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COMPASSION SATISFACTION, SECONDARY TRAUMATIC STRESS AND BURNOUT AMONG RESCUERS.

Byline: Syed Muhammad Imran Haider Zaidi, Nazia Yaqoob and Husnain Mirza

ABSTRACT

Objective: To explore the level of and relationship between compassion satisfaction (CS), secondary traumatic stress (STS), and burnout (BO) and to find out significant predictors of compassion satisfaction among rescuers.

Methodology: This study was based on cross-sectional survey research design. It was conducted in Faisalabad Division from September to December 2016. A sample of 185 men with mean age 32.45 5.64 paramedics (n=100) and firefighters (n=85) working in Rescue 1122 were selected with purposive sampling technique from Faisalabad and Chiniot City. Professional Quality of Life scale developed by Stamm (2009) was used to measure the level of CS, STS and BO among paramedics and fire fighters.

Results: Significant positive relationship between CS and STS and significant negative relationship between CS and BO among rescuers were observed (p <0.01). Rescuers' have moderate level of CS, STS and BO. Compassion satisfaction was significantly predicted from age group, marital status, living area, socioeconomic status, nature of job, STS and BO (F [7,177] =44.37, p =.001) R2 =.64.

Conclusion: Rescuers had average level of and significant relationship with CS, STS, and BO. Compassion satisfaction was significantly predicted from age group, marital status, living area, and socioeconomic status, nature of job, STS and BO.

Key Words: Rescuers, Compassion satisfaction, Secondary traumatic stress, Burnout, Rescue 1122

INTRODUCTION

Accidents are the foremost causes of death in adults1. Pre-hospital providers are former to face trauma on accident scene. Inadequate indications are available regarding pre-hospital trauma care training programs and the advantage of such programs for trauma patients2. There is a high level of involvement and professional belief concerning trauma care on the road2 . In Pakistan, rescue 1122 is one of the chief emergency service in the state3.

According to statistics, before February 2017 Rescue 1122 handled more than 1925964 medical tragedies, 1493422 road catastrophic clangs, 149,867 crime occurrences and 88,779 fire events4. While speaking around Faisalabad Rescue 1122, since 2014 to 2017 acknowledged 7428370 overall calls and salvaged 415841 patients4. These facts undoubtedly indicate how commonly these pre-hospital providers (rescuers) face traumatology. As they are qualified first responders, they truly face the serious conditions of the fatalities. Most of them feel compassion satisfaction (CS) in dealing with such situations5. Compassion satisfaction is the understanding of pleasure resulting from serving others, or being gifted to do effort well and the degree of credit by colleagues6. Rescuers may prefer to benefit others through their services i.e. by donating their aptitude at work setting or even the greater good of humanity7.

On the other hand, un-intended trauma experience is named as secondary traumatic stress (STS)8, also known as compassion fatigue, that is "the stress resulting from serving a traumatized individual9. Persons who constantly interact with wounded of traumatic proceedings are at hazard of emerging traumatic signs themselves10-12. Shocking events have a habit to shiver a person's essential opinions about a harmless, just world, separating the victim in an existential calamity12,13. STS is a multifaceted state of exhaustion and dysfunction in which employees take on the emotional strain and burden of the sufferers themselves9. Burnout (BO) and STS have been documented as the central consequences of risky job demands in human services specialists14,15.

Such strains may comprise recurrent and strong interaction with distressed clients and chronic contact with traumatic content at work16. This study aimed to measure the association amongst compassion satisfaction (CS), secondary traumatic stress (STS) and burnout (BO) among rescuers with two main categories paramedics and firefighters who are first providers of medical facilities. Furthermore the contribution of STS, BO and demographic characteristics such as age group, marital status, living area, socioeconomic status and job category to CS among rescuers was assessed.

METHODOLOGY

A cross-sectional survey based on correlational research design conducted from September 2016 to December 2016 in Faisalabad. A sample of 185 rescuers with mean age 32.45 5.64 was carefully chosen through purposive sampling technique. For data collection all the assigned stations of Rescue 1122 in Faisalabad and Chiniot were visited. Men only between age 20 years to 40 years with at least one year experience as emergency service provider as Firefighters or Paramedics (Medical First Aid providers) in Rescue 1122. Sample consisted of only men because 85% of the population working in Rescue 1122 centers is male. Participants who refused to provide informed consent (5 subjects) or beyond the age range 20-40 years, undergraduates and working as volunteer (not appointed) in Rescue 1122, were excluded from the current study. Due to less proportion in this field, women were also excluded.

Post hoc Power analysis for linear multiple regression was conducted using G-Power software to obtain the sample power. Input parameters for one tail were effect size f2 0.15, alpha 0.05 and total sample size 1857. Based on the above-mentioned assumptions, the desired sample size 185 contains a statistical power (1-[beta] err prob) 0.99.

A self-report sheet consisting of various demographic information and a self-report measure Professional Quality of Life scale (PROQOL) version 5 developed by Stamm (2009) was administered by the researcher to assess rescuers demographic information, CS, STS and BO correspondingly6. PROQOL version 5 consists of three subscales CS, BO and STS with five response categories (never=1 and very often=5); hence there were five reverse score items (1,4,15,17,29). Each of the scale has minimum score of 10 and maximum 50. Detail description of items in each subscale and cut of score is given in table 1. Participants were approached in Rescue 1122 centers after the approval of residential authorities. Informed consent form was provided to the participant at first and subsequently demographic sheet and PROQOL scale were provided to rate their responses.

SPSS 21 was used to run the statistical analyses of Descriptive statistics to find out frequencies and percentages of study variables, Pearson product moment correlation for association between variables and Hierarchical (aka sequential) regression analysis to predict CS from other variables were carried out in this study.

RESULTS

Internal consistency of study instrument's subscales ranges from Cronbach's alpha 0.54 to 0.86 in current study. Table 2 indicates the frequencies and percentages of study sample characteristics. Table 3 specifies significant relationship between CS, STS, and BO at confidence interval of 99%. Table 3 also indicates that rescuers have average level of CS, STS and BO.

In table 4 multiple regression predicted CS from age group, marital status, living area, socioeconomic status, nature of job, STS and BO. These variables significantly predicted CS (F [7,177] =44.37, p =.001, R2 =.64). Out of seven variables only five variables added statistically significant contribution to prediction, p <.05.

DISCUSSION

Compassion satisfaction has a significant positive relationship with STS as literature suggests that STS is the emotional stress that people may experience by having close contact with a trauma survivor17,18. Strong negative relationship existed between CS and BO supported by a study on nurses at Children's Hospital Los Angeles19, 20 and a positive relationship between traumatic stress and BO corresponds with previous study conducted by Alkema et al20. Moderate level of CS, BO and STS among rescuers correspond with study on emergency nurses confirmed that majority of them have moderate to high level of CS, STS and BO21.

Regression analysis predicted CS from age, marital status, living area, supported by Spranget al22 that older age predict CS. Another study showed that along with age, year of education, training and experience years can also predict CS23. A study on medical students of Pakistan indicated that high BO levels were significantly associated with age24. It is evident from the study on police officers that married feel more STS as compared to unmarried25. However, engaging in self-care activities lowers the risk of STS26. Young adults and singles exhibit less STS as compared to adults and the married because an increase in number of experience years increases stress also27. Adults and paramedics have high level of BO than young adults and fire fighters supported by a study declaring increase in age among health professionals contribute well to exhibit high level of BO28.

Table 1: PROQOL version 5 subscales and cut off scores

Subscales###Items###Low###Average###High

Compassion Satisfaction###3,6,12,16,18,20,22,24,27,30

###Between 23

Secondary Traumatic Stress###2,5,7,9,11,13,14,23,25,28###22 and below###42 and above

###and 41

Burnout###1,4,8,10,15,17,19,21,26,29

Table 2: Frequencies and percentage of demographic characteristics of rescuers

Variables###Frequency###Percentage

###Below 30 years###80###43.2

Age

###30 years and above###105###56.8

###Single###65###35.1

Marital Status

###Married###120###64.9

###Urban###65###35.1

Living Area

###Rural###120###64.9

###Joint###123###66.5

Living Style

###Nuclear###62###33.5

###Middle###184###99.5

Socioeconomic Status

###High###1###.5

###Paramedics###100###54.1

Job category

###Fire fighters###85###45.9

Table 3: Correlation between compassion satisfaction, secondary traumatic stress, and burnout among rescuers

Variables###CS###STS###BO

CS###1###.36**###-.58**

STS###1###.13

BO###1

Mean (SD)###36.32 (5.92)###24.62 (3.76)###22.48 (4.46)

Table 4: Summary of sequential/hierarchical regression analysis in compassion satisfaction among rescuers (n=185)

###Model 1###Model 2

Variable

###B###SE###[beta]###B###SE###[beta]

Age Group###-.41###.93###-.04###.03###.61###.01

Marital Status###-2.29###1.04###-.19*###-2.80###.67###-.23**

Living Area###-.68###.96###-.06###-.19###.62###-.02

Socio-economic Status###-11.43###5.81###-.14###-8.90###3.70###-.11*

Nature of Job###-.594###.92###-.5###-1.84###.61###-.16**

Secondary Traumatic Stress###.74###.08###.47**

Job Burnout###-.87###.07###-.65**

R2###.084###.64

F for R2 change###3.27*###134.87**

Workers of rescue 1122 have moderate level of CS that was not only due to their pre-hospital trauma scene services but other factors also contribute in their CS level. These findings can help pre-hospital service trainers to understand factors influencing CS among rescuers.

LIMITATIONS

Limitations of this study include sample from restricted area. Psychological health aspects can also contribute that were ignored in this study. Participants from both genders can be studied in future researches. However this study can provide evidences for future researches in Pakistani context.

CONCLUSION

Rescuers had average level of and significant relationship with CS, STS, and BO. Compassion satisfaction was significantly predicted from age group, marital status, living area, and socioeconomic status, nature of job, STS and BO.

ACKNOWLEDGEMENT

We wish to thank the participants, colleagues and institutional authorities for their valuable contribution in completion of this study.

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Publication:Journal of Postgraduate Medical Institute
Article Type:Report
Date:Sep 30, 2017
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