| Significance and objective of the studySince the 1990s, the mental health of helpers started to become a new focus of international intervention in the field of psychological crisis. Clinicians as an important helper group, their mental health is not optimistic. Large number of studies show that clinicians will be specific to mental health problems, namely empathy fatigue, when they provide patients with empathy as a precondition for assistance. The doctors who suffering from compassion fatigue will reduce empathy and produce burnout, while producing a series of physical and psychological symptoms. These symptoms would not only result in their abnormal emotion, cognition and behavior, so that daily life is affected, but also result in their made a poor professional judgment in the rescue process, such as misdiagnosis, poor development of bailout like, seriously affect the rehabilitation of patients.Has a large number of foreign research shows compassion fatigue and work stress are closely linked, will also be affected by other variables of psychological resources, including social support from others which is important protective factors of compassion fatigue.The domestic research is still in its infancy, the study mainly nurse-based, less involved physician groups, and research focused on the meaning, the mechanism. the relationship between factors and how these factors lead to compassion fatigue need to be further clear.Therefore, this study is intended to clinicians for the study, using questionnaires exploring the relationship among clinicians working pressure, social support and compassion fatigue, not only deepens the research in the field of domestic compassion fatigue, but also provide an effective basis for the interventions of compassion fatigue.Study One:Revision Compassion fatigue scale1. The process of scale revision(1)Review of the literature and screening scale;(2) Revised wording and content to the formation of Chinese clinician fatigue scale;(3) 10-Clinicians’ group discussions and brainstorming:further modify the content of the scale, formed the initial test version of empathy fatigue scale;(4) 30-clinicians’pre-survey:based on feedback and formed Surveying version empathy fatigue scale;(5) Official test:Select 200 clinicians and verify Reliability and Validity of scale2. Subjects and Methods(1) Sampling methods and subjectsIn June 2014, in a Medical University, randomly selected 200 clinicians who has a career in medicine practitioner’s license and experience more than one year do the questionnaire.186 valid questionnaires, the effective rate was 93%.87 were male (46.8%),99 were female (53.2%); aged 24 to 50 years, mean age (33.4±4.5) years.(2) Assessment toolsBasic Information Questionnaire, Compassion Fatigue Scale.(3) Data processingUsing EpiData3.1 for data entry, SPSS 19.0 for data collation and analysis, the use of statistical methods are descriptive analysis, Person correlation analysis and exploratory factor analysis.3. Result(1)10 entries were significantly correlated with the subscale total score; each entry showed a significant difference by t-test with high and low group, determining the scale consists of 30 items composition;(2) Reliability Index:3 subscales Cronbach’s a coefficients were 0.94(compassion satisfaction),0.86(buraout), 0.83(secondary traumatic stress); split-half reliability were 0.96,0.85,0.82; test-retest reliability were 0.82,0.79 and 0.84;(3) Validity Index:Confirmatory-factor-analysis test scale’s construct validity. According to the evaluation criterion of fit index:x2/df=U16<2, RMSEA=0.038<0.05, GFI=0.933, NFI=0.947, CFI=0.976, AGFI=0.901, IFI=0.976 indicating good model fit, the scale has good construct validity;(4) Determine the critical values:Compassion satisfaction≤43,Burnout≥56, Secondary trauma stress≥54.4. ConclusionsCompassion fatigue scale (Doctor Version) has good reliability and validity, the evaluation of the clinician Compassion fatigue has some promotional valueStudy two:Research on the relationship among compassion fatigue, work stress and Perceived Social Support1. Subjects and Methods(1) Sampling methods and subjectsWith the advantages of medical colleges,randomly selected clinicians who have a career in medicine practitioner’s license and experience more than one year in six hospital according to departments do the questionnaire in September 2014 in Guangzhou City. Survey commissioned by the hospital department responsible person, centralized payment fill out the questionnaire, fill in the on-site recycling site.Questionnaires were distributed 600,533 valid questionnaires were returned, the effective rate of 89%. There were 248 Male(46.5%) and 285 female (53.5%); aged 21 to 65 years, mean age (32.1 ± 7.8) years; junior titles were 310 (58.1%), intermediate grade were141(26.5%), senior titles were 82 (15.4%); three-level hospitals were 433 (81.2%), two-level hospitals were 60 (11.3%), one-level hospital were 40 (7.5%); married were 299 (56.1%); internal medicine were 150(28.1%), surgical were 152 (28.6%), gynecology and pediatrics were 60(11.3%), the other 13 departments were1 71 (32.0%).(2) Assessment toolsBasic Information Questionnaire, Compassion fatigue scale (doctors Edition), Clinicians working pressure Scale and Perceived Social Support Scale. The reliability and validity of all used scales have reached the psychometrics and scale requirements.(3) Data processingEpiData3.1 was used for data entry, SPSS19.0 and AMOS20.0 data were used collation and analysis. Statistical methods used are descriptive analysis, two independent samples t-test, ANOVA, chi-square test, Person correlation analysis, multivariate Logistic regression analysis and structural equation modeling.2. Result(1) Compassion fatigue of clinical doctors and its influencing factors:a. The compassion satisfaction average scores of investigated clinicians is 3.78 ±0.68,the burnout average scores of investigated clinicians is 2.42±0.59, the secondary traumatic stress average scores of investigated clinicians is 2.09±0.63;b. The characteristics of clinicians’compassion fatigue is high compassion satisfaction, high burnout and low secondary traumatic stress;c. There were significant difference (p< 0.05)in compassion satisfaction scores on age, education, working life, job satisfaction, and significant difference (p< 0.05) in compassion fatigue scores on age, positional titles, education, marriage, working life, working hours and working intensity, job satisfaction;d. From the results of Logistic regression analysis, marriage, working life and job satisfaction were found to influence compassion fatigue.(2) Analysis on work stressors of clinicians:a. The work stressors average scores of investigated clinicians is 2.60±0.43;b. The dimension average score of external environment is the highest (3.60±0.50) and the second is work load(3.22±0.63);(3) Analysis on social support of clinicians:a. The social support average scores of investigated clinicians is 5.56±0.86;b. The social support from family is the highest(5.71±1.02), the second is from friends (5.59±0.94), the lowest is from other ways (5.39±1.02)(4) The Mediating Effects of Perceived Social Support between Clinicians’ Work Pressure and Compassion Fatigue:a. Work pressure and compassion fatigue scores of the clinicians with high perceived social support were significantly higher than the clinicians with low perceived social support.(t=7.68,-9.44,8.77,5.07; P<0.01);b.According to relevant results, work pressure was significantly negative correlation with both perceived social support(r=-0.34, p< 0.01) and compassion satisfaction( r=-0.44, p<0.01)5 and significantly positive correlation with both burnout( r= 0.69, p<0.01) and secondary traumatic stress( r= 0.53, p<0.01); while perceived social support was significantly positive correlation with compassion satisfaction(r= 0.42, p<0.01),and significantly negative correlation with burnout(r=-0.40, p<0.01) and secondary traumatic stress( r=-0.26, p<0.01);c.According to the results of structural equation modeling, perceived social support played part of the mediate role in the effect of work pressure toward compassion satisfaction and fatigue with the intermediary effect of 55.4% and12.5%;Conclusions1.The characteristics of clinicians’ compassion fatigue is high compassion satisfaction, high biiraout and low secondary traumatic stress; Establish a screening system and increase re-education training opportunities are effective measures for compassion fatigue.2.Clinicians’ work stress is overall high; External environment and medical work load are the main sources of work pressure; Establish a benign guide,reasonable arrangements for working hours and strict control of the working time are effective measures for clinicians working pressure.3.Clinicians, perceived social support is high,mainly from family and friends.4.Clinicians,work pressure can not only higher their compassion fatigue directly, but also increase them through the lower perceived social support; to improve the social support of the clinician is beneficial to improve their mental health level.Countermeasures and suggestions1. Create a learning organization culture and increase re-education opportunities can continue to enhance the clinician’s ability to deal with patients, and then enhance compassion satisfaction to deal with empathy fatigue;2. Reasonable allocation of time and effort and establish the unity of responsibility and rights’ working environment to reduce burnout and improve compassion fatigue;3. To create a psychological quality optimization-oriented mechanism and integration of multiple resources to provide social support with coping empathy fatigue.Characteristics and innovations of the study1. Research tools Revision:Revision rescue personnel quality of life questionnaire (doctors Edition), is the first specifically for the clinician Surveying empathy fatigue scale, empathy for the future fatigue research provides a tool for clinicians.2. Research Perspective expansion:Domestic research on empathy to nurse fatigue as the main clinician lack of empirical research for the study of this study was to hold a practicing physician licensed practitioners and clinicians to more than one year for the study extends the single perspective.3. Deepening research:Analysis of previous studies of empathy fatigue remained mostly general factors, it is difficult reflect empathy fatigue complex relationship with the rest of the factors, this study from the impact of empathy fatigue internal external start a comprehensive study of empathy fatigue and stress, comprehend the relationship between social support and deepen the contents of empathy fatigue.The limitations of the study and predication of future studies1. Although this study revealed the clinician empathy fatigue, stress and perceived social support relationship, but cross-sectional study of the characteristics of such a causal relationship between the three is not entirely reliable, and therefore require further verification.2. In this study, all samples are from Guangdong Province, so the result is extended to other cities and rural areas required more prudent.3. Empathy fatigue mechanism of action is complex, work pressure and its perceived social support only two of many factors, it should be a rational view of the present study work stress and perceived social support clinician empathy fatigue strength prediction and interpretation degree.4. In this study, a method using only survey research on more single methodology to be more detailed in-depth research, qualitative interviews and experimental studies need to supplement late. |
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