Impact of a Pilot Program for the Secondary Prevention of Compassion Fatigue in Healthcare Professionals Who Worked in Covid-19 Units at the Nuestra Señora De Candelaria Hospital Complex: A Quasi-experimental Study

Impact of a Pilot Program for the Secondary Prevention of Compassion Fatigue in Healthcare Professionals Who Worked in Covid-19 Units at the Nuestra Señora De Candelaria Hospital Complex: A Quasi-experimental Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of a Pilot Program for the Secondary Prevention of Compassion Fatigue in Healthcare Professionals Who Worked in Covid-19 Units at the Nuestra Señora De Candelaria Hospital Complex: A Quasi-experimental Study María de los Ángeles Rodríguez García, Cristina Rodríguez de Miguel, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7466497/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background: compassion fatigue is a common condition among healthcare professionals continuously exposed to patient suffering, especially in high-pressure care settings such as those experienced during the COVID-19 pandemic. Evidence highlights its negative impact on mental health of staff and quality of care, as well as the need to implement effective preventive programs. Therefore, the aim of this study was to evaluate the impact of a pilot program of secondary prevention of compassion fatigue in healthcare professionals working in COVID-19 units at the Nuestra Señora de Candelaria University Hospital Complex (CHUNSC). Methods: A quasi-experimental, longitudinal and prospective study was carried out, with pretest-posttest measures in a single group. By initial screening with the IDE-ESAPE and ProQOL-IV tools, 30 professionals with high scores of compassion fatigue or burnout were selected. The psychoeducational program, consisting of five group sessions, included mindfulness, emotional regulation and self-care. The results were evaluated at six months. Results: Significant reductions in compassion fatigue (p<0.01; r=0.48) and burnout (p<0.01; r=0.53) were observed, as well as an increase in compassion satisfaction (p<0.01; r=0.46). A total of 100 % of the participants completed the intervention. No clinical recurrences were detected during follow-up. Conclusion: The program proved to be effective and well accepted, suggesting its feasibility for integration into hospital occupational health policies. empathy burnout burnout health personnel COVID-19 psychosocial intervention Figures Figure 1 Figure 2 Introduction Compassion fatigue is a form of emotional distress that affects healthcare professionals with prolonged exposure to the pain of others. This phenomenon is characterized by a progressive loss of empathic capacity, emotional exhaustion and decreased professional satisfaction( 1 , 2 ). Unlike burnout, whose etiology is associated with organizational factors such as work overload or lack of control, compassion fatigue arises as a direct consequence of repeated contact with suffering patients, and usually coexists with clinical manifestations of secondary traumatic stress( 3 , 4 ) Burnout has been classically conceptualized by Maslach et al.( 5 ), whose multidimensional model remains a seminal reference in psychosocial research. During the COVID-19 pandemic, the intensity, duration and complexity of the clinical situations experienced by healthcare workers created an unprecedented risk scenario for the development of affective disorders related to the exercise of empathy. Emerging evidence has documented elevated levels of acute stress, emotional exhaustion, sleep disturbances, anxiety, and ideation of professional abandonment among frontline workers( 6 – 8 ). In particular, nurses and other clinical profiles in close contact with critically ill patients showed high prevalence of compassion fatigue, associated with reduced quality of care and deterioration of their own mental health( 9 – 11 ) Despite the clinical and organizational impact of compassion fatigue, institutional strategies for its prevention and management are still scarce, partial or reactive. There are interventions based on mindfulness, resilience training and self-care practices that have shown positive effects on the emotional regulation of caregivers( 12 – 15 ), but their systematic integration in healthcare settings remains limited. Therefore, it is essential to develop and evaluate intervention programs that are structured, sustainable and adapted to contexts of high emotional vulnerability.( 16 ) The aim of this study was to evaluate the impact of a pilot program for secondary prevention of compassion fatigue, implemented at the Nuestra Señora de Candelaria University Hospital Complex (CHUNSC), aimed at healthcare professionals who served in COVID-19 units. Through a longitudinal design, we explore the effect of the program on three key dimensions: empathy burnout, burnout and professional satisfaction. Methods Study design A quasi-experimental, longitudinal and prospective study was designed, with pretest-posttest measures in a single group, aimed at evaluating the impact of a psychoeducational intervention in the secondary prevention of compassion fatigue in healthcare professionals exposed to COVID-19 units. Participants and sampling The sample consisted of 30 health professionals from the CHUNSC, chosen by targeted sampling. In a preliminary phase, the Empathic Distress Inventory (IDE-ESAPE) and ProQOL tools were provided to a total of 148 professionals who had worked in COVID-19 services. Those who showed elevated scores on indicators of compassion fatigue or burnout were invited to participate in the intervention. The inclusion criteria were: ( 1 ) presenting high levels of compassion fatigue or burnout according to the tools applied, ( 2 ) performing care functions in COVID-19 units of the hospital, and ( 3 ) voluntarily accepting their participation. Professionals who were temporarily or occupationally incapacitated at the time of the study were excluded. Procedure The study was conducted between March and November 2022. After the preliminary assessment, the selected participants were incorporated into the group intervention program, which consisted of five 120-minute face-to-face sessions (total of 10 hours), developed over five weeks. The sessions were facilitated by professional experts in emotional health, compassion and mindfulness. The sessions were divided into: Session 1: Identification of compassion fatigue symptoms and their triggers through psychoeducational workshops. Session 2: Training in coping and conflict management skills, using practical exercises and role-playing dynamics. Session 3: Strengthening resilience through appreciative inquiry and networking. Session 4: Stress reduction techniques, such as mindfulness, progressive muscle relaxation and controlled breathing. Session 5: Self-monitoring and internal conflict resolution, through open communication spaces. Evaluations were performed at three points in time: before the start of the intervention (T0), after the intervention (T1) and six months after the end of the intervention (T2). The study was approved by the Drug Research Ethics Committee and complied with the ethical principles of the Declaration of Helsinki. All participants signed the informed consent form and their data were treated confidentially. Assessment instruments The following instruments were used, all of them previously validated in healthcare population: - Compassion Fatigue Inventory - Scale for Healthcare Professionals (Spanish acronym: IDE-ESAPE): allows detecting clinical and subclinical profiles of compassion fatigue with high internal reliability (α > 0.85)( 10 ) - Professional Quality of Life Scale (ProQOL IV): international scale that assesses compassion fatigue, burnout and compassion satisfaction( 2 ) - Subjective Traumatic Experiences Questionnaire (STEQ): assesses the degree of subjective emotional impact of traumatic experiences in the care context ( 17 ) In addition, sociodemographic variables such as age, sex, professional category, length of service and work unit were also collected. Data analysis IBM SPSS Statistics v.28 software was used for statistical analysis. Descriptive statistics (means, standard deviations, frequencies) and nonparametric analyses (Wilcoxon signed-rank test for comparison of pre and post measurements; Mann-Whitney U test for comparisons between groups) were performed, as well as Spearman correlations between emotional and sociodemographic variables. A statistical significance level of p < 0.05 was established and effect sizes (r) were calculated to assess the clinical relevance of the results. Results Preliminary phase An initial evaluation using the ProQOL-IV and IDE-ESAPE questionnaires was carried out on a total of 148 health professionals (81.1% women), belonging to CHUNSC services that attended patients with COVID-19. The distribution by professional category was as follows: 68 nurses (45.9%), 71 nursing assistants (48.0%) and 9 physicians (6.1%). The mean age of the participants was 40.1 ± 9.5 years, with a mean work experience of 11.7 ± 7.2 years. Detailed descriptive statistics can be found in Table 1 . Table 1 Sociodemographic statistics of the preliminary phase Variable Category n (%) / Mean ± SD Sex Female 120 (81.1%) Male 28 (18.9%) Age 40.1 ± 9.5 Years of experience 11.7 ± 7.2 Marital status Single 56 (37.8%) Married 44 (29.7%) Separated 15 (10.1%) Widowed 3 (2.0%) In a relationship 30 (20.3%) Lives alone Yes 41 (27.7%) No 107 (72.3%) Dependents Yes 77 (52%) No 71 (48%) Professional category Physician 9 (6.1%) Nurse 68 (45.9%) Nursing assisstant 71 (48%) Workplace Emergency 40 (27%) Hospitalization 67 (45.3%) ICU-Operating room 11 (7.4%) Other 26 (17.6%) In this preliminary assessment, 61.3% of the participants presented elevated levels of compassion fatigue, and 52.3% were classified in the high burnout risk category, according to the ProQOL-IV scale. In the IDE-ESAPE, the empathic profiles identified were: profile 2 (empathic functioning without risk, 0.8%), profile 3 (risk of compassion fatigue, 60.0%) and profile 4 (compassion fatigue, 39.2%) (see Tables 2 and 3 ). Table 2 Results of the ProQOL-IV questionnaire in the preliminary phase Subscale Category n (%) Compassion fatigue No compassion fatigue 55 (38.7%) Compassion fatigue 87 (61.3%) Burnout Low risk 25 (17.1%) Moderate risk 80 (54.1%) High risk 41 (27.7%) Compassion satisfaction Low satisfaction 63 (42.9%) Medium satisfaction 39 (26.5%) High satisfaction 45 (30.6%) Note : The cut-off points to classify the subscales were: Compassion fatigue: ≥17 points Burnout: ≤ 18 Low; 19–26 Moderate; >27 High Compassion satisfaction: ≤ 33 Low; 33–41 Medium; ≥42 High Table 3 Results of the Empathic Fatigue Inventory (IDE-ESAPE) in the preliminary phase Dimension Level n (%) Professional involvement Low 102 (71.8%) Medium 40 (28.2%) Self-care Low 94 (70.1%) Medium 40 (29.9%) Vulnerability Low 109 (77.9%) Medium 31 (22.1%) IDE Diagnosis (ESAPE Profile) Profile 1: No risk 0 (0%) Profile 2: Normal without risk 1 (0.8%) Profile 3: Normal with risk 78 (60.0%) Profile 4: With compassion fatigue 51 (39.2%) Regarding the Subjective Traumatic Experiences Questionnaire (STEQ), 32.6% of the participants reported difficulties in asking for help “frequently or always”, while 21.1% reported feeling unable to connect with others with the same frequency, whilst 42.1% reported feeling emotionally drained at work “frequently”, and 42.2% reported feeling “sometimes or quite often” that they had no reason to live. Likewise, 22.5% reported having no initiative to carry out activities and 69.4% reported feeling completely alone at some point. Finally, 42.1% reported having experienced traumatic situations in the past. Intervention Phase In the intervention phase, 30 participants with high levels of emotional exhaustion were chosen in the initial assessment. The professional distribution was as follows: 40% nurses, 50% nursing assistants and 10% physicians. The intervention was completed in its entirety by the sample (100%), with no losses (see Fig. 1). Subsequently, a statistically significant improvement was evidenced in the mean scores obtained in the ProQOL-IV and IDE-ESAPE questionnaires, both immediately after the intervention (T1) and at the six-month follow-up assessment (T2). In the ProQOL-IV questionnaire, the mean score on the compassion fatigue subscale decreased from 28.6 ± 7.5 at T0 to 15.4 ± 8.5 at T1 (Z= -4.251, p < 0.001), and subsequently to 7.9 ± 2.5 at T2 (Z= -4.786, p < 0.001). The burnout subscale showed a decrease from 32.2 ± 5.6 at T0 to 21.1 ± 5.1 at T1 (Z= -4.488, p < 0.001), and to 17.8 ± 3.5 at T2 (Z= -4.786, p < 0.001). Finally, compassion satisfaction increased significantly from 27.4 ± 13.1 at T0 to 43.7 ± 3.8 at T1 (Z= -4.250, p < 0.001), consolidating at 47.4 ± 2.2 at six months (Z= -4.784, p < 0.001) (see Table 4 and Fig. 2 ). Table 4 Comparison of ProQOL-IV subscales Subscale Time Mean SD Statistic (Z) P value Fatigue T0 28.6 7.5 Z = − 4.25 < .001 T1 15.4 8.5 Z = − 4.79 < .001 T2 7.9 2.5 Burnout T0 32.2 5.6 Z = − 4.49 < .001 T1 21.1 5.1 Z = − 4.79 < .001 T2 17.8 3.5 Satisfaction T0 27.4 13.1 Z = − 4.25 < .001 T1 43.7 3.8 Z = − 4.78 < .001 T2 47.4 2.2 Note. Differences between time points were analyzed using the Wilcoxon signed-rank test for paired samples, appropriate for nonparametric data. All comparisons were statistically significant (P < .001), supporting the positive impact of the program on professional well-being. Fatigue and Burnout scores decreased consistently, whereas Compassion Satisfaction showed a progressive and clinically relevant increase. Analysis of correlations between ProQOL-IV subscales revealed strong and statistically significant associations at baseline (T0), highlighting the inverse relationship between burnout and compassion satisfaction (ρ= -0.83). After intervention (T1), a positive association between compassion fatigue and burnout remained (ρ = 0.70), along with an emerging negative correlation between fatigue and satisfaction (ρ= -0.45). At the six-month assessment (T2), the correlations attenuated, but remained moderate, suggesting a stable evolution of the therapeutic effect (see Table 5 ). Table 5 Correlations between ProQOL-IV subscales Time Variable 1 Variable 2 ρ (Spearman) P value T0 Fatigue Burnout 0.68 < .001 Fatigue Satisfaction −0.56 .0012 Burnout Satisfaction −0.83 < .001 T1 Fatigue Burnout 0.70 < .001 Fatigue Satisfaction −0.45 .0121 Burnout Satisfaction −0.50 .0048 T2 Fatigue Burnout 0.41 .0251 Fatigue Satisfaction −0.34 .0697 Burnout Satisfaction −0.16 .3988 Note. Spearman correlation coefficients (ρ) were used due to the ordinal nature of the data, the small sample size, and the presence of non-normal distributions. All reported correlations are two-tailed. Correlations with P < .05 were considered significant. Regarding the IDE-ESAPE, the percentage of participants classified under profile 4 (compassion fatigue) decreased from 63.3% at baseline to 36.7% immediately after the intervention (P value < .05), and to 0% at six months (P value < .001). Meanwhile, the proportion of professionals classified under profile 3 (empathic functioning with risk of compassion fatigue) increased from 36.7% at T0 to 63.3% at T1, reaching 100% at T2. No study subject reached profile 1 during the study (optimal functioning, without risk of EBS) or profile 2 (empathic functioning without risk). Regarding the ESAPE factors, statistically significant changes were observed in factor 2: self-care, with a mean score of 2.6 ± 0.32 at T0, reduced to 2.1 ± 0.34 at T1 (Z= -4.149), and to 1.86 ± 0.16 at T2 (Z= -4.711; p < 0.001). Discussion The findings of this pilot study provide empirical evidence supporting the efficacy of a structured secondary prevention program in mitigating compassion fatigue in healthcare professionals. The statistically significant reduction in levels of compassion fatigue and burnout, together with the increase in compassion satisfaction scores, demonstrate a favorable impact of the intervention in both the short and medium term. These results are consistent with what has been reported in recent systematic reviews and meta-analyses, which validate the effectiveness of interventions focused on mindfulness, resilience building and emotional self-care ( 4 , 12 ). The data align with previous conceptual frameworks on vicarious trauma and compassion fatigue ( 1 , 3 , 18 ), which postulate that continued exposure to the suffering of others, without institutional coping strategies, can compromise the emotional balance of the healthcare worker. In this study, the intervention implemented allowed a progressive reversal of the clinical profile of compassion fatigue identified in the baseline assessment using the IDE-ESAPE assessment tool, with sustained improvements in the patterns of empathic response. Furthermore, the stability of the emotional indicators during the six-month follow-up suggests a lasting residual effect, which underlines the relevance of designing long-lasting and scalable interventions within the health system, as previously proposed by Baranowsky and Gentry( 18 ), as well as Maben and Bridges( 8 ). The 100% retention rate reinforces the acceptability of the program, a key aspect for its viability in diverse clinical settings. The program included cognitive-behavioral components, mindfulness techniques and resilience training strategies, all of them with solid empirical validation in healthcare contexts with high emotional burden( 12 , 13 ). The incorporation of these elements could have facilitated processes of emotional rebalancing and empathic reconstruction, as indicated by various research conducted in hospital settings characterized by acute stress ( 14 , 19 ) From an institutional perspective, the systematic implementation of programs of this type can contribute significantly to the improvement of the psychological well-being of the staff, as well as to the reduction of labor turnover, absenteeism and clinical errors associated with professional burnout( 6 , 20 ). These benefits justify investment in preventive models that, in addition to preserving the health of the professional, have a positive impact on the quality and continuity of care. In addition, the results allow us to reflect on the need to adopt a systemic and integrated approach in the management of emotional exhaustion among healthcare personnel. As Greenberg et al. ( 7 ) point out, it is not enough to intervene on the individual consequences; it is essential to transform the organizational structures that perpetuate conditions of chronic stress, promoting institutional cultures based on compassion, psychological safety and recognition of emotional effort. Protecting the mental health of staff is not only an ethical imperative, but also a key strategy for strengthening the resilience of health systems in the face of crisis scenarios. Nevertheless, this study has methodological limitations that should be considered. The quasi-experimental design without a control group limits the ability to establish definitive causal relationships between the intervention and the observed outcomes. In addition, the small sample size and the self-selective nature of participation introduce potential biases that affect the generalizability of the findings. The exclusive use of self-report measures also represents a source of bias related to subjective perception and social desirability. Although the 6-month follow-up provides valuable information on the sustainability of the impact, it does not allow conclusions to be drawn on its long-term permanence. Furthermore, the specific context of application -a public hospital in the Canary Islands, in a post-pandemic setting- limits the extrapolation of the results to other clinical and cultural settings. Based on the above, it is recommended that future research adopt experimental designs with control groups and larger samples, in order to rigorously validate the effectiveness of the program. It would also be pertinent to extend the follow-up periods and combine subjective indicators with objective measures (such as biomarkers or absenteeism records). Finally, the evaluation of digital or hybrid versions of the program could facilitate its scalability and adaptability to different healthcare contexts. Conclusion The findings of this pilot study support the effectiveness of a structured secondary prevention program to mitigate compassion fatigue in healthcare professionals who have worked in COVID-19 units. The significant and sustained improvement in key indicators such as compassion fatigue, burnout and professional satisfaction is evidence of the therapeutic potential of this type of intervention in emotionally charged healthcare settings. The intervention proved to be not only effective, but also highly accepted by the participants, which reinforces its viability as an institutional strategy. In light of these results, it is recommended that this type of program be integrated into continuing education plans and psychosocial risk prevention policies within the healthcare system. Strengthening the emotional well-being of personnel not only improves the quality of care, but also acts as a protective factor against future health crises. In a global context in which the mental health of healthcare personnel has been profoundly affected, this study provides a relevant empirical basis for moving towards more humane, safe and sustainable clinical environments. Declarations Acknowledgments The authors are thankful for the participation of the workers of the Hospital Universitario Nuestra Señora de Candelaria in the psychoeducational intervention. Ethics approval and consent to participate This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee for Research with Medicines (CEIm) of the University Hospital Complex of the Canary Islands (CHUNSC_2022_60). All participants signed informed consent. Consent for publication The findings described in this document have not been previously published, and none of the authors are currently submitting them to another publisher for consideration. Competing interests The authors declare no competing interests. Funding This study was financed by the Fundación Canaria Instituto de Investigación Sanitaria de Canarias (Code ENF22/18). Author contributions Rodríguez García, MA and Rodríguez de Miguel, C conceived and designed the study. Rodriguez Garcia, MA collected the data. Rodriguez de Miguel, C managed the project. Reyes Quesada, JG performed the statistical analysis and modeling, and drafted the manuscript. Rey Luque, O supervised the evaluation and revision of the manuscript. Evolution of subscales (gray-blue range by time point) Score Fatigue – Burnout – Satisfaction Moment T0 T1 T2 References Figley CR. Compassion fatigue: Psychotherapists’ chronic lack of self-care. 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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-7466497","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":511487388,"identity":"cb42ac5b-27eb-4752-85d8-06e0f02c6339","order_by":0,"name":"María de los Ángeles Rodríguez García","email":"","orcid":"","institution":"Hospital Universitario Nuestra Señora de Candelaria","correspondingAuthor":false,"prefix":"","firstName":"María","middleName":"de los Ángeles Rodríguez","lastName":"García","suffix":""},{"id":511487389,"identity":"2895c51f-ebcf-4963-9912-7a3a873e22f4","order_by":1,"name":"Cristina Rodríguez de Miguel","email":"","orcid":"","institution":"Hospital Universitario Nuestra Señora de Candelaria","correspondingAuthor":false,"prefix":"","firstName":"Cristina","middleName":"Rodríguez","lastName":"de Miguel","suffix":""},{"id":511487390,"identity":"07f2604e-4aca-4a67-89a1-0386a8121936","order_by":2,"name":"Johan Gregorio Reyes Quesada","email":"data:image/png;base64,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","orcid":"","institution":"Hospital Universitario Nuestra Señora de Candelaria","correspondingAuthor":true,"prefix":"","firstName":"Johan","middleName":"Gregorio Reyes","lastName":"Quesada","suffix":""},{"id":511487391,"identity":"89b120e8-2cc8-4367-9125-de0adcb5700a","order_by":3,"name":"Óscar Rey Luque","email":"","orcid":"","institution":"Hospital Universitario Nuestra Señora de Candelaria","correspondingAuthor":false,"prefix":"","firstName":"Óscar","middleName":"Rey","lastName":"Luque","suffix":""}],"badges":[],"createdAt":"2025-08-26 23:38:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7466497/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7466497/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91075460,"identity":"f2c07e07-055b-43ab-b690-f9beaa6307d8","added_by":"auto","created_at":"2025-09-11 11:07:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":16199,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7466497/v1/6a6cd759a1abea43a752dc01.png"},{"id":91075459,"identity":"9a6c80dd-c93c-4123-a922-f9c5c9cf7553","added_by":"auto","created_at":"2025-09-11 11:07:52","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":69179,"visible":true,"origin":"","legend":"\u003cp\u003eEvolution of ProQOL-IV scores at the three study time points\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7466497/v1/f831081fbaef0970190fe4cf.png"},{"id":91077359,"identity":"1e2a534f-2e9c-4f94-98f1-1e7f4704937f","added_by":"auto","created_at":"2025-09-11 11:15:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":746584,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7466497/v1/dd644dcb-7949-40db-ab1c-2f1ef8fd7237.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eImpact of a Pilot Program for the Secondary Prevention of Compassion Fatigue in Healthcare Professionals Who Worked in Covid-19 Units at the Nuestra Señora De Candelaria Hospital Complex: A Quasi-experimental Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCompassion fatigue is a form of emotional distress that affects healthcare professionals with prolonged exposure to the pain of others. This phenomenon is characterized by a progressive loss of empathic capacity, emotional exhaustion and decreased professional satisfaction(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Unlike burnout, whose etiology is associated with organizational factors such as work overload or lack of control, compassion fatigue arises as a direct consequence of repeated contact with suffering patients, and usually coexists with clinical manifestations of secondary traumatic stress(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) Burnout has been classically conceptualized by Maslach et al.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), whose multidimensional model remains a seminal reference in psychosocial research.\u003c/p\u003e\u003cp\u003eDuring the COVID-19 pandemic, the intensity, duration and complexity of the clinical situations experienced by healthcare workers created an unprecedented risk scenario for the development of affective disorders related to the exercise of empathy. Emerging evidence has documented elevated levels of acute stress, emotional exhaustion, sleep disturbances, anxiety, and ideation of professional abandonment among frontline workers(\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In particular, nurses and other clinical profiles in close contact with critically ill patients showed high prevalence of compassion fatigue, associated with reduced quality of care and deterioration of their own mental health(\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eDespite the clinical and organizational impact of compassion fatigue, institutional strategies for its prevention and management are still scarce, partial or reactive. There are interventions based on mindfulness, resilience training and self-care practices that have shown positive effects on the emotional regulation of caregivers(\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), but their systematic integration in healthcare settings remains limited. Therefore, it is essential to develop and evaluate intervention programs that are structured, sustainable and adapted to contexts of high emotional vulnerability.(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThe aim of this study was to evaluate the impact of a pilot program for secondary prevention of compassion fatigue, implemented at the Nuestra Se\u0026ntilde;ora de Candelaria University Hospital Complex (CHUNSC), aimed at healthcare professionals who served in COVID-19 units. Through a longitudinal design, we explore the effect of the program on three key dimensions: empathy burnout, burnout and professional satisfaction.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design\u003c/h2\u003e\u003cp\u003eA quasi-experimental, longitudinal and prospective study was designed, with pretest-posttest measures in a single group, aimed at evaluating the impact of a psychoeducational intervention in the secondary prevention of compassion fatigue in healthcare professionals exposed to COVID-19 units.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipants and sampling\u003c/h3\u003e\n\u003cp\u003eThe sample consisted of 30 health professionals from the CHUNSC, chosen by targeted sampling. In a preliminary phase, the Empathic Distress Inventory (IDE-ESAPE) and ProQOL tools were provided to a total of 148 professionals who had worked in COVID-19 services. Those who showed elevated scores on indicators of compassion fatigue or burnout were invited to participate in the intervention. The inclusion criteria were: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) presenting high levels of compassion fatigue or burnout according to the tools applied, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) performing care functions in COVID-19 units of the hospital, and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) voluntarily accepting their participation. Professionals who were temporarily or occupationally incapacitated at the time of the study were excluded.\u003c/p\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003eThe study was conducted between March and November 2022. After the preliminary assessment, the selected participants were incorporated into the group intervention program, which consisted of five 120-minute face-to-face sessions (total of 10 hours), developed over five weeks. The sessions were facilitated by professional experts in emotional health, compassion and mindfulness. The sessions were divided into:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eSession 1: Identification of compassion fatigue symptoms and their triggers through psychoeducational workshops.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSession 2: Training in coping and conflict management skills, using practical exercises and role-playing dynamics.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSession 3: Strengthening resilience through appreciative inquiry and networking.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSession 4: Stress reduction techniques, such as mindfulness, progressive muscle relaxation and controlled breathing.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSession 5: Self-monitoring and internal conflict resolution, through open communication spaces.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eEvaluations were performed at three points in time: before the start of the intervention (T0), after the intervention (T1) and six months after the end of the intervention (T2). The study was approved by the Drug Research Ethics Committee and complied with the ethical principles of the Declaration of Helsinki. All participants signed the informed consent form and their data were treated confidentially.\u003c/p\u003e\n\u003ch3\u003eAssessment instruments\u003c/h3\u003e\n\u003cp\u003eThe following instruments were used, all of them previously validated in healthcare population:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e- Compassion Fatigue Inventory - Scale for Healthcare Professionals (Spanish acronym: IDE-ESAPE): allows detecting clinical and subclinical profiles of compassion fatigue with high internal reliability (α\u0026thinsp;\u0026gt;\u0026thinsp;0.85)(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e- Professional Quality of Life Scale (ProQOL IV): international scale that assesses compassion fatigue, burnout and compassion satisfaction(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e- Subjective Traumatic Experiences Questionnaire (STEQ): assesses the degree of subjective emotional impact of traumatic experiences in the care context (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eIn addition, sociodemographic variables such as age, sex, professional category, length of service and work unit were also collected.\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eIBM SPSS Statistics v.28 software was used for statistical analysis. Descriptive statistics (means, standard deviations, frequencies) and nonparametric analyses (Wilcoxon signed-rank test for comparison of pre and post measurements; Mann-Whitney U test for comparisons between groups) were performed, as well as Spearman correlations between emotional and sociodemographic variables. A statistical significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was established and effect sizes (r) were calculated to assess the clinical relevance of the results.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003ePreliminary phase\u003c/h2\u003e\u003cp\u003eAn initial evaluation using the ProQOL-IV and IDE-ESAPE questionnaires was carried out on a total of 148 health professionals (81.1% women), belonging to CHUNSC services that attended patients with COVID-19. The distribution by professional category was as follows: 68 nurses (45.9%), 71 nursing assistants (48.0%) and 9 physicians (6.1%). The mean age of the participants was 40.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5 years, with a mean work experience of 11.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2 years. Detailed descriptive statistics can be found in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\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\u003eSociodemographic statistics of the preliminary phase\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\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003en (%) / Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e120 (81.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28 (18.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYears of experience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56 (37.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44 (29.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSeparated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15 (10.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWidowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (2.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIn a relationship\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30 (20.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLives alone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41 (27.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e107 (72.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDependents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77 (52%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71 (48%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfessional category\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhysician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (6.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68 (45.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNursing assisstant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71 (48%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWorkplace\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmergency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40 (27%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHospitalization\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67 (45.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eICU-Operating room\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (7.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26 (17.6%)\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\u003eIn this preliminary assessment, 61.3% of the participants presented elevated levels of compassion fatigue, and 52.3% were classified in the high burnout risk category, according to the ProQOL-IV scale. In the IDE-ESAPE, the empathic profiles identified were: profile 2 (empathic functioning without risk, 0.8%), profile 3 (risk of compassion fatigue, 60.0%) and profile 4 (compassion fatigue, 39.2%) (see Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\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\u003eResults of the ProQOL-IV questionnaire in the preliminary phase\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\u003eSubscale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCompassion fatigue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo compassion fatigue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55 (38.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCompassion fatigue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e87 (61.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBurnout\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow risk\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25 (17.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate risk\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80 (54.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh risk\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41 (27.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCompassion satisfaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow satisfaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63 (42.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedium satisfaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39 (26.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh satisfaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45 (30.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNote\u003c/b\u003e: The cut-off points to classify the subscales were:\u003c/p\u003e\u003cp\u003eCompassion fatigue: \u0026ge;17 points\u003c/p\u003e\u003cp\u003eBurnout: \u0026le; 18 Low; 19\u0026ndash;26 Moderate; \u0026gt;27 High\u003c/p\u003e\u003cp\u003eCompassion satisfaction: \u0026le; 33 Low; 33\u0026ndash;41 Medium; \u0026ge;42 High\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\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\u003eResults of the Empathic Fatigue Inventory (IDE-ESAPE) in the preliminary phase\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\u003eDimension\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLevel\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfessional involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e102 (71.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedium\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40 (28.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94 (70.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedium\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40 (29.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVulnerability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e109 (77.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedium\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31 (22.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIDE Diagnosis (ESAPE Profile)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProfile 1: No risk\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProfile 2: Normal without risk\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProfile 3: Normal with risk\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e78 (60.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProfile 4: With compassion fatigue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51 (39.2%)\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\u003eRegarding the Subjective Traumatic Experiences Questionnaire (STEQ), 32.6% of the participants reported difficulties in asking for help \u0026ldquo;frequently or always\u0026rdquo;, while 21.1% reported feeling unable to connect with others with the same frequency, whilst 42.1% reported feeling emotionally drained at work \u0026ldquo;frequently\u0026rdquo;, and 42.2% reported feeling \u0026ldquo;sometimes or quite often\u0026rdquo; that they had no reason to live. Likewise, 22.5% reported having no initiative to carry out activities and 69.4% reported feeling completely alone at some point. Finally, 42.1% reported having experienced traumatic situations in the past.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eIntervention Phase\u003c/h3\u003e\n\u003cp\u003eIn the intervention phase, 30 participants with high levels of emotional exhaustion were chosen in the initial assessment. The professional distribution was as follows: 40% nurses, 50% nursing assistants and 10% physicians. The intervention was completed in its entirety by the sample (100%), with no losses (see Fig.\u0026nbsp;1).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eSubsequently, a statistically significant improvement was evidenced in the mean scores obtained in the ProQOL-IV and IDE-ESAPE questionnaires, both immediately after the intervention (T1) and at the six-month follow-up assessment (T2).\u003c/p\u003e\u003cp\u003eIn the ProQOL-IV questionnaire, the mean score on the compassion fatigue subscale decreased from 28.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.5 at T0 to 15.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.5 at T1 (Z= -4.251, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and subsequently to 7.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5 at T2 (Z= -4.786, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The burnout subscale showed a decrease from 32.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.6 at T0 to 21.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1 at T1 (Z= -4.488, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and to 17.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5 at T2 (Z= -4.786, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Finally, compassion satisfaction increased significantly from 27.4\u0026thinsp;\u0026plusmn;\u0026thinsp;13.1 at T0 to 43.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8 at T1 (Z= -4.250, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), consolidating at 47.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2 at six months (Z= -4.784, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (see Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of ProQOL-IV subscales\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\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\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubscale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eStatistic (Z)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFatigue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eT0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eZ\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;4.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eT1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eZ\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;4.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eT2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBurnout\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eT0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eZ\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;4.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eT1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eZ\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;4.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eT2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSatisfaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eT0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eZ\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;4.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eT1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eZ\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;4.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eT2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNote.\u003c/b\u003e Differences between time points were analyzed using the Wilcoxon signed-rank test for paired samples, appropriate for nonparametric data. All comparisons were statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;.001), supporting the positive impact of the program on professional well-being. Fatigue and Burnout scores decreased consistently, whereas Compassion Satisfaction showed a progressive and clinically relevant increase.\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\u003c/p\u003e\u003cp\u003eAnalysis of correlations between ProQOL-IV subscales revealed strong and statistically significant associations at baseline (T0), highlighting the inverse relationship between burnout and compassion satisfaction (ρ= -0.83). After intervention (T1), a positive association between compassion fatigue and burnout remained (ρ\u0026thinsp;=\u0026thinsp;0.70), along with an emerging negative correlation between fatigue and satisfaction (ρ= -0.45). At the six-month assessment (T2), the correlations attenuated, but remained moderate, suggesting a stable evolution of the therapeutic effect (see Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCorrelations between ProQOL-IV subscales\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\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\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVariable 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eVariable 2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eρ (Spearman)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFatigue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBurnout\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFatigue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSatisfaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;0.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.0012\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBurnout\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSatisfaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFatigue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBurnout\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFatigue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSatisfaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;0.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.0121\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBurnout\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSatisfaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;0.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.0048\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFatigue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBurnout\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.0251\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFatigue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSatisfaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;0.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.0697\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBurnout\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSatisfaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;0.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.3988\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNote.\u003c/b\u003e Spearman correlation coefficients (ρ) were used due to the ordinal nature of the data, the small sample size, and the presence of non-normal distributions. All reported correlations are two-tailed. Correlations with P\u0026thinsp;\u0026lt;\u0026thinsp;.05 were considered significant.\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\u003eRegarding the IDE-ESAPE, the percentage of participants classified under profile 4 (compassion fatigue) decreased from 63.3% at baseline to 36.7% immediately after the intervention (P value\u0026thinsp;\u0026lt;\u0026thinsp;.05), and to 0% at six months (P value\u0026thinsp;\u0026lt;\u0026thinsp;.001). Meanwhile, the proportion of professionals classified under profile 3 (empathic functioning with risk of compassion fatigue) increased from 36.7% at T0 to 63.3% at T1, reaching 100% at T2.\u003c/p\u003e\u003cp\u003eNo study subject reached profile 1 during the study (optimal functioning, without risk of EBS) or profile 2 (empathic functioning without risk). Regarding the ESAPE factors, statistically significant changes were observed in factor 2: self-care, with a mean score of 2.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32 at T0, reduced to 2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34 at T1 (Z= -4.149), and to 1.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16 at T2 (Z= -4.711; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this pilot study provide empirical evidence supporting the efficacy of a structured secondary prevention program in mitigating compassion fatigue in healthcare professionals. The statistically significant reduction in levels of compassion fatigue and burnout, together with the increase in compassion satisfaction scores, demonstrate a favorable impact of the intervention in both the short and medium term. These results are consistent with what has been reported in recent systematic reviews and meta-analyses, which validate the effectiveness of interventions focused on mindfulness, resilience building and emotional self-care (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe data align with previous conceptual frameworks on vicarious trauma and compassion fatigue (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), which postulate that continued exposure to the suffering of others, without institutional coping strategies, can compromise the emotional balance of the healthcare worker. In this study, the intervention implemented allowed a progressive reversal of the clinical profile of compassion fatigue identified in the baseline assessment using the IDE-ESAPE assessment tool, with sustained improvements in the patterns of empathic response.\u003c/p\u003e\u003cp\u003eFurthermore, the stability of the emotional indicators during the six-month follow-up suggests a lasting residual effect, which underlines the relevance of designing long-lasting and scalable interventions within the health system, as previously proposed by Baranowsky and Gentry(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), as well as Maben and Bridges(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The 100% retention rate reinforces the acceptability of the program, a key aspect for its viability in diverse clinical settings.\u003c/p\u003e\u003cp\u003eThe program included cognitive-behavioral components, mindfulness techniques and resilience training strategies, all of them with solid empirical validation in healthcare contexts with high emotional burden(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The incorporation of these elements could have facilitated processes of emotional rebalancing and empathic reconstruction, as indicated by various research conducted in hospital settings characterized by acute stress (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eFrom an institutional perspective, the systematic implementation of programs of this type can contribute significantly to the improvement of the psychological well-being of the staff, as well as to the reduction of labor turnover, absenteeism and clinical errors associated with professional burnout(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). These benefits justify investment in preventive models that, in addition to preserving the health of the professional, have a positive impact on the quality and continuity of care.\u003c/p\u003e\u003cp\u003eIn addition, the results allow us to reflect on the need to adopt a systemic and integrated approach in the management of emotional exhaustion among healthcare personnel. As Greenberg et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) point out, it is not enough to intervene on the individual consequences; it is essential to transform the organizational structures that perpetuate conditions of chronic stress, promoting institutional cultures based on compassion, psychological safety and recognition of emotional effort. Protecting the mental health of staff is not only an ethical imperative, but also a key strategy for strengthening the resilience of health systems in the face of crisis scenarios.\u003c/p\u003e\u003cp\u003eNevertheless, this study has methodological limitations that should be considered. The quasi-experimental design without a control group limits the ability to establish definitive causal relationships between the intervention and the observed outcomes. In addition, the small sample size and the self-selective nature of participation introduce potential biases that affect the generalizability of the findings. The exclusive use of self-report measures also represents a source of bias related to subjective perception and social desirability.\u003c/p\u003e\u003cp\u003eAlthough the 6-month follow-up provides valuable information on the sustainability of the impact, it does not allow conclusions to be drawn on its long-term permanence. Furthermore, the specific context of application -a public hospital in the Canary Islands, in a post-pandemic setting- limits the extrapolation of the results to other clinical and cultural settings.\u003c/p\u003e\u003cp\u003eBased on the above, it is recommended that future research adopt experimental designs with control groups and larger samples, in order to rigorously validate the effectiveness of the program. It would also be pertinent to extend the follow-up periods and combine subjective indicators with objective measures (such as biomarkers or absenteeism records). Finally, the evaluation of digital or hybrid versions of the program could facilitate its scalability and adaptability to different healthcare contexts.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings of this pilot study support the effectiveness of a structured secondary prevention program to mitigate compassion fatigue in healthcare professionals who have worked in COVID-19 units. The significant and sustained improvement in key indicators such as compassion fatigue, burnout and professional satisfaction is evidence of the therapeutic potential of this type of intervention in emotionally charged healthcare settings. The intervention proved to be not only effective, but also highly accepted by the participants, which reinforces its viability as an institutional strategy.\u003c/p\u003e\u003cp\u003eIn light of these results, it is recommended that this type of program be integrated into continuing education plans and psychosocial risk prevention policies within the healthcare system. Strengthening the emotional well-being of personnel not only improves the quality of care, but also acts as a protective factor against future health crises. In a global context in which the mental health of healthcare personnel has been profoundly affected, this study provides a relevant empirical basis for moving towards more humane, safe and sustainable clinical environments.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cu\u003eAcknowledgments\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are thankful for the participation of the workers of the Hospital Universitario Nuestra Señora de Candelaria in the psychoeducational intervention.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eEthics approval and consent to participate\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee for Research with Medicines (CEIm) of the University Hospital Complex of the Canary Islands (CHUNSC_2022_60). All participants signed informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConsent for publication\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe findings described in this document have not been previously published, and none of the authors are currently submitting them to another publisher for consideration.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eCompeting interests\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eFunding\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThis study was financed by the Fundación Canaria Instituto de Investigación Sanitaria de Canarias (Code ENF22/18).\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAuthor contributions\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eRodríguez García, MA and Rodríguez de Miguel, C conceived and designed the study. Rodriguez Garcia, MA collected the data. Rodriguez de Miguel, C managed the project. Reyes Quesada, JG performed the statistical analysis and modeling, and drafted the manuscript. Rey Luque, O supervised the evaluation and revision of the manuscript.\u003c/p\u003e\n\u003cp\u003eEvolution of subscales\u003cbr\u003e\u0026nbsp;(gray-blue range by time point)\u003c/p\u003e\n\u003cp\u003eScore\u003cbr\u003e\u0026nbsp;Fatigue – Burnout – Satisfaction\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMoment\u003c/p\u003e\n\u003cp\u003eT0\u003c/p\u003e\n\u003cp\u003eT1\u003c/p\u003e\n\u003cp\u003eT2\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFigley CR. Compassion fatigue: Psychotherapists\u0026rsquo; chronic lack of self-care. 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Med Clin Barc. 2016;147(10):430\u0026ndash;3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.medcli.2016.04.016\u003c/span\u003e\u003cspan address=\"10.1016/j.medcli.2016.04.016\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\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":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"empathy burnout, burnout, health personnel, COVID-19, psychosocial intervention","lastPublishedDoi":"10.21203/rs.3.rs-7466497/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7466497/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cu\u003eBackground:\u003c/u\u003e compassion fatigue is a common condition among healthcare professionals continuously exposed to patient suffering, especially in high-pressure care settings such as those experienced during the COVID-19 pandemic. Evidence highlights its negative impact on mental health of staff and quality of care, as well as the need to implement effective preventive programs. Therefore, the aim of this study was to evaluate the impact of a pilot program of secondary prevention of compassion fatigue in healthcare professionals working in COVID-19 units at the Nuestra Señora de Candelaria University Hospital Complex (CHUNSC).\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eMethods:\u003c/u\u003e A quasi-experimental, longitudinal and prospective study was carried out, with pretest-posttest measures in a single group. By initial screening with the IDE-ESAPE and ProQOL-IV tools, 30 professionals with high scores of compassion fatigue or burnout were selected. The psychoeducational program, consisting of five group sessions, included mindfulness, emotional regulation and self-care. The results were evaluated at six months.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eResults:\u003c/u\u003e Significant reductions in compassion fatigue (p\u0026lt;0.01; r=0.48) and burnout (p\u0026lt;0.01; r=0.53) were observed, as well as an increase in compassion satisfaction (p\u0026lt;0.01; r=0.46). A total of 100 % of the participants completed the intervention. No clinical recurrences were detected during follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConclusion:\u003c/u\u003e The program proved to be effective and well accepted, suggesting its feasibility for integration into hospital occupational health policies.\u003c/p\u003e","manuscriptTitle":"Impact of a Pilot Program for the Secondary Prevention of Compassion Fatigue in Healthcare Professionals Who Worked in Covid-19 Units at the Nuestra Señora De Candelaria Hospital Complex: A Quasi-experimental Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-11 10:59:48","doi":"10.21203/rs.3.rs-7466497/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-23T09:55:39+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-21T19:59:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-08T20:50:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"209001768977049788815570084833256225763","date":"2026-02-08T18:00:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"196804380372178284063860375342932397737","date":"2026-02-06T19:57:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-24T09:12:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"167549223163095436680525453299783677915","date":"2025-09-04T04:07:06+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-04T04:04:06+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-02T18:55:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-28T17:05:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-28T17:04:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-08-26T23:29:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d5f24ce2-39c4-41a1-a46a-2ecd31cd506f","owner":[],"postedDate":"September 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-16T00:23:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-11 10:59:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7466497","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7466497","identity":"rs-7466497","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}