Received: 13 December 2022
|
Revised: 24 February 2023
|
Accepted: 16 April 2023
DOI: 10.1002/nop2.1790
E M P I R I C A L R E S E A R C H Q U A N T I TAT I V E
Factors associated with compassion fatigue and compassion
satisfaction in obstetrics and gynaecology nurses: A cross-­
sectional study
Jia Wang1
| Mei Su1 | Wenzhong Chang1 | Yuchong Hu1 | Yujia Ma2 |
Peijuan Tang1 | Jiaxin Sun3
1
Department of Gynaecology, Inner
Mongolia People's Hospital, Hohhot,
China
2
STD/AIDS Prevention and Control
Section, Tongliao Center for Disease
Control and Prevention, Tongliao, China
3
Department of Clinical Medical Research
Center, Affiliated Hospital of Inner
Mongolia Medical University, Hohhot,
China
Correspondence
Jiaxin Sun, Department of Clinical Medical
Research Center, Affiliated Hospital
of Inner Mongolia Medical University,
Hohhot, Inner Mongolia, China.
Email: sjx9301@163.com
Funding information
Inner Mongolia Science and Technology
Planning Project Fund, Grant/Award
Number: 2020GG011
Abstract
Aims: To examine the factors influencing compassion fatigue and compassion satisfaction in obstetrics and gynaecology nurses and to explore the combined results of
multiple factors.
Design: An online cross-­sectional study was conducted.
Review Methods: Data were collected from 311 nurses using a convenience sampling
method from January to February 2022. Stepwise multiple linear regression analysis
and mediation tests were performed.
Results: Compassion fatigue in obstetrics and gynaecology nurses was in the moderate to high levels. Physical status, number of children, emotional labour, lack of
professional efficacy, emotional exhaustion and the none-­only-­child can influence
compassion fatigue; lack of professional efficacy, cynicism, social support, work experience, employment status and night shift were predictive of compassion satisfaction.
Social support partially mediated between lack of professional efficacy and compassion fatigue/compassion satisfaction; emotional labour moderated in the mediated
analysis model.
Conclusion: Moderate to high levels of compassion fatigue was present in 75.88%
of obstetrics and gynaecology nurses. Some factors affect compassion fatigue and
compassion satisfaction. Thus, nursing managers should consider factors and construct a monitoring system to reduce compassion fatigue and improve compassion
satisfaction.
Implications for the Profession: The results will provide a theoretical basis for improving job satisfaction and the quality of care in obstetrics and gynaecology nurses. And
this may raise concerns about the occupational health of obstetrics and gynaecology
nurses in China.
Reporting Method: The study was reported according to the STROBE.
Patient or Public Contribution: The nurses spent time filling out the questionnaires
during the data collection phase and answered the questions sincerely.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in
any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
© 2023 The Authors. Nursing Open published by John Wiley & Sons Ltd.
Nursing Open. 2023;10:5509–5520.
wileyonlinelibrary.com/journal/nop2
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WANG et al.
What does this article contribute to the wider global clinical community?
1. Obstetrics and gynaecology nurses with 4–­16 years of experience are prone to
experience compassion fatigue.
2. The effect of lack of professional efficacy on compassion fatigue and compassion
satisfaction can be improved by social support.
Relevance to Clinical Practice: Reducing nurse compassion fatigue and improving
compassion satisfaction are important for providing quality nursing care to obstetrics
and gynaecology patients. In addition, clarifying the influencing factors of compassion
fatigue and compassion satisfaction can improve nurses' work efficiency and job satisfaction, and provide theoretical guidance for managers to implement interventions.
KEYWORDS
compassion fatigue, compassion satisfaction, influencing factors, mediating effect, obstetrics
and gynaecology
1
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I NTRO D U C TI O N
are influencing factors of low compassion satisfaction (Kartsonaki
et al., 2022). However, no studies have focused on compassion fa-
Compassion is the understanding and sharing of the emotional state
tigue and compassion satisfaction among obstetrics and gynaecol-
of others. Compassion has long played a positive and active role in
ogy nurses.
both academic research and social life. Research has found that com-
In recent years, with the opening of the three-­child policy, an
passion promotes pro-­social behaviour (Singer & Klimecki, 2014),
ageing population and the promotion of assisted reproductive tech-
improves interpersonal relationships and increases an individual's
nologies, the incidence of obstetric and gynaecological diseases has
level of well-­being (Saunders, 2015). According to the International
increased, nursing workload has increased and nurses are under
Council of Nurses Code of Ethics for nurses, compassion is one
correspondingly greater stress (Favrod et al., 2018). Obstetrics and
of the eight professional values required of nurses (ICN, 2021).
gynaecology nurses are prone to compassion fatigue and low com-
Compassion is both an essential quality and one of the required com-
passion satisfaction as they serve vulnerable groups such as women
petencies for nurses.
or children for long periods of time. Persistent compassion fatigue
However, beneath these positive auras, compassion may also
leads to decreased productivity, increases the incidence of adverse
have certain negative effects. Due to the high workload of pro-
care events and directly reduces the quality of care and patient sat-
longed contact with illness, disability and death, nurses' compassion
isfaction (Labrague & de Los Santos, 2021).
is highly susceptible to compassion fatigue. Studies have shown that
Therefore, this study aimed to investigate the current status of
approximately two in five clinical nurses surveyed suffer from com-
compassion fatigue among obstetrics and gynaecology nurses and
passion fatigue (Duarte & Pinto-­Gouveia, 2016), which has adverse
analyse its influencing factors. And based on conservation of re-
physical, psychological, emotional and cognitive effects (Alharbi
sources theory, it further explored the influence of lack of profes-
et al., 2020). It is also known as the ‘cost of care’.
sional efficacy on compassion fatigue and the role of social support
In order to scientifically and effectively reduce the generation
as a bridge between the two. Thus, prevention and intervention tar-
of compassion fatigue and improve the compassion satisfaction
gets were identified to improve the quality of obstetrical and gynae-
of nurses, it is crucial to identify the influencing factors that in-
cological care.
duce compassion fatigue and compassion satisfaction generation
in nurses. Several studies have been conducted in clinical departments. For example, a study in an intensive care unit showed that
1.1 | Background
female nurses aged between 18 and 25 years, with a bachelor's degree and 1–­3 years of service had higher levels of compassion fa-
The term ‘compassion fatigue’ was originally described by
tigue (İlter et al., 2022); for oncology and palliative care nurses, long
Joinson (1992) to refer to the emotional, physical and psychological
patient stays and high mortality rates trigger compassion fatigue
exhaustion of healthcare workers as a result of work-­related
while decreasing compassion satisfaction (Frey et al., 2018; Jarrad &
stress. Compassion fatigue was prevalent among nurses, and it not
Hammad, 2020); women and the experience of traumatic events in
only decreased work efficiency, but also increased the incidence
their lives are exacerbating compassion fatigue, while poor work en-
of adverse nursing events, which directly reduced the quality of
vironment, poor colleague relationships and irregular working hours
care and patient satisfaction (Ondrejková & Halamová, 2022).
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WANG et al.
5511
Therefore, compassion fatigue was also named ‘cost of caring’
lack of professional efficacy. Some studies have shown that the oc-
(Figley, 2002).
currence of burnout was positively correlated with compassion fa-
Compassion fatigue caused some physical symptoms and mental
tigue (Ruiz-­Fernández et al., 2020). Frequent emotional labour can
symptoms (Alharbi et al., 2020). The current state of compassion fa-
lead to burnout or compassion fatigue and reduce the quality of life
tigue among nurses cannot be ignored. Compassion fatigue has been
and work-­related care of nurses (Kwak et al., 2020).
studied in various contexts and was found in several areas of health
According to conservation of resources theory, when individ-
care: intensive care (İlter et al., 2022), emergency (Yu & Gui, 2022)
uals have insufficient internal resources, they look for supportive
and paediatrics (Kartsonaki et al., 2022). We all know that obstetrics
resources in the work environment to supplement the lost inter-
and gynaecology is a special unit in hospitals because the majority
nal resources. Individuals' social support is a typical supportive
of patients are women during pregnancy, childbirth, postpartum
resource, it helps individuals to regulate the relationship between
and illness. Nurses often witness women's most stressful moments,
stress and physical and mental health, thus helping to alleviate com-
trauma and pain, and may absorb patients' pain and suffering while
passion fatigue. Social support was defined as the level of helpful
experiencing traumatic distress (Berger & Gelkopf, 2011). Chronic
social interaction in the workplace from both co-­workers and su-
compassion fatigue led to decreased quality of care, reduced job
pervisors (Karasek et al., 1998). In a study of paediatric oncology
satisfaction for nurses and increased turnover (Labrague & de Los
nurses, it was found that when nurses felt more social support, it
Santos, 2021).
would reduce nurses' compassion fatigue, thus increasing their pro-
The causes of compassion fatigue are not yet clear.
ductivity and well-­being (Sullivan et al., 2019). In addition, in a study
Conservation of resources theory was based on the concept that
of critical care, nurses who received leadership and administrative
individuals have a tendency to preserve, protect and acquire re-
support had lower levels of compassion fatigue (Alharbi et al., 2019).
sources (Hobfoll, 2004). In 2017, conservation of resources theory
Therefore, social support is an important influential factor in reduc-
was applied to the study of compassion fatigue in nursing (Coetzee
ing compassion fatigue.
& Laschinger, 2017). When the resources available to caregiver
In summary, many factors influence the occurrence of com-
are adequate, caregiver will provide caring and compassionate re-
passion fatigue in obstetrics and gynaecology nurses. Most stud-
sources that will help alleviate the patient's suffering. However,
ies focused on the effect of a single factor on compassion fatigue,
once the nurse experienced the lack of understanding from the
while ignoring the combined results of multiple factors. Therefore,
patients and the lack of support from the hospital leadership, her
the purpose of this study was to understand the levels of nurses'
resources would be consumed more than replenished, that is, a
compassion fatigue and compassion satisfaction and to examine
loss of resources occurred, resulting in compassion fatigue for the
their relationships with multiple variables. To this end, the research
nurse (Coetzee & Laschinger, 2017).
questions for this study were as follows. What are the levels of
According to conservation of resources theory, nurses' emo-
compassion fatigue and compassion satisfaction among obstetrics
tional labour is an important resource and an influencing factor on
and gynaecology nurses? What are the influencing factors of com-
compassion fatigue. Emotional labour was defined as the manage-
passion fatigue and compassion satisfaction among obstetrics and
ment of feelings to create a publicly observable facial and bodily dis-
gynaecology nurses? Are there any associations between these in-
play (Hochschild, 1983). Hospitals, in order for patients to feel that
fluencing factors?
they are being cared for appropriately and safely, require nurses to
work without reflecting the negative emotions they experience to
patients, families and colleagues, which greatly increases the level of
emotional labour in nursing (Hwang et al., 2020). Emotional labour
leads to emotional dysregulation, which manifests as a conflict be-
2
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M E TH O D S
2.1 | Design
tween the underlying emotion and the actual emotion expressed. A
study found that the level of emotional labour in nurses was strongly
An online cross-­sectional study was conducted.
associated with the occurrence of compassion fatigue (Barnett
et al., 2022). In addition, a Korean study found that 117 nurses
had moderate to high levels of emotional labour, which correlated
2.2 | Instrument with validity and reliability
strongly with compassion fatigue. And 23% of the nurses had medical errors in the past 6 months and had a desire to leave nursing
The questionnaires used in this study included socio-­demographic
(Kwon et al., 2021).
characteristics, the Chinese version of the Compassion Fatigue
Prolonged emotional labour can drain nurses, make them feel fa-
Scale, the Maslach Burnout Inventory General Survey (MBI-­GS),
tigued and will lead to burnout (Morris & Feldman, 1996). Burnout
the Emotional Labour Scale and the Social Support Rate Scale
was also known as a syndrome of emotional exhaustion, cynicism
(SSRS). All questionnaires were reviewed by five professors (three
and lack of professional efficacy (Maslach & Jackson, 1981). When
professors in the field of obstetrics and gynaecology, one professor
burnout occurs, the nurse's resources are depleted. Nurses feel that
in psychological care and one professor in care management) in the
patient poses a threat to their resources and exhibits cynicism and
field and then used.
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2.2.1 | Socio-­demographic characteristics
WANG et al.
items) and deep acting (three items). Each item was measured using
a 6-­point Likert scale from 1 point (‘strongly disagree’) to 6 points
Self-­designed after a pre-­review of the literature. This includes age,
(‘strongly agree’). The total score ranges from 14 to 84, with higher
marital status, the only-­child, number of children, education level,
scores indicating higher levels of emotional labour. In this study, the
work experience, professional title, employment status, night shift,
total Cronbach's α coefficient of the scale was 0.870.
average weekly hours and physical condition.
2.2.2 | Chinese version of the Compassion
Fatigue Scale
2.2.5 | Social Support Rate Scale
The SSRS was originally developed by Xiao Shuiyuan (Yu et al., 2015),
including subjective support, objective support and support utiliza-
The Professional Quality of Life Scale (ProQOL) was revised by
tion, with a total of 10 entries, of which entries 1–­4 and 8–­10 are
Stamm (2009) to form the Chinese version of the Compassion
single-­choice questions, each entry has four options, and the first,
Fatigue Scale, which was used in this study. The scale includes three
second, third and fourth answers are scored 1, 2, 3 and 4 respec-
dimensions: compassion satisfaction, burnout and secondary trau-
tively; entry 5 has five options, A, B, C, D and E, and each option
matic stress, each with 10 entries, for a total of 30 entries. The scale
is scored from ‘none’ to ‘fully support’. Each option from ‘none’ to
is based on Likert 5-­point scale, with the frequency of occurrence
‘fully support’ will be scored from 1 to 4 points, and the score of the
ranging from ‘none’ to ‘always’, and the reverse scoring method is
entry will be the sum of the scores of each option; entries 6 and 7
used for items 14, 15, 17 and 29. The total score for each of the
will be scored 0 points if you answer ‘no source’, and 0 points if you
three dimensions is 50, and the threshold values are <37, >27 and
choose from ‘the following sources’. If you choose from the ‘follow-
>17 respectively. The total score of one dimension exceeded the
ing sources’, you will be given several points. The total score of the
threshold value for mild empathy fatigue, two dimensions exceeded
scale ranged from 12 to 66, and the higher the total score, the more
the threshold value for moderate compassion fatigue and all three
social support was received. The total Cronbach's alpha coefficient
dimensions exceeded the threshold value for high compassion fa-
for the scale in this study was 0.815.
tigue. In this study, the sum of the scores of the two dimensions was
used as the compassion fatigue score. The total Cronbach's alpha
coefficient of the scale in this study was 0.821, the Cronbach's alpha
2.3 | Sampling and recruitment
coefficient of compassion fatigue was 0.820 and the Cronbach's
alpha coefficient of compassion satisfaction was 0.882.
This is a cross-­sectional study, using convenience sampling, in
which obstetrics and gynaecology nurses from January to February
2022 from five tertiary care hospitals in ‘XX’ were selected for re-
2.2.3 | Maslach Burnout Inventory General Survey
cruitment. We collected data through a mobile phone questionnaire star mini programme. After the questionnaire was created,
The MBI-­GS scale formulated was used, which includes 15 items
the mini programme generated a two-­dimensional code, and the
(Maslach et al., 2001). Scores range from ‘never (0)’ to ‘very fre-
investigators asked participants to carefully review the informed
quently (6)’. The scale is divided into three dimensions: cynicism,
consent form and then fill out the questionnaire anonymously.
emotional exhaustion and lack of professional efficacy. Cynicism
and emotional exhaustion are positive scores, that is, the higher
the score, the more serious the degree of job burnout. However,
2.4 | Sample size and power
the lack of professional efficacy dimension is scored in reverse, that
is, the lower the score, the more obvious the lack of professional
Sample size calculation formula: N = [(t α/2 + t β)S/δ]2. Interpretation:
efficacy. And the sum of the scores of the two dimensions of cyni-
α = 0.05,
cism and emotional exhaustion was used as the job burnout score.
t β,∞ = t 0.10,∞ = 1.645. S is the standard deviation obtained from the
β = 0.10,
power
(1−β) = 0.90.
t α,∞ = t 0.05,∞ = 1.96;
The total Cronbach's alpha coefficient of the scale in this study was
pre-­experiment. δ is the allowable error, which is set by 0.25 times
0.885, the Cronbach's alpha coefficient of the total score of the
or 0.50 times the standard deviation according to the literature for
two dimensions was 0.943 and the Cronbach's alpha coefficient of
cases where the allowable error level is not given in a professional
the low achievement dimension was 0.902.
sense. N is the sample size, and 208 samples are obtained by calculation. If a 20% error rate is set, 250 are obtained.
2.2.4 | Emotional Labour Scale
2.5 | Quality appraisal
The Chinese Emotional Labour Scale for Nurses compiled by
Grandey (2000) was used, which has sub-­categories for surface
1. Design: The study participants were selected according to the
acting (seven items), emotional expression requirements (four
inclusion and exclusion criteria, exclusion bias was controlled,
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WANG et al.
5513
the purpose of the study was informed and consent was sought
deviation. Demographic data were analysed by univariate anal-
from the study participants to ensure the quality of the survey.
ysis, including independent samples T test, one-­w ay ANOVA
2. Implementation: A uniform guideline was used to inform
test and Kruskal–­Wallis test. Pearson's correlation analysis was
the survey about the entries of the questionnaire and the
used to access the relationships between the two variables and
precautions for filling it out, so that the study participants could
Spearman's correlation analysis was used when the data did
obtain cooperation. If there are any questions, the researcher
not conform to normal distribution. The influencing factors of
or investigator promptly answers them and provides objective
variables were evaluated by stepwise multiple linear regression
guidance to fill them out, requiring the survey participants to
analysis. Harman's single factor analysis was performed to test
fill them out anonymously and independently, so as to control
the degree of variation. Meanwhile, model 4 and model 8 in the
confounding bias.
Process macro of SPSS software were conducted to analyse the
3. Data collation and analysis: After data collection, the investigator
mediating effect, a level of p < 0.05 was accepted as statistically
checked and accepted the returned questionnaires one by one,
significant difference. Bootstrap procedure (5000 duplicate sam-
eliminating invalid questionnaires such as missing items ≥5%,
ples) was performed to test the significance of the mediating ef-
misfilled, regular responses and identical questionnaires. The data
fect and 95% confidence interval (CI) without zero indicates a
entry was done by two-­person double-­computer entry method,
significant indirect effect.
and the data were compared item by item to ensure the accuracy
of the data before statistical analysis. According to the nature of
the variables and the purpose of the study, appropriate statistical
2.9 | Ethical considerations
analysis methods were selected to ensure the reliability of the
study results.
This study was approved by the Ethics Committee of ‘XX’
(REDACTED). All participants provided informed consent and
2.6 | Population and sample
voluntarily participated in the study, which was conducted
anonymously. Their information was confidential. All information
collected was kept by the investigator, and only the investigator
There are 11 public hospitals in ‘XX’, of which five tertiary hospitals
had access to the survey information. All methods used in this study
containing obstetrics and gynaecology departments (including four
were in accordance with the principles of the Institutional Research
grade A hospitals and one grade B hospital), with an estimated
Committee and the Declaration of Helsinki.
overall number of nurses 444. In this study, obstetrics and
gynaecology nurses in public tertiary hospitals containing obstetrics
and gynaecology departments in ‘XX’ area were studied as a whole,
and a total of 329 cases were investigated, with a valid sample of 311
cases. A convenience sampling method was used, and according to
the formula, the minimum sample size was 250, so this sample of 311
cases could represent the obstetrics and gynaecology nurses in the
3
|
R E S U LT S
3.1 | Current situation of compassion fatigue
and compassion satisfaction in gynaecology and
obstetrics nurses with different characteristics
whole ‘XX’ tertiary hospitals.
In this study, 311 valid questionnaires were returned, with an
2.7 | Inclusion and/or exclusion criteria
effective rate of 94.5%. There were 75 (24.12%) normal and mild
compassion fatigue, 148 (47.59%) moderate and 88 (28.30%)
high compassion fatigue among obstetrics and gynaecology
The inclusion criteria were as follows: (1) working registered nurses
nurses; there were 42 (13.50%) low compassion satisfaction, 248
(midwives should hold a maternal and child health certificate); (2)
(79.74%) moderate and 21 (6.75%) high compassion satisfaction
more than 1 year of work experience. Intern nurses, nurses who
among obstetrics and gynaecology nurses. The analysis of general
were studying, nurses on rotation or nurses who were on leave for
information of obstetrics and gynaecology nurses is shown in
various reasons during the survey period were excluded from the
Table 1.
study.
2.8 | Data analysis
3.2 | Survey respondents' scores on each scale
Table 2 showed that obstetrics and gynaecology nurses had
The data were checked by Excel 2019 and analysed by SPSS 24.0.
moderate to high levels of compassion fatigue and moderate level of
Categorical variables were expressed as frequency and percent-
compassion satisfaction. And of the three dimensions of emotional
age, continuous variables were described by mean ± standard
labour, the surface acting played the highest score and dominates.
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WANG et al.
TA B L E 1 Sample characteristics and its relationship with compassion fatigue and compassion satisfaction.
Compassion satisfaction
n (%)
Mean ± SD
Test value
Compassion fatigue
Mean ± SD
p
Test value
p
Age group
0.163
49.91 ± 8.07
79 (25.4)
30–­39
193 (62.1)
30.34 ± 7.21
49.96 ± 8.05
40–­49
32 (10.3)
33.03 ± 8.84
50.94 ± 8.46
7 (2.3)
34.29 ± 6.87
49.14 ± 5.55
60 (19.3)
29.28 ± 7.36
248 (79.7)
31.16 ± 7.52
50.53 ± 8.13
3 (1.0)
26.67 ± 9.81
47.00 ± 6.93
Yes
87 (28.0)
30.49 ± 7.85
No
224 (72.0)
30.85 ± 7.42
0
110 (35.4)
30.97 ± 7.63
1
151 (48.6)
30.53 ± 7.47
51.12 ± 8.65
≥2
50 (16.1)
30.94 ± 7.63
50.06 ± 6.88
Associate degree
30 (9.6)
31.60 ± 7.58
Bachelor degree
271 (87.1)
30.39 ± 7.49
50.39 ± 8.06
10 (3.2)
37.90 ± 4.95
46.20 ± 7.08
47 (15.1)
32.79 ± 7.74
5–­10 years
133 (42.8)
29.10 ± 7.04
11–­15 years
90 (28.9)
31.19 ± 7.21
49.43 ± 7.89
≥16 years
41 (13.2)
32.83 ± 8.53
49.83 ± 6.58
Primary
193 (62.1)
30.52 ± 7.71
Medium
94 (30.2)
29.97 ± 6.50
50.56 ± 7.10
Senior
24 (7.7)
35.67 ± 8.37
50.17 ± 9.05
Permanent
41 (13.2)
33.15 ± 7.67
Fixed term
270 (86.8)
30.39 ± 7.46
50 and older
30.52 ± 7.68
1.718a
18–­29
0.174a
0.914
2.426b
0.090
2.237b
0.026
3.369a
0.036
2.367a
0.095
0.835a
0.475
0.322b
0.725
−0.758a
0.449
7.608d
0.107
2.615a
0.051
Marital status
Unmarried
Married
Divorced/
widowed
1.953a
0.144
48.12 ± 7.42
The only-­child
−0.376b
0.707
51.66 ± 8.99
49.40 ± 7.55
Number of children
0.128a
0.880
48.53 ± 7.41
Education level
Master degree
and above
5.131a
0.006
48.03 ± 7.64
Work experience
≤4 years
4.576a
0.004
49.09 ± 7.87
50.83 ± 8.57
Professional title
5.887a
0.003
49.76 ± 8.34
Employment status
2.198b
0.029
49.15 ± 8.80
50.17 ± 7.91
Night shift
100 (32.2)
177.17c
0–­1
20 (6.4)
90.23c
169.58c
2–­3
4 (1.3)
125.75c
173.13c
3–­4
96 (30.9)
158.13c
140.20 c
91 (29.3)
c
174.23c
0
≥5
146.28
17.847d
0.001
151.17c
Average weekly hours
31.07 ± 7.84
1.887a
0.132
48.97 ± 7.71
<40 h
126 (40.5)
40–­49 h
150 (48.2)
31.01 ± 7.43
50.27 ± 8.10
50–­59 h
12 (3.9)
31.08 ± 6.07
50.83 ± 6.45
≥60 h
23 (7.4)
27.17 ± 6.63
53.87 ± 9.10
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WANG et al.
5515
TA B L E 1 (Continued)
Compassion satisfaction
n (%)
Mean ± SD
Test value
Compassion fatigue
Mean ± SD
p
Test value
p
22.303a
<0.001
Physical condition
a
47.90 ± 7.13
162 (52.1)
Fair
129 (41.5)
29.41 ± 7.66
51.33 ± 7.98
Poor
20 (6.4)
26.80 ± 4.96
58.90 ± 7.66
<0.001
Independent samples T test.
b
c
32.31 ± 7.34
8.666a
Well
One-­way ANOVA test.
Rank average.
d
Kruskal–­Wallis test.
TA B L E 2 Scores of each scales and dimensions.
predictors of compassion satisfaction were lack of professional effi-
Scales and dimensions
Mean ± SD
Compassion satisfaction
30.75 ± 7.53
Compassion fatigue
50.03 ± 8.03
Burnout
26.11 ± 3.70
Secondary traumatic stress
23.92 ± 5.09
MBI-­GS scale
Emotional exhaustion
Cynicism
Lack of professional efficacy
Emotional Labour Scale
32.01 ± 14.71
11.50 ± 6.73
5.97 ± 5.16
14.53 ± 8.47
51.29 ± 11.21
Surface acting
23.76 ± 7.50
Emotional expression requirements
13.66 ± 4.15
Deep acting
13.86 ± 2.97
SSRS
34.81 ± 8.22
Objective support
8.97 ± 2.77
Subjective support
18.13 ± 5.59
Support utilization
7.71 ± 1.93
3.3 | Correlational analysis
cacy, cynicism, social support, work experience, employment status
and night shift (p < 0.01); significant predictors of compassion fatigue were physical condition, number of children, emotional labour,
lack of professional efficacy, emotional exhaustion and the none-­
only-­child (p < 0.05).
3.5 | Common method deviation test
Since the data for this study were obtained from self-­report, common
method bias may exist. We used Harman's single factor method to
test deviation. Results showed 15 factors with characteristic root
greater than ‘1’ and the variance contribution rate of the first factor
without rotation was 22.86%, indicating that there was no serious
common method deviation in this study.
3.6 | Mediating effect analysis
According to conservation of resources theory, when individuals
have insufficient internal resources, they will look for supportive
resources in the work environment to supplement the lost internal
From Table 3, compassion satisfaction was negatively associated
resources. The social support perceived by individuals is a typical
with compassion fatigue (p < 0.01); emotional exhaustion, cynicism,
supportive resource, which helps individuals regulate the relation-
lack of professional efficacy and emotional labour were positively
ship between stress and physical and mental health, and it has a
associated with compassion fatigue (p < 0.01) and social support was
facilitating effect on the formation of psychological resources,
negatively associated with compassion fatigue (p < 0.01).
thus helping to alleviate compassion fatigue. Therefore, this study
used social support as a mediating variable and confirmed the me-
3.4 | Stepwise multiple linear regression analysis of
compassion fatigue and compassion satisfaction of
nurses in obstetrics and gynaecology
diating role of social support between lack of professional efficacy
and compassion fatigue using Model 4 in the Process macro.
Results of the mediation effect analysis have been presented in
Table 5 and Figure 1. The total effect of lack of professional efficacy on compassion fatigue was significant (ß = 0.147, 95% CI [0.042,
A stepwise multiple linear regression analysis was conducted with
0.252]); the direct effect of lack of professional efficacy on social
compassion satisfaction and compassion fatigue as dependent vari-
support and social support on compassion fatigue were also signifi-
ables, and meaningful general demographic data in univariate analy-
cant. Furthermore, the direct effect of lack of professional efficacy
sis, cynicism score, emotional exhaustion score, lack of professional
on compassion fatigue was significant after adjusting for social sup-
efficacy score, emotional labour score and social support score as
port (ß = 0.112, 95% CI [0.006, 0.219]), suggesting that social sup-
independent variables. According to the results (Table 4), significant
port partially mediates the relationship between lack of professional
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WANG et al.
TA B L E 3 Correlational analysis.
1
2
3
4
5
6
7
1 Compassion satisfaction
1
2 Compassion fatigue
−0.214**
1
3 Emotional exhaustion
−0.356**
0.593**
1
4 Cynicism
−0.470**
0.527**
0.734**
1
5 Lack of professional
efficacy
−0.492**
0.155**
0.044
0.194**
1
6 Emotional labour
−0.133*
0.404**
0.378**
0.418**
−0.212**
1
7 Social support
0.428**
−0.190**
−0.348**
−0.328**
−0.223**
−0.093
1
**p < 0.01, *p < 0.05.
TA B L E 4 Stepwise multiple linear regression analysis of predictors of compassion fatigue and compassion satisfaction.
Independent variables
Standardized
coefficient β
Unstandardized B
SE
32.469
2.475
5.073
1.412
Number of children
1.509
0.486
0.130
The none-­only-­child
−1.705
0.755
−0.095
Emotional exhaustion
0.558
0.055
Lack of professional efficacy
0.155
0.041
Emotional labour
0.171
0.034
(constant)
36.695
2.514
Work experience
−1.426
Employment status
−2.716
VIF
t
Compassion fatigue
(constant)
13.120***
Physical condition
Poor
0.155
3.592***
1.070
3.105**
1.005
−2.258*
1.024
0.468
10.153***
1.216
0.164
3.752***
1.090
0.239
5.085***
1.263
0.385
−0.170
−3.706***
1.264
0.925
−0.122
−2.935**
1.037
Compassion satisfaction
14.599***
Night shift
0–­1
−3.712
1.297
−0.121
−2.861**
1.072
Cynicism
−0.432
0.064
−0.296
−6.748***
1.152
Lack of professional efficacy
−0.340
0.038
−0.383
−8.900***
1.106
0.297
0.043
0.324
6.894***
1.319
Social support
Note: Compassion fatigue R 2 = 0.469, adjusted R 2 = 0.459, F = 44.780, p < 0.001. Compassion satisfaction R 2 = 0.492, adjusted R 2 = 0.482, F = 49.049,
p < 0.001.
***p < 0.001, **p < 0.01, *p < 0.05.
efficacy and compassion fatigue. That is, social support can effectively mitigate the exacerbation of lack of professional efficacy on
TA B L E 5 Breakdown table of total effect, direct effect and
indirect effect.
compassion fatigue.
4
|
DISCUSSION
Effect (ES)
95% CI
Total effect
0.147
0.042–­0.252
Direct effect
0.112
0.006–­0.219
Indirect effect
0.035
0.008–­0.068
In our study, we surveyed obstetrics and gynaecology nurses in different tertiary hospitals in ‘XX’ to find out the compassion fatigue and
nurses reported moderate to high levels of compassion fatigue.
compassion satisfaction of obstetrics and gynaecology nurses. Also,
Only 6.75% of obstetrics and gynaecology nurses reported high lev-
compassion fatigue was determined by job burnout and secondary
els of compassion satisfaction. Compared to oncology nurses (Xie
traumatic stress, as these are the variables used in the survey instru-
et al., 2021), emergency nurses (O'Callaghan et al., 2020) and haema-
ment. According to our data, 75.88% of obstetrics and gynaecology
tology cancer nurses (Chen et al., 2022), obstetrics and gynaecology
|
WANG et al.
5517
As revealed in our study, compassion fatigue was higher in
nurses with high emotional labour and compassion satisfaction
was higher in nurses with high social support. Emotional labour is
work that requires individuals to control their emotions in order to
achieve desired outcomes, and is usually associated with negative
outcomes (Hwang et al., 2020). Continuous and regular emotional
labour can lead to burnout or compassion fatigue and reduce the
F I G U R E 1 The mediating role of social support between lack
of professional efficacy and compassion fatigue. ***p < 0.001,
**p < 0.01, *p < 0.05.
quality of life and work-­related care of nurses (Kwak et al., 2020).
The results of our study also showed such results. The negative effects of nurses' emotional labour are an important factor affecting
patient service delivery (Kim, 2020). Similar to the results of some
nurses in this study had lower levels of compassion satisfaction. And
studies (Hunsaker et al., 2015; Yu et al., 2016), we found that so-
the level of compassion fatigue among nurses in the context of ma-
cial support was a protective factor for compassion satisfaction.
ternal and perinatal deaths was comparable to this study (Mashego
Social support facilitates physical and mental health, and promotes
et al., 2016). All of the above studies used ProQOL Version 5, as did
the formation of psychological resources, thus contributing to the
our study. These differences may be related to differences in per-
improvement of compassion satisfaction (Park et al., 2021). Studies
sonal environment and work environment (Stamm, 2010).
have shown that social support can reduce the occurrence of com-
According to our findings, the nurse's personal environment
passion fatigue in nurses and that recognition and support from
is a factor that influences compassion fatigue, including physical
leaders and colleagues were the main sources of social support that
condition and the number of children. This article showed that the
can effectively improve nurses' compassion (Kelly & Lefton, 2017).
poorer the physical condition of nurses, the higher the level of com-
Alternatively, a good work environment (e.g. peer or social support,
passion fatigue, which was consistent with the previous study (Qu
recognition of professional values, manageable workload) increased
et al., 2022). The body is the source of energy, and when individuals
nurses' job satisfaction, which led them to be more proactive in their
are in poor health, their resource balance is disrupted, their com-
work and increased compassion satisfaction (Qu et al., 2022). In
passion decreases and compassion fatigue occurs in severe cases
addition, lack of professional efficacy was a predictor of both com-
(Hobfoll & Wells, 1998). In addition, the number of children were as-
passion satisfaction and compassion fatigue. It has been found that
sociated with compassion fatigue. The number of children of nurses
lack of professional efficacy led to high compassion fatigue and low
is an important factor affecting their quality of life and work (Jarrad
compassion satisfaction, and can also affect an individual's produc-
& Hammad, 2020). In this study, 87.5% of the nurses were in their
tivity and sense of accomplishment at work (Fan & Lin, 2022; Koutra
young adulthood, taking on various roles as mothers, daughters and
et al., 2022). Specifically, individuals who lack professional efficacy
wives in their lives, making family–­work conflicts inevitable. Given
have a lower recognition of themselves and are always in a negative
this, we hypothesized that when nurses are faced with a larger
state, resulting in lower compassion ability.
number of people to care for, work and family are prone to conflict,
which constitutes a risk factor for compassion fatigue.
We were surprised to find that lack of professional efficacy can
influence compassion fatigue and compassion satisfaction through
The nurse's work environment is a factor that influences compassion
social support. Studies have demonstrated that lack of professional
satisfaction, including work experience, and night shift. First, compas-
efficacy negatively predicted social support, while social support
sion satisfaction was higher among nurses with <4 years of experience
was a protective factor for compassion satisfaction against com-
and more than 16 years of experience. Nurses with <4 years of expe-
passion fatigue, supporting existing theoretical perspectives and
rience are new to the profession, have light family responsibilities and
empirical studies (Hunsaker et al., 2015; Ye et al., 2019). For indi-
full work ambitions; nurses with more than 16 years of experience are
viduals, social support was an important form of resource that pro-
more competent and mature in their thinking (Alharbi et al., 2020). In
vided nurses with emotional support and affirmation of self-­worth
contrast, the lower compassion satisfaction of nurses with 4–­16 years
(Park et al., 2021). According to our mediation analysis, social sup-
may be related to their inability to reconcile family and work. What is
port is a critical intermediary between lack of professional efficacy
more, night shift work was associated with high levels of burnout and
and compassion fatigue/compassion satisfaction. Social support can
secondary traumatic stress. A study of Chinese midwives working in
buffer and compensate for the loss of resources due to lack of pro-
the delivery room showed that night shift work increase their level of
fessional efficacy, and reduce the incidence of compassion fatigue,
compassion fatigue (Qu et al., 2022). Other study found that night shift
and increase nurses' compassion satisfaction. In summary, social
work resulted in lower levels of physical and mental health in obstetrics
support acted as a ‘bridge’ between lack of professional efficacy
and gynaecology nurses (Coetzee & Klopper, 2010). Night shift work
and compassion fatigue/compassion satisfaction. Therefore, nursing
has an irregular schedule, leading to the onset of lower compassion
managers can provide an external resource (e.g. social support) for
satisfaction. In response to the above factors, nursing managers should
obstetrics and gynaecology nurses to better retain a compassionate
use flexible scheduling and pay more attention to the emotional status
and dedicated obstetrics and gynaecology nurse workforce based
of nurses with 4–­16 years of experience.
on the findings.
|
5518
WANG et al.
4.1 | Strength and limitations of the work
for nurses to achieve more satisfaction and happiness in their work.
In this study, after identifying the influencing factors of compassion
The research topic is relatively new. Compassion fatigue among
fatigue, we will develop appropriate interventions, such as positive
obstetrics and gynaecology nurses in ‘XX’ provincial tertiary hospitals
stress reduction therapy, reflective debriefing and group drawing, to
is hardly a focus; the impact of ‘XX’ comprehensive two-­child policy
effectively prevent and reduce compassion fatigue among obstetrics
on compassion fatigue among obstetrics and gynaecology nurses
and gynaecology nurses.
also opens up a new area of research; this may raise concerns about
the occupational health of obstetrics and gynaecology nurses in
AU T H O R C O N T R I B U T I O N S
‘XX’ and motivate the government to increase the training of related
Jia Wang and Mei Su contributed to the conceptualization of the study,
professionals.
performed the analysis, wrote the manuscript; Wenzhong Chang,
Limitations of this study include the cross-­sectional survey was
Yuchong Hu and Peijuan Tang contributed significantly to investiga-
conducted in XX and most participants were from tertiary care hos-
tion and project administration; Yujia Ma assisted with data cura-
pitals, which may limit the generalizability of the results; this subject
tion; Jiaxin Sun contributed to the conceptualization of the study and
group captured the views of participants at a specific time with-
reviewed the manuscript. All authors have read and approved the
out follow-­up and the results only reflect what participants really
manuscript.
thought at that time; self-­report bias is an inherent limitation of the
study design. Finally, due to the lack of research in this area, this
AC K N O​W L E D
​ G E ​M E N T S
article was only a preliminary study of the current situation, with the
The authors thank all the participants in this study.
hope of conducting more in-­depth research, such as interviews and
consultations with professionals.
F U N D I N G I N FO R M AT I O N
This study was supported by the Inner Mongolia Science and
4.2 | Recommendations for further research
Technology Planning Project Fund (2020GG011).
C O N FL I C T O F I N T E R E S T S TAT E M E N T
It is recommended that subsequent studies will focus on obstetrics
The authors declare that they have no conflict of interests.
and gynaecology nurses who have been working for 4–­16 years
and may incorporate semi-­structure interviews to further explore
DATA AVA I L A B I L I T Y S TAT E M E N T
in depth more factors influencing compassion fatigue in obstetrics
The data that support the findings of this study are available from
and gynaecology nurses; this study presents only a simple mediating
the corresponding author upon reasonable request.
model with moderation, and there are more potential mediators and
moderators between these two variables that are worth exploring;
ORCID
appropriate interventions may also be developed based on the
Jia Wang
results obtained in this study.
Jiaxin Sun
5
|
CO N C LU S I O N
The study found that 75.88% of obstetrics and gynaecology nurses
had moderate to high levels of compassion fatigue. Based on the
results, it was found that among the personal factors of obstetrics
and gynaecology nurses, physical condition and the number of
children raised were influential factors closely related to compassion
fatigue. Secondly, nurses with 4–­16 years of work experience among
the work environment factors were more likely to experience
low satisfaction. What is more, nurses who lacked professional
efficacy were more likely to experience compassion fatigue, and
the mediated analysis revealed that compassion fatigue could be
effectively reduced by obtaining social support.
In response to these findings, nursing managers are advised to
focus on caring for obstetrics and gynaecology nurses who are in
poor health or have more children; to provide appropriate interventions to reduce the incidence of compassion fatigue for the nurses
who have worked for 4–­16 years and to provide more social support
https://orcid.org/0000-0002-3465-4382
https://orcid.org/0000-0001-9288-0284
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