Purpose of the Current Study



Personality Predictors of Compassion Fatigue in Long-term Care Environments

Rachel Gallardo & Derek Rohde

Blinn College

Quality healthcare and the professionals that provide it are an important part of American society. Compassion fatigue can significantly impact the quality of care for patients and also the quality of life for the caregiver. Little is known about the effect that individual and demographic characteristics may have on the etiology of the compassion fatigue syndrome. This study investigated the prevalence of, and the relationships between, personality types, demographic characteristics and compassion fatigue. A correlational and comparative research design was employed. Long-term care workers, including registered nurses, licensed vocational nurses, certified medication aides, and certified nurse aides (N = 234) from 7 facilities across the state of Texas participated in the study. Findings indicated that 70% of the participants were in the “high risk” category for compassion fatigue. Personality was a significant predictor of compassion fatigue. Multiple regression showed that Big Five personality traits were significantly related to a risk for compassion fatigue, accounting for 37% of the variance (p < .001). Demographic groupings of tenure, licensure type, hours worked, and number of patients cared for were also assessed for their influence on compassion fatigue. Employment tenure was the only demographic grouping directly related to compassion fatigue in this study. The less-than-1-year-of-tenure group showed the lowest level of compassion fatigue and demonstrated a significantly lower level than all of the other comparison groups. Additional findings and implications are discussed.

Nurses worldwide are dealing with issues of heavy workloads, staff shortages, inadequate management support, lack of supplies, an aging workforce, poor working conditions, limited opportunities for educational development, and unstable work environments (Buchan, 2006; Wallis, 2015). The number of palliative care hospitals in the United States has increased 157% in the last 11 years (Center to Advance Palliative Care, 2013). This increase in the number of palliative care hospitals has led to a rise in the number of direct patient care workers needed to care for patients.

Research shows the complex issues occurring in the nursing field contribute to the nursing shortage in healthcare (Fox & Ambrahamson, 2009; Wallis 2015). Turnover rates within healthcare have been found to fluctuate between 10% and 50% (Flint & Webster, 2011). A study completed in 2013 found a 17% vacancy rate for nurses, up from 5.5 % in 2009 (Budryk, 2013), with 51% of nurses worried that their jobs may be negatively affecting their health (AMN Healthcare, 2013). The need to retain direct patient care staff will become increasingly important as baby boomers continue to age. The U.S. Census Bureau (2014) projects that by the year 2030, 20% of U.S. residents will be aged 65 and over, compared with 13% in 2010 and 9.8% in 1970. If current turnover trends and vacancy rates continue, additional pressure and exposure will be put on direct patient care workers to provide care for the aging population. Direct care workers repeatedly exposed to the declining health of long-term care patients can experience a diminished desire to provide care, and these negative cognitive, emotional, and behavioral consequences are often referred to as compassion fatigue (CF) (Adams et al., 2006; Bride, Radey, & Figley, 2007).

Compassion Fatigue

CF is defined as the reduced capacity for empathy toward clients resulting from the repeated exposure to client trauma (Adams, Boscarino, & Figley, 2006; Thieleman & Cacciatore, 2014). Figley (2002) described CF as “a state of tension, preoccupation, persistent arousal, and anxiety associated with a patient” (p. 125). CF is the emotional, physical, social, and spiritual exhaustion that overtakes a person and causes a decline in his or her desire, ability, and energy to feel and care for others (McHolm, 2006; Pfifferling & Gilley, 2000). If not properly treated, the direct patient care worker suffering from CF is at risk of harming the patient and him or herself (Jackson, Burns, & Richter, 2014). Furthermore, if the individual does not address the fatigue, they are at an increased risk of burnout, resulting in exhaustion, cynicism, and a reduced sense of personal accomplishment, which has been shown to be a strong predictor of turnover intentions (Lee & Ashforth, 1996). Once CF progresses to burnout, the associated symptoms are not as reversible as they are with CF (Figley, 2002).

Understanding factors that influence the etiology of CF can support efforts to reduce the occurrence of CF and may help reduce turnover, recruitment, and orientation costs for the organization. To date, there is little research examining factors that might contribute to CF in those who care for geriatric patients in skilled rehabilitation, assisted living, or hospice (long-term care) environments. The lack of data for this demographic within healthcare was the motivation for this study.

Personality and Compassion Fatigue

Personality is a key component of an individual that is not easily changed (Mischel & Shoda, 1998). Personality may impact an individual’s choice of occupation, his or her role in the work environment, as well as how he or she may respond to stressful situations (Halama & Gurnakova, 2014). This influence of personality on behavioral responses to stress has the potential to influence the perspective of CF in the work environment.

The five factor model of personality (FFM) was first introduced to academic audiences in 1961 but did not reach organizations until the 1990s (Costa & McCrae, 1992). The FFM provides a broad analysis of personality characteristics an individual possesses but is not designed to be all-inclusive or to dictate all areas of an individual’s personality. The FFM is comprised of the following traits: openness, conscientiousness, extraversion, agreeableness, and neuroticism (O’Connor, 2002).

In the following paragraphs we will explain each factor in conjunction with how it could be connected to CF from a behavioral perspective. Because each trait is fluid in nature, only the behavior expectancies (i.e., the negative behaviors associated with direct patient care in conjunction with CF) will be discussed.

Openness to Experience. Those with a high level of openness to experiences are typically open to new actions, ideas, and values (McCrae & Costa, 2006). Awareness of these feelings may contribute to the individual recognizing when he or she is becoming fatigued.

Conscientiousness. Highly conscientious people are quick to show self-discipline and can direct their impulses, making them less likely to act impulsively (Saucier & Goldberg, 1996). These individuals are typically predictable and not likely to step outside of their comfort zone. The highly conscientious person is not as easily able to take risks as those who are not so conscientious. The constant exploration of ideas, self-discipline, and careful guidance of each step may create fatigue in the highly conscientious person because such diligent and meticulous thought processing can be time consuming and mentally draining.

Furthermore, a person scoring high in conscientiousness within the FFM indicates perseveration and rigid perfectionism within the DSM-5 traits (Trull, 2012). If a person scores high in conscientiousness, his or her ability to maintain rigid perfectionism or the pursuit of excellence with patients who are not able to adequately care for themselves, may lead to the caregiver becoming frustrated and possibly leading to CF.

Extraversion. Individuals scoring high in extraversion enjoy stimulation from external means outside of the person’s normal day-to-day experience (Grucza & Goldberg, 2007). These individuals tend to be enthusiastic and action oriented. The warmth and eagerness of a person with high extraversion tendencies allow for these individuals to more easily discuss their issues and obtain the support they need from others to lower the risk of developing CF. Extraverts have higher social engagement and energy level than introverts (Grucza & Goldberg, 2007). People with introverted personalities are generally reserved in social situations, which can be perceived as unfriendly or antisocial, a potentially negative trait for a direct patient care worker who needs to be friendly with all patients, families, and fellow coworkers (Grucza & Goldberg, 2007). In essence, the more extraverted the caregiver, the more engaged with their patients the caregiver is likely to be, thus potentially decreasing the likelihood of CF.

Agreeableness. Agreeableness is the ability of a person to get along with another person (Paunonen & Ashton, 2001). Caregivers who score high on this trait are trustful, helpful, and willing to compromise as needed (Paunonen & Ashton, 2001). Agreeableness can be a problem for direct care workers in that their role is not always to agree with the patient but to help direct the person’s care. At times the patient will go against what is necessary for his or her health, and a person with a high degree of agreeableness may allow the patient to do as he or she pleases even if it is not in the patient’s best interest.

Neuroticism. Those scoring high on the neuroticism trait have a propensity to experience negative emotions and have a low tolerance for stress (Levy & Lounsbury, 2011; Paunonen & Ashton, 2001). Although direct patient care workers are responsible for providing appropriate care, workers with a high degree of neuroticism may find the caretaking role very difficult because of the tendency to worry, be impulsive, and lack the ability to deal with their own problems. Further summary of neuroticism in comparison to the FFM traits indicates emotional liability, anxiousness, and separation insecurity (Trull, 2012). Based on the characteristics of the FFM, it is possible for a person with high neuroticism to have high CF because of emotional liability, the likelihood for depression, and anxiousness.

Current Study Rationale

Recent literature has addressed CF in a number of populations, such as oncology nurses, emergency room nurses, doctors, police officers, and social workers (Harr, 2013; Jung-Min & Young-Hee, 2013; Kim, 2013; Lynch & Lobo, 2012; Peterson & Wanzer, 2014; Slocum-Gori, Hemsworth, Chann, Carson, & Kazanjian, 2013). A review of the literature indicates a paucity of research regarding direct patient care workers in long-term care environments. Given the predicted population trends of the United States and the need of workers in these markets, workers with these patients should be assessed. We targeted multiple types of long-term care providers in this research, including those from skilled rehabilitation centers and assisted living and hospice facilities. While the demands placed on the direct patient care worker are different across locations, the population of patients cared for is similar, bringing a cohesiveness to the study and participant demographics chosen for research.

Nurses typically enter the profession with a strong desire to help others, but the consequences of constantly putting patient needs before the care provider’s needs lead many nurses to lose their passion for healthcare (Bloniasz, 2011). Gaining a better understanding of CF in long-term care environments may help decrease the irritability, aggravation of physical ailments, and lack of joy in life (Potter et al., 2010) that impact a patient care provider’s ability to care for their patients.

Research Questions

We designed this study to identify direct patient care workers employed in a long-term care environment and determine if personality or demographic variables played a role in the etiology of the stress-related disorder, CF. Two research questions were the focus of this study:

RQ1: When it comes to displaying compassion fatigue in a long-term care environment, what is the role of the Big Five personality factors in the examination of the syndrome?

RQ2: Is demographic information provided by direct patient care workers in a long-term care environment related to levels of compassion fatigue?

Method

DESIGN AND SETTING

We used a correlational and comparative research design to identify direct patient care worker CF and explore personality types that may be inclined to exhibit signs of CF. This study was carried out across the state of Texas with participants possessing varying amounts of experience working within a direct patient nursing capacity in a long-term care setting. Participants were registered nurses, licensed vocational nurses, certified medication aides, and certified nurse aides. These workers were chosen because of their extensive interaction with long-term care patients and potential vulnerability to CF, due to their daily interactions with said patients.

Procedure and Sample

Power analysis indicated a required sample size of 189 participants. Data collection occurred over a 3-month period through various channels. We contacted multiple long-term care facilities across the state of Texas, with seven facility executive directors allowing their staff to participate in the study. Additionally, social media was used to solicit participation from individuals working in long-term care facilities meeting the inclusion criteria. Data collection was carried out using the Internet-based tool, Survey Monkey, and produced a sample size of 234 participants across all avenues of inquiry.

Instruments

We chose commonly used instruments to assess CF and personality in this study. Additionally, the Big Five Personality Test was used to examine personality facets and their relationship to CF. Each scale, its scoring, reliability, and validity will be described in the following subsections.

ProQOL V. The ProQOL V (Stamm, 2005) is a revision of the original CF Self-Test (Figley, 1995). It is a 30-item measure designed to assess compassion satisfaction, burnout, and CF (Stamm, 2005). Sample items include questions related to how the participant has felt in the last 30 days of employment. Participants are asked to respond to the questions on a Likert scale ranging from 1 (Never) to 5 (Very Often). The scales are summed to indicate the levels of compassion satisfaction, burnout, and CF or secondary traumatic stress. The ProQOL has a history of adequate reliability and validity in the measurement of this syndrome (Figley, 1995). Previous research has produced reliability coefficients ranging from .71 to .90 (Aycock & Boyle, 2009). Cronbach’s alpha in the present study was .67.

Big Five Personality Test NEO-FFI. The Big Five Personality Test is one of the most accepted classifications for personality traits (Scholte, Lieshout, Cees, & Aken, 2005). In this study, we used the NEO-FFI developed by Costa and McCrae (1992), which contains 60 items and a 5-point Likert response scale ranging from 1 (no confidence at all) to 5 (complete confidence). Costa and McCrae reported the following Cronbach alpha coefficients for each of the factors: neuroticism (.86), extraversion (.77), openness (.73), agreeableness (.71), and con-scientiousness (.81). Other researchers looking at the psychometric properties of the NEO-FFI revealed internal consistencies across five studies well above .60 and a demonstrated pattern of convergent, discriminant, and criterion-related validity (Donnellan, Oswald, Baird, & Lucas, 2006). Each personality factor on the test consists of 12 items.

Results

SAMPLE CHARACTERISTICS

Data collection took place over 86 days and resulted in a total of 234 participants. While most participants completed all of the demographic and survey questions, some chose to omit answers to certain questions. Of those responding to the demographic questions, the majority identified as African American (48.5%) and Caucasian (35%). While a broad age range participated in the study (18–60+), the majority of the participants

| | | | |

|TABLE 1 Demographic Characteristics of Sample | | | |

| | | |

|Characteristic |  |Frequency |% |

|Race |African American |102 |43.5 |

| |Caucasian |74 |31.6 |

| |Hispanic or Latino |19 |8.1 |

| |American Indian |3 |1.2 |

| |Asian |3 |1.2 |

| |Other |6 |2.5 |

| |Missing |27 |11.5 |

|Age |> 18-25 |22 |9.4 |

| |26-35 |63 |26.9 |

| |36-45 |65 |27.7 |

| |46-55 |44 |18.8 |

| |> 56 |16 |6.8 |

| |Missing |24 |10.2 |

|Licensure |Registered Nurses (RN) |42 |17.9 |

| |Licensed Vocational Nurses |53 |22.6 |

| |Certified Medication Aides |29 |12.3 |

| |Certified Nurse’s Aides |78 |33.6 |

| |Missing |32 |13.6 |

|Number of Patients |1 to 10 |35 |14.9 |

| |11 to 20 |71 |30.3 |

| |21 to 30 |55 |23.5 |

| |30 or More |55 |23.5 |

| |Missing |18 |7.6 |

|Hours Worked Per Wk|10 or Fewer Hours |17 |7.2 |

| |11 to 20 Hours |7 |3 |

| |21 to 32 Hours |27 |11.5 |

| |33 to 40 Hours |70 |30 |

| |40 + Hours |83 |35.4 |

| |Missing |30 |12 |

|Tenure |Less than 1 year |14 |5.9 |

| |1 to 6 years |61 |26 |

| |7 to 12 years |54 |23 |

| |13 to 18 years |26 |11.1 |

| |19 to 24 years |18 |7.6 |

| |25 or more years |14 |5.9 |

|  |Missing |47 |20 |

(73%) were between 26 and 50. With respect to licensure, 33.6% of the respondents were certified nursing aides, followed by licensed vocational nurses (22.8%), registered nurses (14.4%), and certified medication aides (9.8%). Nursing tenure ranged from less than 1 year (7.5%) to 25 or more years (7.5%), with 50% of the respondents falling into the 1 to 12-year range. Table 1 presents all of the demographical data for the participants in this study.

The risk for CF in this study was high. The average CF score for participants in this study was M = 21.9, SD = 6.6. This is higher than the scores produced by Stamm (2005) in the ProQOL manual (M = 13, SD = 6.3). Stamm developed cut scores to help estimate relative risk for the development of CF using a conservative quartile method of high risk (top 25%, CF score = 17); middle risk (50%, CF score = 13); and low risk (bottom 25%, CF score = 8). Participants in this study demonstrated a strong risk for CF with 18.4% and 69.7% scoring in the mid to high range of the scale respectively. Table 2 provides a summary of the cut scores for relative risk of fatigue for the participants in this study.

| |

|TABLE 2 Compassion Fatigue Levels |

| |

| |

for CF, R2 = .37, F(5, 201) = 23.82, p < .001, indicating that 37% of the variance can be accounted for by the linear combination of personality traits.

In Table 4, effect sizes are presented to indicate the relative strength of the individual predictors. Four of the bivariate correlations between the individual personality factors and the risk for CF were negative, with only neuroticism showing a positive relationship. Of the five predictor variables, only extraversion (p = .05) and neuroticism (p > .01) were statistically significant.

|The second research question was focused on demographic information provided by direct |

|patient care workers in a long-term care environment. We conducted four ANOVA tests to |

|examine the role of demographic variable groupings and their influence on the development |

|of CF. Of the four demographic variables tested, only tenure was significant F(5, 199) = |

|4.11, p < .01. |

|Follow-up tests were conducted to identify the pairwise differences among the means. |

|Levene’s test of the homogeneity of variances was not significant, and therefore, the |

|Tukey HSD test was used. The tenure demographic variable consisted of six categorical |

|groupings ranging from less than a year to 25 or more years in 5-year increments. The |

|less-than- 1-year group showed the lowest level of CF and demonstrated a significantly |

|lower level than all of the other comparison groups. Table 6 provides a summary of the |

|Tukey HSD post hoc analysis for tenure. |

|TABLE 4 Summary of Multiple Regression Analysis for Personality |

|Predicting CF |

|Predictors |B |SE B |β |Correlations w/ predictors |

| | | | |& CF controlling for all other |

| | | | |predictors |

|Openness |.130 |3.57 |.11 |.12 |

|Conscientiousness |-.02 |.07 |-.02 |-.02 |

|Extraversion |-.15 |.08 |-.15 |-.14* |

|Agreeableness |-.04 |.06 |-.05 |-.05 |

|Neuroticism |.41 |.06 |.50 | .42** |

* p < .05, ** p < .00

|TABLE 5 One-Way Analysis of Variance on Demographics and CF |

| |

|Demographic variables |df |F |η2 |p |

| |Between groups | | |

|Tenure |(5, 199) |4.11 |.09 |< .01 |

|Licensure |(3, 203) |.18 |.00 |.91 |

|Hours Worked |(2,197) |.80 |.00 |.45 |

|Number of Patients |(3,189) |1.21 |.01 |.30 |

Discussion

THE FINDINGS ON LONG-TERM CARE DIRECT PATIENT CARE PROVIDERS IN THIS STUDY IS AN IMPORTANT STEP IN UNDERSTANDING THE EMERGENCE OF CF IN THE LONG-TERM CARE ENVIRONMENT. NEGATIVE BEHAVIOR TRAITS IN THE WORK SETTING MAY BE AN INDICATION THAT A DIRECT PATIENT CARE PROVIDER IS EXPERIENCING CF IN THEIR WORK SETTING. APPLYING THE DATA TO THE WORK ENVIRONMENT, IT SHOULD BE NOTED THAT THE LONGER A PERSON WORKS IN A LONG-TERM CARE ENVIRONMENT, THE MORE LIKELY THAT CF WILL EMERGE.

|TABLE 6 Tukey HSD Post Hoc Analyses for Tenure |

|Tenure Group |> 1 |1- 6 |7 -12 Yrs.|13-18 Yrs.|19-24 Yrs.|25+ |

|Contrast |Yr. |Yrs. | | | |Yrs. |

| |N=16 |N=66 |N=59 |N=29 |N=21 |N=14 |

|Mean CF Score |15.7 |21.38 |23.27 |22.27 |22.66 |24.42 |

|SD |3.5 |6.28 |6.23 |6.32 |7.45 |7.44 |

|p |NA |.02 |.01 |.02 |.02 |.01 |

If left unaddressed, CF may transform into burnout, an irreversible emotional and cognitive state for the worker. This high propensity for CF may also cause unnecessary harm to patients. For example, a person testing high in neuroticism is less able to control impulses and more prone to irrational ideas (Schacter, Gilbert, Nock, & Wegner, 2017). Combine this with an individual feeling fatigued from his or her job and numerous patients could potentially be in danger.

Just as it is important for workers to oversee their own personality traits and shifts in behavior (Simpson, Byrne, Gabbay, & Rannard, 2016), so is it equally significant for long-term care facilities to monitor the personality traits of the direct patient care workers (McCrae & Costa, 2003). Additionally, levels of extraversion and, neuroticism should be assessed with the administrators of these facilities. Questions regarding whether these leaders and the impact they may have on the workers, should be explored.

According to our results, individuals with CF are likely to score low in extraversion and high on neuroticism. Individuals scoring low in extraversion do not necessarily enjoy engaging with others in day-to-day experiences (Grucza & Goldberg, 2007). These individuals tend to be reserved and quiet, and they can come across as cold and uncaring.

Neuroticism is a long-term tendency to be in a typically negative state of mind. Those scoring high on the neuroticism trait have a propensity to experience negative emotions and have a low tolerance for stress (Levy & Lounsbury, 2011; Paunonen & Ashton, 2001), and an elevated likelihood of emotional liability, anxiousness, and separation insecurity Trull (2012).

It is not clear from our research if neuroticism causes compassion fatigue or vice versa. Regardless, the association between the two suggests that it is wise to monitor potential caregivers for the warning signs of neuroticism. If a neurotic individual begins exhibiting signs of CF, the person could become emotionally numb to their patients because they are preoccupied with their own problems.

Finally, tenure should be a dynamic reviewed in a long-term care environment. Those working in the long-term care environment for a longer period of time showed a higher level of CF. Over time, the stress of caring for these individuals starts to take its toll and CF may slowly begin to emerge. Those in charge of long-term care environments need to heed our results and find preventive solutions for CF, especially for those who have been employed for longer than a year. Perhaps the advice offered by Aycock and Boyle (2009) might provide a fruitful starting point.

Limitations and Recommendations

Generalization of the results of this study was limited by the fact that our sample came from one state. Additional studies should cast a wider net, and explore a broader range of personality and demographic variables. Moreover, because we were capturing a snapshot in time, the information for the personality types of these individuals prior to the data collection is missing. Participant information over a longer period may yield more valuable information than the snapshot we provided.

In conclusion, the current discourse on CF has served the nursing industry well by illuminating compassion as an essential concept in nursing (Ledoux, 2015). Exploring this concept in all areas of nursing is important, but special interest should focus on those who care for the geriatric community on a regular basis. Not doing so could yield profound emotional and physical impact, leaving a major population with inadequate resources to receive the care they desperately need.

References

ADAMS, R. E., BOSCARINO, J. A., & FIGLEY, C. R. (2006). COMPASSION FATIGUE AND PSYCHOLOGICAL DISTRESS AMONG SOCIAL WORKERS: A VALIDATION STUDY. AMERICAN JOURNAL OF ORTHOPSYCHIATRY, 76(1), 103-108.

AMN Healthcare. (2013). 2013 Survey of registered nurses: Generation gap grows as healthcare transforms. Retrieved from . com/uploadedFiles/MainSite/Content/Healthcare_Industry_Insights/Industry_Research/2013_RNSurvey.pdf.

Ayock, N., & Boyle, D. (2009). Interventions to manage compassion fatigue in oncology nursing. Clinical Journal of Oncology Nursing, 13(2), 183-191. doi:10.1188/09.CJON.183-191.

Bloniasz, E. R. (2011). Caring for the caretaker: A nursing process approach. Creative Nursing, 17(1), 12-15.

Bride, B., Radey, M., & Figley, C. (2007). Measuring compassion fatigue. Journal of Clinical Social Work, 35(3), 155-163.

Buchan, J. (2006). The impact of global nursing migration on health services delivery. Policy Politics in Nursing Practice, 7(1), 16-25.

Budryk, Z. (2013). Majority of hospital execs believe there is doctor, nurse shortage. Fierce Healthcare. Retrieved from . fiercehealthcare. com/story/majority-hospital-execs-believe-there-doctor-burse-shortage/2013-12-17.

Center to Advance Palliative Care. (2013). Growth of palliative care in US hospitals: 2013 snapshot. Retrieved from .

Costa, P. T., & McCrae, R. R. (1992). Revised NEO Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI) manual. Odessa, FL: Psychological Assessment.

Donnellan, M. B., Oswald, F. L., Baird, B. M., & Lucas, R. E. (2006). The Mini-IPIP scales: Tiny yet effective measures of the Big Five factors of personality. Psychological Assessment, 18(2), 192-203.

Figley, C. R. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York, NY: Brunner/Mazel.

Figley, C. R. (2002). Compassion fatigue: Psychotherapist’s chronic lack of self-care. Journal of Clinical Psychology in Session: Psychotherapy in Practice, 58(11), 1433-1441. doi:10.1002/jclp.10090.

Flint, A., & Webster, J. (2011). The use of exit interviews to reduce turnover amongst healthcare professionals. Cochrane Database of Systematic Reviews, 3(1), 1-13. doi: 10.1002/14651858.

Fox, R., & Abrahamson, K. (2009). A critical examination of the U.S. nursing shortage: Contributing factors, public policy implications. Nursing Forum, 44(4), 235-244.

Grucza, R. A., & Goldberg, L. R. (2007). The comparative validity of 11 modern personality inventories: Predictions of behavioral acts, informant reports, and clinical indicators. Journal of Personality Assessment, 89(2), 167-187.

Halama, P., & Gurnakova, J. (2014). Need for structure and Big Five personality traits as predictors of decision making styles in health professionals. Studia Psychologica, 56(3), 171-180.

Harr, C. (2013). Promoting workplace health by diminishing the negative impact of compassion fatigue and increasing compassion satisfaction. Social Work and Christianity, 40(1), 71-88.

Jackson, M. K., Burns, K. K., & Richter, M. S. (2014). Confidentiality and treatment decisions of minor clients: A health professional’s dilemma and policy makers challenge. SpringerPlus, 3(320), 1-8.

Jung-Min, L., & Young-Hee, Y. (2013). Effects of work stress, compassion fatigue, and compassion satisfaction on burnout in clinical nurses. Journal of Korean Academy of Nursing Administration, 19(5), 689-697.

Kim, S. (2013). Compassion fatigue in liver and kidney transplant nurse coordinators: A descriptive research study. Progress in Transplantation, 23(4), 329-335.

Ledoux, J. E. (2015). Anxious: Using the brain to understand and treat fear and anxiety. St. James’s Ward, United Kingdom: Penguin Books.

Lee, R., & Ashforth, B. (1996). A meta-analytic examination of the correlates of the three dimensions of job burnout. Journal of Applied Psychology, 81, 123-133. doi:10.1037/0021-9010.81.2.123.

Levy, J., & Loundbury, J. (2011). Big Five personality traits and performance anxiety in relation to marching arts satisfaction. Work, 40(3), 297-302.

Lynch, S. H., & Lobo, M. L. (2012). Compassion fatigue in family caregivers. Journal of Advanced Nursing, 68(9), 2125-2134. doi:10.1111/j.1365-2648.2012.05985.x.

McCrae, R. R., & Costa, P. T. (2003). Personality in adulthood: A five-factor theory perspective. New York, NY: The Guilford Press.

McCrae, R. R., & Costa, P. T. (2006). Age changes in personality and their origins. Psychological Bulletin, 132(1), 26-28.

McHolm, F. (2006). Rx for compassion fatigue. Journal of Christian Nursing, 23(4), 12-19.

Mischel, W., & Shoda, Y. (1998). Reconciling contextualism with the core assumption of personality psychology. European Journal of Personality, 14(5), 407-428.

O’Connor, B. (2002). A quantitative review of the comprehensiveness of the five-factor model in relation to popular personality inventories. Assessment, 9(2), 188-203.

Paunonen, S. V., & Ashton, M. S. (2001). Big Five factors and facets and the prediction of behavior. Journal of Personality and Social Psychology, 81(3), 524-539. doi:10.1037//002-3514.81.3.524.

Peterson, O. R., & Wanzer, L. (2014). Compassion fatigue in military healthcare teams. Archives of Psychiatric Nursing, 28(1), 2-9.

Pfifferling, J., & Gilley, K. (2000). Overcoming compassion fatigue. Family Practice Management, 7(4), 39-44.

Potter, P., Deshields, T., Divanbeigi, J., Berger, J., Cipriano, D., Norris, L., & Olsen, S. (2010). Compassion fatigue and burnout: Prevalence among oncology nurses. Clinical Journal of Oncology Nursing, 15(5), 56-62.

Saucier, G., & Goldberg, L. R. (1996). The language of personality: Lexical perspectives on the five-factor model. In J.S. Wiggins (Ed.), The five-factor model of personality: Theoretical perspectives (pp. 21-50). New York, NY: Guilford.

Schacter, D. L., Gilbert, D. T., Nock, M. K., & Wegner, D. M. (2017). Psychology (4th ed.). New York, NY: Worth Publisher, Macmillan Learning.

Simpson, G., Byrne, P., Gabbay, M. B., & Rannard, A. (2015). Understanding illness experiences of employees with common mental health disorders. Occupational Medicine, 65(5), 367-372.

Slocum-Gori, S., Hemsworth, D., Chann, W. W., Carson, A., & Kazanjian, A. (2013). Understanding compassion satisfaction, compassion fatigue, and burnout: A survey of the hospice palliative care workforce. Palliative Medicine, 27(2), 172-178.

Stamm, B. H. (2005). The ProQOL manual. Retrieved from .

Thieleman, K., & Cacciatore, J. (2014). Compassion fatigue among traumatic bereavement volunteers and professionals. Social Work, 59(1), 34-41.

Trull, T. J. (2012). The five-factor model of personality disorder and DSM-5. Journal of Personality, 80(6), 1697-1720.

U.S. Census Bureau. (2014). 2014 National population projections. Retrieved from .

Wallis, L. (2015). Moral distress in nursing. American Journal of Nursing, 115(3), 19-20.

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download