Stress, burnout, and compassion fatigue of undergraduate nursing students at a public university during the COVID-19 pandemic
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The Professional Quality of Life conceptual framework forms the foundation for this study and was developed by Stamm (2010:8). This framework explains how stress, secondary trauma, burnout, and compassion fatigue have a negative effect on undergraduate nursing students’ psychological wellbeing. Undergraduate nursing students have been found to have more stress than other students during their studies (Chowet al., 2018:2; Labrague, 2013:424; Turner & McCarthy, 2017:21). This is due to their high academic workload and clinical hours required for nursing competency (Chernomas& Shapiro, 2013:1; Labrague, 2013:428). Stress over a prolonged period of time can lead to burnout (Ferriet al., 2015:106). Burnout in combination with secondary trauma can cause compassion fatigue (Stamm, 2010:13). Secondary trauma is caused by being exposed to someone else’s extremely negative or traumatic experiences within a caring capacity (Stamm, 2010:13). Compassion fatigue summarises the negative effects of caring (Chachula, 2021:2). In opposition to the negative factors, there is compassion satisfaction (Stamm, 2010:12). Compassion satisfaction can be described as the psychological fulfilment of doing work well and acts as a protective agent against compassion fatigue and burnout (Hegneyet al., 2014:507; Hinderer et al., 2014:161; Manson, 2013:28; Mason & Nel, 2012:451; Stamm, 2010:12).The research design for this study was a descriptive cross-sectional survey. The levels of perceived stress, burnout, compassion fatigue, and compassion satisfaction experienced by undergraduate nursing students at a School of Nursing at a university in central South Africa were described. The levels of stress, burnout, compassion fatigue, and compassion satisfaction experienced by first- and second-year students during the coronavirus disease 2019 (COVID-19) pandemic were compared to the levels experienced by first- and second-year students prior to the pandemic in 2018, based on an existing dataset at the same university (Engelbrecht & Wilke, 2021:142). All students at the selected university who were enrolled in the Bachelor’s Degree in Nursing were asked to participate. Of the 288 students, 108 participated in the study; the response rate was 38%. Three previously validated and reliable scales were used – namely, the Maslach Burnout Inventory Human Services Survey (MBI-HSS), Professional Quality of Life Scale (ProQOL-5), and the Perceived Stress Scale (PSS). Additional biographical information and information concerning COVID-19 was also added. Data collection took place just before the ‘second wave’ of COVID-19 at the end of 2020, during the final examinations. No undergraduate nursing students were completing practical hours at this time. Data were cleaned and analysed in the Statistical Package for the Social Sciences (SPSS). Descriptive statistics, including frequency counts and percentages, were calculated for categorical variables. Means, medians, and standard deviations were calculated for continuous variables. Cronbach’s alpha was used to test the internal consistency of the scales and sub-scales. One-way analysis of variance (ANOVA) was used to determine whether there were any statistically significant differences between the means of first-, second-, third-, and fourth-year students on perceived stress, emotional exhaustion, depersonalisation, personal accomplishment, compassion fatigue, and compassion satisfaction. Multiple regression was run to predict compassion fatigue in nursing students from year of study, emotional exhaustion, depersonalisation, and perceived stress. The independent sample t-test was used to determine if there was a statistically significant difference between the mean scores for perceived stress, emotional exhaustion, depersonalisation, personal accomplishment, compassion fatigue, and compassion satisfaction of first- and second-year nursing students who participated in the 2018 study and first- and second-year nursing students who participated in the current study. Ethical clearance was obtained from the Health Science Research Ethics Committee of the Faculty of Health Sciences, University of the Free State. The results of the study indicated that undergraduate nursing students had moderate levels of stress. These findings were similar to other studies that also used the PSS in South Africa (Engelbrecht &Wilke 2021:142) and in Saudi Arabia (Shdaifat et al. 2018:33; Waled & Mohammed, 2019:121). With regards to burnout, the emotional exhaustion sub-scale suggested moderate risk for emotional exhaustion – the first stage of burnout. The participants were at average risk for depersonalisation – the second stage of burnout. Moderate levels of personal accomplishment were also identified. These study findings for burnout correlated with findings of another South African study (Engelbrecht & Wilke, 2021:142).The students were found to have moderate levels of compassion fatigue, which was similar to several other studies that also used the ProQOL– both internationally (Beaumont et al., 2016:242; Caoet al., 2021:1) and in South Africa (Engelbrecht & Wilke, 2021:142;Manson, 2013:28; Mason & Nel, 2012:454; Mathias &Wentzel, 2017:5). Moderate levels of compassion satisfaction were also reported, which correlates with several other South African studies (Engelbrecht & Wilke, 2021:142; Mason & Nel, 2015; Mathias & Wentzel, 2017:5). Second-year nursing students had higher mean scores for compassion fatigue than first-year nursing students. This might be due to the fact that second-year nursing students have to complete double the number of practical hours than first-year students. Emotional exhaustion, depersonalisation, and perceived stress were all statistically significantly associated with compassion fatigue. When comparing the first- and second-year nursing students' levels of perceived stress, burnout, compassion fatigue, and compassion satisfaction in this study to that of a previous study done at the same public university in 2018 (Engelbrecht & Wilke, 2021:142), it was found that students in the current study (during COVID-19) had higher scores on personal accomplishment than the students in the 2018 (pre-COVID-19) group. This might be because data collection took place during exams, when no practical hours were being worked by undergraduate nursing students. The findings of this study are similar to those identified in earlier international and national research publications. Therefore, the recommendations align with those of previous studies and include the introduction of stress- and time-management workshops (Langtree et al., 2018:94; Manson, 2013:23; Waled & Mohammed, 2019:121). It is recommended that future research explore how coping strategies could improve the psychological wellbeing of undergraduate nursing students.