The impact of the alterations in caring for COVID-19 patients on Compassion Satisfaction and Compassion Fatigue in Italian nurses: a multi method study

The impact of the alterations in caring for COVID-19 patients on Compassion Satisfaction and Compassion Fatigue in Italian nurses: a multi method study


  • Chiara Cosentino University of Parma
  • Chiara Foà Department of Medicine and Surgery, University of Parma, Italy
  • Maria Bertuol
  • Valentina Cappi Department of Sociology and Business Law, University of Bologna, Italy
  • Serena Riboni Department of Medicine and Surgery, University of Parma, Italy
  • Sandra Rossi Department of Medicine and Surgery, University of Parma, Italy
  • Giovanna Artioli Department of Medicine and Surgery, University of Parma, Italy
  • Leopoldo Sarli Department of Medicine and Surgery, University of Parma, Italy


COVID-19, nurses, multi-method approach, compassion satisfaction, compassion fatigue, Italy


Background and aim of the work: During COVID-19 first wave,  healthcare professionals were exposed to a major psychological pressure related to uncertainty, a lack of therapies or a vaccine and shortages of healthcare resources. They developed higher levels of Burnout and  Compassion Fatigue, and similar levels of Compassion Satisfaction. Aim is evaluating in Italian nurses Compassion Satisfaction and Compassion Fatigue and impacting individual and relational variables.

Methods: A multi-methods approach was used. Qualitative data were collected through 2 focus group. Quantitative data were collected through a web survey composed by an ad hoc questionnaire developed from the focus group results, the Professional Quality of Life Scale-5 and the Resilience Scale (RS-14).

Results: In the qualitative phase 6 categories emerged. From the quantitative analysis the sample reported a moderate level of Compassion Satisfaction, a low level of Burnout  and a moderate level of Secondary Traumatic Stress. Compassion Satisfaction had as predictors resilience (β = .501), followed by feeling part of the team (β = .406) and collaboration with colleagues (β = .386). Secondary Traumatic Stress had as predictors the impact of PPE (β = .269), and feeling Covid-related individual sufferance (β = .212). The only predictor of Burnout was resilience (β = -2195). Conclusions: During COVID-19 first wave Italian nurses were exposed to a higher risk of Secondary Traumatic Stress, mainly impacted by frustration, loss of control, loss of possibility to properly care for patients, and personal threat. Relational and team support had a crucial role in sustaining Compassion Satisfaction.


WHO Coronavirus (COVID-19) Dashboard. Retrieved February 18, 2022 from

Statistiche coronavirus in Italia [Coronavirus stats in Italy]. Retrieved February 18, 2022 from

Tian T, Meng F, Pan W, Zhang S, Cheung T, Ng CH, ... Xiang YT. Mental health burden of frontline health professionals treating imported patients with COVID-19 in China during the pandemic. Psychol Med 2020; 1-2.

L'epidemiologia per la sanità pubblica Istituto Superiore di Sanità [Epidemiology for public healthcare]. Retrieved February 18, 2022 from

Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, ... Hu S. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA network open 2020; 3(3); e203976-e203976.

Danet AD. Psychological impact of COVID-19 pandemic in Western frontline healthcare professionals. A systematic review. Med Clin (English Edition) 2021; 156(9); 449-458.

Wu PE, Styra R, Gold WL. Mitigating the psychological effects of COVID-19 on health care workers. Cmaj 2020; 192(17); E459-E460.

Barello S, Palamenghi L, Graffigna G. Burnout and somatic symptoms among frontline healthcare professionals at the peak of the Italian COVID-19 pandemic. Psychiatry Res 2020; 290; 113129.

Trumello C, Bramanti SM, Ballarotto G, Candelori C, Cerniglia L, Cimino S, ... Babore A. Psychological adjustment of healthcare professionals in Italy during the COVID-19 pandemic: differences in stress, anxiety, depression, burnout, secondary trauma, and compassion satisfaction between frontline and non-frontline professionals. Int J Environ Res Public Health 2020; 17(22); 8358.

da Silva FCT, Barbosa CP. The impact of the COVID-19 pandemic in an intensive care unit (ICU): Psychiatric symptoms in healthcare professionals. Prog Neuropsychopharmacol Biol Psychiatry 2021; 110;110299.

De Leo A, Cianci E, Mastore P, Gozzoli C. Protective and risk factors of Italian healthcare professionals during the COVID-19 pandemic outbreak: a qualitative study. Int J Environ Res Public Health 2021; 18(2); 453.

Ruiz‐Fernández MD, Pérez‐García E, & Ortega‐Galán ÁM. Quality of life in nursing professionals: Burnout, fatigue, and compassion satisfaction. Int J Environ Res Public Health 2020; 17(4); 1253.

Kübler-Ross E. On Death and Dying: What the Dying have to Teach Doctors, Nurses, Clergy and their own Families. Routledge 2008.

Tehranineshat B, Rakhshan M, Torabizadeh C, Fararouei M. Nurses’, patients’, and family caregivers’ perceptions of compassionate nursing care. Nurs Ethics 2019; 26(6); 1707-1720.

Bobbo, N. (2021). Daniele Bruzzone, Lucia Zannini (Eds.), Sfidare i tabù della cura. Percorsi di formazione emotiva dei professionisti [Challenging care taboos. Emotional trainings for professionals], Franco Angeli, Milano 2021.

Ray SL, Wong C, White D, Heaslip K. Compassion satisfaction, compassion fatigue, work life conditions, and burnout among frontline mental health care professionals. Traumatology 2013; 19(4); 255-267.

Burnett Jr HJ, WahlK . The compassion fatigue and resilience connection: A survey of resilience, compassion fatigue, burnout, and compassion satisfaction among trauma responders. Int J Emerg Ment Health 2015; 17(1); 318-326.

Zhang YY, Zhang C, Han XR, Li W, Wang YL. Determinants of compassion satisfaction, compassion fatigue and burn out in nursing: A correlative meta-analysis. Med 2018; 97(26).

Ames M, Salmond E, Holly C, Kamienski M. Strategies that reduce compassion fatigue and increase compassion satisfaction in nurses: A systematic review protocol. JBI Evid Synth 2017; 15(7); 1800-1804.

Peters E. Compassion fatigue in nursing: A concept analysis. Nurs Forum 2018; 53(4); 466-480.

Coetzee SK, Klopper HC. Compassion fatigue within nursing practice: A concept analysis. Nurs Health Sci 2010; 12(2); 235-243.

Stamm BH. The Concise ProQOL Manual, 2nd ed. Eastwoods LLCC, Denver, CO, USA, 2010.

Ruiz‐Fernández MD, Ramos‐Pichardo JD, Ibáñez‐Masero O, Cabrera‐Troya J, Carmona‐Rega MI, Ortega‐Galán ÁM. Compassion fatigue, burnout, compassion satisfaction and perceived stress in healthcare professionals during the COVID‐19 health crisis in Spain. J Clin Nurs. 2020; 29: 4321– 4330.

Drury V, Craigie M, Francis K, Aoun S, Hegney DG. Compassion satisfaction, compassion fatigue, anxiety, depression and stress in registered nurses in A ustralia: Phase 2 results. J Nurs Manag 2014; 22(4); 519-531.

Adams RE, Boscarino JA, & Figley CR. Compassion fatigue and psychological distress among social workers: A validation study. Am J Orthopsychiatry 2006; 76(1); 103-108.

ProQOL Professional Quality of Life. Retieved February 18, 2022 from

Zhou Q, Lai X, Wan C, Zhang X, Tan, L. Prevalence and impact of burnout, secondary traumatic stress and compassion satisfaction on hand hygiene of healthcare workers in medical aid team during COVID-19 pandemic. Researchsquare preprint 2020

Youngson R. Time to care: How to love your patients and your job. New Zealand: Rebelheart Publishers 2012

Youngson, R. Forward. In Shea S, Wynyard R, Lionis C (Eds.). Providing compassionate healthcare: Challenges in policy and practice. Routledge, London, UK, 2014.

Lorente L, Vera M, & Peiró T. Nurses stressors and psychological distress during the COVID‐19 pandemic: The mediating role of coping and resilience. J Adv Nurs 2021; 77(3); 1335-1344.

Wallace CL, Wladkowski SP, Gibson A, WhiteP. Grief during the COVID-19 pandemic: Considerations for palliative care providers. J Pain Symptom Manage 2020; 60(1); e70-e76.

Lluch-Sanz C, Galiana L, Doménech-Vañó P, Sansó N. The Impact of the COVID-19 Pandemic on Burnout, Compassion Fatigue, and Compassion Satisfaction in Healthcare Personnel: A Systematic Review of the Literature Published during the First Year of the Pandemic. In Healthcare 2022; 10(2); 364.

Hendin A, La Rivière CG, Williscroft DM, O'Connor E, Hughes J, Fischer LM. End-of-life care in the emergency depart- ment for the patient imminently dying of a highly transmissible acute respiratory infection (such as COVID-19). CJEM 2020; 22(4); 414-417.

Mingers J. Combining is research methods: Towards a pluralist methodology. Inf Syst Res 2001; 12(3); 240-259.

Gil-Garcia JR, Pardo TA. Multimethod Approaches to Understanding the Complexity of e-Government. Int J Comput Syst Signals 2006; 7(2); 3-17.

Creswell JW, Klassen AC, Plano Clark VL, Smith KC. Best practices for mixed methods research in the health sciences. Bethesda (Maryland): National Institutes of Health 2011.

Acocella I. Il focus group. Teoria e pratica [The focus group.Theory and practice]. Franco Angeli, Milano, 2008.

Braun V, Clarke V. (2019) Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Health 2019; 11(4); 589-597.

Palestini L, Prati G, Pietrantoni L, Cicognani E. La qualità della vita professionale nel lavoro di soccorso: Un contributo alla validazione italiana della Professional Quality of Life Scale (ProQOL) [Professional quality of life in emergency work: a contribution to the italian validation of the professional Quality of Life Scale (ProQOL)]. Psicoterapia Cognitiva e Comportamentale 2009; 15(2); 205-227.

Stamm BH. The ProQOL manual: The professional quality of life scale: Compassion satisfaction. Burnout & compassion fatigue/secondary trauma scales. Sidran Press, Baltimore, MD, 2005.

Callegari C, Bertù L, Lucano M, Ielmini M, Braggio E, Vender S. Reliability and validity of the Italian version of the 14-item Resilience Scale. Psychol Res Behav Manag 2016; 9; 277.

Wagnild G. A review of the Resilience Scale. J Nurs Meas 2009; 17(2); 105-113.

Houghton C, Meskell P, Delaney H, Smalle M, Glenton C, Booth A, ... Biesty LM. Barriers and facilitators to healthcare professionals’ adherence with infection prevention and control (IPC) guidelines for respiratory infectious diseases: a rapid qualitative evidence synthesis. Cochrane Database Syst Rev 2020; (4).

Maunder R. The experience of the 2003 SARS outbreak as a traumatic stress among frontline healthcare professionals in Toronto: lessons learned. Philos Trans R Soc Lond B Biol Sci 2004; 359(1447); 1117-1125.

Kinman G, Teoh K, Harriss A. Supporting the well-being of healthcare professionals during and after COVID-19. Occup Med 2020;70(5); 294–296,

Kisely S, Warren N, McMahon L, Dalais C, Henry I, Siskind D. Occurrence, prevention, and management of the psychological effects of emerging virus outbreaks on healthcare professionals: rapid review and meta-analysis. BMJ 2020, 369.

Preti E, Di Mattei V, Perego G, Ferrari F, Mazzetti M, Taranto P, ... Calati R. The psychological impact of epidemic and pandemic outbreaks on healthcare professionals: rapid review of the evidence. Curr Psychiatry Rep 2020; 22(8); 1-22.

Tarquinio C, Brennstuhl MJ, Rydberg JA, Bassan F, Peter L, Tarquinio CL, ... Tarquinio P. EMDR in telemental health counseling for healthcare professionals caring for COVID-19 patients: a pilot study. Issues Ment Health Nurs 2020; 1-12.

Torricelli L, Poletti M, & Raballo A. Managing COVID‐19‐related psychological distress in health professionals: Field experience in northern Italy. Psychiatry Clin Neurosci 2021; 75; 23-31.




How to Cite

The impact of the alterations in caring for COVID-19 patients on Compassion Satisfaction and Compassion Fatigue in Italian nurses: a multi method study. Acta Biomed [Internet]. 2022 May 12 [cited 2024 Jun. 20];93(S2):e2022190. Available from:

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