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中华妇幼临床医学杂志(电子版)

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2024, Vol. 20 ›› Issue (03): 302 -311. doi: 10.3877/cma.j.issn.1673-5250.2024.03.009

Original Article

Current status and influencing factors of compassion fatigue in midwives

Tingjun Xia1, Yaoxiang Duan1, Xia Duan2, Jinfeng Liu2,†()   

  1. 1. Deliver Room, Obstetrics and Gynecology Hospital of Tongji University·Shanghai First Maternity and Infant Hospital, Shanghai 200040, China
    2. Nursing Department, Obstetrics and Gynecology Hospital of Tongji University·Shanghai First Maternity and Infant Hospital, Shanghai 200040, China
  • Received:2024-02-12 Revised:2024-05-10 Published:2024-06-01
  • Corresponding author: Jinfeng Liu
  • Supported by:
    Special Project of Medical Innovation Research of Shanghai Municipal " Science and Technology Innovation Action Plan"(21Y11905900)
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Objective

To explore the current situation and influencing factors of compassion fatigue (CF) among midwives in Shanghai.

Methods

A total of 195 midwives from hospitals with midwifery qualifications in Shanghai from May to June in 2023 were selected as study subjects for a cross-sectional survey by convenience sampling method. According to the severity of CF among midwives, they were included into study group (n=100, those with moderate or severe CF) and control group (n=95, those without CF or with mild CF), respectively. General information, social support, and CF of midwives were investigated using the General Information Questionnaire, Social Support Rating Scale (SSRS), and the Professional Quality of Life Scale (ProQOL). Chi-square test and Wilcoxon rank sum test were used to compare the general information of midwives in 2 groups. Pearson correlation analysis was used to analyze the correlation between ProQOL scores and SSRS scores in midwives. Multivariate unconditional logistic regression analysis was used to analyze the influencing factors on the occurrence of CF among midwives. This study was approved by the Ethics Committee of Obstetrics and Gynecology Hospital of Tongji University (Ethics No. KS21273).

Results

① A total of 195 midwives completed the questionnaire in this study, and 195 valid questionnaires were recovered, with a valid questionnaire recovery rate of 100%. The incidence of CF among midwives was 81.5% (159/195), with 59 (30.3%) experiencing mild CF, 43 (22.1%) moderate CF, and 57 (29.2%) severe CF. The ProQOL dimensions were scored as (33.8±7.4) points for compassion satisfaction, (24.4±5.4) points for job burnout, and (22.0±6.6) points for secondary traumatic stress. The SSRS score was (38.2±6.7) points. ② The constituent ratio of marital status, years of experience in midwifery, quality of sleep, witness of traumatic childbirth events, satisfaction with job pay, workload, degree of liking the work environment, and level of work recognition received in the past month between study group and control group were statistically significant (P<0.05). ③ There was a significant positive correlation between the score of compassion satisfaction dimension in ProQOL and scores of the subjective support dimension, objective support dimension, utilization of support dimension, and total score of SSRS (r=0.387, 0.171, 0.250, 0.422; P<0.05). And there was a statistically significant negtive correlation between score of job burnout dimension in ProQOL and scores of subjective support dimension, utilization of support dimension, and total score of SSRS (r=-0.332, -0.332, -0.331; P<0.001). And score of secondary traumatic stress dimension in ProQOL and score of utilization of support dimension and total score of SSRS were significantly negatively correlated (r=-0.221, -0.149, P<0.05). ④ Results of multivariate unconditional logistic regression analysis showed that the marital status of being married or divorced (OR=17.622, 7.792; 95%CI: 3.531-88.341, 2.002-30.328; P<0.001, P=0.003), with ≥16 years of midwifery experience (OR=0.010, 95%CI: <0.001-0.254, P=0.005), witness of 3 to 5 times of traumatic childbirth events (OR=5.994, 95%CI: 1.011-35.524, P=0.009), and with a moderate level of liking the work environment (OR=119.318, 95%CI: 9.072-1 569.257, P<0.001) were all independent influencing factors for the occurrence of CF in midwives.

Conclusions

The incidence of CF among midwives is high and is mainly influenced by marital status, years of experience in midwifery, witness of traumatic childbirth events and degree of liking the work environment. And there is a correlation between SSRS score and CF among midwives.

Key words: Nurse midwives, Compassion fatigue, Social support, Psychosocial support systems, Root cause analysis
表1 本研究195名助产士一般资料比较[例数(%)]
项目 构成比 项目 构成比 项目 构成比
年龄(岁)   职称   睡眠质量  
20～25 30(15.4) 护士 32(16.4) 良好 52(26.7)
26～30 89(45.6) 护师 118(60.5) 一般 50(25.6)
31～35 41(21.0) 主管护师及以上 45(23.1) 欠佳 93(47.7)
>35 35(18.0) 医院类别   经历创伤性分娩事件次数(次)  
婚姻状况   专科医院 155(79.5) 0 63(32.3)
未婚 71(36.4) 综合性医院 40(20.5) 1～2 37(19.0)
已婚 122(62.6) 医院聘用方式   3～5 18(9.2)
离异 2(1.0) 合同制 121(62.1) ≥6 77(39.5)
子女数量(个)   人事代理 4(2.1) 工作负荷强度  
0 108(55.4) 在编人员 70(35.9) 过大 108(55.4)
1 65(33.3) 夜班频率(次/周)   一般 25(12.8)
≥2 22(11.3) 0 19(9.7) 较轻 62(31.8)
从事助产年限(年)   1～2 118(60.5) 对工作氛围喜欢程度  
1～5 75(38.5) 3～4 44(22.6) 喜欢 106(54.4)
6～10 80(41.0) ≥5 14(7.2) 一般 27(13.8)
11～15 21(10.8) 对工作待遇满意度   不喜欢 62(31.8)
≥16 19(9.7) 非常满意 13(6.7) 近1个月工作被认可程度  
最高学历   满意 77(39.5) 高 118(60.5)
大专 55(28.2) 一般 78(40.0) 一般 24(12.3)
本科 135(69.2) 不满意 24(12.3) 低 53(27.2)
硕士及以上 5(2.6) 非常不满意 3(1.5)    
表2 助产士发生CF影响因素的单因素分析结果[例数(%)]
组别 例数 年龄 婚姻状况 子女数量
20～25岁 26～30岁 31～35岁 36～45岁 未婚 已婚 离异 0 1个 ≥2个
研究组 100 16(16.0) 50(50.0) 21(21.0) 13(13.0) 29(29.0) 69(69.0) 2(2.0) 51(51.0) 36(36.0) 13(13.0)
对照组 95 14(14.7) 39(41.1) 20(21.1) 22(23.2) 42(44.2) 53(55.8) 0(0) 57(60.0) 29(30.5) 9(9.5)
χ2值   3.69a 7.14b 1.69b
P值   0.297 0.028 0.430
组别 例数 从事助产年限 最高学历 职称
1～5年 6～10年 11～15年 ≥16年 大专 本科 硕士及以上 护士 护师 主管护师及以上
研究组 100 37(37.0) 46(46.0) 15(15.0) 2(2.0) 26(26.0) 72(72.0) 2(2.0) 16(16.0) 65(65.0) 19(19.0)
对照组 95 38(40.0) 34(35.8) 6(6.3) 17(17.9) 29(30.5) 63(66.3) 3(3.2) 16(16.8) 53(55.8) 26(27.4)
χ2值   17.31a 0.83a 2.17a
P值   0.001 0.660 0.338
组别 例数 医院类别 医院聘用方式 对工作待遇满意度
专科医院 综合医院 合同制 人事代理 在编人员 非常满意 满意 一般 不满意 非常不满意
研究组 100 83(83.0) 17(17.0) 63(63.0) 2(2.0) 35(35.0) 6(6.0) 29(29.0) 45(45.0) 17(17.0) 3(3.0)
对照组 95 72(75.8) 23(24.2) 58(61.1) 2(2.1) 35(36.8) 7(7.4) 48(50.5) 33(34.7) 7(7.4) 0(0)
χ2值   1.55b 0.08b 13.59a
P值   0.213 0.962 0.009
组别 例数 夜班频率 睡眠质量 工作负荷强度
0 1～2次/周 3～4次/周 ≥5次/周 良好 一般 欠佳 过大 一般 较轻
研究组 100 8(8.0) 63(63.0) 26(26.0) 3(3.0) 13(13.0) 39(39.0) 48(48.0) 69(69.0) 7(7.0) 24(24.0)
对照组 95 11(11.6) 55(57.9) 18(18.9) 11(11.6) 39(41.1) 11(11.6) 45(47.4) 39(41.1) 18(18.9) 38(40.0)
χ2值   6.88a 28.52a 16.13a
P值   0.076 <0.001 <0.001
组别 例数 经历创伤性分娩事件次数 对工作氛围喜欢程度 近1个月工作被认可程度
0 1～2次 3～5次 ≥6次 喜欢 一般 不喜欢 高 一般 低
研究组 100 24(24.0) 17(17.0) 14(14.0) 45(45.0) 31(31.0) 25(25.0) 44(44.0) 46(46.0) 12(12.0) 42(42.0)
对照组 95 39(41.1) 20(21.1) 4(4.2) 32(33.7) 75(78.9) 2(2.1) 18(18.9) 72(75.8) 12(12.6) 11(11.6)
χ2值   11.39a 48.41a 23.63a
P值   0.010 <0.001 <0.001
表3 本研究195名助产士ProQOL各维度评分与SSRS各维度评分及其总评分的相关性分析
ProQOL评分 主观支持维度评分 客观支持维度评分 对支持的利用度维度评分 SSRS总评分
r值 P值 r值 P值 r值 P值 r值 P值
共情满意维度评分 0.387 <0.001 0.171 0.017 0.250 <0.001 0.422 <0.001
职业倦怠维度评分 －0.332 <0.001 －0.027 0.709 －0.276 <0.001 －0.331 <0.001
继发性创伤应激维度评分 －0.112 0.120 －0.012 0.872 －0.221 0.002 －0.149 0.038
表4 助产士发生CF影响因素的多因素非条件logistic回归分析变量含义及赋值情况
自变量/因变量 变量名 赋值
助产士CF程度 y y＝0表示无或轻度CF，y＝1表示中度或重度CF
婚姻状况 x1 x1＝1表示未婚，x1＝2表示已婚，x1＝3表示离异
从事助产年限 x2 x2＝1表示1～5年，x2＝2表示6～10年，x2＝3表示11～15年，x2＝4表示≥16年
睡眠质量 x3 x3＝1表示良好，x3＝2表示一般，x3＝3表示欠佳
经历创伤性分娩事件次数 x4 x4＝1表示无，x4＝2表示1～2次，x4＝3表示3～5次，x4＝4表示≥6次
对工作待遇满意度 x5 x5＝1表示非常满意，x5＝2表示满意，x5＝3表示一般，x5＝4表示不满意，x5＝5表示非常不满意
工作负荷强度 x6 x6＝1表示过大，x6＝2表示一般，x6＝3表示较轻
对工作氛围喜欢程度 x7 x7＝1表示喜欢，x7＝2表示一般，x7＝3表示不喜欢
近1个月工作被认可程度 x8 x8＝1表示高，x8＝2表示一般，x8＝3表示低
表5 助产士发生CF影响因素的多因素非条件logistic回归分析结果
影响因素 B SE Wald值 P值 OR值 OR值95%CI
婚姻状况(vs未婚)     12.845 0.002    
已婚 2.871 0.821 12.223 <0.001 17.662 3.531～88.341
离异 2.053 0.693 8.766 0.003 7.792 2.002～30.328
从事助产年限(vs 1～5年)     10.446 0.015    
6～10年 0.048 0.674 0.005 0.943 1.050 0.280～3.934
11～15年 0.983 0.813 1.462 0.277 2.672 0.543～13.146
≥16年 －4.622 1.659 7.766 0.005 0.010 <0.001～0.254
睡眠质量(vs良好)     1.599 0.450    
一般 0.680 0.538 1.599 0.306 1.975 0.688～5.670
欠佳 20.323 28 420.722 <0.001 0.999 669 966 140.000 <0.001
经历创伤性分娩事件次数(vs 0次)     5.723 0.026    
1～2次 －0.405 0.657 0.380 0.538 0.667 0.184～2.418
3～5次 1.791 0.908 3.891 0.009 5.994 1.011～35.524
≥6次 0.095 0.685 0.019 0.890 1.100 0.287～4.215
对工作待遇满意度(vs非常满意)     4.218 0.377    
满意 1.531 0.920 2.770 0.096 4.621 0.762～28.027
一般 1.125 0.921 1.491 0.222 3.079 0.506～18.720
不满意 0.305 1.038 0.087 0.769 1.357 0.177～10.382
非常不满意 19.240 23 044.847 <0.001 0.999 226 840 879.000 <0.001
工作负荷强度(vs过大)     0.673 0.714    
一般 －0.364 0.732 0.246 0.620 0.695 0.165～2.920
较轻 0.268 0.615 0.189 0.664 1.307 0.391～4.364
对工作氛围喜欢程度(vs喜欢)     13.231 0.001    
一般 4.782 1.315 13.231 <0.001 119.318 9.072～1 569.257
不喜欢 1.229 0.661 3.459 0.063 3.417 0.936～12.473
近1个月工作被认可程度(vs高)     8.503 0.014    
一般 －1.733 0.913 3.599 0.058 0.177 0.030～1.059
低 1.041 0.730 2.038 0.153 2.833 0.768～11.838
常数项 －4.256 1.146 13.778 <0.001 0.014 —
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