Compassion fatigue

Nurses delivered much of the direct care to COVID-19 patients and were repeatedly exposed to death, infection risk, and shortages of equipment, yet little is known about how Pakistani nurses experienced and managed posttraumatic stress symptoms (PTSS). This qualitative study explored PTSS, experiences of trauma, perceived psychological impact, and coping strategies among nurses who cared for COVID-19 patients during peak pandemic waves. Eight registered nurses working in COVID wards and intensive care units of public hospitals in Islamabad and Rawalpindi were recruited through purposive sampling and took part in individual semi-structured interviews conducted in Urdu and basic English. Data were analysed using Braun and Clarke’s thematic analysis. Four themes were generated: (a) symptoms related to trauma (altered sleep, changes in temperament, emotional reactivity, diminished interest in social life, flashbacks); (b) threats and stress due to COVID-19 (increased workload, direct threat to self and others, sense of isolation, lack of knowledge and equipment); (c) psychological impact of trauma (increased mental health concerns, burnout and compassion fatigue, elevated death anxiety, lack of optimism about the future); and (d) strategies to cope (sharing workload with the team, emotional support from colleagues). Seven of eight nurses described flashbacks, and accounts spanned several DSM-5 symptom clusters, although no diagnostic assessment was used. Peer teamwork and emotional support were the only coping resources reported, and no participant had received formal counselling. Peer solidarity seems to have been an informal resource of resilience where organizational support was absent and institutional psychological services should be built around it.

Background Helping professionals face elevated risks of compassion fatigue and burnout, yet the daily processes through which emotional transformation occurs during therapeutic interventions remain poorly understood. This study examined how participants’ daily reflections shifted across the Emotion-Focused Training for Helping Professions (EFT-HP), analyzed through three complementary theoretical frameworks: Emotion-Focused Therapy's inner dialogue model (self-criticism, self-compassion, self-protection), Compassion-Focused Therapy's three-systems framework (threat, drive, soothing), and Ekman's basic emotion theory (primary emotions). Method Two hundred twenty-five helping professionals (88.0% female; M age = 38.7 years) from healthcare, social work, psychology, and education began the 14-day online EFT-HP intervention. Primary analyses focused on the 146 participants who completed at least 9 of the 14 days (completers), whose daily written reflections yielded 7,307 coded reflection units. Reflections were analyzed with directed content analysis and frequency quantification, applying non-exclusive, AI-assisted coding within three theoretical frameworks—EFT inner-dialogue categories, CFT emotion-regulation systems, and Ekman's discrete emotions—with a verbatim textual evidence excerpt retained for every assigned code. Results Across the intervention, participants’ reflections shifted from threat- and self-criticism-related content toward soothing and self-compassion. Within the EFT inner-dialogue framework, Self-Compassion was the most frequent category (17.9% of units) and was sustained throughout (Day-13 peak 30.8%), while Self-Criticism fell from 14.3% on Day 1 to 3.9% on Day 14 (73% relative decrease) and Self-Protection peaked on Day 6 (11.3%). Within the CFT emotion-regulation framework, the soothing system was the most frequently coded system overall (31.8% of units), followed by drive (20.4%); over the 14 days the threat system declined from 35.4% on Day 1 to 7.0% on Day 14 (80% relative decrease). Within Ekman's discrete-emotion framework, specific emotions were named less frequently: Fear declined from 2.7% to 0.8%, Anger peaked on Day 6 (15.0%), Joy rose to a Day-13 peak (14.8%), and Love was comparatively prominent (11.9% overall, Day-5 peak). Conclusions Across the 14-day intervention, participants’ daily reflections showed substantial shifts in emotional content, characterized by marked self-criticism and threat reduction alongside sustained self-compassion and soothing activation. Triangulated findings across three analytical frameworks: EFT inner dialogue, CFT emotion systems, and Ekman's primary emotions, are consistent with the emotional-transformation processes proposed by EFT-HP and with findings from previous controlled trials. Because the three frameworks were applied to the same reflection data, their convergence reflects analytic (theoretical) triangulation rather than independent confirmation.

Aim. Compassionate care is vital for quality healthcare. Empathy and compassion are key skills for nurses, but they are often hindered by stress, time pressures and excessive workload. Compassion fatigue can lead to burnout and lower-quality care. This review sought to identify effective interventions for enhancing compassionate nursing care, supporting nurses’ job satisfaction, and reducing the risk of burnout. Material and methods. We conducted a narrative review of international literature (2014-2023) from MEDLINE and CINAHL Ultimate, with the focus on empathy, compassion, burnout, and nursing interventions. After screening titles, abstracts, and full texts, a total of 44 relevant articles were included. Due to heterogeneity, findings were synthesized narratively. Results. Mindfulness, cognitive-behavioral therapy and reflective practices effectively reduce stress among nurses. Supportive leadership, positive work environments and the use of digital tools further enhance stress management. Integrating empathy and emotional regulation into nursing education strengthens resilience and improves job satisfaction. Conclusions. While empathy and compassion are central to nursing, they may also contribute to burnout and compassion fatigue. Empowering nurses through education, self-care, and emotional regulation supported by healthy workplaces and teamwork reduces burnout, enhances job satisfaction, and improves patient care. Ongoing research is essential in order to sustain resilience and compassionate healthcare worldwide.

هدف: مراقبت شفقت‌آمیز برای کیفیت مراقبت‌های بهداشتی حیاتی است. همدلی و شفقت مهارت‌های کلیدی برای پرستاران هستند، اما اغلب به دلیل استرس، فشار زمانی و بار کاری بیش از حد مختل می‌شوند. خستگی شفقت می‌تواند منجر به فرسودگی شغلی و کاهش کیفیت مراقبت شود. این مرور با هدف شناسایی مداخلات مؤثر برای ارتقای مراقبت شفقت‌آمیز پرستاری، حمایت از رضایت شغلی پرستاران و کاهش خطر فرسودگی شغلی انجام شد. مواد و روش‌ها: مرور روایتی ادبیات بین‌المللی (۲۰۱۴ تا ۲۰۲۳) از پایگاه‌های MEDLINE و CINAHL Ultimate با تمرکز بر همدلی، شفقت، فرسودگی شغلی و مداخلات پرستاری انجام شد. پس از غربالگری عناوین، چکیده‌ها و متون کامل، در مجموع ۴۴ مقاله مرتبط وارد مطالعه شدند. به دلیل ناهمگونی، یافته‌ها به صورت روایتی سنتز شدند. نتایج: ذهن‌آگاهی، درمان شناختی‌رفتاری و تمرینات تأملی به طور مؤثری استرس را در میان پرستاران کاهش می‌دهند. رهبری حمایتی، محیط‌های کاری مثبت و استفاده از ابزارهای دیجیتال مدیریت استرس را بیشتر تقویت می‌کنند. ادغام همدلی و تنظیم هیجانی در آموزش پرستاری، تاب‌آوری را تقویت و رضایت شغلی را بهبود می‌بخشد. نتیجه‌گیری: اگرچه همدلی و شفقت در پرستاری نقش محوری دارند، اما ممکن است به فرسودگی شغلی و خستگی شفقت نیز منجر شوند. توانمندسازی پرستاران از طریق آموزش، خودمراقبتی و تنظیم هیجانی با حمایت محیط‌های کاری سالم و کار تیمی، فرسودگی شغلی را کاهش داده، رضایت شغلی را افزایش می‌دهد و مراقبت از بیمار را بهبود می‌بخشد. پژوهش‌های مستمر برای حفظ تاب‌آوری و مراقبت شفقت‌آمیز در سراسر جهان ضروری است.