title: Compassion fatigue, moral distress, and work engagement in surgical intensive care unit trauma nurses: a pilot study.
abstract: Preparation for replacing the large proportion of staff nurses reaching retirement age in the next few decades in the United States is essential to continue delivering high-quality nursing care and improving patient outcomes. Retaining experienced critical care nurses is imperative to successfully implementing the orientation of new inexperienced critical care nurses. It is important to understand factors that affect work engagement to develop strategies that enhance nurse retention and improve the quality of patient care. Nurses' experience of moral distress has been measured in medical intensive care units but not in surgical trauma care units, where nurses are exposed to patients and families faced with sudden life-threatening, life-changing patient consequences.This pilot study is a nonexperimental, descriptive, correlational design to examine the effect of compassion satisfaction, compassion fatigue, moral distress, and level of nursing education on critical care nurses' work engagement. This is a partial replication of Lawrence's dissertation. The study also asked nurses to describe sources of moral distress and self-care strategies for coping with stress. This was used to identify qualitative themes about the nurse experiences. Jean Watson's theory of human caring serves as a framework to bring meaning and focus to the nursing-patient caring relationship.A convenience sample of 26 of 34 eligible experienced surgical intensive care unit trauma nurses responded to this survey, indicating a 77% response rate. Twenty-seven percent of the nurses scored high, and 73% scored average on compassion satisfaction. On compassion fatigue, 58% scored average on burnout and 42% scored low. On the secondary traumatic stress subscale, 38% scored average, and 62% scored low. The mean moral distress situations subscale score was 3.4, which is elevated. The mean 9-item Utrecht Work Engagement Scale total score, measuring work engagement, was 3.8, which is considered low.Content analysis was used to identify themes of Role Conflict With Management/Rules, Death and Suffering, Dealing With Violence in the Intensive Care Unit, Dealing With Family, Powerlessness, Physical Distress, and Medical Versus Nursing Values. Additional themes identified were caring, helping families, long-time interdependent relationships of colleagues, and satisfaction in trauma nursing.As work engagement increased, compassion satisfaction significantly increased, and burnout significantly decreased. Results of this study support moral distress as a clinically meaningful issue for surgical intensive care unit nurses. Moral distress scales were elevated, whereas work engagement scales were low. This finding was congruent with Lawrence's study and may reflect ongoing need for greater supports for experienced intensive care unit nurses, from both education and management. Future recommendations for research include examining the interaction of these variables in larger samples to examine additional explanatory factors as well as strategies for self-care, motivation, and behavior change.
authors.affiliation: Virginia M. Mason, PhD, RN, ACNS-BC, CCRN, is a nurse educator for critical care at Boston Medical Center. She has a BSN from Boston College, MSN from Yale University Graduate School of Nursing, and PhD from University of Mass Worcester-Amherst Collaborative Graduate School of Nursing and has completed postdoctoral studies at Yale University Graduate School of Nursing. She has 35 years of experience as a clinical nurse specialist/nurse educator. She is a member of the Advisory Board of the Continuing Nursing Education Provider Unit, Boston University School of Medicine. Gail Leslie, MSN, RN, PMHCNS-BC, is an advanced practice nurse in urgent care psychiatry and a Connell Fellow in Ethics at Massachusetts General Hospital, Boston. She earned a BSN from Boston College School of Nursing and an MSN degree from Yale University School of Nursing. Her additional clinical experiences include 15 years of psychiatric nursing consultation in the surgical intensive care, burn, transplant and dialysis units and the emergency room Acute Psychiatry Service at Massachusetts General Hospital, and 5 years in outpatient psychiatry at the Boston VA Outpatient Clinic. Kathleen Clark, BSN, RN, MMHC, has been a practicing critical care nurse for 30 years. She has extensive experience in emergency and critical care as a staff nurse, educator, and manager. She is currently a doctoral candidate at Sacred Heart University whose research and pedagogical interests include lateral violence and undergraduate nursing students and critical care staff and patient satisfaction. Pat Lyons, MS, RN, CNS-BC, CCRN, CPAN, is a clinical educator for the surgical intensive care unit and postanesthesia care unit at Boston Medical Center. She has an ASN from Massasoit College, a BSN from University of Massachusetts Boston, and an MSN degree and a post-master's degree certificate in nursing education from Regis College. She has over 25 years of critical care nursing experience. Erica Walke, MSN, ACCNS-AG, RN, i
authors.forename: Virginia M
authors.initials: VM
authors.lastname: Mason
authors.forename: Gail
authors.initials: G
authors.lastname: Leslie
authors.forename: Kathleen
authors.initials: K
authors.lastname: Clark
authors.forename: Pat
authors.initials: P
authors.lastname: Lyons
authors.forename: Erica
authors.initials: E
authors.lastname: Walke
authors.forename: Christina
authors.initials: C
authors.lastname: Butler
authors.forename: Martha
authors.initials: M
authors.lastname: Griffin
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D064648:Critical Care Nursing; D004522:Educational Status; D004645:Empathy; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D009014:Morals; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000523:psychology* / Q000706:statistics & numerical data; D010865:Pilot Projects; D013315:Stress, Psychological; D011795:Surveys and Questionnaires