Burnout, compassion for others and fear of compassion: a quantitative study in Iranian nurses

Abstract Introduction Occupational burnout in nurses is a barrier to job promotion and achievement of job-related goals, resulting in reduced hospital performance. Objective Considering the importance of the role of compassion in occupational burnout among nurses, this cross-sectional study aimed to explore the burnout levels and their relationships with compassion for others and fear of compassion. Methods This descriptive correlation study was carried out with 216 nurses who were selected using a multistage cluster sampling method and asked to respond to the Maslach Burnout Inventory, a compassion for others scale and Fears of Compassion Scales (FCS), which includes three subscales; fears of compassion for self, compassion for others, and compassion from others. Results The results showed that burnout had a negative correlation with compassion for others, but had positive correlations with fear of compassion for others, fear of compassion from others, and fear of self-compassion. Moreover, the results of regression analysis showed that 21% of burnout variance was explained by compassion for others and 29% of its variance was explained by fears of compassion scales. Conclusion Based on the findings, compassion can be considered as a protective factor in preventing burnout among nurses.


Introduction
Healthcare workers are constantly exposed to stressors due to complex care and patient care services, which put them at risk of occupational burnout. 1 Among healthcare workers, nurses reported the highest prevalence of burnout. 2 Burnout syndrome is the constant exposure to work-related stress that is associated with poor working conditions and reduced job enjoyment and performance. 3 The term burnout was first used in 1974 by Herbert J. Freunderberger in the United States to describe a range of symptoms, including decreased mood, lack of motivation to work, and mental and physical fatigue. 4 In 1980, investigating health professionals, Maslach and Jackson defined burnout as "physical and emotional fatigue that leads to a decrease or loss of motivation to work, which also leads to feelings of failure at work." 5 In 1982, they developed a scale for assessing burnout that had three components: depersonalization, decreased personal performance, and emotional exhaustion. 5 In 2019, the World Health Organization (WHO) described burnout as "chronic workplace stress that is not properly managed," defining it as a syndrome in the 11th edition of the International Classification of Diseases (ICD-11), with three indications: 1) feelings of energy depletion or exhaustion; 2) increased mental distance, or feelings of negativism or cynicism related to one's job; and 3) reduced professional efficacy. The International Classification of Diseases also identifies job burnout as a workplace-specific phenomenon that should not be used to describe similar experiences in other areas of life. 6 A meta-analysis reported a 25% prevalence of burnout in Iranian nurses between 2000 and 2017. 7 Another review and meta-analysis study showed that the global prevalence of burnout in nurses is 11.23%. 8 Compassion is an important variable in care services. The English word "compassion" comes from Latin and Greek "pati" and "pathein" (meaning suffering) and "com" (with). So compassion means "suffering" with someone else. 9 Compassion can be defined in different ways. For example, the Dalai Lama defined compassion as "openness to the suffering from others, with a commitment to alleviate it." 10 In recent years, the term "compassionate care" has been introduced because of the importance of compassion in health care settings. 11,12 On the other hand, other terms such as "compassion fatigue" have also been introduced. 13 Compassion can be directed to oneself 14 or to others. 15 Researchers have shown that sympathetic pity and concern about others through altruistic and voluntary acts are associated with psychological and physical benefits. 16,17 Compassion for others is associated with better relationships, mood improvement, 18 and improved psychological wellbeing. 19 Greater compassion for spouses is associated with a lower risk of mortality. 20 Beaumont et al. found that higher levels of compassion were associated with lower levels of burnout and compassion-related fatigue in student counselors and student cognitive behavioral psychotherapists. 21 However, another study found no significant relationship between compassion for others and burnout in student midwives. 22 On the other hand, research by Gilbert has shown that some people are afraid of expressing compassion. 23 In Gilbert's view, this fear can be in the form of fear of self-compassion, fear of compassion for others, and fear of compassion from others. 23 Studies have shown that fear of compassion is associated with fear of happiness and symptoms of psychopathology such as anxiety, stress, and depression. [24][25][26][27] So, perhaps one of the reasons for the exhaustion of the caregiver is the fear of compassion. Furthermore, in recent years, it has been opposed to the 'compassion fatigue' term. 28,29 Singer and Klimecki suggested that rather than compassion fatigue, we should think about empathy fatigue. 28 Based on Singer and Klimecki's work, Dowling suggests increasing the level of compassion through mindfulness meditation. 29 Although compassion is an important factor in mental health and well-being, the results of research into the relation between compassion for others and burnout are contradictory. There was a significant negative relationship between compassion for others and burnout in cognitive-behavioral therapists and counseling students. However, in another study, with midwifery students, no relationship between these two variables was found. On the other hand, research shows that fear of compassion is related to psychopathology.

Demographic questionnaire
Demographic data on the participants were obtained using a self-administrated questionnaire.

Compassion for others scale
This is a self-report measure that was developed by

Results
The

Discussion
This study aimed to investigate the relationship others and thus greater protection against disease. 33,34 Accepting compassion or support from others creates a buffer against numerous mental diseases that can be associated with psychological well-being. 33  In response to a lack of research into the variables of compassion for others and fear of compassion in the context of burnout in nurses, this study was conducted in order to investigate the relationship between burnout and compassion for others and fears of compassion scales. The results of this study proved that compassion for others could be associated with lower levels of burnout in nurses and somehow be positive for nurses' psychological and occupational health. On the other hand, fear of compassion scores were associated with high levels of burnout in nurses. Compassion can therefore be considered a protective factor in preventing burnout among nurses.