Direct effects of workgroup culture differentials on burnout, compassion fatigue and compassion satisfaction. Can one's cultural beliefs mitigate these effects?

• Author: Hemsworth, David
• Position: Report

1.0 INTRODUCTION AND BACKGROUND

Employee burnout, compassion fatigue and secondary traumatic stress are often pronounced in areas of the health care industry that deal with end-of-life and palliative care professionals. There is a paucity of research that examines impact of workplace culture, in its various manifestations, in mediating the negative effects of this demanding work setting. This study uses structural equation models to test how individual--workgroup cultural differentials in palliative care workers can decrease compassion satisfaction; increase burnout and compassion fatigue and how support for cultural believes, values and heritage can mitigate the negative effects and increase worker satisfaction.

Surprisingly, there is a gap within the palliative/end-of-life literature in how cultural factors impact levels of Compassion satisfaction (CS), Compassion fatigue (CF) and Burnout (BO). Furthermore, little is known of the optimal combination of personal attributes of workers, organizational culture and system structure that will support and sustain best practices in palliative care and minimize staff turnover. Bosma et al (2010) conducted a systematic review to identify literature that discussed the cultural dimensions of Hospice Palliative Care (HPC). The results revealed that culture plays an important role in HPC, particularly in Canada where populations comprise of many diverse ethnicities and cultures. To deepen our understanding of culture, we worked to refine existing instruments to be more appropriate for palliative care and end-of-life populations.

2.0 RESEARCH DESIGN AND METHODS

Palliative health care professionals from the member organizations of the Canadian Hospice Palliative Care Association were surveyed (n=504). Measured constructs included, workplace culture differences, burnout, compassion fatigue, compassion satisfaction and micro/meso/macro cultural beliefs. Impacts of gender, employment status, and education on the aforementioned constructs were determined. Additionally, structural equation models were utilized to determine the significant direct and indirect relations among the constructs and to build a graphical model to visualize/describe/test these interactions.

Identification of the Target Population

Health professionals whose primary area of responsibility is palliative care and unpaid volunteers were included in the target population of the research. The approach utilized to target the population was utilized in previous research by our team members (Kazanjian and Pagliccia, 1996). The Canadian Hospice Palliative Care Association (CHPCA) was approached to provide their membership list as a starting point for contacting managers and administrators of HPC organizations. Individual organizations were then approached to inform them of our study and request lists of the palliative care providers in their employ. Hospice and palliative care associations from each province were also contacted for this purpose

Measures

B.H. Stamm's The Professional Quality of Life Scale (ProQOL) contains 30 items in total and was used as part of the palliative workforce questionnaire. The ProQOL is a 5 point likert scale that consists of three subscales: Compassion Satisfaction, Burnout, and Compassion Fatigue. Each scale is psychometrically unique and cannot be combined with the other scores. Therefore, the ProQOL do not yield a composite score. Although ProQOL was originally developed for emergency personnel and trauma counselors, the scale has been utilized internationally and has been psychometrically validated in various studies for various target populations (Figley & Stamm 1996). While therapists were the original target, the measure is used widely with other groups including medical health professionals (particularly nurses), teachers, lawyers, humanitarian workers, social service employees, public service employees such as law enforcement, reporters and journalists, juries at trials, and even soldiers and peace keepers (Figley & Stamm, 1996; Jenkins & Baird, 2002; Larsen, Stamm, & Davis, 2002). However, the ProQOL has been used very little with health care professionals within palliative care. Thus in the initial stage of this study, we conducted focus groups to begin the validation processes of this measure for palliative workers.

The nursing unit assessment tool (NUCAT-3) was developed by Harriet Coeling at the University Michigan School of Nursing and the validity of the tool has been established by a series of research studies in addition to further clarity and relevance testing (Coeling and Simms 1993). Twelve out of 50 NUCAT-3 items were selected to describe three cultural behaviors, professional and personal development, team work and decision-making. Respondents were asked to describe each of the cultural behaviors along two 5 point likert-type scales based on two perspectives: work group practices and own individual practices. The two perspectives allowed the assessment of both macro and meso cultural aspects of the palliative workforce. The results of this tool do not yield a total composite score and the only valid way to analyze the NUCAT data is to analyze each item...