A Comparative Study to Assess Compassion Fatigue, Burnout and Compassion Satisfaction among Casualty Nurses with Intensive Care Unit Nurses at Selected Hospitals in Vadodara

Aim: This study is focussed on comparison and assessment of compassion fatigue, burnout and compassion satisfaction among casualty nurses with intensive care unit (ICU) nurses. Study Design: Quantitative research approach and Descriptive Comparative research design. Materials and Methods: Study targeted casualty nurses and ICU nurses working at selected hospitals in Vadodara. A total of 80 casualty nurses and ICU nurses were asked to participate in this study. Convenient sampling technique was used. First tool consists of demographic variables. Second tool consists of Compassion Fatigue/Satisfaction Self-Test (CFS), assess the existing level of compassion fatigue, burnout and compassion satisfaction. Original Research Article Sachin Sadanandan et al.; JPRI, 33(59A): 368-383, 2021; Article no.JPRI.79043 369 Results: Assessment of compassion fatigue among casualty nurses revealed that 18 [60%] nurses exhibited extremely high-risk level, Analysis of burnout among casualty nurses showed that 15 [50%] half of the nurses presented moderate risk level and among ICU nurses showed that 45 [90%] majority of the nurses presented high risk levels of burnout. Examining the final component of the CFS tool among casualty nurses, more than half of the respondents 16 [53.3%] were characterised as high potential level of compassion satisfaction and among ICU nurses, half of the respondents 25 [50%] were characterised as having a modest potential level of compassion satisfaction. Independent t-test shows that there was no significant difference in the level of compassion fatigue and compassion satisfaction between casualty nurses and ICU nurses. But there was a significant difference in the level of burnout between casualty nurses and ICU nurses, since the t value [18.256] was found to be greater than the table value [1.990] at .05 significant. Conclusion: Study reveals an association was found to exist between the level of compassion fatigue and demographic variables. But there was no association found in the level of burnout and compassion satisfaction among subjects with their selected demographic variables.


INTRODUCTION
Compassion fatigue and burnout are the two most frequent talks about aspects of professional quality of life [1]. Nurses know all about "quality of life." It is the main focus of our profession-we provide care to enhance the quality of our patients' lives. However, many nurses may not know that their own quality of life is at stake, depending upon how they go about their work each day. Indeed, a lot of nurses, although familiar with the terms compassion fatigue and burnout cannot identify how it manifests or whether they or their co-workers are experiencing it [2].
In the field of nursing, compassion fatigue is when a nurse has gradually become less compassionate about the medical challenges facing his or her patients. Compassion fatigue in healthcare settings is quite common with some studies showing that 7.3% to 40% of study subjects suffered from this condition. There's no doubt that healthcare professionals commit a significant amount of effort and time into giving patients the best quality of care, so trying to understand compassion fatigue in nursing needs a deep look at both sides of the fence [3].
Compassion fatigue is related to our connection to other peoples and our ability to bear witness to the suffering of others, burnout arises out of a more generalized dissatisfaction with one's own work life, and it is usually the result of a multitude of things. Of course, one's own relationship with others can be a big factor, but workload, environment, salary, benefits, organizational culture-many things can set the stage for burnout. Burnout develops gradually over time with prolonged emotional and physical exhaustion, and it finally results in widespread lethargy, a disinterest of work and relationships [4].
Some studies have developed strategies for preventing and managing compassion fatigue. For instance, the technique of "critical incident stress debriefing" has been used to prevent compassion fatigue in clinical practice settings who have experienced high levels of stress [5]. Nurses of many hospitals are frustrated with burnout by inadequate staffing, high patientnurse ratios, declining quality of care and verbal abuse directed towards them while working [6].
Most of the studies among burnouts in the nursing field have been done in the areas of oncology, casualty and mental health areas in adults. The reason for nurses leaving the professional workplace is a known and potentially preventable burnout [7]. The casualty block presents a unique set of stressors with potential for impact on nursing staff. These stressors include overcrowding, pressure to improve turnaround time, frequent delays in assignment of inpatient beds, and other factors distinctive to this environment. More importantly, casualty nurses have significant exposure to patients experiencing immediate traumatic events, which may be a contributing factor to compassion fatigue.
Compassion satisfaction is about the pleasure you derive from being able to do your work. For example, you may feel like it is a pleasure to help others through what you do at work. You may feel positively about your colleagues or your ability to contribute to the work setting or even the greater good of society through your work with people who need care. On the other side of compassion satisfaction can be Compassion Fatigue is the negative aspect of helping those who experience traumatic stress and suffering [8].
There are different factors that contribute to compassion fatigue, with emphasis on personality, education, job experience, personal quality of life, the specificity of the work and the changes of the health system [9]. Due to the considerable demand and frequent contact with traumatic situations, nursing work in casualty and urgent care makes nurses susceptible to feel the pain of their patients and leads to increasing compassion fatigue [10].
Therefore, this motivated the researcher to take up this project and aims to compare and assess compassion fatigue, burnout and compassion satisfaction among casualty nurses with intensive care unit nurses at selected hospitals in Vadodara.

Significance of the Study
Compassion fatigue means the physical, mental exhaustion and emotional withdrawal experienced by those that care for sick or traumatized people over an extended period of time [11]. Burnout means the exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration [12].
Consequences of Compassion fatigue included physical, social, emotional, spiritual, and intellectual effects. The nurse experiences insufficient performance, an increase in work errors, more prone to accident, Absenteeism, alcohol or substance abuse and holistic health decline [13,14]. Compassion fatigue can negatively impact patient safety and quality of care, leading to patient dissatisfactions, decreased reimbursement rates, and financial loss of institution [15,16].
The cornerstone of nursing practice can be acknowledged as compassionate care for patients. Compassion fatigue could stop the continuation of empathy and result in the erosion of nurses' mind, body, and spirit. Leaving the profession may be the only way to achieve catharsis in the view of nurses who cannot overcome the situation. This will impact the global shortage of nurses. While looking at the healthcare worker population, the nursing profession is the most prevalent and contrarily has the greatest shortage (World Health Organization [WHO] [17].
As of 2013, there were 20.7 million nurses worldwide, encompassing about half of the healthcare worker population and it is expected to reduce 7.6 million nurses in the year 2030 [17].
Preventative measures for this in nursing are mostly related to the self in the forms of self-care, self-awareness, and self-reflection [18]. It was also suggested that enhancing knowledge about Compassion Fatigue could be protective [19]. So, the researcher found that this study might help the nurses to have an insight about compassion fatigue, burnout, compassion satisfaction and also help the nurses to understand the level of their compassion fatigue, burnout and compassion satisfaction.

Aim
This study is focussed on comparison and assessment of compassion fatigue, burnout and compassion satisfaction among casualty nurses with intensive care unit nurses at selected hospitals in Vadodara.

Hypotheses
H0 1 : There will not be any significant difference in the level of compassion fatigue, burnout and compassion satisfaction among nurses working in casualty and intensive care units at 0.05 level of significance. H0 2 : There will not be any significant association in the level of compassion fatigue, burnout and compassion satisfaction among nurses working in casualty and intensive care units with their selected demographic variables at 0.05 level of significance.

Study Design
This present study used Quantitative research approach and Descriptive -Comparative research design.

Sample and Setting
This comparative study targeted casualty nurses and intensive care unit nurses working at selected hospitals in Vadodara based on the researchers' ability to gain access to the sample. A total of 80 casualty nurses (30) and intensive care unit nurses (50) were asked to participate in this study. Convenient sampling technique was used to select the samples.
Sample size has been calculated with the help of Raosoft sample size calculator software. It has been calculated with a 100-population size of nurses from selected hospitals in Vadodara, with a margin of error 5%, a confidence level of 95% and an ideal size of 80 samples calculated.

Inclusion Criteria
➔ Nurses who were working in the casualty and intensive care unit at selected hospitals in Vadodara. ➔ Nurses who can read English and Guajarati. ➔ Nurses who were willing to participate in the study.

Exclusion Criteria
➔ Nurses who were not willing to participate in the study ➔ Nurses who were too weak to participate in the study. ➔ Nurses who were already having any serious stress issues.

Instrumentation
Two kinds of tools were used for this study. First tool consists of demographic variables such as age in years, gender, professional qualification, marital status, monthly income, clinical experience in years, and job description.
Second tool consists of Compassion Fatigue/Satisfaction Self-Test (CFS), is a standardized questionnaire which was given by (1996). In this study this questionnaire was used to assess the existing level of compassion fatigue, burnout and compassion satisfaction among casualty nurses and intensive care unit nurses at selected hospitals in Vadodara. The 66-item Compassion Satisfaction/Fatigue Self-Test for Helpers which measures compassion fatigue, Burnout and compassion satisfaction. The items of scale are rated on a six-point Likert-type scale representing 0=Never, 1=Rarely, 2=A few times, 3=Somewhat often, 4=Often, and 5=Very often. The instrument yields a 3 subscale scores including compassion fatigue, Burnout and compassion satisfaction with each score being "psychometrically unique," The instrument has been tested extensively and found to be reliable and valid as a measure of the 3 separate concepts [20]. The alpha scale reliability score of compassion fatigue is .87, burnout is .90 and of compassion satisfaction is .87 [21].

Procedure
To obtain research permission for the study settings, preliminary discussions were held with the medical superintendent of selected hospitals in Vadodara and took permission for the same. A cover letter explaining the purpose of the study, a consent form, participant information sheet and a questionnaire (Compassion Fatigue/Satisfaction Self-Test) were then administered to the nurses in the casualty and intensive care units who met inclusion criteria.
Data collection has been done individually from the nurses working in casualty and intensive care units from July 2020 to January 2021. After filling the questionnaire, completed questionnaires were collected by the researcher from the subjects.

Analysis
Responses were coded and entered into SPSS. Scale scores were summed for compassion fatigue, burnout, and compassion satisfaction for each participant. Data were analysed using descriptive statistics (frequency, percentage distribution, mean and standard deviation) and inferential statistics (Chi-square test and independent t test).
Chi square test was used to find out the association between casualty nurses and intensive care unit nurses with their selected demographic variables. An independent t test was used to compare the compassion fatigue, burnout and compassion satisfaction among casualty nurses and intensive care unit nurses.

RESULTS AND DISCUSSION
The analysis and interpretation of data in this study were based on data collected through Compassion Fatigue/Satisfaction Self-Test (CFS), to assess the existing level of compassion fatigue, burnout and compassion satisfaction among casualty nurses and intensive care unit nurses at selected hospitals in Vadodara. The results were computed using descriptive and inferential statistics based on hypotheses and the objectives of the study.
A total of 80 nurses interviewed at selected hospitals in Vadodara. Among them 30 were employed in casualty and 50 were in intensive care units.      Nurses have a great potential for influencing healthcare outcomes. If nurses working in the casualty and intensive care unit experience compassion fatigue and burnout from their work, this may affect their ability to care for patients in the casualty and intensive care unit. Nurses can develop an insight of compassion fatigue, burnout and compassion satisfaction through self-awareness such as that offered in this project.

DISCUSSIONS
Nurses involved in this project were also able to identify potential changes in their behaviour in order to reduce compassion fatigue, burnout and also to improve compassion satisfaction in order to improve the care they provide for patients in the casualty and intensive care units.

CONCLUSION
Independent t-test shows that there was no significant difference in the level of compassion fatigue and compassion satisfaction between casualty nurses and ICU nurses. But there was a significant difference in the level of burnout between casualty nurses and ICU nurses.
Study reveals an association was found to exist between the level of compassion fatigue and demographic variables. But there was no association found in the level of burnout and compassion satisfaction among subjects with their selected demographic variables.
Nurses would have an insight to take care of patients in crisis. However, nurses sometimes can't control themselves until they are in crisis. Frequently the warning signs and symptoms go unidentified by either the nurses themselves or their colleagues. This research study has the potential to raise awareness and hopes that the results in this study give support for nurses working in the hospitals.

CONSENT AND ETHICAL APPROVAL
This research involved human subjects and therefore a formal ethical approval received from the institutional ethical committee. Each participant provided written consent and filled in questionnaires anonymously. Participant data were associated with numbers rather than participant names.

ACKNOWLEDGEMENT
I would like to express my very great appreciation to Dr. Lakhan Kataria for his valuable and constructive suggestions during the planning and development of this research work. His willingness to give his time so generously has been very much appreciated.
Finally, I wish to thank my parents, family members and all my friends for their support and encouragement throughout my study.