Risk For Compassion Fatigue Research Articles

Coping in the classroom: A study of Professional Quality of Life (ProQoL) in Australian teachers

Research has shown that teachers are at increased risk for compassion fatigue and low career satisfaction. Compassion fatigue may occur as a result of repeated exposure to traumatic experiences of someone in their care. Utilising a sample of 334 Australian teachers, the present study examined the impact of coping styles on compassion fatigue and compassion satisfaction. Regression analyses revealed that avoidant coping strategies were significant predictors of compassion fatigue. Conversely, teachers who utilised problem-focused coping strategies reported lower levels of compassion fatigue and higher levels of compassion satisfaction than teachers who used other types of coping strategies. These results serve to inform future supports and strategies to promote teacher wellbeing and satisfaction.

Understanding the interplay of compassion fatigue and moral resilience on moral distress in ICU nurses: a cross-sectional study.

Intensive Care Unit (ICU) nurses frequently confront significant psychological challenges, including compassion fatigue, moral distress, and diminished moral resilience. These issues not only affect their well-being but also impact the quality of care provided to patients. The interplay of these factors is complex and not fully understood, particularly how compassion fatigue influences the relationship between moral resilience and moral distress. To explore the complex interplay between compassion fatigue and moral distress among ICU nurses, and to elucidate how compassion fatigue influences the protective role of moral resilience against moral distress. A cross-sectional study was conducted using a nationwide random sample of ICU nurses in China. Latent profile analysis identified subgroups based on levels of compassion fatigue. Moderation analysis examined whether compassion fatigue moderated the association between moral resilience and moral distress. Among 612 ICU nurses, latent profile analysis revealed three distinct groups with high, moderate, and low levels of compassion fatigue. Being female was protective against high compassion fatigue, while ages 30-49 yrs., lack of bachelor's degree, and dissatisfaction with salary increased compassion fatigue risk. Moderation analysis showed compassion fatigue significantly moderated the relationship between moral resilience and moral distress. Nurses with higher compassion fatigue exhibited a stronger association between low moral resilience and high moral distress. Compassion fatigue and moral distress are interconnected phenomena among ICU nurses. Demographic factors like gender, age, education, and income satisfaction impact compassion fatigue risk. High compassion fatigue impairs moral resilience, exacerbating moral distress. Comprehensive interventions targeting both compassion fatigue and moral resilience, tailored to nurses' demographic profiles, are needed to support this workforce.

Stress coping and resilience of frontline nurses under the emergency infectious disease pandemic: A latent class analysis

AimThis study aimed to classify coping strategies and resilience among nurses caring for COVID-19 patients using latent class analysis (LCA), and to compare variations across these subgroups. BackgroundThe pandemic of emerging infectious diseases is a traumatic stressor for frontline nurses, potentially leading to compassion fatigue. Effective coping strategies and resilience were essential for managing stress, but their nuanced classification and outcomes remain unclear. MethodsA cross-sectional survey was conducted from January to March 2022. Purposive and snowball sampling was utilized to recruit participants. ResultsA total of 215 clinical nurses (mean age 34.59 years) were recruited. A three-class model showed the best fit: class 1 (35.8 %) with proactive coping and high resilience, class 2 (29.8 %) with mixed coping and high resilience, and class 3 (34.4 %) with avoidance coping and low resilience. Compared to class 3, class 1 participants had lower stress (Odds Ratio (OR) = 0.37, 95 % CI: 0.143–0.950, P = 0.039), reduced risk of compassion fatigue (OR = 0.29, 95 % CI: 1.110–4.536, P < 0.001), and lower intention to quit (OR = 0.39, 95 % CI: 0.175–0.843, P = 0.017). Class 2 participants, with higher proportion to live with family, had longer work experience, higher income, and also showed significantly reduced intention to quit (OR = 0.386, 95 % CI: 0.168–0.887, P = 0.025). ConclusionsIdentifying these vulnerable groups can help in providing interventions to reduce stress and prevent compassion fatigue and intention to quit.

Covenantal Care: Nursing with God's Love and Justice.

With resources stretched thin and the growing risk of compassion fatigue, faith beliefs can offer enriching perspectives for nurses. Covenantal care is a nursing approach rooted in theological insights about humanity's inherent purpose to engage in relationship with God and actively participate in acts of love and justice. Based upon interpretations of Judeo-Christian teachings of imago Dei and God's covenant with humankind, this approach provides guidance for the nurse to care for self, patients, and the wider community. This exploration of theology-in-practice provides an orientating ethos for nurses that reflects the loving, restorative, and dignified care that is at the heart of the Christian faith.

Compassion Fatigue in a Cohort of South Italian Nurses and Hospital-Based Clinical Social Workers Following COVID-19: A Cross-Sectional Survey.

Background/Objective: The COVID-19 pandemic has led to a significant increase in the workloads of healthcare workers (HCWs). The fear of contracting the new virus with the frequent medical consequences has affected their mental health. As a result, they are at high risk of compassion fatigue (CF). In this multicentric study, as a primary objective, we evaluate the incidence and/or prevalence of CF in a cohort of Italian nurses and HCWs (hospital-based clinical social workers of neurological patients) who have contracted SARS-CoV-2 infection. Our secondary aim is to evaluate the difference in experiencing CF between subjects with and without long-term COVID. Methods: In this study, 101 HCWs attending three different neurorehabilitation settings (the Neurorehabilitation Unit of the "Bonino Pulejo" Neurolesi Center of Messina, the Neurorehabilitation Department of Crotone, and the Psychiatric Unit of the University Hospital of Messina) were enrolled from May 2021 to May 2023. Data were collected through self-administered semi-structured interviews. Results: We observed high percentages of CF difficulties in both nurses and HCWs, related to mood alteration in 57.7%, headaches in 44.4%, and fatigue in 62%. Higher percentages were found in individuals with long-term COVID-19, including mood alteration in 93.9%, headache in 88.6%, and memory-related problems in 98.5%. Conclusions: The complexity of a patient's care pathway, especially in chronic disease situations, requires an enormous commitment that can lead to burnout and CF, which should be considered to initiate preventive interventions aimed at helping "those who help", for the well-being of patients, healthcare teams, and healthcare organizations.

How Mental Health Nurses Report Their Compassion Fatigue and Compassion Satisfaction: A Cross-Sectional Study and the Implications for Healthcare Leaders

Compassion fatigue is the cost of caring for others in emotional pain where the helping professional absorbs the trauma of those they help and cannot detach emotionally at the end of the day. Stressful and perceived unsupportive work environments may leave the caregiver at a heightened risk for compassion fatigue. To study the level of compassion fatigue and compassion satisfaction experienced by mental health nurses. A descriptive, cross-sectional, electronic survey design was utilized. The Professional Quality of Life Scale-5 was used. The study was conducted at a large, urban hospital that exclusively treats patients with mental health and addiction issues located in Ontario, Canada. The sample included all nurses who were listed on the hospital’s Email list. All nurses who are displayed on this list are mental health nurses. Analyses were conducted to assess for differences between the characteristics and the subscales of professional quality of life. One hundred and forty-eight mental health nurses completed a questionnaire. The response rate was 21%. Seventy-six percent reported moderate levels of burnout, 59% reported moderate levels of secondary traumatic stress, and 21% reported high levels of compassion satisfaction. Predictors were seen for the characteristics of gender, ethnicity, marital status, area, exposure to violence and support felt. Compassion fatigue has clear implications. Organizations willing to invest in reducing it, have the potential to improve patient outcomes and the well-being of nurses. The majority of mental health nurses reported moderate levels for each of the subscales.

Compassion Satisfaction and Compassion Fatigue: Experiences of Rehabilitation Healthcare Workers in Rural and Remote Locations in Australia

Purpose. This study sought to gain an understanding of rural and remote rehabilitation healthcare workers’ perceptions and experiences of compassion satisfaction and compassion fatigue. Method. Sixteen rehabilitation workers from four national providers of rehabilitation services to rural and remote communities participated in semistructured interviews conducted by telephone over a four-month period in 2018-2019. Braun and Clarke’s six-phase framework guided the thematic analysis. Findings. Quality of work life, organisational and workplace culture, and organisational management practices, particularly key performance indicators (KPIs), were reported as impacting compassion satisfaction and compassion fatigue. Sources of compassion satisfaction were also common to the development of compassion fatigue, suggesting that it is unlikely for compassion satisfaction to be experienced without risk of compassion fatigue. Conclusion. Although there are similarities in experiences of compassion satisfaction and compassion fatigue with other remote healthcare workers, for rehabilitation workers, KPIs were a unique concern, mainly due to their uniformity regardless of geographic location. Participants’ concerns about meeting KPIs increased their work-related pressures, normalised unsafe work practices, and were a cause of recruitment and retention concerns. These perceived influences suggest that rehabilitation workers have a lower likelihood of developing and maintaining compassion satisfaction and a heightened risk of developing compassion fatigue than other rural or remote healthcare workers.

Social support, empathy and compassion fatigue among clinical nurses: structural equation modeling

BackgroundClinical nurses are at high risk for compassion fatigue. Empathy is a prerequisite for compassion fatigue, and social support is an important variable in the process of reducing individual stress. However, the role of social support in the relationship between empathy and compassion fatigue remains unclear. This study explored whether social support mediates the relationship between empathy and compassion fatigue among clinical nurses.MethodsA total of 992 clinical nurses were recruited through convenience sampling for a cross-sectional study in Central China. They completed the General Information Questionnaire, Perceived Social Support Scale, Professional Quality of Life Scale, and Jefferson Scale of Empathy. SPSS was used to conduct descriptive statistical analyses. Pearson’s or Spearman’s correlation analyses and AMOS were employed to build a structural equation model (SEM) to verify the mediating effect of social support on the relationship between empathy and compassion fatigue.ResultsThe results indicated that the standardized direct effect of empathy on compassion fatigue was 0.127, and the standardized indirect effect of empathy on compassion fatigue through social support was 0.136. The mediation effect ratio between empathy and compassion fatigue was 51.7%.ConclusionsOur findings show that social support mediates the relationship between empathy and compassion fatigue among clinical nurses. This finding suggests that increasing nurses’ social support can decrease the prevalence of compassion fatigue. Nursing managers should provide training related to flexibly adjusting empathy and educating nurses to establish effective social networks with family, friends, and colleagues to prevent compassion fatigue.

Construction and evaluation of a predictive model for compassion fatigue among emergency department nurses: A cross-sectional study

BackgroundCompassion fatigue is a syndrome resulting from long-term work-related traumatic event stress exposure of medical staff. The emergency department is considered to be a high-risk, high-intensity and high-stress work environment, with a high prevalence of trauma and violence. Nurses in the emergency department are more prone to compassion fatigue than nurses in other departments. Compassion fatigue not only affects the physical and mental health, and job satisfaction of emergency department nurses, but also causes serious consequences for patients, such as poor patient outcome, medical errors, and increased patient mortality during hospitalization. ObjectivesOur study aims to develop and evaluate a predictive model for compassion fatigue among emergency department nurses. DesignA cross-sectional study. Data sourcesThe emergency department nurses (N = 1014) were recruited from 21 tertiary hospitals (from Chengdu, Chongqing, Guiyang, Guangzhou and Shanghai) in central, southwestern, southern, and eastern China from July 25, 2022 to October 30, 2022. MethodsUnivariate and multiple logistic regression analyses were used to determine the potential predictive factors associated with compassion fatigue in emergency department nurses. A nomogram was built based on the predictive factors and internally evaluated using a bootstrap resampling method (1000 bootstrap resamples). The performance of the predictive model was evaluated by measuring the Hosmer–Lemeshow goodness of fit test and calibration curve. ResultsThe prevalence of compassion fatigue among emergency department nurses was 75.9 %. The multiple logistic regression analysis revealed that the independent predictive factors for compassion fatigue among emergency department nurses were working position, job satisfaction, diet habit, sleep hours per day, occupational stress, physical harassment and the level of workplace violence, all of which were identified to create the nomogram. The Hosmer–Lemeshow goodness of fit test indicated that the predictive model was well calibrated (χ2 = 11.520, P = 0.174). The bootstrap-corrected concordance index of nomogram was 0.821 (95 % CI: 0.791–0.851). The calibration curve of the nomogram showed good consistency between the predicted and actual probabilities. ConclusionsA predictive model of compassion fatigue among emergency department nurses has been developed, based on the general demographic, work-related and lifestyle characteristics, occupational stress, and workplace violence, with satisfactory predictive ability. This model can identify emergency department nurses who are at high risk of compassion fatigue. Our study provides an empirical basis for early detection, early diagnosis and early intervention of emergency department nurses at high risk of compassion fatigue.

Inpatient pediatric nursing staff experiences treating psychiatric patients: A mixed methods study.

A gap in the literature exists attempting to understand the impact that the influx of pediatric psychiatric patients has had on inpatient general medicine pediatric nursing staff. A mixed-method research study was conducted among full- and part-time pediatric nurses and nursing assistants working on general pediatric units. Quantitative data was collected via an anonymous survey using the Professional Quality of Life Scale version 5 and Support Appraisal for Work Stressors scale. Surveys were followed by semistructured interviews. Of the 158 staff eligible, 47 (29.7%) participated in the quantitative portion. [Correction added on 29 September 2023, after the first online publication: In the preceding sentence, the participation rate was revised from 23.5% to 29.7% in this version.] Significant differences were found between roles, with nurses experiencing lower levels of compassion satisfaction and higher levels of burnout. Role differences were seen in supervisor support and nonwork support, with nurses reporting less support from both. Supervisor support showed a significant correlational relationship with compassion satisfaction and burnout. Nonwork support showed similar correlations with compassion satisfaction and burnout. Themes that emerged from the interviews were Barriers to Care, Emotional Impact, and "Help Me Help You." Nurses may be at greater risk for compassion fatigue due to perceived inadequate support from leadership, unclear role expectations, and lack of resources.

Compassion Fatigue in Nurses Providing Palliative Cancer Care and Coping Strategies to Prevent and Manage it

End-of-life care for cancer patients is one of the most challenging experiences encountered by nurses. Cancer nurses providing end-of-life care may experience compassion fatigue due to prolonged exposure to the suffering and intense emotional reactions of patients, death and the dying, and grieving families. However, the development of resilience and effective coping skills can decrease nurse turnover rates and increase the quality of palliative cancer care. This article discusses the concept of compassion fatigue, how it develops, compassion fatigue experienced by nurses providing palliative cancer care, and the Compassion Fatigue Resiliency Program (CFRP) coping method. Author experience and journal articles were used. Compassion fatigue can occur from secondary traumatic stress and burnout after nurses' prolonged and intense exposure to helping suffering patients, resulting in decreased ability to care, expend energy, or exhibit empathy and compassion. The CFRP is a structured, comprehensive training program designed to educate nurses about compassion fatigue and enable them to develop a support network, strengthen their coping skills, and improve resilience. It is recommended that the CFRP be included in in-service training in institutions and be applied to oncology nurses at regular intervals in a block program format (1-2 days). Newly recruited oncology nurses in particular should be supported with such training in orientation programs. Institutional managers play an important role in organizing such programs and screening for the risk of compassion fatigue in nurses who provide end-of-life care.

Effect of Frequency of Clinical Supervision Attendance on Compassion Fatigue among Counsellors in Uasin Gishu County, Kenya

Counsellors are often at high risk of developing compassion fatigue as a result of their interaction with the traumatic materials of their clients. It is in line with this concern that this study sought to determine the effect of frequency of clinical supervision attendance on compassion fatigue among counsellors in Uasin Gishu County, Kenya. The study adopted the embedded mixed methods approach where ex post facto and phenomenological designs were used. A census was used to obtain a sample of 97 counsellors practicing in Uasin Gishu County to participate in the study. Using critical case criteria, 5 counsellors were purposively sampled for the qualitative approach. Data on frequency of clinical supervision was collected using the demographic questionnaire while the Professional Quality of Life Version 5 (ProQoL-5) collected data on compassion fatigue. An in-depth interview guide collected qualitative data. Quantitative data was analysed using SPSS, version 26.0. All the inferential statistics were tested at 0.05 level of significance. The study found that over half (52.6%) of the respondents had low compassion fatigue while the frequency of clinical supervision was associated with lower risk of compassion fatigue. Chi-square test results, however, showed no statistically significant relationship between the frequency of clinical supervision attendance and compassion fatigue. The study concluded that the frequency of clinical supervision attendance was associated with low levels of compassion fatigue. Therefore, there is a need to raise awareness on the importance of clinical supervision in managing compassion fatigue among counsellors.

Coping With the Cost of Caring, Part 1: Approaching a Breaking Point in the Current Educational System

Supporting students’ emotional health has become indispensable considering unprecedented collective trauma and present-day stressors including the COVID-19 pandemic, gun violence, longstanding systemic inequities, and a polarized political climate impacting the educational system. In addition to navigating personal and occupational stressors, teachers are frequently exposed to secondhand accounts and effects of students’ traumatic experiences, increasing their risk of compassion fatigue (i.e., the mental, physical, and emotional exhaustion that results from working with and caring for individuals who are impacted by distress and trauma). Teachers’ emotional resilience is essential in the fight against compassion fatigue, burnout, and withdrawal from the profession. The first of a two-part series, this article lays groundwork that encourages pre-service, early career, and veteran physical and health educators to reflect on risk factors and protective factors that safeguard their socioemotional health as they are asked to continue to give. It begins by describing the role of teachers as emotional first responders in the classroom, followed by risk factors and symptoms of compassion fatigue. The importance, challenges, and limitations of practicing “self-care” as a commonly suggested way to prevent and manage compassion fatigue are addressed. Finally, a call is made for a paradigmatic shift aimed at protecting and uplifting teachers and students. The second part of the series continues this discussion by providing guided activities that encourage teachers to explore, practice, and reflect on personalized and practical coping strategies for emotion regulation that promote well-being and healthful longevity in the profession.

Compassion fatigue in healthcare providers during the COVID-19 pandemic: a scoping review protocol

IntroductionThe COVID-19 pandemic has negatively impacted the psychological health and well-being of healthcare providers. An amplification in chronic stressors, workload and fatalities may have increased the risk of compassion fatigue...

A cross-sectional analysis of compassion fatigue, burnout, and compassion satisfaction in maternal–fetal medicine physicians in the United States

Compassion fatigue is secondary traumatic distress experienced by providers from ongoing contact with patients who are suffering. Compassion satisfaction is emotional fulfillment from caring for others. Burnout is distress related to dissonance between job demands and available resources. Although burnout is well-studied, compassion satisfaction and compassion fatigue are neglected components of physician well-being. Because of recurrent exposure to adverse outcomes, maternal-fetal medicine providers may be at particular risk for compassion fatigue. This study aimed to better characterize both clinical and nonclinical drivers of work-related distress vs satisfaction. The modified Compassion Fatigue and Satisfaction Self-Test and a questionnaire of professional and personal characteristics were distributed electronically to maternal-fetal medicine providers nationally. Multivariable regression models were constructed for compassion fatigue, burnout, and compassion satisfaction as a function of potential predictors. The survey response rate was 24% (n=366), primarily consisting of White physicians working in academic medical centers. Significant predictors of lower burnout scores included employment at 1 institution for >20 years, discussing work-related distress with friends, and having one's most recent involvement in decision-making for a periviable fetus >6 months ago; distress because of coworkers and personal factors predicted higher scores. Female sex, self-report of significant emotional depletion, use of mental health services, and having other maternal-fetal medicine physicians as part of the care team for a fetus with severe anomalies were significant predictors of higher compassion fatigue scores, whereas White race and having social work as part of the care team for a maternal mortality predicted lower scores. Personal spiritual practice was a significant predictor of higher compassion satisfaction score, whereas employment at current institution for <5 years predicted lower scores. Compassion fatigue, compassion satisfaction, and burnout are associated with several modifiable risk factors, such as practice type, having a multidisciplinary team, and emotional support outside of the workplace; these are potential targets for intervention.

Compassion Fatigue and Ethical Attitudes in Nursing Care in Intensive Care Nurses During the COVID-19 Pandemic: A Cross-sectional Study.

Intensive care unit (ICU) nurses faced an increased risk of compassion fatigue and ethical concerns during the COVID-19 pandemic. To evaluate compassion fatigue of ICU nurses and their ethical attitudes in care during the COVID-19 pandemic and analyze contributing factors. An exploratory cross-sectional research design was used. A total of 103 ICU nurses participated. The nurses' compassion fatigue and ethical attitude scores were high. Compassion fatigue was explained by the following variables: considering resigning, receiving support for ethical decisions, willingness to work in the ICU, duration of providing activities of daily living in a shift, and number of patients per nurse. Compassion fatigue was high in nurses working in the ICU during COVID-19. The high level of ethical attitudes shows commitment to professional ethics and reflects the development of the nurses' professional identity. Implementation of interventions that help improve compassion fatigue among nurses is needed.

Addressing Compassion Fatigue Using Career Engagement and the Hope-Centered Model for Career Development

The COVID-19 pandemic has exacted a toll on healthcare workers, who have been required to work during times of great challenge and scarcity, as well as risk to themselves, whilst continuing to provide care for others. This desire to alleviate the suffering of others puts healthcare workers at increased risk of compassion fatigue, a traumatic stress response that can develop from supporting others through emotional suffering and trying to alleviate that pain. Increased risk to this large population poses a challenge to career practitioners, who will need effective ways of supporting these workers in healing. This paper discusses conceptualizing compassion fatigue through a career engagement lens, and proposes the uses of the Hope-Centered Model of Career Development as a means of supporting reengagement. Through the reinstallation of hope, feeling of agency and achievement again become possible.

Debriefing Among Hospice Professionals During a Pandemic.

Although the hospice industry cannot afford to lose professionals to compassion fatigue and burnout, work challenges related to the COVID-19 pandemic potentially place hospice professionals at an increased risk. Reflective debriefing has been recommended to provide emotional support to battle job dissatisfaction, compassion fatigue, and burnout. The purpose of this study was to provide reflective debriefing sessions to hospice professionals and identify common themes reported about their professional and personal experiences during the COVID-19 pandemic. A qualitative descriptive design using focus groups set up as reflective debriefing sessions based on the Gibbs' Reflective Cycle was used. Debriefing sessions were recorded and transcribed for coding, followed by identification of themes. A total of 26 themes emerged from the data collected from the debriefing sessions. A postsurvey found that 96.0% of participants found the debriefing session helpful. Furthermore, 92.3% of participants answered they would like to regularly debrief at their workplace. During the pandemic, hospice professionals are at an increased risk of compassion fatigue and burnout from changes in the work, patient, and person environments caused by the pandemic. To address the unprecedented challenges hospice professionals are facing, it is imperative that employers provide them with emotional support.

Prevalence and predictors of compassion satisfaction, secondary traumatic stress, and burnout among Chinese hospice nurses: A cross-sectional study

AimTo explore the prevalence and predictors of compassion satisfaction, secondary traumatic stress, and burnout among Chinese hospice nurses. BackgroundBecause of prolonged and continual contact with suffering, deaths, and grief, hospice nurses may be vulnerable to emotional burdens and have difficulty maintaining their professional quality of life. MethodsA cross-sectional study was conducted. A total of 478 hospice nurses were selected from 24 medical institutions in Sichuan province. Demographic, work-related information and work-related trauma questionnaire, the Chinese version of the Interpersonal Reactivity Index, the Chinese version of the Emotion Regulation Questionnaire, and the Chinese version of the Professional Quality of Life Scale for Nurses were used for collecting data. ResultsThe mean scores of compassion satisfaction, secondary traumatic stress, and burnout were 34.89 ± 6.21, 26.35 ± 5.24, and 24.49 ± 5.01, respectively. Job satisfaction, perspective-taking, empathic concern, working in tertiary hospitals, and adopting cognitive reappraisal strategy were positively associated with compassion satisfaction, while personal distress was a negative factor, all variables explaining 50.7 % of the variance. Higher burnout was found among nurse who had higher personal distress, worked in secondary or primary hospitals, worked >8 h per day and caring for >10 dying patients last month. In addition, job satisfaction, social support, perspective-taking, empathic concern, and cognitive reappraisal were identified as significant protectors, explaining 50.1 % of the variance. We also found that lower job satisfaction, higher personal distress, higher expressive suppression, lack of social support, senior nurses, and cared for >10 dying patients last month, were positively related to secondary traumatic stress. However, cognitive reappraisal had negative associations. These seven factors explained 32.0 % of the variance. ConclusionsHospice care has specific characteristics and hospice nurses may suffer from more work-related stressors compared with other nurses. Our study may provide clues to help nursing administrators identify hospice nurses who are at higher risk of compassion fatigue and design targeted interventions focused on potential risk factors and protectors to improve hospice nurses' compassion satisfaction, while reducing compassion fatigue.

Evidence-Based Strategies to Mitigate Compassion Fatigue Among Oncology Nurses.

Oncology nurses are at higher risk for compassion fatigue (CF) than nurses working in other specialties. This increased incidence occurs as a result of the type of stress oncology nurses encounter in the workplace (e.g., cari.