Nursing- Quantitative Critique

For the QUANTITATIVE CRITIQUE, you are to choose one of the two research articles provided within the module. One article pertains to self-compassion and burnout. The other article explores the effects of localized cold therapy on pain in postoperative patients. The idea here is for you to be thinking about how to thoughtfully read and analyze a research article. Be sure that you reference the NUR 440 Critique Guidelines and Rubric for specific instructions. This is a comprehensive APA paper and must have a title page, a reference page, and be in proper APA format.
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International Journal of Nursing Studies

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Does self-compassion mitigate the relationship between burnout and barriers to compassion? A cross-sectional quantitative study of 799 nurses

Vinayak Deva, Antonio T. Fernando IIIa, Anecita Gigi Limb, Nathan S. Consedinea,⁎

a Department of Psychological Medicine, University of Auckland, New Zealand b School of Nursing, University of Auckland, New Zealand


Keywords: Burnout Compassion Self-compassion Barriers Nursing Compassion-fatigue Resiliency


Background: Burnout has numerous negative consequences for nurses, potentially impairing their ability to deliver compassionate patient care. However, the association between burnout and compassion and, more specifically, barriers to compassion in medicine is unclear. This article evaluates the associations between burnout and barriers to compassion and examines whether dispositional self-compassion might mitigate this association. Hypothesis: Consistent with prior work, the authors expected greater burnout to predict greater barriers to compassion. We also expected self-compassion – the ability to be kind to the self during times of distress – to weaken the association between burnout and barriers to compassion among nurses. Methods: Registered nurses working in New Zealand medical contexts were recruited using non-random con- venience sampling. Following consent, 799 valid participants completed a cross-sectional survey including the Copenhagen Burnout Inventory, the Barriers to Physician Compassion scale, and a measure of dispositional self- compassion. Results: As expected, greater burnout predicted greater barriers to compassion while self-compassion predicted fewer barriers. However, self-compassion mitigated the association between burnout and burnout related bar- riers to compassion (but not other barriers). The interaction suggested that suggested that the association was stronger (rather than weaker) among those with greater self-compassion. Discussion: Understanding the lack of compassion and the effects of burnout in patient care are priorities in health. This report extends evidence on the association between burnout and compassion-fatigue to show that burnout also predicts the experience of specific barriers to compassion. While self-compassion predicted lower burnout and barriers, it may not necessarily reduce the extent to which burnout contributes to the experience of barriers to compassion in medicine. Implications for understanding how burnout manifests in barriers to clinical compassion, interventions and professional training, and future directions in nursing are discussed.

What is already known about the topic?

• Burnout is widespread among nurses and thought to have numerous negative correlates, including those related to their ability to deliver compassionate care.

• Prior researchers have typically linked burnout with other com- passion-related forms of burnout (such as compassion fatigue) and have failed to illuminate factors that might buffer or attenuate this relationship.

What this paper adds

• The paper extends knowledge beyond compassion fatigue to

consider how burnout may manifest in specific barriers to compas- sionate patient care.

• The development of self-compassion (the ability to care for the self in times of stress) may reduce the experience of carer, patient, en- vironmental, and clinical barriers to compassion.

1. Introduction

Burnout is prevalent across a range of healthcare professions, in- cluding nursing (Beck, 1995; Poncet et al., 2007), and has serious consequences for both nurses (Parker and Kulik, 1995; Vahey et al., 2004) and patients (Aiken et al., 2002; McHugh et al., 2011). Burnout is generally defined as a set of symptoms relating to exhaustion, in the Received 26 November 2017; Received in revised form 20 February 2018; Accepted 20 February 2018

⁎ Corresponding author. E-mail address: (N.S. Consedine).

International Journal of Nursing Studies 81 (2018) 81–88

0020-7489/ © 2018 Elsevier Ltd. All rights reserved.

form of negative job attitudes, negative self-concepts, and a loss of concern and feeling for patients (Keidel, 2002). Given the central in- volvement of professional nurses in a variety of healthcare domains (Tingen et al., 2009), understanding the origins and consequences of burnout (Beck, 1995; McHugh et al., 2011; Poncet et al., 2007), parti- cularly in terms of compassion-fatigue (Boyle, 2011; Coetzee and Klopper, 2010; Flarity et al., 2013, 2016a,b; Sabo, 2006; Yoder, 2010) and lower job satisfaction (Aiken et al., 2002; Hayes et al., 2010; Lu et al., 2012; Utriainen and Kyngäs, 2009) is increasingly important. The current report contributes to this area of study by examining the links between burnout and specific barriers to compassion in a large sample of registered nurses and testing the possibility that a key intrapersonal resource, self-compassion, might mitigate this relationship. Specially, the authors evaluate the possibility that burnout is less closely asso- ciated with barriers to compassion among more self-compassionate nurses.

Prior studies of burnout show consistent links to negative mental and physical health outcomes. Greater burnout has been linked to poorer immune functioning (Nakamura et al., 1999), lower social support (Constable and Russell, 1986; Duquette et al., 1994; Eastburg et al., 1994), and greater substance-use (Lee et al., 2003; Shanafelt et al., 2002). Burnout also varies among nurses with different demo- graphic characteristics (Duquette et al., 1994; Keidel, 2002; Lee et al., 2003), those working with different patient populations (Aiken et al., 2002), and in different clinical settings (Aiken et al., 2002; Constable and Russell, 1986; Duquette et al., 1994; Lee et al., 2003).

However, despite the volume of research linking burnout with ne- gative outcomes, the relations between burnout and compassion are unclear. Most prior work has focused on the association between burnout and a lack of compassion (compassion-fatigue), rather than seeking to identify specific factors that might be relevant. Compassion, along with the related constructs of empathy, kindness, and concern, are essential components of effective patient care (Attree, 2001; Bramley and Matiti, 2014; Frost, 2011; Heffernan et al., 2010; Irurita, 1999; McQueen, 2000) and are likely to be negatively impacted by burnout. Research shows a negative relationship between burnout and patient care-satisfaction (Leiter et al., 1998; McHugh et al., 2011; Shanafelt et al., 2002; Vahey et al., 2004) but the reasons for this link remains unclear.

Ironically then, the relationship between burnout and factors likely to influence caring remains understudied while the association between burnout and compassion-fatigue has been widely investigated (Craig and Sprang, 2010; Keidel, 2002; Killian, 2008), including among nurses (Hooper et al., 2010; Maytum et al., 2004; Sabo, 2008). Although compassion fatigue is a complex construct and, at least in trauma en- vironments, includes elements of both secondary traumatisation and burnout (Adams et al., 2006), the fact that the experience of feeling “unable to care” is a highly salient aspect feeling burnt out (Chen and McMurray, 2001) makes this association unsurprising. However, be- cause compassion-fatigue is a type of burnout specific to those in the caring professions (Figley, 2002; Keidel, 2002), associations with gen- eral measures of burnout are difficult to interpret. Put simply, a sig- nificant proportion of the co-variation between general measures of burnout and measures of compassion fatigue (which incorporates burnout) likely reflects their conceptual overlap and shared measure- ment characteristics. With this issue in mind, the primary aim of this report was to extend prior research by examining the associations be- tween burnout and specific measures of caregiver, patient, clinical, and institutional and environmental barriers to compassion among nurses.

A second aim was to evaluate if personality factors in nurses might buffer or attenuate the association between burnout and barriers to compassionate care. Specifically, the authors evaluated whether self- compassion (the ability or tendency to respond to the self in times of failure or distress with kindness and understanding) (Neff, 2003a) might mitigate the association between burnout and barriers. Self- compassion can be viewed as a resilience type factor (Neff and

McGehee, 2010) and early evidence denotes associations between burnout and lower self-compassion (Alkema et al., 2008; Barnard and Curry, 2012) as well as between self-compassion and lower compassion- fatigue (Alkema et al., 2008; Figley, 2002). In theory, these links reflect the notion that more self-compassionate individuals manage stress and burnout more effectively, letting demands exhaust less of their capacity to be caring (Alkema et al., 2008; Figley, 2002; Vigna et al., 2017).

More directly, several recent studies have shown…