COMPASSIONATE FATIGUE IN EMERGENCY DOCTORS

LEVEL AND NATURE OF PARTICIPATION IN THE RESEARCH PROJECT: -

Name conceiving Literature literature developing developing data data data Writing
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students on report
SPSS

Filled by: Group Leader: ______________________________________________

Verified by: Facilitator: ______________________________________________

Prof. Ayesha Humayun, DPHCM-2023

1. INTRODUCTION:
The field of emergency medicine is one with a lot of pressure and exposure to risk and disturbing
events. Emergency department operate in a high�pressure, fast-paced setting with frequently shifting
teams. The Emergency physicians needs to be ready to handle and record anything that happens
throughout a shift. Most of the time they have to face mortality, severe sickness, stress, and suffering,
sometimes with no apparent way to resolve the issues they encounter. The doctor may have emotional
disturbance as a result of this setting, with potentially short- or long-term consequences. [1]

The compassionate fatigue is an emotional and physical burden, felt by doctors which leads to a
decrease in capacity and interest in sympathy for future suffering[3]. Emergency doctors are most
prone to. Compassionate fatigue due to the their work as first line responder in the traumatic events.
The doctors at emergency rooms have to work continuously for long hours and with continuous
interpersonal conflict, a high patient load, and mass casualty incidents. The issue is further exacerbated
by a lack of resources and a skilled workforce. Regardless of overworked and overburdened resources,
emergency department physicians, who are on the front lines of a demanding healthcare system, bear a
major portion of the responsibility for the care of emergency patients. Compassion fatigue, emotional
exhaustion and burnout are among the negative physical and mental health issues that emergency
physicians may face as a result of repeated exposure to mass illness and mortality. According to
reports, emergency physicians who suffer from compassion fatigue, burnout, and depression may
experience negative effects on their mental health as well as a number of serious side effects, such as
increased patient mortality, improper patient care, and medical errors.[2]

The term "compassion fatigue" (CF), first introduced in 1992, refers to the "diminished capacity to
provide care" observed in some emergency department (ED) nurses. Initially attributed to stressors
associated with
their work, the concept was further developed in 1995 to primarily
describe secondary traumatic stress (STS). STS occurs when caregivers
become indirectly traumatized through their exposure to the traumatic
experiences of the individuals they are helping. [4]

Prof. Ayesha Humayun, DPHCM-2023

 If compassionate fatigue remained unnoticed, it can lead to to reduced
patient care, and life threatening medical errors [4]
The main aim to conduct this study is to determine the prevalence and
severity of compassionate fatigue in emergency medicine physicians by
measuring compassionate fatigue, compassionate satisfaction and
secondary traumatic stress ratio and comparing it with the daily workload ,
demographics and behaviour disruption in routine life. [3]

Prof. Ayesha Humayun, DPHCM-2023

 ● Objectives of the study:

The objectives are:

- To estimate the level of compassion satisfaction, compassion fatigue and burnout in
emergency physicians at Shaikh Zayed Hospital, Lahore

References:
Bellolio MF, Cabrera D, Sadosty AT, Hess EP , Campbell RL, Lohse CM, Sunga KL.
Compassion fatigue is similar in emergency medicine residents compared to other
medical and surgical specialties. West J Emerg Med. 2014 Sep;15(6):629-35. doi:
10.5811/westjem.2014.5.21624. PMID: 25247031; PMCID: PMC4162717.

Prof. Ayesha Humayun, DPHCM-2023

2. MATERIALS AND METHODS:

Study area/setting: The study was conducted in the Emergency Department of SKZMD Hospital, a
tertiary care facility in Lahore, Pakistan. The ED is a high-stress environment that handles a large
number of patients with various medical emergencies daily. This setting is ideal for studying
compassion fatigue and burnout among doctors due to the intense and demanding nature of the work,
which often leads to emotional and physical exhaustion.
● Study population and study subjects: The study population consisted of doctors working in
the Emergency Department at SKZMD Hospital
- Inclusion Criteria: Doctors who have been employed in the ED for at least six months and are
currently active in their roles.
- Exclusion Criteria:Doctors on leave during the study period or those with less than six
months of experience in the ED were excluded from the study.

Study design: A cross-sectional study design was employed to assess the levels of compassion
fatigue and burnout. This design was chosen because it allows for the collection of data at a
single point in time, providing a snapshot of the current psychological state of the doctors in
the ED.

Sample size: The sample size for this study was 72 doctors. This size was determined using
convenience sampling, given the specific and limited population of doctors in the ED and the
practical constraints of the study. While not formally calculated, this sample size is adequate
for exploratory analysis and aligns with sample sizes used in similar studies in high-stress
healthcare environments.

Sample Size calculation:

Prof. Ayesha Humayun, DPHCM-2023

Confidence level 90%
Error margin =E= 10%
Standard deviation = P = 0.5
Z=1.440
n=?(Number of participants)
For unknown population
n=z^2P(P-1)/E^2

Putting in the values

n=72
Where n is the number of participants needed
So for we need a sample containing 72 participants

● Sampling technique: Convenience sampling was utilized to select participants. This

non-probability sampling technique was chosen due to the difficulty of random sampling in a
busy emergency department setting. Despite the potential for selection bias, this approach was
deemed appropriate for capturing data from the available doctors during the study period.
● Data Collection: Data were gathered using an electronic questionnaire distributed via email to
all eligible doctors in the ED.The primary tool used for measuring compassion fatigue and
burnout was the Professional Quality of Life Scale (Pro-QOL5). This scale is well-validated
and includes subscales for Compassion Satisfaction, Burnout, and Secondary Traumatic
Stress.methods, instruments used & measurements.
- Measurement Variables:
- Compassion Fatigue and Burnout (measured using Pro-QOL5).
- Demographic variables (age, gender, years of experience, etc.).
- Professional variables (hours worked per week, shift type, etc.).
● Procedure:
1. Recruitment

Prof. Ayesha Humayun, DPHCM-2023

 Eligible physicians in the SKZMD Hospital emergency department were invited to
participate via email, which included study details and an informed consent form. Participation
was voluntary, with assurances of confidentiality.
2. Questionnaire Distribution
After obtaining consent, an electronic questionnaire was sent via email, containing the
Professional Quality of Life Scale (Pro-QOL5) and demographic questions. Participants had
two weeks to complete the survey.
3. Follow-Up and Submission
A reminder email was sent one week before the deadline to encourage completion.
Completed questionnaires were reviewed for completeness; incomplete responses were
excluded from analysis.
4. Data Security
All data were anonymized and securely stored. The finalized dataset was transferred to SAS
software for statistical analysis.
● Data management and analysis plan:
Data were analyzed using SAS software. Descriptive statistics were used to summarize the
demographic and professional characteristics of the participants. Compassion fatigue and
burnout levels were analyzed using the Pro-QOL5 subscales.Pearson's correlation coefficient
was used to test relationships between variables. Group differences were assessed using t-tests
or ANOVA, depending on the number of groups. Multiple regression analysis was performed
to identify significant predictors of burnout and compassion fatigue.All data were anonymized
and stored securely in a password-protected database accessible only to the research team.
● Ethical Considerations

● Consent Form for Study on Compassion Fatigue in Healthcare Professionals

● Title of the Study: Understanding Compassion Fatigue in Healthcare Professional
● Investigator name: Nafeesa Bibi
● Institution: Shiekh Khalifa Bin Zayed Al Nahyan Medical Clg, Lahore

Prof. Ayesha Humayun, DPHCM-2023

 ● Purpose of the Study: Compassion fatigue is the emotional and physical exhaustion that can
develop from caring for others in distress. This study aims to explore the impact of this
condition on your well-being and professional life.
●
● Procedures:
● If you agree to participate, you will be asked to complete a survey and possibly participate in a
one-on-one interview. The survey will take approximately [insert time] to complete, and the
interview, if applicable, will last about [insert time]. All information you provide will be kept
confidential.
●
● Voluntary Participation
● Your participation is entirely voluntary. You are free to withdraw at any time without penalty or
loss of benefits. If you choose not to participate, it will not affect your current or future
relationship with [Your Institution].
●
● Risks and Discomforts:
● This study involves minimal risk. However, discussing topics related to compassion fatigue
may evoke emotional discomfort. If you feel uncomfortable at any point, you may skip
questions or withdraw from the study. Support resources, including counseling, will be
provided upon request.
●
● Benefits:
● While there are no direct benefits to you, your participation may help improve understanding
and support for healthcare professionals experiencing compassion fatigue.
●
● Confidentiality:
● Your privacy is of utmost importance. All data collected will be kept confidential and stored
securely. Your identity will not be disclosed in any reports or publications resulting from this
study. Only the research team will have access to the data.

Prof. Ayesha Humayun, DPHCM-2023

 ●
● Compensation:
● There is no financial compensation for participating in this study.
●
● Questions:
● If you have any questions about the study, you may contact the principal investigator at [Your
Contact Information]. If you have questions about your rights as a research participant, you
may contact [Institutional Review Board contact information].
●
●
● Ethical Considerations
● Informed Consent: Ensuring that all participants provide voluntary and informed consent is
crucial. Participants will be given detailed information about the study, including its purpose,
procedures, risks, benefits, and their right to withdraw at any time.
●
● Confidentiality: Protecting the privacy of participants is a priority. All data collected will be
anonymized and stored securely. Personal identifiers will be removed, and only the research
team will have access to the data.
●
● Emotional Well-being: Given the sensitive nature of the topic, there is potential for emotional
distress. Participants will be informed of this risk and provided with resources for support, such
as counseling services. The research team will also monitor participants’ well-being throughout
the study. Ya
●
● Voluntariness: Participation in the study is completely voluntary. Participants will be assured
that their decision to participate or withdraw will not affect their professional standing or
relationships with their employers or colleagues.
●

Prof. Ayesha Humayun, DPHCM-2023

 ● Non-Maleficence: The study is designed to minimize any potential harm to participants.
Careful consideration will be given to the wording of survey questions and interview
techniques to avoid causing unnecessary distress.
●
● Beneficence: The study aims to contribute positively by enhancing understanding of
compassion fatigue, which may lead to better support and interventions for healthcare
professionals in the future.
●
● Transparency: Participants will be kept informed about the progress of the study and its
outcomes. A summary of the findings will be made available to them upon request.
●
● Institutional Review: The study will undergo review and approval by an ethics committee or
institutional review board to ensure that it meets ethical standards.
Implications of study results
(Instructions: Expected results and potential contributions of the project)

Prof. Ayesha Humayun, DPHCM-2023

 ● RESULTS:

● Composed by ; 05-Amber Ismail & 25- Hazrat Ali

● Compassion fatigue among healthcare professionals is a serious concern as it badly

affects the understanding of patients condition, causing lack of care and leading to
impairment of professional judgement.

● The scores of compassion fatigue and burnout are affected by many socioeconomic and
demographic factors.

● On the compassion fatigue subscale, scores of 26 or below indicate extremely low risk,
scores between 27 and 30 indicate low risk, scores between 31 and 35 indicate moderate
risk, scores between 36 and 40 indicate high risk, and scores of 41 or more indicate
extremely high risk of compassion fatigue

● The Professional Quality of Life Scale (ProQOL) is a self-assessment questionnaire that

measures compassion satisfaction, burnout, and compassion fatigue. This is a helpful tool
for understanding how you are currently handling your work situation.

● Interaction between Empathic ability, empathic concern, exposure to client, residual

compassion stress, traumatic recollections, and life disruption contribute to CF

● Table 1 describes the demographic and work-related characteristics of study participants.

● Table 2 exhibits the univariate and multivariable association of participants’ features

Compassion Satisfaction, Compassion Fatigue and Burnout

● It has been found that healthcare professionals who are not satisfied with their jobs
experience less Compassion Satisfaction and increased Burnout resulting in low
performance in their duties

● There are some parameters used for computation of these results

● n (%) = number or frequency

● M = Mean

Prof. Ayesha Humayun, DPHCM-2023

 ● SD = Standard Deviation

● CS = Compassion Satisfaction

● CF = Compassion Fatigue

● BO = Burnout

Prof. Ayesha Humayun, DPHCM-2023

Prof. Ayesha Humayun, DPHCM-2023
Prof. Ayesha Humayun, DPHCM-2023
 ● REFERENCES (Instructions: mention at least 10 recent articles relevant to the study subject
and enumerated according to their order of appearance in the text. It should be in Vancouver
style.)

1. Howard L, Wibberley C, Crowe L, Body R. How events in emergency medicine impact

doctors’ psychological well-being. Emergency Medicine Journal. 2018;35(10):595-9.

2. Ma H, Huang SQ, We B, Zhong Y. Compassion fatigue, burnout, compassion satisfaction

and depression among emergency department physicians and nurses: a cross-sectional study.
BMJ open. 2022;12(4):e055941.

3. Bellolio MF, Cabrera D, Sadosty AT, Hess EP, Campbell RL, Lohse CM, et al.
Compassion fatigue is similar in emergency medicine residents compared to other medical and
surgical specialties. Western Journal of Emergency Medicine. 2014;15(6):629.

4. Jeanmonod D, Irick J, Munday AR, Awosika AO, Jeanmonod R. Compassion Fatigue in

Emergency Medicine: Current Perspectives. Open Access Emergency Medicine. 2024:167-81.

Prof. Ayesha Humayun, DPHCM-2023

Questionnaire:Assessment of compassion fatigue and compassion
satisfaction among emergency physicians

1.Basic Information

1-Name:

2-Age:

□ 20-30

□ 30-40

□ 40-50

□ 50-60

□ 60+

3-Gender:

□ Male

□ Female

2. Professional Background

- Years in Emergency Medicine Practice:

□ 0-5 years

□ 6-10 years

□11-15 years

Prof. Ayesha Humayun, DPHCM-2023

 □16-20 years

□21+ years

- Current Position:

□ Resident/Registrar

□ Attending Physician

□ Consultant

□Department Head

□ Other (Please specify): ___________

-Workplace Setting:

□ Public Hospital

□ Private Hospital

□ Academic/Teaching Hospital

□ Rural Hospital

□ Other (Please specify): ___________

3. Work Environment

- Average Number of Shifts per Week:

□ 1-2

□ 3-4

□ 5-6

□ 7+

- Average Shift Length:

Prof. Ayesha Humayun, DPHCM-2023

 □ 8 hours

□10 hours

□12 hours

□ 12+ hours

- Shift Type:

□Day shifts

□Night shifts

□Rotating shifts

□Mixed (please specify): ___________

- Number of night shifts per week

□ 1-2

□3-4

□ 5-6

ProQOLv5 Scale: Assessment of Compassion Fatigue (CF) and Compassion Satisfaction (CS)

This section uses the ProQOLv5 scale to assess the levels of compassion fatigue and compassion
satisfaction among emergency physicians.

Instructions: Below are statements about your experiences at work. Please read each statement
carefully and rate how frequently you have experienced these feelings in the past 30 days. Use the
following scale:

Prof. Ayesha Humayun, DPHCM-2023

1 = Never

2 = Rarely

3 = Sometimes

4 = Often

5 = Very Often

Compassionate fatigue

I feel worn out because of my work as a helper.

1 = Never

2 = Rarely

3 = Sometimes

4 = Often

5 = Very Often

I feel overwhelmed because my case [work] load seems endless.

1 = Never

2 = Rarely

3 = Sometimes

Prof. Ayesha Humayun, DPHCM-2023

4 = Often

5 = Very Often

I feel depressed because of the traumatic experiences of the people I help.t

1 = Never

2 = Rarely

3 = Sometimes

4 = Often

5 = Very Often

I feel trapped by my job as a helper.

1 = Never

2 = Rarely

3 = Sometimes

4 = Often

5 = Very Often

Compassion Satisfaction

I get satisfaction from being able to help people.

Prof. Ayesha Humayun, DPHCM-2023

1 = Never

2 = Rarely

3 = Sometimes

4 = Often

5 = Very Often

I believe I can make a difference through my work.

1 = Never

2 = Rarely

3 = Sometimes

4 = Often

5 = Very Often

I am pleased with how I am able to keep up with helping techniques and protocols.

1 = Never

2 = Rarely

3 = Sometimes

Prof. Ayesha Humayun, DPHCM-2023

4 = Often

5 = Very Often

My work makes me feel satisfied.

1 = Never

2 = Rarely

3 = Sometimes

4 = Often

5 = Very Often

I am happy that I chose to do this work.

1 = Never

2 = Rarely

3 = Sometimes

4 = Often

5 = Very Often

Support system and Coping Mechanisms

- Supportive Colleagues/Work Environment:

Prof. Ayesha Humayun, DPHCM-2023

 □ Strongly Agree

□ Agree

□ Neutral

□ Disagree

□ Strongly Disagree

- Use of Stress-Relief Activities (e.g., Exercise, Meditation):

□ Yes, regularly

□ Yes, occasionally

□ No

Utilization of Time OFF in recreational activities

□ Always

□ Often

□ Sometimes

□ Rarely

□ Never

6. Suggestions and Feedback

- Suggestions for Improving Emotional Resilience and Reducing CF in Emergency Departments:

Prof. Ayesha Humayun, DPHCM-2023

 - Any Additional Comments or Observations Regarding Compassion Fatigue and Satisfaction:

Prof. Ayesha Humayun, DPHCM-2023

 ● CONSENT FORM

Consent:

By signing below, you acknowledge that you have read and understood the above information, and
you agree to participate in this study.

Participant's Signature: _________________________

Date: _________________________

Researcher’s Signature: _________________________

Prof. Ayesha Humayun, DPHCM-2023

 ● Timelines: (Instructions: Please indicate the activities to be conducted and mark the
corresponding month on the Gantt chart. The project should be limited to one year at the most.
The research team should be strongly committed to these timelines and to submit the reports
on time. This will depend on and reflects the proper planning of the project )

Task MONTH

August 2024 September 2024 October 2024

1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th
week week week week week week week week week week week week

Final report

Prof. Ayesha Humayun, DPHCM-2023