Development and psychometric properties of the Compassion Fatigue Assessment Scale for Indian Nurses

Development and psychometric properties of the Compassion Fatigue Assessment Scale for Indian Nurses | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Development and psychometric properties of the Compassion Fatigue Assessment Scale for Indian Nurses Shifali Sharma, Bharat Pareek, Harpreet Kaur, Priya Baby, Ramya Kundayi Ravi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6602941/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 12 Aug, 2025 Read the published version in BMC Nursing → Version 1 posted 10 You are reading this latest preprint version Abstract Background Compassion fatigue is a significant concern for nurses because they are constantly exposed to suffering. Aims This study aimed to develop and validate a Compassion Fatigue Assessment Scale (CFAS) for Indian nurses. Methods A quantitative, descriptive, and cross-sectional design was used to evaluate the psychometric properties, including validity and reliability. A total of 200 nurses from two government and two private hospitals participated between February and June 2022. Data were collected using a sociodemographic sheet, CFAS, and the Professional Quality of Life (ProQOL) scale. Exploratory and confirmatory factor analyses were used to assess construct validity, while convergent validity was evaluated using ProQOL. Reliability was tested using the Cronbach’s α coefficient. Results Principal component analysis with varimax rotation identified a ten-factor structure across 36 items, explaining 60.34% of the variance. The extracted domains included “dissatisfaction and burnout,” lack of emotions, “lack of interest,” secondary stress, “hopelessness,” worthlessness, “overwhelming,” compassion, “competency,” and “productivity.” The overall Cronbach’s alpha was 0.88, with the subscale scores ranging from 0.56 to 0.91. The test–retest intra-class correlation coefficient was 0.901, indicating good stability. Conclusions The CFAS demonstrated strong construct validity and internal consistency, making it a reliable tool for assessing and monitoring compassion fatigue among nurses in research and professional settings. Burnout Compassion fatigue Factor analysis Nurses Scale Secondary trauma Figures Figure 1 Key points for policy, practice and further research The newly developed Compassion Fatigue Assessment Scale (CFAS) can be used to identify at-risk nurses and inform targeted intervention. Implementing targeted programs to prevent burnout by identifying at-risk nurses using the newly developed Compassion Fatigue Assessment. This study highlights the need to address systemic issues contributing to secondary traumatic stress, such as long duty hours, heavy workload, and lack of support, particularly in resource-scarce settings. Integrate regular assessments of compassion fatigue using CFAS into organizational policies to monitor and support nurses' well-being. Further research should be conducted to validate CFAS in diverse populations and healthcare settings across India to ensure its broader applicability. Explore the predictive validity of the CFAS in various contexts, such as its ability to predict turnover intentions or quality of patient care. Investigate the effectiveness of interventions designed to reduce compassion fatigue using the CFAS as a measurement tool. Consider the linguistic validation of the CFAS for use in non-English-speaking or multilingual populations to enhance its applicability across diverse linguistic groups in India. BACKGROUND With organizations and administrators following a less traditional hierarchy or structure, the workplace is becoming increasingly complex and difficult. The World Health Organization (WHO) and international Labour organizations (ILO) joint policy urges governments, employers, workers, and their organizations in the public and private sectors to devise and implement strategies to address the mental health and well-being of people at work. 1 According to the ILO estimates, the mortality and disease burden caused by unquantifiable risk are greater than those caused by quantifiable risk. Workers in low- and middle-income countries experience a disproportionately higher share of deaths and disabilities caused by workplace exposure to various risk factors than do those in high-income countries. 2 Healthcare professionals, including doctors, nurses, and other medical staff, face a unique set of challenges that distinguishes them from many others 3 . Healthcare workers have long been recognized as a particularly vulnerable group when they experience burnout, stress, and psychological distress. 4 – 6 One key factor contributing to the heightened prevalence of these issues among healthcare workers is the intense workload and high-pressure environment in which they have been operating for decades. 7 Numerous studies have documented the significant challenges faced by healthcare workers, including staff shortages, long work shifts, prolonged use of personal protective equipment, insufficient supplies, rapidly changing guidelines, the risk of infecting loved ones, and lack of adequate training and psychosocial support. 8 – 10 This trend has been exacerbated only by the recent COVID-19 pandemic, which has placed considerable psychological strain on those working in the healthcare field. 3 , 11 Compassion fatigue, a pervasive issue in the healthcare industry, has emerged as a significant contributor to the alarming rates of burnout, psychological distress, and diminished physical and mental health among healthcare workers, particularly nurses. 8 , 12 – 14 There is growing evidence that nurses are disproportionately affected in this regard compared to other health professionals. 15 This could be because nurses are involved in direct care and are required to empathize with other people as compared to their counterparts, particularly when they are suffering. 16 They are uniquely susceptible to compassion fatigue due to their continuous exposure to the emotional and traumatic experiences of their patients, 17 – 19 as they strive to provide empathetic and compassionate care, the cumulative stress and emotional burden can take a profound toll, leading to a range of negative outcomes. 20 Numerous detrimental physical, psychological, cognitive, and social effects have been linked to compassion fatigue, including decreased productivity, increased absenteeism, low job satisfaction, burnout, impaired professional judgment, and increased medical errors. These effects ultimately result in unsafe and subpar patient care, poor patient outcomes, higher hospitalized patient mortality and morbidity, and an overall negative impact on healthcare organizations' performance. 21 , 22 Most healthcare workers enter the profession because they have passion to help others. Compassion fatigue has also been identified as a “negative consequence and cost of caring that is capable of removing nurses’ compassionate caring forever”. 23 As direct care providers, nurses face challenges in dealing with the complex demands of overly strained health systems. Compassion fatigue affect all nurses. Hence, interventions are necessary to promote and preserve the health and well-being of healthcare workers, especially nurses, by making healthcare organizations healthier and safer places work for nurses, and ultimately for all. Even though, it is imperative that administrators and healthcare organizations should monitor compassion fatigue among nurses, there is no universally accepted and agreed upon definition of compassion fatigue. The scales developed to measure compassion fatigue in nurses in other countries is inadequate to measure the same among Indian nurses owing to several reasons. Indian nurses operate in a different setting due to cultural differences, variations in healthcare scenarios, and many professional problems which are unique to this setting. In this context, the investigators decided to develop a new instrument to measure compassion fatigue among nurses Purpose This study aimed to develop and examine the psychometric properties of a compassion fatigue assessment scale (CFAS)for nurses. METHODS Research design This methodological study used a quantitative approach and cross-sectional survey design. The study was done in two phases. 24 Phase 1: Conceptualization and Item Generation The investigators conducted an extensive review of the literature published in major electronic databases for compassion fatigue and compassion fatigue measurement tools to conceptually define the construct. 18 , 24 – 27 ,, 28 Semi-structured interviews were conducted with a sample of 15 nurses recruited through a maximum variation sample (gender, years of work experience, and working in different levels of care) to further explore the concepts and experiences related to compassion fatigue. Based on this, an initial set of items was selected to measure compassion fatigue among nurses. 17 , 24 , 29 Phase 2: Psychometric evaluation Face validity The face Validity of CFAS was assessed by asking a group of ten nurses to evaluate the scale for clarity, importance, and comprehensiveness on a five-point Likert scale. They were also asked to identify and resolve any ambiguities in their statements. Later, they were asked to evaluate the importance of each item using a 5-point Likert-type scale (5 = completely important and I = not important) . An impact score greater than 1.5 was considered appropriate. Finally, the items were edited for language and grammar by investigators and experts. 21 , 30 Content Validity Assessment The content validity of the instrument was ensured by calculating the Content Validity Ratio (CVR) and Content Validity Index (CVI). A team of nine experts rated the relevance of each item using a three-point Likert scale. Items with a Content Validity Ratio (CVR) of less than 0.78. were excluded (21,31,32). 21 , 31 , 32 To calculate the CVI, ten experts (from the fields of nursing, instrument development, physicians, and psychologists) were invited to determine the relevance of the items on a three-point Likert scale. The item-level content validity index (I-CVI) and scale-level content validity index (S-CVI) content validity indices were calculated. Items with an I-CVI of 0.79 or more, 0.70–0.79, and less than 0.69 were respectively included, revised, and excluded, respectively, and S-CVI values greater than 0.90 were considered acceptable. 21 , 33 , 34 Construct validity Construct validity was ensured using exploratory factor analysis (EFA). The factor structure of the questionnaire was retrieved using varimax rotation and a principal component factor analysis. The Kaiser-Meyer-Olkin (KMO) test was used to ensure further sampling adequacy, while Bartlett's test of sphericity was used to evaluate the suitability of the analytic model. A minimum factor loading value of 0.40 was used to maintain the items in the extracted factors, whereas the scree plot and eigenvalues greater than 1 were used to determine the number of NCFI factors. 35 Setting and Sample Data collection was done between February and June 2022 from all the eligible nurses working in the 4 hospitals conveniently selected from the (two government and two private) Northern part of India. All the hospitals selected for the study were multi-specialty referral hospitals with a bed strength of more than 150. Convenience sampling was used to recruit the participants. All nurses registered under the Punjab Nurses and Registration Council, aged 21 years and above, and working full-time in the selected hospitals in the past year were invited to participate in the study. Nurses who were ill in the past 3 months and who were not willing to participate were excluded. The sample size was estimated based on the recommendations for calculating the sample size for scale development and validation. Assuming data loss and other factors, the final sample size was set at 200. All eligible nurses were invited to participate in this study. The data collection was terminated when the desired sample size was achieved. Convergent validity The convergent validity of the scale was determined by administering a compassion fatigue scale along with the previously validated “Professional Quality of Life” scale to nurses. 35 Pearson’s correlation analysis was performed to examine the correlation between the scores on the two scales. Reliability Assessment The reliability of the scale was assessed using the internal consistency and temporal stability assessment techniques. The results of the internal consistency assessment are reported as Cronbach’s alpha. An alpha of greater than 0.70 was considered as acceptable internal consistency. 36 Moreover, stability assessment was performed using the test–retest technique, in which 30 nurses completed the CFAS twice with a 2-week interval. The correlation between the test and retest scores was examined using the intra-class correlation coefficient (ICC). ICCs greater than 0.75 were considered acceptable. Item analysis was performed to calculate correlations between the items and the scale. 37 The correlation of each item with the scale should be high, and the correlation of the items with each other should be low. Items were removed when the correlation coefficient of an item with the scale was less than 0.30 or when the correlation coefficient of two items was greater than 0.70. 37 Data collection A self-administered questionnaire with three sections was used to collect data to test the construct validity and reliability. The first section contained six sociodemographic items used to gather information regarding age. The second part contains the newly developed 32 items CFAS. The third section included the reliable and validated “professional QOL. 35 Ethical considerations The study protocol was approved by the research and ethics committee of the institution where the study was conducted. Permission was obtained from the administrators of the selected hospitals where data were collected. Written informed consent was obtained from all the nurses after explaining the purpose, nature, and duration of the study. Privacy of information, anonymity, and confidentiality of data were assured to the participants before data collection. They were informed of the voluntary nature of the study and were given the right to withdraw at any time they wished to. Statistical analysis The Statistical Package for the Social Sciences (SPSS) version 24 was used to analyze the data acquired from the participants. Frequencies, percentages, means, and standard deviations were used to describe variables. A two-sided p 0.05 was used to establish statistical significance. The level of significance was set at p < 0.05. RESULTS Phase 1 Initially, the pool contained 83 items, and at the end of phase one 42 items were extracted based on the literature review, expert opinion, and focus group discussion. Phase 2: Psychometric analysis Face Validity Six items were modified to improve clarity during the qualitative assessment of the face validity. In the quantitative face validity assessment, seven items obtained an impact score of less than 1.5, of which four were removed and three were retained by the investigators after modifications. Finally, the scale contained 38 items, which were edited and reworded for language and grammar by experts. Content validity In this step, two items with a CVR of less than 0.78 were excluded. Two items with an I-CVI of 0.70–0.79 were revised. In contrast, the S-CVI was 0.90. At the end of this step, the NCFI contained 36 items. Construct validity A total of hundred nurses participated in the survey (response rate: 92.8%). Most of them were female (81%) and married (51%). Detailed characteristics of the nurses who completed the survey are shown in Table 1. Table 1: Characteristics of participants Variables f % Age 20-25 years 26-30 years 31-35 years >35 years 74 58 34 34 37 17 29 17 Gender Male. female 38.0 162 19 81 Marital status Married. Unmarried. 102 97.0 51.0 48.5 Professional qualification ANM. GNM. B.Sc (Nursing). M.Sc (Nursing). 10 93 89 8.0 5.00 46.0 44.5 4.00 Experience 6 months- 1 year. 1-2 years. 2-3 years. >3 years. 24 47 31 98 12.0 15.5 23.5 49.0 Hospital Private. Government 98.0 102 49 51 CNE/Workshop/conference in last 1 year Yes. No. 84.0 116 42 58 Journal publication in last 2 years Yes. No. 30.0 170 15 85 Subscription of nursing journal Yes. No. 26.0 174 13 87 Any advance course in nursing skills Yes. No. 48.0 152 24 76 Membership of professional organization Yes. No. 52.0 148 26 74 Assessment of sample adequacy and sphericity of compassion fatigue Scale Using the Kaiser-Meyer-Olkin test to assess sampling adequacy, a result of 0.84 was obtained, indicating that the sample size was sufficient to conduct factor analysis. The datasets were highly correlated according to Bartlett's test of sphericity (p=0.000), and the scale was deemed suitable for further psychometric evaluation by exploratory factor analysis (Table 2). Table 2:- Measure of Sampling Adequacy N=200 Kaiser-Meyer-Olkin measure of sampling Adequacy 0.843 Barlett’s Test of Sphericity Approx. Chi Square 2.302 Degree of freedom (df) 630 Sig 0.000 The extraction method was used to determine the total variance in the scale items. The principal component resulted in the extraction of ten factors with eigenvalues >1, and an examination of the scree plot also suggested the same ten primary factors. These ten factors explained 60.33 % of the variance. (Table 3) Table 3:- Extraction Method (Principal Component Analysis) Domains Initial Eigen values Extraction Sums of Squared Loadings Rotation Sums of Squared Loadings Total % of variance Cumulative % Total % of variance Cumulative % Total % of variance Cumulative 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 8.22 2.49 1.90 1.75 1.48 1.33 1.31 1.15 1.07 1.04 22.85 6.92 5.28 4.86 4.13 3.71 3.65 3.21 2.99 2.90 22.85 29.77 35.05 39.92 44.05 47.76 51.41 54.63 57.63 60.53 8.22 2.49 1.90 1.75 1.48 1.33 1.31 1.15 1.07 1.04 22.85 6.92 5.28 4.86 4.13 3.71 3.65 3.21 2.99 2.90 22.85 29.77 35.05 39.92 44.05 47.76 51.41 54.63 57.63 60.53 3.28 2.75 2.63 2.37 2.20 2.07 2.03 1.68 1.42 1.31 9.12 7.66 7.31 6.60 6.12 5.75 5.64 4.69 3.96 3.64 9.12 16.79 24.10 30.71 36.83 42.59 48.23 52.92 56.88 60.53 Convergent Validity A high convergent validity (r=.82) was determined by the score correlation of both measures. Cronbach's alpha was used to measure the preliminary scale's reliability (internal consistency) and was determined to be (p=.89). Reliability assessment The Cronbach’s alpha value of the NCFI was .94, and those of the six factors were .90, .90, .86, .87,and..61, and .80, respectively). Moreover, the test–retest ICC was .935, indicating acceptable stability of the NCFI. In addition, the SEM of NCFI is 7.8. The results are presented in Table 4. The analysis was conducted with a sample of 200 nurses. This study included all the items with a total correlation coefficient of > 0.4. The solution described in Table 4 is based on a principal component analysis. Domain I had six items linked to job satisfaction and burnout, with an individual variance of 22.85, factor loading range of 0.72 to 0.45, and domain reliability of.82. Domain II contained five work sensitivity items with a total variance of 6.92, factor loading range of 0.64 to 0.52, and domain reliability of.70. Domain III contained six work-related items with a total variance of 5.28, factor loading range of 0.66 to 0.48, and domain reliability of.76. Domain IV contained four items on intrusive thoughts, with a total variance of 4.86, factor loading range of 0.75 to 0.45, and domain reliability of.764. Domain V had four items pertaining to hopelessness, with a total variance of 4.13, a factor loading range of 0.64 to 0.42, and domain reliability of.77. Domain VI contained three items associated with worthlessness, with a total variance of 3.71, a factor loading range of 0.79 to 0.48, and domain reliability of.710. Domain VII contained three Overwhelming Thoughts items with a total variance of 3.65, factor loading range of 0.76 to 0.48, and domain reliability of.692. Domain VIII contained three compassion-related items with a total variance of 3.21, a factor loading range of 0.66 to 0.42, and a domain reliability of.79. Domains IX (Competency) and X (Productivity) each featured one item, factor loading range of 0.71 to 0.66 with a total variance of 2.99 and 2.90. (Table 4). Table 4:- Data Reduction Factor Analysis using Principal Component Analysis. Items Factor Loading Total variance explained Cronbach’s Alpha Domain I- Dissatisfaction and Burnout (Total no of items=6) I am dissatisfied with my job. 0.72 22.85 .82 I am dissatisfied with the nature of my work. 0.69 I feel tired while on working. 0.64 I am unhappy with my work. 0.57 I feel that I become very arrogant and harsh towards people since I took this job. 0.52 I feel that there is no one to talk about highly stressful experiences. 0.45 Domain II- Lack of Emotions and Sensitivity (Total no of items=5) I fail to perceive patient’s situation and feelings. 0.64 6.92 .705 I don’t take extra mile to help the patient. 0.62 I feel disconnected to my patients and co-workers. 0.53 I lack curiosity in learning new things. 0.52 I do not communicate my understandings to the client. 0.52 Domain III- Lack of Interest. (Total no of items=6) I do not feel interesting while handling new cases. 0.65 5.28 .764 I avoid spending time with patients. 0.59 I feel boring while working with some people I helped. 0.56 I feel depressed of caring critically ill patients on regular routine 0.52 I feel exhausted when I get up in morning and have to face another day on job. 0.50 I thought that I am experiencing a trauma of a person I care for. 0.48 Domain IV- Secondary stress (Total no of items=4) I feel like pre-occupied with person I helped. 0.75 4.86 .756 I feel like being in danger while caring traumatized patients 0.56 I get intrusive thoughts of terrible experiences of caring others. 0.52 I feel that I am not succeeding as a helper or caregiver. 0.45 Domain V- Hopelessness (Total no of items=4) I feel that I am not succeeding as a helper or caregiver. 0.64 4.13 .770 I feel very weak as a result of my job as a helper 0.56 I do not feel my failings as a part of human conditions. 0.54 I cannot seem to recover easily after facing daily troubling events 0.42 Domain VI- Worthlessness (Total no of items=3) I have a sense of worthlessness associated with my work. 0.79 3.71 .710 I really do not care about my patient. 0.59 I do not feel sincere while caring patients. 0.48 Domain VII- Overwhelming (Total no of items=3) I feel overwhelming while caring critically ill patients. 0.76 3.65 .7 My patient’s stress affects me deeply. 0.56 I experienced frightening dreams at night of those I helped in a day. 0.48 Domain VIII- Compassion (No of items=3) I feel more alive after working with those I help 0.66 3.21 .792 I am proud of what I can do to help others. 0.57 I feel compassionate towards my work 0.43 Domain IX- Competency(No of items=1) I find myself incompetent in my work 0.71 2.99 0.88(test retest) Domain X- Productivity (No of items=1) My productivity at work has been reduced 0.66 2.90 .91 (test retest) Total (10 Domains and 36 Items) 0.76 to 0.42 (Overall) 60.53 (Total Variance) 0.88(overall scale reliability) Inter Domain correlation The inter-domain correlation matrix of 10 extracted components of the Compassion Fatigue Assessment Scale was determined, where all the components of the scale were found to be correlated. (Table 5). Table 5:-Inter Domain correlation matrix of Compassion Fatigue Assessment Scale:- Domains Dissatisfaction and Burnout Lack of Emotions and Sensitivity Lack of Interest Intrusive thoughts Hopelessness Worthlessness Overwhelming Compassion Competency Productivity Dissatisfaction and Burnout 1 .475 ** .497 ** .329 ** .519 ** .299 ** .355 ** .048 .032 .295 ** Lack of Emotions and Sensitivity .475 ** 1 .580 ** .432 ** .555 ** .380 ** .375 ** .035 .034 .325 ** Lack of Interest. .497 ** .580 ** 1 .542 ** .599 ** .280 ** .458 ** .043 -.042 .233 ** Secondary stress .329 ** .432 ** .542 ** 1 .395 ** .129 .505 ** -.017 .029 .110 Hopelessness .519 ** .555 ** .599 ** .395 ** 1 .304 ** .400 ** -.028 -.006 .320 ** Worthlessness .299 ** .380 ** .280 ** .129 .304 ** 1 .101 -.017 .165 .391 ** Overwhelming .355 ** .375 ** .458 ** .505 ** .400 ** .101 1 -.064 -.025 .106 Compassion .048 .035 .043 -.017 -.028 -.017 -.064 1 -.009 .035 Competency .032 .034 -.042 .029 -.006 .165* -.025 -.009 1 .095 Productivity .295** .325** .233** .110 .320** .391** .106 .035 .095 1 **Correlation is significant at the level 0.01 level (2-tailed) *Correlation is significant at the 0.05 level (2-tailed) Inter Domain correlation The inter-domain correlation matrix of 10 extracted components of the Compassion Fatigue Assessment Scale was determined, where all the components of the scale were found to be correlated. (Table 5). Sensitivity and Specificity of Compassion Fatigue Assessment Scale Sensitivity and Specificity assess how positively and negatively participants react to compassion fatigue, respectively. A receiver operating characteristic curve was used to establish the sensitivity and specificity of the compassion fatigue assessment scale (Figure 1). The cut-off point of the scale was then determined. According to the receiver operating curve, 71.5 is the best cut-off point, with scale sensitivity and specificity of 0.7 and 0.38, respectively. DISCUSSION This study developed and validated a new Compassion Fatigue Assessment Scale (Annexure 1) for Indian nurses. The results revealed that the newly developed ten factors,36 - items of the CFAS have strong psychometric properties, including good construct validity and internal consistency (overall Cronbach’s α = 0. 88) and test-retest reliability (ICC = 0.901), making it a valid and reliable tool for assessing and monitoring compassion fatigue among nurses. The scale identified 10 domains associated with compassion fatigue: These ten factors “dissatisfaction and burnout”, “lack of emotions and sensitivity”, “lack of interest”, “secondary stress”, “hopelessness”, “worthlessness”, “overwhelming”, “compassion”, “competency” and “productivity” were accounted for 60.33% of the variance. The multidimensional structure of compassion fatigue observed in this study corroborates previous studies and existing compassion fatigue scales. The Compassion Fatigue Self-Test (CFST) was one of the first measures developed based on clinical experience to assess both compassion fatigue and job burnout. The scale has 40 items and was further developed to measure compassion satisfaction with the addition of 16 items. 38 , 39 Continued work on the scale has resulted in the development of the Professional Quality of Life Scale. The Professional Quality of Life Scale with three subscales namely “compassion satisfaction,” “burnout,” and “secondary traumatic stress” is one of the most widely used tools globally to measure compassion fatigue among nurses. 35 , 39 Burnout is a 21 - items self-report measure that assesses the level of an individual's physical, emotional, and mental exhaustion. Although the tool is useful for assessing general burnout, it does not address other critical aspects of compassion fatigue. 40 The newly developed CFAS has 10 domains(factors), and confirmatory factor analysis indicated excellent construct and cross-validation, which is in line with many other compassion fatigue scales. The scale was tailored to the unique stressors experienced by Indian nurses working in resource-limited settings. Furthermore, the culture of self-sacrifice, hierarchical nature of healthcare systems, demanding work schedules, and resource constraints specific to India might have influenced factors such as hopelessness and worthlessness. 41 Of all domains, Dissatisfaction and Burnout emerged as the strongest, with a variance of 22.85% and Cronbach’s α = 0.82. These findings align with previous research that highlights burnout as a significant contributor to compassion fatigue. 41 The domain “Lack of Emotions and Sensitivity”, with a variance of 6.92% (α = 0.705), reflects the emotional detachment nurses may develop due to prolonged exposure to challenging situations. Similar findings were noted in earlier studies, which emotional disconnection was reported as a key symptom of compassion fatigue and a mechanism adopted by nurses to work in high-stress environments, suggesting targeted interventions to improve emotional resilience and mitigate detachment. 26 , 42 , 43 Lack of interest a domain that accounted for 5.28% of the variance (α = 0.764) suggests apathy and reduced motivation of nurses in professional duties. This is consistent with earlier studies that have identified emotional numbing as a coping mechanism against traumatic exposure. 44 Secondary stress (variance = 4.86%, α = 0.756), a well-documented phenomenon in caregiving profession, has also emerged as a domain in the CFAS. Long duty hours, heavy workload, and lack of support are presumed to be some of the drivers of secondary traumatic stress among Indian nurses, as they work in resource-scarce settings. 19 Hopelessness and worthlessness have emerged as other significant domains highlighting how compassion fatigue erodes self-esteem and professional identity. 45 Feelings of being overwhelmed, identified in this study, corroborate earlier findings indicating that persistent stress and exposure to critical care settings significantly impact the mental health of professionals. 26 This domain underscores the need for system changes to reduce workloads and improve support systems. Paradoxical nurses were found to have a sense of deep care and empathy that coexisted with exhaustion. 26 A; a sense of incompetency and lack of productivity were also found among study participants who doubted their professional abilities. 13 , 45 The present study adheres to well-established processes in scale development, as indicated by professionals in the field. 46 , 47 The Compassion Fatigue Assessment Scale (CFAS) demonstrates robust psychometric properties, positioning it as a reliable and valid instrument for assessing compassion fatigue among Indian nurses. The overall Cronbach’s α of 0.88 for the CFAS highlights excellent internal consistency, with subscales ranging from 0.70 to 0.91, meeting the benchmarks particularly productivity and competency. Additionally, its test-retest reliability, as indicated by an Intra-class Correlation Coefficient of 0.901, confirmed the scale's stability over time. These findings align with, and in some cases surpass, existing scales, indicating excellent construct and cross-validation, which is in line with many other scales. 26 , 48 Strengths, Limitations and Recommendations The scale demonstrated excellent psychometric properties, including high internal consistency (Cronbach’s α = 0.88) and test-retest reliability (ICC = 0.901), indicating that the CFAS is reliable and stable over time. The identification of ten specific domains of compassion fatigue, some of which address the unique cultural and occupational stressors faced by Indian nurses, is another notable strength of this study. Although the researcher conducted extensive statistical analyses to build the scale, the following constraints were unavoidable during the course of the study. The use of a convenience sampling method may have introduced selection bias, limiting the representativeness of the sample to nurses in other healthcare settings or regions. Although the scale demonstrated convergent validity with the Professional Quality of Life Scale (ProQOL), the study did not assess criterion validity, which could have further strengthened its psychometric evaluation. Another limitation is the lack of linguistic validation of the scale for use in non-English-speaking or multilingual populations, which may limit its applicability to the diverse linguistic groups in India. Implications for practice This newly developed and tested Compassion Fatigue Assessment Scale (CFAS) is a reliable and valid tool for measuring compassion fatigue among Indian nurses. This scale can be used to accurately measure and identify compassion fatigue among nurses, thereby allowing timely intervention and support to increase their resilience and well-being. Targeted programs and resources should be implemented to prevent burnout by identifying nurses at risk. is reliable and culturally tailored. This scale can also be used to monitor or evaluate the effectiveness of interventions aimed at improving nurses’ health and wellbeing. Conclusion The Compassion Fatigue Assessment Scale is a psychometrically robust scale for assessing compassion fatigue among nurses in the Indian context. Future research should focus on validating this scale in diverse populations and exploring its predictive validity in various contexts. Ethical considerations The study protocol was approved by the research and ethics committee of the institution where the study was conducted. Permission was obtained from the administrators of the selected hospitals where data were collected. Informed consent was obtained from all the nurses after explaining the purpose, nature, and duration of the study. Privacy of information, anonymity, and confidentiality of data were assured to the participants before data collection. They were informed of the voluntary nature of the study and were given the right to withdraw at any time they wished to. Declarations Human Ethics and Consent to Participate The study protocol was approved by the research and ethics committee of the Saraswati professional & higher education (SPHE) College of Nursing. The study followed all the guidelines given by the Declaration of Helsinki and applicable review boards. Consent for publication Not applicable Availability of data and materials The datasets generated and/or analysed during the current study are available within the manuscript. Competing interests None Funding None Author contributions SS : Conceptualization, project administration, data curation and data interpretation, intellectual content development, and drafting of the manuscript; BP- Conceptualization, project administration, data curation and data interpretation, intellectual content development and supervision.; RKR and PB : Study design, data interpretation, intellectual content development, drafting of the manuscript and supervision ; HK: Conceptualization, data collection and project administration. All authors contributed to the revision and finalization of the manuscript Acknowledgements The authors appreciate the important contributions of study participants. Conflicts of interest There are no conflicts of interest Clinical Trial Number Not applicable References Mental Health at Work: Policy Brief . Lau K, Aldridge R, Norredam M, Mkoma GF, Kugan M, Lin RC-Y, Kiss L, Zimmerman C, Hargreaves S. 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Development and Psychometric Evaluation of the Nurses’ Compassion Fatigue Inventory. J Nurs Meas. 2017;25(3):E185–201. https://doi.org/10.1891/1061-3749.25.3.E185 . Ryu IS, Shim JL. The Relationship between Compassion Satisfaction and Fatigue with Shift Nurses’ Patient Safety-Related Activities. Iran J Public Health. 2022. https://doi.org/10.18502/ijph.v51i12.11463 . Aslan H, Erci B, Pekince H. Relationship Between Compassion Fatigue in Nurses, and Work-Related Stress and the Meaning of Life. J Relig Health. 2022;61(3):1848–60. https://doi.org/10.1007/s10943-020-01142-0 . Carranza Esteban RF, Mamani-Benito O, Turpo Chaparro JE, Chávez Sosa JV, Lingan SK. The Design and Validation of a Compassion Fatigue Scale in Peruvian Nurses. Int J Environ Res Public Health. 2023;20(12). https://doi.org/10.3390/ijerph20126147 . Borges EM, das N, Fonseca CIN da, Baptista S, Queirós PCP, Baldonedo-Mosteiro CML, Mosteiro-Diaz M. M. P. Fadiga Por Compaixão Em Enfermeiros de Urgência e Emergência Hospitalar de Adultos. Revista Latino-Americana de Enfermagem 2019, 27 . https://doi.org/10.1590/1518-8345.2973.3175 . Sun B, Hu M, Yu S, Jiang Y, Lou B. Validation of the Compassion Fatigue Short Scale among Chinese Medical Workers and Firefighters: A Cross-Sectional Study. BMJ Open. 2016;6(6):e011279. https://doi.org/10.1136/bmjopen-2016-011279 . Yıldırım S, Cavcav F. The Compassion Fatigue-Short Scale for Healthcare Professionals: A Turkish Study of Validity and Reliability. Perspect Psychiatr Care. 2021;57(3):1459–65. https://doi.org/10.1111/ppc.12712 . Sun X, Fan X, Cong S, Wang R, Sha L, Xie H, Han J, Zhu Z, Zhang A. Psychological Birth Trauma: A Concept Analysis. Frontiers in Psychology 2023, 13 . https://doi.org/10.3389/fpsyg.2022.1065612 Park SH, Choi MY. Development and Validation of the Nursing Students’ Rights Awareness Scale in Clinical Practice: A Scale Development Study. Healthcare (Switzerland) 2021, 9 (10). https://doi.org/10.3390/healthcare9101323 Broder HL, McGrath C, Cisneros GJ. Questionnaire Development: Face Validity and Item Impact Testing of the Child Oral Health Impact Profile. Commun Dent Oral Epidemiol. 2007;35(s1):8–19. https://doi.org/10.1111/j.1600-0528.2007.00401.x . Ayre C, Scally AJ. Critical Values for Lawshe’s Content Validity Ratio. Meas Evaluation Couns Dev. 2014;47(1):79–86. https://doi.org/10.1177/0748175613513808 . LAWSHE CH, A QUANTITATIVE APPROACH TO, CONTENT VALIDITY 1. Pers Psychol. 1975;28(4):563–75. https://doi.org/10.1111/j.1744-6570.1975.tb01393.x . Hyrkäs K, Appelqvist-Schmidlechner K, Oksa L. Validating an Instrument for Clinical Supervision Using an Expert Panel. Int J Nurs Stud. 2003;40(6):619–25. https://doi.org/10.1016/S0020-7489(03)00036-1 . Polit DF, Beck CT, Owen SV. Is the CVI an Acceptable Indicator of Content Validity? Appraisal and Recommendations. Res Nurs Health. 2007;30(4):459–67. https://doi.org/10.1002/nur.20199 . Bahari G, Asiri K, Nouh N, Alqahtani N. Professional Quality of Life Among Nurses: Compassion Satisfaction, Burnout, and Secondary Traumatic Stress: A Multisite Study. SAGE Open Nursing 2022, 8 . https://doi.org/10.1177/23779608221112329 . Taber KS. The Use of Cronbach’s Alpha When Developing and Reporting Research Instruments in Science Education. Res Sci Educ. 2018;48(6):1273–96. https://doi.org/10.1007/s11165-016-9602-2 . Koo TK, Li MY. A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. J Chiropr Med. 2016;15(2):155–63. https://doi.org/10.1016/j.jcm.2016.02.012 . Figley CR. Compassion Fatigue. Routledge; 2013. Stamm BH, Rudolph JM, Varra EM, Davis K, Larsen D, Higson-Smith C, Hudnall AC, Stamm HE. The ProQOL Manual 1 The ProQOL Manual THE PROFESSIONAL QUALITY OF LIFE SCALE: Compassion Satisfaction, Burnout & Compassion Fatigue/Secondary Trauma Scales The ProQOL Manual 2 Acknowledgements for Their Faithful Contributions to the Development of the ProQOL Go To . Malach-Pines A. The Burnout Measure, Short Version. Int J Stress Manage. 2005;12(1):78–88. https://doi.org/10.1037/1072-5245.12.1.78 . Lluch C, Galiana L, Doménech P, Sansó N. The Impact of the COVID-19 Pandemic on Burnout, Compassion Fatigue, and Compassion Satisfaction in Healthcare Personnel: A Systematic Review of the Literature Published during the First Year of the Pandemic. Healthcare. 2022;10(2):364. https://doi.org/10.3390/healthcare10020364 . Sinclair S, Raffin-Bouchal S, Venturato L, Mijovic-Kondejewski J, Smith-MacDonald L. Compassion Fatigue: A Meta-Narrative Review of the Healthcare Literature. Int J Nurs Stud. 2017;69:9–24. https://doi.org/10.1016/j.ijnurstu.2017.01.003 . Galiana L, Arena F, Oliver A, Sansó N, Benito EC, Satisfaction. Compassion Fatigue, and Burnout in Spain and Brazil: ProQOL Validation and Cross-Cultural Diagnosis. J Pain Symptom Manag. 2017;53(3):598–604. https://doi.org/10.1016/j.jpainsymman.2016.09.014 . Jenzer T, Meisel SN, Blayney JA, Colder CR, Read JP. Reciprocal Processes in Trauma and Coping: Bidirectional Effects over a Four-Year Period. Psychol Trauma: Theory Res Pract Policy. 2020;12(2):207–18. https://doi.org/10.1037/tra0000500 . Gustafsson T, Hemberg J. Compassion Fatigue as Bruises in the Soul: A Qualitative Study on Nurses. Nurs Ethics. 2022;29(1):157–70. https://doi.org/10.1177/09697330211003215 . Streiner DL, Norman GR. Health Measurement Scales. Oxford University Press; 2008. Streiner DL, Norman GR, Cairney J. Health Measurement Scales. Volume 1. Oxford University Press; 2015. Hinkin TR, Tracey JB, Enz CA. Scale Construction: Developing Reliable and Valid Measurement Instruments. J Hospitality Tourism Res. 1997;21(1):100–20. https://doi.org/10.1177/109634809702100108 . Additional Declarations No competing interests reported. Supplementary Files CompassionfatigueassessmentscaleAnnexure1.docx Cite Share Download PDF Status: Published Journal Publication published 12 Aug, 2025 Read the published version in BMC Nursing → Version 1 posted Editorial decision: Revision requested 16 Jun, 2025 Reviews received at journal 14 Jun, 2025 Reviews received at journal 05 Jun, 2025 Reviewers agreed at journal 02 Jun, 2025 Reviewers agreed at journal 01 Jun, 2025 Reviewers invited by journal 28 May, 2025 Editor invited by journal 20 May, 2025 Editor assigned by journal 16 May, 2025 Submission checks completed at journal 16 May, 2025 First submitted to journal 06 May, 2025 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. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6602941","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":463355071,"identity":"2773c8eb-5b42-4179-84f8-2dc6fef63f70","order_by":0,"name":"Shifali Sharma","email":"","orcid":"","institution":"Dr. Rajendra Prasad Government Medical College","correspondingAuthor":false,"prefix":"","firstName":"Shifali","middleName":"","lastName":"Sharma","suffix":""},{"id":463355072,"identity":"4e488162-ee63-40cc-89d4-b1fe3a82bb6b","order_by":1,"name":"Bharat Pareek","email":"","orcid":"","institution":"Saraswati Professional and Higher Education College of Nursing, Ghauruan","correspondingAuthor":false,"prefix":"","firstName":"Bharat","middleName":"","lastName":"Pareek","suffix":""},{"id":463355073,"identity":"6400a36e-689e-47f4-a5ba-7bec0b5ece82","order_by":2,"name":"Harpreet Kaur","email":"","orcid":"","institution":"MM University","correspondingAuthor":false,"prefix":"","firstName":"Harpreet","middleName":"","lastName":"Kaur","suffix":""},{"id":463355074,"identity":"7ce9cb7d-82a8-433c-b728-962222f45ecb","order_by":3,"name":"Priya Baby","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwElEQVRIiWNgGAWjYFACxgYGBgMbORDzwAPitRSkGYO1JBBv04fDiQ0gmigt5tKHGz/dMDicPj/s8EOgLXZyug0EtFj2JTZL5xik5268nWYA1JJsbHaAgBaDM4wNQC3WuRtnJ4C0HEjcRoSW5t85BszphrPTPxCtpQ1oi3OCPJAkTotlD2ObdY5BmuEG6ZyCAwkGRPjFnIf98e2cPzby8rPTN3/4UGEnR9j7cMYBFC4xWuQbiFA9CkbBKBgFIxMAAO6QRaNmCJe2AAAAAElFTkSuQmCC","orcid":"","institution":"National Institute of Mental Health and 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1","display":"","copyAsset":false,"role":"figure","size":39940,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eReceiver Operating Curve\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6602941/v1/fd861d688e613bbd66fa3412.jpg"},{"id":89310462,"identity":"980c5057-6272-4c3a-b23f-157019b4b312","added_by":"auto","created_at":"2025-08-18 16:00:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1759179,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6602941/v1/d4ef8ff5-f7e9-4b90-9b57-7bcc24ca2373.pdf"},{"id":83623030,"identity":"38cde7d0-d0b0-4712-92cf-ce6382b674bf","added_by":"auto","created_at":"2025-05-29 15:51:49","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":23717,"visible":true,"origin":"","legend":"","description":"","filename":"CompassionfatigueassessmentscaleAnnexure1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6602941/v1/fae10134b245feb0ea91a225.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Development and psychometric properties of the Compassion Fatigue Assessment Scale for Indian Nurses","fulltext":[{"header":"Key points for policy, practice and further research","content":"\u003cul\u003e\n \u003cli\u003eThe newly developed Compassion Fatigue Assessment Scale (CFAS) can be used to identify at-risk nurses and inform targeted intervention.\u003c/li\u003e\n \u003cli\u003eImplementing targeted programs to prevent burnout by identifying at-risk nurses using the newly developed Compassion Fatigue Assessment.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eThis study highlights the need to address systemic issues contributing to secondary traumatic stress, such as long duty hours, heavy workload, and lack of support, particularly in resource-scarce settings.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eIntegrate regular assessments of compassion fatigue using CFAS into organizational policies to monitor and support nurses\u0026apos; well-being.\u003c/li\u003e\n \u003cli\u003eFurther research should be conducted to validate CFAS in diverse populations and healthcare settings across India to ensure its broader applicability.\u003c/li\u003e\n \u003cli\u003eExplore the predictive validity of the CFAS in various contexts, such as its ability to predict turnover intentions or quality of patient care.\u003c/li\u003e\n \u003cli\u003eInvestigate the effectiveness of interventions designed to reduce compassion fatigue using the CFAS as a measurement tool.\u003c/li\u003e\n \u003cli\u003eConsider the linguistic validation of the CFAS for use in non-English-speaking or multilingual populations to enhance its applicability across diverse linguistic groups in India.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"BACKGROUND","content":"\u003cp\u003eWith organizations and administrators following a less traditional hierarchy or structure, the workplace is becoming increasingly complex and difficult. The World Health Organization (WHO) and international Labour organizations (ILO) joint policy urges governments, employers, workers, and their organizations in the public and private sectors to devise and implement strategies to address the mental health and well-being of people at work.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e According to the ILO estimates, the mortality and disease burden caused by unquantifiable risk are greater than those caused by quantifiable risk. Workers in low- and middle-income countries experience a disproportionately higher share of deaths and disabilities caused by workplace exposure to various risk factors than do those in high-income countries.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eHealthcare professionals, including doctors, nurses, and other medical staff, face a unique set of challenges that distinguishes them from many others\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Healthcare workers have long been recognized as a particularly vulnerable group when they experience burnout, stress, and psychological distress.\u003csup\u003e\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e–\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e One key factor contributing to the heightened prevalence of these issues among healthcare workers is the intense workload and high-pressure environment in which they have been operating for decades.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Numerous studies have documented the significant challenges faced by healthcare workers, including staff shortages, long work shifts, prolonged use of personal protective equipment, insufficient supplies, rapidly changing guidelines, the risk of infecting loved ones, and lack of adequate training and psychosocial support.\u003csup\u003e\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e–\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e This trend has been exacerbated only by the recent COVID-19 pandemic, which has placed considerable psychological strain on those working in the healthcare field.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eCompassion fatigue, a pervasive issue in the healthcare industry, has emerged as a significant contributor to the alarming rates of burnout, psychological distress, and diminished physical and mental health among healthcare workers, particularly nurses.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e–\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e There is growing evidence that nurses are disproportionately affected in this regard compared to other health professionals.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e This could be because nurses are involved in direct care and are required to empathize with other people as compared to their counterparts, particularly when they are suffering.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e They are uniquely susceptible to compassion fatigue due to their continuous exposure to the emotional and traumatic experiences of their patients,\u003csup\u003e\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e–\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e as they strive to provide empathetic and compassionate care, the cumulative stress and emotional burden can take a profound toll, leading to a range of negative outcomes.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eNumerous detrimental physical, psychological, cognitive, and social effects have been linked to compassion fatigue, including decreased productivity, increased absenteeism, low job satisfaction, burnout, impaired professional judgment, and increased medical errors. These effects ultimately result in unsafe and subpar patient care, poor patient outcomes, higher hospitalized patient mortality and morbidity, and an overall negative impact on healthcare organizations' performance.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e Most healthcare workers enter the profession because they have passion to help others. Compassion fatigue has also been identified as a “negative consequence and cost of caring that is capable of removing nurses’ compassionate caring forever”.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAs direct care providers, nurses face challenges in dealing with the complex demands of overly strained health systems. Compassion fatigue affect all nurses. Hence, interventions are necessary to promote and preserve the health and well-being of healthcare workers, especially nurses, by making healthcare organizations healthier and safer places work for nurses, and ultimately for all. Even though, it is imperative that administrators and healthcare organizations should monitor compassion fatigue among nurses, there is no universally accepted and agreed upon definition of compassion fatigue. The scales developed to measure compassion fatigue in nurses in other countries is inadequate to measure the same among Indian nurses owing to several reasons. Indian nurses operate in a different setting due to cultural differences, variations in healthcare scenarios, and many professional problems which are unique to this setting. In this context, the investigators decided to develop a new instrument to measure compassion fatigue among nurses\u003c/p\u003e\n\u003ch3\u003ePurpose\u003c/h3\u003e\n\u003cp\u003eThis study aimed to develop and examine the psychometric properties of a compassion fatigue assessment scale (CFAS)for nurses.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003c/div\u003e \u003c/div\u003e\n\n\n\n \n\n\n\n "},{"header":"METHODS","content":"\u003ch2\u003eResearch design\u003c/h2\u003e\u003cp\u003eThis methodological study used a quantitative approach and cross-sectional survey design.\u003c/p\u003e\u003cp\u003eThe study was done in two phases.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003ch3\u003ePhase 1: Conceptualization and Item Generation\u003c/h3\u003e\u003cp\u003eThe investigators conducted an extensive review of the literature published in major electronic databases for compassion fatigue and compassion fatigue measurement tools to conceptually define the construct.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan additionalcitationids=\"CR25 CR26\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e–\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e,,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e Semi-structured interviews were conducted with a sample of 15 nurses recruited through a maximum variation sample (gender, years of work experience, and working in different levels of care) to further explore the concepts and experiences related to compassion fatigue. Based on this, an initial set of items was selected to measure compassion fatigue among nurses.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003ch3\u003ePhase 2: Psychometric evaluation\u003c/h3\u003e\u003ch2\u003eFace validity\u003c/h2\u003e\u003cp\u003eThe face Validity of CFAS was assessed by asking a group of ten nurses to evaluate the scale for clarity, importance, and comprehensiveness on a five-point Likert scale. They were also asked to identify and resolve any ambiguities in their statements. Later, they were asked to evaluate the importance of each item using a 5-point Likert-type scale (5 = \u003cem\u003ecompletely important\u003c/em\u003e and I = \u003cem\u003enot important)\u003c/em\u003e. An impact score greater than 1.5 was considered appropriate. Finally, the items were edited for language and grammar by investigators and experts.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003ch2\u003eContent Validity Assessment\u003c/h2\u003e\u003cp\u003eThe content validity of the instrument was ensured by calculating the Content Validity Ratio (CVR) and Content Validity Index (CVI). A team of nine experts rated the relevance of each item using a three-point Likert scale. Items with a Content Validity Ratio (CVR) of less than 0.78. were excluded (21,31,32).\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e,\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e To calculate the CVI, ten experts (from the fields of nursing, instrument development, physicians, and psychologists) were invited to determine the relevance of the items on a three-point Likert scale. The item-level content validity index (I-CVI) and scale-level content validity index (S-CVI) content validity indices were calculated. Items with an I-CVI of 0.79 or more, 0.70–0.79, and less than 0.69 were respectively included, revised, and excluded, respectively, and S-CVI values greater than 0.90 were considered acceptable.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e,\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003ch3\u003eConstruct validity\u003c/h3\u003e\u003cp\u003eConstruct validity was ensured using exploratory factor analysis (EFA). The factor structure of the questionnaire was retrieved using varimax rotation and a principal component factor analysis. The Kaiser-Meyer-Olkin (KMO) test was used to ensure further sampling adequacy, while Bartlett's test of sphericity was used to evaluate the suitability of the analytic model. A minimum factor loading value of 0.40 was used to maintain the items in the extracted factors, whereas the scree plot and eigenvalues greater than 1 were used to determine the number of NCFI factors.\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003ch3\u003eSetting and Sample\u003c/h3\u003e\u003cp\u003eData collection was done between February and June 2022 from all the eligible nurses working in the 4 hospitals conveniently selected from the (two government and two private) Northern part of India. All the hospitals selected for the study were multi-specialty referral hospitals with a bed strength of more than 150.\u003c/p\u003e\u003cp\u003eConvenience sampling was used to recruit the participants. All nurses registered under the Punjab Nurses and Registration Council, aged 21 years and above, and working full-time in the selected hospitals in the past year were invited to participate in the study. Nurses who were ill in the past 3 months and who were not willing to participate were excluded. The sample size was estimated based on the recommendations for calculating the sample size for scale development and validation. Assuming data loss and other factors, the final sample size was set at 200. All eligible nurses were invited to participate in this study. The data collection was terminated when the desired sample size was achieved.\u003c/p\u003e\u003ch2\u003eConvergent validity\u003c/h2\u003e\u003cp\u003eThe convergent validity of the scale was determined by administering a compassion fatigue scale along with the previously validated “Professional Quality of Life” scale to nurses.\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e Pearson’s correlation analysis was performed to examine the correlation between the scores on the two scales.\u003c/p\u003e\u003ch2\u003eReliability Assessment\u003c/h2\u003e\u003cp\u003eThe reliability of the scale was assessed using the internal consistency and temporal stability assessment techniques. The results of the internal consistency assessment are reported as Cronbach’s alpha. An alpha of greater than 0.70 was considered as acceptable internal consistency.\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e Moreover, stability assessment was performed using the test–retest technique, in which 30 nurses completed the CFAS twice with a 2-week interval. The correlation between the test and retest scores was examined using the intra-class correlation coefficient (ICC). ICCs greater than 0.75 were considered acceptable. Item analysis was performed to calculate correlations between the items and the scale.\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e The correlation of each item with the scale should be high, and the correlation of the items with each other should be low. Items were removed when the correlation coefficient of an item with the scale was less than 0.30 or when the correlation coefficient of two items was greater than 0.70.\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003ch2\u003eData collection\u003c/h2\u003e\u003cp\u003eA self-administered questionnaire with three sections was used to collect data to test the construct validity and reliability. The first section contained six sociodemographic items used to gather information regarding age. The second part contains the newly developed 32 items CFAS. The third section included the reliable and validated “professional QOL.\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003ch2\u003eEthical considerations\u003c/h2\u003e\u003cp\u003e The study protocol was approved by the research and ethics committee of the institution where the study was conducted. Permission was obtained from the administrators of the selected hospitals where data were collected. Written informed consent was obtained from all the nurses after explaining the purpose, nature, and duration of the study. Privacy of information, anonymity, and confidentiality of data were assured to the participants before data collection. They were informed of the voluntary nature of the study and were given the right to withdraw at any time they wished to.\u003c/p\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eThe Statistical Package for the Social Sciences (SPSS) version 24 was used to analyze the data acquired from the participants. Frequencies, percentages, means, and standard deviations were used to describe variables. A two-sided p 0.05 was used to establish statistical significance. The level of significance was set at p \u0026lt; 0.05.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003ePhase 1\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInitially, the pool contained 83 items, and at the end of phase one 42 items were extracted based on the literature review, expert opinion, and focus group discussion.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhase 2: Psychometric analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFace Validity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSix items were modified to improve clarity during the qualitative assessment of the face validity. In the quantitative face validity assessment, seven items obtained an impact score of less than 1.5, of which four were removed and three were retained by the investigators after modifications. Finally, the scale contained 38 items, which were edited and reworded for language and grammar by experts.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContent validity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this step, two items with a CVR of less than 0.78 were excluded. Two items with an I-CVI of 0.70\u0026ndash;0.79 were revised. In contrast, the S-CVI was 0.90. At the end of this step, the NCFI contained 36 items.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConstruct validity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of hundred nurses participated in the survey (response rate: 92.8%). Most of them were female (81%) and married (51%). Detailed characteristics of the nurses who completed the survey are shown in Table 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Characteristics of participants\u003c/strong\u003e\u003c/p\u003e\n\u003ctable style=\"width:90.94%;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.24%;border: 1pt solid black;padding: 0in;height: 16.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:.4pt;text-align:center;line-height:15.05pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003eVariables\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.02%;border-top: 1pt solid black;border-right: 1pt solid black;border-bottom: 1pt solid black;border-image: initial;border-left: none;padding: 0in;height: 16.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:.35pt;text-align:center;line-height:15.05pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003ef\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.72%;border-top: 1pt solid black;border-right: 1pt solid black;border-bottom: 1pt solid black;border-image: initial;border-left: none;padding: 0in;height: 16.05pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:15.8pt;text-align:left;line-height:15.05pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003e%\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.24%;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in;height: 71.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:11.4pt;text-align:left;line-height:13.5pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003eAge\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003col style=\"margin-bottom:0in;list-style-type: lower-alpha;margin-left: 31.35px;\"\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e20-25\u0026nbsp;years\u003c/span\u003e\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e26-30\u0026nbsp;years\u003c/span\u003e\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e31-35\u0026nbsp;years\u003c/span\u003e\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026gt;35\u0026nbsp;years\u003c/span\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/div\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.02%;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in;height: 71.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:1.95pt;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.3pt;text-align:left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e74\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.3pt;text-align:left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e58\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:.05pt;margin-right:0in;margin-bottom:.0001pt;margin-left:5.3pt;text-align:left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e34\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.3pt;text-align:left;line-height:13.2pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e34\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.72%;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in;height: 71.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:13.35pt;margin-right: 0in;margin-bottom:.0001pt;margin-left:5.35pt;text-align: left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e37\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.35pt;text-align:left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e17\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.35pt;text-align:left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e29\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:.05pt;margin-right:0in;margin-bottom:.0001pt;margin-left:5.35pt;text-align:left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e17\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.24%;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in;height: 43.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:8.4pt;text-align:left;line-height:13.5pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003eGender\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003col style=\"margin-bottom:0in;list-style-type: lower-alpha;margin-left: 31.35px;\"\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003eMale.\u003c/span\u003e\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003efemale\u003c/span\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/div\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.02%;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in;height: 43.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:1.85pt;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:.05pt;margin-right:0in;margin-bottom:.0001pt;margin-left:5.3pt;text-align:left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e38.0\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.3pt;text-align:left;line-height:13.2pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e162\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.72%;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in;height: 43.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:1.85pt;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:.05pt;margin-right:0in;margin-bottom:.0001pt;margin-left:5.35pt;text-align:left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e19\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.35pt;text-align:left;line-height:13.2pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e81\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.24%;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in;height: 54.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:11.4pt;text-align:left;line-height:13.5pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003eMarital\u0026nbsp;status\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003col style=\"margin-bottom:0in;list-style-type: lower-alpha;margin-left: 31.35px;\"\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003eMarried.\u003c/span\u003e\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003eUnmarried.\u003c/span\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/div\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.02%;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in;height: 54.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:13.35pt;margin-right: 0in;margin-bottom:.0001pt;margin-left:5.3pt;text-align: left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e102\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.3pt;text-align:left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e97.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.72%;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in;height: 54.8pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:13.35pt;margin-right: 0in;margin-bottom:.0001pt;margin-left:5.35pt;text-align: left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e51.0\u003c/span\u003e\u003c/p\u003e\n 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style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003col style=\"margin-bottom:0in;list-style-type: lower-alpha;margin-left: 31.35px;\"\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003eANM.\u003c/span\u003e\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003eGNM.\u003c/span\u003e\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003eB.Sc\u0026nbsp;(Nursing).\u003c/span\u003e\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003eM.Sc\u0026nbsp;(Nursing).\u003c/span\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/div\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.02%;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in;height: 71.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:1.85pt;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.3pt;text-align:left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e10\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.3pt;text-align:left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e93\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.3pt;text-align:left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e89\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.3pt;text-align:left;line-height:13.2pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e8.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.72%;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in;height: 71.25pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:1.85pt;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.35pt;text-align:left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e5.00\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.35pt;text-align:left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e46.0\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.35pt;text-align:left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e44.5\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.35pt;text-align:left;line-height:13.2pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e4.00\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.24%;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in;height: 69pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.4pt;text-align:left;line-height:13.5pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003eExperience\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003col style=\"margin-bottom:0in;list-style-type: lower-alpha;margin-left: 31.35px;\"\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e6\u0026nbsp;months-\u0026nbsp;1\u0026nbsp;year.\u003c/span\u003e\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e1-2\u0026nbsp;years.\u003c/span\u003e\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e2-3\u0026nbsp;years.\u003c/span\u003e\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e\u0026gt;3\u0026nbsp;years.\u003c/span\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/div\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.02%;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in;height: 69pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:13.35pt;margin-right: 0in;margin-bottom:.0001pt;margin-left:5.3pt;text-align: left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e24\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.3pt;text-align:left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e47\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:.05pt;margin-right:0in;margin-bottom:.0001pt;margin-left:5.3pt;text-align:left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e31\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.3pt;text-align:left;line-height:13.2pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e98\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.72%;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in;height: 69pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:13.35pt;margin-right: 0in;margin-bottom:.0001pt;margin-left:5.35pt;text-align: left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e12.0\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.35pt;text-align:left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e15.5\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:.05pt;margin-right:0in;margin-bottom:.0001pt;margin-left:5.35pt;text-align:left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e23.5\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.35pt;text-align:left;line-height:13.2pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e49.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.24%;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in;height: 41.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.4pt;text-align:left;line-height:13.5pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003eHospital\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n 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Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e98.0\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.3pt;text-align:left;line-height:13.2pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e102\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.72%;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in;height: 41.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:13.35pt;margin-right: 0in;margin-bottom:.0001pt;margin-left:5.35pt;text-align: left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e49\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.35pt;text-align:left;line-height:13.2pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e51\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.24%;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in;height: 41.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.4pt;text-align:left;line-height:13.65pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003eCNE/Workshop/conference\u0026nbsp;in last\u0026nbsp;1 year\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003col style=\"margin-bottom:0in;list-style-type: lower-alpha;margin-left: 31.35px;\"\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003eYes.\u003c/span\u003e\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003eNo.\u003c/span\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/div\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.02%;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in;height: 41.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:13.5pt;margin-right: 0in;margin-bottom:.0001pt;margin-left:5.3pt;text-align: left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e84.0\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.3pt;text-align:left;line-height:13.2pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e116\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.72%;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in;height: 41.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:13.5pt;margin-right: 0in;margin-bottom:.0001pt;margin-left:5.35pt;text-align: left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e42\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.35pt;text-align:left;line-height:13.2pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e58\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.24%;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in;height: 41.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.4pt;text-align:left;line-height:13.5pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003eJournal\u0026nbsp;publication\u0026nbsp;in\u0026nbsp;last\u0026nbsp;2 years\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003col style=\"margin-bottom:0in;list-style-type: lower-alpha;margin-left: 31.35px;\"\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003eYes.\u003c/span\u003e\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003eNo.\u003c/span\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/div\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.02%;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in;height: 41.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:13.35pt;margin-right: 0in;margin-bottom:.0001pt;margin-left:5.3pt;text-align: left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e30.0\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.3pt;text-align:left;line-height:13.2pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e170\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.72%;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in;height: 41.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:13.35pt;margin-right: 0in;margin-bottom:.0001pt;margin-left:5.35pt;text-align: left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e15\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.35pt;text-align:left;line-height:13.2pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e85\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.24%;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in;height: 41.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.4pt;text-align:left;line-height:13.5pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003eSubscription\u0026nbsp;of\u0026nbsp;nursing journal\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003col style=\"margin-bottom:0in;list-style-type: lower-alpha;margin-left: 31.35px;\"\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003eYes.\u003c/span\u003e\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003eNo.\u003c/span\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/div\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.02%;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in;height: 41.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:13.35pt;margin-right: 0in;margin-bottom:.0001pt;margin-left:5.3pt;text-align: left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e26.0\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:.05pt;margin-right:0in;margin-bottom:.0001pt;margin-left:5.3pt;text-align:left;line-height:13.2pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e174\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.72%;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in;height: 41.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:13.35pt;margin-right: 0in;margin-bottom:.0001pt;margin-left:5.35pt;text-align: left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e13\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:.05pt;margin-right:0in;margin-bottom:.0001pt;margin-left:5.35pt;text-align:left;line-height:13.2pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e87\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.24%;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in;height: 41.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.4pt;text-align:left;line-height:13.5pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003eAny\u0026nbsp;advance\u0026nbsp;course\u0026nbsp;in\u0026nbsp;nursing skills\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003col style=\"margin-bottom:0in;list-style-type: lower-alpha;margin-left: 31.35px;\"\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003eYes.\u003c/span\u003e\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003eNo.\u003c/span\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/div\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.02%;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in;height: 41.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:13.35pt;margin-right: 0in;margin-bottom:.0001pt;margin-left:5.3pt;text-align: left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e48.0\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.3pt;text-align:left;line-height:13.2pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e152\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.72%;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in;height: 41.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:13.35pt;margin-right: 0in;margin-bottom:.0001pt;margin-left:5.35pt;text-align: left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e24\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.35pt;text-align:left;line-height:13.2pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e76\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.24%;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in;height: 41.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.4pt;text-align:left;line-height:13.5pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:16px;\"\u003eMembership\u0026nbsp;of\u0026nbsp;professional\u0026nbsp;organization\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cdiv style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003col style=\"margin-bottom:0in;list-style-type: lower-alpha;margin-left: 31.35px;\"\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003eYes.\u003c/span\u003e\u003c/li\u003e\n \u003cli style='margin-top:0in;margin-right:0in;margin-bottom:10.0pt;margin-left:0in;line-height:115%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003eNo.\u003c/span\u003e\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/div\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.02%;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in;height: 41.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:13.35pt;margin-right: 0in;margin-bottom:.0001pt;margin-left:5.3pt;text-align: left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e52.0\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.3pt;text-align:left;line-height:13.2pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e148\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.72%;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in;height: 41.35pt;vertical-align: top;\"\u003e\n \u003cp style='margin-top:13.35pt;margin-right: 0in;margin-bottom:.0001pt;margin-left:5.35pt;text-align: left;line-height:normal;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e26\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0in;margin-right:0in;margin-bottom:.0001pt;margin-left:5.35pt;text-align:left;line-height:13.2pt;font-size:15px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:16px;\"\u003e74\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAssessment of sample adequacy and sphericity of compassion fatigue Scale\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUsing the Kaiser-Meyer-Olkin test to assess sampling adequacy, a result of 0.84 was obtained, indicating that the sample size was sufficient to conduct factor analysis. The datasets were highly correlated according to Bartlett\u0026apos;s test of sphericity (p=0.000), and the scale was deemed suitable for further psychometric evaluation by exploratory factor analysis (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:- Measure of Sampling Adequacy N=200\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 398px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKaiser-Meyer-Olkin measure of sampling Adequacy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e0.843\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 219px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eBarlett\u0026rsquo;s Test of Sphericity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eApprox. Chi Square\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e2.302\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eDegree of freedom (df)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e630\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSig\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe extraction method was used to determine the total variance in the scale items. The principal component resulted in the extraction of ten factors with eigenvalues \u0026gt;1, and an examination of the scree plot also suggested the same ten primary factors. These ten factors explained 60.33 % of the variance. (Table 3)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:- Extraction Method (Principal Component Analysis)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"702\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDomains\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInitial Eigen values\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExtraction Sums of Squared Loadings\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRotation Sums of Squared Loadings\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e% of variance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCumulative %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e% of variance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCumulative %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e% of variance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCumulative\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e3.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e4.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e5.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e6.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e7.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e8.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e9.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e10.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e8.22\u003c/p\u003e\n \u003cp\u003e2.49\u003c/p\u003e\n \u003cp\u003e1.90\u003c/p\u003e\n \u003cp\u003e1.75\u003c/p\u003e\n \u003cp\u003e1.48\u003c/p\u003e\n \u003cp\u003e1.33\u003c/p\u003e\n \u003cp\u003e1.31\u003c/p\u003e\n \u003cp\u003e1.15\u003c/p\u003e\n \u003cp\u003e1.07\u003c/p\u003e\n \u003cp\u003e1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e22.85\u003c/p\u003e\n \u003cp\u003e6.92\u003c/p\u003e\n \u003cp\u003e5.28\u003c/p\u003e\n \u003cp\u003e4.86\u003c/p\u003e\n \u003cp\u003e4.13\u003c/p\u003e\n \u003cp\u003e3.71\u003c/p\u003e\n \u003cp\u003e3.65\u003c/p\u003e\n \u003cp\u003e3.21\u003c/p\u003e\n \u003cp\u003e2.99\u003c/p\u003e\n \u003cp\u003e2.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e22.85\u003c/p\u003e\n \u003cp\u003e29.77\u003c/p\u003e\n \u003cp\u003e35.05\u003c/p\u003e\n \u003cp\u003e39.92\u003c/p\u003e\n \u003cp\u003e44.05\u003c/p\u003e\n \u003cp\u003e47.76\u003c/p\u003e\n \u003cp\u003e51.41\u003c/p\u003e\n \u003cp\u003e54.63\u003c/p\u003e\n \u003cp\u003e57.63\u003c/p\u003e\n \u003cp\u003e60.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e8.22\u003c/p\u003e\n \u003cp\u003e2.49\u003c/p\u003e\n \u003cp\u003e1.90\u003c/p\u003e\n \u003cp\u003e1.75\u003c/p\u003e\n \u003cp\u003e1.48\u003c/p\u003e\n \u003cp\u003e1.33\u003c/p\u003e\n \u003cp\u003e1.31\u003c/p\u003e\n \u003cp\u003e1.15\u003c/p\u003e\n \u003cp\u003e1.07\u003c/p\u003e\n \u003cp\u003e1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e22.85\u003c/p\u003e\n \u003cp\u003e6.92\u003c/p\u003e\n \u003cp\u003e5.28\u003c/p\u003e\n \u003cp\u003e4.86\u003c/p\u003e\n \u003cp\u003e4.13\u003c/p\u003e\n \u003cp\u003e3.71\u003c/p\u003e\n \u003cp\u003e3.65\u003c/p\u003e\n \u003cp\u003e3.21\u003c/p\u003e\n \u003cp\u003e2.99\u003c/p\u003e\n \u003cp\u003e2.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e22.85\u003c/p\u003e\n \u003cp\u003e29.77\u003c/p\u003e\n \u003cp\u003e35.05\u003c/p\u003e\n \u003cp\u003e39.92\u003c/p\u003e\n \u003cp\u003e44.05\u003c/p\u003e\n \u003cp\u003e47.76\u003c/p\u003e\n \u003cp\u003e51.41\u003c/p\u003e\n \u003cp\u003e54.63\u003c/p\u003e\n \u003cp\u003e57.63\u003c/p\u003e\n \u003cp\u003e60.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3.28\u003c/p\u003e\n \u003cp\u003e2.75\u003c/p\u003e\n \u003cp\u003e2.63\u003c/p\u003e\n \u003cp\u003e2.37\u003c/p\u003e\n \u003cp\u003e2.20\u003c/p\u003e\n \u003cp\u003e2.07\u003c/p\u003e\n \u003cp\u003e2.03\u003c/p\u003e\n \u003cp\u003e1.68\u003c/p\u003e\n \u003cp\u003e1.42\u003c/p\u003e\n \u003cp\u003e1.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e9.12\u003c/p\u003e\n \u003cp\u003e7.66\u003c/p\u003e\n \u003cp\u003e7.31\u003c/p\u003e\n \u003cp\u003e6.60\u003c/p\u003e\n \u003cp\u003e6.12\u003c/p\u003e\n \u003cp\u003e5.75\u003c/p\u003e\n \u003cp\u003e5.64\u003c/p\u003e\n \u003cp\u003e4.69\u003c/p\u003e\n \u003cp\u003e3.96\u003c/p\u003e\n \u003cp\u003e3.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e9.12\u003c/p\u003e\n \u003cp\u003e16.79\u003c/p\u003e\n \u003cp\u003e24.10\u003c/p\u003e\n \u003cp\u003e30.71\u003c/p\u003e\n \u003cp\u003e36.83\u003c/p\u003e\n \u003cp\u003e42.59\u003c/p\u003e\n \u003cp\u003e48.23\u003c/p\u003e\n \u003cp\u003e52.92\u003c/p\u003e\n \u003cp\u003e56.88\u003c/p\u003e\n \u003cp\u003e60.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eConvergent Validity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA high convergent validity (r=.82) was determined by the score correlation of both measures. Cronbach\u0026apos;s alpha was used to measure the preliminary scale\u0026apos;s reliability (internal consistency) and was determined to be (p=.89).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReliability assessment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Cronbach\u0026rsquo;s alpha value of the NCFI was .94, and those of the six factors were .90, .90, .86, .87,and..61, and .80, respectively). Moreover, the test\u0026ndash;retest ICC was .935, indicating acceptable stability of the NCFI. In addition, the SEM of NCFI is 7.8. The results are presented in Table 4.\u003c/p\u003e\n\u003cp\u003eThe analysis was conducted with a sample of 200 nurses. This study included all the items with a total correlation coefficient of \u0026gt; 0.4. The solution described in Table 4 is based on a principal component analysis.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDomain I had six items linked to job satisfaction and burnout, with an individual variance of 22.85, factor loading range of 0.72 to 0.45, and domain reliability of.82. Domain II contained five work sensitivity items with a total variance of 6.92, factor loading range of 0.64 to 0.52, and domain reliability of.70. Domain III contained six work-related items with a total variance of 5.28, factor loading range of 0.66 to 0.48, and domain reliability of.76. Domain IV contained four items on intrusive thoughts, with a total variance of 4.86, factor loading range of 0.75 to 0.45, and domain reliability of.764. Domain V had four items pertaining to hopelessness, with a total variance of 4.13, a factor loading range of 0.64 to 0.42, and domain reliability of.77. Domain VI contained three items associated with worthlessness, with a total variance of 3.71, a factor loading range of 0.79 to 0.48, and domain reliability of.710. Domain VII contained three Overwhelming Thoughts items with a total variance of 3.65, factor loading range of 0.76 to 0.48, and domain reliability of.692. Domain VIII contained three compassion-related items with a total variance of 3.21, a factor loading range of 0.66 to 0.42, and a domain reliability of.79. Domains IX (Competency) and X (Productivity) each featured one item, factor loading range of 0.71 to 0.66 with a total variance of 2.99 and 2.90. (Table 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:- Data Reduction Factor Analysis using Principal Component Analysis.\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\" style=\"width: 366px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eItems\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactor Loading\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal variance explained\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCronbach\u0026rsquo;s\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAlpha\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 638px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDomain I- Dissatisfaction and Burnout (Total no of items=6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI am dissatisfied with my job.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e22.85\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI am dissatisfied with the nature of my work.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI feel tired while on working.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI am unhappy with my work.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI feel that I become very arrogant and harsh towards people since I took this job.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI feel that there is no one to talk about highly stressful experiences.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 638px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDomain II- Lack of Emotions and Sensitivity (Total no of items=5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI fail to perceive patient\u0026rsquo;s situation and feelings.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e6.92\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.705\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI don\u0026rsquo;t take extra mile to help the patient.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI feel disconnected to my patients and co-workers.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI lack curiosity in learning new things.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI do not communicate my understandings to the client.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 638px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDomain III- Lack of Interest. (Total no of items=6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI do not feel interesting while handling new cases.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e5.28\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.764\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI avoid spending time with patients.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI feel boring while working with some people I helped.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI feel depressed of caring critically ill patients on regular routine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI feel exhausted when I get up in morning and have to face another day on job.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI thought that I am experiencing a trauma of a person I care for.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 638px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDomain IV- Secondary stress (Total no of items=4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI feel like pre-occupied with person I helped.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e4.86\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.756\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI feel like being in danger while caring traumatized patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI get intrusive thoughts of terrible experiences of caring others.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI feel that I am not succeeding as a helper or caregiver.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 638px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDomain V- Hopelessness \u0026nbsp;(Total no of items=4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI feel that I am not succeeding as a helper or caregiver.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e4.13\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.770\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI feel very weak as a result of my job as a helper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI do not feel my failings as a part of human conditions.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI cannot seem to recover easily after facing daily troubling events\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 638px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDomain VI- Worthlessness (Total no of items=3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI have a sense of worthlessness associated with my work.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e3.71\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.710\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI really do not care about my patient.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI do not feel sincere while caring patients.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 638px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDomain VII- Overwhelming (Total no of items=3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI feel overwhelming while caring critically ill patients.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e3.65\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eMy patient\u0026rsquo;s stress affects me deeply.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI experienced frightening dreams at night of those I helped in a day.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 638px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDomain VIII- Compassion (No of items=3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI feel more alive after working with those I help\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.66\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e3.21\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.792\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI am proud of what I can do to help others.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI feel compassionate towards my work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 638px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDomain IX- Competency(No of items=1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eI find myself incompetent in my work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.71\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2.99\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.88(test retest)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 638px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDomain X- Productivity (No of items=1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eMy productivity at work has been reduced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.91 (test retest)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 366px;\"\u003e\n \u003cp\u003eTotal (10 Domains and 36 Items)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.76 to 0.42\u003c/p\u003e\n \u003cp\u003e(Overall)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e60.53 (Total Variance)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.88(overall scale reliability)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eInter Domain correlation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe inter-domain correlation matrix of 10 extracted components of the Compassion Fatigue Assessment Scale was determined, where all the components of the scale were found to be correlated. (Table 5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5:-Inter Domain correlation matrix of Compassion Fatigue Assessment Scale:-\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"718\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDomains\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eDissatisfaction and Burnout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eLack of Emotions and Sensitivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eLack of Interest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eIntrusive thoughts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eHopelessness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eWorthlessness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eOverwhelming\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eCompassion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eCompetency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eProductivity\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDissatisfaction and Burnout\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.475\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.497\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e.329\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.519\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.299\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e.355\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e.295\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLack of Emotions and Sensitivity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.475\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.580\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e.432\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.555\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.380\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e.375\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e.325\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLack of Interest.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.497\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.580\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e.542\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.599\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.280\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e.458\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e.233\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSecondary stress\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.329\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.432\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.542\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.395\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e.505\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e.110\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHopelessness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.519\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.555\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.599\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e.395\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.304\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e.400\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e.320\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWorthlessness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.299\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.380\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.280\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e.129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.304\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e.101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e.391\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverwhelming\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.355\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.375\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.458\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e.505\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.400\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e.106\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCompassion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e.035\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCompetency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.165*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e-.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e.095\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProductivity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.295**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.325**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.233**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e.110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.320**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.391**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e.106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e.095\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"11\" valign=\"top\" style=\"width: 718px;\"\u003e\n \u003cp\u003e**Correlation is significant at the level 0.01 level (2-tailed)\u003c/p\u003e\n \u003cp\u003e*Correlation is significant at the 0.05 level (2-tailed)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eInter Domain correlation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe inter-domain correlation matrix of 10 extracted components of the Compassion Fatigue Assessment Scale was determined, where all the components of the scale were found to be correlated. (Table 5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSensitivity and Specificity of Compassion Fatigue Assessment Scale\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSensitivity and Specificity assess how positively and negatively participants react to compassion fatigue, respectively. A receiver operating characteristic curve was used to establish the sensitivity and specificity of the compassion fatigue assessment scale (Figure 1). The cut-off point of the scale was then determined. According to the receiver operating curve, 71.5 is the best cut-off point, with scale sensitivity and specificity of 0.7 and 0.38, respectively.\u0026nbsp;\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study developed and validated a new Compassion Fatigue Assessment Scale (Annexure 1) for Indian nurses. The results revealed that the newly developed ten factors,36 - items of the CFAS have strong psychometric properties, including good construct validity and internal consistency (overall Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0. 88) and test-retest reliability (ICC\u0026thinsp;=\u0026thinsp;0.901), making it a valid and reliable tool for assessing and monitoring compassion fatigue among nurses. The scale identified 10 domains associated with compassion fatigue: These ten factors \u0026ldquo;dissatisfaction and burnout\u0026rdquo;, \u0026ldquo;lack of emotions and sensitivity\u0026rdquo;, \u0026ldquo;lack of interest\u0026rdquo;, \u0026ldquo;secondary stress\u0026rdquo;, \u0026ldquo;hopelessness\u0026rdquo;, \u0026ldquo;worthlessness\u0026rdquo;, \u0026ldquo;overwhelming\u0026rdquo;, \u0026ldquo;compassion\u0026rdquo;, \u0026ldquo;competency\u0026rdquo; and \u0026ldquo;productivity\u0026rdquo; were accounted for 60.33% of the variance.\u003c/p\u003e \u003cp\u003eThe multidimensional structure of compassion fatigue observed in this study corroborates previous studies and existing compassion fatigue scales. The Compassion Fatigue Self-Test (CFST) was one of the first measures developed based on clinical experience to assess both compassion fatigue and job burnout. The scale has 40 items and was further developed to measure compassion satisfaction with the addition of 16 items.\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e,\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e Continued work on the scale has resulted in the development of the Professional Quality of Life Scale. The Professional Quality of Life Scale with three subscales namely \u0026ldquo;compassion satisfaction,\u0026rdquo; \u0026ldquo;burnout,\u0026rdquo; and \u0026ldquo;secondary traumatic stress\u0026rdquo; is one of the most widely used tools globally to measure compassion fatigue among nurses.\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e,\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e Burnout is a 21 - items self-report measure that assesses the level of an individual's physical, emotional, and mental exhaustion. Although the tool is useful for assessing general burnout, it does not address other critical aspects of compassion fatigue.\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e The newly developed CFAS has 10 domains(factors), and confirmatory factor analysis indicated excellent construct and cross-validation, which is in line with many other compassion fatigue scales. The scale was tailored to the unique stressors experienced by Indian nurses working in resource-limited settings. Furthermore, the culture of self-sacrifice, hierarchical nature of healthcare systems, demanding work schedules, and resource constraints specific to India might have influenced factors such as hopelessness and worthlessness.\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOf all domains, Dissatisfaction and Burnout emerged as the strongest, with a variance of 22.85% and Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.82. These findings align with previous research that highlights burnout as a significant contributor to compassion fatigue.\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e The domain \u0026ldquo;Lack of Emotions and Sensitivity\u0026rdquo;, with a variance of 6.92% (α\u0026thinsp;=\u0026thinsp;0.705), reflects the emotional detachment nurses may develop due to prolonged exposure to challenging situations. Similar findings were noted in earlier studies, which emotional disconnection was reported as a key symptom of compassion fatigue and a mechanism adopted by nurses to work in high-stress environments, suggesting targeted interventions to improve emotional resilience and mitigate detachment.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e,\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e,\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e Lack of interest a domain that accounted for 5.28% of the variance (α\u0026thinsp;=\u0026thinsp;0.764) suggests apathy and reduced motivation of nurses in professional duties. This is consistent with earlier studies that have identified emotional numbing as a coping mechanism against traumatic exposure.\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e Secondary stress (variance\u0026thinsp;=\u0026thinsp;4.86%, α\u0026thinsp;=\u0026thinsp;0.756), a well-documented phenomenon in caregiving profession, has also emerged as a domain in the CFAS. Long duty hours, heavy workload, and lack of support are presumed to be some of the drivers of secondary traumatic stress among Indian nurses, as they work in resource-scarce settings.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e Hopelessness and worthlessness have emerged as other significant domains highlighting how compassion fatigue erodes self-esteem and professional identity.\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e Feelings of being overwhelmed, identified in this study, corroborate earlier findings indicating that persistent stress and exposure to critical care settings significantly impact the mental health of professionals.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e This domain underscores the need for system changes to reduce workloads and improve support systems. Paradoxical nurses were found to have a sense of deep care and empathy that coexisted with exhaustion.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e A; a sense of incompetency and lack of productivity were also found among study participants who doubted their professional abilities.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe present study adheres to well-established processes in scale development, as indicated by professionals in the field.\u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e,\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e The Compassion Fatigue Assessment Scale (CFAS) demonstrates robust psychometric properties, positioning it as a reliable and valid instrument for assessing compassion fatigue among Indian nurses. The overall Cronbach\u0026rsquo;s α of 0.88 for the CFAS highlights excellent internal consistency, with subscales ranging from 0.70 to 0.91, meeting the benchmarks particularly productivity and competency. Additionally, its test-retest reliability, as indicated by an Intra-class Correlation Coefficient of 0.901, confirmed the scale's stability over time. These findings align with, and in some cases surpass, existing scales, indicating excellent construct and cross-validation, which is in line with many other scales.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e,\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cdiv class=\"Heading\"\u003e\u003cb\u003eStrengths, Limitations and Recommendations\u003c/b\u003e\u003c/div\u003e \u003cp\u003eThe scale demonstrated excellent psychometric properties, including high internal consistency (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.88) and test-retest reliability (ICC\u0026thinsp;=\u0026thinsp;0.901), indicating that the CFAS is reliable and stable over time. The identification of ten specific domains of compassion fatigue, some of which address the unique cultural and occupational stressors faced by Indian nurses, is another notable strength of this study. Although the researcher conducted extensive statistical analyses to build the scale, the following constraints were unavoidable during the course of the study. The use of a convenience sampling method may have introduced selection bias, limiting the representativeness of the sample to nurses in other healthcare settings or regions. Although the scale demonstrated convergent validity with the Professional Quality of Life Scale (ProQOL), the study did not assess criterion validity, which could have further strengthened its psychometric evaluation. Another limitation is the lack of linguistic validation of the scale for use in non-English-speaking or multilingual populations, which may limit its applicability to the diverse linguistic groups in India.\u003c/p\u003e \u003cdiv id=\"Sec30\" class=\"Section2\"\u003e \u003ch2\u003eImplications for practice\u003c/h2\u003e \u003cp\u003eThis newly developed and tested Compassion Fatigue Assessment Scale (CFAS) is a reliable and valid tool for measuring compassion fatigue among Indian nurses. This scale can be used to accurately measure and identify compassion fatigue among nurses, thereby allowing timely intervention and support to increase their resilience and well-being. Targeted programs and resources should be implemented to prevent burnout by identifying nurses at risk. is reliable and culturally tailored. This scale can also be used to monitor or evaluate the effectiveness of interventions aimed at improving nurses\u0026rsquo; health and wellbeing.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe Compassion Fatigue Assessment Scale is a psychometrically robust scale for assessing compassion fatigue among nurses in the Indian context. Future research should focus on validating this scale in diverse populations and exploring its predictive validity in various contexts.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the research and ethics committee of the institution where the study was conducted. Permission was obtained from the administrators of the selected hospitals where data were collected. Informed consent was obtained from all the nurses after explaining the purpose, nature, and duration of the study. Privacy of information, anonymity, and confidentiality of data were assured to the participants before data collection. They were informed of the voluntary nature of the study and were given the right to withdraw at any time they wished to.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the research and ethics committee of the\u0026nbsp;Saraswati professional \u0026amp; higher education (SPHE) College of Nursing. The study followed all the guidelines given by the Declaration of Helsinki and applicable review boards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNot applicable\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe datasets generated and/or analysed during the current study are available within the manuscript.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNone\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNone\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSS : Conceptualization, project administration, data curation and data interpretation, intellectual content development, and drafting of the manuscript; BP- Conceptualization, project administration, data curation and data interpretation, intellectual content development and supervision.; RKR and PB : Study design, data interpretation, intellectual content development, drafting of the manuscript and supervision ; HK: Conceptualization, data collection and project administration. All authors contributed to the revision and finalization of the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors appreciate the important contributions of study participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere are no conflicts of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e\u003cem\u003eMental Health at Work: Policy Brief\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLau K, Aldridge R, Norredam M, Mkoma GF, Kugan M, Lin RC-Y, Kiss L, Zimmerman C, Hargreaves S. Workplace Mortality Risk and Social Determinants among Migrant Workers: A Systematic Review and Meta-Analysis. 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J Hospitality Tourism Res. 1997;21(1):100\u0026ndash;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/109634809702100108\u003c/span\u003e\u003cspan address=\"10.1177/109634809702100108\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Burnout, Compassion fatigue, Factor analysis, Nurses, Scale, Secondary trauma","lastPublishedDoi":"10.21203/rs.3.rs-6602941/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6602941/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCompassion fatigue is a significant concern for nurses because they are constantly exposed to suffering.\u003c/p\u003e\u003ch2\u003eAims\u003c/h2\u003e \u003cp\u003eThis study aimed to develop and validate a Compassion Fatigue Assessment Scale (CFAS) for Indian nurses.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA quantitative, descriptive, and cross-sectional design was used to evaluate the psychometric properties, including validity and reliability. A total of 200 nurses from two government and two private hospitals participated between February and June 2022. Data were collected using a sociodemographic sheet, CFAS, and the Professional Quality of Life (ProQOL) scale. Exploratory and confirmatory factor analyses were used to assess construct validity, while convergent validity was evaluated using ProQOL. Reliability was tested using the Cronbach\u0026rsquo;s α coefficient.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003ePrincipal component analysis with varimax rotation identified a ten-factor structure across 36 items, explaining 60.34% of the variance. The extracted domains included \u0026ldquo;dissatisfaction and burnout,\u0026rdquo; lack of emotions, \u0026ldquo;lack of interest,\u0026rdquo; secondary stress, \u0026ldquo;hopelessness,\u0026rdquo; worthlessness, \u0026ldquo;overwhelming,\u0026rdquo; compassion, \u0026ldquo;competency,\u0026rdquo; and \u0026ldquo;productivity.\u0026rdquo; The overall Cronbach\u0026rsquo;s alpha was 0.88, with the subscale scores ranging from 0.56 to 0.91. The test\u0026ndash;retest intra-class correlation coefficient was 0.901, indicating good stability.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe CFAS demonstrated strong construct validity and internal consistency, making it a reliable tool for assessing and monitoring compassion fatigue among nurses in research and professional settings.\u003c/p\u003e","manuscriptTitle":"Development and psychometric properties of the Compassion Fatigue Assessment Scale for Indian Nurses","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-29 15:51:44","doi":"10.21203/rs.3.rs-6602941/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-16T07:13:10+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-14T20:30:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-05T11:50:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"260607288592507761789609030625640560511","date":"2025-06-02T11:38:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"247146470672425976578315011078237199136","date":"2025-06-01T06:04:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-28T07:51:47+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-20T09:53:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-16T06:38:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-16T06:34:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-05-06T12:08:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"aabc1489-1aba-45b7-b569-b17be108050e","owner":[],"postedDate":"May 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-18T15:58:21+00:00","versionOfRecord":{"articleIdentity":"rs-6602941","link":"https://doi.org/10.1186/s12912-025-03670-0","journal":{"identity":"bmc-nursing","isVorOnly":false,"title":"BMC Nursing"},"publishedOn":"2025-08-12 15:56:51","publishedOnDateReadable":"August 12th, 2025"},"versionCreatedAt":"2025-05-29 15:51:44","video":"","vorDoi":"10.1186/s12912-025-03670-0","vorDoiUrl":"https://doi.org/10.1186/s12912-025-03670-0","workflowStages":[]},"version":"v1","identity":"rs-6602941","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6602941","identity":"rs-6602941","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}