Winter 2016 edition of the EONS Magazine - catch up with the EONS-10 Congress

Compassion fatigue, burnout, and compassion satisfaction among oncology nurses in Turkey

Sultan Kav presents the results of a new study.

A great deal of time is spent trying to understand and reduce conditions of stress afflicting professionals working with traumatised or suffering persons. This study attempts to understand better the risk of compassion fatigue and burnout, and the potential for compassion satisfaction among oncology nurses in Turkey.

Sultan Kav presenting to the EONS-10 Congress

Sultan Kav presenting to the EONS-10 Congress

Nurses entering the profession are usually motivated by the desire to provide quality compassionate care. Oncology nurses experience intense physical and emotional exhaustion, identified in the literature as symptoms of cumulative grief and compassion fatigue.1-3 In the current state of healthcare, institutional and political constraints (limited resources, lack of management support, increased workloads and staffing shortages, increasing patient acuity) put at risk oncology nurses’ ability to provide compassionate care. Oncology nurses’ experiences with compassion fatigue are not clearly defined in Turkey. The aim of this study is to describe the prevalence of compassion fatigue, burnout and compassion satisfaction among nurses working in oncology clinics there and to explore their views.


This descriptive study was planned in two consecutive phases and conducted with nurses working in oncology clinics. In the first phase, an online survey was created, which consists of demographics and a Turkish version4 of the 30-item Professional Quality of Life (ProQOL R-IV) scale developed by Stamm for measuring compassion fatigue, compassion satisfaction and burnout.

The ProQOL R-IV scale is one of the most commonly used instruments in the study of compassion fatigue. It is a 30-item, five-point Likert-type scale ranging from 1 (never) to 5 (very often) with three subscales for compassion satisfaction, burnout and secondary traumatic stress. The scale measures the negative and positive aspects of working, for people who experience stressful events in the course of their work, within the past 30 days.5 It is recommended that the tool be used only for screening and not for diagnostic purposes. According to Stamm,5 scores lower than 22 show low levels of burnout and secondary stress, whereas scores of 42 or higher show high levels. In this study, the Cronbach's alpha was 0.78 for the total scale.

Tired nurses and doctors

This study highlights the problems of compassion fatigue amongst nurses

Nurses who are members of the Oncology Nursing Association of Turkey (TONA) who work in oncology clinics were emailed. At the time of the study, there were 500 members of TONA in Turkey and permission to undertake this study was obtained from its board and from the nurses.

The email explained the aim of the study and included link to the survey. A reminder was sent two weeks later to those who did not respond. In the end, 110 nurses replied. In the second phase, nurses reporting a high level of compassion fatigue were invited for qualitative interviews to explore their experiences and views (n=10 nurses).


    N %

(mean±SD: 31.3±7.7;

range:19-52 yr)
>25 27 24.5
25-34 44 40.0
35-44 31 28.2
  >45 8 7.3
Gender Female 100 90.9
  Male 10 9.1
Education Diploma 28 25.5
  Associate 12 10.9
  Bachelor 54 49.1
  Master 16 14.5
Institution State Hospital 46 41.8
  University Hospital 22 20.0
  Private 42 38.8
Years in Nursing

(mean:10; range:2-30)
<5 35 31.8
5-9 28 25.5
10-14 15 13.6
  >15 32 29.1
Years in oncology

(mean: 5.3; range:1-24)
<5 68 61.9
5-9 22 20.0
10-14 11 10.0
  >15 10 9.1
Position Staff/clinical nurse 88 80.0
  Head nurse 22 20.0
Oncology settings Ambulatory/infusion 37 33.6
  Inpatient 53 48.2
  Outpatient 6 5.5
  Other 14 12.7

Table 1. Demographic and work-related characteristics.

The majority of the 110 nurses who responded were women (90.9%), working in day shifts (74.5 %), at university (38.2%) or private hospitals (37.3%), as clinical nurses (69.5%) and had a bachelor degree in nursing (49.1%). The mean number of years in nursing was about 10 (range 2-30) and the mean number of working years in oncology was 5.3 (range 1-24) (Table 1).

    N %
Compassion satisfaction

(mean±SD=36.26±8.49; 14-50)
Low 4 3.6
Average 73 66.4
High 33 30.0

(mean±SD = 26.38 ± 5.03; 16-44)
Low 26 23.6
Average 83 75.5
High 1 0.9
Compassion Fatigue/ST

(mean±SD=23.35±9.41; 3-45)
Low 62 56.4
Average 41.8 49.1
High 2 1.8
TOTAL   110 100.0

Table 2. Level of compassion satisfaction, burnout and compassion fatigue

Nurses’ compassion satisfaction scale means were 36.26 ±8.49, burnout scale means were 26.38 ± 5.03 and compassion fatigue scale means were 23.35 ±9.41 (Table 2). We found a significant relationship between position and compassion satisfaction, and that head nurses stated higher level of satisfaction than staff nurses (p<0.05).

  • How you are feeling about your patients’ negative experiences?
  • How do these experiences impact on you?
  • What strategies do you have for coping with these experiences?
  • What do you expect from your institution and managers regarding these experiences?
  • Suggestions

Themes and subthemes

Figure 1. Themes and subthemes.


Compared to the current literature, our results showed that nurses’ average scores of compassion satisfaction were similar; however their burnout and compassion fatigue scores were higher which showed increased risk. Factors affecting burnout and compassion fatigue should be evaluated (Fig. 1).