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Enfermería Global

versión On-line ISSN 1695-6141

Enferm. glob. vol.20 no.64 Murcia oct. 2021  Epub 25-Oct-2021 


Satisfaction, compassion fatigue and associated factors in primary care nurses

Natalia Violim Fabri1  , Julia Trevisan Martins1  , Maria Jose Quina Galdino2  , Renata Perfeito Ribeiro1  , Aline Aparecida Oliveira Moreira1  , Maria do Carmo Lourenço Fernandez Haddad1 

1 . Universidad Estadual de Londrina . Brasil.

2 .Universidad Estadual do Norte do Paraná. Brasil.



Verifying satisfaction and fatigue due to compassion and its associated factors in nurses of the Basic Health Unit.


A descriptive and cross-sectional research developed with 101 nurses from 40 Basic Health Units in a municipality of Parana. Data were collected between November 2019 and February 2020 through a questionnaire of sociodemographic characterization, occupational and life habits and the Professional Quality of Life Scale that assesses Satisfaction and Fatigue by Compassion. The associated factors were obtained by logistic regression models.


Having a good interpersonal relationship decreased the chances of low satisfaction by compassion (p=0.025) and burnout (p=0.049). Being recognized at work had a significantly lower probability of low compassion satisfaction (p=0.040).


Good interpersonal relationships were associated with compassion satisfaction and burnout. Feeling recognized for the work done was also associated with satisfaction for compassion. Most nurses, even with high levels of satisfaction due to compassion, feel tired, which leads to reinforce the need for greater attention to the work developed by nurses in the Basic Health Unit by managers.

Keywords: Compassion Fatigue; Psychological Exhaustion; Quality of Life; Nurses; Health Centers; Primary Health Care; Family Health Strategy


Health professionals experience suffering and compassion for the other's problem, which can interfere in their quality of professional life, providing compassion fatigue syndrome1. The quality of professional life is understood from two perspectives, the positive one that is satisfaction for compassion, which happens now when professional feels joy for collaborating with other people; and the negative, compassion fatigue, which encompasses feelings of emotional exhaustion and frustration with work, peculiar to burnout and work-related traumas, characteristic of secondary traumatic stress2.

The manifestations of compassion fatigue can be perceived by workers through losses related to aspects of personal life, by health problems of a physical and emotional nature, and, above all, of the work routine, in which the quality of care for the patient is decreased, compromising the institution's work process and interpersonal relationships3.

Compassion fatigue is rightly related to the decrease in satisfaction levels due to compassion, in addition to worsening of secondary traumatic stress and burnout, understood as dimensions that affect the quality of life of the worker4. It is emphasized that satisfaction by compassion concerns the professional's ability to face traumatic situations, suffering, sadness, illness and, even so, feeling happy to assist the other5,6.

Regarding burnout syndrome, it is considered as a mental condition, resulting from emotional exhaustion, characterized by a lack or lack of energy, enthusiasm and a feeling of depletion of resources. This situation results in depersonalization, in which the worker treats people, colleagues and the organization in a distant and impersonal way; and, consequently, in low professional achievement, in which the worker has the propensity to perform his self-assessment negatively in work activities4.

In addition, individuals have feelings of unhappiness and dissatisfaction with their professional development and experience feelings of low competence and little success in work7. Thus, burnout refers to aspects related to emotional exhaustion, that is, a feeling of lack of energy and discouragement7.

The work of Primary Health Care (PHC) nurses involves direct contact care activities with the user and management activities, confrontations between work teams, controversies in task distributions, which can lead to overload at work and in turn to burnout8.

Authors point out that low satisfaction related to emotional aspects and depersonalization during work activity interferes both in personal life and in the quality of professional life9. This statement is confirmed by the Japanese literature by presenting that factors such as irritability, anxiety, depression and time of service are associated with low professional satisfaction and the development of burnout, significantly influencing the professional quality of life of these professionals10.

There is a lack of scientific knowledge about the quality of professional life and the perspective of satisfaction and fatigue due to compassion among health professionals, especially nursing professionals11. Thus, this study is justified, since it can contribute to managers and workers together, implement strategies in the work environment that can prevent and promote healthier work environment and, thus, provide a better quality of life at work. Therefore, the study aimed to verify satisfaction and fatigue due to compassion and its associated factors in nurses from the Basic Health Unit (BHU).


Study design

This is a descriptive, cross-sectional and quantitative research.

Study place

Developed with nurses from 40 BHUs in a city of Parana. These nurses work 40 hours per week, Monday to Friday, in the morning and afternoon. It is noteworthy that these professionals have a flexible work schedule, since they attend the BHU itself, as well as also work in the Family Health Strategy (FHS), that is, they perform activities through home visits in their territory of coverage.


During the study period, 114 nurses worked in the BHU. Based on this number, the sample size was calculated considering the proportion of the outcome of 50, confidence interval of 95 and maximum error of 5, obtaining a minimum number of 84 nurses.

Inclusion criteria were working at BHU for at least 12 months and not being on leave of any kind. Thus, six professionals were excluded by health leave, making 108 nurses eligible. However, there were seven losses, totaling 101 participants.

Data collection

It occurred between November 2019 and February 2020, if they met the following inclusion criteria: working at BHU for at least 12 months and not being on leave of any kind. Each potential research participant was approached individually in their workplace and according to the day and time previously scheduled with the coordination of the BHU. The nurse received an envelope with the research instrument, which after being filled out was placed in a sealed urn in the BHU.

The data collection instrument was composed of a questionnaire containing the following variables: age (in years), gender (female or male), marital status (with partner or without partner), family income (in Real, R$), weekly workload, work shift (fixed or flexible), working time at the institution (in years) and physical activity (yes or no).

The quality of professional life was evaluated by the Brazilian version of the Professional Quality of life Scale (ProQOL-5), which has adequate psychometric properties5. It is a self-applicable instrument that assesses compassion fatigue through 28 items divided into 3 subscales: compassion satisfaction (10 items), burnout (9 items) and secondary traumatic stress (9 items). Item responses are provided on a Likert scale, which ranges from 1 (rarely) to 5 (almost always). Compassion fatigue results from high burnout scores, secondary traumatic stress and low compassion satisfaction12. It is noteworthy that the option for this scale occurred because it integrated the positive component of satisfaction by compassion and not only the negative component.

The ProQOL score was transformed into Zscores and these into Tscores12 and the dimensions were dichotomized through the median: low satisfaction for compassion (≤49), high burnout (≥49) and traumatic secondary stress (≥50).

Data analysis and treatment

The data were analyzed in the Statistical Package for the Social Science® program version 20.0. The variables of this study were presented through frequency distribution and measures of central tendency and variability. The associated factors were obtained by binary logistic regression, considering burnout, secondary traumatic stress and low compassion satisfaction as dependent variables; and the characterization variables as independent. The results were expressed by Odds ratio estimates with respective 95% confidence interval.

Ethical aspects

Approved by the Research Ethics Committee according to opinion number 3,537,838. All participants signed the Free and Informed Consent Form (FICF).


The study included 101 nurses, whose predominant characteristics were female (97%) age group from 41 to 63 years (93.1%), with a partner (65.3%), monthly family income of 1 to 5 minimum wages (50.1%), sedentary lifestyle (65.3%), fixed work shift (75.2%), working time from 8 to 10 years (56.4%), interpersonal relationships at work well/excellent (88.1%), being recognized by work (54.5%) and present absenteeism due to disease from 1 to 14 days (84.2%).

Good interpersonal relationships at work and feeling recognized at work decreased the chances of low satisfaction by compassion (Table 1).

Table 1.  Association between the quality of professional life related to satisfaction by compassion and the variables of characterization of nurses (n=101). Londrina, PR, Brazil. 2019-2020. 

*.Wald Chi-square Test **2020 Minimum Wage: R$1,045.00

Significantly lower chances of burnout were associated with nurses who reported having good or excellent interpersonal relationships at work (Table 2).

Table 2.  Association between the quality of professional life related to burnout and the variables of characterization of nurses (n=101). Londrina, PR, Brazil. 2019-2020. 

*.Wald Chi-square Test **2020 Minimum Wage: R$1,045.00

Secondary traumatic stress did not present statistically significant differences with the variables analyzed (Table 3).

Table 3.  Association between the quality of professional life related to secondary traumatic stress and the variables of characterization of nurses (n=101). Londrina, PR, Brazil. 2019-2020. 

*.Wald Chi-square Test **2020 Minimum Wage: R$1,045.00


Regarding the age group of the professionals in the present study, they are like the research with PHC nurses from Paraiba13. Because they are not beginners, it is believed that the age group of the participants in the present study and the time of service have already provided skills to face work adversities. This statement is corroborated by a research conducted with intensive care unit nurses in Australia, pointing out that less experienced professionals had lower satisfaction for compassion14.

Other studies showed that workers who were working shorter in the service and with a lower age were more likely to fatigue by compassion, that is, satisfaction by compassion is related to age and with greater professional experience15.

It is noteworthy that compassion fatigue decreases with years of professional experience, that is, the more experienced the less experienced the lower the probability of compassion fatigue4,16. Thus, it may be associated with the adaptability that may exist among nurses with less professional experience15.

Regarding most women, it is verified that nursing documented has a female majority among its professionals, but recently, there has been a greater demand of men for the profession17.

Most of the participants in the study in question lived with a partner. A study showed that professionals who live with a partner perceive work with greater satisfaction and highlight that a partner can provide social and family support for the mental and emotional structure of the professional in his/her place of activity18.

Physical activities were also not associated with satisfaction or compassion fatigue among the nurses in the present study, and most of them indicated that they are sedentary. Results of a study conducted with nurses identified that not performing physical or leisure activities provides greater exposure to burnout and secondary traumatic stress, corroborating the premise that workers who do not invest in their private quality of life have a higher risk of fatigue due to compassion, since work occupies centrality in their lives19.

Performing physical or leisure activity provides pleasure and is indicated as a protective factor for various chronic physical diseases, such as cardiovascular and psychic diseases20. The performance of physical activity has a significant influence on the reduction of stress and absenteeism rates and improves satisfaction when performing their work activities in PHC11.

A study conducted with Portuguese nurses found that compassion fatigue is related to personal factors such as age, sex, professional experience and leisure activities15. Furthermore, a study conducted in Turkey showed that burnout syndrome triggers low satisfaction due to compassion and the quality of life of health professionals9. A study conducted with nurses from the United States of America and Canada found that professionals who declared their health bad were more likely to develop burnout and compassion fatigue21.

The results of the study in question showed that having good interpersonal relationships and feeling recognized in work decreases the probability of low satisfaction for compassion. Nurses experience an intense environment about intense and conflicting interpersonal relationships with their team, with other professionals, with patients, among others. This situation can have negative impacts on the quality of the care provided, as well as satisfaction, pleasure, and well-being when performing their work activities22.

Having a good interpersonal relationship in the work environment was associated with satisfaction for compassion. A study conducted in Australia indicates that inadequate working conditions of nurses are directly associated with stress and compassion fatigue23. Furthermore, the non-formalization of the aggressive act, the scarcity of dialogue with managers within the work environment, are related to satisfaction by compassion in labor24.

A study indicated that nurses tend to be people with a care profile and compassionate and when they feel recognized for what they do, they decrease considerably for compassion fatigue14. Another literature review study conducted with PHC professionals also indicated that the non-recognition of what is done in the work predisposes the development of burnout25.

In the study in question, the lowest chances of burnout were associated with nurses who claimed to have good and excellent interpersonal relationships at work. The absence or interpersonal relationship conflicts are related to burnout syndrome among nurses26. A study developed in China showed that professional exhaustion is present among community health nurses, culminating in decreased job satisfaction and, consequently, increasing complaints of psychological symptoms. This was due to the lack of recognition for the activities performed, in addition to workloads and extensive responsibilities, such as: performing actions for disease prevention and health education, psychological consultation, administrative work and providing services in homes27.

Regarding limitations, the cross-sectional study does not evaluate cause and effect, as well as having been conducted with BHU nurses from only one city, which does not allow the generalization of results to other realities. However, it can contribute to nurses together as managers of the BHU to reflect on the theme of satisfaction and fatigue due to compassion, since their occurrence can be configured in injuries and mental illness of nurses affecting their quality of professional and private life and, in turn, interfere in the care of patients and their families.


Good interpersonal relationships were associated with compassion satisfaction and burnout. Feeling recognized for the work done was also associated with satisfaction for compassion. Most nurses, even with high levels of satisfaction due to compassion, feel tired, which leads to reinforce the need for greater attention to the work developed by nurses in the BHU by managers.


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Received: November 28, 2020; Accepted: March 27, 2021

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