RELATIONSHIP BETWEEN COMPASSION

FATIGUE AND COMPASSION SATISFACTION

AMONG CRITICAL CARE NURSES IN A
TERTIARY HOSPITAL

PREPARED BY : KELLY ROSALIA RICHARD

MATRIC NO. : 193337
SUPERVISOR : PN HNG SIEW HONG
Thesis Presentation Outline

Chapter 1: Introduction
Chapter 2 : Literature review
Chapter 3: Methodology
Chapter 4: Results and Discussion
Chapter 5: Conclusion
References
 Chapter 1

Introduction

3
 Background of Study
• Compassion Fatigue (CF) is the mentally and
emotionally exhaustion experienced from prolonged
caring of people who is suffering.
(Figley C,1999 ;Joinson,2007; Fukumori et al., 2020 ; Alharbi, Jackson & Usher ,2020)

• Evidently, more acknowledged on nurses as they

provided care towards people who are in ill state.

(Henson,2017)

4
Background of Study

Nurses from all fields

53% experiences Compassion
fatigue.
( Zhang Ying-Ying et.al., 2018 )

Stamm,2002 ; Sacco,curzynski, Harvey & ingersol,2015; Fukumori et al., 2020)

5
Background of Study

;
(Jakimowicz, Perry, & Lewis,2018 Wells-English, 2019;)

6
Problem statement
• Majority of study focus on solely the factor causing CF
and only a few evidence that study the relationship of
CF and CS.

7
 Problem statement
• There is no study was done in
Malaysia context among critical are
nurses and yet interestingly there is
an acknowledgement of “second
victim” with similar definition of CF
occurring among nurses.

(The Malaysian Journal of Nursing,2020)

8
Significant of Study

9
 Objectives
 General Objectives 

To identify the relationship between compassion

fatigue and compassion satisfaction among critical
care nurses in a tertiary hospital.

10
Objectives
Specific Objectives
I.To determine the level of Compassion fatigue among the critical area
nurses

II.To detemine the level compasion satisfaction among critical area nurses

III.To identify relationship between compassion fatigue and compassion

satisfaction .

IV.To identify the relationship between sociodemographic data and

compassion fatigue and compassion satisfaction

11
 Chapter 2

Literature
review

12
Literature review
• Professional healthcare provider especially nurses
that is working in a critical care area are likely to
experience high level of CF
(Henson, 2017 ; Alharbi, Jackson, & Usher ,2020)
• Critical care nurses are the most skilled nurses as they
are required to tend and care for unstable patient in
the most challenging environment and that research by
Hooper et. Al (2010) found that 85 % of Emergency
Department Nurses met the criteria of CF.

13
Literature review
• CF is a manifestation of Secondary Traumatic stress
(STS) and the accumulation of Burnout (BO).

• Finding from the study shows there is significant

reduction in Compassion satisfaction scores when
there is higher burnout and STS scores.

(Jakimowicz,Perry & Lewis, 2017)

14
Literature review
• Similarly finding in study by Beevi et. Al. (2019) shows high
percentage of CF has lower percentage score of CS

• Study by Jakimowicz,Perry & Lewis(2017) in Australia shows

that there is significant association of demographic factor
with CF however in study by Beevi et. al.(2019) in India
shows no significant association between CF and CS towards
the demographic factor.

(Jakimowicz,Perry & Lewis, 2017)

15
Literature review
• Study by Hooper C. et al (2010) on the CS and CF in
comparing ED nurses to nurses from other specialties
find that increase in level of nurses caring and being
compassionate towards their patient increases the
level of satisfaction thus lowering CF

• From review we can see that the differences in

specialties, demographic, environment, culture and
management affect the CS and CF differently.

16
 Chapter 3

Methodology

17
Methodology

18
Methodology
Sample Size
Strata (Area of study) Total number of nurses Number of nurses in
in strata sample
204 122
Emergency Department (ED)
 
Intensive Care unit (ICU)  
29 17
 
Coronary Care unit (CCU)  
24 15

19
Methodology
No Inclusion criteria Exclusion criteria

I Nurses from critical area - Male Nurses

 

II Critical nurses that is working - Nurses who are on Maternity leave

or study leave
in this tertiary hospital
 

III   - Nurses who refuse to participate in

the study

20
Methodology

21
Methodology
Objective Q: What Is the Level of Compssion fatigue among critical area nurses?

Research objective Variables Type of variables Statistical Analysis

• To determine the Secondary Dependent Descriptive Statistic (Mean
level of Traumatic stress and Standard deviation)
Compassion (STS)
fatigue among  
the critical area  
nurses  
   
  Burnout (BO) Dependent
 

22
Methodology
Objective Q: What is the level of Compassion satisfaction among critical area
Nurses?

Research objective Variables Type of variables Statistical Analysis

II. To determine the Compassion Independent Descriptive Statistic

level of compassion Satisfaction (CS) variables (Mean and Standard
satisfaction among Deviation)
critical area nurses

23
Methodology
Objective Q: Is there any relationship between Compassion Fatigue and
Compassion Satisfaction?

Objectives Dependent Independent variables Statistical Analysis

variables
• To identify Compassion Secondary stress Pearson Correlation
relationship Satisfaction satisfaction (STS) &
between (Continuous) (Continuous)
compassion    
fatigue and   Burnout
compassion   (Continuous)
satisfaction .

24
Methodology
Objective Q: Is there any relationship between Compassion Fatigue and Compassion
Satisfaction with the sociodemographic characteristic of critical area Nurses

Dependent
Objectives Independent variables Statistical Analysis
variables

• To identify the Compassion Age (continuous) Pearson Correlation

relationship satisfaction Race (categorical) One way Independent
between (Continuous) ANOVA
sociodemogra Grade( Categorical) Independent T-test
phic data and Level of Independent T-test
compassion education( Categorical)
fatigue and
Working Experience Pearson Correlation
compassion
( continuous)
association
Area of working One way Independent
 
(Categorical) ANOVA
25
Methodology
Objectives Dependent Independent variables Statistical Analysis
variables
Age (continuous) Pearson Correlation
Compassion
Race (categorical) One way Independent
Fatigue ANOVA
(Secondary Grade( Categorical) Independent T-test
stress Level of Independent T-test
education( Categorical)
satisfaction)
Working Experience Pearson Correlation
  ( continuous)
Burnout Area of specialization One way Independent
(Categorical) ANOVA

26
 Chapter 4

Result &
Discussion

27
Methodology
Socio-demographic Analysis

Age Demographic

28 to 29 Years old

Ethnicity
Demographic

28
Methodology
Socio-demographic Analysis
Grade Demographic

U29 140 (90.9 %)

14 (9.1 %)
U41

Diploma 139 (90.3 %)

Degree 14 (9.1%)
Master 1 (0.6%)

29
Methodology
Socio-demographic Analysis
Years of working Experience
Mean (95% CI)
Mean (95% CI)
4.7338

(4.3383 to 5.1292)

30
Chapter 4: Results
Objective Q 1: What Is the Level of Compssion fatigue
among critical area nurses?

Objective Q: What is the level of Compassion satisfaction

among critical area Nurses?

31
Results
Variables Mean (95% CI) Standard Deviation
(SD)
Compassion Satisfaction 30.05 7.96
(28.75 to 31.31)
Low (<22)    
Moderate(23 – 41)    
High (>42)    
Secondary traumatic Stress 29.58 7.27
(28.45 to 30. 74)
Low (<22)    
Moderate (23 – 41)    
High (>42)    
Burnout 26.55 5.36
(25.69 to 27.4)
Low (<22)    
Moderate (23 – 41)    
High (>42)    

32
Inferential Analysis

Objective Q: Is there any relationship between Compassion Fatigue and

Compassion Satisfaction?

To identify relationship between compassion fatigue and

compassion satisfaction .

33
Findings
Pearson Correlation Analysis
Secondary
Compassion traumatic
  Satisfaction Burnout stress
Compassion Pearson
1 0.348** 0.385**
Satisfaction Correlation
Sig. (2-tailed)
  0.000 0.000
N 154 154 154
Burnout Pearson
1 0.673**
Correlation
Sig. (2-tailed)
  0.000
N 154 154
Secondary traumatic Pearson
stress Correlation 1
Sig. (2-tailed)
 
N 154

34
Inferential Analysis

Objective Q: Is there any relationship between Compassion Fatigue and

Compassion Satisfaction with the sociodemographic characteristic of critical
area Nurses

To identify relationship between compassion fatigue and

compassion satisfaction .

35
Findings
Pearson Correlation Analysis

WORKING
AGE OF EXPERIENCE
  PARTICIPANT (YEARS)
BURNOUT Pearson Correlation -0.048 -0.004 Age
Sig. (2-tailed) 0.557 0.958
and
N 154 154
COMPASSION Pearson Correlation 0.097 0.158 years of working
SATISFACTION Sig. (2-tailed) 0.233 0.050 experience
N 154 154
SECONDARY TRAUMATIC Pearson Correlation -0.057 .009
STRESS Sig. (2-tailed) .479 .915
N 154 154

36
Findings
Independent T-test on Compassion Satisfaction,
Grade and Level of Education

M SD t-value p-value
Grade -2.223 0.028
Grade and level of
U29 29.6 8.09 education
U41 34.5 4.75

Level of Education
Diploma 29.27 7.75 -3.944 0.000
Degree 37.3 6.28
P= value is significant at p <0.05
Levene’s test F = 1.55, P= 0.215

37
Findings
Independent T-test on secondary traumatic
Stress, Grade and Level of Education

M SD t-value p-value

Grade -2.098 0.038

U29 29.2 7.3 Grade and level of
U41 33.42 5.81 education

Level of Education -2.134 0.34

Diploma 29.18 7.02
Degree 32.5 8.96

P= value is significant at p <0.05

Levene’s test F = 1.17, P= 0.28

38
Findings
One way ANOVA on Compassion satisfaction, Ethnicity and
area of specialization
CS df F P-value
Ethnicity 5.19 0.002
Between Groups 3
Within Groups 150

Area of specialization 20.5 0.000

Between Group 2
Within Group 151

P= value is significant at p <0.05

Levene’s test F = 0.7, P= 0.4

39
 Findings
Further Post Hoc
 
 

ETHNICITY OF Mean
ETHNICITY OF PARTICIPANT PARTICIPANT Difference (I-J) Std. Error Sig.
Bonferroni MELAYU CINA
-2.61157 2.41073 1.000

INDIA
-3.84389 2.64489 .889

OTHER
-8.29688* 2.23428 .002

*. The mean difference is significant at the 0.05 level.

There was a statistically significant (p=0.02) was

between Malay (M= 28.98, SD= 7.95) and Other
ethnicity (M= 37.23, SD= 7.69).

40
Findings
Further Post Hoc

Dependent Variable WORK UNIT WORK UNIT Mean difference Sig.

TOTAL_COMPASSION_S EMERGENCY INTENSIVE CARE UNIT
-9.87850* 0.000
ATISFACTION DEPARTMENT (ED) (ICU)
CORONARY CARE UNIT
-7.95301* 0.000
(CCU)
TOTAL_STS EMERGENCY INTENSIVE CARE UNIT
DEPARTMENT (ED) (ICU) 2.33607 0.616

CORONARY CARE UNIT

-5.19727* 0.025
(CCU)

*. The mean difference is significant at the 0.05 level.

There was a statistically significant (p<0.05) differences of

Emergency Department (M= 28.18, SD= 7. 48) and Intensive
Care unit (M= 38.06, SD=5.48) and Coronary Care Unit (M=
36.13, SD= 7.96)

41
Findings
Further Post Hoc

Dependent Variable WORK UNIT WORK UNIT Mean difference Sig.

TOTAL_COMPASSION_S EMERGENCY INTENSIVE CARE UNIT
-9.87850* 0.000
ATISFACTION DEPARTMENT (ED) (ICU)
CORONARY CARE UNIT
-7.95301* 0.000
(CCU)
TOTAL_STS EMERGENCY INTENSIVE CARE UNIT
DEPARTMENT (ED) (ICU) 2.33607 0.616

CORONARY CARE UNIT

-5.19727* 0.025
(CCU)

*. The mean difference is significant at the 0.05 level.

There was a statistically significant (p<0.05) differences of

Emergency Department (M= 28.18, SD= 7. 48) and Intensive
Care unit (M= 38.06, SD=5.48) and Coronary Care Unit (M=
36.13, SD= 7.96)

42
 Chapter 5

Conclusion

43
Chapter 5: Limitation

44
 Chapter 5: Conclusion
This study was designed to determine the relationship between Compassion fatigue
and compassion satisfaction among critical Area nurses in a tertiary hospital.

From finding, it can be conclude that there is a statically significant balance

relationship between Compassion Fatigue and Compassion Satisfaction

In achieving this balance, it is believe that nurses need to have the resilience.
Resilience is an important trait that a nurses must pose especially being in healthcare
where the system and organization are complex.

45
 Chapter 5: Conclusion
Recommendation:
1.higher management and nurses’ leader to take initiative and educate them and
teach techniques in building resilience and to prepare themselves.

2.Intervention and management programs that is important to train nurses to

strengthen their foundation in resilience and build a strong foundation of coping
mechanism

Implication:
This can have an impact in reducing nurse turnover increase quality care of patient
and also increase in job satisfaction.

46
 References
Alharbi, J., Jackson, D., & Usher, K. (2020). The potential for COVID‐19 to contribute to compassion
fatigue in critical care nurses. Journal of Clinical Nursing, 29(15–16), 2762–2764.
https://doi.org/10.1111/jocn.15314
Ames, M., Salmond, E., Holly, C., & Kamienski, M. (2017). Strategies that reduce compassion
fatigue and increase compassion satisfaction in nurses. JBI Database of Systematic Reviews and
Implementation Reports, 15(7), 1800–1804. https://doi.org/10.11124/jbisrir-2016-003142
rimon-Pagès, E., Torres-Puig-Gros, J., Fernández-Ortega, P., & Canela-Soler, J. (2019). Emotional
impact and compassion fatigue in oncology nurses: Results of a multicentre study. European
Journal of Oncology Nursing, 43, 101666. https://doi.org/10.1016/j.ejon.2019.09.007

Boyle DA. Countering compassion fatigue: a requisite nursing agenda. Online J Issues Nurs.
2011;16(1):2.

Cocker, F., & Joss, N. (2016). Compassion Fatigue among Healthcare, Emergency and Community
Service Workers: A Systematic Review. International Journal of Environmental Research and Public
Health, 13(6), 618. https://doi.org/10.3390/ijerph13060618

47
 References
Duarte J, Pinto-Gouveia J, Cruz B. Relationships between nurses' empathy, self-compassion and
dimensions of professional quality of life: A cross-sectional study. Int J Nurs Stud. 2016 Aug;60:1-11.
doi: 10.1016/j.ijnurstu.2016.02.015. Epub 2016 Mar 4. PMID: 27297364.

Fahey, D. M., & Glasofer, A. (2016). An inverse relationship. Nursing Critical Care, 11(5), 30–35.
https://doi.org/10.1097/01.ccn.0000490957.22107.50 

Figley, C. R. (1995). Compassion fatigue: Toward a new understanding of the costs of caring. In B. H.
Stamm (Ed.), Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators
(p. 3–28). The Sidran Press.

Fracis R. Report of the Mid Staffordshire NHS Foundation Trust Public In- quiry: executive summary.
Trust TMSNF. London, UK: The Stationery Office Limited; 2013.

Fukumori, T., Miyazaki, A., Takaba, C., Taniguchi, S., & Asai, M. (2020). Traumatic Events Among
Cancer Patients That Lead to Compassion Fatigue in Nurses: A Qualitative Study. Journal of Pain and
Symptom Management, 59(2), 254–260. https://doi.org/10.1016/j.jpainsymman.2019.09.026

48
 References
Henry BJ. Nursing burnout interventions: what is being done? Clin J Oncol Nurs. 2014;18(2):211-214

Henson, J. Sheree. "When compassion is lost." MedSurg Nursing, vol. 26, no. 2, 2017, p. 13.Accessed
29 Dec. 2020

Hooper, C., Craig, J., Janvrin, D. R., Wetsel, M. A., & Reimels, E. (2010). Compassion Satisfaction,
Burnout, and Compassion Fatigue Among Emergency Nurses Compared With Nurses in Other
Selected Inpatient Specialties. Journal of Emergency Nursing, 36(5), 420–427.
https://doi.org/10.1016/j.jen.2009.11.027

Jakimowicz, S., Perry, L., & Lewis, J. (2018). Compassion satisfaction and fatigue: A cross-sectional
survey of Australian intensive care nurses. Australian Critical Care, 31(6), 396–405.
https://doi.org/10.1016/j.aucc.2017.10.003

Jarrad R, Hammad S, Shawashi T, Mahmoud N. Compassion fatigue and substance use among
nurses. Ann Gen Psychiatry. 2018 Mar 13;17:13. doi: 10.1186/s12991-018-0183-5. PMID: 29563960;
PMCID: PMC5848583.

49
 References
Kelly, L. A., McHugh, M. D., & Aiken, L. H. (2011). Nurse outcomes in MagnetR and non-Magnet
hospitals. Journal of Nursing Administration, 41(10), 428–433.

Kelly, L., Runge, J., & Spencer, C. (2015). Predictors of Compassion Fatigue and Compassion
Satisfaction in Acute Care Nurses. Journal of Nursing Scholarship, 47(6), 522–528.
https://doi.org/10.1111/jnu.12162

Ledoux, K. (2015). Understanding compassion fatigue: understanding compassion. Journal of

Advanced Nursing, 71(9), 2041–2050. https://doi.org/10.1111/jan.12686

MacKusick CI, Minick P. Why are nurses leaving? Findings from an initial qualitative study on nursing
attrition. Medsurg Nurs. 2010 Nov-Dec;19(6):335-40. PMID: 21337990.

50
TERIMA KASIH / THANK YOU
www.upm.edu.my