Relation between Compassion Fatigue, Pandemic Emotional Impact, and Time Management among Nurses at Isolation Hospitals during COVID- 19

Introduction:

Public health is threatened by a new pandemic, the Corona Virus Disease (COVID-19), which was first detected in late 2019 in Wuhan, China. The World Health Organization (WHO) issued a pandemic declaration in March 2020 (Jebril, 2020). The common cold, severe acute respiratory syndrome, and Middle East respiratory syndrome are all caused by members of the coronavirus family (MERS). Coughing, sneezing, shortness of breath, difficulty breathing, and fever are all signs of the COVID-19 virus; more severe complications include pneumonia, acute respiratory failure, kidney failure, and death (Gabutti et al., 2020).

As part of the country's efforts to contain the COVID-19 pandemic, General Hospitals and Fever and Chest Hospitals have been designated as COVID isolation centers and triage centers, respectively, for all suspected COVID-19 cases referred from General Hospitals or identified through a hotline or from walk-in patients (Ministry of Health and Population, 2021). Many nurses from all nursing specialties have been assigned to care for persons infected with COVID-19. For example, nurses with only a basic understanding of infectious diseases may work in stressful situations outside their comfort zone (Catton, 2020). Worldwide, the infection claimed the lives of around 1,500 nurses by the end of October 2020 (International Council of Nurses, 2020).

Compassion fatigue (CF) is "the result of a progressive and cumulative process that is induced by lengthy, continuous, intense interaction with patients and exposure to stress" (Salmond et al., 2019). Burnout, the slow emergence of cumulative stress connected to the work environment, and secondary traumatic stress, an internal reaction to a second exposure to severely stressful or traumatic events, comprise CF (Steinheiser, 2018). Nurses must also think about how to avoid COVID-19-related medical issues, which may make them doubt their capacity to offer comprehensive care to patients in a compassionate manner. Consequently, nurses caring for COVID-19 patients are at increased risk of compassion fatigue. Persons who provide long-term care for those who are ill or have undergone trauma are at risk of developing compassion fatigue, characterized by depletion on all levels of functioning and an inability to empathize with the people they help. The emotional anguish that leads to compassion fatigue sets it apart from burnout, which is caused by more routine, non-emotional sources of stress like those found in administrative work (Alharbi et al., 2020).

The present health crisis owing to the coronavirus pandemic can aggravate and increase the exposure of health workers (stressful workload, increased anxiety, increased reactivity to stress, and compassion fatigue) (CF). Consequently, the quality of the treatment nurses delivers to their patients suffers from increased emotional distress and avoidance behaviors (Franza et al., 2020). Health experts typically take the opposite approach during pandemics, when the world faces a shutdown or slowdown in regular activity and individuals are encouraged to apply social distancing to decrease connections between people and, thus, the likelihood of new infections. Long hours in a dangerous environment while wearing bulky protective gear that can restrict movement and make it hard to breathe are just a few of the challenges that healthcare workers confront as the demand for their services continues to soar (Wilder-Smith & Freedman, 2020).

Furthermore, many professionals may feel unprepared to carry out the therapeutic intervention of patients afflicted with a new virus, about which little is known and for which there are no well-established clinical protocols or treatments. Concern for one's immune system's health comes into play here, as does the potential for transmitting the illness to one's loved ones and coworkers (Kang et al., 2020; Xiang et al., 2020). Because of this, they may withdraw from their immediate and extended families, alter their daily habits, and find it necessary to spend more time alone (Huang et al., 2020). Stress, irritation, exhaustion, mental and physical drowsiness, and depression are only some negative emotional states that might result from these external influences. Professionals in the health care industry are particularly at risk for experiencing mental anguish and developing psychiatric disorders due to their high work demands and stress-related symptoms (Lee et al., 2018). Therefore, it is vital to provide psychological support, improve mental health support services, and boost mental healthcare globally by having a deeper awareness of the emotional burden among various groups of healthcare workers, notably nurses, during this time (Zhang et al., 2020).

COVID-19 causes stress and time management problems because of the simultaneous exposure to news of many deaths, long work shifts with a wide variety of unknowns, and the stress of meeting various demanding objectives. At the same time, nurses are essential to the global response to the epidemic but are among the most at risk of contracting the disease. There have been many cases of infection and quarantine among frontline nurses during the COVID-19 pandemic (Sanderson et al., 2020). Since nurses have traditionally played a crucial role in epidemic prevention and control, prioritizing their health is of the utmost importance in managing infectious diseases (Mo et al., 2020).

Time management can be defined in various ways but generally involves assessing how one spends one's time and setting priorities to get the most out of one's day. Another way of looking at it is as a form of self-management, or more specifically, as an active method of self-regulation. Another writer Bley , (2015) describes it as "behaviors that aim at achieving effective use of time while executing particular goal-directed activities". The term "time management" refers to making the most of one's time using various components, such as planning, goal setting, goal-and-activity prioritization, communication, and delegating. A nurse's ability to manage their time effectively is crucial since any time away from a patient reduces the standard of care they can provide. The introduction of COVID-19 causes shifts in hospital care, affecting time allocations (Molaei et al., 2021).

Nurses must work more rigorously and strategically due to the peculiar circumstances brought on by the COVID-19 virus's short-term existence (Karakose, 2015). Nurses who fail to develop practical time management skills during their academic careers risk failing to graduate with the credentials needed to practice in a clinical setting and provide adequate patient care. Time management abilities are linked to compassion fatigue and the psychological toll of pandemics (Ghiasvand et al., 2017). When nurses learn to manage their time better, they feel refreshed and energized. So, nurses may focus on the current patient without worrying about the next one. As well as physical health, a disease-free life requires mental tranquility (Wolverhampton, 2018).

Nursing workloads and time spent on patient care have improved as a result of reform measures in hospitals. It implies that nurses need to be more disciplined and strategic in their approach to daily work in order to get more done in the same amount of time. A nurse's ability to effectively manage their time and study during their academic years is crucial to their success in the nursing profession. Successful time management is linked to reduced compassion fatigue and lessened effects of emotional pandemics (Ghiasvand et al., 2017).

According to Sainz et al., (2019), nurses can benefit from a wide range of abilities that contribute to effective time management. When it comes to managing time, the following are some of the most crucial skills: Organization, Nurses who take the time to stay organized are better able to see the big picture of what has to be done and when (Hamzehkola & Naderi, 2018).Prioritization, a vital part of managing one's time effectively, determines the importance of one's many duties. The nurse could start with the shorter, more manageable tasks and work up to the more time-consuming ones. Alternately, the nurse might arrange the list from most urgent to least. (Watanabe et al., 2020). Goal-setting is the first step in learning to manage one’s time effectively. The nurse visualizes the result and chooses what steps should be taken first. Career success can be achieved by setting immediate and distant objectives (Van der Hoek et al., 2018). Strong communication skills can help nurses communicate with lone patients about their aims and objectives. Nurses can assign responsibilities to other staff members, freeing time to concentrate on what matters most in achieving the organization's mission and objectives (Cameron et al., 2018). Planning plays a crucial role; nurses who take the time to meticulously organize their days' events, meetings, and care delivery are more likely to keep to their schedules (Botha et al., 2018). Delegation is a skill that could be useful in many settings, but especially those requiring isolation, such as hospitals and those where the future is uncertain (Jiang et al., 2018). So, Lack of time is a significant problem in modern healthcare. Emergencies in isolation hospitals must be managed with a focus on the quality of treatment, safety, standardization, and efficiency, all within the constraints of a predetermined timetable (Goldsby et al., 2020).

Time management is the art of making the most of one's available time in order to complete tasks and accomplish objectives. Furthermore, time management effectively utilizes time for a healthy life. Competence in time management can alleviate a lot of the emotional toll of pandemics and prevent burnout from helping others (Marquis & Huston, 2012).

Significance of the study:

Nurses were on the front lines during the COVID-19 pandemic, as nurses regularly reported experiencing anxiety and sadness due to their exposure to infected patients. Patient dissatisfaction can trickle down to the staff, leading to a vicious cycle of low morale, absenteeism, apathy, and stressful work (An et al., 2020). Although estimates of the pandemic's emotional toll on healthcare professionals across departments are high, health authorities can still develop prevention strategies, and efficient treatment plans to minimize the pandemic's negative effects on healthcare professionals. According to research, health professionals may encounter various psychological issues when working in high-stress and high-risk situations, such as during crisis and pandemic situations (Arafa et al., 2021).

Time is the most precious resource, and its presence and availability are prerequisites for the growth of any other resources. Successful people focus on time management because it's the key to achieving their goals. In the nursing profession, time squandered by nurses is time not spent with the patient, which has a detrimental impact on the quality of care provided to the patient. Enhanced emotional regulation, originality, efficiency, and job fulfillment among nurses (Ghiasvand et al., 2017).

When caring for COVID-19 patients, nurses should find a balance between emotional impact and time management. The study found that most nurses were unable to face problems, irritated, anxious, emotionally concerned, and did not arrange the work during the COVID-19 pandemic. So, the researchers are introducing this study to investigate the relationship between compassion fatigue, pandemic emotional impact, and time management among nurses at isolation hospitals during COVID- 19.

Aim of the study:

The current study aims to investigate the relationship between compassion fatigue, pandemic emotional impact, and time management among nurses at isolation hospitals during COVID- 19.

Research questions:

1. What are the levels of compassion fatigue, pandemic emotional impact, and time management among nurses at isolation hospitals during COVID- 19?
2. Is there a relationship between compassion fatigue, pandemic emotional impact, and time management among nurses at isolation hospitals during COVID- 19?

Subjects and Method:

Research design:

The present study employed a descriptive correlational research design.

Setting:

This study was conducted at Minia isolation hospitals, including the Minia fever isolation hospital and the Minia chest isolation hospital; each hospital consists of in-patient departments, an intensive care unit, and an emergency unit. Minia fever hospital consists of three buildings; each building has three floors, and a capacity is 143 beds, while Minia chest hospital has one building with three floors and 110 beds.

Sample:  

A convenience sample of 200 nurses from the previously mentioned settings wasrecruited. All age ranges were represented, both sexes were included, nurses with direct patient care were prioritized, and volunteers had to be healthy and willing to participate in the study.

Tools of data collection:

Four tools were used in the present study, based on related literature, to collect the necessary data for this study, which is divided into the followings:

1-Personal interview sheet:

The researchers developed this tool after reviewing relevant literature and encompassing items such as age, gender, marital status, educational qualification, functional class, and years of experience, hospital name, department, and residence.

2-Professional Quality of Life Scale version 5 (ProQual-5).

The ProQual-5 was originally developed by Figley (1995), and the last version was developed by Stamm (2009). It is a 30-item scale known as compassion fatigue and satisfaction and is designed to evaluate both the positive and negative outcomes of interacting with individuals who have endured stressful events. The ProQOL-5 is a 30-item scale. The researchers used the compassion fatigue scale in this study, which consists of 20 items; divided into two subscales (burnout and secondary traumatic stress), and did not take the 10 items of satisfaction. The compassion fatigue subscale consists of 20 items, divided into two subscales, the first is burnout, which includes 10 items numbers (1- 10), and the second is secondary traumatic stress, which includes 10 items (11- 20). Rated on 3-point scale; as 1 (rarely), 2 (sometimes), 3 (always). The score was reversed for questions (11, 12, 15, 16, and 20).

The studied sample total scores were divided into the following base:

1- Burnout

· 10 or less: Low risk for burnout

· 11 - 20: Moderate risk for burnout

· 20 or more: High risk for burnout

2- (Secondary traumatic stress)

· 10 or less: Low risk for secondary traumatic stress

· 11 - 20: Moderate risk for secondary traumatic stress

· 20 or more: High risk for secondary traumatic stress

TOTAL COMPASSION FATIGUE :

• 22 or less: Low risk for Compassion Fatigue (Low level)
• 23 - 41: Moderate risk for Compassion Fatigue (Moderate level)
• 42 or more: High risk  for Compassion Fatigue (High level)

1-       Pandemic Emotional Impact Scale (PEIS):

The Pandemic Emotional Impact Scale (PEIS) was designed by Ballou et al., (2020) to evaluate the emotional impact of a worldwide pandemic and to illuminate the long-term effects of this and future epidemics on people's mental health and includes 16 items. Respondents are asked to rate how each emotional domain had changed in the previous 4 weeks compared to before the pandemic began on a scale from 0 to 3-point scale, as 1 (rarely), 2 (sometimes), and 3 (always). The overall score is a sum of these items, ranging from 1 to 48, and divided into three levels: low pandemic emotional impact from 1 to 16, moderate pandemic emotional impact from 17 to 32, and high pandemic emotional impact from 34 to 48.

2-       Time management questionnaire:

This questionnaire was developed by Gazawy, (2012) to assess the time management among nurses working at isolation hospitals during COVID-19. The questionnaire included 53 items in total and was divided into 8 dimensions as follows: fulfillment of obligations (7 items), district control (6 items), time planning (9 items), setting of priorities (7 items), discipline in the use of time (6 items), uses of resources (8 items), negotiation requirement (4 items), and balance lifestyle (6 items).

Scoring system:

Each item has a set of at least three possible answer choices ranging from (agree = 3, neutral = 2, disagree =1). The scoring system ranged from 53 to 159 and was divided into three levels: low time management from 53 to 88, moderate time management from 89 to 124, and high time management from 125 to 159.

The three scales were translated into Arabic language by an accredited professional translator and back-translated by an independent bilingual professional from the population group.

Validity and reliability of tools:

A panel of five professionals in nursing administration and psychiatric mental health nursing from the faculty of nursing determined the face validity of the current study tools. Each expert panel judged the tools' content, phrasing, length, coverage clarity, format, and overall appearance. All jury members agreed that the current study techniques were legitimate and appropriate to the study's goal based on their recommendation, hence no change. Hence made by the Jury panel. The reliability test was calculated using Cronbach's Alpha Coefficient for the analysis equipment. Cronbach's Alpha Coefficient was employed to assess the study scales' internal correctness. The tools’ reliability was calculated statistically at 0.83, 0.89, and 0.888, respectively.

Pilot Study:

A pilot study was conducted at the beginning of the research. It includes (10%) of the total sample representing 20 nurses; a pilot study was conducted to test clarity, feasibility, completeness, objectivity, adequacy of the study tools, applicability, determine possible problems in the methodological approach or tool, and determine the time needed to complete the tools. No changes have done to the assessment sheet, so the sample selected for the pilot study was included in the primary study sample.

Procedure:

Review the current and past related literature on the various aspects of the study using recent books and available journals to be acquainted with the research problem, give a clear picture of the subject, and select the appropriate tools for measuring the study variables. In addition, the study tools were translated into Arabic by the researchers. They were reviewed and validated by the jury committee composed of five experts in (psychiatric mental health nursing and nursing administration) to test the tools' validity.

Formal permission was granted from the manager and head nurses of Minia fever hospital and Minia chest hospital in Minia governorate after the explanation of the purpose and nature of the current study. The researchers interviewed each study subject to collect the necessary data using all the study tools by self-administrative techniques. The interview began with the researchers introducing themselves to the participants and providing a brief overview of the study's purpose. The study tools were distributed to nurses individually in the workplace at isolation hospitals. The data was collected between the periods of November 2021 to the end of February 2022, and it was done during the morning and afternoon shifts according to the nurses' and researchers' time. The time spent filling the study tools ranged from 20 to 25 minutes according to the needed explanation with each nurse.

Ethical considerations:

An official letter was granted from the Faculty of Nursing, Minia University research ethics committee, before the pilot study's conduction and the actual research; oral consent was obtained from nurses participating in the study after explaining the nature and purpose of the study. The study subject has the right to refuse to participate or withdraw from the study without any rationale at any time. Study subject privacy was considered during the collection of data. Participants were assured that all their data were highly confidential; anonymity was also confirmed by assigning a number for each nurse instead of names to protect their privacy Plagiarism was avoided, and intellectual property rights were maintained.      

Statistical Analysis:

Statistical analysis of data implemented by an excel program and using SPSS (IBM 26). The content of each tool was analyzed, categorized, and then coded. The reliability analysis was used to determine the reliability of the tools for the present sample. Qualitative data was used to describe the frequency distribution of the study sample. Quantitative data presented as mean & SD. Chi-square and Spearman correlation tests were used to identify differences in the prevalence of compassion fatigue, pandemic emotional impact, and time management among the studied sample. Statistical significance was used at P. value <0.05 at a confidence interval 95%.

Results:

Table (1): Frequency distribution of the personal characteristics among the studied sample (n = 200)

Table (1) shows that less than half of the studied sample (48.0%) is in the age group between 19 - < 29 years old, with mean age (32.3 ± 9.7). Females are more prevalent than males in the studied participants (83.0%), while nearly two third (64.5%) are married. Regarding years of experience, less than half of the studied sample had 6-10 years of experience, with a mean (6.9 ± 3.3). Moreover, more than one-third (39.2%) of them are bachelor's degrees, and three-quarters (75%) are staff nurses. On the other hand, more than half of them worked in fever hospitals, and less than two-thirds (59.5%) are from rural areas.

Figure (1): Frequency distribution of compassion fatigue domains among the studied sample (n = 200).

Figure (1): depicts that, nearly two-thirds of the studied sample (64.0%) is a high level of total compassion fatigue, while more than one-third of them (36.0%) is a moderate level. 

Figure (2): Frequency distribution of pandemic emotional impact among the studied sample (n = 200)

Figure (2): shows that more than half of the studied sample (51.5%) is a moderate level of pandemic emotional impact, while (48.5%) of them are a high level. 

Figure (3): Frequency distribution of the total time management among the studied sample (n = 200)

Figure (3): presented that, less than two-thirds of the studied sample (63.5%) are at a moderate level of time management, while (36.5%) of them are at a low level. 

Table (2):  Mean score of compassion fatigue, pandemic emotional impact, and time management among the studied sample (n = 200).

Table (2): Indicates that, the total mean scores of compassion fatigue among the studied sample are (42.9 ± 5.6). At the same time, mean scores of pandemic emotional impact are (32.7 ± 5.9). On the other hand, the total mean scores for time management are high among the studied sample (91.1 ± 9.4).

Table (3): Relation between compassion fatigue and personal characteristics of the studied sample (n = 200)

Table (3): illustrates that there are no significant relations between compassion fatigue and personal characteristics of the study sample, except for marital status, hospital name, and residence at p-value = (0.018*, 0.024*, 0.001**, respectively).

Table (4): Relation between pandemic emotional impact and personal characteristics of the studied sample (n = 200).

Table (4): illustrates that there is no significant relation between pandemic emotional impact and personal characteristics of the study sample, and on the contrary, there is a highly significant relation between pandemic emotional impact and age at P value= (0.0001**).

Table (5): Relation between time management and personal characteristics of the studied sample (n = 200).

Table (5): illustrates that; there is significant relation between time management with gender, nurses' qualifications, job position and residence at p value= (0.012*, 0.006**, 0.05*, 0.049 *respectively). On the other hand, there is no significant relation between time management with age, marital status, hospital name, and department

Table (6): Correlation matrix between compassion fatigue domains, pandemic emotional impact, and time management domains of the studied sample (n = 200).

Table (8): summarizes that a statistically significant positive correlation between subdomains of compassion fatigue (secondary traumatic stress and burnout) at r= (.384) P-value= (.0001**). Moreover, there is a statistically significant positive correlation between pandemic emotional impact and burnout subdomain of compassion fatigue at r= (.257) P- value = (.0001**).  In addition, there is a statistically significant positive correlation between pandemic emotional impact with discipline time subdomains of time management at r= (.178) P- value = (.012*).  On the other hand, there is a statistically significant negative correlation between time planning with compassion fatigue (secondary traumatic stress) at r = (-.211) P- value = (.003**).