Compassion fatigue and COVID-19: A global view from nurses.

BACKGROUND: Due to the rapid spread of COVID-19 variants, the number of people hospitalized for COVID-19 may create psychological burdens on nurses. Nurses with high levels of compassion fatigue (CF) are more likely to make work errors, deliver poor-quality care, and have greater intent to leave their position. OBJECTIVES: This study utilized the social-ecological model to examine factors associated with nurses' CF and compassion satisfaction (CS) during the COVID-19 pandemic. METHODS: Data were collected from the United States, Japan, and South Korea from July to December 2020. The Professional Quality of Life Scale was used to measure burnout (BO), secondary traumatic stress (STS), and CS. RESULTS: Data from 662 responses were used in the analysis. Mean scores were 25.04 (±6.44) for BO, 24.81 (±6.43) for STS, and 37.85 (±7.67) for CS. Multiple regression analyses indicated that resilience and intention to leave nursing were related to each study outcome (i.e., BO, STS, and CS). Greater resilience predicted lower BO and STS but greater CS, whereas intention to leave nursing indicated greater BO and STS, but lower CS. Furthermore, intrapersonal factors and organizational factors (i.e., nurses involved in developing policies to prepare for COVID-19 patients, organizational support, and personal protective equipment [PPE] provisions) were related to BO, STS, and CS. LINKING EVIDENCE TO PRACTICE: To promote nurses' psychological well-being, improvement of organizational factors such as support, PPE, and programs to enhance resilience is recommended to prepare for future emerging infectious disease crises.

Debriefing Among Hospice Professionals During a Pandemic.

Although the hospice industry cannot afford to lose professionals to compassion fatigue and burnout, work challenges related to the COVID-19 pandemic potentially place hospice professionals at an increased risk. Reflective debriefing has been recommended to provide emotional support to battle job dissatisfaction, compassion fatigue, and burnout. The purpose of this study was to provide reflective debriefing sessions to hospice professionals and identify common themes reported about their professional and personal experiences during the COVID-19 pandemic. A qualitative descriptive design using focus groups set up as reflective debriefing sessions based on the Gibbs' Reflective Cycle was used. Debriefing sessions were recorded and transcribed for coding, followed by identification of themes. A total of 26 themes emerged from the data collected from the debriefing sessions. A postsurvey found that 96.0% of participants found the debriefing session helpful. Furthermore, 92.3% of participants answered they would like to regularly debrief at their workplace. During the pandemic, hospice professionals are at an increased risk of compassion fatigue and burnout from changes in the work, patient, and person environments caused by the pandemic. To address the unprecedented challenges hospice professionals are facing, it is imperative that employers provide them with emotional support.

The Well-Being of Peer Supporters in a Pandemic: A Mixed-Methods Study.

BACKGROUND: Peer support is an effective, well-received approach to caring for health care professionals who face stress, challenges, and reduced well-being. Peer supporters may be at risk for emotional exhaustion and secondary traumatic stress due to their primary roles and involvement as peer supporters during the COVID-19 pandemic. METHODS: Peer supporters from five well-established peer support programs completed surveys (ProQOL and a five-item emotional exhaustion measure) to assess secondary traumatic stress, compassion satisfaction, and burnout during the pandemic. Analysis of variance models analyzed differences in these well-being outcomes by role, age, years in health care, and working in high-risk areas. Qualitative content analysis was performed for open-response questions about challenges, needs, and successful well-being strategies using Braun and Clarke's six-phase thematic analysis. RESULTS: A total of 375 peer supporters completed the survey between spring and summer 2021 for a response rate of about 38%. Most participants had low secondary traumatic stress and moderate to high compassion satisfaction; nearly 44% had concerning levels of emotional exhaustion. Compassion satisfaction was significantly lower (p = 0.003) and emotional exhaustion significantly higher (p < 0.001) among the youngest cohort, and both compassion satisfaction and emotional exhaustion differed across career stages (p = 0.003 and p = 0.04, respectively). Emotional exhaustion was significantly higher in peer supporters working in COVID units than in non-COVID units (p = 0.021). Peer supporters identified numerous protective and risk factors associated with serving as a peer supporter. CONCLUSION: Despite having moderate to high levels of compassion satisfaction, peer supporters report high levels of burnout and numerous challenges and needs to sustain their well-being. To maintain effective peer support programs during the ongoing pandemic, health care organizations must study and support the well-being of health care professional peer supporters.

Compassion fatigue among frontline healthcare workers during the covid-19 pandemic in Tunisia.

BACKGROUND: Healthcare workers (HCWs) are highly vulnerable to compassion fatigue (CF), which not only leads to decreased mental and physical health, but also to deterioration in the safety of care delivered. Our study aims to measure compassion satisfaction (CS), CF levels and their predictors among Tunisian HCWs. METHODS: We conducted a cross-sectional study among HCWs caring for confirmed and suspected Covid-19 patients, staff at two university hospitals in Sousse, Tunisia during the 4thwave of coronavirus through a self-administrated Questionnaire, using the French version of the Professional Quality of Life scale ProQol, version 5. RESULTS: A total of 274 professionals were recruited with a mean age of 32.87±8.35 years. HCWs tend to have an overall moderate levels of compassion satisfaction, secondary traumatic stress and burnout with mean scores 35.09±7.08, 29.72±7.62, 28.54±5.44 respectively. Self-reported resilience (ß = 0.14, p = 10-3), work engagement (ß = 0.39, p = 10-3) and burnout (ß = -0.32, p = 10-3) were the predictors of compassion satisfaction in the linear regression analysis (adjusted r2 = 0.45). Similarly, limited work experience, compassion satisfaction and secondary traumatic sub-scores were the determinants of burnout (ß = -0.1, p = 0.04; ß = -0.54, p = 10-3; ß = 0.35, p = 10-3 respectively); (adjusted r2 = 0.48). Regarding STS, female professionals (ß = 0.20, p = 10-3), being married (ß = 0.19, p = 10-3), the fear of transmitting the infection (ß = 0.11, p = 0.03) and burnout (ß = 0.39, p = 10-3) were the predictors for the occurrence of secondary traumatic stress (adjusted r2 = 0.48). CONCLUSION: More resilience promoting interventions and more coping skills programs must be implemented to fulfill HCWs' psychological well-being needs.

Compassion satisfaction and compassion fatigue in frontline nurses during the COVID-19 pandemic in Wuhan, China.

AIM: The aim of this study is to investigate the compassion satisfaction and compassion fatigue among Chinese frontline nurses during the COVID-19 pandemic in Wuhan, China and to explore the related factors. BACKGROUND: Frontline nurses undertake a huge nursing workload with a risk of infection, causing great pressure on them and making them face a risk of compassion fatigue during the pandemic. METHODS: A cross-sectional online survey was conducted from 9 March to 15 March 2020. A total of 1582 nurses caring for critical patients with COVID-19 participated. Compassion satisfaction and compassion fatigue (comprising burnout and secondary traumatic stress) were assessed with the Professional Quality of Life Scale, and resilience was measured with the Chinese 10-item Connor-Davidson Resilience Scale. RESULTS: Moderate levels of compassion satisfaction (36.99 ± 6.71), burnout (24.14 ± 5.33) and secondary traumatic stress (24.53 ± 5.24) were experienced by frontline nurses. Resilience and perceived work pressure were the main predictors. CONCLUSIONS: Frontline nurses demonstrated a moderate level of compassion satisfaction and compassion fatigue. IMPLICATIONS FOR NURSING MANAGEMENT: The compassion fatigue of frontline nurses should be considered. Strategies aiming to reduce stress and enhance resilience, such as training about psychological adjustment, developing professional skills and creating a supportive workplace environment, are several options. The trial is not registered. This study is a cross-sectional study, and according to China's clinical trial registration standards, such studies are not required to be registered. So the trial is not registered. However, oral consent was obtained from the ethics committee of the hospital before this study was conducted.

Secondary traumatic stress and dissociative coping strategies in nurses during the COVID-19 pandemic: The protective role of resilience.

During the COVID-19 pandemic, nurses are repeatedly exposed to acute stress at their workplace, and therefore, they are at high risk for developing mental health symptoms. The prolonged exposure of healthcare professionals may lead to Secondary Traumatic Stress (STS). STS is an aspect of "cost of care", the natural consequence of providing care to people who suffer physically or psychologically. The purpose of this study was to investigate the levels of STS in nurses during the first phase of the COVID-19 pandemic in Greece and to detect aggravating and protective factors. Participants were 222 nurses (87.4 % women; mean age 42.3 years) who completed an online survey. The questionnaire comprised of the Secondary Traumatic Stress Scale, the Brief Resilience Scale, and the Brief Coping Orientation to Problems Experienced Inventory. Nurses had high levels of STS. The hierarchical regression analyses showed that STS and its dimensions Avoidance and Arousal were positively predicted mainly by denial and self-distraction coping strategies and inversely by resilience. Resilience exhibited a protective (partial mediation) effect on the strong relationship between the dissociative coping strategies (denial, self-distraction, venting and behavioral disengagement) and STS. Trauma-informed care psychosocial interventions are needed to support the already overburdened nursing staff during the coronavirus pandemic.

Associations between compassion fatigue, burnout and secondary traumatic stress with lifestyle factors in mental health nurses: A multicenter study from Uganda.

PURPOSE: This cross-sectional study aimed (a) to explore levels of compassion satisfaction, secondary traumatic stress, and symptoms of burnout among Ugandan mental health nurses working in regional referral hospitals in Uganda during the Covid-19 pandemic, and (b) to investigate associations between compassion satisfaction, secondary traumatic stress, and symptoms of burnout and sedentary levels, physical activity (PA) levels, sleep quality, and harmful drinking. MATERIAL AND METHODS: In total 108 mental health nurses from 8 regional referral hospitals across Uganda (age = 34.8 ± 10.0 years; 55.6 % female) completed the Professional Quality of Life Scale-5, (PQoLS-5), the Simple Physical Activity Questionnaire (SIMPAQ), Physical Activity Vital Sign (PAVS), Pittsburgh Sleep Quality Index (PSQI), and Alcohol Use Disorder Identification Test - Concise (AUDIT-C). Spearman Rho correlations and Mann-Whitney U tests were applied. RESULTS: ProQOL-5 compassion satisfaction correlated significantly with SIMPAQ walking, PSQI and AUDIT-C, ProQOL-5 burnout with SIMPAQ exercise and PSQI and ProQOL-5 traumatic with SIMPAQ walking and PSQI. Mental health nurses meeting PA guidelines reported higher ProQOL-5 compassion satisfaction and lower ProQOL-5 burnout and traumatic stress than those who did not. Those who reported a poor sleep quality reported significantly less ProQOL-5 compassion satisfaction and higher ProQOL-5 burnout than those who did not. Those who reported harmful drinking patterns reported a significantly lower compassion satisfaction versus those who did not. DISCUSSION: In mental health nurses, a lower professional quality of life is associated with an unhealthy lifestyle. The effectiveness and efficacy of resilience and self-care programs for mental health nurses focusing on unhealthy lifestyle patterns should be explored.

Fear of COVID-19 Impact on Professional Quality of Life among Mental Health Workers.

Several studies have examined the impact of the COVID-19 pandemic on healthcare workers' mental health, but only a few have investigated its detrimental effect on the mental well-being of mental health workers (MHWs). BACKGROUND: The current study aimed to explore the effect of the fear of COVID-19 (FCV-19) on professional quality of life dimensions, namely compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS) in MHWs above and beyond sociodemographic and professional factors. METHODS: Hierarchical linear regression models were employed to examine the relationship of extreme FCV-19 with CS, BO, and STS in MHWs (n = 224), after considering sociodemographic variables as potential confounding factors. Extreme FCV-19 was operationalized as a binary variable with a cut-off score of ≥16.5 considered as extreme fear. RESULTS: We found that extreme FCV-19 in MHWs is linked with increased compassion fatigue (BO and STS), and this relationship is exacerbated by younger age in regard to BO and by female gender concerning STS. CS remains unaffected by severe FCV-19, and it is higher in older participants. CONCLUSION: Organizational support is required to protect MHWs' mental well-being and ensure the quality of care they provide during prolonged crises, such as the COVID-19 pandemic. Measures that intensify a sense of safety, protection, and control against COVID-19 infections in mental health services should be included in the recommendations that may reduce BO and STS among MHWs.

Buffering the Effects of Burnout on Healthcare Professionals' Health-The Mediating Role of Compassionate Relationships at Work in the COVID Era.

Managing the COVID-19 pandemic posed several challenges for healthcare professionals, which likely heightened their risk of burnout (Amanullah and Ramesh Shankar, 2020) and, consequently, their general physical and mental health. Although it may not be possible to address and eliminate the causes of burnout, current research informs healthcare organizations about protective strategies to reduce its detrimental consequences. The promotion of compassionate interactions among healthcare professionals may play such a role. Compassion within healthcare organizations positively affects individual performance and well-being. Building on these considerations and within the framework of the Conservation of Resources theory, this study explores the relationships among burnout dimensions, received compassion at work, and general health in 711 Italian healthcare professionals (68.5% female), aged between 21 and 73 years (Mage = 36.4, SD = 11.2). Analyses were conducted to investigate the association between burnout and general well-being (H1) and between burnout symptoms and perceived compassion at work (H2); and the mediational role of compassion in the relationship between burnout symptoms and general well-being. H1 and H2 were confirmed (r < 0.01 for both), and a SEM model showed the mediating role of compassion at work in the association between burnout symptoms and general well-being (RMSEA < 0.08, SRMR < 0.08, CFI and TLI > 0.90). Theoretical and practical implications of the findings are discussed in the paper.

Perspectives on an exhausted medical radiation practitioner workforce: emotional labour and the impact of compassion fatigue.

As the COVID-19 pandemic in Australia reaches its peak, medical radiation practitioners (MRPs) are at capacity both physically and emotionally. High workloads and stress impact the mental wellbeing of MRPs, with suppression of feelings and emotions resulting in experiences of compassion fatigue. From a MRP workforce perspective, the long-term cost of the pandemic has yet to be realised. MRPs need to be supported to prevent unintended health consequences. Robust management interventions will be required to support the MRP workforce to manage and hopefully mitigate compassion fatigue transitioning out of the pandemic.

The impact of the alterations in caring for COVID-19 patients on Compassion Satisfaction and Compassion Fatigue in Italian nurses: a multi method study.

BACKGROUND AND AIM OF THE WORK: During COVID-19 first wave,  healthcare professionals were exposed to a major psychological pressure related to uncertainty, a lack of therapies or a vaccine and shortages of healthcare resources. They developed higher levels of Burnout and  Compassion Fatigue, and similar levels of Compassion Satisfaction. Aim is evaluating in Italian nurses Compassion Satisfaction and Compassion Fatigue and impacting individual and relational variables. METHODS: A multi-methods approach was used. Qualitative data were collected through 2 focus group. Quantitative data were collected through a web survey composed by an ad hoc questionnaire developed from the focus group results, the Professional Quality of Life Scale-5 and the Resilience Scale (RS-14). RESULTS: In the qualitative phase 6 categories emerged. From the quantitative analysis the sample reported a moderate level of Compassion Satisfaction, a low level of Burnout  and a moderate level of Secondary Traumatic Stress. Compassion Satisfaction had as predictors resilience (ß = .501), followed by feeling part of the team (ß = .406) and collaboration with colleagues (ß = .386). Secondary Traumatic Stress had as predictors the impact of PPE (ß = .269), and feeling Covid-related individual sufferance (ß = .212). The only predictor of Burnout was resilience (ß = -2195). Conclusions: During COVID-19 first wave Italian nurses were exposed to a higher risk of Secondary Traumatic Stress, mainly impacted by frustration, loss of control, loss of possibility to properly care for patients, and personal threat. Relational and team support had a crucial role in sustaining Compassion Satisfaction.

Alleviating psychological symptoms in nurses during disease outbreaks: An integrative review.

AIM: To explore interventions and coping strategies used to treat the psychological symptoms associated with compassion fatigue among nurses. BACKGROUND: The rapid transmission of infectious diseases (e.g., COVID-19) has put nurses, around the world, at high risk of developing profound psychological health issues due to compassion fatigue. If unrelieved, compassion fatigue can lead to catastrophic psychological symptoms such as depression, stress, anxiety, and insomnia, negatively impacting patient care. This necessitates interventions to prevent or mitigate the psychological symptoms of compassion fatigue. METHOD: Following Whittemore and Knafl's integrative review method, the literature search comprised three databases: CINAHL, MEDLINE-OVID, and Scopus. RESULTS: The 11 included studies were categorized into four themes: (1) using relaxation strategies, (2) neutralizing emotional trauma, (3) enhancing nurses' preparedness for confronting disasters, and (4) educating nurses about coping strategies to manage their psychological issues. CONCLUSION: Researchers studied several coping strategies and interventions. There is a need for policymakers' support and hospital-level interventions. Early interventions may prevent or relieve psychological issues. IMPLICATIONS: The findings have implications for hospital leaders around the world to initiate interventions that teach nurses strategies to cope with stressful events. Future researchers might consider long-term supports and multiple interventions that target several leading causes of psychological symptoms among nurses before, during, and after high-stress situations. Policymakers around the world could use the findings to initiate policies to facilitate nurses' access to needed resources, hence protecting their mental health and increasing the quality of patient care.

COVID-19 vicarious traumatization links functional connectome to general distress.

As characterized by repeated exposure of others' trauma, vicarious traumatization is a common negative psychological reaction during the COVID-19 pandemic and plays a crucial role in the development of general mental distress. This study aims to identify functional connectome that encodes individual variations of pandemic-related vicarious traumatization and reveal the underlying brain-vicarious traumatization mechanism in predicting general distress. The eligible subjects were 105 general university students (60 females, aged from 19 to 27 years) undergoing brain MRI scanning and baseline behavioral tests (October 2019 to January 2020), whom were re-contacted for COVID-related vicarious traumatization measurement (February to April 2020) and follow-up general distress evaluation (March to April 2021). We applied a connectome-based predictive modeling (CPM) approach to identify the functional connectome supporting vicarious traumatization based on a 268-region-parcellation assigned to network memberships. The CPM analyses showed that only the negative network model stably predicted individuals' vicarious traumatization scores (q2 = -0.18, MSE = 617, r [predicted, actual] = 0.18, p = 0.024), with the contributing functional connectivity primarily distributed in the fronto-parietal, default mode, medial frontal, salience, and motor network. Furthermore, mediation analysis revealed that vicarious traumatization mediated the influence of brain functional connectome on general distress. Importantly, our results were independent of baseline family socioeconomic status, other stressful life events and general mental health as well as age, sex and head motion. Our study is the first to provide evidence for the functional neural markers of vicarious traumatization and reveal an underlying neuropsychological pathway to predict distress symptoms in which brain functional connectome affects general distress via vicarious traumatization.

A structural equation model analysis of the association between work-related stress, burnout and job-related affective well-being among nurses in Saudi Arabia during the COVID-19 pandemic.

AIM: To test a model that examines the direct and indirect effects of work-related stress on job-related affective well-being through compassion fatigue. BACKGROUND: Despite the danger of infection, nurses' dedication to their work appears to be an innate desire to provide care for patients with COVID-19. Nonetheless, the universal effort to control the outbreak has led to extended work hours and workload, which has been defined as the primary contributor to work-related stress among nurses and might impact their job-related affective well-being. METHOD: We used a cross-sectional exploratory design. Data were collected using an online survey from 161 nurses working in the Saudi health care system. The survey included obtaining information on demographics and work-related stress using Professional Quality of Life Scale version 5 to measure compassion fatigue as well as a job-related affective well-being scale. RESULTS: Work-related stress had significant negative direct effects on job-related affective well-being and positive effects on compassion fatigue. Compassion fatigue had significantly negative direct effects on job-related affective well-being. Work-related stress exerted negative indirect effects on job-related affective well-being through compassion fatigue, which partially mediated the relationship. CONCLUSION: The findings supported the model and added to our understanding regarding the impact of work-related stress on nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Stress reduction is an important element in improving staff outcomes as well as job-related affective well-being.

Professional quality of life, stress, and trauma in nursing students: Before and during the novel coronavirus pandemic.

OBJECTIVE: The aim of the study was to assess the levels of stress, burnout, primary and secondary trauma, and self-efficacy before and during the novel coronavirus pandemic in a sample of baccalaureate nursing and psychiatric nursing students, a population which has seldom been studied regarding these factors. METHOD: The study used a nonexperimental, cross-sectional methodology at 2 time-points. Nursing and psychiatric nursing students enrolled at 1 western Canadian university were invited to participate in an online, anonymous survey in 2020 prior to the pandemic and in 2021 during Canada's third-wave. Survey measures included the Professional Quality of Life Scale (includes Compassion Satisfaction, Burnout, and Secondary Traumatic Stress), the Perceived Stress Scale, the Life Events Checklist to assess the amount of prior traumatic experiences, and the Core Self-Evaluations Scale. RESULTS: Statistically higher significant differences in prior traumatic experiences measured by the Life Events Checklist were found in the midpandemic cohort in comparison to the prepandemic 2020 student cohort (t(159) = -2.32, p < .05, 95% CI [-2.23, -.18]). Strong correlated relationships were found in many of the study variables (ranging from r = .301 to -.745, p ≤ .001). CONCLUSION: This preliminary study is the first to reveal that students in the nursing field experienced more traumatic events during the pandemic than before. The findings imply that access to greater support for experiences of trauma may be needed to support undergraduate students entering the health care arena amid the novel coronavirus pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Individual factors in the relationship between stress and resilience in mental health psychology practitioners during the COVID-19 pandemic.

Utilising an online survey, this study aimed to investigate the concurrent effects of pre-pandemic and COVID-19 stress on resilience in Mental Health Psychology Practitioners (MHPPs) (n = 325), focussing on the mediation effects of specific individual factors. Optimism, burnout and secondary traumatic stress, but not coping strategies, self-efficacy, compassion satisfaction, or self-compassion, mediated both the relationship between pre-pandemic stress and resilience and COVID-19 stress and resilience. Increased job demands caused by the pandemic, the nature and duration of COVID-19 stress may explain this finding. Training and supervision practices can help MHPPs deal with job demands under circumstances of general and extreme stress.

Prevalence and severity of secondary traumatic stress and optimism in Indian health care professionals during COVID-19 lockdown.

BACKGROUND: The COVID-19 pandemic has brought to light the lacunae in the preparedness of healthcare systems across the globe. This preparedness also includes the safety of healthcare providers (HCPs) at various levels. Sudden spread of COVID-19 infection has created threatening and vulnerable conditions for the HCPs. The current pandemic situation has not only affected physical health of HCPs but also their mental health. OBJECTIVE: This study aims to understand the prevalence and severity of secondary traumatic stress, optimism parameters, along with states of mood experienced by the HCPs, viz., doctors, nurses and allied healthcare professionals (including Physiotherapist, Lab technicians, Phlebotomist, dieticians, administrative staff and clinical pharmacist), during the COVID-19 lockdown in India. METHODOLOGY: The assessment of level of secondary traumatic stress (STS), optimism/pessimism (via Life Orientation Test-Revised) and current mood states experienced by Indian HCPs in the present COVID-19 pandemic situation was done using a primary data of 2,008 HCPs from India during the first lockdown during April-May 2020. Data was collected through snow-ball sampling technique, reaching out to various medical health care professionals through social media platforms. RESULT: Amongst the study sample 88.2% of doctors, 79.2 of nurses and 58.6% of allied HCPs were found to have STS in varying severity. There was a female preponderance in the category of Severe STS. Higher optimism on the LOTR scale was observed among doctors at 39.3% followed by nurses at 26.7% and allied health care professionals 22.8%. The mood visual analogue scale which measures the "mood" during the survey indicated moderate mood states without any gender bias in the study sample. CONCLUSION: The current investigation sheds light on the magnitude of the STSS experienced by the HCPs in the Indian Subcontinent during the pandemic. This hitherto undiagnosed and unaddressed issue, calls for a dire need of creating better and accessible mental health programmes and facilities for the health care providers in India.

Volunteers' compassion fatigue, compassion satisfaction, and post-traumatic growth during the SARS-CoV-2 lockdown in Spain: Self-compassion and self-determination as predictors.

Volunteers have played an important role by supporting essential services that have been overwhelmed during the most critical moments of the SARS-CoV-2 pandemic. Hence, nonprofit organizations may be interested in preventing negative consequences of these volunteers' exposure to potentially traumatic events. The aim of this cross-sectional study was twofold. First, to examine to what extent self-compassion and self-determination would contribute to differentiating between volunteers with different levels of compassion fatigue, compassion satisfaction, and post-traumatic growth. Second, to identify the best predictors of the most extreme levels of each outcome. Participants were 211 Spanish Red Cross volunteers (60.7% women), who completed a survey. They were separately classified into three groups (low, medium, and high) according to the 33rd and 66th percentile scores on each outcome (compassion fatigue, compassion satisfaction, and post-traumatic growth). Univariate analyses of variance and post-hoc comparisons revealed that self-compassion and self-determination contributed differently to distinguishing between levels of each outcome. Volunteers lowest in compassion fatigue stood out for showing fewer non-compassionate strategies and more mindfulness than the other groups. Moreover, those higher in satisfaction compassion also showed lower use of unhealthy strategies and higher scores in all other predictive variables. Volunteers highest in post-traumatic growth showed higher self-kindness and satisfaction of all psychological needs. Binary logistic regressions allowed for the identification of predictors of belonging to the most extreme groups. The protective factors may be useful to guide volunteers' self-care and help them thrive in the face of critical service demands.

The role of nurses' professional values during the COVID-19 crisis.

BACKGROUND: The COVID-19 pandemic has produced high stress in nurses, affecting their professional quality of life. Different variables affect psychological stress response and professional quality of life. In this context, the role of professional values represents an interesting object of research. OBJECTIVES: To analyze the relationship between professional values, perceived stress, and professional quality of life among nurses during the COVID-19 crisis. RESEARCH DESIGN, PARTICIPANTS, AND RESEARCH CONTEXT: Descriptive cross-sectional study. Participants were 439 registered nurses from the public health system. Perceived stress, professional quality of life, and professional values were evaluated by using measuring instruments adapted and validated in the geographic context of research. Data were collected online in December 2020 during the second wave of the COVID-19 pandemic in Spain. ETHICAL CONSIDERATIONS: This study was approved by the Ethics Committee on Clinical Research of the Principality of Asturias. FINDINGS: Within professional values, ethics obtained higher scores showing the primacy of ethical values among nurses. Moderate correlations between ethics, mastery, expertise, and compassion satisfaction were found. Frontline nurses informed high perceived stress. The correlations between professional values and compassion satisfaction were higher in non-frontline nurses. A moderate negative correlation between perceived stress and compassion satisfaction was found in both groups, which implies that the higher the stress, the lower the satisfaction in the helping relationship. CONCLUSION: Professional values positively influence compassion satisfaction during the COVID-19 pandemic. Compassion satisfaction presents a negative correlation with fatigue compassion and burnout in frontline and non-frontline nurses. Given the functionality of values both to guide clinical practice professionally and ethically, and prevent dissatisfaction with one's professional quality of life by reinforcing compassion satisfaction, it is necessary to reinforce them with an intensive and cross-sectional learning during the university training.

Efficacy and Safety of Cannabidiol Plus Standard Care vs Standard Care Alone for the Treatment of Emotional Exhaustion and Burnout Among Frontline Health Care Workers During the COVID-19 Pandemic: A Randomized Clinical Trial.

Importance: Frontline health care professionals who work with patients with COVID-19 have an increased incidence of burnout symptoms. Cannabidiol (CBD) has anxiolytic and antidepressant properties and may be capable of reducing emotional exhaustion and burnout symptoms. Objective: To investigate the safety and efficacy of CBD therapy for the reduction of emotional exhaustion and burnout symptoms among frontline health care professionals working with patients with COVID-19. Design, Setting, and Participants: This prospective open-label single-site randomized clinical trial used a 1:1 block randomization design to examine emotional exhaustion and burnout symptoms among frontline health care professionals (physicians, nurses, and physical therapists) working with patients with COVID-19 at the Ribeirão Preto Medical School University Hospital in São Paulo, Brazil. Participants were enrolled between June 12 and November 12, 2020. A total of 214 health care professionals were recruited and assessed for eligibility, and 120 participants were randomized in a 1:1 ratio by a researcher who was not directly involved with data collection. Interventions: Cannabidiol, 300 mg (150 mg twice per day), plus standard care or standard care alone for 28 days. Main Outcomes and Measures: The primary outcome was emotional exhaustion and burnout symptoms, which were assessed for 28 days using the emotional exhaustion subscale of the Brazilian version of the Maslach Burnout Inventory-Human Services Survey for Medical Personnel. Results: A total of 120 participants were randomized to receive either CBD, 300 mg, plus standard care (treatment arm; n = 61) or standard care alone (control arm; n = 59) for 28 days. Of those, 118 participants (59 participants in each arm; 79 women [66.9%]; mean age, 33.6 years [95% CI, 32.3-34.9 years]) received the intervention and were included in the efficacy analysis. In the treatment arm, scores on the emotional exhaustion subscale of the Maslach Burnout Inventory significantly decreased at day 14 (mean difference, 4.14 points; 95% CI, 1.47-6.80 points; partial eta squared [ηp2] = 0.08), day 21 (mean difference, 4.34 points; 95% CI, 0.94-7.73 points; ηp2 = 0.05), and day 28 (mean difference, 4.01 points; 95% CI, 0.43-7.59 points; ηp2 = 0.04). However, 5 participants, all of whom were in the treatment group, experienced serious adverse events: 4 cases of elevated liver enzymes (1 critical and 3 mild, with the mild elevations reported at the final 28-day assessment) and 1 case of severe pharmacodermia. In 2 of those cases (1 with critical elevation of liver enzymes and 1 with severe pharmacodermia), CBD therapy was discontinued, and the participants had a full recovery. Conclusions and Relevance: In this study, CBD therapy reduced symptoms of burnout and emotional exhaustion among health care professionals working with patients during the COVID-19 pandemic. However, it is necessary to balance the benefits of CBD therapy with potential undesired or adverse effects. Future double-blind placebo-controlled clinical trials are needed to confirm the present findings. Trial Registration: ClinicalTrials.gov Identifier: NCT04504877.