| Abstract |
Introduction:
Constant exposure of health professionals to the pain and suffering of patients can negatively affect their emotional well-being. Nurses often find satisfaction in helping people who have experienced extremely stressful events, but the stress associated with these efforts can affect them negatively.
Τhe purpose
The main purpose of this research was to investigate the risk of secondary traumatic stress/compassion fatigue in health professionals working in units and departments with seriously ill patients in public hospitals in Crete, as well as its effect on the development of depression and anxiety disorders.
Methodology:
A descriptive cross-sectional survey with the use of the Professional Quality of Life Scale (ProQOL-CSF-R-IV) questionnaire.
The study included all public hospitals in Crete and more specifically the University General Hospital of Heraklion, the General Hospital of Heraklion Venizelio-Pananeio, the General Hospital of Chania "Agios Georgios", the General Hospital of Rethymno, and the General Hospital of Rethymno.
During the second phase of the study, questionnaires were collected only from the University General Hospital of Heraklion, since as a reference hospital in Crete it received the largest burden. The results of this phase were compared only to those collected in the first phase from University Hospital of Heraklion. The study was conducted between the period August 2017 to November 2021 for both phases.
A questionnaire recording demographic, individual, occupational and general characteristics was used for data collection. The Professional Quality of Life Scale (ProQOL-CSF-R-IV), which consists of three subscales: the Compassion Satisfaction (CS) Assessment subscale, the burnout (BO) assessment subscale, and the Compassion Secondary Post-Traumatic/Fatigue Assessment (STS/CF) subscale. The CES-D scale was used to assess depression. The State-Trait Anxiety Inventory (STAI) questionnaire for stress assessment consists of two sub-scales assessing transient stress as a result of the current situation and assessing persistent stress as a personality trait. Finally, the General Health Questionnaire 28 was used, which consists of four subscales of somatization, anxiety/insomnia, social dysfunction and severe depression.
The statistical processing and evaluation of the results were done with the statistical program SPSS 26.0.
Results:
During the first phase of the study, 598 health professionals completed the questionnaire (response rate 73.19%). Significantly increased levels of STS/CF were observed in non – ICU as compared to ICU staff (p=0.009), females compared to males (p<0.001), those who have previously experienced a traumatic event (p <0.004), nurses and support staff compared to doctors (p=0.007 and p=0.028 respectively), and people not working in a department by choice (p<0.001). CS was higher for older health professionals, personnel subjected to stress reduction techniques (p <0.019), and professionals working with children or a mixed population of adults and children (p=0.009). Rolling schedule and bad working conditions negatively affected the CS (p= 0.002, p =0.001). Increased BO levels were associated with younger age (p= 0.029) and showed a positive correlation with STS/CF (r =0.356, p<0.001).
According to the General Health questionnaire, 50.3% of the participants had a mental problem, while according to the results of the CES-D scale it was recorded that 55.5% had some degree of depression. 90.1% recorded a score of 40-59, ie they had moderate anxiety symptoms for transient anxiety and 69.2% had moderate anxiety symptoms for permanent anxiety.
The 2nd phase of the study involved 238 health professionals from the 1st phase and 190 recruited during the covid -19 pandemic. The results of General Health questionnaire, showed a significant increase between the two phases of the study (7.18 5.97 vs 6.61 6.2 before the pandemic, p=0.012). The levels of compassion satisfaction, burnout and secondary traumatic stress/compassion fatigue did not change significantly during the pandemic. Multivariate analysis revealed that younger professionals (r=0.130, p=0.045) and doctors (r=-0.122, p=0.012) and personnel working with adults reported increased burnout levels. Similarly to the findings of the first phase of the study, female gender was associated with increased levels of secondary traumatic stress/compassion fatigue (r=0.145, p=0.003). The results of Center for Epidemiologic Studies Depression Scale CES-D) deteriorated during the pandemic but the differences did not reach statistical significance. Significantly increased levels of depression were reported by married professionals (r =-0.097, p=0.046), people with children (r=-0.109, p=0.025), women (r=0.120, p=0.013), personnel with little experience (r=-0.097, p=0.045) and those who had experienced a traumatic event (r=-0.105, p=0.029) or the loss of a beloved one the last year (r=-0.133, p=0.006). The results of State-Trait Anxiety Inventory (STAI) did not show significant differences between the two phases. Multivariate analysis revealed significantly higher levels of anxiety for people working in Intensive Care Units (r=-0.166, p=0.001) and it also showed positive correlation with the number of patients treated (r=-0.106, p=0.034).
Conclusions:
Our results indicate moderate or high levels of compassion fatigue and burnout in health professionals, regardless of the health crisis caused by the COVID-19 pandemic, which represents a significant aggravating factor in ProQoL subscales. It is, therefore, necessary to implement interventions that help prevent these problems among professionals in the long run.
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