.

Keywords

• Compassion Fatigue
• Intensive Care Nurse
• Covid-19

COVID-19 Pandemisinde Yoğun Bakım Hemşirelerinde Merhamet Yorgunluğu

Öz

Amaç: Bu araştırma, COVID-19 pandemisinde ağır çalışma koşulları ve yoğun stres altında çalışan yoğun bakım hemşirelerinde merhamet yorgunluğu düzeyini belirlemek amacıyla yürütüldü. Yöntem: Kesitsel ve tanımlayıcı tipteki bu araştırma, pandemi döneminde İstanbul’da bir Pandemi Hastanesinin Erişkin Anestezi Yoğun Bakım Ünitelerinde, 01.02.2021–01.03.2021 tarihleri arasında çalışan 363 yoğun bakım hemşiresinin tamamının gönüllü katılımıyla ile gerçekleştirildi. Örneklem seçimine gidilmedi. Veriler, araştırmacılar tarafından hazırlanan 5 soruluk kişisel bilgiler ile 13 maddeden oluşan Merhamet Yorgunluğu – Kısa Ölçek (MY-KÖ) formu kullanılarak toplandı. Toplanan verilerin SPSS 25.0 (Statistical Packages for the Social Sciences) istatistik paket programı kullanılarak analizi yapıldı. Merhamet yorgunluğu kısa ölçek alt boyutlarından ikincil travma, mesleki tükenmişlik ve toplam skorun Shapiro-Wilk Testi ile normal dağılım göstermediği saptandı (p<0,05). Bu nedenle tüm analizler non-parametrik yöntemlerle ile yapıldı. Ortalamaların karşılaştırılmasında Mann-Whitney ve Kruskal-Wallis Test; değişkenler arasındaki ilişkiyi saptamak için Spearman's rho Correlation kullanıldı. Bulgular: Araştırmaya katılan 363 hemşirenin 286’sı kadın (%78,8), 268’i (%73,8) 18-25 yaş aralığında, 279’u (%76,9) lisans mezunu, 265’inin (%73) mesleki deneyimi 0-1 yıl arasında ve 103’ü (%28,4) Covid-19 pozitif tanısı almıştır. Merhamet yorgunluğu kısa ölçek puan ortalaması 65,01±25,56 olarak saptandı. Sosyodemografik veriler ile merhamet yorgunluğu puanı ve alt boyutların puanları karşılaştırıldığında anlamlı bir fark görülmedi. Covid-19 virüsü ile enfekte olup hastalığı geçiren hemşireler ile geçirmeyenler arasında merhamet yorgunluğu kısa ölçek alt boyutlarından ikincil travma, mesleki tükenmişlik ve toplam puan ortalamaları arasında istatistiksel olarak anlamlı fark bulundu. Merhamet yorgunluğu kısa ölçek alt boyutlarından ikincil travma puanı (p=0,0199), mesleki tükenmişlik puanı (p=0,0482) ve toplam puan (p=0,0264) ortalamaları Covid-19 geçiren hemşirelerde daha yüksektir. Sonuç: Çoğunluğu genç, yeni mezun ve yoğun bakım ünitesinde sadece 0-1 yıllık deneyimi olan hemşirelerde, Covid-19 virüsü ile enfekte olup hastalığı geçirenlerin merhamet yorgunluğu daha yüksek bulundu. Hemşirelik hizmetlerinin bakım kalitesinin düşmemesi, kişilerin mesleğin ilk yıllarında iken kendilerini yetersiz hissetmemesi ve meslekten ayrılma ile sonuçlanmaması açısından hastane yönetimi tarafından bu konuya ilişkin önlemler alınması, tüm hemşireler ile bu riskli durum hakkında motivasyonel görüşmeler yapılması ve hizmet içi eğitimlerle bireylerin desteklenmesi önerilmektedir.

Anahtar Kelimeler

• Merhamet Yorgunluğu
• Yoğun Bakım Hemşiresi
• Covid-19

References

1. 1. Circenis K, Millere I. Compassion Fatigue, Burnout and Contributory Factors Among Nurses in Latvia. Procedia-Social and Behavioral Sciences, 2011;30:2042-2046. doi: 10.1016/j.sbspro.2011.10.395
2. 2. Joinson C. Coping with compassion fatigue. Nursing, 1992;22(4):116,118-120.
3. 3. Dunn DJ. The intentionality of compassion energy. Holist Nurs Pract 2009;23(4):222-229. doi: 10.1097/HNP.0b013e3181aecebb.
4. 4. Coeztee SK, Klopper HC. Compassion fatigue within nursing practice: A concept analysis. Nurs Health Sci, 2010 Jun;12(2):235-243. doi: 10.1111/j.1442-2018.2010.00526.x.
5. 5. Melvin CS. Historical review in understanding burnout, professional compassion fatigue, and secondary traumatic stress disorder from a hospice and palliative nursing perspective. Journal of Hospice & Palliative Nursing, 2015;17(1), 66-72. doi: 10.1097/NJH.0000000000000126
6. 6. Stamm BH. The ProQOL manual [electronic version]. The professional quality of life scale: Compassion satisfaction, burnout and compassion fatigue/secondary trauma scales. http://www.compassionfatigue.org/pages/ProQOLManualOct05.pdf (Erişim Tarihi: 21.01.2021).
7. 7. Figley CR. Compassion Fatigue: Psychotherapists' Chronic Lack of Self Care. Journal of Clinical Psychology 2002;58(11):1433-1441. doi: 10.1002/jclp.10090
8. 8. Sabo B. Reflecting On The Concept Of Compassion Fatigue. OJIN: The Online Journal Of Issues in Nursing, 2011;16(1). doi: 10.3912/OJIN.Vol16No01Man01 66

9. 9. Yoder EA. Compassion Fatigue in Nurses, Appl Nurs Res, 2010;23(4):191-197. doi: 10.1016/j.apnr.2008.09.003.
10. 10. Potter P, Deshields T, Divanbeigi J. Berger J, Cipriano D, Norris L, Olsen S. Compassion Fatigue And Burnout: Prevalence Among Oncology Nurses. Clinical Journal of Oncology Nursing, 2010;14(5): 56-62. doi: 10.1188/10.CJON.E56-E62.
11. 11. Sacco TL, Ciurzynski SM., Harvey ME, Ingersoll GL. Compassion Satisfaction and Compassion Fatigue Among. Critical Care Nurses. 2015;35(4).32-43 doi: 10.4037/ccn2015392.
12. 12. Hooper VD. Working Toward a Healthier You: Recognizing Compassion Fatigue. J Perianesth Nurs, 2017;32(3):165-166. doi: 10.1016/j.jopan.2017.04.007.
13. 13. Boyle DA. Compassion fatigue: The cost of caring. Nursing. 2015;45(7):48-51. doi: 10.1097/01.NURSE.0000461857.48809.a1
14. 14. Maiden J, Georges JM, Connelly CD. Moral Distress, Compassion Fatigue and Perceptions About Medication Errors in Certified Critical Care Nurses. Dimensions of Critical Care Nursing. 2011;30(6): 339-345. doi: 10.1097/DCC.0b013e31822fab2a.
15. 15. Romano J, Trotta R, Rich VL. Combating Compassion Fatigue: An Exemplar of an Approach to Nursing Renewal. Nursing Administration Quarterly, 2013;37(4):333-336. doi: 10.1097/NAQ.0b013e3182a2f9ff.
16. 16. VanMol MMC, Kompanje EJO, Benoit DD, Bakker J, Nijkamp MD. The Prevalence of Compassion Fatigue and Burnout among Healthcare Professionals in İntensive Care Units: A Systematic Review. Plos One, 2015;10(8), e0136955. doi: 10.1371/journal.pone.0136955
17. 17. Baud D, Qi X, Nielsen-Saines K, Musso D, Pomar L, Favre G. Real estimates of mortality following COVID-19 infection. The Lancet Infectious Diseases. 2020; 20(7):773. doi: https://doi.org/10.1016/S1473-3099(20)30195-X
18. 18. Alharbi J, Jackson D, Usher K. The potential for COVID-19 to contribute to compassion fatigue in critical care nurses. J Clin Nurs. 2020;29:2762-2764. doi: 10.1111/jocn.15314
19. 19. Wallace CL, Wladkowski SP, Gibson A, White P. Grief during the COVID-19 pandemic: considerations for palliative care providers. Journal of Pain and Symptom Management, 2020;60(1):e70-e76. doı:https://doi.org/10.1016/j.jpainsymman.2020.04.012
20. 20. Adams RE, Boscarino JA, Figley CR. Compassion fatigue and psychological distress among social workers:a validation study. Am J Orthopsychiatry, 2006;76(1):103-108. doi: 10.1037/0002-9432.76.1.103
21. 21. Dinç S, Ekinci M. Merhamet Yorgunluğu Kısa Ölçeğinin Türkçe’ye Uyarlanması, Geçerlilik ve Güvenirliği. Psikiyatride Güncel Yaklaşımlar-Current Approaches in Psychiatry, 2019;11(Suppl 1):192-202. doi: 10.18863/pgy.590616
22. 22. Mason VM, Leslie G, Clark K, Lyons P, Walke E, Butler C ve Griffin M. Compassion fatigue, moral distress, and work engagement in surgical intensive care unit trauma nurses: a pilot study. Dimens Crit Care Nurs. 2014;33(4): 215-25. doi: 10.1097/DCC.0000000000000056.
23. 23. Young JL, Derr DM, Cicchillo VJ ve Bressler S. Compassion Satisfaction, Burnout, And Secondary Traumatic Stress in Heart And Vascular Nurses. Critical Care Nursing. Critical Care Nursing, 2011;34(3): 227-234. doi: 10.1097/CNQ.0b013e31821c67d5.
24. 24. Özdelikara A, Babur S. Hemşirelik Öğrencilerinin Merhamet Düzeyi ve Empatik Eğilim İlişkisi. ACU Sağlık Bil Derg 2020; 11(2):342-349. Doi: https://doi.org/10.31067/0.2020.271
25. 25. Çingöl N, Çelebi E, Zengin S, Karakaş M. Bir Sağlık Yüksekokulu Hemşirelik Bölümü Öğrencilerinin Merhamet Düzeylerinin İncelenmesi. Klinik Psikiyatri Derg 2018;21:61–7. doi: 10.5505/kpd.2018.65487
26. 26. Salazar LR. The Relationship Between Compassion, Interpersonal Communication Apprehension, Narcissism and Verbal Aggressiveness. J Happiness Well-Being 2016;4:1–14.
27. 27. Romeo-Ratliff A. (2014). An Investigation into the Prevalence of and Relationships among Compassion Fatigue, Burnout, Compassion Satisfaction and 94 Selftranscendence in Oncology Nurses. Submitted in partial fulfillment of the Requirements for the degree of Doctor of Philosophy in Nursing Seton Hall University.
28. 28. Kelly L, Runge J, Spencer C. Predictors of Compassion Fatigue and Compassion Satisfaction in Acute Care Nurses. Journal of Nursing Scholarship, 2015;47(6): 522–528. doi: 10.1111/jnu.12162. Epub 2015 Aug 19.
29. 29. Dikmen Y, Aydın Y, Tabakoğlu P. Compassion Fatigue: A Study Of Critical Care Nurses İn Turkey. Journal Of Human Sciences. 2016;13 (2): 2879-2884.
30. 30. Reese MT. (2008). Compassion Fatigue And Spirituality With Emergency Health Care Providers. Unpublished Doctoral Dissertation, Regent University, Virginia, USA.
31. 31. Katula KR. (2015). Compassion Fatigue in Critical Care Nursing and Development of An Educational Module in Partial Fulfillment of The Requirements. North Dakota State University, USA.
32. 32. Watkins TR. (2014). Factors Influencing Compassion Fatigue Risk among in-Home Clinicians, in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy, A Dissertation Presented to the Faculty of the School of Psychology & Counseling Regent University.
33. 33. Yu H, Jiang A ve Shen J. Prevalence and Predictors Of Compassion Fatigue, Burnout and Satisfaction Among Oncolog Nurses: Across-Sectional Survey. International Journal Of Nursing Studies, 2016;57:28-38. doi: 10.1016/j.ijnurstu.2016.01.012.
34. 34. Wu Y, Wang J, Luo, Hu S, Lin X, Anderson A.E. et al. A comparison of burnout frequency among oncology physicians and nurses working on the front lines and usual wards during the COVID-19 epidemic in Wuhan, China. J Pain Symptom Manage; 2020.