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869© 2017 Annals of Tropical Medicine and Public Health | Published by Wolters Kluwer - Medknow

The relationship between “compassion fatigue” and “burnout” among nurses Abbas Abbaszadeh, Arezo Elmi1, Fariba Borhani2, Reyhaneh Sefidkar3

Medical Ethics and Law Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, 1Department of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, 2Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, 3Department of Paramedicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

ABSTRACT

Background and Purpose: Burnout has an impact on the quality of care and can cause damages to the quality of care. It seems that there is a relationship between “compassion fatigue” and “burnout.” If we can help reducing compassion fatigue and burnout among nurses, then we can take a step toward improving the quality of services in the field of nursing. Materials and Methods: This study is a descriptive correlative one which its purpose is to investigate the relation between “compassion fatigue” and “burnout” among nurses of selective educational health centers of Tabriz in 2016. One hundred and ninety-one nurses have been selected from these centers based on two-stage clustering sampling method. The tools used in this study consist of three parts: (1) exploring the demographic information including age, gender, education, marital status, years of service, type of employment, and the type of service sector, (2) the questionnaire of compassion fatigue (Figley), and (3) the questionnaire of burnout (Maslach). SPSS20 software has been used for analyzing the data. The descriptive-analytical statistics (including frequency distribution tables and mean indicators and standard deviation) and Pearson correlation coefficient also have been used for studying the relationship between aforementioned variables. Results: Pearson correlation coefficient among the “compassion fatigue” and “burnout” in the sample has been calculated as r = 0.087 and P = 0.233, and there is no significant relationship among these variables (P > 0.05). In exploring the relation of “compassion fatigue” and “burnout” with demographic variables such as type of service sector and location of work, there can be seen a significant relationship, and it is reported that nurses working in emergency sectors show greater risk for reduced compassion fatigue and burnout compared to nurses working in Intensive Care Units and surgery rooms. Conclusion: The result shows that compassion fatigue and burnout are two separate issues, so we need educated nurses regarding these issue to overcome the problem. This papers reveals the extent of nursing burnout in intermediate and long term care sector as well as identifies factors associated with burnout.

Key words: Burnout, compassion fatigue, nurses

Introduction

Burnout refers to reduced compatibility ability of an individual against stressors along with the symptoms of physical and mental exhaustion. Burnout is a chronic syndrome characterized with feeling tired and lack of energy followed by leaving the profession.[1] Burnout is defined as lack of energy and exhilaration such that the individual is bored of

doing job activity.[2,3] The term burnout was firstly introduced by MacPhee et al. 2006 defining as inability in performing job and the result of failing to meet the needs and desires in the job.[3] Burnout is often seen in jobs where the employees spend a major portion of working hours in close interaction with other people.[4] Nurses are responsible for

Correspondence: Dr. Arezo Elmi, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran. E-mail: [email protected]

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DOI: 10.4103/ATMPH.ATMPH_234_17

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Cite this article as: Abbaszadeh A, Elmi A, Borhani F, Sefidkar R. The relationship between “compassion fatigue” and “burnout” among nurses. Ann Trop Med Public Health 2017;10:869-73.

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24-h care of the patients; hence, they are exposed to stress factors. Probably, these factors may cause burnout in long term and interfere with the activity of the nurses constantly servicing the patients.[5] Nurses, entering nursing profession, are disciplined, compassionate, and eager individuals; however, after some years and facing occupational tensions, they may feel tired of working and prefer leaving the job.[6] Maslach et al. believe that burnout causes reduced quality of service delivery to patients. Several studies investigated burnout in nurses.[7] According to Galindo et al., 19% of nurses in Brazil suffer severe burnout.[8] The results of a study, conducted in Japan in 2008, on 5956 nurses in 302 units, demonstrated that 56% of the research samples showed high burnout.[9] Abusheiykha expressed that burnout may create emotional exhaustion and depression and cause reduced individual performance.[10] The individual feels discouraged followed by compassion fatigue.

Joinson first described compassion fatigue where the caregiver is frustrated due to undergoing job tensions and is exhausted of service delivering.[11,12] Figley, defining this phenomenon, expresses that compassion fatigue results from indirect damages of giving help to the patients.[13] If it is left untreated, it may impair nurse performance and cause a sense of cruelty that gradually ignores the patients.[14] This factor intensifies burnout.

Burnout and compassion fatigue may lead to inadequate care to the patient. The nurses experience compassion fatigue as daily interactions to the patients and recognition of their painful conditions. This will adversely influence their care quality.[15] Yoder, in a study, demonstrated that the nurses are unconsciously vulnerable to compassion fatigue.[16]

Decreasing compassion fatigue and burnout in nurses paves the road to improved quality of services in nursing course. The studies conducted so far were about burnout and the areas such as job satisfaction and like. It seems that compassion fatigue is related to burnout; however, it is not clearly cut in national studies. Thus, the purpose of this research is to study the relationship between compassion fatigue and burnout in nurses.

Materials and Methods

This is a descriptive-correlative study carried out on 191 nurses working in selective educational health centers, in Tabriz in 2016, to investigate the relationship between compassion fatigue and burnout. The samples were selected through two-stage clustering sampling method. Research instrumentations included three

phases. The first studied demographic data such as age, sex, education level, marital status, years of service, type of employment, and service sector. The second phase includes Figley compassion fatigue questionnaire and the third is Maslach Burnout Inventory. Maslach Burnout Inventory includes 22 items in a 7-point Likert scale (never, very little, little, medium, medium-high, high, very high). The questionnaire of compassion fatigue embraces thirty questions on a 6-point Likert scale (never, rarely, a few times, sometimes, often, always).

The questionnaires were distributed among the nurses (from selected hospitals in Tabriz) who randomly participated in this study once the researcher was authorized by the recommendation letter from Shahid Beheshti University of Medical Sciences. Research population of educational health centers in Tabriz included Shohada Hospital, Sina Hospital, Imam Reza Hospital, and Shahid Madani Hospital selected from surgery room, emergency room, and Intensive Care Unit (ICU) nurses through two-stage clustering sampling method. The selected nurses replied to the questions of the inventory provided by the researcher. The nurses were ensured of confidentiality of the responses. The questionnaire validity was verified in Iran. The questionnaire reliability was measured by Cronbach alpha, which obtained 0.72 and 0.90 for compassion fatigue and burnout, respectively. Since they were larger than 0.7, the questionnaires are properly reliable. Research data were analyzed through SPSS 20 software developed by IBM Corporation in London. Moreover, research variables were described by descriptive and analytical statistics including frequency distribution, mean, and standard deviation, and the relationship between variables was determined using Pearson correlation coefficient.

Results

This research studied 191 nurses working in educational health centers in Tabriz at ICU, surgery, emergency units. The questionnaires were homogeneously distributed. The mean age range was 35 years, and the mean of years of service was 11 years. A minimum year of service was 2 years and the maximum was reported 29 years. In relation to sex, 71% of the understudied nurses were female and 29% were male. The nurses were employed in following formal, contracting, and

Table 1: Related correlation between Compassion fatigue and burnout

Variable Correlation coefficient P

Compassion fatigue and burnout 0.087 0.233

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project groups by employment of 42.2% as the highest and the least was related to the project employment at 8.9%. About 92% of the nurses held bachelor degrees. Nearly, 97% worked as circulating shift. About 71% of the nurses were married; while, 29% were single. As seen in Table 1 and according the results, there is no significant relationship between compassion fatigue and burnout in nurses of selective educational health centers in Tabriz, at Pearson correlation coefficient of r = 0.087 P > 0.05, which is presented in Table 1.

In relation to demographic variables, service location showed a significant relationship between compassion fatigue and burnout such that in the present study, the nurses working in emergency unit were higher vulnerable to compassion fatigue and burnout than ICU and surgery unit nurses.

Discussion

The objective of this research is to study the relationship between compassion fatigue and burnout. The results indicate that there is no significant relationship between compassion fatigue and burnout at r = 0.087 and P = 0.233 (P > 0.05). In relation to the research first objective of “determining compassion fatigue in nurses of the selected hospitals in Tabriz,” research results revealed that the mean and standard deviation of compassion fatigue total score is 118.5 ± 12.66 indicating that understudied individuals suffered compassion fatigue more than average. Understudied individuals were the nurses working at ICU that gradually felt exhaustion and discouragement, on the one hand, due to over workload and rush working shifts, and stressful conditions of these units, on the other hand.[17] Mangoulia et al., studying ICU nurses stated high level of compassion fatigue.[18] Mohammadi et al. in consistent with this study, also declared compassion fatigue at medium-high.[11]

In relation to the research second objective “determining burnout in nurses of the selected educational health centers in Tabriz,” the findings of the present research imply that mean and standard deviation of burnout total score is 64.8 ± 19.26 demonstrating that understudied individuals suffer medium burnout. Since this study investigated ICU nurses, stressful environment, dealing with emotional troubles as well as high workload influence nurses such that they are discouraged and left their job.[19] The research of Kuhpayehzadeh et al. on nurses working in the faculty of Zanjan University of Medical Sciences demonstrated low level of burnout. This difference may be due to the fact that this study examined the nurses working in nonclinical units or nurses working

in units rather than emergency units; hence, they probably face less stressful conditions.[20]

In relation to research third objective of “determining the correlation between compassion fatigue and burnout in nurses of the selected hospitals of Tabriz,” the results of the present research imply that there is no significant relationship seen between total scores of compassion fatigue and burnout in nurses working in selected hospitals in Tabriz (r = 0.087) and (P = 0.233).

Probably, the result of the present study is that sometimes nurses are exhausted and discouraged of working anymore due to high workload and working shifts as well as dealing with stressful working environment; therefore, they experience burnout. Despite this burnout, they are not supposed to be compassionately fatigue as they believe that the patients require support and care. Burnout and compassion fatigue are two distinctive issues whether related or not. It is possible that a nurse experiences burnout; whereas, he/she is not compassion fatigue or otherwise. Maytum et al., in a study, expressed that there is a significant relationship between compassion fatigue and burnout in nurses working with children suffering chronic diseases.[21] Alkema et al. presented that there is a positive, significant relationship between compassion fatigue and burnout in nurses (r = 0.761).[22] Kraus et al. carried out a study.[23] The findings demonstrated that compassion fatigue may not significantly reduce burnout; thus, these two variables were not correlated. This research is consistent with the present findings.

In relation to demographic variables, the service location showed a significant relationship between compassion fatigue and burnout. In the present study, the nurses working in emergency units were more vulnerable to compassion fatigue and burnout than ICU and surgery room nurses. According to research findings, compassion fatigue score of emergency nurses was 5.336 larger than ICU nurses that may be due to dealing with much critical patients at emergency comparing other units. The patients’ critical conditions and facing unpleasant, stressful scenes intensify stress in nurses and cause compassion fatigue among nurses. In addition, rush shifts and high workloads of emergency unit may expose nurses to the risk of exhaustion such that it leads to compassion fatigue in nurses. Hooper et al. stated that 82% of emergency nurses showed medium-high burnout and 86% of compassion fatigue.[24]

Conclusion

Working in the ICU environment is an stressful challenge, and the emotional price of caring might

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become a burden for professionals’ personal lives, possibly manifested in compassion fatigue or burnout.

In relation to compassion fatigue and age and years of experience, a reverse statistical relationship was observed. This result shows that the more the age and years of experience, the lower the compassion fatigue. It is probably due to that, with increasing experience to deal with job and works, the work stresses decreases. In this study, females were more vulnerable to compassion fatigue than males in consistent with Abendroth and Flannery study.[25]

In a research which studies the burnout in relation to demographic variables, no significant relationship was seen between sex and burnout. The present study showed a higher burnout mean score in females than males. Khodabakhsh and Mansouri, as cited by Maslach, revealed that sex is not a significant predictor for female burnout.[26]

Research limitations Research limitations including limited number of nurses as well as patients’ large population at ICUs, as well as workload fatigue. Specially at emergency unit due to lack of time, participants in research didn't have enough time and there were not allowed to answer the questionnaires completely.

Further studies Regarding that the present research only studied the nurses working at ICUs including emergency, ICU, and surgery rooms, it is recommended that another research is carried out to study the relationship between compassion fatigue and burnout in nurses working at all hospital wards. Moreover, it is also recommended that the effective factors of compassion fatigue on nurses are investigated as there are few studies carried out in Iran on this issue.

Acknowledgment I would like to express my gratitude to the dean and authorities of Shahid Beheshti School of Nursing and Midwifery, the professors, the head of hospital, hospital security, and the nurses of Shohada, Sina, Imam Reza, and Shahid Madani Hospitals in Tabriz, who willingly helped during the process of this study.

Financial support and sponsorship Nil.

Conflicts of interest There are no conflicts of interest.

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