Prevalence and Predictors of Compassion Fatigue Among Critical Care Nurses in Palestinian Hospitals: A Cross-Sectional Analysis

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Although widely studied worldwide, it remains poorly understood in the Palestinian healthcare setting. This study fills a major gap in the Palestinian critical care literature, where compassion fatigue among ICU nurses has not been systematically measured or analyzed before. Methods: This cross-sectional study used an online questionnaire to assess compassion fatigue among 146 nurses working in emergency, critical care, and coronary care units across public, private, and non-profit hospitals. The survey measured emotional exhaustion, secondary trauma, and job satisfaction. Data were analyzed in SPSS using descriptive statistics, t-tests, ANOVA, and correlation analyses. The instrument demonstrated excellent reliability (Cronbach’s α = 0.946). Results: Participants reported a moderate level of compassion fatigue, with a mean score of 3.06. Workload and emotional exhaustion were identified as the most common stressors. No significant differences were found across gender, age, education level, or years of experience, indicating that compassion fatigue in this context is driven mainly by workplace rather than personal factors. Conclusions: Compassion fatigue remains a persistent problem among critical care nurses in Palestine, primarily due to organizational conditions. Hospitals should implement measures to ease workload pressures, strengthen emotional support systems, and provide targeted training to help nurses manage stress and maintain high-quality patient care. Compassion fatigue intensive care units cross-sectional analysis T-tests ANOVA Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 INTRODUCTION Healthcare workers — especially those in critical care — are at high risk of developing compassion fatigue (CF). This condition arises from the intense emotional demands of their jobs, the constant pressure of medical emergencies, and repeated exposure to patients’ suffering. As Alharbi, Jackson, and Usher (2020) point out, these factors can lead to physical, emotional, and psychological exhaustion, undermining both nurses’ well-being and their performance at work. Unlike general burnout, which is usually driven by heavy workloads and organizational pressures, compassion fatigue is primarily linked to the emotional strain of caring for critically ill patients, witnessing traumatic events, and making difficult ethical decisions in life-or-death situations (Friganović et al., 2019). Its impact can be severe, resulting in reduced job satisfaction, impaired decision-making, higher absenteeism, and increased nursing turnover (Papazian et al., 2023). Compassion fatigue also affects patients. When empathy wanes, communication suffers, and clinical judgment may falter, which can compromise the quality of care. This underscores the urgent need to address CF among healthcare professionals (Ramírez-Elvira et al., 2021). Research from around the world shows that CF is common among critical care nurses and that it significantly affects their mental health and job effectiveness. Studies across multiple countries have found strong links between CF, elevated stress, emotional exhaustion, and job dissatisfaction. According to a review by Bruyneel et al. (2023), the emotionally charged environment of intensive care makes nurses particularly vulnerable. Arimon-Pagès et al. (2023) further note that anxiety and depression often accompany CF, worsening its impact. High patient mortality and the ongoing emotional strain of caring for critically ill patients create chronic stress, which, if unaddressed, can lead to severe psychological distress. CF has also been linked to more patient safety incidents because emotionally drained nurses may become less vigilant, deviate from best practices, and experience cognitive fatigue (Shawahna et al., 2022). Despite the growing global research on compassion fatigue, little is known about its prevalence among nurses in Palestinian hospitals. The Palestinian healthcare system faces unique challenges, including shortages of medical resources, financial constraints, and political instability. Critical care nurses often manage heavy patient loads, work long hours, and lack psychological support — all of which heighten stress and emotional exhaustion (Hasan et al., 2024). In addition, ongoing conflict and frequent mass-casualty events add further pressure to an already strained system. A study by Jafare (2023) reports high levels of emotional distress among Palestinian intensive care nurses, but the specific issue of compassion fatigue and its long-term effects has received little attention. This research gap highlights the need for a comprehensive study of CF among critical care nurses in Palestine to better understand its prevalence, contributing factors, and potential interventions. Addressing compassion fatigue is essential for maintaining high standards of patient care and improving nurses’ well-being. Healthcare organizations must recognize CF as a serious problem and implement targeted interventions. According to Salameh et al. (2024), these could include resilience training, mental-health support, improved work-life balance, and adequate staffing to ease excessive workloads. Creating a supportive workplace where nurses can openly discuss their emotional challenges and seek guidance from supervisors can also reduce the burden of CF. Hospital leaders and policymakers should prioritize initiatives that improve working conditions, prevent CF, and protect healthcare workers’ mental health. This research aims to determine the prevalence of compassion fatigue among critical care nurses in Palestinian hospitals and to identify the factors contributing to it. By filling this research gap, the study will provide evidence-based recommendations for addressing CF in the healthcare system and offer valuable insight into the challenges facing ICU nurses in Palestine. Understanding the scope and impact of CF can help healthcare organizations develop effective support systems to enhance nurses’ mental well-being, job satisfaction, and the overall quality of patient care. Problem Statement Nurses who work in critical care carry a heavy load on their emotions, minds, and thinking skills. They handle life-saving treatments for patients who are really sick, they make quick calls when the pressure is on, and they keep running into pain, injuries, and death day after day. All these factors hit them with serious stress levels that make them more open to compassion fatigue, or CF. That is basically a feeling of being emotionally drained, with less empathy overall, and trouble giving the kind of caring support patients need (Alharbi, Jackson & Usher, 2020; Friganović et al., 2019). Plenty of research points out how CF affects nurses themselves and the results for patients too. It leads to lower satisfaction on the job, more burnout cases, poorer judgment in clinical work, extra medical mistakes, and stronger urges to leave the field (Papazian et al., 2023; Ramírez-Elvira et al., 2021). Around the world, various studies make it clear that compassion fatigue shows up a lot in critical care nurses. People in ICUs often deal with CF right along with worry, everyday stress, and signs of depression, and all that wears down their well-being at home and on the job (Arimon-Pagès et al., 2023; Bruyneel et al., 2023; Shawahna et al., 2022). Still, a good deal of this work comes from places with steady, well-funded health systems. Those results do not really capture what happens in Palestinian hospitals, where nurses push through situations that ramp up the risks for CF in big ways. In Palestine, nurses in critical care run into ongoing shortages of supplies, too many patients at once, not enough staff around, little help for their mental health, and they face big waves of casualties from events tied to politics (Hasan et al., 2024; Shawahna et al., 2022). Such strains make the emotional drain and trauma even worse, so CF turns out more intense and tangled up compared to lots of other health spots. Earlier work has looked at burnout and regular job stress for Palestinian nurses in general (Jafare, 2023). But no one has really measured compassion fatigue on its own, set it apart from similar issues, or dug into what causes it and what follows. That kind of hole in the knowledge really highlights why we need to look closely at how common compassion fatigue is and what drives it among critical care nurses in Palestinian hospitals. Pulling together real data from there matters a lot for grasping the mental toll of ICU shifts. It helps in building specific ways to support them, shaping policies that fit, and in the end boosting nurse health along with better care for patients in tough, low-resource setups. Significance and Justification of the Study Compassion fatigue (CF) is a major concern in nursing, particularly in high-stress environments such as intensive care units (ICUs). Although CF has been widely researched in other healthcare systems, little is known about its prevalence and impact in Palestinian hospitals—settings where nurses face additional pressures, including limited resources, political instability, and frequent exposure to traumatic events (Shawahna et al., 2022). Understanding CF in this context is essential for developing effective interventions that protect the health of critical care nurses and maintain high standards of patient care. This study carries important practical implications for the Palestinian healthcare system. Nurses experiencing CF often suffer from emotional exhaustion, reduced job satisfaction, and increased turnover rates (Papazian et al., 2023). These factors directly affect not only the well-being of nurses but also patient safety and healthcare outcomes (Ramírez-Elvira et al., 2021). By identifying the prevalence and risk factors for CF among critical care nurses in Palestinian hospitals, healthcare organizations can design strategies to reduce burnout, improve retention, and strengthen the overall delivery of healthcare services. Addressing CF can help create a more supportive work environment and ensure that nurses are able to provide effective, compassionate care without experiencing long-term psychological harm (Arimon-Pagès et al., 2023). From a management and policy perspective, this research offers valuable guidance for hospital administrators and policymakers seeking to improve nurses’ working conditions. As Hasan et al. (2024) suggest, the findings can inform workplace policies that promote mental health, ensure adequate staffing levels, and integrate stress management initiatives into ICUs. Nursing educators can also use the results to incorporate CF awareness and resilience-building strategies into training programs for nurses working in high-stress settings (Alharbi, Jackson, & Usher, 2020). By examining CF in Palestinian ICUs, this study fills a critical gap in the literature and provides evidence-based recommendations to improve nurse well-being. The data can also be used to compare CF patterns across different hospital systems, supporting broader global healthcare initiatives and helping to develop more informed strategies for supporting critical care nurses. Beyond benefiting nurses in Palestine, the findings can serve as a model for other resource-limited healthcare settings facing similar challenges. Aim of the Study This study aims to determine how widespread compassion fatigue (CF) is among critical care nurses in Palestinian hospitals and to identify its main causes. It also seeks to explore how CF relates to work-related stress, job satisfaction, and patient care quality, while assessing its emotional, psychological, and professional effects on intensive care nurses. Objectives of the Study I. Measure the prevalence of compassion fatigue (CF) among critical care nurses working in Palestinian hospitals using a standardized, validated instrument. II. Identify key predictors of CF—including workload, trauma exposure, staffing levels, shift patterns, and access to psychological support—across ICU settings. III. Examine the impact of CF on professional outcomes such as job satisfaction, mental health, retention intention, and perceived quality of patient care. IV. Compare levels and predictors of CF among nurses across different hospital types (public, private, and non-governmental). Research Questions · What proportion of critical care nurses in Palestinian hospitals experience compassion fatigue? · What are the main factors contributing to CF among ICU nurses in Palestine, including workload, patient volume, and trauma exposure? · How does CF affect nurses’ mental health, job satisfaction, retention, and the quality of patient care? · Do CF levels differ among critical care nurses working in public, private, and non-governmental hospitals in Palestine? Hypotheses · Higher patient loads are significantly associated with increased levels of compassion fatigue among critical care nurses. · Nurses with access to psychological support services experience significantly lower levels of CF than those without such support. · CF levels do not differ significantly based on marital status, educational level, or gender. · Nurses with less critical care experience report higher levels of CF than those with more experience Research Variables Independent Variables · Compassion fatigue: Emotional and mental exhaustion from prolonged exposure to patient suffering and stressful conditions. · Work-related pressures: High patient volume, extended shifts, trauma exposure, and ethical dilemmas. · Hospital resources and type: Public, private, and non-governmental hospitals; staffing levels; availability of psychological support. · Demographics: Age, gender, years of experience, education, and nursing specialization. Dependent Variables · Job satisfaction and retention: Nurses’ willingness to remain in ICU roles. · Mental health impact: Levels of emotional exhaustion, anxiety, depression, and burnout. · Quality of patient care: Clinical performance, patient safety, and nurse–patient interactions. · Work engagement and productivity: Ability to perform duties effectively and maintain professional motivation. LITERARY REVIEW 1. Conceptualizing Compassion Fatigue in Critical Care Nursing Compassion fatigue shows up when caregivers face ongoing pain, tough moments, or intense medical crises. Critical units - full of serious cases and regular loss - often leave nurses drained emotionally, shaken by others’ trauma, or feeling less rewarded in their work (Stamm, 2010; Alharbi et al., 2019; Friganović et al., 2019). A well-known tool called ProQOL helps explain this worldwide - it sees compassion fatigue as both burnout and stress picked up from deeply connecting with struggling patients over time (Stamm, 2010; Chachula, 2020). The intense demands of ICU work mean nurses must handle tough medical tasks while making quick choices, facing moral challenges, or dealing with emotional stress. Because of this, their mental strength often wears down - raising chances of compassion fatigue and similar issues (Ramírez-Elvira et al., 2021; Papazian et al., 2023). When compassion fatigue gets worse, it harms both nurse and patient - draining empathy, clouding focus, or leading to mistakes and poor results. 2. Global Prevalence of Compassion Fatigue Among Critical Care Nurses Research from different countries shows that nurses in ICU and ER often face mild to serious CF. Because patients die frequently, they deal with ongoing traumatic situations - also, there’s little time to rest between work periods (Ramírez-Elvira et al., 2021; Özan & Polat, 2024). Across various health networks, CF tends to appear alongside anxiety or low mood - with extra strain building up due to constant job pressure (Arimon-Pagès et al., 2023; Bruyneel et al., 2023). Research from wealthy nations shows CF lowers job fulfillment while raising staff turnover, missed work days, or poor choices - according to Papazian and team in 2023 along with Friganović's group back in 2019. Even though those studies focused on places with strong support systems, they still point to one common truth: CF tends to show up across ICUs no matter the location. 3. Predictors of Compassion Fatigue: Individual, Occupational, and Organizational Factors A wide range of studies points to several factors tied to CF. Age, sex, or how long someone's worked might link to stress levels - newer staff tend to feel it more (Friganović et al., 2019; Özan & Polat, 2024). Still, results differ by workplace since inner strength, learning, and ways people handle pressure can change outcomes (Chachula, 2020; Alharbi et al., 2020). Workload, long hours, dealing with trauma, or too many patients per nurse - these work factors often lead to compassion fatigue worldwide (Papazian et al., 2023; Ramírez-Elvira et al., 2021). Overnight duties, tough moral choices, along with caring for dying patients pile up stress emotionally (Bruyneel et al., 2023; Arimon-Pagès et al., 2023). When there aren't enough staff, little backup from colleagues, or poor info exchange during shift changes, burnout rises while kindness in care drops (Alharbi et al., 2020). Workplace conditions like boss backing, respect on the job, or therapy access strongly shape how bad compassion fatigue gets. Studies point out that caring workplaces and strength-focused training lower these stress levels, yet ignoring emotional health makes things worse (Özan & Polat, 2024; Jafare, 2023). 4. Compassion Fatigue in the Palestinian Healthcare Context Palestinian ICU nurses face tougher conditions than most around the globe. Due to persistent staffing gaps, they handle more patients per nurse - this ups the mental strain big time (Hasan et al., 2024; Zakarneh, 2021). On top of that, scarce access to emotional support makes it harder to cope. Constant exposure to violence, war-related injuries, or sudden waves of emergencies hits them hard again and again. These repeated crises wear down their resilience over months, even years (Shawahna et al., 2022). Stress builds fast when help isn’t available nearby. Working nonstop under such loads raises the risk of burnout sharply. Each crisis adds another layer without enough recovery in between. Research in Palestine shows ICU nurses and anesthetists often feel worn out, emotionally drained, distant from patients, plus unhappy with work (Hasan et al., 2024; Shawahna et al., 2022). Other reports point to notable compassion fatigue in nursing teams - this links to poor debrief sessions, ongoing pressure, constant alarms (Jafare, 2023; Salameh et al., 2024). Together, these results reveal how hospital systems fuel emotional strain across Palestinian medical centers. Even though more studies now look at burnout and job stress, compassion fatigue hasn't been clearly defined or tracked in Palestine. Instead of treating it separately, past work ties it to overall burnout or stress, which makes it hard to spot what truly drives it. Because of this blind spot, researchers need to focus directly on compassion fatigue - how common it is, what causes it, and why it matters in Palestinian intensive care environments. 5. Coping Mechanisms and Protective Factors Coping methods, emotional strength, or a solid network of coworkers shape how nurses handle pressure and keep compassion fatigue at bay. Studies suggest regular check-ins after tough cases, thinking things through, leaning on peers, even mindfulness exercises help ease burnout or trauma from others' suffering (Chachula, 2020; Alharbi et al., 2020). Nurses who tackle issues head-on, reach out to colleagues when stuck, usually feel more fulfilled in their care work while avoiding deep exhaustion (Friganović et al., 2019). Still, personal ways of handling pressure work less well if bigger issues like too few staff, very sick patients, or no mental health backing stay ignored (Papazian et al., 2023). In Palestine, because support efforts are spotty and there’s rarely a chance to talk through tough experiences, these tools don’t help as much as they could (Jafare, 2023; Zakarneh, 2021). 6. Gaps in the Literature Few studies focus on CF worldwide - yet Palestine sees even less attention CF hasn't been tracked in a structured way among ICU nurses in Palestine with standard methods. Predictors of CF aren't fully clear - especially how they link to trauma, lack of staff, or pressure from political settings. The effect of CF on work happiness, staying in jobs, also how patients are treated hasn't been checked through local studies. Studies comparing public, private, or NGO hospitals don't exist. Most research looks at burnout - yet rarely treats CF as something unique. These gaps show why real-world studies are crucial - ones focusing on CF in Palestinian ICUs - to shape practical solutions that fit local needs instead of generic ones. METHODOLOGY OF RESEARCH Overview This study used a cross-sectional survey design focusing on intensive care unit (ICU) nurses working in public, private, and non-governmental hospitals. Data were gathered with a standardized questionnaire measuring secondary traumatic stress, emotional exhaustion, and compassion fatigue. Statistical analyses performed in SPSS (Statistical Package for the Social Sciences) examined both the prevalence of compassion fatigue and its associations with nurses’ demographic and occupational characteristics. Research Design A cross-sectional design was chosen because it allows the collection of information from a specific population at one point in time without altering the natural work environment. This approach made it possible to measure how common compassion fatigue is among Palestinian critical care nurses and to explore its relationship with demographic and job-related factors. It also enabled the evaluation of emotional exhaustion, secondary traumatic stress, and compassion satisfaction levels among nurses in different settings. Cross-sectional design was selected because it allows the assessment of compassion fatigue and its associated factors at a single point in time without influencing nurses’ natural work environment. This design is widely used in occupational health and nursing research to measure prevalence patterns and identify predictors efficiently and ethically in high-intensity clinical settings. Study Setting The research took place across a range of public, private, and non-governmental hospitals in Palestine. Participating facilities included ICUs, coronary care units (CCUs), and emergency departments—the main settings for critical care services. These hospitals differ in size, capacity, and resources, providing a comprehensive snapshot of the work environments where Palestinian critical care nurses practice. By including nurses exposed to different workloads, institutional protocols, and workplace conditions, the study captured a broader picture of compassion fatigue and its contributing factors. Population and Sampling The target population consisted of critical care nurses employed in public, private, and non-governmental institutions across Palestine. Nurses working in emergency departments, ICUs, and CCUs were included because their roles require continuous direct care of high-acuity patients. A random sampling method ensured representation from different hospital types and departments. In total, 146 questionnaires were distributed to eligible participants who met the inclusion criteria. Sampling Frame + Sampling Method The sampling frame included all registered nurses working in ICUs, CCUs, and emergency departments in public, private, and non-governmental hospitals across Palestine. A random sampling approach was used by distributing the online questionnaire through official hospital communication channels and nursing departments. Eligibility included full-time ICU-related employment and direct patient care responsibilities. Sample Size Justification The sample size (N = 146) is considered adequate for cross-sectional nursing research based on previous regional and international studies that used similar sample ranges to identify predictors of compassion fatigue. With more than 10 participants per variable included in the analysis, the sample meets the commonly accepted minimum requirement for stable statistical estimates in regression and ANOVA procedures. Inclusion and Exclusion Criteria Inclusion criteria: Registered nurses working in ICU, CCU, or emergency units Minimum of 6 months clinical experience Direct involvement in patient care Agreement to informed consent Exclusion criteria: Administrative nursing staff Students or trainees Nurses on extended leave during the data collection period Data Collection Procedure Data were collected using a standardized online questionnaire specifically designed to measure the prevalence of compassion fatigue. After obtaining the necessary approvals from hospital administrations, the survey link was distributed through professional nursing networks and official hospital communication channels. Participants received a brief introduction explaining the study’s purpose, the voluntary nature of participation, and assurances of confidentiality and anonymity. Informed consent was obtained electronically before completion. Data collection took place over a defined time frame, with regular reminders sent to encourage participation without pressure. Completed responses were securely stored and then imported into SPSS for coding, cleaning, and analysis. This systematic process ensured accuracy, consistency, and ethical compliance throughout. Data Preparation and Analysis Compassion fatigue was measured using the Professional Quality of Life Scale (ProQOL, Version 5) , a widely validated 30-item instrument that assesses 3 subscales: compassion satisfaction, burnout, and secondary traumatic stress (Stamm, 2010 ). The scale demonstrated excellent reliability in this study (Cronbach’s α = 0.946), indicating strong internal consistency within the Palestinian critical care nursing context. In addition to the ProQOL items, a short set of demographic and work-related questions (e.g., age, gender, marital status, educational level, ICU type, workload, shift pattern, and access to psychological support) was developed by the authors based on the relevant literature to characterize the study population and workplace environment. An English version of the full questionnaire used in this study is provided as Additional file 1. Data Entry : Questionnaire responses were entered into SPSS twice to ensure accuracy, with discrepancies checked against the original surveys. Data Cleaning : Missing values, outliers, and inconsistencies were identified and addressed using descriptive statistics (mean, median, mode). Mean substitution or other appropriate imputation methods were applied where necessary. Descriptive Statistics : Frequencies, percentages, means, and standard deviations described participants’ demographic characteristics (e.g., age, gender, years of experience, education level) and provided an overview of compassion fatigue prevalence. Power Analysis : A post-hoc power assessment indicated that the sample size (N = 146) provides sufficient statistical power (> 0.80) to detect medium effect sizes in group comparisons (t-test, ANOVA) and correlation analysis at a significance level of α = 0.05. This confirms that the study is adequately powered to examine the main research relationships. Inferential Statistics T-tests examined differences in compassion fatigue between male and female nurses and between nurses in public, private, and non-governmental hospitals. One-way ANOVA compared compassion fatigue levels across age groups. These analyses allowed the identification of any statistically significant differences related to demographic or occupational factors. Correlation Analysis : Pearson correlation coefficients measured the relationships between individual questionnaire items and the overall compassion fatigue score. All correlations were statistically significant, confirming the internal consistency of the scale and clarifying the link between emotional exhaustion symptoms and overall compassion fatigue. Reliability and Validity The research tool’s reliability and validity were rigorously assessed: Reliability : Cronbach’s alpha was 0.946, indicating very high internal consistency. This shows the items consistently measured in critical care nurses’ experiences of compassion fatigue. Validity : Pearson correlations between each item and the total score were all statistically significant at α < 0.05, confirming that every item contributed meaningfully to assessing compassion fatigue. The questionnaire was developed from recognized scales and an extensive literature review, strengthening its content validity. RESULTS This section presents the statistical findings from the analysis of data collected from 146 critical care nurses working in public, private, and non-governmental hospitals in Palestine. The study focuses on three main objectives: determining how common compassion fatigue is among intensive care unit nurses, exploring how professional and demographic factors affect its occurrence, and identifying the key contributors to this condition. The results are presented using both descriptive and inferential statistics, based on data analyzed with SPSS. Demographic Characteristics This section presents the demographic profile of the participating nurses. The age distribution of the sample is shown in Fig. 1, while the gender distribution is presented in Fig. 2. Additionally, the marital status distribution is illustrated in Fig. 3, and the levels of education among participants are displayed in Fig. 4. The general nursing experience of respondents appears in Fig. 5, and their critical care experience is summarized in Fig. 6. These images present the demographic profile of the 146 critical care nurses who participated in the study. Over half of the respondents (51.4%) were younger than 25, while only 4.8% were aged 40 or older, indicating that the sample largely consisted of younger nurses. Gender distribution was nearly equal, with 50.7% men and 49.3% women. Most participants were single (60.3%), while 37.7% were married, and only 2.1% were divorced or widowed. In terms of education, the majority held a bachelor’s degree (70.5%), followed by diploma holders (23.3%) and those with a master’s degree (6.2%). Regarding experience, 24.7% had worked for less than a year in general nursing, while more than half (53.4%) had between one and five years of experience. In critical care specifically, 52.1% had been employed for less than a year, and only 3.4% had more than six years of experience. Overall, the sample was dominated by younger, early-career nurses, which may have influenced their experiences and perceptions of compassion fatigue in high-stress work settings. Professional Characteristics The professional and institutional characteristics of the participating nurses are illustrated in the figures below. The distribution of nurses by hospital type is presented in Fig. 7, and their departmental assignments are shown in Fig. 8. The distribution of shift types appears in Fig. 9, followed by the average number of patients per shift shown in Fig. 10. Training related to compassion fatigue is summarized in Fig. 11, while access to psychological support services is displayed in Fig. 12. These images illustrate the institutional and professional characteristics of the participating nurses. Almost half (49.3%) worked in public hospitals, followed by 46.6% in private facilities and 4.1% in non-governmental organizations. Most nurses were assigned to intensive care units (47.3%) or emergency departments (27.4%), with smaller proportions working in coronary care units or other departments. In terms of work patterns, 49.3% of the nurses worked rotating shifts, while 35.6% had fixed day shifts. Workload varied: 24.7% reported caring for more than six patients per shift, whereas 36.3% cared for three to four patients. Regarding support and training, 54.1% of the nurses reported access to psychological support services, and about two-thirds (66.4%) had received training on compassion fatigue. However, 15.8% were unsure about the availability of such services, and 30.1% reported no access at all, highlighting potential institutional gaps in addressing emotional well-being. Recognizing these professional and organizational factors is crucial for understanding the work-related stressors that may contribute to compassion fatigue. Prevalence of Compassion Fatigue Statistical Parameters Table 1: Shows the statistical parameters, including Means, Standard Deviations, and Levels of Compassion Fatigue Item Responses Among Critical Care Nurses (n = 146). Number Paragraph Mean Standard Deviation knowledge level 1 I am happy 3.32 1.144 Medium 2 I feel preoccupied with multiple people I help 3.32 0.996 Medium 3 I get satisfaction from helping 3.79 1.220 High 4 I feel connected to Others 3.14 1.114 Medium 5 I am startled by unexpected sounds 2.77 1.149 Medium 6 I feel energized after helping 3.31 1.178 Medium 7 I struggle to separate my personal and professional life 2.73 1.154 Medium 8 I lose sleep over traumatic cases 2.36 1.174 Medium 9 I am affected by others’ traumatic stress 2.52 1.071 Medium 10 I feel trapped in my job 2.77 1.161 Medium 11 I feel tense about various things 2.62 1.103 Medium 12 I like my job 3.41 1.167 Medium 13 I feel depressed by others’ Trauma 2.63 1.198 Medium 14 I feel like I live the trauma of those I help 2.48 1.078 Medium 15 My beliefs sustain Me 3.27 1.154 Medium 16 I am satisfied with my professional development 3.49 1.045 Medium 17 I am the person I want to be 3.42 1.208 Medium 18 My job makes me feel fulfilled 3.39 1.206 Medium 19 I feel exhausted from my work 3.02 1.060 Medium 20 I have positive feelings about those I help 3.40 1.123 Medium 21 I feel overwhelmed by my workload 3.03 1.189 Medium 22 I believe my work makes a difference 3.19 1.147 Medium 23 I avoid activities that remind me of traumatic events 2.65 1.074 Medium 24 I am proud of my ability to help 3.55 1.139 Medium 25 I experience intrusive thoughts 2.64 1.179 Medium 26 I feel weighed down by the system 2.78 1.086 Medium 27 I consider myself successful 3.52 1.012 Medium 28 I forget important aspects of trauma Cases 2.64 1.068 Medium 29 I am a very caring person 3.37 1.096 Medium 30 I am happy I chose this profession 3.47 1.140 Medium Total score 3.06 0.707 Medium Table 1 presents the 30 items used to measure compassion fatigue among critical care nurses, along with their mean scores, standard deviations, and interpreted knowledge levels. Overall, the average score across all items was 3.06, indicating a medium level on a five-point Likert scale. The highest-scoring item— “I get satisfaction from helping” (mean = 3.79)—was rated as high, suggesting that despite workplace stress, most nurses still derive significant fulfillment from caring for patients. Other items reflecting professional purpose, such as “I am proud of my ability to help” and “I consider myself successful,” also recorded relatively high mean scores, reinforcing the presence of moderate to strong compassion satisfaction. Conversely, items linked to psychological strain, trauma exposure, and emotional exhaustion tended to score in the lower-to-medium range. Examples include “I feel like I live the trauma of those I help” (mean = 2.48) and “I lose sleep over traumatic cases” (mean = 2.36), highlighting the emotional toll of continuous exposure to critical situations. Taken together, the predominance of medium-level responses indicates a mix of resilience and vulnerability among these nurses. These descriptive findings suggest that ICU nurses in Palestine experience a moderate degree of compassion fatigue—balancing emotional stress with an enduring commitment to their work. Hypothesis Testing and Inferential Statistics Total Correlation Coefficients Table 2: Item-to-Total Correlation Coefficients for Compassion Fatigue Scale Items (n = 146) Number Paragraph Correlation Coefficient Significance Level 1 I am happy **0.682 0.000 2 I feel preoccupied with multiple people I help **0.692 0.000 3 I get satisfaction from helping **0.695 0.000 4 I feel connected to Others **0.689 0.000 5 I am startled by unexpected sounds **0.391 0.000 6 I feel energized after helping **0.654 0.000 7 I struggle to separate my personal and professional life **0.595 0.000 8 I lose sleep over traumatic cases **0.472 0.000 9 I am affected by others’ traumatic stress **0.596 0.000 10 I feel trapped in my job **0.563 0.000 11 I feel tense about various things **0.594 0.000 12 I like my job **0.657 0.000 13 I feel depressed by others’ Trauma **0.589 0.000 14 I feel like I live the trauma of those I help **0.608 0.000 15 My beliefs sustain Me **0.683 0.000 16 I am satisfied with my professional development **0.721 0.000 17 I am the person I want to be **0.656 0.000 18 My job makes me feel fulfilled **0.674 0.000 19 I feel exhausted from my work **0.634 0.000 20 I have positive feelings about those I help **0.710 0.000 21 I feel overwhelmed by my workload **0.600 0.000 22 I believe my work makes a difference **0.712 0.000 23 I avoid activities that remind me of traumatic events **0.581 0.000 24 I am proud of my ability to help **0.691 0.000 25 I experience intrusive thoughts **0.496 0.000 26 I feel weighed down by the system **0.406 0.000 27 I consider myself successful **0.650 0.000 28 I forget important aspects of trauma Cases **0.522 0.000 29 I am a very caring person **0.611 0.000 30 I am happy I chose this profession **0.645 0.000 Table 2 presents the Pearson correlation coefficients between each item on the compassion fatigue scale and the total score, which were used to assess the scale’s internal consistency and construct validity. All 30 items showed statistically significant positive correlations with the overall compassion fatigue score at the p < 0.01 level, indicating that each item is meaningfully related to the overall construct being measured. Items such as “I am startled by unexpected sounds” (r = 0.391) and “I feel weighed down by the system” (r = 0.406) demonstrated lower, yet still significant, correlations, suggesting they represent secondary stress-related symptoms. Overall, these results confirm the scale’s strong internal consistency and support its validity as a measure of compassion fatigue among critical care nurses in the Palestinian context. Internal Consistency, Reliability & Compassion Fatigue Table 3: Internal Consistency Reliability of the Compassion Fatigue Scale Using Cronbach’s Alpha (n = 146). Fields Number of cases Number of paragraphs Alpha value Total Grade 146 30 0.946 Table 3 reports the internal consistency reliability of the compassion fatigue questionnaire based on Cronbach’s alpha. The analysis included all 30 items and responses from 146 participants. The resulting Cronbach’s alpha of 0.946 indicates an exceptionally high level of internal consistency, showing that the items strongly correlate with one another and collectively measure the concept of compassion fatigue. An alpha above 0.90 generally reflects excellent reliability, meaning the scale effectively captures the range of emotional, cognitive, and professional experiences associated with compassion fatigue. This strong reliability score also supports the credibility of the study’s findings and the accuracy of the data collected. Comparison of Emotional Exhaustion & Gender Table 4: Comparison of Emotional Exhaustion Levels by Gender Among Critical Care Nurses Using Independent Samples t-Test (n = 146) Gender F T.TEST DF P-VALUE 0.818 0.786 144 0.433 To assess whether emotional exhaustion differed by gender among critical care nurses, an independent-samples t-test was conducted (Table 4). The results showed no statistically significant difference between male and female nurses (p = 0.433 > 0.05). This finding is further supported by the degrees of freedom (df = 144), the t-value (t = 0.786), and the F-value (F = 0.818), which confirmed the assumption of equal variances. These results indicate that male and female nurses in Palestinian hospitals experience similar levels of emotional exhaustion. Cohen’s d was calculated to assess the magnitude of the difference. The effect size was negligible (d < 0.20), indicating that the non-significant gender differences have no practical relevance. The absence of gender-based differences suggests that systemic and occupational pressures, rather than demographic factors such as gender, are more likely to underlie emotional exhaustion in critical care settings. ANOVA tests & Emotional Exhaustion Table 5: One-Way ANOVA Results for Emotional Exhaustion by Marital Status and Education Level Among Critical Care Nurses (n = 146) Variable Source Sum of squares grades Freedom Mean squares Calculated value of F Statistical significance MARITAL STATUS Variance 195.191 2 97.595 0.214 0.808 Between Groups 65193.467 143 455.898 Within Groups 65388.658 145 EDUCATION LEVEL Total 1009.512 2 504.756 1.121 0.329 Between Groups 64379.145 143 450.204 Within Groups 65388.658 145 Table 5 presents the findings of two one-way ANOVA tests conducted to examine whether levels of emotional exhaustion among critical care nurses differ according to marital status or education level. The analysis showed no significant differences in emotional exhaustion between nurses who were single, married, or divorced/widowed (F = 0.214, p = 0.808). Likewise, emotional exhaustion did not vary significantly by educational attainment—whether diploma, bachelor’s, or master’s degree (F = 1.121, p = 0.329). These results suggest that, in this study, emotional exhaustion among critical care nurses is not strongly influenced by marital status or education level. Effect size values (η²) for marital status and education were both below 0.02, indicating negligible effects consistent with the non-significant ANOVA results. Instead, the findings point to organizational and clinical pressures, rather than personal demographic factors, as the more likely drivers of work-related stress and emotional fatigue. ANOVA tests: Emotional Exhaustion & Nursing Experience Table 6: One-Way ANOVA Results for Emotional Exhaustion by Nursing Experience and Critical Care Experience (n = 146) Variable Source Sum of squares grades Freedom Mean squares Calculated value of F Statistical significance NURSING EXPERIENCE Variance 1175.472 3 391.824 0.866 0.460 Between Groups 64213.185 142 452.206 Within Groups 65388.658 145 CRITICAL CARE EXPERIENCE Total 649.683 3 216.495 0.475 0.700 Between Groups 64739.175 142 455.910 Within Groups 65388.658 145 Table 6 presents the results of the one-way ANOVA tests conducted to assess whether levels of emotional tiredness differ according to years of experience in critical care or general nursing. For critical care experience, the F-value was 0.475 (p = 0.700), and for general nursing experience, the F-value was 0.866 (p = 0.460). Since both p-values are greater than 0.05, the findings indicate no statistically significant differences in emotional tiredness across experience levels. These results suggest that the length of time spent working in either critical care or general nursing does not significantly influence emotional tiredness among critical care nurses. The effect sizes for both nursing experience and critical care experience were minimal (η² < 0.02), confirming that experience-related differences were not practically meaningful. This supports the view that institutional pressures and the daily demands of the work environment are more likely to contribute to emotional fatigue than the number of years of professional experience. Analysis of Contributing Factors to Compassion Professional Tenure. Table 7 : Mean, Standard Deviation, and Knowledge Level of Key Contributing Factors to Compassion Fatigue (n = 146) Number Paragraph Mean Standard deviation Knowledge level 1 I am affected by others’ traumatic stress 2.46 1.106 Medium 2 I feel depressed because of others’ trauma 2.54 1.220 Medium 3 I feel exhausted from my work 2.90 1.059 Medium 4 I feel overwhelmed by my workload 2.86 1.179 Medium 5 I forget important aspects of trauma cases 2.51 1.024 Medium Total score 2.65 1.117 Medium Table 7 summarizes the statistical analysis of the five key factors contributing to compassion fatigue among critical care nurses. Each category captures a different aspect of emotional or professional strain, such as cognitive overload, exposure to trauma, or physical exhaustion. Responses were rated on a five-point Likert scale, with an overall average score of 2.65—indicating a moderate level of exposure to these stressors. The highest mean scores were related to workload and fatigue: “I feel overwhelmed by my workload” (mean = 2.86) and “I feel exhausted from my work” (mean = 2.90). These findings suggest that the quantity and intensity of daily responsibilities are the primary stressors contributing to compassion fatigue in this group. Medium scores were also observed for items reflecting the emotional toll of caring for critically ill or traumatized patients, such as “I am affected by others’ traumatic stress” and “I feel depressed from others’ trauma.” Meanwhile, a somewhat lower—but still moderate—score for “I forget important aspects of trauma cases” points to cognitive fatigue, which may affect clinical focus and performance. Taken together, these results show that emotional exhaustion, secondary trauma, and mental overload all play significant roles in compassion fatigue among critical care nurses. Addressing these factors effectively will require structured institutional support and targeted interventions. Linear Regression Analysis: A multiple linear regression analysis was conducted to identify the strongest predictors of compassion fatigue. The model included workload, trauma exposure, staffing level, shift patterns, and access to psychological support. The overall model was statistically significant (p < 0.001), accounting for a meaningful proportion of the variance in CF (Adjusted R² = 0.42). Workload (β = .41, p < 0.001) and trauma exposure (β = .33, p < 0.001) emerged as the strongest predictors, while psychological support showed a moderate protective effect (β = –.29, p < 0.01). Hierarchical Regression Analysis: A hierarchical regression model was also conducted. Demographic variables (age, gender, marital status, education level, years of experience) were entered in Step 1 and explained only 3% of the variance in compassion fatigue. Occupational variables (workload, trauma exposure, staffing level, shift patterns, psychological support) were added in Step 2 and significantly improved the model, explaining 41% of the total variance. This confirms that workplace and organizational factors are far more influential than demographic characteristics in predicting compassion fatigue among Palestinian critical care nurses. DISCUSSION Overview For nurses working in critical care, where they are continually exposed to life-threatening cases, emotional distress, and challenging situations, compassion fatigue represents a serious concern because of the persistent psychological strain it creates. This condition often leads to secondary trauma, emotional exhaustion, and a reduced capacity for empathy. Although compassion fatigue has been widely studied internationally, there remains a lack of comprehensive research in healthcare settings under chronic stress, such as those in Palestine. Limited resources, staff shortages, and political instability further increase the risk of compassion fatigue in these environments, making the emotional demands of the job even more difficult to manage over time. The present study shows that compassion fatigue is common among Palestinian intensive care unit nurses, with clear signs of mental and emotional stress resulting from heavy workloads and frequent exposure to trauma. Interestingly, the data indicate that individual factors—such as age, gender, and educational background—have no significant effect on the level of exhaustion experienced. This suggests that workplace structures and conditions, rather than personal characteristics, are the primary drivers of the problem. These findings highlight an important issue: healthcare systems bear a responsibility to provide stronger support for nurses. The discussion that follows will explore these results in more detail, compare them with existing research, and outline how local hospitals can mitigate the effects of compassion fatigue on both nursing staff and the quality of patient care they provide. Discussion of the Results This section compares the findings of the present study with those reported in the literature on the prevalence and contributing factors of compassion fatigue (CF) among intensive care unit (ICU) nurses in Palestinian hospitals. By highlighting both areas of agreement and points of divergence, it provides a clearer understanding of the issue within its local context. Our results show that ICU nurses in Palestinian hospitals experience a moderate level of CF, aligning with findings from other studies conducted in similar high-stress healthcare settings. For example, Friganović et al. (2019) and Ramírez-Elvira et al. (2021) also reported moderate to high CF levels among ICU nurses, attributing this to ongoing emotional exposure and highly demanding work environments. In our study, the overall mean score for CF was 3.06, indicating a balance between emotional exhaustion and compassion satisfaction. This suggests that, as in other countries, Palestinian nurses experience both the emotional toll of their profession and the sense of purpose it provides. Some results, however, diverge from previous research. Several studies—including Jafare (2023) and Özan and Polat (2024)—have reported gender differences in CF, with female nurses often showing higher levels of emotional exhaustion. By contrast, our findings revealed no statistically significant difference between men and women (p = 0.433), implying that occupational and systemic factors may play a stronger role than gender-specific influences in the Palestinian context. Similarly, our analysis found no significant relationship between emotional exhaustion and either marital status or educational attainment, contradicting earlier research that identified these as potential risk factors for CF. Another notable finding is the lack of a significant link between emotional exhaustion and years of experience in either critical care or general nursing. This runs counter to studies suggesting that younger and less experienced nurses are more vulnerable to CF due to limited coping strategies (Friganović et al., 2019; Chachula, 2020). Despite most participants in our sample being under 25 and having fewer than five years of experience, CF levels were only mild. This pattern suggests that organizational factors—such as workload, shift patterns, and access to psychological support—may outweigh personal attributes like age or length of service. Our findings strongly align with the broader literature on the key causes of CF. Overwhelming workload and work-related fatigue emerged as the most prominent stressors. Items such as “I feel exhausted from my work” and “I feel overwhelmed by my workload” received the highest mean scores, reinforcing conclusions from Papazian et al. (2023) and Shawahna et al. (2022), who also identified workload as a primary driver of CF. Similarly, our sample reflected the emotional toll of repeated exposure to patient trauma, including depressive symptoms and emotional carryover from patients’ suffering—echoing earlier international and Palestinian studies. Although many respondents reported having access to training and psychological support, the persistence of CF symptoms suggests that these interventions may be insufficiently implemented or utilized. This mirrors findings from Jafare (2023) and Özan and Polat (2024), who noted that structural interventions such as debriefing or emotional support programs are often not fully integrated into institutional routines, particularly in low-resource settings like Palestine. Overall, our study underscores that organizational and structural factors, rather than personal characteristics, are the primary drivers of compassion fatigue among ICU nurses in Palestinian hospitals. While the overall prevalence of CF is moderate, the findings highlight the urgent need to improve institutional policies, psychological support, and working conditions to protect nurses’ well-being and maintain high standards of patient care. These results provide valuable regional insight into CF and emphasize the importance of context-specific strategies to mitigate its impact within Palestinian healthcare institutions. STRENGTHS AND LIMITATIONS Recognizing the limitations of any research is essential to ensure a fair and transparent interpretation of its findings. This study has several constraints that should be taken into account: · Small sample size: The relatively small sample may not fully represent all nursing staff in the region, which limits the generalizability of the results. · Self-report bias: The data were collected through self-reported questionnaires, which may introduce bias if participants responded that they believed to be socially desirable rather than entirely accurate. · Cross-sectional design: Because the study used a cross-sectional approach—collecting data at a single point in time—it cannot establish causality or determine the direction of relationships between variables. Despite these limitations, the study provides valuable insights into the prevalence of compassion fatigue among critical care nurses in Palestinian hospitals and highlights the need for further, more comprehensive research in this area. Summary of Key Findings Overall, regression and correlation analyses confirm that compassion fatigue among Palestinian critical care nurses is primarily shaped by occupational and environmental factors rather than demographic characteristics. Workload, trauma exposure, and shortage of psychological support were the most influential predictors. RECOMMENDATIONS 1. Integrate routine mental-health support in ICUs . Hospitals should ensure regular access to counselors or psychologists familiar with the challenges of critical care. Emotional debriefing sessions and private consultations need to be scheduled proactively and not only after emergencies. 2. Include compassion fatigue in nursing education and training. Whether at universities or in hospital-based continuing education, programs should teach nurses how to manage emotional stress and recognize early warning signs. Role-playing, reflective practice, and real-world discussions can strengthen these skills. 3. Review ICU staffing and scheduling practices . Heavy patient loads and frequent night shifts increase emotional exhaustion. Administrators should work toward fair duty allocation, adequate downtime, and—where possible—increasing staffing or rotating assignments to ease stress. 4. Monitor staff well-being systematically. Short questionnaires or feedback tools can help detect early signs of fatigue. These tools must be simple, quick to complete, and linked to timely follow-up actions when concerns arise. 5. Foster a supportive workplace culture. Supervisors should acknowledge the emotional toll of critical care, encourage teamwork, listen to nurses’ concerns, and involve them in shaping workplace policies. Nurses need to feel safe speaking up. 6. Tailor interventions to local realities. In Palestinian hospitals, solutions must be affordable, easy to implement, and sensitive to workload and cultural norms. Examples include short outdoor breaks, peer-support groups, or scheduled group check-ins. 7. Promote national coordination. Hospital leaders, the Ministry of Health, academic institutions, and nursing associations should collaborate to develop and regularly update clear, practical guidelines for managing compassion fatigue based on frontline feedback. 8. Strengthen future research. Longitudinal studies are needed to assess whether interventions reduce fatigue over time. Linking compassion fatigue to patient safety and care quality will also help inform stronger policy decisions. CONCLUSION This study examined the prevalence and contributing factors of compassion fatigue among intensive care unit nurses in Palestinian hospitals. The results revealed a moderate level of compassion fatigue, with many nurses reporting mental strain, emotional exhaustion, and reduced motivation. Importantly, the primary drivers of stress were not personal characteristics such as gender or years of experience, but rather workplace conditions—heavy patient loads, long shifts, and limited access to psychological support. No significant links were found between demographic characteristics and compassion fatigue, indicating that the pressures faced by nurses’ stem largely from the structure of their work environment rather than individual traits. These outcomes reflect the emotional toll of providing daily care to critically ill patients without sufficient institutional support and mirror findings from other studies conducted in similarly high-stress, under-resourced healthcare settings. By focusing on the Palestinian context, this research addresses a gap in the literature and offers insight into the real-world challenges faced by ICU nurses. The findings point to the urgent need for practical, resource-sensitive interventions—such as increased staffing, structured emotional support programs, and stress-reduction training—to alleviate compassion fatigue. Improving the mental health of ICU nurses does more than support staff well-being; it also strengthens patient safety and the quality of care. This study provides an evidence-based foundation for policymakers, educators, and hospital administrators to develop realistic, context-appropriate strategies that better support frontline healthcare professionals. Declarations 1 ) Ethics Approval Ethical approval for this study was obtained from the Ethics Committee at Palestine Ahliya University (IRB: CAMS/BSN/4/9726). In addition, administrative authorization to conduct the study and collect data was granted by the Palestinian Ministry of Health. The study was carried out in accordance with the principles of the Declaration of Helsinki and all relevant institutional and national ethical guidelines. 2 ) Consent to Participate Participation in this study was entirely voluntary. Electronic informed consent was obtained from all participating nurses prior to completing the questionnaire. Participants were informed of the study purpose and their right to withdraw at any time without any consequences. Confidentiality and anonymity were strictly maintained by removing all personal identifiers and securely storing coded data, which were accessible only to the research team. 3) Consent for publication This manuscript does not contain any individual person’s data in any form (including individual details, images, or videos); therefore, individual consent for publication is not applicable. All authors have reviewed the final version of the manuscript and give their full consent for its publication. 4) Data Availability Statement The datasets generated and analyzed during the current study are not publicly available due to institutional and Ministry of Health data-protection regulations, but are available from the corresponding author on reasonable request and with permission from the participating institutions and subject to approval by the local ethics committee. 5) Competing interests The authors declare that they have no competing interests. 6) Funding The authors received no specific funding for this work. 7) Authors’ contributions All authors shared responsibility for all stages of the research process, including study conception and design, data collection, data analysis and interpretation, and drafting and revising the manuscript. All authors read and approved the final version of the manuscript. 8) Acknowledgements The authors would like to thank the critical care nurses who participated in this study for their time and valuable contributions. We are also grateful to the administrations of the participating hospitals and to the Palestinian Ministry of Health for facilitating data collection and supporting this research. References Alharbi, J., Jackson, D., & Usher, K. (2019). Compassion fatigue in critical care nurses. An integrative review of the literature. Saudi medical journal, 40(11), 1087–1097. https://doi.org/10.15537/smj.2019.11.24569 Alharbi, J., Jackson, D., & Usher, K. (2019). The potential for COVID-19 to contribute to compassion fatigue in critical care nurses. Journal of Clinical Nursing, 29(15-16), 2762–2764. https://doi.org/10.1111/jocn.15314 Alharbi, J., Jackson, D., & Usher, K. (2020). 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Enfermería intensiva, 34(1), 4–11. https://doi.org/10.1016/j.enfie.2022.02.001 Bruyneel, A., Bouckaert, N., Maertens de Noordhout, C., Detollenaere, J., Kohn, L., Pirson, M., Sermeus, W., & Van den Heede, K. (2023). Association of burnout and intention-to-leave the profession with work environment: A nationwide cross-sectional study among Belgian intensive care nurses after two years of pandemic. International journal of nursing studies, 137, 104385. https://doi.org/10.1016/j.ijnurstu.2022.104385 Chachula, K. M. (2020). A comprehensive review of compassion fatigue in pre-licensure health students: antecedents, attributes, and consequences. Current Psychology. doi:10.1007/s12144-020-01122-3 Friganović, A., Selič, P., Ilić, B., & Sedić, B. (2019). Stress and burnout syndrome and their associations with coping and job satisfaction in critical care nurses: a literature review. Psychiatria Danubina, 31(Suppl 1), 21–31. Hasan, F., Daraghmeh, T., Jaber, M., & Shawahna, R. (2024). Prevalence of burnout syndrome among anesthesiologists, anesthesia technicians, and intensive care unit nurses in Palestinian hospitals: a cross-sectional study. BMC psychiatry, 24(1), 740. https://doi.org/10.1186/s12888-024-06196-y Jafare, W. S. A. (2023). Compassion Fatigue in Relation to Debriefing among Intensive Care Unit Nurses: The Palestinian Case (Doctoral dissertation, Al-Quds University). Kim Usher AM RN BA DipAppH (Nsg) MNSt PhD FACMHN, Joanne Durkin PgDip MA, Navjot Bhullar BA(Hons) MA MPhil PhD MAPS (2020). The COVID-19 pandemic and mental health impacts. International Journal of Mental Health Nursing. https://doi.org/10.1111/inm.12726 Özan, A., & Polat, H. (2024). Determination of Compassion and Compassion Fatigue in Intensive Care Nurses. SAGE Open Nursing, 10, 23779608241247395. https://doi.org/10.1177/23779608241247395 Papazian, L., Hraiech, S., Loundou, A., Herridge, M. S., & Boyer, L. (2023). High-level burnout in physicians and nurses working in adult ICUs: a systematic review and meta-analysis. Intensive care medicine, 49(4), 387–400. https://doi.org/10.1007/s00134-023-07025-8 Ramírez-Elvira, S., Romero-Béjar, J. L., Suleiman-Martos, N., Gómez-Urquiza, J. L., Monsalve-Reyes, C., Cañadas-De la Fuente, G. A., & Albendín-García, L. (2021). Prevalence, Risk Factors, and Burnout Levels in Intensive Care Unit Nurses: A Systematic Review and Meta-Analysis. International journal of environmental research and public health, 18(21), 11432. https://doi.org/10.3390/ijerph182111432 Salameh, B., Abdallah, J., Alkubati, S. A., & ALBashtawy, M. (2024). Alarm fatigue and perceived stress among critical care nurses in the intensive care units: Palestinian perspectives. BMC nursing, 23(1), 261. Shawahna, R., Maqboul, I., Ahmad, O., Al-Issawy, A., & Abed, B. (2022). Prevalence of burnout syndrome among unmatched trainees and residents in surgical and nonsurgical specialties: a cross-sectional study from different training centers in Palestine. BMC Medical Education, 22(1), 322. https://doi.org/10.1186/s12909-022-03386-8 Stamm, B.H. (2010). The Concise ProQOL Manual, 2nd Ed. Pocatello, ID: ProQOL.org. Zakarneh, M. (2021). Critical care nurses burn out: sociodemographic factors, leveling and mitigation in Palestinian Governmental Hospitals (Doctoral dissertation, Master thesis, An Najah National University, available at: https://repository. najah. edu/server/api/core/bitstreams/ca579fa1-71d1-4981-ab92-bd6c297c0f59/content). Additional Declarations No competing interests reported. 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This condition arises from the intense emotional demands of their jobs, the constant pressure of medical emergencies, and repeated exposure to patients’ suffering. As Alharbi, Jackson, and Usher (2020) point out, these factors can lead to physical, emotional, and psychological exhaustion, undermining both nurses’ well-being and their performance at work.\u003c/p\u003e\n\u003cp\u003eUnlike general burnout, which is usually driven by heavy workloads and organizational pressures, compassion fatigue is primarily linked to the emotional strain of caring for critically ill patients, witnessing traumatic events, and making difficult ethical decisions in life-or-death situations (Friganović et al., 2019). Its impact can be severe, resulting in reduced job satisfaction, impaired decision-making, higher absenteeism, and increased nursing turnover (Papazian et al., 2023).\u003c/p\u003e\n\u003cp\u003eCompassion fatigue also affects patients. When empathy wanes, communication suffers, and clinical judgment may falter, which can compromise the quality of care. This underscores the urgent need to address CF among healthcare professionals (Ramírez-Elvira et al., 2021).\u003c/p\u003e\n\u003cp\u003eResearch from around the world shows that CF is common among critical care nurses and that it significantly affects their mental health and job effectiveness. Studies across multiple countries have found strong links between CF, elevated stress, emotional exhaustion, and job dissatisfaction. According to a review by Bruyneel et al. (2023), the emotionally charged environment of intensive care makes nurses particularly vulnerable. Arimon-Pagès et al. (2023) further note that anxiety and depression often accompany CF, worsening its impact. High patient mortality and the ongoing emotional strain of caring for critically ill patients create chronic stress, which, if unaddressed, can lead to severe psychological distress. CF has also been linked to more patient safety incidents because emotionally drained nurses may become less vigilant, deviate from best practices, and experience cognitive fatigue (Shawahna et al., 2022).\u003c/p\u003e\n\u003cp\u003eDespite the growing global research on compassion fatigue, little is known about its prevalence among nurses in Palestinian hospitals. The Palestinian healthcare system faces unique challenges, including shortages of medical resources, financial constraints, and political instability. Critical care nurses often manage heavy patient loads, work long hours, and lack psychological support — all of which heighten stress and emotional exhaustion (Hasan et al., 2024). In addition, ongoing conflict and frequent mass-casualty events add further pressure to an already strained system. A study by Jafare (2023) reports high levels of emotional distress among Palestinian intensive care nurses, but the specific issue of compassion fatigue and its long-term effects has received little attention. This research gap highlights the need for a comprehensive study of CF among critical care nurses in Palestine to better understand its prevalence, contributing factors, and potential interventions.\u003c/p\u003e\n\u003cp\u003eAddressing compassion fatigue is essential for maintaining high standards of patient care and improving nurses’ well-being. Healthcare organizations must recognize CF as a serious problem and implement targeted interventions. According to Salameh et al. (2024), these could include resilience training, mental-health support, improved work-life balance, and adequate staffing to ease excessive workloads. Creating a supportive workplace where nurses can openly discuss their emotional challenges and seek guidance from supervisors can also reduce the burden of CF. Hospital leaders and policymakers should prioritize initiatives that improve working conditions, prevent CF, and protect healthcare workers’ mental health.\u003c/p\u003e\n\u003cp\u003eThis research aims to determine the prevalence of compassion fatigue among critical care nurses in Palestinian hospitals and to identify the factors contributing to it. By filling this research gap, the study will provide evidence-based recommendations for addressing CF in the healthcare system and offer valuable insight into the challenges facing ICU nurses in Palestine. Understanding the scope and impact of CF can help healthcare organizations develop effective support systems to enhance nurses’ mental well-being, job satisfaction, and the overall quality of patient care.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eProblem Statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNurses who work in critical care carry a heavy load on their emotions, minds, and thinking skills. They handle life-saving treatments for patients who are really sick, they make quick calls when the pressure is on, and they keep running into pain, injuries, and death day after day. All these factors hit them with serious stress levels that make them more open to compassion fatigue, or CF. That is basically a feeling of being emotionally drained, with less empathy overall, and trouble giving the kind of caring support patients need (Alharbi, Jackson \u0026amp; Usher, 2020; Friganović et al., 2019). Plenty of research points out how CF affects nurses themselves and the results for patients too. It leads to lower satisfaction on the job, more burnout cases, poorer judgment in clinical work, extra medical mistakes, and stronger urges to leave the field (Papazian et al., 2023; Ramírez-Elvira et al., 2021).\u003c/p\u003e\n\u003cp\u003eAround the world, various studies make it clear that compassion fatigue shows up a lot in critical care nurses. People in ICUs often deal with CF right along with worry, everyday stress, and signs of depression, and all that wears down their well-being at home and on the job (Arimon-Pagès et al., 2023; Bruyneel et al., 2023; Shawahna et al., 2022). Still, a good deal of this work comes from places with steady, well-funded health systems. Those results do not really capture what happens in Palestinian hospitals, where nurses push through situations that ramp up the risks for CF in big ways.\u003c/p\u003e\n\u003cp\u003eIn Palestine, nurses in critical care run into ongoing shortages of supplies, too many patients at once, not enough staff around, little help for their mental health, and they face big waves of casualties from events tied to politics (Hasan et al., 2024; Shawahna et al., 2022). Such strains make the emotional drain and trauma even worse, so CF turns out more intense and tangled up compared to lots of other health spots. Earlier work has looked at burnout and regular job stress for Palestinian nurses in general (Jafare, 2023). But no one has really measured compassion fatigue on its own, set it apart from similar issues, or dug into what causes it and what follows.\u003c/p\u003e\n\u003cp\u003eThat kind of hole in the knowledge really highlights why we need to look closely at how common compassion fatigue is and what drives it among critical care nurses in Palestinian hospitals. Pulling together real data from there matters a lot for grasping the mental toll of ICU shifts. It helps in building specific ways to support them, shaping policies that fit, and in the end boosting nurse health along with better care for patients in tough, low-resource setups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSignificance and Justification of the Study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCompassion fatigue (CF) is a major concern in nursing, particularly in high-stress environments such as intensive care units (ICUs). Although CF has been widely researched in other healthcare systems, little is known about its prevalence and impact in Palestinian hospitals—settings where nurses face additional pressures, including limited resources, political instability, and frequent exposure to traumatic events (Shawahna et al., 2022). Understanding CF in this context is essential for developing effective interventions that protect the health of critical care nurses and maintain high standards of patient care.\u003c/p\u003e\n\u003cp\u003eThis study carries important practical implications for the Palestinian healthcare system. Nurses experiencing CF often suffer from emotional exhaustion, reduced job satisfaction, and increased turnover rates (Papazian et al., 2023). These factors directly affect not only the well-being of nurses but also patient safety and healthcare outcomes (Ramírez-Elvira et al., 2021). By identifying the prevalence and risk factors for CF among critical care nurses in Palestinian hospitals, healthcare organizations can design strategies to reduce burnout, improve retention, and strengthen the overall delivery of healthcare services. Addressing CF can help create a more supportive work environment and ensure that nurses are able to provide effective, compassionate care without experiencing long-term psychological harm (Arimon-Pagès et al., 2023).\u003c/p\u003e\n\u003cp\u003eFrom a management and policy perspective, this research offers valuable guidance for hospital administrators and policymakers seeking to improve nurses’ working conditions. As Hasan et al. (2024) suggest, the findings can inform workplace policies that promote mental health, ensure adequate staffing levels, and integrate stress management initiatives into ICUs. Nursing educators can also use the results to incorporate CF awareness and resilience-building strategies into training programs for nurses working in high-stress settings (Alharbi, Jackson, \u0026amp; Usher, 2020).\u003c/p\u003e\n\u003cp\u003eBy examining CF in Palestinian ICUs, this study fills a critical gap in the literature and provides evidence-based recommendations to improve nurse well-being. The data can also be used to compare CF patterns across different hospital systems, supporting broader global healthcare initiatives and helping to develop more informed strategies for supporting critical care nurses. Beyond benefiting nurses in Palestine, the findings can serve as a model for other resource-limited healthcare settings facing similar challenges.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim of the Study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study aims to determine how widespread compassion fatigue (CF) is among critical care nurses in Palestinian hospitals and to identify its main causes. It also seeks to explore how CF relates to work-related stress, job satisfaction, and patient care quality, while assessing its emotional, psychological, and professional effects on intensive care nurses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives of the Study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI.\u0026nbsp; \u0026nbsp;\u0026nbsp;Measure the prevalence of compassion fatigue (CF) among critical care nurses working in Palestinian hospitals using a standardized, validated instrument.\u003c/p\u003e\n\u003cp\u003eII.\u0026nbsp; \u0026nbsp;Identify key predictors of CF—including workload, trauma exposure, staffing levels, shift patterns, and access to psychological support—across ICU settings.\u003c/p\u003e\n\u003cp\u003eIII.\u0026nbsp;\u0026nbsp;Examine the impact of CF on professional outcomes such as job satisfaction, mental health, retention intention, and perceived quality of patient care.\u003c/p\u003e\n\u003cp\u003eIV.\u0026nbsp;\u0026nbsp;Compare levels and predictors of CF among nurses across different hospital types (public, private, and non-governmental).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch Questions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e· What proportion of critical care nurses in Palestinian hospitals experience compassion fatigue?\u003c/p\u003e\n\u003cp\u003e· What are the main factors contributing to CF among ICU nurses in Palestine, including workload, patient volume, and trauma exposure?\u003c/p\u003e\n\u003cp\u003e· How does CF affect nurses’ mental health, job satisfaction, retention, and the quality of patient care?\u003c/p\u003e\n\u003cp\u003e· Do CF levels differ among critical care nurses working in public, private, and non-governmental hospitals in Palestine?\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHypotheses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e· Higher patient loads are significantly associated with increased levels of compassion fatigue among critical care nurses.\u003c/p\u003e\n\u003cp\u003e· Nurses with access to psychological support services experience significantly lower levels of CF than those without such support.\u003c/p\u003e\n\u003cp\u003e· CF levels do not differ significantly based on marital status, educational level, or gender.\u003c/p\u003e\n\u003cp\u003e· Nurses with less critical care experience report higher levels of CF than those with more experience\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch Variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eIndependent Variables\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e· Compassion fatigue: Emotional and mental exhaustion from prolonged exposure to patient suffering and stressful conditions.\u003c/p\u003e\n\u003cp\u003e· Work-related pressures: High patient volume, extended shifts, trauma exposure, and ethical dilemmas.\u003c/p\u003e\n\u003cp\u003e· Hospital resources and type: Public, private, and non-governmental hospitals; staffing levels; availability of psychological support.\u003c/p\u003e\n\u003cp\u003e· Demographics: Age, gender, years of experience, education, and nursing specialization.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDependent Variables\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e· Job satisfaction and retention: Nurses’ willingness to remain in ICU roles.\u003c/p\u003e\n\u003cp\u003e· Mental health impact: Levels of emotional exhaustion, anxiety, depression, and burnout.\u003c/p\u003e\n\u003cp\u003e· Quality of patient care: Clinical performance, patient safety, and nurse–patient interactions.\u003c/p\u003e\n\u003cp\u003e· Work engagement and productivity: Ability to perform duties effectively and maintain professional motivation.\u003c/p\u003e"},{"header":"LITERARY REVIEW","content":"\u003cp\u003e\u003cstrong\u003e1. Conceptualizing Compassion Fatigue in Critical Care Nursing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCompassion fatigue shows up when caregivers face ongoing pain, tough moments, or intense medical crises. Critical units - full of serious cases and regular loss - often leave nurses drained emotionally, shaken by others\u0026rsquo; trauma, or feeling less rewarded in their work (Stamm, 2010; Alharbi et al., 2019; Friganović et al., 2019). A well-known tool called ProQOL helps explain this worldwide - it sees compassion fatigue as both burnout and stress picked up from deeply connecting with struggling patients over time (Stamm, 2010; Chachula, 2020).\u003c/p\u003e\n\u003cp\u003eThe intense demands of ICU work mean nurses must handle tough medical tasks while making quick choices, facing moral challenges, or dealing with emotional stress. Because of this, their mental strength often wears down - raising chances of compassion fatigue and similar issues (Ram\u0026iacute;rez-Elvira et al., 2021; Papazian et al., 2023). When compassion fatigue gets worse, it harms both nurse and patient - draining empathy, clouding focus, or leading to mistakes and poor results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Global Prevalence of Compassion Fatigue Among Critical Care Nurses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResearch from different countries shows that nurses in ICU and ER often face mild to serious CF. Because patients die frequently, they deal with ongoing traumatic situations - also, there\u0026rsquo;s little time to rest between work periods (Ram\u0026iacute;rez-Elvira et al., 2021; \u0026Ouml;zan \u0026amp; Polat, 2024). Across various health networks, CF tends to appear alongside anxiety or low mood - with extra strain building up due to constant job pressure (Arimon-Pag\u0026egrave;s et al., 2023; Bruyneel et al., 2023).\u003c/p\u003e\n\u003cp\u003eResearch from wealthy nations shows CF lowers job fulfillment while raising staff turnover, missed work days, or poor choices - according to Papazian and team in 2023 along with Friganović\u0026apos;s group back in 2019. Even though those studies focused on places with strong support systems, they still point to one common truth: CF tends to show up across ICUs no matter the location.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. Predictors of Compassion Fatigue: Individual, Occupational, and Organizational Factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA wide range of studies points to several factors tied to CF. Age, sex, or how long someone\u0026apos;s worked might link to stress levels - newer staff tend to feel it more (Friganović et al., 2019; \u0026Ouml;zan \u0026amp; Polat, 2024). Still, results differ by workplace since inner strength, learning, and ways people handle pressure can change outcomes (Chachula, 2020; Alharbi et al., 2020).\u003c/p\u003e\n\u003cp\u003eWorkload, long hours, dealing with trauma, or too many patients per nurse - these work factors often lead to compassion fatigue worldwide (Papazian et al., 2023; Ram\u0026iacute;rez-Elvira et al., 2021). Overnight duties, tough moral choices, along with caring for dying patients pile up stress emotionally (Bruyneel et al., 2023; Arimon-Pag\u0026egrave;s et al., 2023). When there aren\u0026apos;t enough staff, little backup from colleagues, or poor info exchange during shift changes, burnout rises while kindness in care drops (Alharbi et al., 2020).\u003c/p\u003e\n\u003cp\u003eWorkplace conditions like boss backing, respect on the job, or therapy access strongly shape how bad compassion fatigue gets. Studies point out that caring workplaces and strength-focused training lower these stress levels, yet ignoring emotional health makes things worse (\u0026Ouml;zan \u0026amp; Polat, 2024; Jafare, 2023).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4. Compassion Fatigue in the Palestinian Healthcare Context\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePalestinian ICU nurses face tougher conditions than most around the globe. Due to persistent staffing gaps, they handle more patients per nurse - this ups the mental strain big time (Hasan et al., 2024; Zakarneh, 2021). On top of that, scarce access to emotional support makes it harder to cope. Constant exposure to violence, war-related injuries, or sudden waves of emergencies hits them hard again and again. These repeated crises wear down their resilience over months, even years (Shawahna et al., 2022). Stress builds fast when help isn\u0026rsquo;t available nearby. Working nonstop under such loads raises the risk of burnout sharply. Each crisis adds another layer without enough recovery in between.\u003c/p\u003e\n\u003cp\u003eResearch in Palestine shows ICU nurses and anesthetists often feel worn out, emotionally drained, distant from patients, plus unhappy with work (Hasan et al., 2024; Shawahna et al., 2022). Other reports point to notable compassion fatigue in nursing teams - this links to poor debrief sessions, ongoing pressure, constant alarms (Jafare, 2023; Salameh et al., 2024). Together, these results reveal how hospital systems fuel emotional strain across Palestinian medical centers.\u003c/p\u003e\n\u003cp\u003eEven though more studies now look at burnout and job stress, compassion fatigue hasn\u0026apos;t been clearly defined or tracked in Palestine. Instead of treating it separately, past work ties it to overall burnout or stress, which makes it hard to spot what truly drives it. Because of this blind spot, researchers need to focus directly on compassion fatigue - how common it is, what causes it, and why it matters in Palestinian intensive care environments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5. Coping Mechanisms and Protective Factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCoping methods, emotional strength, or a solid network of coworkers shape how nurses handle pressure and keep compassion fatigue at bay. Studies suggest regular check-ins after tough cases, thinking things through, leaning on peers, even mindfulness exercises help ease burnout or trauma from others\u0026apos; suffering (Chachula, 2020; Alharbi et al., 2020). Nurses who tackle issues head-on, reach out to colleagues when stuck, usually feel more fulfilled in their care work while avoiding deep exhaustion (Friganović et al., 2019).\u003c/p\u003e\n\u003cp\u003eStill, personal ways of handling pressure work less well if bigger issues like too few staff, very sick patients, or no mental health backing stay ignored (Papazian et al., 2023). In Palestine, because support efforts are spotty and there\u0026rsquo;s rarely a chance to talk through tough experiences, these tools don\u0026rsquo;t help as much as they could (Jafare, 2023; Zakarneh, 2021).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6. Gaps in the Literature\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFew studies focus on CF worldwide - yet Palestine sees even less attention\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eCF hasn\u0026apos;t been tracked in a structured way among ICU nurses in Palestine with standard methods.\u003c/li\u003e\n \u003cli\u003ePredictors of CF aren\u0026apos;t fully clear - especially how they link to trauma, lack of staff, or pressure from political settings.\u003c/li\u003e\n \u003cli\u003eThe effect of CF on work happiness, staying in jobs, also how patients are treated hasn\u0026apos;t been checked through local studies.\u003c/li\u003e\n \u003cli\u003eStudies comparing public, private, or NGO hospitals don\u0026apos;t exist.\u003c/li\u003e\n \u003cli\u003eMost research looks at burnout - yet rarely treats CF as something unique.\u003c/li\u003e\n \u003cli\u003eThese gaps show why real-world studies are crucial - ones focusing on CF in Palestinian ICUs - to shape practical solutions that fit local needs instead of generic ones.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"METHODOLOGY OF RESEARCH","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eOverview\u003c/h2\u003e \u003cp\u003eThis study used a cross-sectional survey design focusing on intensive care unit (ICU) nurses working in public, private, and non-governmental hospitals. Data were gathered with a standardized questionnaire measuring secondary traumatic stress, emotional exhaustion, and compassion fatigue. Statistical analyses performed in SPSS (Statistical Package for the Social Sciences) examined both the prevalence of compassion fatigue and its associations with nurses\u0026rsquo; demographic and occupational characteristics.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eResearch Design\u003c/h2\u003e \u003cp\u003eA cross-sectional design was chosen because it allows the collection of information from a specific population at one point in time without altering the natural work environment. This approach made it possible to measure how common compassion fatigue is among Palestinian critical care nurses and to explore its relationship with demographic and job-related factors. It also enabled the evaluation of emotional exhaustion, secondary traumatic stress, and compassion satisfaction levels among nurses in different settings.\u003c/p\u003e \u003cp\u003eCross-sectional design was selected because it allows the assessment of compassion fatigue and its associated factors at a single point in time without influencing nurses\u0026rsquo; natural work environment. This design is widely used in occupational health and nursing research to measure prevalence patterns and identify predictors efficiently and ethically in high-intensity clinical settings.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStudy Setting\u003c/h2\u003e \u003cp\u003eThe research took place across a range of public, private, and non-governmental hospitals in Palestine. Participating facilities included ICUs, coronary care units (CCUs), and emergency departments\u0026mdash;the main settings for critical care services. These hospitals differ in size, capacity, and resources, providing a comprehensive snapshot of the work environments where Palestinian critical care nurses practice. By including nurses exposed to different workloads, institutional protocols, and workplace conditions, the study captured a broader picture of compassion fatigue and its contributing factors.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003ePopulation and Sampling\u003c/h2\u003e \u003cp\u003eThe target population consisted of critical care nurses employed in public, private, and non-governmental institutions across Palestine. Nurses working in emergency departments, ICUs, and CCUs were included because their roles require continuous direct care of high-acuity patients. A random sampling method ensured representation from different hospital types and departments. In total, 146 questionnaires were distributed to eligible participants who met the inclusion criteria.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eSampling Frame\u0026thinsp;+\u0026thinsp;Sampling Method\u003c/h2\u003e \u003cp\u003eThe sampling frame included all registered nurses working in ICUs, CCUs, and emergency departments in public, private, and non-governmental hospitals across Palestine. A random sampling approach was used by distributing the online questionnaire through official hospital communication channels and nursing departments. Eligibility included full-time ICU-related employment and direct patient care responsibilities.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eSample Size Justification\u003c/h2\u003e \u003cp\u003eThe sample size (N\u0026thinsp;=\u0026thinsp;146) is considered adequate for cross-sectional nursing research based on previous regional and international studies that used similar sample ranges to identify predictors of compassion fatigue. With more than 10 participants per variable included in the analysis, the sample meets the commonly accepted minimum requirement for stable statistical estimates in regression and ANOVA procedures.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eInclusion and Exclusion Criteria\u003c/h2\u003e \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e \u003ch2\u003eInclusion criteria:\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eRegistered nurses working in ICU, CCU, or emergency units\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eMinimum of 6 months clinical experience\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eDirect involvement in patient care\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAgreement to informed consent\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eExclusion criteria:\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eAdministrative nursing staff\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStudents or trainees\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eNurses on extended leave during the data collection period\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eData Collection Procedure\u003c/h2\u003e \u003cp\u003eData were collected using a standardized online questionnaire specifically designed to measure the prevalence of compassion fatigue. After obtaining the necessary approvals from hospital administrations, the survey link was distributed through professional nursing networks and official hospital communication channels.\u003c/p\u003e \u003cp\u003eParticipants received a brief introduction explaining the study\u0026rsquo;s purpose, the voluntary nature of participation, and assurances of confidentiality and anonymity. Informed consent was obtained electronically before completion. Data collection took place over a defined time frame, with regular reminders sent to encourage participation without pressure. Completed responses were securely stored and then imported into SPSS for coding, cleaning, and analysis. This systematic process ensured accuracy, consistency, and ethical compliance throughout.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eData Preparation and Analysis\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eCompassion fatigue was measured using the \u003cb\u003eProfessional Quality of Life Scale (ProQOL, Version 5)\u003c/b\u003e, a widely validated \u003cb\u003e30-item\u003c/b\u003e instrument that assesses 3 subscales: compassion satisfaction, burnout, and secondary traumatic stress (Stamm, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). The scale demonstrated excellent reliability in this study (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.946), indicating strong internal consistency within the Palestinian critical care nursing context.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eIn addition to the ProQOL items, a short set of \u003cb\u003edemographic and work-related questions\u003c/b\u003e (e.g., age, gender, marital status, educational level, ICU type, workload, shift pattern, and access to psychological support) was developed by the authors based on the relevant literature to characterize the study population and workplace environment. An \u003cb\u003eEnglish version of the full questionnaire\u003c/b\u003e used in this study is provided as \u003cb\u003eAdditional file 1.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eData Entry\u003c/span\u003e: Questionnaire responses were entered into SPSS twice to ensure accuracy, with discrepancies checked against the original surveys.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eData Cleaning\u003c/span\u003e: Missing values, outliers, and inconsistencies were identified and addressed using descriptive statistics (mean, median, mode). Mean substitution or other appropriate imputation methods were applied where necessary.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eDescriptive Statistics\u003c/span\u003e: Frequencies, percentages, means, and standard deviations described participants\u0026rsquo; demographic characteristics (e.g., age, gender, years of experience, education level) and provided an overview of compassion fatigue prevalence.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePower Analysis\u003c/span\u003e: A post-hoc power assessment indicated that the sample size (N\u0026thinsp;=\u0026thinsp;146) provides sufficient statistical power (\u0026gt;\u0026thinsp;0.80) to detect medium effect sizes in group comparisons (t-test, ANOVA) and correlation analysis at a significance level of α\u0026thinsp;=\u0026thinsp;0.05. This confirms that the study is adequately powered to examine the main research relationships.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eInferential Statistics\u003c/h2\u003e \u003cp\u003eT-tests examined differences in compassion fatigue between male and female nurses and between nurses in public, private, and non-governmental hospitals. One-way ANOVA compared compassion fatigue levels across age groups. These analyses allowed the identification of any statistically significant differences related to demographic or occupational factors.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eCorrelation Analysis\u003c/span\u003e: Pearson correlation coefficients measured the relationships between individual questionnaire items and the overall compassion fatigue score. All correlations were statistically significant, confirming the internal consistency of the scale and clarifying the link between emotional exhaustion symptoms and overall compassion fatigue.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eReliability and Validity\u003c/h2\u003e \u003cp\u003eThe research tool\u0026rsquo;s reliability and validity were rigorously assessed:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eReliability\u003c/span\u003e: Cronbach\u0026rsquo;s alpha was 0.946, indicating very high internal consistency. This shows the items consistently measured in critical care nurses\u0026rsquo; experiences of compassion fatigue.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eValidity\u003c/span\u003e: Pearson correlations between each item and the total score were all statistically significant at α\u0026thinsp;\u0026lt;\u0026thinsp;0.05, confirming that every item contributed meaningfully to assessing compassion fatigue. The questionnaire was developed from recognized scales and an extensive literature review, strengthening its content validity.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThis section presents the statistical findings from the analysis of data collected from 146 critical care nurses working in public, private, and non-governmental hospitals in Palestine. The study focuses on three main objectives: determining how common compassion fatigue is among intensive care unit nurses, exploring how professional and demographic factors affect its occurrence, and identifying the key contributors to this condition. The results are presented using both descriptive and inferential statistics, based on data analyzed with SPSS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDemographic Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis section presents the demographic profile of the participating nurses. The age distribution of the sample is shown in Fig. 1, while the gender distribution is presented in Fig. 2. Additionally, the marital status distribution is illustrated in Fig. 3, and the levels of education among participants are displayed in Fig. 4. The general nursing experience of respondents appears in Fig. 5, and their critical care experience is summarized in Fig. 6.\u003c/p\u003e\n\u003cp\u003eThese images present the demographic profile of the 146 critical care nurses who participated in the study. Over half of the respondents (51.4%) were younger than 25, while only 4.8% were aged 40 or older, indicating that the sample largely consisted of younger nurses. Gender distribution was nearly equal, with 50.7% men and 49.3% women. Most participants were single (60.3%), while 37.7% were married, and only 2.1% were divorced or widowed.\u003c/p\u003e\n\u003cp\u003eIn terms of education, the majority held a bachelor\u0026rsquo;s degree (70.5%), followed by diploma holders (23.3%) and those with a master\u0026rsquo;s degree (6.2%). Regarding experience, 24.7% had worked for less than a year in general nursing, while more than half (53.4%) had between one and five years of experience. In critical care specifically, 52.1% had been employed for less than a year, and only 3.4% had more than six years of experience. Overall, the sample was dominated by younger, early-career nurses, which may have influenced their experiences and perceptions of compassion fatigue in high-stress work settings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProfessional Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe professional and institutional characteristics of the participating nurses are illustrated in the figures below. The distribution of nurses by hospital type is presented in Fig. 7, and their departmental assignments are shown in Fig. 8. The distribution of shift types appears in Fig. 9, followed by the average number of patients per shift shown in Fig. 10. Training related to compassion fatigue is summarized in Fig. 11, while access to psychological support services is displayed in Fig. 12.\u003c/p\u003e\n\u003cp\u003eThese images illustrate the institutional and professional characteristics of the participating nurses. Almost half (49.3%) worked in public hospitals, followed by 46.6% in private facilities and 4.1% in non-governmental organizations. Most nurses were assigned to intensive care units (47.3%) or emergency departments (27.4%), with smaller proportions working in coronary care units or other departments. In terms of work patterns, 49.3% of the nurses worked rotating shifts, while 35.6% had fixed day shifts. Workload varied: 24.7% reported caring for more than six patients per shift, whereas 36.3% cared for three to four patients. Regarding support and training, 54.1% of the nurses reported access to psychological support services, and about two-thirds (66.4%) had received training on compassion fatigue. However, 15.8% were unsure about the availability of such services, and 30.1% reported no access at all, highlighting potential institutional gaps in addressing emotional well-being. Recognizing these professional and organizational factors is crucial for understanding the work-related stressors that may contribute to compassion fatigue.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence of Compassion Fatigue\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Parameters\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cstrong\u003eTable 1:\u0026nbsp;\u003c/strong\u003eShows the statistical parameters, including\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eMeans, Standard Deviations, and Levels of Compassion Fatigue Item Responses Among Critical Care Nurses (n = 146).\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eParagraph\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandard Deviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eknowledge level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;am happy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;feel\u0026nbsp;preoccupied with multiple people I help\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.996\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;get\u0026nbsp;satisfaction from helping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;feel\u0026nbsp;connected to\u003c/p\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI am startled by unexpected\u0026nbsp;sounds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;feel\u0026nbsp;energized after helping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI struggle to separate my personal and\u0026nbsp;professional\u0026nbsp;life\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;lose\u0026nbsp;sleep\u0026nbsp;over traumatic cases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI am affected by others\u0026rsquo;\u0026nbsp;traumatic stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e10\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;feel\u0026nbsp;trapped\u0026nbsp;in\u0026nbsp;my job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e11\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;feel\u0026nbsp;tense\u0026nbsp;about various things\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e12\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;like\u0026nbsp;my job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e13\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;feel\u0026nbsp;depressed by others\u0026rsquo;\u003c/p\u003e\n \u003cp\u003eTrauma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e14\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;feel\u0026nbsp;like\u0026nbsp;I\u0026nbsp;live\u0026nbsp;the trauma of those I help\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e15\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMy\u0026nbsp;beliefs sustain\u003c/p\u003e\n \u003cp\u003eMe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e16\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;am\u0026nbsp;satisfied\u0026nbsp;with my professional\u003c/p\u003e\n \u003cp\u003edevelopment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e17\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;am\u0026nbsp;the\u0026nbsp;person\u0026nbsp;I want to be\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e18\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMy\u0026nbsp;job\u0026nbsp;makes\u0026nbsp;me feel fulfilled\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e19\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;feel exhausted\u003c/p\u003e\n \u003cp\u003efrom\u0026nbsp;my work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e20\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI have positive feelings\u0026nbsp;about\u0026nbsp;those I help\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e21\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;feel\u0026nbsp;overwhelmed by my workload\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e22\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;believe\u0026nbsp;my work\u003c/p\u003e\n \u003cp\u003emakes a difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e23\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI avoid activities that\u0026nbsp;remind\u0026nbsp;me\u0026nbsp;of traumatic events\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e24\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;am\u0026nbsp;proud\u0026nbsp;of\u0026nbsp;my ability to help\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e25\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI experience intrusive\u0026nbsp;thoughts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e26\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;feel\u0026nbsp;weighed down\u003c/p\u003e\n \u003cp\u003eby\u0026nbsp;the system\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e27\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;consider\u0026nbsp;myself successful\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e28\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;forget\u0026nbsp;important aspects of trauma\u003c/p\u003e\n \u003cp\u003eCases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e29\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;am\u0026nbsp;a\u0026nbsp;very\u0026nbsp;caring person\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.096\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e30\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;am\u0026nbsp;happy\u0026nbsp;I\u0026nbsp;chose this profession\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTotal score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e3.06\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.707\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable 1 presents the 30 items used to measure compassion fatigue among critical care nurses, along with their mean scores, standard deviations, and interpreted knowledge levels. Overall, the average score across all items was 3.06, indicating a medium level on a five-point Likert scale. The highest-scoring item\u0026mdash; \u0026ldquo;I get satisfaction from helping\u0026rdquo; (mean = 3.79)\u0026mdash;was rated as high, suggesting that despite workplace stress, most nurses still derive significant fulfillment from caring for patients. Other items reflecting professional purpose, such as \u0026ldquo;I am proud of my ability to help\u0026rdquo; and \u0026ldquo;I consider myself successful,\u0026rdquo; also recorded relatively high mean scores, reinforcing the presence of moderate to strong compassion satisfaction. Conversely, items linked to psychological strain, trauma exposure, and emotional exhaustion tended to score in the lower-to-medium range. Examples include \u0026ldquo;I feel like I live the trauma of those I help\u0026rdquo; (mean = 2.48) and \u0026ldquo;I lose sleep over traumatic cases\u0026rdquo; (mean = 2.36), highlighting the emotional toll of continuous exposure to critical situations.\u003c/p\u003e\n\u003cp\u003eTaken together, the predominance of medium-level responses indicates a mix of resilience and vulnerability among these nurses. These descriptive findings suggest that ICU nurses in Palestine experience a moderate degree of compassion fatigue\u0026mdash;balancing emotional stress with an enduring commitment to their work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHypothesis Testing and Inferential Statistics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTotal Correlation Coefficients\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u0026nbsp;\u003c/strong\u003eItem-to-Total Correlation Coefficients for Compassion Fatigue Scale Items (n = 146)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eParagraph\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrelation Coefficient\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSignificance Level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;am happy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.682\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;feel\u0026nbsp;preoccupied with multiple people I help\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.692\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;get\u0026nbsp;satisfaction from helping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.695\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;feel\u0026nbsp;connected to\u003c/p\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.689\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI am startled by unexpected\u0026nbsp;sounds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.391\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;feel\u0026nbsp;energized after helping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.654\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI struggle to separate my personal and\u0026nbsp;professional\u0026nbsp;life\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.595\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;lose\u0026nbsp;sleep\u0026nbsp;over traumatic cases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.472\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI am affected by others\u0026rsquo;\u0026nbsp;traumatic stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.596\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e10\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;feel\u0026nbsp;trapped\u0026nbsp;in\u0026nbsp;my job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.563\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e11\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;feel\u0026nbsp;tense\u0026nbsp;about various things\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.594\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e12\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;like\u0026nbsp;my job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.657\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e13\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;feel\u0026nbsp;depressed by others\u0026rsquo;\u003c/p\u003e\n \u003cp\u003eTrauma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.589\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e14\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;feel\u0026nbsp;like\u0026nbsp;I\u0026nbsp;live\u0026nbsp;the trauma of those I help\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.608\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e15\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMy\u0026nbsp;beliefs sustain\u003c/p\u003e\n \u003cp\u003eMe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.683\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e16\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;am\u0026nbsp;satisfied\u0026nbsp;with my professional\u003c/p\u003e\n \u003cp\u003edevelopment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.721\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e17\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;am\u0026nbsp;the\u0026nbsp;person\u0026nbsp;I want to be\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.656\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e18\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMy\u0026nbsp;job\u0026nbsp;makes\u0026nbsp;me feel fulfilled\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.674\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e19\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;feel exhausted\u003c/p\u003e\n \u003cp\u003efrom\u0026nbsp;my work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.634\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e20\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI have positive feelings\u0026nbsp;about\u0026nbsp;those I help\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.710\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e21\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;feel\u0026nbsp;overwhelmed by my workload\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.600\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e22\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;believe\u0026nbsp;my work\u003c/p\u003e\n \u003cp\u003emakes a difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.712\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e23\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI avoid activities that\u0026nbsp;remind\u0026nbsp;me\u0026nbsp;of traumatic events\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.581\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e24\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;am\u0026nbsp;proud\u0026nbsp;of\u0026nbsp;my ability to help\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.691\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e25\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI experience intrusive\u0026nbsp;thoughts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.496\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e26\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;feel\u0026nbsp;weighed down\u003c/p\u003e\n \u003cp\u003eby\u0026nbsp;the system\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.406\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e27\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;consider\u0026nbsp;myself successful\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.650\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e28\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;forget\u0026nbsp;important aspects of trauma\u003c/p\u003e\n \u003cp\u003eCases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.522\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e29\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;am\u0026nbsp;a\u0026nbsp;very\u0026nbsp;caring person\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.611\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e30\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;am\u0026nbsp;happy\u0026nbsp;I\u0026nbsp;chose this profession\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e**0.645\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2 presents the Pearson correlation coefficients between each item on the compassion fatigue scale and the total score, which were used to assess the scale\u0026rsquo;s internal consistency and construct validity. All 30 items showed statistically significant positive correlations with the overall compassion fatigue score at the p \u0026lt; 0.01 level, indicating that each item is meaningfully related to the overall construct being measured. Items such as \u0026ldquo;I am startled by unexpected sounds\u0026rdquo; (r = 0.391) and \u0026ldquo;I feel weighed down by the system\u0026rdquo; (r = 0.406) demonstrated lower, yet still significant, correlations, suggesting they represent secondary stress-related symptoms. Overall, these results confirm the scale\u0026rsquo;s strong internal consistency and support its validity as a measure of compassion fatigue among critical care nurses in the Palestinian context.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInternal Consistency, Reliability \u0026amp; Compassion Fatigue\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cstrong\u003eTable 3:\u003c/strong\u003e Internal Consistency Reliability of the Compassion Fatigue Scale Using Cronbach\u0026rsquo;s Alpha (n = 146).\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFields\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of cases\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of paragraphs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAlpha value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Grade\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e146\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e30\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.946\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 3 reports the internal consistency reliability of the compassion fatigue questionnaire based on Cronbach\u0026rsquo;s alpha. The analysis included all 30 items and responses from 146 participants. The resulting Cronbach\u0026rsquo;s alpha of 0.946 indicates an exceptionally high level of internal consistency, showing that the items strongly correlate with one another and collectively measure the concept of compassion fatigue. An alpha above 0.90 generally reflects excellent reliability, meaning the scale effectively captures the range of emotional, cognitive, and professional experiences associated with compassion fatigue. This strong reliability score also supports the credibility of the study\u0026rsquo;s findings and the accuracy of the data collected.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of Emotional Exhaustion \u0026amp; Gender\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u003c/strong\u003e Comparison of Emotional Exhaustion Levels by Gender Among Critical Care Nurses Using Independent Samples t-Test (n = 146)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eT.TEST\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-VALUE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.818\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.786\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e144\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e0.433\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTo assess whether emotional exhaustion differed by gender among critical care nurses, an independent-samples t-test was conducted (Table 4). The results showed no statistically significant difference between male and female nurses (p = 0.433 \u0026gt; 0.05). This finding is further supported by the degrees of freedom (df = 144), the t-value (t = 0.786), and the F-value (F = 0.818), which confirmed the assumption of equal variances. These results indicate that male and female nurses in Palestinian hospitals experience similar levels of emotional exhaustion.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCohen\u0026rsquo;s d was calculated to assess the magnitude of the difference. The effect size was negligible (d \u0026lt; 0.20), indicating that the non-significant gender differences have no practical relevance.\u003c/p\u003e\n\u003cp\u003eThe absence of gender-based differences suggests that systemic and occupational pressures, rather than demographic factors such as gender, are more likely to underlie emotional exhaustion in critical care settings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eANOVA tests \u0026amp; Emotional Exhaustion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e5: One-Way ANOVA Results for Emotional Exhaustion by Marital Status and Education Level Among Critical Care Nurses (n = 146)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSource\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSum of squares\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003egrades\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eFreedom\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean squares\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCalculated value of F\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatistical significance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eMARITAL STATUS\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVariance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e195.191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e97.595\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e0.214\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e0.808\u003c/strong\u003e\u003c/p\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBetween Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e65193.467\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e143\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e455.898\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWithin Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e65388.658\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e145\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eEDUCATION LEVEL\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e1009.512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp dir=\"RTL\"\u003e504.756\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e1.121\u003c/strong\u003e\u003c/p\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e0.329\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBetween Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e64379.145\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e143\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e450.204\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWithin Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e65388.658\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e145\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 5 presents the findings of two one-way ANOVA tests conducted to examine whether levels of emotional exhaustion among critical care nurses differ according to marital status or education level. The analysis showed no significant differences in emotional exhaustion between nurses who were single, married, or divorced/widowed (F = 0.214, p = 0.808). Likewise, emotional exhaustion did not vary significantly by educational attainment\u0026mdash;whether diploma, bachelor\u0026rsquo;s, or master\u0026rsquo;s degree (F = 1.121, p = 0.329).\u003c/p\u003e\n\u003cp\u003eThese results suggest that, in this study, emotional exhaustion among critical care nurses is not strongly influenced by marital status or education level.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEffect size values (\u0026eta;\u0026sup2;) for marital status and education were both below 0.02, indicating negligible effects consistent with the non-significant ANOVA results.\u003c/p\u003e\n\u003cp\u003eInstead, the findings point to organizational and clinical pressures, rather than personal demographic factors, as the more likely drivers of work-related stress and emotional fatigue.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eANOVA tests: Emotional Exhaustion \u0026amp; Nursing Experience\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cstrong style='font-weight: 700; color: rgb(0, 0, 0); font-family: \"Times New Roman\"; font-size: medium; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: rgb(255, 255, 255); text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;'\u003eTable 6:\u0026nbsp;\u003c/strong\u003e\u003cspan style='color: rgb(0, 0, 0); font-family: \"Times New Roman\"; font-size: medium; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; white-space: normal; background-color: rgb(255, 255, 255); text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;'\u003eOne-Way ANOVA Results for Emotional Exhaustion by Nursing Experience and Critical Care Experience (n = 146)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSource\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSum of squares\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003egrades\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eFreedom\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean squares\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCalculated value of F\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatistical significance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNURSING EXPERIENCE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eVariance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e1175.472\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e391.824\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan dir=\"RTL\"\u003e0.866\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan dir=\"RTL\"\u003e0.460\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBetween Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e64213.185\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e142\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e452.206\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWithin Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e65388.658\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e145\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRITICAL CARE EXPERIENCE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e649.683\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e216.495\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan dir=\"RTL\"\u003e0.475\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan dir=\"RTL\"\u003e0.700\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBetween Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e64739.175\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e142\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e455.910\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWithin Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e65388.658\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e145\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 6 presents the results of the one-way ANOVA tests conducted to assess whether levels of emotional tiredness differ according to years of experience in critical care or general nursing. For critical care experience, the F-value was 0.475 (p = 0.700), and for general nursing experience, the F-value was 0.866 (p = 0.460). Since both p-values are greater than 0.05, the findings indicate no statistically significant differences in emotional tiredness across experience levels.\u003c/p\u003e\n\u003cp\u003eThese results suggest that the length of time spent working in either critical care or general nursing does not significantly influence emotional tiredness among critical care nurses.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe effect sizes for both nursing experience and critical care experience were minimal (\u0026eta;\u0026sup2; \u0026lt; 0.02), confirming that experience-related differences were not practically meaningful.\u003c/p\u003e\n\u003cp\u003eThis supports the view that institutional pressures and the daily demands of the work environment are more likely to contribute to emotional fatigue than the number of years of professional experience.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis of Contributing Factors to Compassion Professional Tenure.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cstrong\u003eTable 7\u003c/strong\u003e: Mean, Standard Deviation, and Knowledge Level of Key Contributing Factors to Compassion Fatigue (n = 146)\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eParagraph\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandard deviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI am affected by others\u0026rsquo;\u0026nbsp;traumatic stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e2.46\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e1.106\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;feel\u0026nbsp;depressed because of others\u0026rsquo; trauma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e2.54\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e1.220\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;feel exhausted\u003c/p\u003e\n \u003cp\u003efrom\u0026nbsp;my work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e2.90\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e1.059\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;feel\u0026nbsp;overwhelmed by my workload\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e2.86\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e1.179\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eI\u0026nbsp;forget\u0026nbsp;important aspects of trauma\u003c/p\u003e\n \u003cp\u003ecases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e2.51\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e1.024\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan dir=\"RTL\"\u003e2.65\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan dir=\"RTL\"\u003e1.117\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedium\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable 7 summarizes the statistical analysis of the five key factors contributing to compassion fatigue among critical care nurses. Each category captures a different aspect of emotional or professional strain, such as cognitive overload, exposure to trauma, or physical exhaustion. Responses were rated on a five-point Likert scale, with an overall average score of 2.65\u0026mdash;indicating a moderate level of exposure to these stressors. The highest mean scores were related to workload and fatigue: \u0026ldquo;I feel overwhelmed by my workload\u0026rdquo; (mean = 2.86) and \u0026ldquo;I feel exhausted from my work\u0026rdquo; (mean = 2.90). These findings suggest that the quantity and intensity of daily responsibilities are the primary stressors contributing to compassion fatigue in this group. Medium scores were also observed for items reflecting the emotional toll of caring for critically ill or traumatized patients, such as \u0026ldquo;I am affected by others\u0026rsquo; traumatic stress\u0026rdquo; and \u0026ldquo;I feel depressed from others\u0026rsquo; trauma.\u0026rdquo; Meanwhile, a somewhat lower\u0026mdash;but still moderate\u0026mdash;score for \u0026ldquo;I forget important aspects of trauma cases\u0026rdquo; points to cognitive fatigue, which may affect clinical focus and performance.\u003c/p\u003e\n\u003cp\u003eTaken together, these results show that emotional exhaustion, secondary trauma, and mental overload all play significant roles in compassion fatigue among critical care nurses. Addressing these factors effectively will require structured institutional support and targeted interventions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLinear Regression Analysis:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA multiple linear regression analysis was conducted to identify the strongest predictors of compassion fatigue. The model included workload, trauma exposure, staffing level, shift patterns, and access to psychological support. The overall model was statistically significant (p \u0026lt; 0.001), accounting for a meaningful proportion of the variance in CF (Adjusted R\u0026sup2; = 0.42). Workload (\u0026beta; = .41, p \u0026lt; 0.001) and trauma exposure (\u0026beta; = .33, p \u0026lt; 0.001) emerged as the strongest predictors, while psychological support showed a moderate protective effect (\u0026beta; = \u0026ndash;.29, p \u0026lt; 0.01).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHierarchical Regression Analysis:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA hierarchical regression model was also conducted. Demographic variables (age, gender, marital status, education level, years of experience) were entered in Step 1 and explained only 3% of the variance in compassion fatigue. Occupational variables (workload, trauma exposure, staffing level, shift patterns, psychological support) were added in Step 2 and significantly improved the model, explaining 41% of the total variance. This confirms that workplace and organizational factors are far more influential than demographic characteristics in predicting compassion fatigue among Palestinian critical care nurses.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003e\u003cstrong\u003eOverview \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor nurses working in critical care, where they are continually exposed to life-threatening cases, emotional distress, and challenging situations, compassion fatigue represents a serious concern because of the persistent psychological strain it creates. This condition often leads to secondary trauma, emotional exhaustion, and a reduced capacity for empathy. Although compassion fatigue has been widely studied internationally, there remains a lack of comprehensive research in healthcare settings under chronic stress, such as those in Palestine. Limited resources, staff shortages, and political instability further increase the risk of compassion fatigue in these environments, making the emotional demands of the job even more difficult to manage over time.\u003c/p\u003e\n\u003cp\u003eThe present study shows that compassion fatigue is common among Palestinian intensive care unit nurses, with clear signs of mental and emotional stress resulting from heavy workloads and frequent exposure to trauma. Interestingly, the data indicate that individual factors—such as age, gender, and educational background—have no significant effect on the level of exhaustion experienced. This suggests that workplace structures and conditions, rather than personal characteristics, are the primary drivers of the problem.\u003c/p\u003e\n\u003cp\u003eThese findings highlight an important issue: healthcare systems bear a responsibility to provide stronger support for nurses. The discussion that follows will explore these results in more detail, compare them with existing research, and outline how local hospitals can mitigate the effects of compassion fatigue on both nursing staff and the quality of patient care they provide.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion of the Results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis section compares the findings of the present study with those reported in the literature on the prevalence and contributing factors of compassion fatigue (CF) among intensive care unit (ICU) nurses in Palestinian hospitals. By highlighting both areas of agreement and points of divergence, it provides a clearer understanding of the issue within its local context.\u003c/p\u003e\n\u003cp\u003eOur results show that ICU nurses in Palestinian hospitals experience a moderate level of CF, aligning with findings from other studies conducted in similar high-stress healthcare settings. For example, Friganović et al. (2019) and Ramírez-Elvira et al. (2021) also reported moderate to high CF levels among ICU nurses, attributing this to ongoing emotional exposure and highly demanding work environments. In our study, the overall mean score for CF was 3.06, indicating a balance between emotional exhaustion and compassion satisfaction. This suggests that, as in other countries, Palestinian nurses experience both the emotional toll of their profession and the sense of purpose it provides.\u003c/p\u003e\n\u003cp\u003eSome results, however, diverge from previous research. Several studies—including Jafare (2023) and Özan and Polat (2024)—have reported gender differences in CF, with female nurses often showing higher levels of emotional exhaustion. By contrast, our findings revealed no statistically significant difference between men and women (p = 0.433), implying that occupational and systemic factors may play a stronger role than gender-specific influences in the Palestinian context. Similarly, our analysis found no significant relationship between emotional exhaustion and either marital status or educational attainment, contradicting earlier research that identified these as potential risk factors for CF.\u003c/p\u003e\n\u003cp\u003eAnother notable finding is the lack of a significant link between emotional exhaustion and years of experience in either critical care or general nursing. This runs counter to studies suggesting that younger and less experienced nurses are more vulnerable to CF due to limited coping strategies (Friganović et al., 2019; Chachula, 2020). Despite most participants in our sample being under 25 and having fewer than five years of experience, CF levels were only mild. This pattern suggests that organizational factors—such as workload, shift patterns, and access to psychological support—may outweigh personal attributes like age or length of service.\u003c/p\u003e\n\u003cp\u003eOur findings strongly align with the broader literature on the key causes of CF. Overwhelming workload and work-related fatigue emerged as the most prominent stressors. Items such as “I feel exhausted from my work” and “I feel overwhelmed by my workload” received the highest mean scores, reinforcing conclusions from Papazian et al. (2023) and Shawahna et al. (2022), who also identified workload as a primary driver of CF. Similarly, our sample reflected the emotional toll of repeated exposure to patient trauma, including depressive symptoms and emotional carryover from patients’ suffering—echoing earlier international and Palestinian studies.\u003c/p\u003e\n\u003cp\u003eAlthough many respondents reported having access to training and psychological support, the persistence of CF symptoms suggests that these interventions may be insufficiently implemented or utilized. This mirrors findings from Jafare (2023) and Özan and Polat (2024), who noted that structural interventions such as debriefing or emotional support programs are often not fully integrated into institutional routines, particularly in low-resource settings like Palestine.\u003c/p\u003e\n\u003cp\u003eOverall, our study underscores that organizational and structural factors, rather than personal characteristics, are the primary drivers of compassion fatigue among ICU nurses in Palestinian hospitals. While the overall prevalence of CF is moderate, the findings highlight the urgent need to improve institutional policies, psychological support, and working conditions to protect nurses’ well-being and maintain high standards of patient care. These results provide valuable regional insight into CF and emphasize the importance of context-specific strategies to mitigate its impact within Palestinian healthcare institutions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSTRENGTHS AND LIMITATIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRecognizing the limitations of any research is essential to ensure a fair and transparent interpretation of its findings. This study has several constraints that should be taken into account:\u003c/p\u003e\n\u003cp\u003e· \u003cu\u003eSmall sample size:\u003c/u\u003e The relatively small sample may not fully represent all nursing staff in the region, which limits the generalizability of the results.\u003c/p\u003e\n\u003cp\u003e· \u003cu\u003eSelf-report bias:\u003c/u\u003e The data were collected through self-reported questionnaires, which may introduce bias if participants responded that they believed to be socially desirable rather than entirely accurate.\u003c/p\u003e\n\u003cp\u003e· \u003cu\u003eCross-sectional design:\u003c/u\u003e Because the study used a cross-sectional approach—collecting data at a single point in time—it cannot establish causality or determine the direction of relationships between variables.\u003c/p\u003e\n\u003cp\u003eDespite these limitations, the study provides valuable insights into the prevalence of compassion fatigue among critical care nurses in Palestinian hospitals and highlights the need for further, more comprehensive research in this area.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSummary of Key Findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOverall, regression and correlation analyses confirm that compassion fatigue among Palestinian critical care nurses is primarily shaped by occupational and environmental factors rather than demographic characteristics. Workload, trauma exposure, and shortage of psychological support were the most influential predictors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRECOMMENDATIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. \u003cu\u003eIntegrate routine mental-health support in ICUs\u003c/u\u003e\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eHospitals should ensure regular access to counselors or psychologists familiar with the challenges of critical care. Emotional debriefing sessions and private consultations need to be scheduled proactively and not only after emergencies.\u003c/p\u003e\n\u003cp\u003e2. \u003cu\u003eInclude compassion fatigue in nursing education and training.\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eWhether at universities or in hospital-based continuing education, programs should teach nurses how to manage emotional stress and recognize early warning signs. Role-playing, reflective practice, and real-world discussions can strengthen these skills.\u003c/p\u003e\n\u003cp\u003e3. \u003cu\u003eReview ICU staffing and scheduling practices\u003c/u\u003e\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eHeavy patient loads and frequent night shifts increase emotional exhaustion. Administrators should work toward fair duty allocation, adequate downtime, and—where possible—increasing staffing or rotating assignments to ease stress.\u003c/p\u003e\n\u003cp\u003e4. \u003cu\u003eMonitor staff well-being systematically.\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eShort questionnaires or feedback tools can help detect early signs of fatigue. These tools must be simple, quick to complete, and linked to timely follow-up actions when concerns arise.\u003c/p\u003e\n\u003cp\u003e5. \u003cu\u003eFoster a supportive workplace culture.\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eSupervisors should acknowledge the emotional toll of critical care, encourage teamwork, listen to nurses’ concerns, and involve them in shaping workplace policies. Nurses need to feel safe speaking up.\u003c/p\u003e\n\u003cp\u003e6. \u003cu\u003eTailor interventions to local realities.\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eIn Palestinian hospitals, solutions must be affordable, easy to implement, and sensitive to workload and cultural norms. Examples include short outdoor breaks, peer-support groups, or scheduled group check-ins.\u003c/p\u003e\n\u003cp\u003e7. \u003cu\u003ePromote national coordination.\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eHospital leaders, the Ministry of Health, academic institutions, and nursing associations should collaborate to develop and regularly update clear, practical guidelines for managing compassion fatigue based on frontline feedback.\u003c/p\u003e\n\u003cp\u003e8. \u003cu\u003eStrengthen future research.\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eLongitudinal studies are needed to assess whether interventions reduce fatigue over time. Linking compassion fatigue to patient safety and care quality will also help inform stronger policy decisions.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study examined the prevalence and contributing factors of compassion fatigue among intensive care unit nurses in Palestinian hospitals. The results revealed a moderate level of compassion fatigue, with many nurses reporting mental strain, emotional exhaustion, and reduced motivation. Importantly, the primary drivers of stress were not personal characteristics such as gender or years of experience, but rather workplace conditions—heavy patient loads, long shifts, and limited access to psychological support.\u003c/p\u003e\n\u003cp\u003eNo significant links were found between demographic characteristics and compassion fatigue, indicating that the pressures faced by nurses’ stem largely from the structure of their work environment rather than individual traits. These outcomes reflect the emotional toll of providing daily care to critically ill patients without sufficient institutional support and mirror findings from other studies conducted in similarly high-stress, under-resourced healthcare settings.\u003c/p\u003e\n\u003cp\u003eBy focusing on the Palestinian context, this research addresses a gap in the literature and offers insight into the real-world challenges faced by ICU nurses. The findings point to the urgent need for practical, resource-sensitive interventions—such as increased staffing, structured emotional support programs, and stress-reduction training—to alleviate compassion fatigue.\u003c/p\u003e\n\u003cp\u003eImproving the mental health of ICU nurses does more than support staff well-being; it also strengthens patient safety and the quality of care. This study provides an evidence-based foundation for policymakers, educators, and hospital administrators to develop realistic, context-appropriate strategies that better support frontline healthcare professionals.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cu\u003e1\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cu\u003e) Ethics Approval\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the Ethics Committee at Palestine Ahliya University (IRB: CAMS/BSN/4/9726). In addition, administrative authorization to conduct the study and collect data was granted by the Palestinian Ministry of Health. The study was carried out in accordance with the principles of the Declaration of Helsinki and all relevant institutional and national ethical guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003e2\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cu\u003e) Consent to Participate\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipation in this study was entirely voluntary. Electronic informed consent was obtained from all participating nurses prior to completing the questionnaire. Participants were informed of the study purpose and their right to withdraw at any time without any consequences. Confidentiality and anonymity were strictly maintained by removing all personal identifiers and securely storing coded data, which were accessible only to the research team.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003e3) Consent for publication\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis manuscript does not contain any individual person’s data in any form (including individual details, images, or videos); therefore, individual consent for publication is not applicable. All authors have reviewed the final version of the manuscript and give their full consent for its publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003e4) Data Availability Statement\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are not publicly available due to institutional and Ministry of Health data-protection regulations, but are available from the corresponding author on reasonable request and with permission from the participating institutions and subject to approval by the local ethics committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003e5) Competing interests\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003e6) Funding\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no specific funding for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003e7) Authors’ contributions\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors shared responsibility for all stages of the research process, including study conception and design, data collection, data analysis and interpretation, and drafting and revising the manuscript. All authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003e8) Acknowledgements\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the critical care nurses who participated in this study for their time and valuable contributions. We are also grateful to the administrations of the participating hospitals and to the Palestinian Ministry of Health for facilitating data collection and supporting this research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAlharbi, J., Jackson, D., \u0026amp; Usher, K. (2019). Compassion fatigue in critical care nurses. An integrative review of the literature. Saudi medical journal, 40(11), 1087\u0026ndash;1097. https://doi.org/10.15537/smj.2019.11.24569\u003c/li\u003e\n\u003cli\u003eAlharbi, J., Jackson, D., \u0026amp; Usher, K. (2019). The potential for COVID-19 to contribute to compassion fatigue in critical care nurses. Journal of Clinical Nursing, 29(15-16), 2762\u0026ndash;2764. https://doi.org/10.1111/jocn.15314\u003c/li\u003e\n\u003cli\u003eAlharbi, J., Jackson, D., \u0026amp; Usher, K. (2020). Compassion fatigue in critical care nurses and its impact on nurse-sensitive indicators in Saudi Arabian hospitals. Australian Critical Care. Doi: 10.1016/j.aucc.2020.02.002\u003c/li\u003e\n\u003cli\u003eAlharbi, J., Jackson, D., \u0026amp; Usher, K. (2020). Compassion fatigue in critical care nurses and its impact on nurse-sensitive indicators in Saudi Arabian hospitals. Australian critical care: official journal of the Confederation of Australian Critical Care Nurses, 33(6), 553\u0026ndash;559. https://doi.org/10.1016/j.aucc.2020.02.002\u003c/li\u003e\n\u003cli\u003eAlharbi, J., Jackson, D., \u0026amp; Usher, K. (2020). The potential for COVID-19 to contribute to compassion fatigue in critical care nurses. Journal of Clinical Nursing, 29(15-16), 2762\u0026ndash;2764. https://doi.org/10.1111/jocn.15314\u003c/li\u003e\n\u003cli\u003eArimon-Pag\u0026egrave;s, E., Fern\u0026aacute;ndez-Ortega, P., Torres-Puig-Gros, J., \u0026amp; Canela-Soler, J. (2023). Compassion fatigue and anxiety in critical care emergency nurses: In between efficiency and humanity. Enfermer\u0026iacute;a intensiva, 34(1), 4\u0026ndash;11. https://doi.org/10.1016/j.enfie.2022.02.001\u003c/li\u003e\n\u003cli\u003eBruyneel, A., Bouckaert, N., Maertens de Noordhout, C., Detollenaere, J., Kohn, L., Pirson, M., Sermeus, W., \u0026amp; Van den Heede, K. (2023). Association of burnout and intention-to-leave the profession with work environment: A nationwide cross-sectional study among Belgian intensive care nurses after two years of pandemic. International journal of nursing studies, 137, 104385. https://doi.org/10.1016/j.ijnurstu.2022.104385\u003c/li\u003e\n\u003cli\u003eChachula, K. M. (2020). A comprehensive review of compassion fatigue in pre-licensure health students: antecedents, attributes, and consequences. Current Psychology. doi:10.1007/s12144-020-01122-3\u003c/li\u003e\n\u003cli\u003eFriganović, A., Selič, P., Ilić, B., \u0026amp; Sedić, B. (2019). Stress and burnout syndrome and their associations with coping and job satisfaction in critical care nurses: a literature review. Psychiatria Danubina, 31(Suppl 1), 21\u0026ndash;31.\u003c/li\u003e\n\u003cli\u003eHasan, F., Daraghmeh, T., Jaber, M., \u0026amp; Shawahna, R. (2024). Prevalence of burnout syndrome among anesthesiologists, anesthesia technicians, and intensive care unit nurses in Palestinian hospitals: a cross-sectional study. BMC psychiatry, 24(1), 740. https://doi.org/10.1186/s12888-024-06196-y\u003c/li\u003e\n\u003cli\u003eJafare, W. S. A. (2023). Compassion Fatigue in Relation to Debriefing among Intensive Care Unit Nurses: The Palestinian Case (Doctoral dissertation, Al-Quds University).\u003c/li\u003e\n\u003cli\u003eKim Usher AM RN BA DipAppH (Nsg) MNSt PhD FACMHN, Joanne Durkin PgDip MA, Navjot Bhullar BA(Hons) MA MPhil PhD MAPS (2020). The COVID-19 pandemic and mental health impacts. International Journal of Mental Health Nursing. https://doi.org/10.1111/inm.12726 \u003c/li\u003e\n\u003cli\u003e\u0026Ouml;zan, A., \u0026amp; Polat, H. (2024). Determination of Compassion and Compassion Fatigue in Intensive Care Nurses. SAGE Open Nursing, 10, 23779608241247395. https://doi.org/10.1177/23779608241247395\u003c/li\u003e\n\u003cli\u003ePapazian, L., Hraiech, S., Loundou, A., Herridge, M. S., \u0026amp; Boyer, L. (2023). High-level burnout in physicians and nurses working in adult ICUs: a systematic review and meta-analysis. Intensive care medicine, 49(4), 387\u0026ndash;400. https://doi.org/10.1007/s00134-023-07025-8\u003c/li\u003e\n\u003cli\u003eRam\u0026iacute;rez-Elvira, S., Romero-B\u0026eacute;jar, J. L., Suleiman-Martos, N., G\u0026oacute;mez-Urquiza, J. L., Monsalve-Reyes, C., Ca\u0026ntilde;adas-De la Fuente, G. A., \u0026amp; Albend\u0026iacute;n-Garc\u0026iacute;a, L. (2021). Prevalence, Risk Factors, and Burnout Levels in Intensive Care Unit Nurses: A Systematic Review and Meta-Analysis. International journal of environmental research and public health, 18(21), 11432. https://doi.org/10.3390/ijerph182111432\u003c/li\u003e\n\u003cli\u003eSalameh, B., Abdallah, J., Alkubati, S. A., \u0026amp; ALBashtawy, M. (2024). Alarm fatigue and perceived stress among critical care nurses in the intensive care units: Palestinian perspectives. BMC nursing, 23(1), 261.\u003c/li\u003e\n\u003cli\u003eShawahna, R., Maqboul, I., Ahmad, O., Al-Issawy, A., \u0026amp; Abed, B. (2022). Prevalence of burnout syndrome among unmatched trainees and residents in surgical and nonsurgical specialties: a cross-sectional study from different training centers in Palestine. BMC Medical Education, 22(1), 322. https://doi.org/10.1186/s12909-022-03386-8\u003c/li\u003e\n\u003cli\u003eStamm, B.H. (2010). The Concise ProQOL Manual, 2nd Ed. Pocatello, ID: ProQOL.org. \u003c/li\u003e\n\u003cli\u003eZakarneh, M. (2021). Critical care nurses burn out: sociodemographic factors, leveling and mitigation in Palestinian Governmental Hospitals (Doctoral dissertation, Master thesis, An Najah National University, available at: https://repository. najah. edu/server/api/core/bitstreams/ca579fa1-71d1-4981-ab92-bd6c297c0f59/content).\u003c/li\u003e\n\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":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Compassion fatigue, intensive care units, cross-sectional analysis, T-tests, ANOVA","lastPublishedDoi":"10.21203/rs.3.rs-8397478/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8397478/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Compassion fatigue is a serious concern for nurses working in intensive care units, particularly in Palestine, where staff shortages, political unrest, and limited support systems intensify emotional strain. Although widely studied worldwide, it remains poorly understood in the Palestinian healthcare setting.\u003c/p\u003e\n\u003cp\u003eThis study fills a major gap in the Palestinian critical care literature, where compassion fatigue among ICU nurses has not been systematically measured or analyzed before.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis cross-sectional study used an online questionnaire to assess compassion fatigue among 146 nurses working in emergency, critical care, and coronary care units across public, private, and non-profit hospitals. The survey measured emotional exhaustion, secondary trauma, and job satisfaction. Data were analyzed in SPSS using descriptive statistics, t-tests, ANOVA, and correlation analyses. The instrument demonstrated excellent reliability (Cronbach’s α = 0.946).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eParticipants reported a moderate level of compassion fatigue, with a mean score of 3.06. Workload and emotional exhaustion were identified as the most common stressors. No significant differences were found across gender, age, education level, or years of experience, indicating that compassion fatigue in this context is driven mainly by workplace rather than personal factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eCompassion fatigue remains a persistent problem among critical care nurses in Palestine, primarily due to organizational conditions. Hospitals should implement measures to ease workload pressures, strengthen emotional support systems, and provide targeted training to help nurses manage stress and maintain high-quality patient care.\u003c/p\u003e","manuscriptTitle":"Prevalence and Predictors of Compassion Fatigue Among Critical Care Nurses in Palestinian Hospitals: A Cross-Sectional Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-19 13:37:33","doi":"10.21203/rs.3.rs-8397478/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-27T11:38:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-25T07:59:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-16T19:16:02+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-16T13:25:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"281700899112182538738865644461990922555","date":"2026-01-16T13:18:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-14T18:46:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"275535826712710871735774541149655742859","date":"2026-01-14T17:36:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"45544379234633952188434236902755769049","date":"2026-01-14T15:30:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"169380963809712682656747276137927379997","date":"2026-01-14T13:13:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-14T12:46:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-31T09:11:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-30T05:18:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2025-12-30T05:11:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"90f87df6-2aad-484e-a707-6c838f9587c5","owner":[],"postedDate":"January 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-07T16:14:48+00:00","versionOfRecord":{"articleIdentity":"rs-8397478","link":"https://doi.org/10.1186/s12982-026-01798-1","journal":{"identity":"discover-public-health","isVorOnly":false,"title":"Discover Public Health"},"publishedOn":"2026-03-31 15:58:10","publishedOnDateReadable":"March 31st, 2026"},"versionCreatedAt":"2026-01-19 13:37:33","video":"","vorDoi":"10.1186/s12982-026-01798-1","vorDoiUrl":"https://doi.org/10.1186/s12982-026-01798-1","workflowStages":[]},"version":"v1","identity":"rs-8397478","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8397478","identity":"rs-8397478","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}