University of New England, Australia.
University of Technology Sydney, Australia.
Aust Crit Care. 2020 Nov;33(6):553-559. doi: 10.1016/j.aucc.2020.02.002. Epub 2020 Apr 4.
To examine the previously untested relationship between the level of compassion fatigue (CF) in critical care nurses and the rates of three nurse-sensitive indicators in four critical care units in hospitals in Saudi Arabia.
CF can manifest in nurses who provide direct, intimate care to patients with different levels of illness including nurses working in specialty areas such as critical care where they care for patients experiencing challenging illnesses. Pressure injuries, patient falls, and medication errors are key nurse-sensitive indicators that identify critical care nurses as the primary causal agent. These indicators also correlate with burnout and poor multidisciplinary team communication, both factors that govern CF.
A multisite survey was conducted to collate and examine the number of reported pressure injuries, falls, and medication errors over 3 months at four hospitals in two Saudi Arabian cities during 2018 to determine the relationship between the occurrence of these nurse-sensitive indicators and the level of CF in critical care (intensive care unit [ICU]) nurses. A survey of 516 critical care nurses was undertaken; analysis was performed using the Professional Quality of Life Scale, version 5 (ProQol-5), and results were further analysed using Pearson's correlations and three-way analysis of variance.
The results of the regression analysis indicated resilience as a predictor explained 66% of the compassion satisfaction (CS) variance (B = 0.318, R = 0.436, F = 123.013, p < 0.001) and 26% of the burnout (BO) variance (B = 0.152, R = 0.067, F = 3.279, p < 0.001). In addition, the level of resilience as a predictor explained 15.4% of the secondary traumatic stress (STS) variance (B = 0.063, R = 0.024, F = 2.785, p = 0.006). Conversely, coping strategies did not predict CS, BO, or STS (p > 0.05) at a statistically significant level. The concurrent measure of CF, BO, and STS found that almost 20% of the critical care nurse participants reported having very low CS, indicating increased potential for the development of CF. In addition, male nurses reported experiencing higher levels of stress and BO than female nurses. This study also found that neither the number of patients being treated nor the number of beds in the care setting affected the rate of the nominated nurse-sensitive indicators. The results for rates of pressure injuries did vary among the hospitals, with the worst performing hospital reporting pressure injury rates of one in every 40 patients and the better performing hospital reporting no cases of pressure injuries after treating more than 100 patients. Patient falls and medication errors were rare occurrences and did not vary between hospitals.
This study indicates that there is a possible issue contributing to the differential level of care between hospitals. The mode and length of time nurses spend on handover may also reflect communication issues that increase both the rate of nurse-sensitive indicators and the level of CF reported by nurses. Therefore, the implications of this study, in terms of improving nursing practice, occurs in handover to ensure that information on aspects of nonpatient critical care are fully covered, such as time of patient turning to avoid pressure injuries.
检验同情心疲劳（CF）水平与沙特阿拉伯四家医院四个重症监护病房中三种护士敏感指标发生率之间以前未被检验的关系。
CF 可表现为向不同疾病程度的患者提供直接、亲密护理的护士，包括在重症监护等专业领域工作的护士，他们照顾患有挑战性疾病的患者。压力性损伤、患者跌倒和用药错误是确定重症监护护士为主要因果因素的三个关键护士敏感指标。这些指标还与倦怠和多学科团队沟通不良相关，这两个因素都影响 CF。
在 2018 年期间，在沙特阿拉伯的两个城市的四家医院进行了一项多地点调查，以收集和检查三个月内报告的压力性损伤、跌倒和用药错误的数量，以确定这些护士敏感指标的发生与重症监护（重症监护病房 [ICU]）护士 CF 水平之间的关系。对 516 名重症监护护士进行了调查；使用专业生活质量量表，第 5 版（ProQol-5）进行分析，结果使用 Pearson 相关分析和三因素方差分析进一步分析。
回归分析的结果表明，韧性作为预测因子，解释了同情心满足（CS）变异的 66%（B=0.318，R=0.436，F=123.013，p<0.001）和倦怠（BO）变异的 26%（B=0.152，R=0.067，F=3.279，p<0.001）。此外，作为预测因子的韧性水平解释了二次创伤性应激（STS）变异的 15.4%（B=0.063，R=0.024，F=2.785，p=0.006）。相反，应对策略在统计学上没有显著水平预测 CS、BO 或 STS（p>0.05）。CF、BO 和 STS 的同期测量发现，近 20%的重症监护护士报告说 CS 非常低，表明 CF 发展的可能性增加。此外，男性护士报告的压力和 BO 水平高于女性护士。本研究还发现，接受治疗的患者数量和护理环境中的床位数量均不会影响提名的护士敏感指标的发生率。各医院的压力性损伤发生率存在差异，表现最差的医院报告每 40 名患者中就有 1 名发生压力性损伤，表现较好的医院在治疗超过 100 名患者后，没有报告压力性损伤病例。患者跌倒和用药错误很少发生，且各医院之间没有差异。
这项研究表明，医院之间护理水平可能存在差异。护士交接的模式和时间长短也可能反映沟通问题，增加护士敏感指标的发生率和护士报告的 CF 水平。因此，这项研究在改善护理实践方面的意义在于，在交接时确保充分涵盖非患者重症监护方面的信息，例如患者翻身以避免压力性损伤的时间。
