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Compassion fatigue, burnout and hopelessness of the health workers in

COVID-19 pandemic emergency

Poster · September 2020

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5 authors, including:

Francesco Franza Gianfranco Del Buono

Psychiatric Rehabilitation Centre Villa dei Pini, Avellino, Italy Azienda Ospedaliera Universitaria OO.RR. S.Giovanni di Dio e Ruggi d'Aragona
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Barbara Solomita V. Fasano

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Compassion fatigue, burnout and hopelessness

of the health workers in COVID-19 pandemic
emergency

Francesco Franza (1,4), Gianfranco Del Buono (2,4), Ferdinando Pellegrino (3), Barbara
Solomita (1,4), Vincenzo Fasano (4)

1) Psychiatric Rehabilitation Center “Villa dei Pini”, Avellino, Italy

2) Division Psychiatry, "S. Giovanni di Dio and Ruggi D'Aragona Hospital", University Salerno, Italy
3) Mental Health Department, ASL Salerno, ltaly
4) Neamente Association, Avellino – Naples, Italy

PRESENTED AT:

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BACKGROUND
Providing assistance and support to people with complex disabling organic and mental disorders can increase the work-stress
burden. The current health emergency due to the coronavirus pandemic can aggravate and increase the exposure of health
workers (stressful workload, with increased anxiety, increased responses to stress and Compassion Fatigue (CF)). All this can
lead to negative effects on mental and physical well-being, incorrect behavior and looking for help that can overburden
healthcare facilities and on available resources (Garfin et al., 2020). In mental health workers the hope is one of the main coping
strategies and is a resource that influences people's ability to interact with stress in life-threatening situations (Jones-Schenk
2020).

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OBJECTIVE
The aim of our study, 
during the pandemic lockdown, was: 
to investigate the stress of mental health workers (particularly psychiatrists, psychologists, social workers, psychiatric
nurses, and healthcare support worker);
to evaluate the role of the Compassion Fatigue of health workers with inpatients of different rehabilitation departments
affected by subacute or chronic organic diseases and in psychiatric residential inpatients;
to assess the role of hope in the coronavirus pandemic explosion period.

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METHODS

In a natural observational study, we evaluated the effects of the COVID pandemic on the psychological health of a group of
workers from the Multidisciplinary Rehabilitation Center (psychiatric, cardiological, orthopedic, neurological and respiratory)
"Villa dei Pini", Avellino, Italy and in other healthcare centers.

All healthcare professionals were asked to complete anonymously the rating scales shown below.

Among the healthcare professionals who delivered the complete tests, we selected only 102 (57 F, 45 M) healthcare workers
(physicians, psychologists, nurses, therapists, social health workers).

In table 1 we show some epidemiological data:

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Main inclusion criteria:

All health professionals

Observation period during the Italian lockdown (from 10 March 2020 to 30 April 2020)

Main esclusion criteria:

Psychiatric disorders

Psychiatric drug treatment

In this group to research stress levels, fatigue of compassion, vicarious trauma, burnout and hope (in particular hopeleness), we
administered the following rating scales:

- Fatigue Compassion Short Scale (FCs) (Adams et at., 2004)

- Caregiver Burden Inventory (CBI) (Novak M. e Guest C., Gerontologist, 29, 798-803, 1989)-

- Professional Quality of Life (PROQoL)-Compassion Satisfaction and Fatigue Subscales. (Stamm BH. The concise ProQOL manual 2010. Available
from: http://proqol.org)

- Beck Hopelessness Scale (BHS); (BHS, Beck Hopelessness Scale. San Antonio, Tex. : New York :Psychological Corp. ; Harcourt Brace Jovanovich, 1988)

Statistical significance was ascertained by t-tests or repeated measures ANOVA (to test multiple groups) with EZAnalyze 3.1
Excel Platform.

The second phase of the study involves evaluating the results of these scales after one year in same sample.

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RESULTS

Tables 2 and 3 show the data of the scales administered in the group of health workers.

Compassion fatigue (FCs):

Data showed an increase of overall compassion fatigue scores in all workers; however, there was a more increase CF in
psychiatric health workers (22% and 33%, respectively).

Burnout (CBI):

With CBI we observed a greater increase in the mean values in all the groups analyzed (p=.003). The highest mean total result is
that of nurses (39.81%) at CBI scale.

PROQoL data are superimposable (24% vs 37%, respectively). The most significant data of FC scale is represented by the
percentage of vicarious trauma in psychologist group (39.26%); this group has also a high percentage also in job burnout (in
35.23%).

Hopelessness (BHS):

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About half of the respondents scored above the average (47,5%) in mental health workers vs (34%) multidisciplinary workers.

Unfortunately, the data for these latter scales (PROQOL and BHS) are insufficient in the disciplinary rehabilitation group.

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2015 VS 2020

Graphic 1 shows the average scores obtained in the same group of health workers of the psychiatric department from our
previous study (Franza et al., 2015).

The comparative mean results (2015 vs 2020) showed that in the same group of mental health professionals, the mean values
obtained with same scales were higher during the lockdown (2020) than in 2015.

However, we found lower mean values of the scales administered in the physician group.

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CONCLUSIONS
During a health crisis, health workers are subjected to high levels of stress. In our small observational group, compassion fatigue
and burnout are higher than previous data in mental health workers. One of the problems closely linked to this extraordinary
period is the expectations and the hope that the emergency will end.

The hopelenesses can be an important indicator for implementing psychological and pharmacological intervention strategies.
Although some professionals have a greater responsibility in the management of therapeutic interventions, our study has shown
how higher school levels can be a protective factor against stress and hopelessness. The group of physicians and psychologists
have, in fact, presented higher levels of job satisfaction (compassion satisfaction) and lower burnout levels compared to other
HCWs.

However, the outlook and initial assumptions have been confirmed. In this historically unexpected period, health workers are
subjected to higher levels of stress, reaching high percentages of workers involved. It’s the responsibility of the health authorities
and health companies to implement strategies to manage the psychological emergency.

They must promote a reduction of stress levels, in a stress-low and quiet working atmosphere, where every worker can make his
own professional contribution to the patient's well-being; a favorable working environment in which the patient's well-being
associated with the operator's well-being contributes definitively to the company's well-being.

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DISCLOSURES
Conflict of interest: None to declare.

Contribution of individual authors:

All authors made substantial contributions to the design of the study, and/or data acquisition, and/or its analysis and interpretation

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AUTHOR INFORMATION
Francesco Franza, MD

Dr. Franza was born in Naples February 29, 1960.

Currently, he is a Director of Psychiatric Rehabilitation Center “Villa dei Pini”, Avellino – Italy. He graduated in Medicine and
Surgery from the Naples University. At Psychiatry Institute of Naples (Director Prof. Mario Maj) he specialized in Psychiatry in
1994. Since 1992 he worked as a psychiatrist at Mental Health Dept. “Villa dei Pini”, Avellino – Italy, where he directed First
Neuropsychiatric Division of the Psychiatric Department (from 2001). Dr. Franza is now a member of several scientific
associations (ECNP, EPA, Cent.Stu.Psi, WFSBP, AAS), and coordinator of scientific research and organization scientific events.

He’s the author of several studies and articles. The most recent works are following:

- Franza F. The emotional and psychological burden of the "burnout" in families of psychiatric patients. Psychiatr Danub.
2019;31(Suppl 3):438-442.

- Franza F et al. Relationship between Cognitive Remediation and Evaluation Tools in Clinical Routine. Psychiatr Danub.
2018 Nov;30(Suppl 7):405-408.

- Tavormina MGM, Tavormina R, Franza F, Vacca A, Di Napoli W. Mental Illness and Prejudices in Psychiatric
Professionals. Data from the Social Stigma Questionnaire for Psychiatric Professionals: A Multicentre Study. Psychiatr Danub.
2018 Nov;30(Suppl 7):479-484

- Franza F et al. Relationship between cognitive remediation and atypical antipsychotics in negative syndrome of
schizophrenia. Presentation E-poster n. EP.1069. 31st ECNP Congress - Barcelona 2018

- Franza F et al.. “Assessing the critical issues of atypical antipsychotics in schizophrenic inpatients”. Psychiatr Danub 2017;
29(Suppl. 3), 405-408

- Tavormina G, Franza F, Stranieri G, Juli M, Juli MR “Clinical utilisation and usefullness of the rating scale of mixed states,
("GT-MSRS"): a multicenter study”. Psychiatr Danub 2017; 29(Suppl. 3), 365-367

- Perito M, Calia RM, Carpentieri G, De Guglielmo S, Del Buono G, Fasano V, Fiorentino N, Napolitano R, Forgione M,
Scotti D, Solomita B, Franza F. “Migrants and Psychosomatic Symptoms: an Evaluation in an Emergency Centre” e-Poster
presented at the 25th European Congress of Psychiatry 1-4 April 2017, Florence, Italy

- Franza F et al. Neurocognitive management of the primary negative symptoms of schizophrenia: a role of atypical
antipsychotics. Psychiatr Danub 2016, 28, S:145-148

- Franza F et al. Burnout in families. The emotional burden of the "traumatized" families. J Family Med Dis Prevention
2016, 2,4:040

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ABSTRACT
Background: Providing assistance and support to people with complex disabling organic and mental disorders can increase the
work-stress burden. The current health emergency due to the coronavirus pandemic can aggravate and increase the exposure of
health workers (stressful workload, with increased anxiety, increased responses to stress and Compassion Fatigue (CF)). All this
can lead to negative effects on mental and physical well-being, incorrect behavior and looking for help that can overburden
healthcare facilities and on available resources (Garfin et al., 2020). In mental health workers the hope is one of the main coping
strategies and is a resource that influences people's ability to interact with stress in life-threatening situations (Jones-Schenk
2020). Objective: The aim of our study was to investigate the stress of mental health workers (particularly psychiatrists,
psychologists, social workers, psychiatric nurses, and healthcare support workers. To evaluate the role of the fatigue of
compassion of health workers with patients hospitalized in different medical and surgical hospital departments or in psychiatric
residential inpatients affected by subacute or chronic organic diseases. To assess the role of hope in the coronavirus pandemic
explosion period. Methods: In a natural observational study, we assessed the effects of the COVID pandemic on the
psychological health of Multidisciplinary (psychiatric, cardiologic, orthopedic, neurological and respiratory) Rehabilitation
Centre “Villa dei Pini”, Avellino, Italy. In 102 (54 F, 48 M) healthcare workers (doctors, psychologists, nurses, rehabilitators,
social and health workers), we researched the levels of stress, fatigue of compassion and hope with the following rating scales:
Fatigue Compassion Scale (FCs) Caregiver Burden Inventory (CBI) Professional Quality of Life (PROQoL)-Compassion
Satisfaction and Fatigue Subscales Beck Hopelessness Scale (BHS). Statistical significance was ascertained by t-tests or repeated
measures ANOVA (to test multiple groups) with EZAnalyze 3.1 Excel Platform. The second phase of the study involves
evaluating the results of these scales after one year Results : Compassion fatigue (FCs): Data showed an increase of overall
compassion fatigue scores in all workers however, there was a more increase CF in psychiatric health workers (22% and 33%,
respectively). With PROQoL data are superimposable (24% vs 37%, respectively). The most significant data of FC scale is
represented by the percentage of vicarious trauma in psychologist group (39.26%) this group has also a high percentage also in
job burnout (in 35.23%). These data are similar to those of our previous study. Burnout (CBI): With CBI we observed a greater
increase in the mean values in all the groups analyzed (p=.003). The highest mean total result is that of nurses (39.81%) at CBI
scale. Hopelessness (BHS): About half of the respondents scored above the average (47,5%) in mental health workers vs (34%)
multidisciplinary workers. Conclusions: During a health crisis, health workers are subjected to high levels of stress. In our small
observational group, the fatigue of compassion and burnout are higher to previous data in mental health workers. The
hopelenesses can be an important indicator for implementing psychological and pharmacological intervention strategies.
References Franza F, Del Buono G, Pellegrino F. Psychiatric caregiver stress: clinical implications of compassion fatigue.
Psychiatr Danub 2015 Sep 27 Suppl 1:S321-7. Garfin DR, Silver RC, Holman EA: The novel coronavirus (COVID-2019)
outbreak: Amplification of public health consequences by media exposure. Health Psychol 2020 Mar 23 Jones-Schenk J. Hope as
a Generative Force: Lifting Our Gaze to the Future. J Contin Educ Nurs. 2020 51(5):203-204.

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REFERENCES
Barello S, Graffigna G: Caring for Health Professionals in the COVID-19 Pandemic Emergency: Toward an "Epidemic of
Empathy" in Healthcare. Front Psychol 2020; 11:1431.

Franza F. The emotional and psychological burden of the "burnout" in families of psychiatric patients. Psychiatr Danub.
2019;31(Suppl 3):438-442.

Franza F, Del Buono G, Pellegrino F. Psychiatric caregiver stress: clinical implications of compassion fatigue. Psychiatr Danub
2015 Sep;27 Suppl 1:S321-7.

Garfin DR, Silver RC, Holman EA: The novel coronavirus (COVID-2019) outbreak: Amplification of public health
consequences by media exposure. Health Psychol 2020 Mar 23

Jones-Schenk J. Hope as a Generative Force: Lifting Our Gaze to the Future. J Contin Educ Nurs. 2020;51(5):203-204.

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