Impact of Exposure to Patient Death or Near Death on Compassion Fatigue in Pediatric Intensive Care Nurses

Kyle S. Richardson, BSc, RN; Meredith MacKenzie Greenle, PhD, RN, CRNP, CNE

Disclosures

Am J Crit Care. 2020;29(4):285-291. 

In This Article

Methods

This descriptive study examined compassion satisfaction, burnout, and secondary traumatic stress among nurses in relation to exposure to patient death and near-death experiences in pediatric intensive care settings. We broadly defined pediatric to include both the pediatric and neonatal intensive care settings.

Ethics

The Villanova University Institutional Review Board reviewed and approved this study, which conformed to the ethical standards of the Declaration of Helsinki. In order to protect participants' identity, responses to the survey used in the study were anonymous, and participants were under no obligation to begin or complete the survey. We would not know the participants' identities or employers, and this point was made explicit in the consent form.

Sample Selection and Recruitment

We recruited electronically nurses working in pediatric and neonatal intensive care settings. We received permission to email the survey link to nurses employed by a large metropolitan hospital in the northeastern United States. We also distributed the link via LinkedIn groups, including the American Nurses Association's group and alumni groups from several large nursing schools located in the northeastern United States. We asked nurses to respond to the survey if they were currently working in a pediatric or neonatal intensive care setting. Participants were offered an incentive in the form of a virtual $5.00 gift card.

Data Collection

Data were gathered through JotForm, an online survey program with secure sockets layer (SSL) encryption. The survey could be completed on a mobile device or computer. After completing the survey, respondents were linked to a separate survey form, where they entered an email address if they wanted to receive the incentive. The email addresses were never linked to the survey data and were destroyed after the incentive was sent.

Instrument

Participants completed a 2-part survey. The first part focused on participants' characteristics and experiences, and included questions on age, highest academic degree earned, years of experience in intensive care, mean number of hours worked per week in intensive care, whether they held a certification in intensive care nursing, spiritual beliefs, and the number of resuscitation events, codes, rapid response events, or patient deaths that occurred in their work setting during the past month.

The second part of the survey was version 5 of the Professional Quality of Life Scale (ProQOL), a 30-item instrument with subscales for compassion satisfaction, burnout, and secondary traumatic stress. Each item is measured on a 5-point Likert scale. Cut points have already been established for low, average, and high compassion satisfaction, burnout, and secondary traumatic stress.[2]

Analysis

We used Stata/MP software version 12 (StataCorp) to perform all statistical analysis. We computed descriptive statistics, including the count and percentage for binary/categorical variables and the mean and SD for continuous variables. We used variance inflation factors to assess for multicollinearity between variables.

Outcomes. We used the total scores from the 3 ProQOL subscales as dependent variables (outcomes), each of which was included in a separate regression equation.

Exposure. As the exposure variable of interest, we used a scale variable that measured the number of resuscitation events, codes, rapid response events, or patient deaths to which the nurse had been exposed during the past month.

Other Correlates. We examined other possible correlates: nurse's age, academic degree, years of experience in intensive care, mean number of hours worked per week, intensive care certification, and spiritual beliefs. In addition, we tested for an interaction between nurse's age and years of experience, as we hypothesized, on the basis of previous findings,[12] that differences would exist between first- and second-career nurses.

Statistical Analysis. We conducted hierarchical multiple regression analysis for each of the outcome variables. First, we evaluated bivariate linear regression equations between the outcome variables and the exposure variable to determine statistical significance (P < .05). Then we entered into the multivariate models the other correlates related to nurse characteristics, along with each outcome variable and the exposure variable. At this step, we also entered into each model an interaction term between age and experience.

We used the Professional Quality of Life Scale (ProQOL), a 30-item instrument with subscales for compassion satisfaction, burnout, and secondary traumatic stress.

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