Skip to main content
NCBI home page
Nursing Open logoLink to Nursing Open
. 2023 Apr 26;10(8):5509–5520. doi: 10.1002/nop2.1790

Factors associated with compassion fatigue and compassion satisfaction in obstetrics and gynaecology nurses: A cross‐sectional study

Jia Wang 1, Mei Su 1, Wenzhong Chang 1, Yuchong Hu 1, Yujia Ma 2, Peijuan Tang 1, Jiaxin Sun 3,✉
PMCID: PMC10333879  PMID: 37099249

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.

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. INTRODUCTION

Compassion is the understanding and sharing of the emotional state of others. Compassion has long played a positive and active role in both academic research and social life. Research has found that compassion promotes pro‐social behaviour (Singer & Klimecki, 2014), improves interpersonal relationships and increases an individual's level of well‐being (Saunders, 2015). According to the International Council of Nurses Code of Ethics for nurses, compassion is one of the eight professional values required of nurses (ICN, 2021). Compassion is both an essential quality and one of the required competencies for nurses.

However, beneath these positive auras, compassion may also have certain negative effects. Due to the high workload of prolonged contact with illness, disability and death, nurses' compassion is highly susceptible to compassion fatigue. Studies have shown that approximately two in five clinical nurses surveyed suffer from compassion fatigue (Duarte & Pinto‐Gouveia, 2016), which has adverse physical, psychological, emotional and cognitive effects (Alharbi et al., 2020). It is also known as the ‘cost of care’.

In order to scientifically and effectively reduce the generation of compassion fatigue and improve the compassion satisfaction of nurses, it is crucial to identify the influencing factors that induce 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 female nurses aged between 18 and 25 years, with a bachelor's degree and 1–3 years of service had higher levels of compassion fatigue (İlter et al., 2022); for oncology and palliative care nurses, long patient stays and high mortality rates trigger compassion fatigue while decreasing compassion satisfaction (Frey et al., 2018; Jarrad & Hammad, 2020); women and the experience of traumatic events in their lives are exacerbating compassion fatigue, while poor work environment, poor colleague relationships and irregular working hours are influencing factors of low compassion satisfaction (Kartsonaki et al., 2022). However, no studies have focused on compassion fatigue and compassion satisfaction among obstetrics and gynaecology nurses.

In recent years, with the opening of the three‐child policy, an ageing population and the promotion of assisted reproductive technologies, the incidence of obstetric and gynaecological diseases has increased, nursing workload has increased and nurses are under correspondingly greater stress (Favrod et al., 2018). Obstetrics and gynaecology nurses are prone to compassion fatigue and low compassion satisfaction as they serve vulnerable groups such as women or children for long periods of time. Persistent compassion fatigue leads to decreased productivity, increases the incidence of adverse care events and directly reduces the quality of care and patient satisfaction (Labrague & de Los Santos, 2021).

Therefore, this study aimed to investigate the current status of compassion fatigue among obstetrics and gynaecology nurses and analyse its influencing factors. And based on conservation of resources theory, it further explored the influence of lack of professional efficacy on compassion fatigue and the role of social support as a bridge between the two. Thus, prevention and intervention targets were identified to improve the quality of obstetrical and gynaecological care.

1.1. Background

The term ‘compassion fatigue’ was originally described by Joinson (1992) to refer to the emotional, physical and psychological exhaustion of healthcare workers as a result of work‐related stress. Compassion fatigue was prevalent among nurses, and it not only decreased work efficiency, but also increased the incidence of adverse nursing events, which directly reduced the quality of care and patient satisfaction (Ondrejková & Halamová, 2022). Therefore, compassion fatigue was also named ‘cost of caring’ (Figley, 2002).

Compassion fatigue caused some physical symptoms and mental symptoms (Alharbi et al., 2020). The current state of compassion fatigue among nurses cannot be ignored. Compassion fatigue has been studied in various contexts and was found in several areas of health care: intensive care (İlter et al., 2022), emergency (Yu & Gui, 2022) and paediatrics (Kartsonaki et al., 2022). We all know that obstetrics and gynaecology is a special unit in hospitals because the majority of patients are women during pregnancy, childbirth, postpartum and illness. Nurses often witness women's most stressful moments, trauma and pain, and may absorb patients' pain and suffering while experiencing traumatic distress (Berger & Gelkopf, 2011). Chronic compassion fatigue led to decreased quality of care, reduced job satisfaction for nurses and increased turnover (Labrague & de Los Santos, 2021).

The causes of compassion fatigue are not yet clear. Conservation of resources theory was based on the concept that individuals have a tendency to preserve, protect and acquire resources (Hobfoll, 2004). In 2017, conservation of resources theory was applied to the study of compassion fatigue in nursing (Coetzee & Laschinger, 2017). When the resources available to caregiver are adequate, caregiver will provide caring and compassionate resources that will help alleviate the patient's suffering. However, once the nurse experienced the lack of understanding from the patients and the lack of support from the hospital leadership, her resources would be consumed more than replenished, that is, a loss of resources occurred, resulting in compassion fatigue for the nurse (Coetzee & Laschinger, 2017).

According to conservation of resources theory, nurses' emotional labour is an important resource and an influencing factor on compassion fatigue. Emotional labour was defined as the management of feelings to create a publicly observable facial and bodily display (Hochschild, 1983). Hospitals, in order for patients to feel that 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 between the underlying emotion and the actual emotion expressed. A study found that the level of emotional labour in nurses was strongly 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 strongly with compassion fatigue. And 23% of the nurses had medical errors in the past 6 months and had a desire to leave nursing (Kwon et al., 2021).

Prolonged emotional labour can drain nurses, make them feel fatigued and will lead to burnout (Morris & Feldman, 1996). Burnout was also known as a syndrome of emotional exhaustion, cynicism and lack of professional efficacy (Maslach & Jackson, 1981). When burnout occurs, the nurse's resources are depleted. Nurses feel that patient poses a threat to their resources and exhibits cynicism and lack of professional efficacy. Some studies have shown that the occurrence of burnout was positively correlated with compassion fatigue (Ruiz‐Fernández et al., 2020). Frequent emotional labour can lead to burnout or compassion fatigue and reduce the quality of life and work‐related care of nurses (Kwak et al., 2020).

According to conservation of resources theory, when individuals have insufficient internal resources, they look for supportive resources in the work environment to supplement the lost internal resources. Individuals' social support is a typical supportive resource, it helps individuals to regulate the relationship between stress and physical and mental health, thus helping to alleviate compassion fatigue. Social support was defined as the level of helpful social interaction in the workplace from both co‐workers and supervisors (Karasek et al., 1998). In a study of paediatric oncology nurses, it was found that when nurses felt more social support, it would reduce nurses' compassion fatigue, thus increasing their productivity and well‐being (Sullivan et al., 2019). In addition, in a study of critical care, nurses who received leadership and administrative support had lower levels of compassion fatigue (Alharbi et al., 2019). Therefore, social support is an important influential factor in reducing compassion fatigue.

In summary, many factors influence the occurrence of compassion fatigue in obstetrics and gynaecology nurses. Most studies focused on the effect of a single factor on compassion fatigue, while ignoring the combined results of multiple factors. Therefore, the purpose of this study was to understand the levels of nurses' compassion fatigue and compassion satisfaction and to examine their relationships with multiple variables. To this end, the research questions for this study were as follows. What are the levels of compassion fatigue and compassion satisfaction among obstetrics and gynaecology nurses? What are the influencing factors of compassion fatigue and compassion satisfaction among obstetrics and gynaecology nurses? Are there any associations between these influencing factors?

2. METHODS

2.1. Design

An online cross‐sectional study was conducted.

2.2. Instrument with validity and reliability

The questionnaires used in this study included socio‐demographic characteristics, the Chinese version of the Compassion Fatigue Scale, the Maslach Burnout Inventory General Survey (MBI‐GS), the Emotional Labour Scale and the Social Support Rate Scale (SSRS). All questionnaires were reviewed by five professors (three professors in the field of obstetrics and gynaecology, one professor in psychological care and one professor in care management) in the field and then used.

2.2.1. Socio‐demographic characteristics

Self‐designed after a pre‐review of the literature. This includes age, marital status, the only‐child, number of children, education level, work experience, professional title, employment status, night shift, average weekly hours and physical condition.

2.2.2. Chinese version of the Compassion Fatigue Scale

The Professional Quality of Life Scale (ProQOL) was revised by Stamm (2009) to form the Chinese version of the Compassion Fatigue Scale, which was used in this study. The scale includes three dimensions: compassion satisfaction, burnout and secondary traumatic stress, each with 10 entries, for a total of 30 entries. The scale is based on Likert 5‐point scale, with the frequency of occurrence ranging from ‘none’ to ‘always’, and the reverse scoring method is used for items 14, 15, 17 and 29. The total score for each of the three dimensions is 50, and the threshold values are <37, >27 and >17 respectively. The total score of one dimension exceeded the threshold value for mild empathy fatigue, two dimensions exceeded the threshold value for moderate compassion fatigue and all three dimensions exceeded the threshold value for high compassion fatigue. 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 coefficient of compassion fatigue was 0.820 and the Cronbach's alpha coefficient of compassion satisfaction was 0.882.

2.2.3. Maslach Burnout Inventory General Survey

The MBI‐GS scale formulated was used, which includes 15 items (Maslach et al., 2001). Scores range from ‘never (0)’ to ‘very frequently (6)’. The scale is divided into three dimensions: cynicism, 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, the lack of professional efficacy dimension is scored in reverse, that is, the lower the score, the more obvious the lack of professional efficacy. And the sum of the scores of the two dimensions of cynicism and emotional exhaustion was used as the job burnout score. The total Cronbach's alpha coefficient of the scale in this study was 0.885, the Cronbach's alpha coefficient of the total score of the two dimensions was 0.943 and the Cronbach's alpha coefficient of the low achievement dimension was 0.902.

2.2.4. Emotional Labour Scale

The Chinese Emotional Labour Scale for Nurses compiled by Grandey (2000) was used, which has sub‐categories for surface acting (seven items), emotional expression requirements (four items) and deep acting (three items). Each item was measured using a 6‐point Likert scale from 1 point (‘strongly disagree’) to 6 points (‘strongly agree’). The total score ranges from 14 to 84, with higher scores indicating higher levels of emotional labour. In this study, the total Cronbach's α coefficient of the scale was 0.870.

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 utilization, with a total of 10 entries, of which entries 1–4 and 8–10 are single‐choice questions, each entry has four options, and the first, second, third and fourth answers are scored 1, 2, 3 and 4 respectively; entry 5 has five options, A, B, C, D and E, and each option is scored from ‘none’ to ‘fully support’. Each option from ‘none’ to ‘fully support’ will be scored from 1 to 4 points, and the score of the entry will be the sum of the scores of each option; entries 6 and 7 will be scored 0 points if you answer ‘no source’, and 0 points if you choose from ‘the following sources’. If you choose from the ‘following sources’, you will be given several points. The total score of the scale ranged from 12 to 66, and the higher the total score, the more social support was received. The total Cronbach's alpha coefficient for the scale in this study was 0.815.

2.3. Sampling and recruitment

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 recruitment. We collected data through a mobile phone questionnaire star mini programme. After the questionnaire was created, the mini programme generated a two‐dimensional code, and the investigators asked participants to carefully review the informed consent form and then fill out the questionnaire anonymously.

2.4. Sample size and power

Sample size calculation formula: N = [(t α/2  + t β )S/δ]2. Interpretation: α = 0.05, β = 0.10, power (1−β) = 0.90. t α,∞  = t 0.05,∞  = 1.96; t β,∞  = t 0.10,∞  = 1.645. S is the standard deviation obtained from the pre‐experiment. δ is the allowable error, which is set by 0.25 times or 0.50 times the standard deviation according to the literature for cases where the allowable error level is not given in a professional sense. N is the sample size, and 208 samples are obtained by calculation. If a 20% error rate is set, 250 are obtained.

2.5. Quality appraisal

  1. Design: The study participants were selected according to the inclusion and exclusion criteria, exclusion bias was controlled, the purpose of the study was informed and consent was sought from the study participants to ensure the quality of the survey.

  2. Implementation: A uniform guideline was used to inform the survey about the entries of the questionnaire and the precautions for filling it out, so that the study participants could obtain cooperation. If there are any questions, the researcher or investigator promptly answers them and provides objective guidance to fill them out, requiring the survey participants to fill them out anonymously and independently, so as to control confounding bias.

  3. Data collation and analysis: After data collection, the investigator checked and accepted the returned questionnaires one by one, eliminating invalid questionnaires such as missing items ≥5%, misfilled, regular responses and identical questionnaires. The data entry was done by two‐person double‐computer entry method, 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 analysis methods were selected to ensure the reliability of the study results.

2.6. Population and sample

There are 11 public hospitals in ‘XX’, of which five tertiary hospitals containing obstetrics and gynaecology departments (including four grade A hospitals and one grade B hospital), with an estimated 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 whole ‘XX’ tertiary hospitals.

2.7. Inclusion and/or exclusion criteria

The inclusion criteria were as follows: (1) working registered nurses (midwives should hold a maternal and child health certificate); (2) more than 1 year of work experience. Intern nurses, nurses who were studying, nurses on rotation or nurses who were on leave for various reasons during the survey period were excluded from the study.

2.8. Data analysis

The data were checked by Excel 2019 and analysed by SPSS 24.0. Categorical variables were expressed as frequency and percentage, continuous variables were described by mean ± standard deviation. Demographic data were analysed by univariate analysis, including independent samples T test, one‐way ANOVA test and Kruskal–Wallis test. Pearson's correlation analysis was used to access the relationships between the two variables and Spearman's correlation analysis was used when the data did not conform to normal distribution. The influencing factors of variables were evaluated by stepwise multiple linear regression analysis. Harman's single factor analysis was performed to test the degree of variation. Meanwhile, model 4 and model 8 in the Process macro of SPSS software were conducted to analyse the mediating effect, a level of p < 0.05 was accepted as statistically significant difference. Bootstrap procedure (5000 duplicate samples) was performed to test the significance of the mediating effect and 95% confidence interval (CI) without zero indicates a significant indirect effect.

2.9. Ethical considerations

This study was approved by the Ethics Committee of ‘XX’ (REDACTED). All participants provided informed consent and 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 had access to the survey information. All methods used in this study were in accordance with the principles of the Institutional Research Committee and the Declaration of Helsinki.

3. RESULTS

3.1. Current situation of compassion fatigue and compassion satisfaction in gynaecology and obstetrics nurses with different characteristics

In this study, 311 valid questionnaires were returned, with an 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 nurses; there were 42 (13.50%) low compassion satisfaction, 248 (79.74%) moderate and 21 (6.75%) high compassion satisfaction among obstetrics and gynaecology nurses. The analysis of general information of obstetrics and gynaecology nurses is shown in Table 1.

TABLE 1.

Sample characteristics and its relationship with compassion fatigue and compassion satisfaction.

n (%) Compassion satisfaction Compassion fatigue
Mean ± SD Test value p Mean ± SD Test value p
Age group
18–29 79 (25.4) 30.52 ± 7.68 1.718 a 0.163 49.91 ± 8.07 0.174 a 0.914
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
50 and older 7 (2.3) 34.29 ± 6.87 49.14 ± 5.55
Marital status
Unmarried 60 (19.3) 29.28 ± 7.36 1.953 a 0.144 48.12 ± 7.42 2.426 b 0.090
Married 248 (79.7) 31.16 ± 7.52 50.53 ± 8.13
Divorced/widowed 3 (1.0) 26.67 ± 9.81 47.00 ± 6.93
The only‐child
Yes 87 (28.0) 30.49 ± 7.85 −0.376 b 0.707 51.66 ± 8.99 2.237 b 0.026
No 224 (72.0) 30.85 ± 7.42 49.40 ± 7.55
Number of children
0 110 (35.4) 30.97 ± 7.63 0.128 a 0.880 48.53 ± 7.41 3.369 a 0.036
1 151 (48.6) 30.53 ± 7.47 51.12 ± 8.65
≥2 50 (16.1) 30.94 ± 7.63 50.06 ± 6.88
Education level
Associate degree 30 (9.6) 31.60 ± 7.58 5.131 a 0.006 48.03 ± 7.64 2.367 a 0.095
Bachelor degree 271 (87.1) 30.39 ± 7.49 50.39 ± 8.06
Master degree and above 10 (3.2) 37.90 ± 4.95 46.20 ± 7.08
Work experience
≤4 years 47 (15.1) 32.79 ± 7.74 4.576 a 0.004 49.09 ± 7.87 0.835 a 0.475
5–10 years 133 (42.8) 29.10 ± 7.04 50.83 ± 8.57
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
Professional title
Primary 193 (62.1) 30.52 ± 7.71 5.887 a 0.003 49.76 ± 8.34 0.322 b 0.725
Medium 94 (30.2) 29.97 ± 6.50 50.56 ± 7.10
Senior 24 (7.7) 35.67 ± 8.37 50.17 ± 9.05
Employment status
Permanent 41 (13.2) 33.15 ± 7.67 2.198 b 0.029 49.15 ± 8.80 −0.758 a 0.449
Fixed term 270 (86.8) 30.39 ± 7.46 50.17 ± 7.91
Night shift
0 100 (32.2) 177.17 c 17.847 d 0.001 151.17 c 7.608 d 0.107
0–1 20 (6.4) 90.23 c 169.58 c
2–3 4 (1.3) 125.75 c 173.13 c
3–4 96 (30.9) 158.13 c 140.20 c
≥5 91 (29.3) 146.28 c 174.23 c
Average weekly hours
<40 h 126 (40.5) 31.07 ± 7.84 1.887 a 0.132 48.97 ± 7.71 2.615 a 0.051
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
Physical condition
Well 162 (52.1) 32.31 ± 7.34 8.666 a <0.001 47.90 ± 7.13 22.303 a <0.001
Fair 129 (41.5) 29.41 ± 7.66 51.33 ± 7.98
Poor 20 (6.4) 26.80 ± 4.96 58.90 ± 7.66
Open in a new tab
a

Independent samples T test.

b

One‐way ANOVA test.

c

Rank average.

d

Kruskal–Wallis test.

3.2. Survey respondents' scores on each scale

Table 2 showed that obstetrics and gynaecology nurses had moderate to high levels of compassion fatigue and moderate level of compassion satisfaction. And of the three dimensions of emotional labour, the surface acting played the highest score and dominates.

TABLE 2.

Scores of each scales and dimensions.

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 32.01 ± 14.71
Emotional exhaustion 11.50 ± 6.73
Cynicism 5.97 ± 5.16
Lack of professional efficacy 14.53 ± 8.47
Emotional Labour Scale 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
Open in a new tab

3.3. Correlational analysis

From Table 3, compassion satisfaction was negatively associated with compassion fatigue (p < 0.01); emotional exhaustion, cynicism, lack of professional efficacy and emotional labour were positively associated with compassion fatigue (p < 0.01) and social support was negatively associated with compassion fatigue (p < 0.01).

TABLE 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
Open in a new tab

**p < 0.01, *p < 0.05.

3.4. Stepwise multiple linear regression analysis of compassion fatigue and compassion satisfaction of nurses in obstetrics and gynaecology

A stepwise multiple linear regression analysis was conducted with compassion satisfaction and compassion fatigue as dependent variables, and meaningful general demographic data in univariate analysis, cynicism score, emotional exhaustion score, lack of professional efficacy score, emotional labour score and social support score as independent variables. According to the results (Table 4), significant predictors of compassion satisfaction were lack of professional efficacy, 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).

TABLE 4.

Stepwise multiple linear regression analysis of predictors of compassion fatigue and compassion satisfaction.

Independent variables Unstandardized B SE Standardized coefficient β t VIF
Compassion fatigue
(constant) 32.469 2.475 13.120***
Physical condition
Poor 5.073 1.412 0.155 3.592*** 1.070
Number of children 1.509 0.486 0.130 3.105** 1.005
The none‐only‐child −1.705 0.755 −0.095 −2.258* 1.024
Emotional exhaustion 0.558 0.055 0.468 10.153*** 1.216
Lack of professional efficacy 0.155 0.041 0.164 3.752*** 1.090
Emotional labour 0.171 0.034 0.239 5.085*** 1.263
Compassion satisfaction
(constant) 36.695 2.514 14.599***
Work experience −1.426 0.385 −0.170 −3.706*** 1.264
Employment status −2.716 0.925 −0.122 −2.935** 1.037
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
Social support 0.297 0.043 0.324 6.894*** 1.319
Open in a new tab

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.

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 resources. The social support perceived by individuals is a typical supportive resource, which helps individuals regulate the relationship between stress and physical and mental health, and it has a facilitating effect on the formation of psychological resources, thus helping to alleviate compassion fatigue. Therefore, this study used social support as a mediating variable and confirmed the mediating 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, 0.252]); the direct effect of lack of professional efficacy on social support and social support on compassion fatigue were also significant. Furthermore, the direct effect of lack of professional efficacy on compassion fatigue was significant after adjusting for social support (ß = 0.112, 95% CI [0.006, 0.219]), suggesting that social support partially mediates the relationship between lack of professional efficacy and compassion fatigue. That is, social support can effectively mitigate the exacerbation of lack of professional efficacy on compassion fatigue.

TABLE 5.

Breakdown table of total effect, direct effect and indirect effect.

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
Open in a new tab

FIGURE 1.

FIGURE 1

Open in a new tab

The mediating role of social support between lack of professional efficacy and compassion fatigue. ***p < 0.001, **p < 0.01, *p < 0.05.

4. DISCUSSION

In our study, we surveyed obstetrics and gynaecology nurses in different tertiary hospitals in ‘XX’ to find out the compassion fatigue and compassion satisfaction of obstetrics and gynaecology nurses. Also, compassion fatigue was determined by job burnout and secondary traumatic stress, as these are the variables used in the survey instrument. According to our data, 75.88% of obstetrics and gynaecology nurses reported moderate to high levels of compassion fatigue. Only 6.75% of obstetrics and gynaecology nurses reported high levels of compassion satisfaction. Compared to oncology nurses (Xie et al., 2021), emergency nurses (O'Callaghan et al., 2020) and haematology cancer nurses (Chen et al., 2022), obstetrics and gynaecology nurses in this study had lower levels of compassion satisfaction. And the level of compassion fatigue among nurses in the context of maternal and perinatal deaths was comparable to this study (Mashego et al., 2016). All of the above studies used ProQOL Version 5, as did our study. These differences may be related to differences in personal environment and work environment (Stamm, 2010).

According to our findings, the nurse's personal environment is a factor that influences compassion fatigue, including physical condition and the number of children. This article showed that the poorer the physical condition of nurses, the higher the level of compassion fatigue, which was consistent with the previous study (Qu et al., 2022). The body is the source of energy, and when individuals are in poor health, their resource balance is disrupted, their compassion decreases and compassion fatigue occurs in severe cases (Hobfoll & Wells, 1998). In addition, the number of children were associated with compassion fatigue. The number of children of nurses is an important factor affecting their quality of life and work (Jarrad & Hammad, 2020). In this study, 87.5% of the nurses were in their young adulthood, taking on various roles as mothers, daughters and wives in their lives, making family–work conflicts inevitable. Given this, we hypothesized that when nurses are faced with a larger number of people to care for, work and family are prone to conflict, which constitutes a risk factor for compassion fatigue.

The nurse's work environment is a factor that influences compassion satisfaction, including work experience, and night shift. First, compassion satisfaction was higher among nurses with <4 years of experience and more than 16 years of experience. Nurses with <4 years of experience are new to the profession, have light family responsibilities and full work ambitions; nurses with more than 16 years of experience are more competent and mature in their thinking (Alharbi et al., 2020). In contrast, the lower compassion satisfaction of nurses with 4–16 years may be related to their inability to reconcile family and work. What is more, night shift work was associated with high levels of burnout and secondary traumatic stress. A study of Chinese midwives working in the delivery room showed that night shift work increase their level of compassion fatigue (Qu et al., 2022). Other study found that night shift work resulted in lower levels of physical and mental health in obstetrics and gynaecology nurses (Coetzee & Klopper, 2010). Night shift work has an irregular schedule, leading to the onset of lower compassion satisfaction. In response to the above factors, nursing managers should use flexible scheduling and pay more attention to the emotional status of nurses with 4–16 years of experience.

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 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 studies (Hunsaker et al., 2015; Yu et al., 2016), we found that social support was a protective factor for compassion satisfaction. Social support facilitates physical and mental health, and promotes the formation of psychological resources, thus contributing to the improvement of compassion satisfaction (Park et al., 2021). Studies have shown that social support can reduce the occurrence of compassion fatigue in nurses and that recognition and support from leaders and colleagues were the main sources of social support that can effectively improve nurses' compassion (Kelly & Lefton, 2017). Alternatively, a good work environment (e.g. peer or social support, recognition of professional values, manageable workload) increased nurses' job satisfaction, which led them to be more proactive in their work and increased compassion satisfaction (Qu et al., 2022). In addition, lack of professional efficacy was a predictor of both compassion satisfaction and compassion fatigue. It has been found that lack of professional efficacy led to high compassion fatigue and low compassion satisfaction, and can also affect an individual's productivity and sense of accomplishment at work (Fan & Lin, 2022; Koutra et al., 2022). Specifically, individuals who lack professional efficacy have a lower recognition of themselves and are always in a negative state, resulting in lower compassion ability.

We were surprised to find that lack of professional efficacy can influence compassion fatigue and compassion satisfaction through social support. Studies have demonstrated that lack of professional efficacy negatively predicted social support, while social support was a protective factor for compassion satisfaction against compassion fatigue, supporting existing theoretical perspectives and empirical studies (Hunsaker et al., 2015; Ye et al., 2019). For individuals, social support was an important form of resource that provided nurses with emotional support and affirmation of self‐worth (Park et al., 2021). According to our mediation analysis, social support is a critical intermediary between lack of professional efficacy and compassion fatigue/compassion satisfaction. Social support can buffer and compensate for the loss of resources due to lack of professional efficacy, and reduce the incidence of compassion fatigue, and increase nurses' compassion satisfaction. In summary, social support acted as a ‘bridge’ between lack of professional efficacy and compassion fatigue/compassion satisfaction. Therefore, nursing managers can provide an external resource (e.g. social support) for obstetrics and gynaecology nurses to better retain a compassionate and dedicated obstetrics and gynaecology nurse workforce based on the findings.

4.1. Strength and limitations of the work

The research topic is relatively new. Compassion fatigue among obstetrics and gynaecology nurses in ‘XX’ provincial tertiary hospitals is hardly a focus; the impact of ‘XX’ comprehensive two‐child policy on compassion fatigue among obstetrics 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 ‘XX’ and motivate the government to increase the training of related professionals.

Limitations of this study include the cross‐sectional survey was conducted in XX and most participants were from tertiary care hospitals, which may limit the generalizability of the results; this subject group captured the views of participants at a specific time without follow‐up and the results only reflect what participants really 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 article was only a preliminary study of the current situation, with the hope of conducting more in‐depth research, such as interviews and consultations with professionals.

4.2. Recommendations for further research

It is recommended that subsequent studies will focus on obstetrics and gynaecology nurses who have been working for 4–16 years and may incorporate semi‐structure interviews to further explore in depth more factors influencing compassion fatigue in obstetrics and gynaecology nurses; this study presents only a simple mediating model with moderation, and there are more potential mediators and moderators between these two variables that are worth exploring; appropriate interventions may also be developed based on the results obtained in this study.

5. CONCLUSION

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 for nurses to achieve more satisfaction and happiness in their work. In this study, after identifying the influencing factors of compassion fatigue, we will develop appropriate interventions, such as positive stress reduction therapy, reflective debriefing and group drawing, to effectively prevent and reduce compassion fatigue among obstetrics and gynaecology nurses.

AUTHOR CONTRIBUTIONS

Jia Wang and Mei Su contributed to the conceptualization of the study, performed the analysis, wrote the manuscript; Wenzhong Chang, Yuchong Hu and Peijuan Tang contributed significantly to investigation and project administration; Yujia Ma assisted with data curation; Jiaxin Sun contributed to the conceptualization of the study and reviewed the manuscript. All authors have read and approved the manuscript.

FUNDING INFORMATION

This study was supported by the Inner Mongolia Science and Technology Planning Project Fund (2020GG011).

CONFLICT OF INTEREST STATEMENT

The authors declare that they have no conflict of interests.

ACKNOWLEDGEMENTS

The authors thank all the participants in this study.

Wang, J. , Su, M. , Chang, W. , Hu, Y. , Ma, Y. , Tang, P. , & Sun, J. (2023). Factors associated with compassion fatigue and compassion satisfaction in obstetrics and gynaecology nurses: A cross‐sectional study. Nursing Open, 10, 5509–5520. 10.1002/nop2.1790

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

REFERENCES

  1. Alharbi, J. , Jackson, D. , & Usher, K. (2019). Compassion fatigue in critical care nurses. An integrative review of the literature. Saudi Medical Journal, 40(11), 1087–1097. 10.15537/smj.2019.11.24569 [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Alharbi, J. , Jackson, D. , & Usher, K. (2020). Personal characteristics, coping strategies, and resilience impact on compassion fatigue in critical care nurses: A cross‐sectional study. Nursing & Health Sciences, 22(1), 20–27. 10.1111/nhs.12650 [DOI] [PubMed] [Google Scholar]
  3. Barnett, M. D. , Hays, K. N. , & Cantu, C. (2022). Compassion fatigue, emotional labor, and emotional display among hospice nurses. Death Studies, 46(2), 290–296. [DOI] [PubMed] [Google Scholar]
  4. Berger, R. , & Gelkopf, M. (2011). An intervention for reducing secondary traumatization and improving professional self‐efficacy in well baby clinic nurses following war and terror: A random control group trial. International Journal of Nursing Studies, 48(5), 601–610. [DOI] [PubMed] [Google Scholar]
  5. Chen, F. , Leng, Y. , Li, J. , & Zheng, Y. (2022). Compassion satisfaction and compassion fatigue in haematology cancer nurses: A cross‐sectional survey. Nursing Open, 9(4), 2159–2170. 10.1002/nop2.1226 [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Coetzee, S. K. , & Klopper, H. C. (2010). Compassion fatigue within nursing practice: A concept analysis. Nursing & Health Sciences, 12(2), 235–243. 10.1111/j.1442-2018.2010.00526.x [DOI] [PubMed] [Google Scholar]
  7. Coetzee, S. K. , & Laschinger, H. K. S. (2017). Toward a comprehensive, theoretical model of compassion fatigue: An integrative literature review. Nursing & Health Sciences, 20(1), 4–15. 10.1111/nhs.12387 [DOI] [PubMed] [Google Scholar]
  8. Duarte, J. , & Pinto‐Gouveia, J. (2016). Effectiveness of a mindfulness‐based intervention on oncology nurses' burnout and compassion fatigue symptoms: A non‐randomized study. International Journal of Nursing Studies, 64, 98–107. 10.1016/j.ijnurstu.2016.10.002 [DOI] [PubMed] [Google Scholar]
  9. Fan, S.‐Y. , & Lin, W.‐C. (2022). The relationships between self‐efficacy, self‐care ability, and burnout and compassion satisfaction among hospice staff in Taiwan. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 30(6), 5491–5497. 10.1007/s00520-022-06980-0 [DOI] [PubMed] [Google Scholar]
  10. Favrod, C. , Jan du Chêne, L. , Martin Soelch, C. , Garthus‐Niegel, S. , Tolsa, J.‐F. , Legault, F. , Briet, V. , & Horsch, A. (2018). Mental health symptoms and work‐related stressors in hospital midwives and NICU nurses: A mixed methods study. Frontiers in Psychiatry, 9, 364. 10.3389/fpsyt.2018.00364 [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Figley, C. R. (2002). Compassion fatigue: Psychotherapists' chronic lack of self care. Journal of Clinical Psychology, 58(11), 1433–1441. [DOI] [PubMed] [Google Scholar]
  12. Frey, R. , Robinson, J. , Wong, C. , & Gott, M. (2018). Burnout, compassion fatigue and psychological capital: Findings from a survey of nurses delivering palliative care. Applied Nursing Research: ANR, 43, 1–9. 10.1016/j.apnr.2018.06.003 [DOI] [PubMed] [Google Scholar]
  13. Grandey, A. (2000). Emotion regulation in the workplace: A new way to conceptualize emotional labor. Journal of Occupational Health Psychology, 5(1), 95–110. 10.1037//1076-8998.5.1.95 [DOI] [PubMed] [Google Scholar]
  14. Hobfoll, S. E. (2004). Stress, culture, and community: The psychology and philosophy of stress. Springer Science & Business Media. [Google Scholar]
  15. Hobfoll, S. E. , & Wells, J. D. (1998). Conservation of resources, stress, and aging. In Hantke N., Etkin A., & O'Hara R. (Eds.), Handbook of aging and mental health (pp. 121–134). Springer. [Google Scholar]
  16. Hochschild, A. R. (1983). The managed heart: Commercialization of human feeling. University of California Press. [Google Scholar]
  17. Hunsaker, S. , Chen, H.‐C. , Maughan, D. , & Heaston, S. (2015). Factors that influence the development of compassion fatigue, burnout, and compassion satisfaction in emergency department nurses. Journal of Nursing Scholarship: An Official Publication of Sigma Theta Tau International Honor Society of Nursing, 47(2), 186–194. 10.1111/jnu.12122 [DOI] [PubMed] [Google Scholar]
  18. Hwang, W. J. , Yang, H. K. , & Kim, J. H. (2020). What are the experiences of emotional labor and workplace violence that are more harmful to health in Korean workforce? International Journal of Environmental Research and Public Health, 17(21), 8019. 10.3390/ijerph17218019 [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. ICN, I. C. O. N . (2021). The ICN code of ethics for nurses . https://www.icn.ch/news/revised‐icn‐code‐ethics‐nurses‐reflects‐lessons‐learned‐covid‐19‐pandemic
  20. İlter, S. M. , Ovayolu, Ö. , Serçe, S. , & Ovayolu, N. (2022). An investigation of the relationship between compassion fatigue and moral sensitivity of intensive care nurses. Omega, 302228221107976. 10.1177/00302228221107976 [DOI] [PubMed] [Google Scholar]
  21. Jarrad, R. A. , & Hammad, S. (2020). Oncology nurses' compassion fatigue, burn out and compassion satisfaction. Annals of General Psychiatry, 19(1), 1–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Joinson, C. (1992). Coping with compassion fatigue. Nursing, 22(4), 116–118. [PubMed] [Google Scholar]
  23. Karasek, R. , Brisson, C. , Kawakami, N. , Houtman, I. , Bongers, P. , & Amick, B. (1998). The job content questionnaire (JCQ): An instrument for internationally comparative assessments of psychosocial job characteristics. Journal of Occupational Health Psychology, 3(4), 322–355. 10.1037//1076-8998.3.4.322 [DOI] [PubMed] [Google Scholar]
  24. Kartsonaki, M. G. , Georgopoulos, D. , Kondili, E. , Nieri, A. S. , Alevizaki, A. , Nyktari, V. , & Papaioannou, A. (2022). Prevalence and factors associated with compassion fatigue, compassion satisfaction, burnout in health professionals. Nursing in Critical Care, 28, 225–235. 10.1111/nicc.12769 [DOI] [PubMed] [Google Scholar]
  25. Kelly, L. A. , & Lefton, C. (2017). Effect of meaningful recognition on critical care Nurses' compassion fatigue. American Journal of Critical Care: An Official Publication, American Association of Critical‐Care Nurses, 26(6), 438–444. 10.4037/ajcc2017471 [DOI] [PubMed] [Google Scholar]
  26. Kim, J. S. (2020). Emotional labor strategies, stress, and burnout among hospital nurses: A path analysis. Journal of Nursing Scholarship, 52(1), 105–112. 10.1111/jnu.12532 [DOI] [PubMed] [Google Scholar]
  27. Koutra, K. , Mavroeides, G. , & Triliva, S. (2022). Mental health Professionals' attitudes towards people with severe mental illness: Are they related to professional quality of life? Community Mental Health Journal, 58(4), 701–712. 10.1007/s10597-021-00874-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Kwak, Y. , Han, Y. , Song, J. S. , & Kim, J. S. (2020). Impact of emotional labour and workplace violence on professional quality of life among clinical nurses. International Journal of Nursing Practice, 26(1), e12792. 10.1111/ijn.12792 [DOI] [PubMed] [Google Scholar]
  29. Kwon, C.‐Y. , Lee, B. , Kwon, O.‐J. , Kim, M.‐S. , Sim, K.‐L. , & Choi, Y.‐H. (2021). Emotional labor, burnout, medical error, and turnover intention among south Korean nursing staff in a university hospital setting. International Journal of Environmental Research and Public Health, 18(19), 10111. 10.3390/ijerph181910111 [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Labrague, L. J. , & de Los Santos, J. A. A. (2021). Resilience as a mediator between compassion fatigue, nurses' work outcomes, and quality of care during the COVID‐19 pandemic. Applied Nursing Research, 61, 151476. 10.1016/j.apnr.2021.151476 [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Mashego, T.‐A. B. , Nesengani, D. S. , Ntuli, T. , & Wyatt, G. (2016). Burnout, compassion fatigue and compassion satisfaction among nurses in the context of maternal and perinatal deaths. Journal of Psychology in Africa, 26(5), 469–472. 10.1080/14330237.2016.1219566 [DOI] [Google Scholar]
  32. Maslach, C. , & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of Organizational Behavior, 2(2), 99–113. 10.1002/job.4030020205 [DOI] [Google Scholar]
  33. Maslach, C. , Schaufeli, W. B. , & Leiter, M. P. (2001). Job burnout. Annual Review of Psychology, 52(1), 397–422. [DOI] [PubMed] [Google Scholar]
  34. Morris, J. A. , & Feldman, D. C. (1996). The dimensions, antecedents, and consequences of emotional labor. Academy of Management Review, 21(4), 986–1010. 10.2307/259161 [DOI] [Google Scholar]
  35. O'Callaghan, E. L. , Lam, L. , Cant, R. , & Moss, C. (2020). Compassion satisfaction and compassion fatigue in Australian emergency nurses: A descriptive cross‐sectional study. International Emergency Nursing, 48, 100785. 10.1016/j.ienj.2019.06.008 [DOI] [PubMed] [Google Scholar]
  36. Ondrejková, N. , & Halamová, J. (2022). Prevalence of compassion fatigue among helping professions and relationship to compassion for others, self‐compassion and self‐criticism. Health & Social Care in the Community, 30(5), 1680–1694. 10.1111/hsc.13741 [DOI] [PubMed] [Google Scholar]
  37. Park, C. , Won, M. H. , & Son, Y.‐J. (2021). Mediating effects of social support between type D personality and self‐care behaviours among heart failure patients. Journal of Advanced Nursing, 77(3), 1315–1324. 10.1111/jan.14682 [DOI] [PubMed] [Google Scholar]
  38. Qu, L. , Gao, J. , Liu, L. , Lun, B. , & Chen, D. (2022). Compassion fatigue and compassion satisfaction among Chinese midwives working in the delivery room: A cross‐sectional survey. Midwifery, 113, 103427. 10.1016/j.midw.2022.103427 [DOI] [PubMed] [Google Scholar]
  39. Ruiz‐Fernández, M. D. , Ramos‐Pichardo, J. D. , Ibáñez‐Masero, O. , Cabrera‐Troya, J. , Carmona‐Rega, M. I. , & Ortega‐Galán, Á. M. (2020). Compassion fatigue, burnout, compassion satisfaction and perceived stress in healthcare professionals during the COVID‐19 health crisis in Spain. Journal of Clinical Nursing, 29(21–22), 4321–4330. 10.1111/jocn.15469 [DOI] [PubMed] [Google Scholar]
  40. Saunders, J. (2015). Compassion. Clinical Medicine (London, England), 15(2), 121–124. 10.7861/clinmedicine.15-2-121 [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Singer, T. , & Klimecki, O. M. (2014). Empathy and compassion. Current Biology: CB, 24(18), R875–R878. 10.1016/j.cub.2014.06.054 [DOI] [PubMed] [Google Scholar]
  42. Stamm, B. H. (2009). Professional quality of life: Compassion satisfaction and fatigue version 5 (ProQOL) . https://proqol.org/proqol‐measure
  43. Stamm, B. H. (2010). The concise proqol manual (2nd ed.). ProQOL.org, Pocatello. In. [Google Scholar]
  44. Sullivan, C. E. , King, A.‐R. , Holdiness, J. , Durrell, J. , Roberts, K. K. , Spencer, C. , Roberts, J. , Ogg, S. W. , Moreland, M. W. , Browne, E. K. , Cartwright, C. , Crabtree, V. M. , Baker, J. N. , Brown, M. , Sykes, A. , & Mandrell, B. N. (2019). Reducing compassion fatigue in inpatient pediatric oncology nurses. Oncology Nursing Forum, 46(3), 338–347. 10.1188/19.ONF.338-347 [DOI] [PubMed] [Google Scholar]
  45. Xie, W. , Wang, J. , Zhang, Y. , Zuo, M. , Kang, H. , Tang, P. , Zeng, L. , Jin, M. , Ni, W. , & Ma, C. (2021). The levels, prevalence and related factors of compassion fatigue among oncology nurses: A systematic review and meta‐analysis. Journal of Clinical Nursing, 30(5–6), 615–632. 10.1111/jocn.15565 [DOI] [PubMed] [Google Scholar]
  46. Ye, J. , Wang, H. , Wu, H. , Ye, L. , Li, Q. , Ma, X.‐Y. , Yu, X. , Zhang, H. , & Luo, X. (2019). Burnout among obstetricians and paediatricians: A cross‐sectional study from China. BMJ Open, 9(1), e024205. 10.1136/bmjopen-2018-024205 [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Yu, H. , & Gui, L. (2022). Compassion fatigue, burnout and compassion satisfaction among emergency nurses: A path analysis. Journal of Advanced Nursing, 78(5), 1294–1304. 10.1111/jan.15034 [DOI] [PubMed] [Google Scholar]
  48. Yu, H. , Jiang, A. , & Shen, J. (2016). Prevalence and predictors of compassion fatigue, burnout and compassion satisfaction among oncology nurses: A cross‐sectional survey. International Journal of Nursing Studies, 57, 28–38. 10.1016/j.ijnurstu.2016.01.012 [DOI] [PubMed] [Google Scholar]
  49. Yu, Y. , Yang, J. , Shiu, C. , Simoni, J. , Xiao, S. , Chen, W. , Rao, D. , & Wang, M. (2015). Psychometric testing of the Chinese version of the medical outcomes study social support survey among people living with HIV/AIDS in China. Applied Nursing Research: ANR, 28(4), 328–333. 10.1016/j.apnr.2015.03.006 [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Articles from Nursing Open are provided here courtesy of Wiley

RESOURCES