MANUAL DE ProQOL PDF

2010
TheConciseProQOLManual
BethHudnallStamm,PhD
Proqol.org
BethHudnallStamm.comand
CompassionSatisfactionAndCompassionFatigue.com
THECONCISEMANUALFORTHE
PROFESSIONALQUALITYOFLIFESCALE
THEProQOL
TheConciseProQOLManual,2ndEdition
Reference
Stamm, B.H. (2010). The Concise ProQOL Manual, 2nd Ed. Pocatello, ID:
ProQOL.org.
Copyright Beth Hudnall Stamm. All rights reserved.

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Published The ProQOL.org, P.O. Box 4362. Pocatello, ID 83205-4362
Cover design by Beth Hudnall Stamm
Images copyright 2008 Henry E. Stamm, IV
Printed in Trebuchert MS font for the headers and 11 point Calibrifontforthebody.
ISSN to be applied for
Reference
Stamm, B.H. (2010). The Concise ProQOL Manual. Pocatello, ID: ProQOL.org.
Acknowledgements
IhereprovideacknowledgementsfortheirfaithfulcontributionstothedevelopmentoftheProQOL
gotoJosephM.Rudolph,EdwardM.Varra,KellyDavis,DebraLarsen,CraigHigsonSmith,AmyC.
Hudnall,HenryE.Stamm,andtoallthosefromaroundtheworldwhocontributedtheirrawdatato
thedatabank.IamforeverindebtedtoCharlesF.Figleywhooriginatedthescale,andin1996,
handedthescaleofftomesayingIputasemicolonthere;youtakeitandputaperiodattheendof
thesentence.Noonecouldhavewishedforabettermentor,colleague,andfriend.
This material may be freely copied as long as (a) author is credited, (b) no changes are made, & (c)
it is not sold except for in agreement specifically with the author.
TABLEOFCONTENTS
TheProQOL..........................................................................................................................................................3
Section1:CompassionSatisfactionandCompassionFatigue.............................................................................8
Figure1:DiagramofProfessionalQualityofLife........................................................8
Background..............................................................................................................................................8
Figure2:Theoreticalpathanalysis............................................................................10
Section2:ScaleDefinitions...............................................................................................................................12
CompassionSatisfaction............................................................................................12
CompassionFatigue...................................................................................................12
Section3:ScaleProperties................................................................................................................................13
ScaleDistribution...................................................................................................................................13
Table1:ProQOLMoments........................................................................................13
Reliability................................................................................................................................................13
Validity 13
Section4:AdministrationoftheProQOL..........................................................................................................14
IndividualAdministration.......................................................................................................................14
GroupAdministration............................................................................................................................15
ResearchAdministration........................................................................................................................15
Section5:Proqolscoring...................................................................................................................................15
CalculatingtheScoresonTheproqol....................................................................................................15
ScaleDefinitionsandScores..................................................................................................................17
CutScores..............................................................................................................................................18
Table2:CutScoresfortheProQOL...........................................................................18
Section6:InterpretingtheProQOL...................................................................................................................18
TheProQOLIsNotDiagnostic................................................................................................................18
TheImportanceofKnowingMorethanJusttheProQOLScores...........................................................19
ScoresAcrossDemographicCategories.................................................................................................19
Table3:Gender........................................................................................................19
Table4:AgeGroup...................................................................................................20
Table4:Race.............................................................................................................20
Table5:IncomeGroup.............................................................................................20
Table6:YearsatCurrentEmployer..........................................................................20
Table7:YearsinField...............................................................................................21
InterpretingIndividualScales.................................................................................................................21
CompassionSatisfaction...........................................................................................21
CompassionFatigue..................................................................................................21
InterpretingScaleScoresinCombination..............................................................................................22
HighCompassionSatisfaction,ModeratetoLowBurnoutand
SecondaryTraumaticStress......................................................................................22
HighBurnout,ModeratetoLowCompassionSatisfactionand
SecondaryTraumaticStress......................................................................................22
HighSecondaryTraumaticStresswithLowBurnoutandLow
HighSecondaryTraumaticStressandHighCompassion
SatisfactionwithLowBurnout..................................................................................23
HighSecondaryTraumaticStressandHighBurnoutwithLow
InterpretingtheProQOLataGroupLevel................................................................23
Section7:UsingtheProQOLforDecisionMaking............................................................................................24
ChangingthePersonEventInteraction.................................................................................................24
MonitoringChangeAcrossTime............................................................................................................25
Section8:TheProQOLTestandHandout........................................................................................................26
ProfessionalQualityofLifeScale(ProQOL)..................................................Error!Bookmarknotdefined.
ProQOLSelfScoringWorksheet................................................................Error!Bookmarknotdefined.
Scoring..................................................................................................................Error!Bookmarknotdefined.
6
YourScoresonTheProQOL:ProfessionalQualityOfLifeScale...............Error!Bookmarknotdefined.
SECTION9:ConvertingfromtheProQOLIVtotheProQOL5...........................................................................31
TableforDeterminingProQOLtScorefromRawScores..........................................31
SECTION10:Bibliography..................................................................................................................................35
SECTION11:FrequentlyAskedQuestions.........................................................................................................73
AbouttheAuthor...............................................................................................................................................77
SECTION1:COMPASSIONSATISFACTIONANDCOMPASSIONFATIGUE
Professionalqualityoflifeisthequalityonefeelsnrelationtotheirworkasahelper.Boththepositiveand
negativeaspectsofdoingonesjobinfluenceonesprofessionalqualityoflife.Peoplewhoworkinhelping
professionsmayrespondtoindividual,community,national,andeveninternationalcrises.Helperscanbe
foundinthehealthcareprofessionals,socialserviceworkers,teachers,attorneys,policeofficers,firefighters,
clergy,airlineandothertransportationstaff,disastersitecleanupcrews,andotherswhoofferassistanceat
thetimeoftheeventorlater.
Professionalqualityoflifeincorporatestwoaspects,thepositive(CompassionSatisfaction)andthenegative
(CompassionFatigue).Compassionfatiguebreaksintotwoparts.Thefirstpartconcernsthingssuchlike
exhaustion,frustration,angeranddepressiontypicalofburnout.SecondaryTraumaticStressisanegative
feelingdrivenbyfearandworkrelatedtrauma.Sometraumaatworkcanbedirect(primary)trauma.Inother
cases,workrelatedtraumabeacombinationofbothprimaryandsecondarytrauma.
FIGURE1:DIAGRAMOFPROFESSIONALQUALITYOFLIFE
ProfessionalQualityofLife
Compassion
Satisfaction
Compassion
Fatigue
Burnout
Secondary
Trauma
BACKGROUND
Professionalqualityoflifeforthoseprovidingcarehasbeenatopicofgrowinginterestoverthepasttwenty
years.Researchhasthatshownthosewhohelppeoplethathavebeenexposedtotraumaticstressorsareat
riskfordevelopingnegativesymptomsassociatedwithburnout,depression,andposttraumaticstress
disorder.Inthisbodyofliterature,typicallyknownassecondarytraumatizationorvicarioustraumatization,
thepositivefeelingsaboutpeoplesabilitytohelpareknownasCompassionSatisfaction(CS).Thenegative,
secondaryoutcomeshavevariouslybeenidentifiedasburnout,countertransference,CompassionFatigue(CF)
andSecondaryTraumaticStress(STS),andVicariousTraumatization(VT).
Whiletheincidenceofdevelopingproblemsassociatedwiththenegativeaspectsofprovidingcareseemsto
below,theyareseriousandcanaffectanindividual,theirfamilyandcloseothers,thecaretheyprovide,and
theirorganizations.Thepositiveaspectsofhelpingcanbeviewedasaltruism;feelinggoodthatyoucando
somethingtohelp.Thenegativeeffectsofprovidingcareareaggravatedbytheseverityofthetraumatic
materialtowhichthehelperisexposed,suchasdirectcontactwithvictims,particularlywhentheexposureis
ofagrotesqueandgraphicnature.Theoutcomesmayincludeburnout,depression,increaseduseof
substances,andsymptomsofposttraumaticstressdisorder.
8
In1995,threebooksintroducedtheconceptsofthenegativeeffectsoncaregiverswhoprovidecaretothose
whohavebeentraumatized.123Theterminologywasatthattime,andcontinuestobe,ataxonomical
conundrum.However,sincethattime,Figley,Stamm,andPearlmantogetherhaveproducedover50
additionalscientificwritingsonthetopic.Castingabroadnetacrossthetopic,over500papers,booksand
articleshavebeenwritten,includingnearly200peerreviewedpapers,130dissertationsalongwithvarious
unpublishedstudies.Amongwhichthereareandahundredresearchpapersusingatypeofmeasurementof
thenegativeeffectsofsecondaryexposuretotraumaticstress.Researchhasbeenconductedacrossmultiple
culturesworldwide,andacrossmultipletypesoftraumaticeventexposures.
Asnotedabove,thereareissuesassociatedwiththevarioustermsusedtodescribenegativeeffects.There
arethreeacceptedterms:compassionfatigue,secondarytraumaticstress,andvicarioustrauma.Theredo
seemtobenuancesbetweenthetermsbutthereisnodelineationbetweenthemsufficienttosaythatthey
aretrulydifferent.Therehavebeensomepapersthathavetriedtoferretoutthespecificdifferencesbetween
thenamesandtheconstructs.4Thesepapershavebeenlargelyunsuccessfulinidentifyingrealdifferences
betweentheconceptsaspresentedundereachname.Thethreetermsareusedoften,eveninwritingthat
combinesFigley(compassionfatigue),Stamm(secondarytraumaticstress)andPearlman(vicarious
traumatization).Thevariousnamesrepresentthreeconverginglinesofevidencethatproducedthree
differentconstructnames.Asthetopichasmatured,reconfigurationofthetermsseemstimely.
Ingeneral,lookingbeyondissuesoftaxonomy,therehasbeenlittlenegativecritiqueofthetopicasawhole.
Nonetheless,therearearticlesthatquestioninitsentiretytheconceptofsecondarynegativeeffectsdueto
workwithpeoplewhohavebeentraumatized.56Botharticlespointtoalackofresearch,perhapsallowablein
somepartgiventhenascentnatureoftheconstruct,particularlyintheArvaypaper,whichwaspublishedin
2001.Fouryearslater,atthecoreofKadambi&Ennis(2005)suggestiontoreexaminethecredibilityofthe
topicaremeasurementissues,thatis,refineddefinitionsofthecharacteristicsandreliableandvalidmeasures
oftheconstructs.Thesecritiquesseemwellearnedatthepointthattheywerewritten.Whetherinresponse
tothecritiques,orasnaturalevolution,overhalfoftheresearcharticlesthatexistwerewrittenafterthese
critiquesreviewswereconducted.Inaddition,astheauthorspointedout,therewerevariedmeansof
assessingthenegativeeffects.
Basedonexperienceandsomeresearch,organizationalpreventionprogramsarebelievedtohelpmaximize
helperswellbeing(CS)andreducetherisksfordevelopingcompassionfatigueandsecondarytrauma.Ata
minimum,organizationalprogramsshowtheworkerthattheyhaveformallyaddressedthepotentialforthe
worktoaffecttheworker.Goodprogramsdonotidentifytootherworkersorsupervisors,specificinformation
abouttheworker'sprofessionalqualityoflifeunlesstheinformationissharedbytheworker.Insomecases,
Figley,C.R.(Ed.)(1995).Compassionfatigue:Copingwithsecondarytraumaticstressdisorderinthosewhotreatthetraumatized.New
York:Brunner/Mazel.
Pearlman,L.A.,&Saakvitne,K.W.(1995).Traumaandthetherapist:Countertransferenceandvicarioustraumatizationinpsychotherapy
withincestsurvivorsNewYork:Norton.
3
Stamm,B.H.(.Ed).(1995).Secondarytraumaticstress:Selfcareissuesforclinicians,researchers,andeducators.Maryland:SidranPress:
Lutherville.
4
cfBaird,K.,&Kracen,A.C.(2006).Vicarioustraumatizationandsecondarytraumaticstress:Aresearchsynthesis.Counselling
PsychologyQuarterly,19(2),181188.
5
Kadambi,M.A.,&Ennis,L.(2004).Reconsideringvicarioustrauma:Areviewoftheliteratureandits'limitations.JournalofTrauma
Practice,3(2),121.
6
Arvay,M.J.(2001).Secondarytraumaticstressamongtraumacounsellors:Whatdoestheresearchsay?InternationalJournalforthe
AdvancementofCounselling,23(4),283293.
2
supervisorsaddressperformanceissuesthattheybelievemaybenegativeaspectsofhelpingbutinthose
cases,theprincipalsoforganizationalhumanresourcessuggestthattheseperformanceissuesshouldbe
handledassuch,notasaflawinthecharacteroftheemployee,butaperformanceissue.
Theoverallconceptofprofessionalqualityoflifeiscomplexbecauseitisassociatedwithcharacteristicsofthe
workenvironment(organizationalandtaskwise),theindividual'spersonalcharacteristicsandtheindividual's
exposuretoprimaryandsecondarytraumaintheworksetting.Thiscomplexityappliestopaidworkers(e.g.
medicalpersonnel)andvolunteers(e.g.RedCrossdisasterresponders).
ThediagrambelowhelpsillustratetheelementsofProfessionalQualityofLife.Inthecenterofthediagram
arecompassionsatisfactionandcompassionfatigue.CompassionSatisfactionisthepositiveaspectsofhelping
othersandCompassionSatisfactionarethenegativeone.Ascanbeseen,oneworkenvironment,client(or
thepersonhelped)environmentandthepersonsenvironmentallhavearolltoplay.Forexample,apoor
workenvironmentmaycontributetoCompassionFatigue.Atthesametime,apersoncouldfeelcompassion
satisfactionthattheycouldhelpothersdespitethatpoorworkenvironment.CompassionFatiguecontains
twoverydifferentaspects.Bothhavethecharacteristicofbeingnegative.However,workrelatedtraumahas
adistinctiveaspectoffearassociatedwithit.Whileitismorerarethanoverallfeelingsofwhatwecancall
burnout,itisverypowerfulinitseffectonaperson.Whenbothburnoutandtraumaarepresentinapersons
lifetheirlifecanbeverydifficultindeed.Thediagrambelowshowsatheoreticalpathanalysisofpositiveand
negativeoutcomesofhelpingthosewhohaveexperiencedtraumaticstress.
FIGURE2:THEORETICALPATHANALYSIS
10
11
Fourscalesemergedintheearlyresearch.Twoofthem(theImpactofEventScaleandtheTraumaticStress
InstituteBeliefScale)werenotspecifictosecondaryexposure.Theywereusedequallyforpeoplewhowere
thedirectvictimsoftraumaaswellasforthosewhoweresecondarilyexposedintheirroleashelpers.78Two
measuresemergedasspecificmeasuresforsecondaryexposure.TheCompassionFatigueTestinitsvarious
versions9101112andtheSecondaryTraumaticStressScale.13
TheProfessionalQualityofLifeScale,knownastheProQOL,isthemostcommonlyusedmeasureofthe
positiveandnegativeeffectsofworkingwithpeoplewhohaveexperiencedextremelystressfulevents.Ofthe
100papersinthePILOTSdatabase(thePublishedLiteratureinPosttraumaticStressDisorder),46useda
versionoftheProQOL.ThemeasurewasoriginallycalledtheCompassionFatigueSelfTestanddevelopedby
CharlesFigleyinthelate1980sStammandFigleybegancollaboratingin1988.In1993,Stammaddedthe
conceptofcompassionsatisfactionandthenameofthemeasurechangedtotheCompassionSatisfactionand
FatigueTest,ofwhichtherewereseveralversions.Theseversionsintheearly1990swereFigleyandStamm,
thenStammandFigley.ThroughapositivejointagreementbetweenFigleyandStammthemeasureshifted
entirelytoStamminthelate1990sandwasrenamedtheProfessionalQualityofLifeScale.TheProQOL,
originallydevelopedinEnglish,istranslatedintoFinnish,French,German,Hebrew,Italian,Japanese,Spanish,
Croat.EuropeanPortugueseandRussiantranslationsareinprocess.
SECTION2:SCALEDEFINITIONS
COMPASSIONSATISFACTION
Compassionsatisfactionisaboutthepleasureyouderivefrombeingabletodoyourworkwell.Forexample,
youmayfeellikeitisapleasuretohelpothersthroughyourwork.Youmayfeelpositivelyaboutyour
colleaguesoryourabilitytocontributetotheworksettingoreventhegreatergoodofsociety.
COMPASSIONFATIGUE
Professionalqualityoflifeincorporatestwoaspects,thepositive(CompassionSatisfaction)andthenegative
(CompassionFatigue).Compassionfatiguebreaksintotwoparts.Thefirstpartconcernsthingssuchassuchas
exhaustion,frustration,angeranddepressiontypicalofburnout.SecondaryTraumaticStressisanegative
feelingdrivenbyfearandworkrelatedtrauma.Itisimportanttorememberthatsometraumaatworkcanbe
direct(primary)trauma.Workrelatedtraumabeacombinationofbothprimaryandsecondarytrauma.
Kadambi,M.A.,&Ennis,L.(2004).Reconsideringvicarioustrauma:Areviewoftheliteratureandits'limitations.JournalofTrauma
Practice,3(2),121.
8
Arvay,M.J.(2001).Secondarytraumaticstressamongtraumacounsellors:Whatdoestheresearchsay?InternationalJournalforthe
AdvancementofCounselling,23(4),283293.
9
Figley,C.R(Ed.).(1995)Compassionfatigue:Copingwithsecondarytraumaticstressdisorderinthosewhotreatthetraumatized.New
York:Brunner/Mazel.
10
Figley,C.R.,&Stamm,B.H.(1996).PsychometricReviewofCompassionFatigueSelfTest.InB.H.Stamm(Ed),MeasurementofStress,
TraumaandAdaptation.Lutherville,MD:SidranPress.
11
Stamm,B.H.(2002).MeasuringCompassionSatisfactionasWellasFatigue:DevelopmentalHistoryoftheCompassionFatigueand
SatisfactionTest.InC.R.Figley(Ed.),107119.
12
nd
Stamm,B.H.(2008).TheProQOLTestManual,2 Ed.Towson,MD:SidranPressandtheProQOL.org.
13
Bride,B.E.,Robinson,M.M.,Yegidis,B.L.,&Figley,C.R.(2004).Developmentandvalidationofthesecondarytraumaticstressscale.
ResearchonSocialWorkPractice,14(1),2735.
12
BURNOUT
BurnoutisoneelementofthenegativeeffectsofcaringthatisknownasCompassionFatigue.Mostpeople
haveanintuitiveideaofwhatburnoutis.Fromtheresearchperspective,burnoutisassociatedwithfeelingsof
hopelessnessanddifficultiesindealingwithworkorindoingyourjobeffectively.Thesenegativefeelings
usuallyhaveagradualonset.Theycanreflectthefeelingthatyoureffortsmakenodifference,ortheycanbe
associatedwithaveryhighworkloadoranonsupportiveworkenvironment.
SECONDARYTRAUMATICSTRESS
SecondaryTraumaticStress(STS)isanelementofCompassionfatigue(CF).STSisaboutworkrelated,
secondaryexposuretopeoplewhohaveexperiencedextremelyortraumaticallystressfulevents.Thenegative
effectsofSTSmayincludefearsleepdifficulties,intrusiveimages,oravoidingremindersofthepersons
traumaticexperiences.STSisrelatedtoVicariousTraumaasitsharesmanysimilarcharacteristics.
SECTION3:SCALEPROPERTIES
SCALEDISTRIBUTION
TABLE1:PROQOLMOMENTS
CStscore
BOtscore
STStscore
N
Mean
Std.ErrorofMean
Median
Mode
Std.Deviation
Skewness
Kurtosis
1187
50
0.29
51
53
10
0.92
1.51
1187
50
0.29
49
51
10
0.25
0.31
1187
50
0.29
49
49
10
0.82
0.87
RELIABILITY
VALIDITY
Thereisgoodconstructvaliditywithover200publishedpapers.Therearealsomorethan100,000articleson
theinternet.Ofthe100publishedresearchpapersoncompassionfatigue,secondarytraumaticstressand
vicarioustraumatization,nearlyhalfhaveutilizedtheProQOLoroneofitsearlierversions.Thethreescales
measureseparateconstructs.TheCompassionFatiguescaleisdistinct.Theinterscalecorrelationsshow2%
sharedvariance(r=.23;co=5%;n=1187)withSecondaryTraumaticStressand5%sharedvariance(r=..14;
co=2%;n=1187)withBurnout.WhilethereissharedvariancebetweenBurnoutandSecondaryTraumatic
Stressthetwoscalesmeasuredifferentconstructswiththesharedvariancelikelyreflectingthedistressthatis
commontobothconditions.Thesharedvariancebetweenthesetwoscalesis34%(r=.58;;co=34%;
13
n=1187).Thescalesbothmeasurenegativeaffectbutareclearlydifferent;theBOscaledoesnotaddressfear
whiletheSTSscaledoes.
SECTION4:ADMINISTRATIONOFTHEPROQOL
PerhapsthemostimportantpartofadministrationoftheProQOL,orforthatmatteranypsychologicaltest,is
forpeopletounderstandwhattheyarebeingaskedtodo.Iftheyfeelliketheyarebeingobservedand
measuredfortheir(bad)behavior,theyareunlikelytowanttoparticipateor,iftheydo,toprovidereliable
answers.Itisimportanttoexplainthelogicofthemeasureandtoengagethepersonsdesiretotakethetest.
Itisalsoimportanttoestablishifthepersonhasarighttorefusetotakethetestorifitisrequiredasa
conditionofsomesituationsuchasemployment.
INDIVIDUALADMINISTRATION
Inthistypeofadministration,apersontypicallytakesthetestandeitherselfscoresorreceivesscores
computedbyacomputer.Inthissituation,thedataarenotrecordedelsewhereandthepersondoesnot
discusshisorherresultsunlesstheychoosetodoso.Individualadministrationmayalsobeinitiatedbyan
outsidesource.Thedatamayormaynotbearchived.Forexample,apersonmaytaketheProQOLaspartof
jobcounselingoranemployeeassistanceprogram.TheymaytaketheProQOLaspartoftheirongoingself
careplan.Itisimportanttoestablishwiththeindividualexactlywhatwillhappenwithhisorherdatabecause
datasecurityandprivacyareveryimportantissues.Inmanycases,therequiredstandardsexceedthoseof
generalmedicalrecords.
14
GROUPADMINISTRATION
Inthistypeofadministration,agroupofpeoplecompletetheProQOLsimultaneously.Thismaybeina
classroomsettingorsomethinglikeindividualcomputerworkstationsinacomputerlab.Thekeyaspectofthe
groupadministrationisthatthereareotherspresentwhoaredoingthesameactivity.Inagroup
administrationitisimportanttoconsiderthegroupeffectonscores.Ifafewpeoplearequitevocalabout
theirunwillingnesstoparticipate,thereisaneffectonalloftheparticipants.Ifpeoplefeeltheyarebeing
watchedbyothers,orareembarrassedtobeinthegroup,thescoresareunlikelytobevalidandprivacyrights
mayhavebeenviolated.Peopleshouldnotbesingledoutsoastocauseembarrassment.Forexample,you
shouldnotsetupagroupadministrationforallpeoplewhomademedicalerrorsiftheadministrationisbased
ontheassumptionthattheirmistakesoccurredbecauseofburnout.
Inthecaseofaselftest,peoplemaybegivengeneralinformationsuchasotherswhoscoresimilarlyto
youBycontrast,inthecaseofindividualadministration,feedbackmaybemuchmorespecific.Feedbackin
groupsettingsshouldnotbeaboutasingleindividualbutaboutthingsthatapplytomorethanoneperson.
Themostimportantthingaboutgivingfeedbackistobeprepared.Bepreparedtogivespecificandclear
informationappropriatetothesettingandbepreparedtoanswerquestions.Youwillalwaysgetthatone
questionyoumostdontwanttoanswer!
Whenworkingingroupsettings,itisnotuncommonforoneortwoindividualstoproviderevealingpersonal
informationthatarenotappropriatetothegroupsetting.Inthesecasesitisincumbentonthetest
administratortocontainandrefocustheattentionoftheclass.Goodethicalbehaviorsuggeststhetest
administratorfollowupwiththepersoninamoreappropriatesetting.Insituationssuchasthese,itisusually
appropriatetoprovideareferralforemployeeassistanceorotherhelpsuchasmentalorphysicalhealthcare.
Inthecasethattheadministratorbelievesthatthereisanimminentdanger,theyshouldtakeemergency
actionssuchascalling911andprotectingtheperson,themselves,andothersfromharminthebestwaythat
theycan.
RESEARCHADMINISTRATION
TheProQOLisfrequentlyusedinresearch.Thetestmaybecollectedaspartofasurveypacketinwhichthe
participantreceivesnoinformationregardingtheiranswers,oritmaybegivenasacombinedresearchand
trainingactivity.Ineithercase,thedataaregenerallyrecordedandscoredbycomputer.Groupresultsmaybe
published.Insomecases,acopyoftherawdataaredonatedtotheProQOLdatabankwheretheyare
combinedwithotherresearchdatatosupportdevelopmentalworkontheProQOL.
SECTION5:PROQOLSCORING
CALCULATINGTHESCORESONTHEPROQOL
TherearethreestepstoscoringtheProQOL.Thefirststepistoreversesomeitems.Thesecondstepistosum
theitemsbysubscaleandthethirdstepistoconverttherawscoretoatscore.Thefirstsetbelowshowsthe
scoringactionsindetail.Twomethodsforscoringarepresented.ThefirstistofollowSteps12andthenuse
thetableattheendofthissectiontoconvertrawscorestotscores.Thesecondmethodusescomputer
15
scoring.ThecomputercodepresentedbelowiswrittenforSPSSthatcanbeconvertedbytheusertoother
statisticalprogramsifneeded.
Step1:Reverseitems1,4,15,17,and29into1r,4r,15r,17rand29r(1=5)(2=4)(3=3)(4=2)(5=1)
Step2:Sumtheitemsforeachsubscale.
CS=SUM(pq3,pq6,pq12,pq16,pq18,p20,pq22,pq24,pq27,pq30).
BO=SUM(pq1r,pq4r,pq8,pq10,pq15r,pq17r,pq19,pq21,pq26,pq29r).
STS=SUM(pq2,pq5,pq7,pq9,pq11,pq13,pq14,pq23,pq25,pq28).
Step3:ConverttheZscorestotscoreswithrawscoremean=50andtherawscorestandarddeviation=10.
BelowistheSPSSCodeforScoringtheProQOL,includingroutinestocomputetherawandtscores.
COMMENT:Step1:ScoreProQOLIV.or5Variablenamesinsyntaxassumepq#foreachitem.Thisroutine
reversesitems1,14,15,17and29thenscoresthethreescalesoftheProQOLIV;SecondaryTraumaticStress
thenewscalenamefortheoldCompassionFatiguescale.
RECODEpq1pq4pq15pq17pq29
(1=5)(2=4)(3=3)(4=2)(5=1)
INTOpq1Rpq4Rpq15Rpq17Rpq29r.
COMPUTECS=SUM(pq3,pq6,pq12,pq16,pq18,pq20,pq22,pq24,pq27,pq30).
COMPUTEBO=SUM(pq1r,pq4r,pq8,pq10,pq15r,pq17r,pq19,pq21,pq26,pq29r).
COMPUTESTS=SUM(pq2,pq5,pq7,pq9,pq11,pq13,pq14,pq23,pq25,pq28).
EXECUTE.
COMMENT:Step2:ConvertrawscoretoZscore.Notethatthisroutineproducesanextraneousoutputfile
withnandmeansthatcanbedeleted.
DESCRIPTIVES
VARIABLES=CSBOSTS/SAVE.
COMMENT:Step3ConvertZscoretotscore.
COMPUTEtCS=(ZCS*10)+50.
VARIABLELABELStCS'CStscore'.
EXECUTE.
COMPUTEtBO=(ZBO*10)+50.
VARIABLELABELStBO'BOtscore'.
EXECUTE.
COMPUTEtSTS=(ZSTS*10)+50.
VARIABLELABELStSTS'STStscore'.
EXECUTE.
COMMENT:Interpretationofscores:Themeanscoreforanyscaleis50withastandarddeviationof10.
COMMENT:ThecutscoresfortheCSscaleare44atthe25thpercentileand57atthe75thpercentile.
COMMENT:ThecutscoresfortheBOscaleare43atthe25thpercentileand56atthe75thpercentile.
COMMENT:ThecutscoresfortheSTSscaleareat42forthe25thpercentileand56forthe75th percentile.
16
SCALEDEFINITIONSANDSCORES
Belowarethescaledefinitionsandtheaveragescores.Thissectionisthesameasthescoringhandout.
Compassionsatisfactionisaboutthepleasureyouderivefrombeingabletodoyourworkwell.Forexample,
youmayfeellikeitisapleasuretohelpothersthroughyourwork.Youmayfeelpositivelyaboutyour
colleaguesoryourabilitytocontributetotheworksettingoreventhegreatergoodofsociety.Higherscores
onthisscalerepresentagreatersatisfactionrelatedtoyourabilitytobeaneffectivecaregiverinyourjob.
Theaveragescoreis50(SD10;alphascalereliability.88).About25%ofpeoplescorehigherthan57and
about25%ofpeoplescorebelow43.Ifyouareinthehigherrange,youprobablyderiveagooddealof
professionalsatisfactionfromyourposition.Ifyourscoresarebelow40,youmayeitherfindproblemswith
yourjob,ortheremaybesomeotherreasonforexample,youmightderiveyoursatisfactionfromactivities
otherthanyourjob.
BurnoutMostpeoplehaveanintuitiveideaofwhatburnoutis.Fromtheresearchperspective,burnoutisone
oftheelementsofcompassionfatigue.Itisassociatedwithfeelingsofhopelessnessanddifficultiesindealing
withworkorindoingyourjobeffectively.Thesenegativefeelingsusuallyhaveagradualonset.Theycan
reflectthefeelingthatyoureffortsmakenodifference,ortheycanbeassociatedwithaveryhighworkloador
anonsupportiveworkenvironment.Higherscoresonthisscalemeanthatyouareathigherriskforburnout.
Theaveragescoreontheburnoutscaleis50(SD10;alphascalereliability.75).About25%ofpeoplescore
above57andabout25%ofpeoplescorebelow43.Ifyourscoreisbelow18,thisprobablyreflectspositive
feelingsaboutyourabilitytobeeffectiveinyourwork.Ifyouscoreabove57youmaywishtothinkabout
whatatworkmakesyoufeellikeyouarenoteffectiveinyourposition.Yourscoremayreflectyourmood;
perhapsyouwerehavingabaddayorareinneedofsometimeoff.Ifthehighscorepersistsorifitis
reflectiveofotherworries,itmaybeacauseforconcern.
SecondaryTraumaticStressThesecondcomponentofCompassionFatigue(CF)issecondarytraumaticstress
(STS).Itisaboutyourworkrelated,secondaryexposuretoextremelyortraumaticallystressfulevents.
Developingproblemsduetoexposuretootherstraumaissomewhatrarebutdoeshappentomanypeople
whocareforthosewhohaveexperiencedextremelyortraumaticallystressfulevents.Forexample,youmay
repeatedlyhearstoriesaboutthetraumaticthingsthathappentootherpeople,commonlycalledVicarious
Traumatization.Youmayseeorprovidetreatmenttopeoplewhohaveexperiencedhorrificevents.Ifyour
workputsyoudirectlyinthepathofdanger,forexampleduetoyourworkasaemergencymedicalpersonnel,
adisasterresponderorasamedicinepersonnel,thisisnotsecondaryexposure;yourexposureisprimary.
However,ifyouareexposedtootherstraumaticeventsasaresultofyourwork,suchasprovidingcareto
peoplewhohavesustainedemotionalorphysicalinjuries,thisissecondaryexposure.ThesymptomsofSTS
areusuallyrapidinonsetandassociatedwithaparticularevent.Theymayincludebeingafraid,having
difficultysleeping,havingimagesoftheupsettingeventpopintoyourmind,oravoidingthingsthatremind
youoftheevent.
Theaveragescoreonthisscaleis50(SD10;alphascalereliability.81).About25%ofpeoplescorebelow43
andabout25%ofpeoplescoreabove57.Ifyourscoreisabove57,youmaywanttotakesometimetothink
aboutwhatatworkmaybefrighteningtoyouorifthereissomeotherreasonfortheelevatedscore.While
higherscoresdonotmeanthatyoudohaveaproblem,theyareanindicationthatyoumaywanttoexamine
17
howyoufeelaboutyourworkandyourworkenvironment.Youmaywishtodiscussthiswithyoursupervisor,
acolleague,orahealthcareprofessional.
CUTSCORES
TheProQOLmeasureisbestusedinitscontinuousform.However,manypeopleprefertohavecutscoresto
indicaterelativerisksorprotectivefactors.Toaddresstheseneeds,cutscoresareprovided.Thecutsareset
atthe25thand75thpercentiles.TheyarepotentiallyoverlyinclusivethatistheytendtoType1error.This
meansthatthethereisagreaterpossibilityofhavingafalsepositivethanmissingsomeonewhoactually
belongsinaparticulargroup.Becausethisisascreeningandplanningtool,itisprobablylessproblematiccto
includesomeonewhoshouldnotbeincludedthantoexcludesomeonewhatshouldbeincludedsothat
supportiveorcorrectiveactionisconsideredevenifitisnotneeded.Scoresneartheboarderscanbe
particularlytroublesomeinthatthecutpointisanartificiallyappliedcriteria.Pleasenotethatwhilewe
providecutscoresbasedonthe75thpercentile,wedonotrecommendthatthemeasurebeusedforanything
otherthanscreening,andwepreferfromastatisticalperspective,tousethecontinuousnumbers.
TABLE2:CUTSCORESFORTHEPROQOL
Compassion
Satisfaction
Burnout
SecondaryTraumatic
Stress
BottomQuartile(25th
Percentile)
44
43
42
Mean(50thPercentile)
50
50
50
TopQuartile(75thPercentile)
57
56
56
SECTION6:INTERPRETINGTHEProQOL
THEPROQOLISNOTDIAGNOSTIC
ThemostimportantaspectaboutinterpretingtheProQOListhatitisnotadiagnostictest.Thereareno
officialdiagnosesintheInternationalStatisticalClassificationofDiseasesandRelatedHealthProblems10th
Revision(ICD10)orintheDiagnosticandStatisticalManualofMentalDisorders(DSMIVTR,2000).
Thebodyofresearchonburnoutandposttraumaticstressdisorderindicatesaclosekinshipwitheachto
depression.Whilethisisusefulinformation,depressionisageneraltermthatalsoisaspecificdiagnosisofa
mentaldisorderandiswidelyandofficiallyrecognizedbyboththemedicalandthementalhealth
communities.Therefore,itisimpossible,andgrievouslyinappropriate,todiagnosedepressionoranyother
disorderfromtheresultoftheProQOL.
WhattheProQOLcando,fromadiagnosticperspective,istoraiseissuestoaddresswithuseofappropriate
diagnosticprocedures.Forexample,asnotedabove,bothburnoutandPTSDarefrequentcotravelerswith
18
depression.Ahighscoreoneitherburnoutorsecondarytraumaticstress,orahighscoreonbothwithalow
scoreoncompassionsatisfaction,canbeanauguryofclinicaldepressionthatdeservestreatment.Clearlythe
disordermostcommonlyassociatedwithsecondarytraumaisPTSD.Infact,theDSMIVTRPTSDA1criteria
specifythattheeventmayhappentoselfortoothers.Additionally,itspecifiesthatapersonsreactionmust
involvefear,helplessness,orhorror.However,whatitdoesnotspecifyiswhenonehasexperienced,
witnessed,orwasconfrontedwiththethreattoanother.Despitethisparallelofcompassionfatigueand/or
secondarytraumatoPTSD,itcannotbeoveremphasizedthattheseissuesareanaturalconsequenceof
traumaworkandnotnecessarilypathologicalinnature(Figley,1995;Larsen&Stamm,2008;Stamm,1999).
Giventheseconcerns,theProQOLcanbeaguideinregardtoanindividualsororganizationsbalanceof
positiveandnegativeexperiencerelatedtodoingeitherpaidorvolunteerwork.Foranindividualoran
organization,highscoresoncompassionsatisfactionareareflectionofengagementwiththeworkbeingdone.
THEIMPORTANCEOFKNOWINGMORETHANJUSTTHEPROQOLSCORES
Itisimportanttokeepinmindthatknowingmoreinformationaboutthetesttakeroragroupsscoreisbetter
thanhavinglessinformation.Theinterpretationsectionbelowisgeneralandnotbasedoncovariatesor
demographicsthatmustbeconsideredwheninterpretingscoresforspecificpeopleorspecificgroups.For
example,scoresforapersonwhoisadeployedservicemanorwomanmightbenormalforthatsituationbut
elevatedforsomeoneworkinginanondeploymentsetting.Similarly,itmaybeimportanttoknowbasic
demographicinformationisthetesttakermaleorfemale.
SCORESACROSSDEMOGRAPHICCATEGORIES
Somedataareavailableacrossvariousdemographiccategories.Thesemeansareproducedfromadatabank
of1,289casescreatedfrommultiplestudies.Whilethisisalargenumberandshouldreducethe
measurementerror,testingconditionsandparticipantnumbersacrossthevariablesfluctuatewidely.Caution
shouldbeexercisedinusingthesedata.Additionally,thesedataarereportedacrosssingledemographics.
Otheranalysesofthesedataindicatethattheremaybeverycomplexinteractionsthatcouldnotbereported
hereduetoconstraintswithinthedatabank.
Twoveryimportantcovariatesthatcannotbeaddressedatthistimethroughdatainthedatabankarework
settingandtypesofpeopleassisted.Anystudymustincludethisvariable.
TABLE3:GENDER
CStscore
BOtscore
sex
Mean
Std.Deviation
N
male
49.01
10.81
315
female
50.14
9.77
760
male
48.99
9.75
315
Nostatisticaldifferenceswereobservedacrossgender.
19
STStscore
female
50.37
10.26
760
male
49.05
9.95
315
female
50.18
10.15
760
TABLE4:AGEGROUP
CStscore
BOtscore
Mean
Std.Deviation
N
1835yrs
50.12
8.76
106
36andup
51.00
9.50
93
1835 yrs
50.11
8.50
106
STStscore
36andup
47.74
8.25
93
1835yrs
53.61
9.74
106
36andup
50.75
9.27
93
Nostatisticaldifferenceswereobservedacrossagegroup.
TABLE4:RACE
CStscore
BOtscore
Mean
Std.Deviation
N
NonWhite
50.16
9.86
540
White
49.87
10.12
647
NonWhite
52.82
10.23
540
STStscore
White
47.65
9.17
647
NonWhite
51.46
9.74
540
White
48.78
10.06
647
Nosignificantdifferenceswereobservedacrosswhiteandnonwhites.Significantdifferencewereobserved
onBurnoutandonSecondaryTraumaticStress.Whitesreportedlessburnout(F1,1183=84,14;p<.001;Power=
1)andlessSTS(F1,1183=21.38;p<.001;Power=.97).
TABLE5:INCOMEGROUP
CStscore
BOtscore
STStscore
Income
Group
Mean
Std.Dev
N
Upto
45KUSD
46Kto
75KUSD
More
than75K
Upto
45KUSD
46Kto
75KUSD
More
than75K
Upto
45KUSD
46Kto
75KUSD
More
than75K
49.96
11.49
270
48.94
9.25
256
51.46
9.91
167
47.22
9.56
270
48.11
8.16
256
46.67
9.72
167
49.56
11.10
270
48.07
8.76
256
48.33
9.66
167
Nostatisticaldifferenceswereobservedacrossincomegroups.
TABLE6:YEARSATCURRENTEMPLOYER
CStscore
<5years
Mean
49.85
Std.Dev 10.21
N
420
BOtscore
STStscore
5to15
years
>15
years
<5years
5to15
years
>15
years
<5years
5to15
years
>15
years
49.49
10.85
101
50.31
8.99
58
47.55
8.86
420
47.32
9.85
101
49.43
9.35
58
48.93
9.65
420
47.95
10.10
101
49.10
9.38
58
Nostatisticaldifferenceswereobservedacrossyearswithcurrentemployergroups.
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TABLE7:YEARSINFIELD
CStscore
<5years
Mean
Std.Dev
N
49.52
10.41
183
5to15
years
BOtscore
>15
years
49.80
9.38
136
50.36
9.47
165
<5years
5to15
years
47.44
9.16
183
STStscore
>15
years
48.59
8.14
136
47.36
9.59
165
<5years
48.35
8.83
183
5to15
years
47.42
8.80
136
>15
years
47.85
9.89
165
Nostatisticaldifferenceswereobservedacrossyearsinfieldgroups.
INTERPRETINGINDIVIDUALSCALES
COMPASSIONSATISFACTION
Compassionsatisfactionischaracterizedbyfeelingsatisfiedbyonesjobandfromthehelpingitself.Itis
characterizedbypeoplefeelinginvigoratedbyworkthattheyliketodo.Theyfeeltheycankeepupwithnew
technologyandprotocols.Theyexperiencehappythoughts,feelsuccessful,arehappywiththeworktheydo,
wanttocontinuetodoit,andbelievetheycanmakeadifference.
COMPASSIONFATIGUE
Compassionfatigueischaracterizedbythenegativeaspectsofprovidingcaretothosewhohaveexperienced
extremeortraumaticstressors.Thesenegativeresponsesincludefeelingsofbeingoverwhelmedbythework
thataredistinguishedfromfeelingsoffearassociatedwiththework.Thus,therearetwoscalesfor
CompassionFatigue.
BURNOUT
BurnoutisthepartofCompassionFatiguethatischaracterizedbyfeelingsofunhappiness,disconnectedness,
andinsensitivitytotheworkenvironment.Itcanincludeexhaustion,feelingsofbeingoverwhelmed,bogged
down,beingoutoftouchwiththepersonheorshewantstobe,whilehavingnosustainingbeliefs.
SECONDARYTRAUMATICSTRESS
SecondaryTraumaticStressisanelementofcompassionfatiguethatischaracterizedbybeingpreoccupied
withthoughtsofpeopleonehashelped.Caregiversreportfeelingtrapped,onedge,exhausted,overwhelmed,
andinfectedbyotherstrauma.Characteristicsincludeaninabilitytosleep,sometimesforgettingimportant
things,andaninabilitytoseparateonesprivatelifeandhisorherlifeasahelperandexperiencingthe
traumaofsomeoneonehelped,eventotheextentofavoidingactivitiestoavoidremindersofthetrauma.It
isimportanttonotethatdevelopingproblemswithsecondarytraumaticstressisrarebutitdoeshappento
manypeople.
21
INTERPRETINGSCALESCORESINCOMBINATION
HIGHCOMPASSIONSATISFACTION,MODERATETOLOWBURNOUTANDSECONDARY
TRAUMATICSTRESS
Thisisthemostpositiveresult.Thisresultrepresentsapersonwhoreceivespositivereinforcementfromtheir
work.Theycarrynosignificantconcernsaboutbeingboggeddownorinabilitytobeefficaciousintheir
workeitherasanindividualorwithintheirorganization.Theydonotsufferanynoteworthyfearsresulting
fromtheirwork.Thesepersonsmaybenefitfromengagement,opportunitiesforcontinuingeducation,and
otheropportunitiestogrowintheirposition.Theyarelikelygoodinfluencesontheircolleaguesandtheir
organization.Theyareprobablylikedbytheirpatients,whoseekouttheirassistance.
HIGHBURNOUT,MODERATETOLOWCOMPASSIONSATISFACTIONANDSECONDARY
TRAUMATICSTRESS
Peoplewhoscorehighonburnout,inanycombinationwiththeotherscales,areatriskasindividualsandmay
alsoputtheirorganizationsinhighrisksituations.Burnoutisafeelingofinefficacy.Intheworksetting,this
maybearesultofpersonalororganizationalfactors.Theprototypeburnoutisassociatedwithhighworkloads
andpoorsystemfunction.Apersonmayfeelasifthereisnothingtheycandotomakethingsbetter.Itis
likelytheyaredisengagedfromtheirpatients,eventhoughthisisnotassociatedwithanyfearasaresultof
engagementwiththeirpatients.Peoplesufferingfromburnoutoftenbenefitfromtakingtimeoff.Theymay
alsobenefitfromchangingtheirroutinewithintheorganization.Organizationsthathavemanypeoplewith
burnoutshouldseriouslyconsidertheirorganizationalsystemandtheuseoftheirhumancapitaltoidentify
pitfallsinthesystemandwaystosupportpeopleinaccomplishingbusinessgoalsandwork.
HIGHSECONDARYTRAUMATICSTRESSWITHLOWBURNOUTANDLOWCOMPASSION
SATISFACTION
Peoplewhomakethesescoresaretypicallyoverwhelmedbyanegativeexperienceatworkascharacterized
byfear.Ifthisfearisrelatedtoaneventthathappenedtothepersondirectly,suchashavingtheirlife
endangeredasaresultofparticipatinginadangerousrescue,oriftheyexperiencedatraumaticeventsuchas
sexualviolencebyacolleague,thesearenotsecondaryexperiences.Thesearedirectexposurestodangerous
events.However,ifthepersonsfearisrelatedtotakingcareofotherswhoweredirectlyinharmsway,thisis
secondarytraumaticstress.Thesepeoplearelikelytobenefitfromimmediatetreatmentfortraumaticstress
and,whenpresent,depression.Becausetheyareneutralinregardtotheirfeelingsofinefficacyatwork,or
feelingsofpleasureassociatedwiththeirwork,considerfocusingonthefearrelatedworkexperiences.
Counteringthefearmightincludechangingthecaseloadmix,theworkenvironment(likeassigningworkwith
colleagueswhomtheytrust),orintroducingothersafetymeasures.
22
HIGHSECONDARYTRAUMATICSTRESSANDHIGHCOMPASSIONSATISFACTIONWITH
LOWBURNOUT
Thiscombinationistypicallyuniquetohighrisksituationssuchasworkinginareasofwarandcivilviolence.
Peoplewhoscoreinthisrangeareoftenhighlyeffectiveattheirworkbecausetheyfeeltheirworkmatters.
However,theyhaveaprivateselfthatisextremelyfearfulbecauseoftheirengagementwithothers.Some
fearisaccurateandappropriateinhighrisksituation.However,highsecondarytraumaticstressismarkedby
thoughts,feelings,andmemoriesofotherstraumaticexperiencesmixedwiththeirownexperiences.Thiscan
beparticularlydifficulttounderstandwhentheexperiencesofthosetowhomthepersonprovideshelpare
similartohisorherown.Knowingthatothershavebeentraumatizedbythesametypeofsituationsinwhich
thepersonfindshimorherselfhasthepotentialtochangethepersonsinterpretationoftheevent.
Peoplewithscoreslikethistypicallybenefitfromencouragementtobuildontheirfeelingsofaltruismand
thoughtsthattheyarecontributingtothegreatergood.Simultaneously,theirfearsandfearrelated
symptomsshouldbeaddressed.Depressionistheoreticallyunlikelygiventheirhighfeelingsofsatisfaction.At
times,changesintheworkenvironmentcoupledwithadditionalsupportivesupervisionmayalleviatethe
PTSDlikesymptoms.Atothertimes,therapyormedicationorbothmaybeagoodalternative.
HIGHSECONDARYTRAUMATICSTRESSANDHIGHBURNOUTWITHLOWCOMPASSION
SATISFACTION
Thiscombinationisseeminglythemostdistressing.Notonlydoesthepersonfeeloverwhelmedanduselessin
theworksetting,theyareliterallyfrightenedbyit.Peoplewiththiscombinationofscoresareprobablyhelped
mostbybeingremovedfromtheircurrentworksetting.AssessmentforPTSDanddepressionisimportant.
Treatmentforeitherorbothmayhavepositiveoutcomes,butareturntoanunmodifiedworksituationis
unlikelytobefruitful.However,ifthepersoniswilling,itmaybethatheorshecanchangetheefficacyby
addressingtheirownskillsandsystems(suchasadditionaltraining)orbyworkingwiththeorganizationto
identifyareorganizedworkassignment.
INTERPRETINGTHEPROQOLATAGROUPLEVEL
Yearsofdatacollectionandpracticebasedevidencehaveprovidedusefulinformationonsystemand
individuallevels.Forexample,thereappeartobenoscalescoredifferencesbygender.Nonehavebeen
observedbycountry,althoughthismaybereflectiveofthetypeofworkersandsettingsthatareusing
westernizedmeasures.Whilenotshownintheoveralldatabank,someunpublishedstudiesaswellassome
individualstudiesthatcontributedtothebankshoweddifferencesbasedonthenumberofyearsinthefield
moreyearsinthefieldtypicallyisassociatedwithlowerscores.Whileitistemptingtopresumethosewith
moreexperiencedobetter,itislikelythatthosewithgreaterexposureandlowresiliencyleftthefield,while
thosethatremainedweredifferentiallyresilient.Whenlookingacrossprofessions,suchasmentalhealth,
physicalhealth,andchildprotectionworkers,dataindicatesthatphysicalhealthworkers(e.g.,nurses,primary
caredoctors)experiencetheleasttrauma,whileteachersremainthemostsatisfied.Ascouldbeexpected,
thoseworkersdealingwithchildrenandfamiliesintraumatendtoexperiencehigherlevelsofBOthanany
othergroup.
23
SECTION7:USINGTHEPROQOLFORDECISIONMAKING
Obviously,theidealworkenvironmentintermsofmanagingstressandtraumaisonethatcombineshighCS
withlowBOandSTS.Practicebasedevidenceandpreliminaryquantitativeevidencesuggestinteresting
resultsinlessthanidealworkenvironments.ThosewhohavehighlevelsofSTSaccompaniedbyhighCSand,
typically,astrongsenseofaltruism,maycontinuetobeeffectiveattheirjobsandoftenrespondwelltoa
shortSTSintervention.Whileitisimportantforaworkerssupervisortomakethistypeofdecision
individually,sometimesitispossibletoaccomplishinterventioninvivo,withoutchangingaworkassignment.
Incontrast,thosewithhighlevelsofbothBOandSTSmaybethemostatrisk,bothtothemselvesandina
worksetting.Inthissituation,thecaregiversareafraidandseenohopeforchange,whichpotentiallyruins
theireffectiveness.Theoretically,thisnegativeprofileisassociatedwithmedicalerror,butbecausethedata
arenotinonthatconcern,itistoosoontosaywithcertainty.Regardlessofthesystemeffectsofpeoplewho
areexperiencinghighlevelsofbothBOandSTS,itisimportantthatinterventionsbepursuedforthemas
individuals.Supervisorsshouldconsiderjobreassignmentduringtheinterventiontime.
CHANGINGTHEPERSONEVENTINTERACTION
OneoftherewardingaspectsoftheProQOListhatitprovidesaplatformforchange.Itcanleadto
introspectionandtobrainstormingaboutwhatisrightandwhatcanbemadebetterandwhatiswrongand
cannotbemadebetter.Itisimportanttoidentifythingsthataregoingwellandthosethingsthatarenot.Itis
alsoimportanttorealizethatsomethingsshouldbehorrible.Dealingwithburnvictims,forexample,cannot
reallybenormalized.Theburnsthemselvesareseriouswoundsandnooneshouldtrytopretendotherwise.
However,thatsameburnvictimmayprovideagoodsourceofcompassionsatisfactionwhenthehelperfeels
thatadifferenceisbeingmade.Indangeroussettings,itiscriticallyimportantnottotrytotakeawaypeoples
necessaryfears.Beingafraidmaybetheverythingthatkeepsthemfrombeingkilled.
Attheindividuallevel,apersonmayreviewpersonalandworkenvironments.Thismaybedoneindividually,
withfamily,withafriendorcolleague,orwithaprofessional.Regardlessofthemethod,thisisaplanabout
thatpersonandforthatperson;itishisorhersandnottheiremployersortheirdoctors.Aplandictated
fromoutsideislikelytoleadtodissatisfactionandamarkerforburnoutanorganizationthatdictates
personalbeliefsisprobablyanorganizationthatdoesnotvaluetheirpersonnelsthoughtsandfeelings.
Changingworkgroupscanbeeasyoritcanbeverydifficult.Thedifferenceistheinterestofthegroupin
investigatingandrespondingtoissuesofprofessionalqualityoflife.Someworkgroupsjustdonotwantto
dealwiththeissue.Theremaybeanattitudeofifyoucannottaketheheat,getoutofthekitchen.Other
groupsmaygenuinelywanttochangebutmaynotknowhowbesttochange.Somegroupsbecomedistressed
thatchangeisnotpossiblewithoutanoutsidesource.Somegroupsmayalreadybefunctioningwellandno
changeisadvisable.Theroleofthehelperinthissituationistotrytohelpthegroupmembersidentifytheir
styleandworkfromthere.Theprinciplesofanygoodgrouptheorycanassistinmanagingagroupsneeds.
Itisimportanttorememberthattherewillbetimeswhenagroupsneedsareveryclearandquite
reasonable,butunattainable.Thisiscommonincivilviolenceorwarsettings.Aworkgroupsmembersmay
decidethattheywishtochangeshiftsmoreoften.However,theremaybeinsufficientnumbersofpeopleto
makethatpossible.Insituationssuchasthis,yourroleistotrytoidentifyalternativestothereallyneeded,
butimpossible,intervention.Thegroupmembersthemselvesmaybethebestsourceofalternatives.
24
MONITORINGCHANGEACROSSTIME
TheProQOLitselfisstableacrosstime,whichmeansthatthescoresacrosstimereflectchangesintheperson,
notinthemeasureitself.SomepeopleselfadministertheProQOLataregularselfdeterminedintervaltosee
howtheyaredoing.Othersmaychoosetotakethetestonce.Someorganizationswillrequiremultiple
administrationswhileothersmayignoreprofessionalqualityoflifealtogether.
IftheProQOLisusedacrosstime,thereshouldbeawaytoconsiderwhatthosechangesmean.Thiscanbe
somethingassimpleasagraphshowingapersonsupsanddownsacrosstimeoritmaybeaformalreviewof
onesselfcareplanortheplanforaworkgroup.Itisimportantthattheinformationbeuseful.Onepotentially
importantuseoftheinformationistoreevaluateandadjustonesselfcareplanorevenagroupsor
organizationsplan.
25
SECTION8:THEPROQOLTESTANDHANDOUT
PROFESSIONAL QUALITY OF LIFE SCALE (PROQOL)
COMPASSION SATISFACTION AND COMPASSION FATIGUE
(PROQOL) VERSION 5 (2009)
When you [help] people you have direct contact with their lives. As you may have found, your
compassion for those you [help] can affect you in positive and negative ways. Below are some
questions about your experiences, both positive and negative, as a [helper]. Consider each of the
following questions about you and your current work situation. Select the number that honestly
reflects how frequently you experienced these things in the last 30 days.
1=Never
2=Rarely
3=Sometimes
4=Often
5=Very Often
1.
I am happy.
2.
I am preoccupied with more than one person I [help].
3.
I get satisfaction from being able to [help] people.
4.
I feel connected to others.
5.
I jump or am startled by unexpected sounds.
6.
I feel invigorated after working with those I [help].
7.
I find it difficult to separate my personal life from my life as a [helper].
8.
I am not as productive at work because I am losing sleep over traumatic experiences of

a person I [help].
9.
I think that I might have been affected by the traumatic stress of those I [help].
10. I feel trapped by my job as a [helper].

11.
Because of my [helping], I have felt "on edge" about various things.
12. I like my work as a [helper].

13. I feel depressed because of the traumatic experiences of the people I [help].
14. I feel as though I am experiencing the trauma of someone I have [helped].
15. I have beliefs that sustain me.
26
16. I am pleased with how I am able to keep up with [helping] techniques and protocols.
17. I am the person I always wanted to be.
18. My work makes me feel satisfied.
19. I feel worn out because of my work as a [helper].
20. I have happy thoughts and feelings about those I [help] and how I could help them.
21. I feel overwhelmed because my case [work] load seems endless.
22. I believe I can make a difference through my work.
23. I avoid certain activities or situations because they remind me of frightening experiences
of the people I [help].
24. I am proud of what I can do to [help].
25. As a result of my [helping], I have intrusive, frightening thoughts.
26. I feel "bogged down" by the system.
27. I have thoughts that I am a "success" as a [helper].
28. I can't recall important parts of my work with trauma victims.
29. I am a very caring person.
30. I am happy that I chose to do this work.
27
YOUR SCORES ON THE PROQOL: PROFESSIONAL QUALITY OF LIFE

SCREENING
Based on your responses, place your personal scores below. If you have any concerns, you should discuss
them with a physical or mental health care professional.
Compassion Satisfaction _____________

Compassion satisfaction is about the pleasure you derive from being able to do your work well. For example,
you may feel like it is a pleasure to help others through your work. You may feel positively about your
colleagues or your ability to contribute to the work setting or even the greater good of society. Higher scores
on this scale represent a greater satisfaction related to your ability to be an effective caregiver in your job.
The average score is 50 (SD 10; alpha scale reliability .88). About 25% of people score higher than 57 and
about 25% of people score below 43. If you are in the higher range, you probably derive a good deal of
professional satisfaction from your position. If your scores are below 40, you may either find problems with
your job, or there may be some other reasonfor example, you might derive your satisfaction from activities
other than your job.
Burnout_____________
Most people have an intuitive idea of what burnout is. From the research perspective, burnout is one of the
elements of Compassion Fatigue (CF). It is associated with feelings of hopelessness and difficulties in dealing
with work or in doing your job effectively. These negative feelings usually have a gradual onset. They can
reflect the feeling that your efforts make no difference, or they can be associated with a very high workload or
a non-supportive work environment. Higher scores on this scale mean that you are at higher risk for burnout.
The average score on the burnout scale is 50 (SD 10; alpha scale reliability .75). About 25% of people score
above 57 and about 25% of people score below 43. If your score is below 18, this probably reflects positive
feelings about your ability to be effective in your work. If you score above 57 you may wish to think about
what at work makes you feel like you are not effective in your position. Your score may reflect your mood;
perhaps you were having a bad day or are in need of some time off. If the high score persists or if it is
reflective of other worries, it may be a cause for concern.
Secondary Traumatic Stress_____________

The second component of Compassion Fatigue (CF) is secondary traumatic stress (STS). It is about your work
related, secondary exposure to extremely or traumatically stressful events. Developing problems due to
exposure to others trauma is somewhat rare but does happen to many people who care for those who have
experienced extremely or traumatically stressful events. For example, you may repeatedly hear stories about
the traumatic things that happen to other people, commonly called Vicarious Traumatization. If your work
puts you directly in the path of danger, for example, field work in a war or area of civil violence, this is not
secondary exposure; your exposure is primary. However, if you are exposed to others traumatic events as a
result of your work, for example, as a therapist or an emergency worker, this is secondary exposure. The
symptoms of STS are usually rapid in onset and associated with a particular event. They may include being
afraid, having difficulty sleeping, having images of the upsetting event pop into your mind, or avoiding things
that remind you of the event.
The average score on this scale is 50 (SD 10; alpha scale reliability .81). About 25% of people score below 43
and about 25% of people score above 57. If your score is above 57, you may want to take some time to think
about what at work may be frightening to you or if there is some other reason for the elevated score. While
higher scores do not mean that you do have a problem, they are an indication that you may want to examine
how you feel about your work and your work environment. You may wish to discuss this with your
supervisor, a colleague, or a health care professional.
28
WHAT IS MY SCORE AND WHAT DOES IT MEAN?

In this section, you will score your test and then you can compare your score to the interpretation below.
To find your score on each section, total the questions listed on the left in each section and then find your
score in the table on the right of the section.
Compassion Satisfaction Scale:

3. ____
6. ____
The sum of my
Compassion
Satisfaction questions
So My Score
Equals
My Level of
Compassion
22 or less
43 or less
Low
20. ____
Between 23 and 41
Around 50
Average
22. ____
42 or more
57 or more
High
The sum of my
Burnout Questions
So My Score
Equals
My Level of
Burnout
10. ____
22 or less
43 or less
Low
*15. ____ = ____
Between 23 and 41
Around 50
Average
42 or more
57 or more
High
12. ____
16. ____
18. ____
24. ____
27. ____
30. ____
T o t a l : _____
Burnout Scale:
*1. ____ = ____
*4. ____ = ____
8. ____
*17. ____ = ____

19. ____
21. ____
26. ____
*29. ____ = ____
Reverse the scores for those that are starred.

0=0, 1=5, 2=4, 3=3, 4=2, 5=1
T o t a l : _____
29
Secondary Trauma Scale:

2. ____
5. ____
7. ____
9. ____
11. ____
13. ____
14. ____
23. ____
The sum of my
Secondary Traumatic
Stress questions
So My Score
Equals
My Level of
Secondary
Traumatic
Stress
22 or less
43 or less
Low
Between 23 and 41
Around 50
Average
42 or more
57 or more
High
25. ____
28. ____
T o t a l : _____
30
SECTION9:CONVERTINGFROMTHEPROQOLIVTOTHEPROQOL5
ThissectionprovidesdirectionsifyouhaveusedpreviousversionsoftheProQOLandwouldliketobridge
fromolderversionstothenewversion.ThecurrentProQOL(version5)issimplerthanitspreviousversions.
Thegrammarhasbeenrefinedandthescaleforscoringismorefamiliartomostpeople.
Thecurrentversionisnearlyidenticaltotheolderversion.Thereareafewgrammarchangesinthequestions.
Theprimarychangeisreportingscoresinatscoreformatratherthanarawscoreformat.Thetscorehas
multipleadvantages,includingtheequilibrationofthemeanscoreacrossversionsoftheProQOLandacross
thescales.Thetscoreuseameanof50andastandarddeviationof10.Thus,ifyouscore50onthe
CompassionSatisfactionScaleitiscomparabletoa50ontheSecondaryTraumaorBurnoutscale.Ascoreof
50isthemeanscoreonanyscale.
ByusingthestandardizedtscoremakesitpossibletoeasilycompareacrossversionsoftheProQOL.Theolder
versionsoftheProQOLdonotincludetheadditionalstepstoconverttherawscorestoatscore.Becausethe
tscoreisastandardizedscore,onceanypreviousversionoftheProQOL,includingtheProQOLIV,scoresare
convertedtotscores,theyaredirectlycomparabletotscoresontheProQOL5.
Pleasemakesurethatyouareusingthe30itemProOQLwiththesubscalesCompassionSatisfaction,Burnout
andSecondaryTraumaticStress(alsoformerlycalledtheCompassionFatigueScale).Ifyouareusingtheolder
66itemCompassionSatisfactionandFatigueScaleortheCompassionFatiguescale,thesecannotbedirectly
compared.
WerecognizethatthesechangescanbeworrisomeifapreviousversionoftheProQOLhasbeenused.When
possible,tscoresshouldbereportedratherthanrawscores.InsomecasesProQOLscoresfromanearlier
versionhavebeendistributedtothepersonwhotookthetest.IfthetestisrepeatedusingtheProQOL5,the
reportinghandoutcansay
WhenyoutooktheProQOLlast,youroriginalscorewas[rawscore]whichisequivalentto[tscore].Your
currentscoreis[tscore].Youcancompareyour[earliertestingtscore]toyourcurrentscore[tscore].
TABLEFORDETERMININGPROQOLTSCOREFROMRAWSCORES
Whenusingthistabletoconvertscores,itshouldbenotedthattheconversionfromrawscoresto
standardizedtscoresisnotstrictlynumericastherearemorescoresavailableonastandardizedtscorethan
ontherawscore.CalculationsusingtheSPSSscoringschemewillhavesomevarianceincomparisontothe
table.Thevarianceistrivial,andonlyappliesifapersonisontheontheborderofacutscore.Themaximum
rawscoreontheProQOLis50andthetotalpercentilesavailableare100.
CompassionSatisfaction
Burnout
%tile
RawScore
SecondaryTraumaticStress
%tile
Rawscore
tscore
13
19
28
34
16
23
31
35
19
27
32
35
31
tscore
%tile
RawScore
tscore
22
31
34
36
24
34
10
35
36
24
34
10
35
36
25
35
11
37
38
26
36
11
37
38
27
37
11
37
38
10
27
37
10
12
38
10
38
11
27
37
11
12
38
11
39
12
28
39
12
12
38
12
39
13
28
39
13
13
39
13
39
14
29
40
14
13
39
14
39
15
29
40
15
13
39
15
39
16
30
41
16
14
41
16
39
17
30
41
17
14
41
17
41
18
30
41
18
14
41
18
41
19
31
43
19
14
41
19
41
20
31
43
20
14
41
20
41
21
31
43
21
15
42
21
41
22
31
43
22
15
42
22
42
23
32
44
23
15
42
23
42
24
32
44
24
15
42
24
42
25
32
44
25
15
43
25
42
26
32
44
26
16
44
26
42
27
33
45
27
16
44
27
43
28
33
45
28
16
44
28
44
29
33
45
29
16
44
29
44
30
33
45
30
16
44
30
44
31
34
47
31
16
44
31
44
32
34
47
32
17
45
32
44
33
34
47
33
17
45
33
44
34
34
47
34
17
45
34
45
35
35
48
35
17
45
35
45
36
35
48
36
17
45
36
45
37
35
48
37
18
46
37
45
38
35
48
38
18
46
38
45
39
35
48
39
18
46
39
10
46
32
40
36
49
40
18
46
40
10
47
41
36
49
41
19
48
41
10
47
42
36
49
42
19
48
42
10
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43
36
49
43
19
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43
10
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36
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44
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10
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19
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11
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46
37
51
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19
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11
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11
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20
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11
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20
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11
48
50
37
20
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20
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50
11
49
51
38
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51
20
50
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12
50
52
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20
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12
50
53
38
52
53
21
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53
12
50
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38
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21
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12
50
55
38
52
55
21
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55
12
50
56
39
53
56
21
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12
50
57
39
53
57
21
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57
13
51
58
39
53
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13
51
59
39
53
59
21
51
59
13
51
60
39
53
60
22
52
60
13
51
61
39
53
61
22
52
61
13
52
62
40
55
62
22
52
62
14
52
63
40
55
63
22
52
63
14
52
64
40
55
64
23
53
64
14
52
65
40
55
65
23
53
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14
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40
55
66
23
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66
15
54
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40
55
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23
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15
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41
56
68
23
53
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15
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41
56
69
24
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15
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41
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24
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15
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24
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16
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25
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16
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25
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75
17
56
33
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42
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26
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17
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17
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43
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43
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43
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20
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45
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20
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30
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21
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21
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31
65
90
22
64
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46
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31
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91
22
64
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46
62
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31
65
92
23
65
93
46
62
93
32
66
93
23
66
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46
62
94
32
66
94
24
67
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47
64
95
33
68
95
26
70
96
47
64
96
34
69
96
27
71
97
48
65
97
34
69
97
28
73
98
49
66
98
36
72
98
29
75
99
50
68
99
37
73
99
31
77
34
SECTION10:BIBLIOGRAPHY
ComprehensiveBibliographyOfTheEffectOfCaringForThoseWhoHave
ExperiencedExtremelyStressfulEventsandSuffering
Date:28November,2010
Compiler:BethHudnallStamm
Reference:Stamm,B.H.(2010,November).ComprehensiveBibliographyOfTheEffectOfCaringForThose
WhoHaveExperiencedExtremelyStressfulEventsandSuffering.www.proqol.org.Outofrespectforthe
scholarlyandcommunityendeavor,ifyouuselargeportionsofthisbibliography,ornoteitasawhole,please
includethereferenceprovidedhere.
CommentontheBibliography:Thisbibliographyisprovidedfortheuseofanyoneandisprovidedasa
volunteereffortfromtheProQOL.org.Everyefforthasbeenmadetobeasaccurateandcompleteaspossible.
Nonetheless,itisincumbentontheusertoverifythereferenceandthedetailsofthereference.ProQOL.org
cannottakeresponsibilityforthespecificaccuracyofthedetailsofthereferences.
SearchTermsinAlphabeticalOrder:compassionfatigue,compassionsatisfaction,compassionstress
secondarytrauma,secondarytraumaticstress,vicarioustrauma,vicarioustraumatization,vicarious
transformation.
TermsExcludedFromtheSearch:burnoutandcountertransferecewerenotincluded.Searchesusingthe
termsbutcrossreferencingwithatleastoneofthetermsabove,werenotsufficientlyaccuratetomakethe
effortworthwhile.Paperswiththesearchtermsabovethatalsoincludeburnoutorcountertransferncewere
notexcluded.BurnoutandCountertransferencewithouttheoccurrenceofoneofthesearchtermsabove
generallywereexcluded.Burnoutandcountertransferenceappearingwithoneofthetermsabovewere
included.
RationaleforTermExclusion:
Burnoutwasnotincludedinthesearchtermsasitisawidelyusedtermthatcanapplytoanytypeof
job.Itisnotuniquetoworkingwithpeoplewhohaveexperiencedextremesuffering.Itcanbe
appliedtoanytypeofjobsuchasworkinginafactoryoranoffice.
Countertransferencewasnotincludedinthesearchtermsasitmayormaynotrelatetothe
therapistsinteractionwithpatientswhohaveexperiencedtraumaticstress.Countertransferencecan
occurevenifthepatient/clienthasnotexperiencedanextremelystressfuleventortraumarelated
suffering.
SearchLocations:Medline,PsychInfo,PILOTS,Amazon.com,Google.TheGooglesearchwasconductedto
identifytheoverallsizeofthebodyofwork(over250,000accuratehits).Somedocuments,particularly
35
organizationalpublications,wereidentifiedthere.Individualpresentations,etc.werenotincludedinthis
bibliography.
TestsandMeasuresSearchinPILOTS:TM=(secondarytraumaquestionnaire(mottaetal))orTM=(secondary
traumascale(mottaetal))orTM=(secondarytraumaticstressscale(brideetal))orTM=(secondarytraumatic
stressscale)orTM=(innerexperiencequestionnaire(brocketal))andTM=(traumaandattachmentbelief
scale)orTM=(compassionfatigueselftestforpractitioners(figley))orTM=(compassionfatigue/satisfaction
scale)orTM=(compassion/satisfactionfatiguetestforhelpers(stammandfigley))orTM=(professionalquality
oflifescale(stamm))orTM=(traumaticstressinstitutebeliefscale(stammetal))
CommentonFormatting:TheformattinggenerallyfollowsthepatternofAPAformat.Theitalicsand
underlinesarenotpresenttoavoidtruetypeandotherformattingerrorsmakingthebibliographymore
difficulttoread.SomereferencesareinformatsotherthanAPA.Thetechnicalcapacitytoformateach
referenceidenticallyexceedsgreatlythecapacityofthetinyvolunteerProOQL.orgstaff.Insomecases
informationwasnotreadilyavailable.Inthesecases,theremaybemarkingsindicatingthemissing
information.Themostcommonoccurrencewasthelackofcityinformationonvariouspublishingcompanies.
Thus,thereferencemayreadCity:ABCBooks.
ToMakeComments,AdditionsorCorrections:writetoinfo@proqol.orgorcompletetheformonlineat
www.proqol.org,ontheBibliography.
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SECTION11:FREQUENTLYASKEDQUESTIONS
Q:IunderstandthattheProQOL5isthecurrentversionoftheCompassionFatigueSelfTestorthe
CompassionSatisfactionandFatigueTest.Whathappenstotheoldtests?
A:TheProQOListhecurrentversionoftheearliertests.Thescalesarethesameandthetoneofthe
measureisthesameacrosstheversions.Thenewversionitisamuchbettertest.Itismorepsychometrically
sound,anditisshorterreducingtheburdenonthetesttaker.Additionalinformationcanbefoundinthe
ProQOLmanual(www.proqol.org).
Q:CanIcomparetheProQOL5topreviousversions?
A:Yes.StartingwiththeProQOL5scoresarereportedinstandardizedformat,usingatscore.Thisallowsyou
tocompareacrossversionsoftheProQOLsimplybystandardizingthosescores.Moreinformationabout
standardizingscoresisfoundintheProQOLmanualunderscoring.
Q:Whydidstartusingastandardizedscore?
A:Standardizedscoreshavemultipleadvantages.Thegreatestadvantageisforthetesttaker.Withtheraw
scoreformat,thenumbersoneachscalemeantsomethingdifferent.A23ononescalewasnotequivalentto
a23onanother.Byusingastandardizedscore,scoresacrossthescalescanbeinterpretedthesame.The
meanis50andthestandarddeviationis10,regardlessofthescale.
Q:HowdoIcalculatethestandardizedscores?
A:Thereareseveralmethodsdependingonwhatworksbestforyou.ThereiscomputercodeontheProQOL
manual.Thereisalsoatablethatyoucanlookupscores.Forapplicationswhenyoudonotneedagreatdeal
ofinformation,youcanusetheselfscoreversion.
Q:MayIusetheProQOL?
A:Yes.Weencouragepeopletousethemeasure.Thepermissionyouneedtousethemeasureisonthetest
itselfinthefooter.
Q:DoIhavetopayfortheProQOL?
A:Thatdepends.WehaveintentionallykepttheProQOLavailableatnoorlowcostinordertomakeiteasyto
useforanyone,anywhereintheworld.Thechoiceisuptoyou.Ifyouwouldliketocollectthematerialsup
yourself,youcandothatforfree.Ifyouwouldliketohavethemdeliveredtoyouinanorganizedpackage,
Sidranwilldothatforyou.
ForFree:Youmaydownloadthemeasureandotherinformationaboutitforfreefrom
www.proqol.org.
AtCost:Throughanagreementwiththenonprofit/charityorganizationTheSidranFoundation
(www.sidran.org),theProQOLandmaterialsareavailableforasmallchargetocoverthecostsof
handling.Youcanaccessthemeasuredirectlyathttp://www.sidran.org/catalog/ProQOL.html.
73
Q:MayImakecopiesthemeasure?
A:Thepermissionthatyouneedisinthecopyrightagreementatthebottomofthemeasure.Youmayusethe
measurefreelyaslongas(a)authoriscredited,(b)nochangesaremade,and(c)itisnotsold.
Q:MayIreformattheProQOL?
A:Youmayreformatthemeasuretofitwithyourneeds.Pleasemakesuretokeepthecontentthesame.
Q:MayIchangetheProQOLtobettermatchthepeoplethatIamworkingwith?
A:Yes.Wetriedtousethemostgenericformofaddresswecouldfind,helperbutwerecognizethatthisis
notsuitableforeveryone.Thus,weincludepermissiontoreplacethewordhelperanditsderivativeswith
wordsthataremoresuitedforyourgroup.Youwillnoteonthemeasurethatthetermsareinbracketand
italicized.Youmayreplacethebracketedtermwithonethatismoresuitableforyourgroup.Ifyouare
workingwithteachers,forexample,youmaywanttoreplacehelperwithteacherandhelpwithteach.For
nurses,replacethewordhelperwithnurseandhelpwithnurse.Forattorneys,replacethewordhelperwith
attorneyandhelpwithrepresentandsoforth.Youdonotneedtoseekspecialpermissiontomakethese
changes.
Q:HowistheProQOLtypicallyused?
A:PeopletypicallyusetheProQOLoneofthreeways
Forresearchstudies.
Tomonitortheprofessionalqualityoflifeamongstaffatanorganizationlikeastatessocialwokers
orgroupsuchasaidworkers.
Toselfmonitoronesstatusforpersonalinterest.
Q:WhoisthetargetoftheProQOL?
A:Whiletherapistsweretheoriginaltarget,themeasureisusedwidelywithothergroupsincludingmedical
healthprofessionals(particularlynurses),teachers,lawyers,humanitarianworkers,socialserviceemployees,
publicserviceemployeessuchaslawenforcement,reportersandjournalists,juriesattrials,andevensoldiers
andpeacekeepers.ThekeytotheProQOLsappropriatenessisthetheoreticalpossibilityofbeingexposedto
anotherspotentiallytraumatizingmaterialasaresultofpaidorvolunteerwork.Ifthisrelationshipcanexist,
themeasureislikelyappropriate.
Q:Iaminterestedinworkingwithfamilycaregivers.IstheProQOLappropriateforthesepeople?
A:WedonotrecommendtheProQOLforfamilycaregivers.Thereareanumberofmeasuresforfamily
caregiversavailable.YoumaywishtocheckTheCaregiverBurdenScalewhichcanbeseenat
http://www.mywhatever.com/cifwriter/content/41/pe1278.html,orotherstofindsomethingthatmeetsyour
needs.
Q:Canyoutellmeaboutthearticlesthathavebeenpublishedusingthemeasure?
74
A:Wetrytokeepacomprehensiveandreasonablyuptodatebibliographyatwww.proqol.org.We
recommendthatyoucheckthePILOTSdatabaseattheNationalCenterforPTSDforadditionalreferences
http://biblioline.nisc.com/scripts/login.dll.
Q:WherecanIgetmoreinformationabouttheProQOL,andsecondary/vicarioustraumatizationor
CompassionFatigue?
A:Youcanfindmanyhandoutsanddocumentsatwww.proqol.orgtheHandoutslink.Thereismore
technicalinformationontheResearchlinkatwww.proqol.org.Ifyouarelookingforhandoutsandaquick
overview,thehandoutssectionisthebestlocation.Ifyouarelookingformorescientificandresearchdetailed
information,gototheresearchsectionofwww.proqol.org.
Q:Isthereasinglescoreforthemeasureacrossallofthethreescales?
A:No.Wehavetriedforyearstocreateacompositescorewithoutsuccess.However,wearenotgivingup!
Thereasonthereisnosensiblecompositescoreisthatweasyetdonotfullyunderstandtherelationship
betweenCompassionSatisfaction,BurnoutandCompassionFatigue/SecondaryTrauma.Oneoftheproblems
encounteredovertheyearswastheproblemswiththeoriginalscalethatclearlyshowedcollinearitybetween
thescales.Thus,werevisedthescalestominimizethedestructiveeffectsofcollinearityandarenowre
collectingdatatoseeifwecanunderstandtheinterrelatednessofthethreescales.Infact,thiswouldbea
greatdissertationforsomeone!
Q:IamonlyinterestedinCompassionFatigue/SecondaryTrauma.CanIusejusttheCompassionFatigue
Scale?
A:Westronglysuggestthisisnotagoodidea.Whilewedonotasyetfullyunderstandtherelationship
betweenthethreesubscales,wedoknowthatCompassionSatisfactionisamoderator,ifnotamediatorof
CompassionFatigue/SecondaryTrauma.BurnoutrarelyexistsatthesametimeasCompassionSatisfaction
andwhenbothBurnoutandCompassionFatigue/SecondaryTraumaarepresent,itseemstosuggestthemost
negativeoutcome.Thus,webelieveitisimportanttoknowallthreescores.Moreover,includingthepositive
itemsreducesnegativeresponseset,improvingthepsychometricpropertiesofthescale.
Q:CanIdiagnosePTSDfromtheProQOL?
A:No.TheProQOLisascreeningandresearchtoolthatprovidesinformationbutdoesnotyieldadiagnosis.If
yoususpectPTSDoranyotherpsychopathologyasaresultofworkrelatedtraumaexposure,wesuggestyou
useaclinicaldiagnostictoolsuchastheSCIDorCAPS.Moreinformationaboutthesetoolsmaybeobtained
usinganysearchengineonline.
Q:Canyougivemethepsychometricinformationaboutthemeasure?
A:ReliabilityandvalidityinformationincontainedintheProQOLManualwhichcanbefoundatourwebsiteat
www.proqol.org.
Q:WhatnormsdoIuse?
A:ThegeneralnormsareavailableintheProQOLmanualatwww.proqol.org,Therearealsogeneralnormson
thescoringsheethandout.Thesearethebestnormsatthistime.
75
Q:Whatarethecutscoresforthemeasure?
A:Weprovidenormsatthe25thand75thpercentiles.However,westronglysuggestthatthemeasureismost
sensitivewhenusingthecontinuousscores.Pleasenotethatthemeasureisnottobeusedfordiagnostic
purposes,andthus,cutscoresaretypicallynotused.Ifyourstudydesignrequiresthelesspowerful
categorizationofparticipants(asopposedtousingcontinuousscores),wesuggestthe25thand75%
percentilesprovidedwiththenorms.
Q:WhenIreversethescores,whatdoIdowiththe0score?
A:TheProQOL5usesthemorefamiliar15Likertscalesothe0isnolongeranissue.
IfyouhaveusedtheProQOLIV,belowisinformationaboutthe0.Pleasedorememberthatalloftheversions
oftheProQOLscorescanbecomparedbyusingthestandardizedscore.
OntheProQOLIV,the0remains0andallotherscoresarereversed.Whilethisseemsoddatfirst,
conceptually,youcanunderstandit.Thepersonansweringtheitemselectsnever/notatallwhichtranslates
mathematicallytoanullset,thatis0.Theotheritemsarereversedbecauseofthewaythattheyloadonthe
differentscales.Thisisbecausetheconceptistheothersideoftheitemasked.Forexample,ifIaskifyou
arehappyandyousaynever,thatisa0.Ifyousaysometimes(2)thatcanbereversescoredtomostly(4)Iam
nothappy.Itisawaytoallowtheitemtobephrasedinthepositivewhileaddressingtheflipsideofthe
concept.Frankly,fromascoringperspectiveifwehaditalltodooveragain,wewouldnotinclude0inthe
score.Itworkedeasilyoriginallysincealloftheitemswerepositivescored.Overtimeandthousandsofdata
points,werealizedthatthetestwasmoreeffectivereflectingpeoplesperceptionswhenwereversescored
someoftheitems.Sadly,fortheresearcher,thiscausesmomentsofmathematicalconsternation.However,
forthepersontakingthemeasure,itisvastlyusefultohaveanoptiontorespondnotatall,0sowehave
learnedtolivewiththemathematicalodditiesofthereversescoring.Allofthepsychometricanalysishasbeen
doneusingthe05scoringwiththeitemsreversescored0=0,1=5,2=4,3=3.
Q:IhaveheardthatifIdonateacopyofmyrawdatatothedatabank,youwillruncomparisonstospecific
groupsforme.
A:Yes,ifyoudonateacopyofyourdatatothedatabank,wewillrunacomparisontotheclosestgroupfor
you.Pleasebeawarethatthisislargelyavolunteereffortonourpartsoweneedsometimetoscheduleyour
request.
Q:IfIdonateacopyofmydatatothedatabank,willIlosetheownershipofmystudy?
A:No.Weneverpublishanyonedatasetalone.Wealwayscombinedatabankdatasoyourstudywillneverbe
publishedbyus.Forexample,werunanalysesbycountry,typesofparticipants,rural/urban,male/female,
etc.
Q:IfIsendyoumystudy,willyoureviewitandmakecommentsonit?
A:WetryasmuchaspossibletosupportresearchwiththeProQOL.Ifyouwouldlikeustomakecommentson
yourstudy,pleasesendus<irh@isu.edu>anoverview(notmorethan5pages)ofthestudyandwewilltryto
76
respondtoyouwithourthoughts.Wecannotpromisetorevieweverystudy,butwedomakeaneffortto
assistineverywaypossible.
Q:Willsomeoneonyourteambeonmythesisordissertationcommittee?
A:Wehaveinthepastbeenabletoparticipateinanumberofstudies.However,pleaserealizethatwe
receivemanyrequestseachyear.Ifyouwouldlikeustoworkwithyouonyourthesisordissertation,sendus
<irh@isu.edu>arequestthatincludes(a)youruniversity,(b)theareaandlevelofdegree,(c)thenameof
yourchairandasmanyofyourothercommitteemembersasyouknowof,(d)anabstractofyourproposal
notlongerthanonepage,and(e)abriefdetailsofthewayyouruniversityincludesoutsideparticipants.We
willreviewtheinformationandseeifthereisanyoneonourlargerteamwhocanworkwithyou.
ABOUTTHEAUTHOR
BethHudnallStamm,Ph.D.,educatedinpsychologyandstatisticsatAppalachianStateUniversity(BS,MA)and
UniversityofWyoming(Ph.D.),isaResearchProfessorattheIdahoStateUniversityInstituteofRuralHealth.
ShehasheldappointmentsattheVeteransAffairsNationalCenterforPosttraumaticStressDisorder,
DartmouthMedicalSchool,StateUniversityofNewYorkatOswego,andattheUniversityofAlaska
Anchorage.
Workingprimarilywithhelpersandunderservedpeople;Stamm'seffortsfocusesonsecondarytraumaamong
helpersandculturaltrauma.Shehasservedonboardsandcommitteesformultipleorganizationsincluding
TheInternationalSocietyforTraumaticStressStudies(ISTSS),theAmericanPsychologicalAssociation(APA),
theNationalAssociationforRuralMentalHealth(NARMH),theNationalAssociationofRuralHealth(NRHA),
andtheAmericanTelemedicineAssociation(ATA).Shehasbeenaprincipalon$27milliondollarsworthof
grantsfocusingonruralandurbanchildrenandadultsaddresstheeffectsofdifficultlifeevents.
Stammhasworkedwithsecondarytraumaticstressandprofessionalqualityoflifesince1990.Sheoriginally
becameinterestedinthetopicwhenshewasdirectingalongitudinalstudyonselfreportedperceptionsof
traumaticstressatwhichtimeshediscoveredtheresearchontraumahadanegativeeffectonthe
researchers.Sincethattimeshehasworkedwithhumanitarianaidorganizationsfromaroundtheworld
assistingthemindevelopingprofessionalqualityofliferesiliencyprogramsthatfocusonpreventionand
interventionofburnoutandsecondarytrauma.Shehasworkedwithhealthprofessionalsofalltypesinin
NorthandSouthAmerica,Europe,NewZeland,AustraliaandseveralcountriesinAsiaandAfrica.Shehasalso
77
workedwithmilitaryandRedCross/RedCrescentpersonnelintheUnitedStates,ThePalestinianTerritories,
andJordan.
Stammsactivitiesfocusonrecoveryfromexposuretowarandcivilviolenceaswellastoterrorismand
disasterforallpeopleincommunity,includinghelpers.Amongherotheractivities,in2008,shetestifiedon
PostTraumaticStressDisorder(PTSD)HealthCareSymposiumtotheHouseCommitteeonVeterans'Affairs
regardingtheneedsofourservicemenandwomenwhohaveexperiencedinjuryinIraqandAfghanistan.In
2006shetraveledtoAmman,JordantoaNATOAdvancedResearchWorkshoptohelpidentifywaysto
mitigatetheeffectsofterrorismonindividualsandcommunities.Followingthatwork,shewasaninvited
speakeratthe10thInternationalTortureRehabilitationCouncilMeeting,inBerlin,Germany.Intheaftermath
oftheSouthAsianTsunamiin2004,StammwastheU.S.RepresentativetotheInterGovernmentalMeeting
ofExpertsToFormulatePsychosocialProgrammeforRehabilitationofTsunamiSurvivors.Shealsoprovided
technicalassistancetotheIndonesiasoldestpsychosocialrecoveryprogram,Pulih,whowereprovidinglocal
rehabilitationtotsunamisurvivors.In2003,aspartofaU.S.StateDepartmentprogram,Stammworkedwith
thePalestineRedCrescentSocietytoaddressusingtechnologytoaddresssecondarytraumaamong
emergencyandprimarycarehealthprofessionals.In1992,shewasadelegatewiththeTrumanFoundation,
PeopletoPeopleProgramteachingaboutposttraumaticstressdisorderacrosseasternChina.
Herworkhasbeenrecognizedbymultipleorganizations.In2005,shereceivedaPresidentialCitationfromthe
AmericanPsychologicalAssociationnamingherasoneoftheoutstandingpsychologistsofthisgeneration.
Shewascreditedwithhelpingtoestablishthefieldsoftraumaticstress,telehealth,andtheireffectsonrural
health.In2004,shereceivedtheInternationalSocietyforTraumaticStressStudiesPublicInterestAwardfor
fundamentalandoutstandingcontributionstothepublicsunderstandingoftrauma.Withhercolleagues,
shehasbeenrecognizedmultipletimesbytheAmericanTelemedicineAssociationforscientificrigorand
contributionstothefield.In2004,StammwasselectedastheIdahoStateUniversityDistinguished
Researcher.In2003,shewasrecognizedbytheNationalRuralHealthAssociationasoneofthenations
DistinguishedResearchers.SheisafellowintheDivisionofTraumaticStressandtheDivisionofPublicService
oftheAmericanPsychologicalAssociation.
Stammisatraumaticbraininjurysurvivorfrom1987and2004.Asapersonwithadisability,sheisan
advocatefortheuseofassistanceanimalstomitigatedisabilities.SheisanAssociateAnimalBehavior
Consultant(AABC)withtheInternationalAssociationofAnimalBehaviorConsultants;amemberofthe
InternationalAssociationofAssistanceDogPartners;andislistedintheDeltaSocietyServiceAnimalTraining
Registry.
Stammhasover100professionalpublicationsandistheEditoroftheJournalofRuralMentalHealth.Her
booksincludeSecondaryTraumaticStress(1995,1999,SidranPress,EnglishEditions,2002Japaneseedition
and2004,German);MeasurementofStress,TraumaandAdaptation(1996,SidranPress);CulturalIssuesand
theTreatmentofTraumaandLoss(withKathleenNaderandNancyDubrow,1999,Brunner/Mazel);Rural
BehavioralHealthCarewithAPABooks(2003);andTheProfessionalQualityofLifeTestManual(Sidran,2005,
2008).
Herworkisusedinover30countriesanddiversefieldsincludinghealthcare,bioterrorismanddisaster
responding,newsmedia,andthemilitary.ShemakesherhomeinalogcabininthemountainsofIdahowith
herhistorianhusbandandherservicedogSophie.Seewww.proqol.organdwww.isu.edu/irhformore
information.
78

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2010

Copyright Beth Hudnall Stamm. All rights reserved.

I am preoccupied with more than one person I [help].

I get satisfaction from being able to [help] people.

I feel connected to others.

I jump or am startled by unexpected sounds.

I feel invigorated after working with those I [help].

I find it difficult to separate my personal life from my life as a [helper].

I am not as productive at work because I am losing sleep over traumatic experiences of

10. I feel trapped by my job as a [helper].

Because of my [helping], I have felt "on edge" about various things.

12. I like my work as a [helper].

YOUR SCORES ON THE PROQOL: PROFESSIONAL QUALITY OF LIFE

Compassion Satisfaction _____________

Secondary Traumatic Stress_____________

WHAT IS MY SCORE AND WHAT DOES IT MEAN?

Compassion Satisfaction Scale:

*15. =

*17. =

Reverse the scores for those that are starred.

Secondary Trauma Scale:

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