Compassion Fatigue and Nursing Education: A Q-Methodology Study

Background: Compassion fatigue is a phenomenon that is experienced by a vast number of health care workers and those whose work is to help others. Also known as secondary traumatic stress syndrome, compassion fatigue results from caregivers handling the stress of an encumbered healthcare system, along with the emotions and trauma affecting their patients. Although experienced daily, a significant number of caregivers do not take the time they should to practice self-care and self-compassion, leading to inevitable lack of empathy and compassion for others. Caregivers who are affected psychologically, physically, spiritually, and socially with no recovery are then unable to care for patients holistically.

Much of the current literature using surrounding compassion fatigue involves the analysis of self-reported survey data. Such studies assess the signs and symptoms associated with compassion fatigue, but not what leads to the symptoms and/or when those symptoms begin. The purpose of this study is to explore how nursing students experienced compassion and compassion fatigue during their pre-licensure nursing education.

Method: This IRB approved Q methodology study used a recruited sample of 30 participants from a baccalaureate nursing program at a private college in the Northeastern United States. The sample included 10 sophomores, 10 juniors, and 10 seniors. Participants rank-ordered 40 opinion statements about compassion behaviors in self, peers, and faculty according to their level of agreement. Results were recorded on a -5 to +5 sorting sheet. Centroid factor extraction with varimax rotation was completed using Ken Q Analysis. Factor scores were calculated to estimate how much the participants loading on each factor agreed or disagreed with each of the 40 statements.

Results: A three-factor final solution explained 59% of the variance. Twenty-three sorts loaded on one of the three factors, 5 sorts were confounded showing hybrid opinions, and 2 sorts failed to load. Seven sorts loaded on Factor 1, Happy with nursing but no time to recharge,explaining 19% of the variance. This viewpoint was characterized by strong agreement with the statement, “I would not change my field of work if I had the opportunity to,” and strongly disagreeing that students in nursing took time for self-care. Five sorts loaded on Factor 2, Worn out from nursing with no time for self-care.This viewpoint explained 16% of the variance. Factor 2 was characterized by the statement “I feel worn out because of my work within nursing.” Participants loading on this factor also strongly disagreed that they took time for self-care or had a social life outside of school. Factor 3, Happy in nursing with compassionate faculty role models, explained 24% variance. This viewpoint was characterized by strong agreement with the statement, “I believe that I make a positive impact on those that I take care of,” while also disagreeing that faculty prioritized research over the classes that they taught, did not allow open discussion, and had forgotten what it was like to care for patients. Eleven participants loaded Factor 3.

Conclusions:This study found three viewpoints among pre-licensure students reflecting a group that already exhibited early symptoms of compassion fatigue, a group functioning well but having risk factors, and a group functioning well with good faculty role models. Understanding that the risk for compassion fatigue may begin well before nurses enter practice may lead to improved intervention strategies. Faculty should strive to be good role models and seek ways to promote self-care and self-compassion among students in nursing curriculums.