Compassion Fatigue in Caregivers: A Hidden Crisis in Healthcare Systems-A Study from Jashore, Bangladesh

Compassion Fatigue in Caregivers: A Hidden Crisis in Healthcare Systems-A Study from Jashore, Bangladesh | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Compassion Fatigue in Caregivers: A Hidden Crisis in Healthcare Systems-A Study from Jashore, Bangladesh Mansur Helal Sajid, Pothik Hossain, Ridwane Sharife, Farzana Haque This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7641375/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Compassion fatigue, arising from prolonged exposure to patient suffering, is a critical yet under-recognized problem among healthcare workers, particularly in resource-limited settings like Bangladesh, where nurses face high patient loads and limited support. Aim This study assessed the prevalence, risk factors, and consequences of compassion fatigue among nurses at Jashore 250-Bedded General Hospital, highlighting local determinants affecting caregiver well-being and patient care. Methods A cross-sectional survey was conducted among 380 nurses, selected via stratified random sampling across medicine, surgery, pediatrics, and ICU/emergency departments. The Professional Quality of Life Scale (ProQOL-V) measured compassion fatigue. Sample size calculation assumed 45% prevalence, validated by a pilot study of 30 nurses. Descriptive statistics, chi-square tests, and logistic regression were applied to identify demographic and occupational predictors. Results High compassion fatigue was observed in 44.2% of nurses, with ICU/emergency staff most affected (52%). Significant predictors included > 10 years of service (OR 2.3, 95% CI 1.4–3.8), ICU/emergency roles (OR 1.9, 95% CI 1.2–2.9), and insufficient support (OR 2.6, 95% CI 1.6–4.1). Outcomes included reduced job satisfaction, increased turnover risk, and potential patient safety concerns. Conclusion Compassion fatigue is a significant challenge among Bangladeshi nurses. Targeted organizational and individual interventions—including workload management, peer support, and mental health programs—are essential to sustain nurse well-being and quality patient care. Health sciences/Diseases Health sciences/Health care Health sciences/Health occupations Health sciences/Medical research Health sciences/Risk factors Compassion fatigue nurses healthcare systems burnout resilience Bangladesh 1. Introduction Nurses are vital to healthcare delivery in Bangladesh, particularly in district hospitals such as Jashore 250-Bedded General Hospital, which contend with high patient volumes and limited resources. Compassion fatigue refers to the emotional and physical exhaustion resulting from prolonged exposure to patient suffering, often accompanied by secondary traumatic stress and reduced empathy. Unlike burnout, which develops gradually, compassion fatigue can emerge suddenly, threatening both nurse well-being and care quality. Compassion fatigue has been described as a secondary traumatic stress response, often resulting from repeated exposure to patient suffering (Figley, 1995) [5]. Globally, compassion fatigue affects 30–50% of nurses (2–4), contributing to absenteeism, turnover, and compromised patient safety (12–14). In Bangladesh, these challenges are exacerbated by overcrowded wards, staff shortages, and limited mental health support (8, 9). Despite its importance, research on compassion fatigue among Bangladeshi nurses remains scarce. This study aims to determine the prevalence, risk factors, and consequences of compassion fatigue among nurses at Jashore General Hospital, providing evidence for context-specific interventions. 2. Background and Literature Review First described by Figley (1), compassion fatigue arises from prolonged caregiving for patients experiencing trauma or chronic illness. Key contributors include high patient-to-nurse ratios, long working hours, inadequate support systems, and individual coping mechanisms. Consequences span personal distress, diminished empathy, absenteeism, and economic burdens for healthcare systems (12, 13). Recent studies in Bangladesh highlight nurses’ vulnerability due to resource limitations, staffing deficits, and the psychological burden of the COVID-19 pandemic (8, 9, 11). Globally, ICU and emergency nurses report higher prevalence of compassion fatigue, consistent with findings from other developing countries (2, 6, 7). Understanding these factors is essential for implementing preventive and supportive measures tailored to local healthcare contexts. 3. Methods 3.1 Study Design and Setting A cross-sectional survey was conducted at Jashore 250-Bedded General Hospital, Khulna Division, Bangladesh, between January and June 2025. Similar cross-sectional approaches have been employed in prior studies conducted in South Asia to explore caregiver stress and workforce challenges [10]. 3.2 Sample Size Calculation Using the standard formula: $$\:n=\frac{{Z}^{2}.p.(1-p)}{{d}^{2}}$$ where Z = 1.96 (95% confidence), p = 0.45 (expected prevalence), and d = 0.05 (margin of error), the minimum sample size was 381. Accounting for 10% non-response, 424 nurses were approached, with 380 completing the survey. 3.3 Pilot Study A pilot study with 30 nurses tested the ProQOL-V questionnaire’s clarity and reliability, yielding Cronbach’s α = 0.78. Minor wording adjustments were made to improve comprehension. 3.4 Sampling and Inclusion Criteria Stratified random sampling included nurses from medicine, surgery, pediatrics, and ICU/emergency departments with ≥ 1 year of experience who consented to participate. Interns, nurses on leave, or unwilling participants were excluded. 3.5 Data Collection and Ethics Data were collected via structured questionnaires. Informed consent and confidentiality were ensured. Ethical approval was obtained from the Jashore General Hospital IRB (JGH/2023/045). 3.6 Data Analysis Descriptive statistics (mean ± SD, frequencies) and inferential tests (chi-square, logistic regression) analyzed relationships between demographics, occupational factors, and high compassion fatigue (ProQOL-V score ≥ 30). SPSS v26 was used for analysis. 4. Results 4.1 Demographics Among 380 participants, 91% were female and 9% male, with a mean age of 29.4 ± 5.8 years. Mean years of service were 7.2 ± 4.1. Departmental distribution: Medicine (28%), Surgery (25%), Pediatrics (22%), ICU/Emergency (25%). 4.2 Prevalence High : 44.2% (n = 168) Moderate : 37.6% (n = 143) Low : 18.2% (n = 69) 4.3 Departmental Variation ICU/Emergency nurses had the highest prevalence (52%), followed by Pediatrics (45%), Surgery (40%), and Medicine (38%). 4.4 Risk Factors Table 1 presents the demographic characteristics of the study participants. Multivariate logistic regression identified significant predictors of high compassion fatigue: Years of service > 10: OR 2.3, 95% CI 1.4–3.8, p = 0.002 ICU/Emergency role: OR 1.9, 95% CI 1.2–2.9, p = 0.005 Lack of organizational support: OR 2.6, 95% CI 1.6–4.1, p < 0.001 Table 1 Prevalence of Compassion Fatigue among Nurses (n = 380) Level Frequency Percentage (%) High 168 44.2 Moderate 143 37.6 Low 69 18.2 Table 2 summarizes the prevalence and predictors of compassion fatigue among nurses. Table 2 Risk Factors Associated with High Compassion Fatigue Factor OR (95% CI) P-value Years of service > 10 2.3 (1.4–3.8) 0.002 ICU/Emergency role 1.9 (1.2–2.9) 0.005 Lack of support 2.6 (1.6–4.1) < 0.001 5. Discussion Approximately 44.2% of nurses reported high compassion fatigue, with ICU and emergency staff most affected. This is consistent with global prevalence rates (30–50%) but is exacerbated locally by staffing shortages, high patient loads, and limited support systems (8, 9). Caregiver well-being has a direct influence on both patient safety and the overall quality of health services [15]. Implications : System-level : Hospitals should implement workload management, peer support programs, and accessible mental health services. Individual-level : Training in resilience, mindfulness, and self-care strategies can mitigate compassion fatigue. Limitations : This study is limited by its single-site, cross-sectional design and reliance on self-reported data. Future multi-center longitudinal research is recommended to establish causality and evaluate intervention effectiveness. 6. Conclusion Compassion fatigue is a critical, under-recognized challenge among Bangladeshi nurses, particularly in high-pressure settings. Organizational policies, mental health support, and resilience training are essential to safeguard nurse well-being and maintain high-quality patient care. Declarations Consent to Publish: Participants consented to anonymized data publication. Competing Interests: None declared. Funding: No external funding received. Author Contribution M.H.S. conceptualized the study, designed the methodology, performed the analysis, and drafted the manuscript.P.H. contributed to methodology development and manuscript editing.R.S. was responsible for data collection and contributed to manuscript review.F.H. provided supervision and validation of the study.All authors read and approved the final manuscript.All authors contributed to manuscript revision, read, and approved the final version. Acknowledgement The authors sincerely thank the administration and staff of Jashore 250-Bedded General Hospital for their cooperation and logistical support throughout this study. We are also grateful to the participating nurses and caregivers for their valuable time and insights, without which this research would not have been possible. Data Availability Available from M.H. Sajid ( [email protected] ) upon request, subject to ethical approval. References Figley CR. Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. Brunner/Mazel; 1995. Ye L, et al. Prevalence and related factors of compassion fatigue among nurses: A systematic review. BMC Nurs. 2024;23:1–12. Heritage B, Rees CS, Hegney DG. The ProQOL-21: A revised version of the Professional Quality of Life scale. J Clin Psychol. 2018;74(3):379–391. Duarte J, Pinto-Gouveia J. Empathy and compassion fatigue in health professionals: The role of self-compassion. J Appl Soc Psychol. 2016;46(3):201–210. Lv J, et al. Prevalence and risk factors of compassion fatigue in obstetric and gynecological nurses: Systematic review and meta-analysis. Front Public Health. 2025;13:1590995. Saribudak TP, et al. Compassion fatigue in nurses providing palliative cancer care: A cross-sectional study. Eur J Oncol Nurs. 2023;58:102091. Santos CGC, et al. Compassion fatigue and burnout among healthcare professionals: Systematic review and meta-analysis. JMIR Res Protoc. 2025;14:e66360. Rizwan F, et al. Burnout risks in Bangladeshi physicians: A multicenter survey. J Occup Health. 2023;65:e12432. Rahman F, et al. Insomnia and job stressors among healthcare workers in COVID-19 units, Bangladesh. BMC Health Serv Res. 2023;23:94. Rashid F, et al. Burnout syndrome among frontline doctors of secondary and tertiary care hospitals in Chattogram, Bangladesh. PLoS One. 2022;17:e0277875. Chowdhury SR, et al. Mental health symptoms among the nurses of Bangladesh during COVID-19 outbreak. BMC Nurs. 2021;20:1–8. Zhang YY, et al. Relationship between burnout, compassion fatigue, and compassion satisfaction among nurses. Int J Nurs Stud. 2018;79:19–26. Mohamed-W Abdelmaksoud. Quality of work life, burnout, and compassion fatigue among mental health nurses. Egypt J Health Care. 2024;15(4):1138–1150. Sawyer GV. Compassion fatigue, burnout, and secondary traumatic stress among Bahamian nurses and social workers. J Soc Work Values Ethics. 2024;21(1):1–15. Nagle E, et al. Factors affecting healthcare workers’ burnout and conceptual models. J Healthc Manag. 2024;69(5):321–330. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7641375","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":530442362,"identity":"0a7091b0-371d-4008-9af4-c5a0c3d25a13","order_by":0,"name":"Mansur Helal Sajid","email":"data:image/png;base64,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","orcid":"","institution":"Jashore University of Science and Technology","correspondingAuthor":true,"prefix":"","firstName":"Mansur","middleName":"Helal","lastName":"Sajid","suffix":""},{"id":530442363,"identity":"341a6534-7fba-4dc6-bcb2-bf305d9413e4","order_by":1,"name":"Pothik Hossain","email":"","orcid":"","institution":"Jashore University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Pothik","middleName":"","lastName":"Hossain","suffix":""},{"id":530442364,"identity":"66cac86c-2a2d-476d-8dce-3a0898378069","order_by":2,"name":"Ridwane Sharife","email":"","orcid":"","institution":"Jashore University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Ridwane","middleName":"","lastName":"Sharife","suffix":""},{"id":530442365,"identity":"cc6c31dc-8eff-4a81-9c85-a945c4daf9ff","order_by":3,"name":"Farzana Haque","email":"","orcid":"","institution":"Jashore University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Farzana","middleName":"","lastName":"Haque","suffix":""}],"badges":[],"createdAt":"2025-09-17 14:38:23","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7641375/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7641375/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":95644246,"identity":"f82f2f5e-01c5-4907-ab64-8b8af80394f0","added_by":"auto","created_at":"2025-11-11 13:56:17","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":25707,"visible":true,"origin":"","legend":"","description":"","filename":"Manuscript.docx","url":"https://assets-eu.researchsquare.com/files/rs-7641375/v1/bdc00b435d09b0d8cfd319c2.docx"},{"id":95657704,"identity":"6d35c1d9-fb08-4380-affc-ad9b3c5cdf9a","added_by":"auto","created_at":"2025-11-11 16:21:42","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6530,"visible":true,"origin":"","legend":"","description":"","filename":"b8be8a2cceb1437faab04e4249115975.json","url":"https://assets-eu.researchsquare.com/files/rs-7641375/v1/26f320a52786e06a63ee9d8d.json"},{"id":95644244,"identity":"4107f5bf-d4ba-4ccb-a370-93f8bfad9edc","added_by":"auto","created_at":"2025-11-11 13:56:16","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":28599,"visible":true,"origin":"","legend":"","description":"","filename":"b8be8a2cceb1437faab04e42491159751enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7641375/v1/e22f3bc380c43b645a81865b.xml"},{"id":95644243,"identity":"3429d3d1-63ef-49a1-9da9-1406e81edb27","added_by":"auto","created_at":"2025-11-11 13:56:16","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":27467,"visible":true,"origin":"","legend":"","description":"","filename":"b8be8a2cceb1437faab04e42491159751structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7641375/v1/5a5e1734743afc8465d0bf59.xml"},{"id":95644247,"identity":"4aa82634-d506-44b7-b300-29e70f39da0e","added_by":"auto","created_at":"2025-11-11 13:56:17","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":33600,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7641375/v1/2112574ef0ae5ccb348de58e.html"},{"id":100767181,"identity":"59a9b162-5f38-465a-84fe-be5f455f3ac2","added_by":"auto","created_at":"2026-01-21 09:10:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":553073,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7641375/v1/b5aebd2a-80fb-4be9-823f-30e3d711fd3c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Compassion Fatigue in Caregivers: A Hidden Crisis in Healthcare Systems-A Study from Jashore, Bangladesh","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eNurses are vital to healthcare delivery in Bangladesh, particularly in district hospitals such as Jashore 250-Bedded General Hospital, which contend with high patient volumes and limited resources. \u003cstrong\u003eCompassion fatigue\u003c/strong\u003e refers to the emotional and physical exhaustion resulting from prolonged exposure to patient suffering, often accompanied by secondary traumatic stress and reduced empathy. Unlike burnout, which develops gradually, compassion fatigue can emerge suddenly, threatening both nurse well-being and care quality. Compassion fatigue has been described as a secondary traumatic stress response, often resulting from repeated exposure to patient suffering (Figley, 1995) [5].\u003c/p\u003e\n\u003cp\u003eGlobally, compassion fatigue affects 30\u0026ndash;50% of nurses (2\u0026ndash;4), contributing to absenteeism, turnover, and compromised patient safety (12\u0026ndash;14). In Bangladesh, these challenges are exacerbated by overcrowded wards, staff shortages, and limited mental health support (8, 9). Despite its importance, research on compassion fatigue among Bangladeshi nurses remains scarce. This study aims to determine the prevalence, risk factors, and consequences of compassion fatigue among nurses at Jashore General Hospital, providing evidence for context-specific interventions.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"2. Background and Literature Review","content":"\u003cp\u003eFirst described by Figley (1), compassion fatigue arises from prolonged caregiving for patients experiencing trauma or chronic illness. Key contributors include high patient-to-nurse ratios, long working hours, inadequate support systems, and individual coping mechanisms. Consequences span personal distress, diminished empathy, absenteeism, and economic burdens for healthcare systems (12, 13).\u003c/p\u003e\u003cp\u003eRecent studies in Bangladesh highlight nurses\u0026rsquo; vulnerability due to resource limitations, staffing deficits, and the psychological burden of the COVID-19 pandemic (8, 9, 11). Globally, ICU and emergency nurses report higher prevalence of compassion fatigue, consistent with findings from other developing countries (2, 6, 7). Understanding these factors is essential for implementing preventive and supportive measures tailored to local healthcare contexts.\u003c/p\u003e"},{"header":"3. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Study Design and Setting\u003c/h2\u003e\u003cp\u003eA cross-sectional survey was conducted at Jashore 250-Bedded General Hospital, Khulna Division, Bangladesh, between January and June 2025. Similar cross-sectional approaches have been employed in prior studies conducted in South Asia to explore caregiver stress and workforce challenges [10].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Sample Size Calculation\u003c/h2\u003e\u003cp\u003eUsing the standard formula:\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:n=\\frac{{Z}^{2}.p.(1-p)}{{d}^{2}}$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003ewhere Z\u0026thinsp;=\u0026thinsp;1.96 (95% confidence), p\u0026thinsp;=\u0026thinsp;0.45 (expected prevalence), and d\u0026thinsp;=\u0026thinsp;0.05 (margin of error), the minimum sample size was 381. Accounting for 10% non-response, 424 nurses were approached, with 380 completing the survey.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Pilot Study\u003c/h2\u003e\u003cp\u003eA pilot study with 30 nurses tested the ProQOL-V questionnaire\u0026rsquo;s clarity and reliability, yielding Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.78. Minor wording adjustments were made to improve comprehension.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Sampling and Inclusion Criteria\u003c/h2\u003e\u003cp\u003eStratified random sampling included nurses from medicine, surgery, pediatrics, and ICU/emergency departments with \u0026ge;\u0026thinsp;1 year of experience who consented to participate. Interns, nurses on leave, or unwilling participants were excluded.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e3.5 Data Collection and Ethics\u003c/h2\u003e\u003cp\u003eData were collected via structured questionnaires. Informed consent and confidentiality were ensured. Ethical approval was obtained from the Jashore General Hospital IRB (JGH/2023/045).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e3.6 Data Analysis\u003c/h2\u003e\u003cp\u003eDescriptive statistics (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, frequencies) and inferential tests (chi-square, logistic regression) analyzed relationships between demographics, occupational factors, and high compassion fatigue (ProQOL-V score\u0026thinsp;\u0026ge;\u0026thinsp;30). SPSS v26 was used for analysis.\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e4.1 Demographics\u003c/h2\u003e\u003cp\u003eAmong 380 participants, 91% were female and 9% male, with a mean age of 29.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8 years. Mean years of service were 7.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1. Departmental distribution: Medicine (28%), Surgery (25%), Pediatrics (22%), ICU/Emergency (25%).\u003c/p\u003e\u003cp\u003e\u003cb\u003e4.2 Prevalence\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eHigh\u003c/b\u003e: 44.2% (n\u0026thinsp;=\u0026thinsp;168)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e: 37.6% (n\u0026thinsp;=\u0026thinsp;143)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eLow\u003c/b\u003e: 18.2% (n\u0026thinsp;=\u0026thinsp;69)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e4.3 Departmental Variation\u003c/h2\u003e\u003cp\u003eICU/Emergency nurses had the highest prevalence (52%), followed by Pediatrics (45%), Surgery (40%), and Medicine (38%).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e4.4 Risk Factors\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the demographic characteristics of the study participants. Multivariate logistic regression identified significant predictors of high compassion fatigue:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eYears of service\u0026thinsp;\u0026gt;\u0026thinsp;10: OR 2.3, 95% CI 1.4\u0026ndash;3.8, p\u0026thinsp;=\u0026thinsp;0.002\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eICU/Emergency role: OR 1.9, 95% CI 1.2\u0026ndash;2.9, p\u0026thinsp;=\u0026thinsp;0.005\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eLack of organizational support: OR 2.6, 95% CI 1.6\u0026ndash;4.1, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePrevalence of Compassion Fatigue among Nurses (n\u0026thinsp;=\u0026thinsp;380)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLevel\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e168\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e44.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e143\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarizes the prevalence and predictors of compassion fatigue among nurses.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRisk Factors Associated with High Compassion Fatigue\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFactor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYears of service\u0026thinsp;\u0026gt;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.3 (1.4\u0026ndash;3.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eICU/Emergency role\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.9 (1.2\u0026ndash;2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLack of support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.6 (1.6\u0026ndash;4.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"5. Discussion","content":"\u003cp\u003eApproximately \u003cb\u003e44.2% of nurses\u003c/b\u003e reported high compassion fatigue, with ICU and emergency staff most affected. This is consistent with global prevalence rates (30\u0026ndash;50%) but is exacerbated locally by staffing shortages, high patient loads, and limited support systems (8, 9). Caregiver well-being has a direct influence on both patient safety and the overall quality of health services [15].\u003c/p\u003e\u003cp\u003e\u003cb\u003eImplications\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eSystem-level\u003c/b\u003e: Hospitals should implement workload management, peer support programs, and accessible mental health services.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eIndividual-level\u003c/b\u003e: Training in resilience, mindfulness, and self-care strategies can mitigate compassion fatigue.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eThis study is limited by its single-site, cross-sectional design and reliance on self-reported data. Future multi-center longitudinal research is recommended to establish causality and evaluate intervention effectiveness.\u003c/p\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003eCompassion fatigue is a critical, under-recognized challenge among Bangladeshi nurses, particularly in high-pressure settings. Organizational policies, mental health support, and resilience training are essential to safeguard nurse well-being and maintain high-quality patient care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eConsent to Publish:\u003c/h2\u003e\u003cp\u003eParticipants consented to anonymized data publication.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting Interests:\u003c/h2\u003e\u003cp\u003eNone declared.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eNo external funding received.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eM.H.S. conceptualized the study, designed the methodology, performed the analysis, and drafted the manuscript.P.H. contributed to methodology development and manuscript editing.R.S. was responsible for data collection and contributed to manuscript review.F.H. provided supervision and validation of the study.All authors read and approved the final manuscript.All authors contributed to manuscript revision, read, and approved the final version.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors sincerely thank the administration and staff of Jashore 250-Bedded General Hospital for their cooperation and logistical support throughout this study. We are also grateful to the participating nurses and caregivers for their valuable time and insights, without which this research would not have been possible.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAvailable from M.H. Sajid ([email protected]) upon request, subject to ethical approval.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFigley CR. Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. Brunner/Mazel; 1995.\u003c/li\u003e\n\u003cli\u003eYe L, et al. Prevalence and related factors of compassion fatigue among nurses: A systematic review. BMC Nurs. 2024;23:1–12.\u003c/li\u003e\n\u003cli\u003eHeritage B, Rees CS, Hegney DG. The ProQOL-21: A revised version of the Professional Quality of Life scale. J Clin Psychol. 2018;74(3):379–391.\u003c/li\u003e\n\u003cli\u003eDuarte J, Pinto-Gouveia J. Empathy and compassion fatigue in health professionals: The role of self-compassion. J Appl Soc Psychol. 2016;46(3):201–210.\u003c/li\u003e\n\u003cli\u003eLv J, et al. Prevalence and risk factors of compassion fatigue in obstetric and gynecological nurses: Systematic review and meta-analysis. Front Public Health. 2025;13:1590995.\u003c/li\u003e\n\u003cli\u003eSaribudak TP, et al. Compassion fatigue in nurses providing palliative cancer care: A cross-sectional study. Eur J Oncol Nurs. 2023;58:102091.\u003c/li\u003e\n\u003cli\u003eSantos CGC, et al. Compassion fatigue and burnout among healthcare professionals: Systematic review and meta-analysis. JMIR Res Protoc. 2025;14:e66360.\u003c/li\u003e\n\u003cli\u003eRizwan F, et al. Burnout risks in Bangladeshi physicians: A multicenter survey. J Occup Health. 2023;65:e12432.\u003c/li\u003e\n\u003cli\u003eRahman F, et al. Insomnia and job stressors among healthcare workers in COVID-19 units, Bangladesh. BMC Health Serv Res. 2023;23:94.\u003c/li\u003e\n\u003cli\u003eRashid F, et al. Burnout syndrome among frontline doctors of secondary and tertiary care hospitals in Chattogram, Bangladesh. PLoS One. 2022;17:e0277875.\u003c/li\u003e\n\u003cli\u003eChowdhury SR, et al. Mental health symptoms among the nurses of Bangladesh during COVID-19 outbreak. BMC Nurs. 2021;20:1–8.\u003c/li\u003e\n\u003cli\u003eZhang YY, et al. Relationship between burnout, compassion fatigue, and compassion satisfaction among nurses. Int J Nurs Stud. 2018;79:19–26.\u003c/li\u003e\n\u003cli\u003eMohamed-W Abdelmaksoud. Quality of work life, burnout, and compassion fatigue among mental health nurses. Egypt J Health Care. 2024;15(4):1138–1150.\u003c/li\u003e\n\u003cli\u003eSawyer GV. Compassion fatigue, burnout, and secondary traumatic stress among Bahamian nurses and social workers. J Soc Work Values Ethics. 2024;21(1):1–15.\u003c/li\u003e\n\u003cli\u003eNagle E, et al. Factors affecting healthcare workers’ burnout and conceptual models. J Healthc Manag. 2024;69(5):321–330.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Compassion fatigue, nurses, healthcare systems, burnout, resilience, Bangladesh","lastPublishedDoi":"10.21203/rs.3.rs-7641375/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7641375/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eCompassion fatigue, arising from prolonged exposure to patient suffering, is a critical yet under-recognized problem among healthcare workers, particularly in resource-limited settings like Bangladesh, where nurses face high patient loads and limited support.\u003c/p\u003e\u003ch2\u003eAim\u003c/h2\u003e\u003cp\u003eThis study assessed the prevalence, risk factors, and consequences of compassion fatigue among nurses at Jashore 250-Bedded General Hospital, highlighting local determinants affecting caregiver well-being and patient care.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional survey was conducted among 380 nurses, selected via stratified random sampling across medicine, surgery, pediatrics, and ICU/emergency departments. The \u003cb\u003eProfessional Quality of Life Scale (ProQOL-V)\u003c/b\u003e measured compassion fatigue. Sample size calculation assumed 45% prevalence, validated by a pilot study of 30 nurses. Descriptive statistics, chi-square tests, and logistic regression were applied to identify demographic and occupational predictors.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eHigh compassion fatigue was observed in 44.2% of nurses, with ICU/emergency staff most affected (52%). Significant predictors included\u0026thinsp;\u0026gt;\u0026thinsp;10 years of service (OR 2.3, 95% CI 1.4\u0026ndash;3.8), ICU/emergency roles (OR 1.9, 95% CI 1.2\u0026ndash;2.9), and insufficient support (OR 2.6, 95% CI 1.6\u0026ndash;4.1). Outcomes included reduced job satisfaction, increased turnover risk, and potential patient safety concerns.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eCompassion fatigue is a significant challenge among Bangladeshi nurses. Targeted organizational and individual interventions\u0026mdash;including workload management, peer support, and mental health programs\u0026mdash;are essential to sustain nurse well-being and quality patient care.\u003c/p\u003e","manuscriptTitle":"Compassion Fatigue in Caregivers: A Hidden Crisis in Healthcare Systems-A Study from Jashore, Bangladesh","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-11 13:56:12","doi":"10.21203/rs.3.rs-7641375/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"420d0223-477d-4455-a827-bf87aeade24f","owner":[],"postedDate":"November 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":56388028,"name":"Health sciences/Diseases"},{"id":56388029,"name":"Health sciences/Health care"},{"id":56388030,"name":"Health sciences/Health occupations"},{"id":56388031,"name":"Health sciences/Medical research"},{"id":56388032,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2026-01-25T04:38:11+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-11 13:56:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7641375","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7641375","identity":"rs-7641375","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}