Background: The Coronavirus Disease (COVID-19) pandemic significantly disrupted regular health care services, mainly in the hospitals. Nurses soldiering on the battlefront of care of disaster response in the Philippines during the disease outbreak are at high risk of developing rapid-onset compassion fatigue. Notably, research is still needed to investigate the impact of compassion fatigue on various clinical areas and further develop a theory of compassion fatigue within the nursing context. Objectives: The study explored the concept of compassion as experienced by nurses directly caring for COVID-19 patients. The study further explored the experiences of nurses on compassion fatigue. Methods: This study employed qualitative methodology, specifically the constructivist grounded theory. Results: Thirty-four participants were included in the study. The narratives and voices of the nurses unfolded the following themes: (1) Acts of Compassion, (2) COVID-19 Pandemic: Nursing Challenges and Detours, (3) Nurses’ Compassion Fatigue, (4) Narratives of Opportunities: Thriving at the outset of COVID-19. All four concepts are linked to the multidimensional concept of compassion fatigue. A substantive theory, “Remon’s CF Theory in Nursing," is proposed based on the grounded experiences of nurses caring for COVID-19 patients related to compassion fatigue. Conclusion: Compassion Fatigue (CF) is a psycho-social phenomenon and occupational hazard affecting nurses directly caring for or in contact with COVID-19 patients. CF is a process that develops over time brought by prolonged enactment of compassion, the experience of empathic distress, and concurrence of organizational, contextual, and psychosocial factors. Nurses' CF can potentially affect safety and lead to poor nursing care, compromised work relations, and burnout. Nurse leaders' organizational and leadership commitment and support through up-to-date policies and continuous research on the topic are necessary to regain compassion among nurses. Likewise, reframing nurse compassion fatigue as an organizational and collective problem provides the larger perspective to further improve clinical practice and nurses’ welfare. Recommendations Nurse leaders, hospital and COVID-19 facility administrators must ensure specific policies and priorities that address issues causing and fueling nurse compassion fatigue, including frequency of exposure to traumatic events, lack of resources, and inadequate support system. The study further suggests conducting quantitative research to test the proposed theory and explore the relationship between organizational, psychosocial, and environmental context, compassion fatigue, and compassion-driven factors.
Compassion Fatigue ; Nurses ; Grounded Theory

INTRODUCTION: Increased healthcare demands due to the COVID-19 pandemic have overwhelmed nurses worldwide. Resilience of nurses has been impacted due to many factors (e.g., longer work shifts) causing psychological distress. The study aimed to determine the correlation of burnout, compassion fatigue, and moral injury with resilience among nurses assigned in COVID-19 wards. METHODS: Virtual survey tools were sent to nurses of a public hospital to obtain data. Data were analyzed using JAMOVI and SPSS. RESULTS: Levels of burnout showed moderate burnout in personal burnout (f=44) (65.7%); Moderate burnout in work-telated burnout (f=36) (53.7%); no/low level of burnout in client-related burnout (f=48) (71.6%). Level of compassion fatigue showed job burnout (f=59) (88.1%). Level of moral injury indicated “requiring clinical attention” (f=52) (77.6%). Level of resilience showed medium resilience (f=45) (67.2%). Correlation between burnout and resilience yielded negligible negative correlations between personal burnout and resilience (r=-0.160, p=0.031), work-related burnout and resilience (r=-0.222, p=0.008), and client-related burnout and resilience (r=-0.120, p=0.741). Correlation yielded weak negative correlations between compassion fatigue and resilience (r=-0.254, p=0.038) and between moral injury and resilience (r=-0.318, p=0.009). The linear regression showed no significant correlations between personal burnout and resilience (p=0.063), work-related burnout and resilience (p=0.070), client-related burnout and resilience (p=0.331), compassion fatigue and resilience (p=0.080), moral injury and resilience (p=0.227). CONCLUSION The findings showed significant correlations between personal burnout and resilience, work- related burnout and resilience, compassion fatigue and resilience, and moral injury and resilience. There were no significant correlations between client-related burnout and resilience. Multiple linear regression indicated burnout, compassion fatigue, and moral injury are not predictive factors for resilience.
Resilience ; burnout ; compassion fatigue ; moral injury

Background: Compassion fatigue is a true phenomenon experienced by overworked and exhausted nurses. Objective: This study assessed frontline nurses' compassion fatigue, stress, mental health, and turnover intention during the second year of the COVID-19 outbreak. Methods: Using a cross-sectional design, an online survey was administered in the first quarter of 2021 to 259 hospital nurses in the Central Philippines using standardized scales to gather the necessary data. Results: Nurses were found to have moderate levels of compassion fatigue and turnover intention, high stress, and good mental health. Results revealed that compassion fatigue was associated with poor mental health (r = −5.05, p = 0.01), higher stress levels (r = 0.54, p = <0.001), and turnover intention (r = 0.27, p = <0.001). Conclusion Pandemic-related compassion fatigue in nurses increases their stress, worsens their mental health, and heightens their intentions to leave their jobs. Organizations should address compassion fatigue through a supportive work climate.
Compassion Fatigue ; mental health ; nursing ; stress

Objective: To systematically evaluate the impact of psychological intervention on nursing staff' compassion fatigue. Methods: From March to May 2020, PubMed, Cochrane Library, EMbase, Web of Science, CNKI, VIP, Wanfang and other databases were electronically searched to collect randomized controlled trials (RCTs) on the influence of psychological intervention on nursing staff' compassion fatigue with the main search terms including compassion fatigue, nurs*, psychological intervention, mental intervention, RCT and so on from inception to March 31, 2020. Screened literature, extracted data and assessed the risk of bias of included studies. The Stata 16.0 software was used to calculate the pooled effectiveness of psychological intervention on nursing staff' compassion fatigue. Results: All 13 RCTs were enrolled, including 940 nursing staff. Meta-analysis results demonstrated that the psychological intervention group was superior to the control group in the improvement of the compassion fatigue score (SMD=-0.96, 95%CI: -1.17-0.74, P=0.001) , compassion satisfaction score (SMD=0.61, 95%CI: 0.45-0.77, P=0.002) , burnout score (SMD=-0.46, 95%CI: -0.62-0.29, P=0.006) , secondary trauma score (SMD=-0.40, 95%CI: -0.68-0.12, P=0.020) , and the difference was statistically significant. Subgroup analysis found that the psychological intervention group was more effective than the control group in improving compassion satisfaction score, reducing burnout score and secondary trauma score, and the differences were statistically significant (P<0.05) in different intervention time (<8 weeks and ≥8 weeks) and intervention methods. Conclusion: The psychological intervention can improve the level of compassion satisfaction, and reduce the compassion fatigue among nursing staff, and have a certain preventive effect on compassion fatigue.
Burnout, Professional/prevention & control* ; Compassion Fatigue/prevention & control* ; Empathy ; Humans ; Nursing Staff ; Psychosocial Intervention ; Quality of Life

Introduction: Physician burnout (BO) is an increasing global concern due to its rising prevalence and effect on patient care Objective: This study determined the prevalence of BO, compassion fatigue (CF), and compassion satisfaction (CS), among residents of obstetrics and gynecology in the Philippines, and identified the factors associated with these Methods: This was a cross‑sectional study, which used stratified random sampling. The strata comprised public and private hospitals that were subdivided into Luzon, Visayas, Mindanao, and National Capital Region. From these, 33 training hospitals were randomly selected, which served as clusters wherein all resident physicians of obstetrics and gynecology were invited to answer either an online or printed version of the Professional Quality of Life Scale Version 5 questionnaire Results: Majority of the 311 participants included had average level of BO (n = 281, 90.4%), CF (n = 237, 76.2%), and CS (n = 213, 68.5%). CS was negatively correlated with burnout (r = −0.31, P < 0.001) and CF (r = −0.34, P < 0.001), whereas BO and CS were positively correlated (r = +0.48, P < 0.001). Type of institution, sleeping hours, and interrupted leaves were the common factors that yield significant differences in BO (P = 0.037, P < 0.001, and P < 0.001) and CF (P = 0.002, P = 0.043, and P = 0.005). Significant differences were observed in CS scores in terms of age (P = 0.016), marital status (P = 0.038), child dependents (P = 0.006), level of training (P = 0.005), and location and type of institution (P ≤ 0.001 and P = 0.003). Conclusion There is a need to develop active awareness of BO and CF among resident physicians to effect interventions at the individual and institutional level.
Burnout, Psychological ; Compassion Fatigue

Introduction: COVID-19 pandemic places additional strain on healthcare detrimental to the well-being of primary health care workforce, increasing their risk for compassion fatigue (CF). Identifying individuals at risk and needing intervention is essential to lessen the prevalence and negative consequences of CF Objective: To determine the prevalence of compassion satisfaction (CS) and components of CF - burnout(BO) and secondary traumatic stress(STS) - and significant score differences in terms of identified factors among clinic staff of a chain of communitybased primary care clinics in Manila, Quezon City, Marikina, Caloocan, and Valenzuela during COVID-19 pandemic. Methods: Descriptive cross-sectional design with survey methodology was implemented. Online self- administered questionnaire with demographic survey, Perceived Stress Scale, and ProQoL 5, was pilot tested then administered to 68 clinic staff in 13 clinics in Manila, Quezon City, Marikina, Caloocan, and Valenzuela. One-tailed t-test was applied to determine score differences for each subscale (95% confidence interval). Results: 53 participants responded. Most had high levels of CS (79.47%), BO (73.6%), and STS (73.60%). Higher CS scores were found in those with safe working environment (mean=52.02, p = 0.048) and attendees of company-sponsored illness mitigation programs (mean=53.22, p = 0.043). Those who travel ≥1 hour have higher BO (mean=53.46, p=0.038). Those with adequate managerial support (mean 53.35, p = 0.045), patient interaction ≥15 minutes (mean 52.38, p = 0.028), and allied staff with ≥20 patients per day (mean 53.68, p = 0.013) have higher STS. No differences were found for the other investigated factors. Conclusion and Recommendations The study determined that the primary care workers in the studied population were not spared from the burden of high CF despite having high CS. This becomes a quality assurance concern, hence mitigation programs addressing these concerns as well as follow-up studies with pooled data and evaluation for associated risk factors are recommended.
Compassion Fatigue ; COVID-19

Background and Objective: The burden of caring for others comes naturally for healthcare providers particularly nurses as this is part of their altruistic nature. The right balance of caring for others and self-care is key to a healthy professional quality of life (ProQOL) which encompasses Compassion Satisfaction and prevents Burnout (BO) and Secondary Traumatic Stress (STS). With the challenge of the COVID-19 pandemic that has resulted in higher morbidity and mortality, the demands of the healthcare system on nurses are overwhelming. The objective of this study was to determine the prevalence, and the related factors of compassion satisfaction, burnout, and secondary traumatic stress among nurses in a government facility during a pandemic Method: This was a cross-sectional descriptive study which utilized a validated Professional Quality of Life (ProQOL) selfadministered questionnaire measuring Compassion Satisfaction, Burnout, and Secondary Traumatic Stress (Stamm, 2010). The survey was conducted from June 1-30, 2020 among a sample size of 204 qualified and willing nurses who signed an informed consent. All data were analyzed using descriptive statistics and parametric statistical tests (T-test and ANOVA). Statistical significance was at 99% CI and p-value of 0.05. Results: A total of 204 qualified and willing nurses were included in the study. Majority of the respondents belonged to the 2035 years of age bracket. Sixty-seven percent were female, married (54%); with no children (50%); finished BSN (91%); currently holding a Nurse II position (34%) with less than 5 years government service (56%) and with less than 5 years of field experience (58%). Seventy-seven percent (77%) did not have pre-existing diseases while 33% had either Hypertension, Diabetes Mellitus, Bronchial Asthma and other non-communicable diseases. Overall ProQOL mean scores ranged from average to high compassion satisfaction; low to average Burnout; and low to average Secondary Traumatic Stress. Related factors found significant at p vale 0.05 or less were areas of rotation and years in the field of practice Conclusion The study showed that the mean scores of the nurse respondents’ ProQOL encompassing Compassion Satisfaction, Burnout, and Secondary Traumatic Stress indicate a healthy ProQOL from June 1-30, 2020. Areas of rotation and years in the field of practice are statistically significant in relation to ProQOL mean scores. All other factors are not statistically significant correlates
Burnout, Psychological ; Compassion Fatigue ; Nurses ; COVID-19 ; Burnout, Professional

Background: Compassion fatigue is a true phenomenon experienced by overworked and exhausted nurses. Objective: This study assessed frontline nurses' compassion fatigue, stress, mental health, and turnover intention during the second year of the COVID-19 outbreak Methods: Using a cross-sectional design, an online survey was administered in the first quarter of 2021 to 259 hospital nurses in the Central Philippines using standardized scales to gather the necessary data. Results: Nurses were found to have moderate levels of compassion fatigue and turnover intention, high stress, and good mental health. Results revealed that compassion fatigue was associated with poor mental health (r = −5.05, p = 0.01), higher stress levels (r = 0.54, p = <0.001), and turnover intention (r = 0.27, p = <0.001). Conclusion Pandemic-related compassion fatigue in nurses increases their stress, worsens their mental health, and heightens their intentions to leave their jobs. Organizations should address compassion fatigue through a supportive work climate.
Compassion Fatigue ; Mental Health ; Nursing

Background: The Coronavirus Disease (COVID-19) pandemic significantly disrupted regular health care services, mainly in the hospitals. Nurses soldiering on the battlefront of care of disaster response in the Philippines during the disease outbreak are at high risk of developing rapid-onset compassion fatigue. Notably, research is still needed to investigate the impact of compassion fatigue on various clinical areas and further develop a theory of compassion fatigue within the nursing context. Objectives: The study explored the concept of compassion as experienced by nurses directly caring for COVID-19 patients. The study further explored the experiences of nurses on compassion fatigue. Methods: This study employed qualitative methodology, specifically the constructivist grounded theory. Results: Thirty-four participants were included in the study. The narratives and voices of the nurses unfolded the following themes: (1) Acts of Compassion, (2) COVID-19 Pandemic: Nursing Challenges and Detours, (3) Nurses’ Compassion Fatigue, (4) Narratives of Opportunities: Thriving at the outset of COVID-19. All four concepts are linked to the multidimensional concept of compassion fatigue. A substantive theory, “Remon’s CF Theory in Nursing," is proposed based on the grounded experiences of nurses caring for COVID-19 patients related to compassion fatigue. Conclusion: Compassion Fatigue (CF) is a psycho-social phenomenon and occupational hazard affecting nurses directly caring for or in contact with COVID-19 patients. CF is a process that develops over time brought by prolonged enactment of compassion, the experience of empathic distress, and concurrence of organizational, contextual, and psychosocial factors. Nurses' CF can potentially affect safety and lead to poor nursing care, compromised work relations, and burnout. Nurse leaders' organizational and leadership commitment and support through up-to-date policies and continuous research on the topic are necessary to regain compassion among nurses. Likewise, reframing nurse compassion fatigue as an organizational and collective problem provides the larger perspective to further improve clinical practice and nurses’ welfare. Recommendations Nurse leaders, hospital and COVID-19 facility administrators must ensure specific policies and priorities that address issues causing and fueling nurse compassion fatigue, including frequency of exposure to traumatic events, lack of resources, and inadequate support system. The study further suggests conducting quantitative research to test the proposed theory and explore the relationship between organizational, psychosocial, and environmental context, compassion fatigue, and compassion-driven factors.
Compassion Fatigue ; Nurses ; Grounded Theory

PURPOSE: This study is a descriptive survey to identify emotional labor and job stress recognized in the course of administrative work, and how these affect the professional quality of life of public health nurses according to the employment type.METHODS: Data was collected through a survey of public health nurses conducted from Dec. 2018 to Jan. 2019 (N=232).RESULTS: The emotional labor of public health nurses was 3.27 out of 5 and full-time public health nurses had the highest scores. The job stress score was moderate at 2.45 out of four. The job stress of full-time nurses was also the highest. Among the sub-divisions of professional quality of life, compassion satisfaction was 3.55 out of five, while secondary traumatic stress was moderate at 2.48 and exhaustion at 3.01. Factors affecting compassion satisfaction were shown to be employment types and exhaustion. Factors affecting secondary traumatic stress were exhaustion, job stress and emotional labor. Factors affecting exhaustion were secondary traumatic stress and compassion satisfaction.CONCLUSION: The results of this study shows that full-time public health nurses in charge of nursing organizations at public health centers have extreme difficulty with excessive role responsibilities, resulting in high emotional labor intensity and high job stress.
Compassion Fatigue ; Empathy ; Employment ; Nurses, Public Health ; Nursing ; Public Health ; Quality of Life