Factors Affecting Compassion Fatigue Among Nurses During the Global COVID-19 Pandemic: Through a Socio-Ecological Model

Background: During the Coronavirus disease (COVID-19) pandemic, nurses experienced increased workloads which affected their compassion fatigue (CF). High levels of CF affect quality of care. However, little is known about what factors are associated with CF among nurses during the pandemic. Aim: This study aims to examine the factors associated with CF using the socio-ecological model (SEM). Methods: This study is a cross-sectional correlational study which targeted nurses who are actively practicing and can speak English, Korean, Japanese, or French. Online websites for the recruitment including the study description and survey link were provided in each country. Survey data were collected from July 1, 2020 to January 25, 2021. CF, consisting of burnout and secondary traumatic stress (STS), was measured using Professional Quality of Life scale (ProQOL). Factors based on each level of the SEM were measured: intrapersonal factors (demographic factors, resilience), fear of infection, intention to leave their job, care of COVID-19 patients, developing policies, being asked to work at higher acuity levels, received training about COVID-19, and any COVID-19 test results); interpersonal factors (fear of bringing COVID-19 to family); organizational factors (provision of personal protective equipment [PPE] or masks, organizational support to prevent COVID-19, type of organization, and accommodational support); community factors (country of practice and incidence rate); and policy factor (mask policy). These data were analyzed using multiple regression using maximum likelihood estimation with robust standard errors. Results: Intrapersonal factors (resilience, age, being bedside staff, fear of infection, intention to leave their job, being asked to work at higher acuity levels, and receiving the positive COVID-19 results), organizational factors (provision of PPE, organizational support for COVID-19, and accommodational support), community factors (incidence rate when the mask policy was not in effect, and country of practice), and policy factor (mask policy under a high incidence rate) were the associated factors. The interaction between incidence rate and mask policy was significant. Conclusion: To prepare for future emerging infectious disease crises, organizational support with proper PPE supplies, continuing education on emerging infectious diseases, and providing interventions to increase resilience are suggested.