Consequences of compassion fatigue in palliative care nurses: The experience of meaninglessness and emptiness in life

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Despite its impact, the nuanced consequences of compassion fatigue from the perspective of palliative care nurses remain underexplored. Aim Due to this issue, this study sought to explore and elucidate the perceived consequences of compassion fatigue among palliative care nurses in Iran. Methods A qualitative study employing conventional content analysis was conducted. Seventeen Iranian palliative care nurses were recruited via purposive sampling. Data were collected through semi-structured interviews and analysed to identify emergent themes. Ethical approval was obtained from the Ethics Committee of Tarbiat Modares University, and written informed consent was secured from all participants. Results Four subcategories emerged as key consequences of compassion fatigue:(1)reluctance to remain in the ward or continue nursing,(2)forgetfulness in care delivery,(3)emotional incapacity to manage personal and professional responsibilities, and(4)a pervasive sense of meaninglessness and hopelessness toward life. The overarching theme highlighted a profound existential impact, characterized by diminished motivation and hope, affecting both professional engagement and personal well-being. Conclusion In conclusion, early identification and management of compassion fatigue consequences are critical for nurse managers to enhance resilience, address emotional needs, and reduce turnover intentions. Compassion Fatigue Consequence Palliative Care Nursing Qualitative Research Introduction Compassion forms the foundational basis for enhancing interpersonal interaction between nurses and patients, and compassionate care is widely recognized as a core attribute of professional nursing. Nurses are expected to alleviate patient suffering through empathetic, patient-centered approaches[ 1 ]. However, the demanding nature of nursing work coupled with the constant expectation to provide empathy and compassion can lead to emotional exhaustion and, ultimately, compassion fatigue. The concept of compassion fatigue was first introduced as a unique form of occupational burnout experienced by healthcare professionals engaged in caregiving, resulting from continuous and intense contact with patients under significant stress, enduring substantial pain and suffering. It is also recognized as a consequence of the stress associated with helping individuals who have undergone traumatic experiences, particularly those suffering or injured[ 2 ]. Compassion fatigue has numerous negative individual and organizational consequences for both nurses and patients. It can impair sustained empathetic engagement, leading to mental, physical, and spiritual exhaustion among nurses [ 3 ]. Beyond psychological and physiological effects, it may negatively influence job performance, resulting in decreased quality of care, reduced patient satisfaction, increased clinical errors, higher staff turnover rates, and increased absenteeism. These outcomes impact hospital units and healthcare systems, contributing to a growing intent among nurses to leave the profession [ 4 ]. Given that palliative care nurses constantly witness patient suffering and death and are regularly surrounded by critically ill or dying patients, they are particularly vulnerable to compassion fatigue due to their repeated, empathetic responses to others' distress, making it an inherent occupational risk in palliative care practice likely to produce significant consequences [ 5 , 6 ]. Studies in other countries have reported consequences such as decreased well-being, increased intent to leave the profession, occupational burnout, indifference, moral distress, and physical and emotional breakdowns [ 7 ]. Challenges related to job performance, as well as issues affecting family life and personal relationships, have also been identified. However, these studies were conducted in cultural and social contexts different from Iran’s, where spirituality and religion hold high value, often framing caregiving as a means of drawing closer to God [ 8 ]. Moreover, palliative care delivery systems in Iran are underdeveloped, with poorly defined specialized nursing roles, contrasting with more established systems elsewhere. Since compassion fatigue contributes to global nursing shortages and is prevalent worldwide, addressing its consequences—alongside developing preventive and mitigating strategies—is crucial for retaining palliative care nurses in Iran’s unique sociocultural setting [ 9 ] Despite extensive research on compassion fatigue across disciplines, ambiguities persist, particularly regarding its individual impact on nurses. Although it is a complex, multifaceted concept affecting nurses, healthcare organizations, and patient outcomes, few studies have explored its consequences in depth, leaving a comprehensive understanding of its impact on palliative care nurses lacking [ 10 , 11 ]. Therefore, this qualitative study was conducted to elucidate the consequences of compassion fatigue among palliative care nurses, leveraging the depth and nuance of qualitative research to address these gaps. The objective was to explore nurses’ perceptions and experiences of compassion fatigue consequences, with the innovation of providing culturally contextual insights from Iran’s underdeveloped palliative care system, offering a novel perspective to inform tailored interventions and retention strategies. Methods A qualitative study employing conventional (inductive) content analysis was conducted to explore the consequences of compassion fatigue among palliative care nurses, following Humble and Mozelius (2022) framework [ 12 ]. This approach was selected due to the limited empirical evidence on compassion fatigue consequences within nursing, particularly where existing theories remain underdeveloped, necessitating an inductive exploration. The study’s design was deemed appropriate given the paucity of nursing-specific research compared to other disciplines [ 13 ]. Participants and research setting The study included 17 Iranian palliative care nurses purposively sampled based on inclusion criteria: current employment in palliative care wards, oncology units, or home care settings; willingness to participate; and readiness to share experiences. Sampling continued until data saturation was achieved, identified after 15 interviews when no new themes emerged, with two additional interviews confirming saturation [ 14 ]. Participants’ ages ranged from 25 to 65 years, with professional experience spanning 3 to 41 years. Demographic details are presented in Table 1 . Data were collected from palliative care units, oncology wards, and home care settings for cancer patients in Tehran and Arak, Iran. Participants were selected to maximize variation in age, work experience, education, and residence, enhancing the diversity of perspectives. Nurses were actively engaged in palliative care, and although familiar with compassion fatigue, they received a brief explanation of the concept prior to interviews to ensure a shared understanding. Table 1 Demographic characteristics of participants ID Participant Age Gender Marital Status Education Working Ward Previous Ward Nursing Experience (Years) Ward Experience (Years) Shift 1 Nurse 37 Female Married Bachelor Palliative Care Nephrology 15 4 Rotating 2 Nurse 37 Female Married Master’s Oncology ICU 13 4.5 Rotating 3 Nurse 33 Female Married Bachelor Oncology ICU 10 1 Fixed Afternoon 4 Nurse 29 Female Married Bachelor Oncology Emergency 6 3 Rotating 5 Nurse 32 Female Married Bachelor Oncology Gynecological Surgery 9 8.5 Rotating 6 Nurse 62 Female Married Bachelor Palliative Care Angiography 41 11 Rotating 7 Nurse 40 Female Married Bachelor Palliative Care Obstetrics/Gynecology 10 4 Rotating 8 Nurse 25 Female Married Bachelor Oncology ICU 3 2 Rotating 9 Nurse 48 Male Married Bachelor Palliative Care Chemotherapy 24 5 Fixed Afternoon 10 Nurse 32 Female Single Bachelor Palliative Care ICU 8 1 Fixed Afternoon 11 Nurse 65 Male Married Bachelor Home Care ICU 43 2 Fixed Morning 12 Nurse 30 Male Single Bachelor Palliative Care Neurology/Psychiatry 4 3 Rotating 13 Nurse 31 Female Married Bachelor Palliative Care Emergency 9 6 Rotating 14 Nurse 31 Female Married Master’s Palliative Care Internal Medicine 8 6 Rotating 15 Nurse 32 Female Married Bachelor Palliative Care CCU 10 3 Rotating 16 Nurse 26 Female Married Bachelor Oncology Oncology 3 3 Rotating 17 Nurse 55 Male Married Bachelor Home Care ICU 32 8 Rotating Data collection Face-to-face, semi-structured interviews were conducted between February and August 2024 at participants’ workplaces, averaging 30 minutes each. Interviews were audio-recorded, transcribed verbatim, and guided by the following questions: Describe a typical work shift as a palliative care nurse. What feelings or effects do patients’ distressing conditions evoke in you? How has providing care emotionally affected you personally? Have you felt emotionally exhausted or less motivated due to empathizing with patients? Has working with patients in pain unconsciously affected your professional performance? Have you noticed a diminished ability to fulfill professional or family responsibilities after exposure to patient suffering? Probing questions (e.g., “Could you elaborate further?” or “What do you mean by that?”) were used to deepen responses. At each interview’s conclusion, a summary was reviewed with participants for accuracy, with opportunities to add further insights. Data analysis Transcripts were analyzed using Elo and Kyngäs’ (2008) inductive content analysis [ 15 ]. The researcher immersed themselves in the data through repeated readings, identifying meaning units and extracting codes. Open coding of transcripts generated initial categories, refined through iterative comparison and synthesis across interviews, reducing categories to capture core themes (Table 2 ). Table 2 Sample Data Analysis Process Meaning Unit Code Subcategory Category “Working with these patients…makes me want to change my job role…” (P12) 1. Indifference and decline in work motivation Lack of motivation to remain in the ward Decreased caregiving performance “…wish I weren’t working here…” (P8) 2. Strong desire to change work units Lack of motivation to remain in the ward Decreased caregiving performance “…my motivation has decreased…feel burned out…” (P3) 3. Emotional exhaustion and inadequate capacity Lack of motivation to remain in the ward Decreased caregiving performance “…I forget to document…vital signs…” (P9) 4. Forgetfulness and unintentional errors Forgetfulness in delivering care Decreased caregiving performance “…my mind becomes preoccupied…miss some tasks…” (P16) 5. Forgetfulness due to mental fatigue Forgetfulness in delivering care Decreased caregiving performance Trustworthiness and rigor Trustworthiness was ensured using Lincoln and Guba’s (1985) criteria: credibility, dependability, confirmability, and transferability [ 16 ]. Credibility was enhanced through prolonged engagement and member checking, with participants validating transcripts and interpretations. Dependability was achieved via peer debriefing, with the research team reviewing codes for consistency, while the researcher minimized bias. Confirmability was supported by an audit trail and external expert review of interviews and coding. Transferability was facilitated by maximum variation sampling across demographic and workplace variables, enriching the applicability of findings. Ethical considerations The study was approved by the Research Ethics Committee of Tarbiat Modares University (Ethical Approval Code: IR.MODARES.REC.1402.206). Participants received detailed information on the study’s purpose and procedures, providing written informed consent. They were assured of their right to withdraw without consequence and the confidentiality of data, adhering to the Declaration of Helsinki principles. Results The qualitative analysis revealed four primary themes reflecting the consequences of compassion fatigue among palliative care nurses, capturing a spectrum of emotional and psychological impacts. These themes are: (1) lack of motivation to remain in the ward or continue nursing, (2) forgetfulness in delivering care, (3) emotional inability to manage personal and professional responsibilities, and (4) a sense of meaninglessness and hopelessness toward life. Each theme is elaborated below, supported by participant narratives, with a summary provided in Table 3 . Lack of motivation to remain in the ward or continue nursing Participants frequently described a progressive decline in motivation to remain in palliative care settings due to the emotionally taxing nature of their work. Many expressed indifferences toward their roles, a lack of emotional readiness to continue, and a desire to transfer to less stressful units or leave nursing entirely. For instance, Participant 2 (37 years, female) stated, “Sometimes I wish I could leave nursing altogether…this unit constantly drains me emotionally. I always hope for a day off—I don’t feel like coming in.” Similarly, Participant 10 (32 years, female) noted, “Working in this unit is psychologically exhausting… I’d prefer to work in ICU rather than stay here.” Participant 4 (29 years, female) added, “Because of the conditions in this unit…I’ll look for another job one that satisfies me emotionally and mentally.” Forgetfulness in delivering care Nurses reported diminished concentration and performance due to prolonged rumination over patients’ suffering, leading to forgetfulness and errors in care delivery, particularly in documentation and medication administration. Participant 3 (32 years, female) explained, “I become deeply affected by my patients’ conditions… I’ve unconsciously forgotten to do something or made a small mistake.” Participant 16 (26 years, female) elaborated, “When my mind is preoccupied…it feels like some things slip…like forgetting to give a medication. My colleagues sometimes remind me.” Participant 11 (65 years, male, home care) reflected, “There have been times when I forgot something due to high stress… minor unintentional mistakes influenced by the patient’s condition.” Emotional inability to manage personal and professional responsibilities The emotional demands of palliative care led to reduced well-being, manifesting as irritability, decreased tolerance, and an inability to balance professional and personal responsibilities. Participants reported feeling drained, impacting their capacity to support patients, families, and their own households. Participant 9 (48 years, male) shared, “Sometimes I reach a dead end…I feel completely drained. I can’t do anything more, emotionally or mentally.” At home, Participant 5 (32 years, female) noted, “I can’t perform my usual duties… I don’t have the energy to take care of my family. I can’t play with my child properly.” Participant 4 (29 years, female) added, “I experience energy depletion… I no longer have motivation for domestic life.” Sense of meaninglessness or hopelessness toward life Participants described a profound sense of meaninglessness and hopelessness, often triggered by witnessing patient deaths, especially among younger individuals. This led to disillusionment and emotional numbness. Participant 6 (62 years, female) expressed, “Sometimes I ask myself: What am I even living for? … I feel a deep sense of hopelessness about life.” Participant 5 (32 years, female) stated, “Working in this unit has emotionally broken me—I’ve lost hope in life.” Participant 7 (40 years, female) shared, “Since starting work in this unit, I’ve developed a depressive mood… I can stay emotionally numb for several days.” Table 3 Summary of themes and representative quotes Theme Description Representative Quote (Participant, Age, Gender) Lack of Motivation to Remain in the Ward or Continue Nursing Progressive decline in motivation, indifference, and desire to leave the unit or profession. “Sometimes I wish I could leave nursing altogether…this unit constantly drains me emotionally.” (P2, 37, Female) Forgetfulness in Delivering Care Reduced concentration leading to errors in documentation and medication administration. “When my mind is preoccupied… I might forget to give a medication.” (P16, 26, Female) Emotional Inability to Manage Responsibilities Emotional exhaustion impacting professional duties and personal/family roles. “I don’t have the energy to take care of my family… I can’t play with my child properly.” (P5, 32, Female) Sense of Meaninglessness or Hopelessness Profound despair, emotional numbness, and disillusionment with life. “I ask myself: What am I even living for? … I feel a deep sense of hopelessness.” (P6, 62, Female) Discussion This study illuminates the profound consequences of compassion fatigue among palliative care nurses, revealing a multifaceted decline in both professional caregiving and personal functioning. Four key themes emerged: (1) lack of motivation to remain in the ward or continue nursing, (2) forgetfulness in delivering care, (3) emotional inability to manage personal and professional responsibilities, and (4) a pervasive sense of meaninglessness and hopelessness toward life. These findings underscore the significant emotional toll of working in palliative care, where nurses are repeatedly exposed to patient suffering, death, and end-of-life challenges. The lack of motivation to continue nursing aligns with prior research by Chachula (2020), who identified reduced psychological well-being, poor mental health, and intentions to leave the profession among health students experiencing compassion fatigue [ 7 ],. Similarly, in this study, nurses expressed a diminished desire to remain in their roles, often citing emotional exhaustion and insufficient energy to sustain their responsibilities. This overlap may reflect the universal demands of nursing, a profession rooted in compassion and humanistic care, which predisposes practitioners across specialties to compassion fatigue [ 8 ]. However, the Iranian context introduces additional complexity. Limited employment opportunities and systemic constraints in Iran often compel nurses to remain in emotionally taxing roles despite burnout, exacerbating the negative impact on their mental health and potentially leading to chronic psychological distress [ 17 ]. Comparatively, Pérez-García et al. (2021) documented occupational performance issues, such as difficulty coping with patient suffering, alongside personal challenges like irritability, fatigue, and insomnia, among nurses experiencing compassion fatigue [ 9 ]. Their findings also highlighted anxiety, loss of motivation, and intentions to transfer to less demanding roles, resonating with the present study’s themes of job dissatisfaction and desire to change units. However, unique to this study are the reports of forgetfulness in care delivery, emotional incapacity to balance responsibilities, and a profound sense of meaninglessness or hopelessness. These distinct outcomes may stem from sociocultural and systemic differences between Spain and Iran. In Iran, the scarcity of specialized palliative care units means that most advanced-stage cancer patients are treated in oncology wards, resulting in frequent exposure to death and dying. This heightened exposure likely intensifies feelings of hopelessness and existential despair among Iranian nurses, a phenomenon less pronounced in settings with more robust palliative care infrastructure [ 18 ]. Cross (2019) identified similar consequences among palliative care nurses, including loss of empathetic capacity, emotional burnout, indifference, and moral distress, which partially align with the current findings of impaired performance and emotional disengagement [ 8 ]. However, the emotional inability to manage dual responsibilities and the deep sense of meaninglessness were distinct to this study. These similarities may be attributed to the shared context of palliative care, where nurses form close emotional bonds with patients and families, heightening their vulnerability to compassion fatigue [ 19 ]. The differences, however, likely reflect structural disparities in care delivery. In Iran, palliative care services are often integrated into general hospital departments rather than operating as independent units, and there is a lack of specialized education for palliative care nurses. This lack of training and support may amplify the emotional burden, contributing to the unique existential impacts observed in this study [ 20 ]. A critical psychosocial consequence highlighted by this study is the profound sense of meaninglessness and hopelessness toward life, which reflects the cumulative impact of daily exposure to end-of-life experiences. This finding underscores the urgent need to address the emotional wellness of palliative care nurses, as such experiences not only diminish their motivation and hope but also pose risks to their long-term mental health and professional retention. The Iranian sociocultural context, where spirituality and religion are deeply valued, may further shape these experiences. Nurses often view caregiving as a spiritual duty, yet the relentless exposure to suffering can challenge their existential beliefs, leading to a crisis of meaning [ 21 ]. Future research should explore how cultural and spiritual frameworks influence the manifestation of compassion fatigue in diverse settings. The findings have significant implications for nursing practice and policy, particularly in resource-limited settings like Iran. Nurse managers must prioritize early identification of compassion fatigue symptoms and implement targeted interventions, such as peer support programs, mindfulness-based stress reduction, and access to mental health resources. Such strategies can bolster nurses’ resilience, mitigate emotional exhaustion, and reduce turnover intentions, ultimately enhancing patient care quality. At a systemic level, developing specialized palliative care units and providing comprehensive training for nurses could alleviate the emotional burden and improve professional satisfaction [ 22 ]. This study’s strength lies in its use of maximum variation sampling, including diverse Iranian palliative care nurses across genders, ages, and work settings, enhancing the richness and transferability of findings while providing novel insights into compassion fatigue consequences through a qualitative design. However, the findings may be shaped by Iran’s sociocultural norms and underdeveloped palliative care systems, limiting generalizability, and self-reported data introduces recall bias despite mitigation efforts like member checking. Future research should employ longitudinal designs to explore the long-term trajectory of compassion fatigue and conduct comparative studies in varied cultural contexts to validate and broaden these insights. Conclusion In conclusion, the findings of this study revealed that compassion fatigue profoundly impacts Iranian palliative care nurses, manifesting as a lack of motivation to continue nursing, forgetfulness in care delivery, emotional inability to manage personal and professional responsibilities, and a pervasive sense of meaninglessness and hopelessness toward life. These consequences underscore the urgent need for targeted interventions to support nurses’ emotional well-being. Strategies such as fostering self-compassion, enhancing resilience through structured programs, and integrating recovery periods into work schedules can mitigate these effects, reduce burnout, and improve both nurses’ mental health and patient care quality. Such efforts are vital to sustaining a resilient nursing workforce in palliative care settings. Declarations Acknowledgments This article is derived from a doctoral dissertation in nursing (Ethics Code: IR.MODARES.REC.1402.206), approved and supported by Tarbiat Modares University. The researchers extend their deepest gratitude to all participating nurses who generously shared their experiences and contributed to this study through interviews. Authors' contributions Conception and design of the research: RG, ZV, EM, and AK. Acquisition of data: RG, and AK. Analysis and interpretation of the data: RG, and ZV. Statistical analysis: RG, and ZV, Obtaining financing: None. Writing of the manuscript: RG, ZV, EM, and AK. Critical revision of the manuscript for intellectual content: RG, ZV, EM, and AK. All authors reviewed the manuscript. Consent for publication Not applicable Consent to Participate declaration: Participants were informed about the study objectives and procedures and provided written informed consent before participation. Confidentiality and anonymity were ensured, and participants had the right to withdraw from the study at any time without consequences. The study adhered to the ethical principles outlined in the Declaration of Helsinki. Availability of data and materials The data supporting the findings of this study are available within the article and are available from the corresponding author on reasonable request. Competing Interests The authors declare no conflict of interest regarding this article. Funding No funding or any financial support. Ethics declaration: Ethical approval was obtained from the Research Ethics Committee of Tarbiat Modares University (Ethics Approval Code: IR.MODARES.REC.1402.206). References Storm J, Chen HC. The relationships among alarm fatigue, compassion fatigue, burnout and compassion satisfaction in critical care and step-down nurses. J Clin Nurs. 2021;30(3–4):443–53. Cheng WL-S, Tang AC-Y, Siu KL-S. Examining the effects of moral distress, compassion fatigue and burnout on intention to leave among nursing students in Hong Kong: A cross-sectional study. Appl Nurs Res. 2024;80:151861. Jin M, Wang J, Zeng L, Xie W, Tang P, Yuan Z. Prevalence and factors of compassion fatigue among nurse in China: A protocol for systematic review and meta-analysis. Medicine. 2021;100(3). Ondrejková N, Halamová J. Qualitative analysis of compassion fatigue and coping strategies among nurses. Int J Nurs Sci. 2022;9(4):467–80. Aslan H, Erci B, Pekince H. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7009665","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":494550312,"identity":"7da1133d-c5a4-46a5-b3d9-682277b618f3","order_by":0,"name":"Rezvan Ghafarzadegan","email":"","orcid":"","institution":"Tarbiat Modares University","correspondingAuthor":false,"prefix":"","firstName":"Rezvan","middleName":"","lastName":"Ghafarzadegan","suffix":""},{"id":494550313,"identity":"591e1b00-c94a-4b07-8696-f69488d94cc7","order_by":1,"name":"Zohreh Vanaki","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7UlEQVRIie2PsWrDMBCGzxTcxaBVIn2IA4MgtFSv4iDwJEIfQVOmQNdAXqIP4OGMhyzpWhqy2IsnL90SCKQ3hJAlSrtl0AcnxKHvTj9AJHKnJB4BBF/kuVX8RVH+fwofSJdKCFx91j+LNzD5V1N/76sXA49NC10VUNZTqz4QHvS2tON5X058ViIU/XVFeYeqRUj11mmZUcMpHGehgPI+5HtWsnzptDrQ0YAYwoqQ/JI/JnHk9CgjSry8sUXIQY8XCCg5y/MT2clM9kghJRUu38wPYMTS1puBXo0Qtut2AeXE8WII120hEolEIkF+AVaFS9r2FNp2AAAAAElFTkSuQmCC","orcid":"","institution":"Tarbiat Modares University","correspondingAuthor":true,"prefix":"","firstName":"Zohreh","middleName":"","lastName":"Vanaki","suffix":""},{"id":494550314,"identity":"6945c765-1cef-4adb-8591-d16d41918df3","order_by":2,"name":"Eesa Mohammadi","email":"","orcid":"","institution":"Tarbiat Modares University","correspondingAuthor":false,"prefix":"","firstName":"Eesa","middleName":"","lastName":"Mohammadi","suffix":""},{"id":494550316,"identity":"46ee9b03-5d3f-4d08-8d16-5b00d93a183e","order_by":3,"name":"Anoshirvan Kazemnejad","email":"","orcid":"","institution":"Tarbiat Modares University","correspondingAuthor":false,"prefix":"","firstName":"Anoshirvan","middleName":"","lastName":"Kazemnejad","suffix":""}],"badges":[],"createdAt":"2025-06-30 10:53:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7009665/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7009665/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88278527,"identity":"04cf17d3-3e82-49cb-94b0-18b01831e143","added_by":"auto","created_at":"2025-08-04 19:01:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":757854,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7009665/v1/89b3e296-b74e-4149-80c3-811ef74ef3af.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Consequences of compassion fatigue in palliative care nurses: The experience of meaninglessness and emptiness in life","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCompassion forms the foundational basis for enhancing interpersonal interaction between nurses and patients, and compassionate care is widely recognized as a core attribute of professional nursing. Nurses are expected to alleviate patient suffering through empathetic, patient-centered approaches[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, the demanding nature of nursing work coupled with the constant expectation to provide empathy and compassion can lead to emotional exhaustion and, ultimately, compassion fatigue. The concept of compassion fatigue was first introduced as a unique form of occupational burnout experienced by healthcare professionals engaged in caregiving, resulting from continuous and intense contact with patients under significant stress, enduring substantial pain and suffering. It is also recognized as a consequence of the stress associated with helping individuals who have undergone traumatic experiences, particularly those suffering or injured[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCompassion fatigue has numerous negative individual and organizational consequences for both nurses and patients. It can impair sustained empathetic engagement, leading to mental, physical, and spiritual exhaustion among nurses [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Beyond psychological and physiological effects, it may negatively influence job performance, resulting in decreased quality of care, reduced patient satisfaction, increased clinical errors, higher staff turnover rates, and increased absenteeism. These outcomes impact hospital units and healthcare systems, contributing to a growing intent among nurses to leave the profession [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Given that palliative care nurses constantly witness patient suffering and death and are regularly surrounded by critically ill or dying patients, they are particularly vulnerable to compassion fatigue due to their repeated, empathetic responses to others' distress, making it an inherent occupational risk in palliative care practice likely to produce significant consequences [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eStudies in other countries have reported consequences such as decreased well-being, increased intent to leave the profession, occupational burnout, indifference, moral distress, and physical and emotional breakdowns [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Challenges related to job performance, as well as issues affecting family life and personal relationships, have also been identified. However, these studies were conducted in cultural and social contexts different from Iran\u0026rsquo;s, where spirituality and religion hold high value, often framing caregiving as a means of drawing closer to God [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Moreover, palliative care delivery systems in Iran are underdeveloped, with poorly defined specialized nursing roles, contrasting with more established systems elsewhere. Since compassion fatigue contributes to global nursing shortages and is prevalent worldwide, addressing its consequences\u0026mdash;alongside developing preventive and mitigating strategies\u0026mdash;is crucial for retaining palliative care nurses in Iran\u0026rsquo;s unique sociocultural setting [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eDespite extensive research on compassion fatigue across disciplines, ambiguities persist, particularly regarding its individual impact on nurses. Although it is a complex, multifaceted concept affecting nurses, healthcare organizations, and patient outcomes, few studies have explored its consequences in depth, leaving a comprehensive understanding of its impact on palliative care nurses lacking [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Therefore, this qualitative study was conducted to elucidate the consequences of compassion fatigue among palliative care nurses, leveraging the depth and nuance of qualitative research to address these gaps. The objective was to explore nurses\u0026rsquo; perceptions and experiences of compassion fatigue consequences, with the innovation of providing culturally contextual insights from Iran\u0026rsquo;s underdeveloped palliative care system, offering a novel perspective to inform tailored interventions and retention strategies.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA qualitative study employing conventional (inductive) content analysis was conducted to explore the consequences of compassion fatigue among palliative care nurses, following Humble and Mozelius (2022) framework [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This approach was selected due to the limited empirical evidence on compassion fatigue consequences within nursing, particularly where existing theories remain underdeveloped, necessitating an inductive exploration. The study\u0026rsquo;s design was deemed appropriate given the paucity of nursing-specific research compared to other disciplines [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants and research setting\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study included 17 Iranian palliative care nurses purposively sampled based on inclusion criteria: current employment in palliative care wards, oncology units, or home care settings; willingness to participate; and readiness to share experiences. Sampling continued until data saturation was achieved, identified after 15 interviews when no new themes emerged, with two additional interviews confirming saturation [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Participants\u0026rsquo; ages ranged from 25 to 65 years, with professional experience spanning 3 to 41 years. Demographic details are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Data were collected from palliative care units, oncology wards, and home care settings for cancer patients in Tehran and Arak, Iran. Participants were selected to maximize variation in age, work experience, education, and residence, enhancing the diversity of perspectives. Nurses were actively engaged in palliative care, and although familiar with compassion fatigue, they received a brief explanation of the concept prior to interviews to ensure a shared understanding.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic characteristics of participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"11\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eID\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eParticipant\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarital Status\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eEducation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eWorking Ward\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003ePrevious Ward\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNursing Experience (Years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eWard Experience (Years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eShift\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBachelor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePalliative Care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNephrology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eRotating\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMaster\u0026rsquo;s\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eOncology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eICU\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e4.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eRotating\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBachelor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eOncology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eICU\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eFixed Afternoon\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBachelor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eOncology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eEmergency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eRotating\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBachelor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eOncology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eGynecological Surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e8.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eRotating\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBachelor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePalliative Care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eAngiography\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eRotating\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBachelor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePalliative Care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eObstetrics/Gynecology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eRotating\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBachelor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eOncology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eICU\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eRotating\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBachelor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePalliative Care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eChemotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eFixed Afternoon\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBachelor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePalliative Care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eICU\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eFixed Afternoon\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBachelor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eHome Care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eICU\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eFixed Morning\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBachelor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePalliative Care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNeurology/Psychiatry\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eRotating\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBachelor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePalliative Care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eEmergency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eRotating\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMaster\u0026rsquo;s\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePalliative Care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eInternal Medicine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eRotating\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBachelor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePalliative Care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCCU\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eRotating\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBachelor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eOncology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eOncology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eRotating\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBachelor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eHome Care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eICU\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eRotating\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eData collection\u003c/b\u003e\u003c/p\u003e\u003cp\u003e Face-to-face, semi-structured interviews were conducted between February and August 2024 at participants\u0026rsquo; workplaces, averaging 30 minutes each. Interviews were audio-recorded, transcribed verbatim, and guided by the following questions:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eDescribe a typical work shift as a palliative care nurse.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eWhat feelings or effects do patients\u0026rsquo; distressing conditions evoke in you?\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHow has providing care emotionally affected you personally?\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHave you felt emotionally exhausted or less motivated due to empathizing with patients?\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHas working with patients in pain unconsciously affected your professional performance?\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHave you noticed a diminished ability to fulfill professional or family responsibilities after exposure to patient suffering?\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eProbing questions (e.g., \u0026ldquo;Could you elaborate further?\u0026rdquo; or \u0026ldquo;What do you mean by that?\u0026rdquo;) were used to deepen responses. At each interview\u0026rsquo;s conclusion, a summary was reviewed with participants for accuracy, with opportunities to add further insights.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eTranscripts were analyzed using Elo and Kyng\u0026auml;s\u0026rsquo; (2008) inductive content analysis [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The researcher immersed themselves in the data through repeated readings, identifying meaning units and extracting codes. Open coding of transcripts generated initial categories, refined through iterative comparison and synthesis across interviews, reducing categories to capture core themes (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSample Data Analysis Process\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMeaning Unit\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCode\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSubcategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ldquo;Working with these patients\u0026hellip;makes me want to change my job role\u0026hellip;\u0026rdquo; (P12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1. Indifference and decline in work motivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLack of motivation to remain in the ward\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDecreased caregiving performance\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ldquo;\u0026hellip;wish I weren\u0026rsquo;t working here\u0026hellip;\u0026rdquo; (P8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2. Strong desire to change work units\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLack of motivation to remain in the ward\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDecreased caregiving performance\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ldquo;\u0026hellip;my motivation has decreased\u0026hellip;feel burned out\u0026hellip;\u0026rdquo; (P3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3. Emotional exhaustion and inadequate capacity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLack of motivation to remain in the ward\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDecreased caregiving performance\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ldquo;\u0026hellip;I forget to document\u0026hellip;vital signs\u0026hellip;\u0026rdquo; (P9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4. Forgetfulness and unintentional errors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eForgetfulness in delivering care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDecreased caregiving performance\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ldquo;\u0026hellip;my mind becomes preoccupied\u0026hellip;miss some tasks\u0026hellip;\u0026rdquo; (P16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5. Forgetfulness due to mental fatigue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eForgetfulness in delivering care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDecreased caregiving performance\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eTrustworthiness and rigor\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTrustworthiness was ensured using Lincoln and Guba\u0026rsquo;s (1985) criteria: credibility, dependability, confirmability, and transferability [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Credibility was enhanced through prolonged engagement and member checking, with participants validating transcripts and interpretations. Dependability was achieved via peer debriefing, with the research team reviewing codes for consistency, while the researcher minimized bias. Confirmability was supported by an audit trail and external expert review of interviews and coding. Transferability was facilitated by maximum variation sampling across demographic and workplace variables, enriching the applicability of findings.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEthical considerations\u003c/b\u003e\u003c/p\u003e\u003cp\u003e The study was approved by the Research Ethics Committee of Tarbiat Modares University (Ethical Approval Code: IR.MODARES.REC.1402.206). Participants received detailed information on the study\u0026rsquo;s purpose and procedures, providing written informed consent. They were assured of their right to withdraw without consequence and the confidentiality of data, adhering to the Declaration of Helsinki principles.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe qualitative analysis revealed four primary themes reflecting the consequences of compassion fatigue among palliative care nurses, capturing a spectrum of emotional and psychological impacts. These themes are: (1) lack of motivation to remain in the ward or continue nursing, (2) forgetfulness in delivering care, (3) emotional inability to manage personal and professional responsibilities, and (4) a sense of meaninglessness and hopelessness toward life. Each theme is elaborated below, supported by participant narratives, with a summary provided in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLack of motivation to remain in the ward or continue nursing\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipants frequently described a progressive decline in motivation to remain in palliative care settings due to the emotionally taxing nature of their work. Many expressed indifferences toward their roles, a lack of emotional readiness to continue, and a desire to transfer to less stressful units or leave nursing entirely. For instance, Participant 2 (37 years, female) stated, \u0026ldquo;Sometimes I wish I could leave nursing altogether\u0026hellip;this unit constantly drains me emotionally. I always hope for a day off\u0026mdash;I don\u0026rsquo;t feel like coming in.\u0026rdquo; Similarly, Participant 10 (32 years, female) noted, \u0026ldquo;Working in this unit is psychologically exhausting\u0026hellip; I\u0026rsquo;d prefer to work in ICU rather than stay here.\u0026rdquo; Participant 4 (29 years, female) added, \u0026ldquo;Because of the conditions in this unit\u0026hellip;I\u0026rsquo;ll look for another job one that satisfies me emotionally and mentally.\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u003cb\u003eForgetfulness in delivering care\u003c/b\u003e\u003c/p\u003e\u003cp\u003eNurses reported diminished concentration and performance due to prolonged rumination over patients\u0026rsquo; suffering, leading to forgetfulness and errors in care delivery, particularly in documentation and medication administration. Participant 3 (32 years, female) explained, \u0026ldquo;I become deeply affected by my patients\u0026rsquo; conditions\u0026hellip; I\u0026rsquo;ve unconsciously forgotten to do something or made a small mistake.\u0026rdquo; Participant 16 (26 years, female) elaborated, \u0026ldquo;When my mind is preoccupied\u0026hellip;it feels like some things slip\u0026hellip;like forgetting to give a medication. My colleagues sometimes remind me.\u0026rdquo; Participant 11 (65 years, male, home care) reflected, \u0026ldquo;There have been times when I forgot something due to high stress\u0026hellip; minor unintentional mistakes influenced by the patient\u0026rsquo;s condition.\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u003cb\u003eEmotional inability to manage personal and professional responsibilities\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe emotional demands of palliative care led to reduced well-being, manifesting as irritability, decreased tolerance, and an inability to balance professional and personal responsibilities. Participants reported feeling drained, impacting their capacity to support patients, families, and their own households. Participant 9 (48 years, male) shared, \u0026ldquo;Sometimes I reach a dead end\u0026hellip;I feel completely drained. I can\u0026rsquo;t do anything more, emotionally or mentally.\u0026rdquo; At home, Participant 5 (32 years, female) noted, \u0026ldquo;I can\u0026rsquo;t perform my usual duties\u0026hellip; I don\u0026rsquo;t have the energy to take care of my family. I can\u0026rsquo;t play with my child properly.\u0026rdquo; Participant 4 (29 years, female) added, \u0026ldquo;I experience energy depletion\u0026hellip; I no longer have motivation for domestic life.\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u003cb\u003eSense of meaninglessness or hopelessness toward life\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipants described a profound sense of meaninglessness and hopelessness, often triggered by witnessing patient deaths, especially among younger individuals. This led to disillusionment and emotional numbness. Participant 6 (62 years, female) expressed, \u0026ldquo;Sometimes I ask myself: What am I even living for? \u0026hellip; I feel a deep sense of hopelessness about life.\u0026rdquo; Participant 5 (32 years, female) stated, \u0026ldquo;Working in this unit has emotionally broken me\u0026mdash;I\u0026rsquo;ve lost hope in life.\u0026rdquo; Participant 7 (40 years, female) shared, \u0026ldquo;Since starting work in this unit, I\u0026rsquo;ve developed a depressive mood\u0026hellip; I can stay emotionally numb for several days.\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSummary of themes and representative quotes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDescription\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRepresentative Quote (Participant, Age, Gender)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLack of Motivation to Remain in the Ward or Continue Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProgressive decline in motivation, indifference, and desire to leave the unit or profession.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;Sometimes I wish I could leave nursing altogether\u0026hellip;this unit constantly drains me emotionally.\u0026rdquo; (P2, 37, Female)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eForgetfulness in Delivering Care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReduced concentration leading to errors in documentation and medication administration.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;When my mind is preoccupied\u0026hellip; I might forget to give a medication.\u0026rdquo; (P16, 26, Female)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmotional Inability to Manage Responsibilities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmotional exhaustion impacting professional duties and personal/family roles.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;I don\u0026rsquo;t have the energy to take care of my family\u0026hellip; I can\u0026rsquo;t play with my child properly.\u0026rdquo; (P5, 32, Female)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSense of Meaninglessness or Hopelessness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProfound despair, emotional numbness, and disillusionment with life.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;I ask myself: What am I even living for? \u0026hellip; I feel a deep sense of hopelessness.\u0026rdquo; (P6, 62, Female)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study illuminates the profound consequences of compassion fatigue among palliative care nurses, revealing a multifaceted decline in both professional caregiving and personal functioning. Four key themes emerged: (1) lack of motivation to remain in the ward or continue nursing, (2) forgetfulness in delivering care, (3) emotional inability to manage personal and professional responsibilities, and (4) a pervasive sense of meaninglessness and hopelessness toward life. These findings underscore the significant emotional toll of working in palliative care, where nurses are repeatedly exposed to patient suffering, death, and end-of-life challenges.\u003c/p\u003e\u003cp\u003eThe lack of motivation to continue nursing aligns with prior research by Chachula (2020), who identified reduced psychological well-being, poor mental health, and intentions to leave the profession among health students experiencing compassion fatigue [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e],. Similarly, in this study, nurses expressed a diminished desire to remain in their roles, often citing emotional exhaustion and insufficient energy to sustain their responsibilities. This overlap may reflect the universal demands of nursing, a profession rooted in compassion and humanistic care, which predisposes practitioners across specialties to compassion fatigue [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, the Iranian context introduces additional complexity. Limited employment opportunities and systemic constraints in Iran often compel nurses to remain in emotionally taxing roles despite burnout, exacerbating the negative impact on their mental health and potentially leading to chronic psychological distress [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eComparatively, P\u0026eacute;rez-Garc\u0026iacute;a et al. (2021) documented occupational performance issues, such as difficulty coping with patient suffering, alongside personal challenges like irritability, fatigue, and insomnia, among nurses experiencing compassion fatigue [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Their findings also highlighted anxiety, loss of motivation, and intentions to transfer to less demanding roles, resonating with the present study\u0026rsquo;s themes of job dissatisfaction and desire to change units. However, unique to this study are the reports of forgetfulness in care delivery, emotional incapacity to balance responsibilities, and a profound sense of meaninglessness or hopelessness. These distinct outcomes may stem from sociocultural and systemic differences between Spain and Iran. In Iran, the scarcity of specialized palliative care units means that most advanced-stage cancer patients are treated in oncology wards, resulting in frequent exposure to death and dying. This heightened exposure likely intensifies feelings of hopelessness and existential despair among Iranian nurses, a phenomenon less pronounced in settings with more robust palliative care infrastructure [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCross (2019) identified similar consequences among palliative care nurses, including loss of empathetic capacity, emotional burnout, indifference, and moral distress, which partially align with the current findings of impaired performance and emotional disengagement [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, the emotional inability to manage dual responsibilities and the deep sense of meaninglessness were distinct to this study. These similarities may be attributed to the shared context of palliative care, where nurses form close emotional bonds with patients and families, heightening their vulnerability to compassion fatigue [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The differences, however, likely reflect structural disparities in care delivery. In Iran, palliative care services are often integrated into general hospital departments rather than operating as independent units, and there is a lack of specialized education for palliative care nurses. This lack of training and support may amplify the emotional burden, contributing to the unique existential impacts observed in this study [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA critical psychosocial consequence highlighted by this study is the profound sense of meaninglessness and hopelessness toward life, which reflects the cumulative impact of daily exposure to end-of-life experiences. This finding underscores the urgent need to address the emotional wellness of palliative care nurses, as such experiences not only diminish their motivation and hope but also pose risks to their long-term mental health and professional retention. The Iranian sociocultural context, where spirituality and religion are deeply valued, may further shape these experiences. Nurses often view caregiving as a spiritual duty, yet the relentless exposure to suffering can challenge their existential beliefs, leading to a crisis of meaning [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Future research should explore how cultural and spiritual frameworks influence the manifestation of compassion fatigue in diverse settings.\u003c/p\u003e\u003cp\u003eThe findings have significant implications for nursing practice and policy, particularly in resource-limited settings like Iran. Nurse managers must prioritize early identification of compassion fatigue symptoms and implement targeted interventions, such as peer support programs, mindfulness-based stress reduction, and access to mental health resources. Such strategies can bolster nurses\u0026rsquo; resilience, mitigate emotional exhaustion, and reduce turnover intentions, ultimately enhancing patient care quality. At a systemic level, developing specialized palliative care units and providing comprehensive training for nurses could alleviate the emotional burden and improve professional satisfaction [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study\u0026rsquo;s strength lies in its use of maximum variation sampling, including diverse Iranian palliative care nurses across genders, ages, and work settings, enhancing the richness and transferability of findings while providing novel insights into compassion fatigue consequences through a qualitative design. However, the findings may be shaped by Iran\u0026rsquo;s sociocultural norms and underdeveloped palliative care systems, limiting generalizability, and self-reported data introduces recall bias despite mitigation efforts like member checking. Future research should employ longitudinal designs to explore the long-term trajectory of compassion fatigue and conduct comparative studies in varied cultural contexts to validate and broaden these insights.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, the findings of this study revealed that compassion fatigue profoundly impacts Iranian palliative care nurses, manifesting as a lack of motivation to continue nursing, forgetfulness in care delivery, emotional inability to manage personal and professional responsibilities, and a pervasive sense of meaninglessness and hopelessness toward life. These consequences underscore the urgent need for targeted interventions to support nurses\u0026rsquo; emotional well-being. Strategies such as fostering self-compassion, enhancing resilience through structured programs, and integrating recovery periods into work schedules can mitigate these effects, reduce burnout, and improve both nurses\u0026rsquo; mental health and patient care quality. Such efforts are vital to sustaining a resilient nursing workforce in palliative care settings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis article is derived from a doctoral dissertation in nursing (Ethics Code: IR.MODARES.REC.1402.206), approved and supported by Tarbiat Modares University. The researchers extend their deepest gratitude to all participating nurses who generously shared their experiences and contributed to this study through interviews.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConception and design of the research: RG, ZV, EM, and AK. \u0026nbsp; Acquisition of data: RG, and AK. Analysis and interpretation of the data: RG, and ZV. Statistical analysis: RG, and ZV, Obtaining financing: None. Writing of the manuscript: RG, ZV, EM, and AK. Critical revision of the manuscript for intellectual content: RG, ZV, EM, and AK. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate declaration:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were informed about the study objectives and procedures and provided written informed consent before participation. Confidentiality and anonymity were ensured, and participants had the right to withdraw from the study at any time without consequences. The study adhered to the ethical principles outlined in the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study are available within the article and are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest regarding this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding or any financial support.\u003c/p\u003e\n\u003cp\u003eEthics declaration:\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Research Ethics Committee of Tarbiat Modares University (Ethics Approval Code: IR.MODARES.REC.1402.206).\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eStorm J, Chen HC. 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Qualitative research in nursing and healthcare. 3th edition. ed: West Sussex: Willey-Blackwell; 2010.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShamsi A, Peyravi HJMIRI. Nursing shortage, a different challenge in Iran: A systematic review. 2020;34:8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoradi A, Hashemi S, Sadeghi H, Jafari-Oori, MJBn. Exploring facilitators and barriers faced by PhD nursing faculty in clinical settings: a qualitative content analysis. 2025;24(1):250.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWentzel D, Collins A, Brysiewicz P. Describing compassion fatigue from the perspective of oncology nurses in Durban, South Africa. Health SA Gesondheid. 2019;24.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAhmadi Chenari H, Zakerimoghadam M, Baumann SLJNSQ. Nurs Iran: Issues challenges. 2020;33(3):264\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShen X, Bu H, Zhang J, Duan W, Wang H, Tao Y, et al. The dual roles of empathy in mediating structural empowerment and compassion fatigue among Chinese nurses. BMC Nurs. 2024;23(1):837.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEbrahimi H, Rahmani F, Ghorbani KJB. Relationships between nurses\u0026rsquo; perceived social support, emotional labor, presenteeism, and psychiatric distress during the COVID-19 pandemic: a cross-sectional study. 2025;13(1):458.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-palliative-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pcar","sideBox":"Learn more about [BMC Palliative Care](http://bmcpalliatcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pcar/default.aspx","title":"BMC Palliative Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Compassion Fatigue, Consequence, Palliative Care Nursing, Qualitative Research","lastPublishedDoi":"10.21203/rs.3.rs-7009665/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7009665/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eCompassion fatigue is a significant occupational hazard in palliative care nursing, with potential adverse effects on nurses, healthcare organizations, and patient care quality. Despite its impact, the nuanced consequences of compassion fatigue from the perspective of palliative care nurses remain underexplored.\u003c/p\u003e\u003ch2\u003eAim\u003c/h2\u003e\u003cp\u003eDue to this issue, this study sought to explore and elucidate the perceived consequences of compassion fatigue among palliative care nurses in Iran.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA qualitative study employing conventional content analysis was conducted. Seventeen Iranian palliative care nurses were recruited via purposive sampling. Data were collected through semi-structured interviews and analysed to identify emergent themes. Ethical approval was obtained from the Ethics Committee of Tarbiat Modares University, and written informed consent was secured from all participants.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eFour subcategories emerged as key consequences of compassion fatigue:(1)reluctance to remain in the ward or continue nursing,(2)forgetfulness in care delivery,(3)emotional incapacity to manage personal and professional responsibilities, and(4)a pervasive sense of meaninglessness and hopelessness toward life. The overarching theme highlighted a profound existential impact, characterized by diminished motivation and hope, affecting both professional engagement and personal well-being.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eIn conclusion, early identification and management of compassion fatigue consequences are critical for nurse managers to enhance resilience, address emotional needs, and reduce turnover intentions.\u003c/p\u003e","manuscriptTitle":"Consequences of compassion fatigue in palliative care nurses: The experience of meaninglessness and emptiness in life","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-04 18:45:18","doi":"10.21203/rs.3.rs-7009665/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-28T11:19:36+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-23T04:24:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"210367541812996756741872091048673796299","date":"2025-08-23T03:38:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"2908585979383383828510304451138199999","date":"2025-08-20T22:31:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-02T03:57:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"312862367296831758772284067275336904148","date":"2025-07-30T06:38:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-30T06:35:25+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-29T05:56:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-28T12:07:37+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-28T12:07:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Palliative Care","date":"2025-06-30T10:39:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-palliative-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pcar","sideBox":"Learn more about [BMC Palliative Care](http://bmcpalliatcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pcar/default.aspx","title":"BMC Palliative Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"60537b86-6461-4315-9dc2-d445970b7509","owner":[],"postedDate":"August 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-27T06:54:01+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-04 18:45:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7009665","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7009665","identity":"rs-7009665","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}