Bacground: The aim of the study is to determine the level of compassion and affecting factors among Emergency Department (ED) health workers. Methodology: The Compassion Scale, which was developed by Pommier in 2011 and was adapted to Turkish, was used in the evaluation of the level of compassion of the Training and Research Hospital ED staff, who had more than 500 patient admissions per day. Results: The mean age of 84 ED health workers included in the study was 27.20±5.430, 32.2% were male and 67.8% were female. 41.7% (n=35) of the ED health workers were Emergency Doctors and 58.3% were Emergency Nurses. Women's "Kindness", "Common humanity" and "Mindfulness" compassion subgroup average scores were found to be higher than men (15.859±2.538 versus 15.000±3.637; 16.859±2.488 versus 16.037±3.345; 16.245±1.606 versus 14.777±3.467). Women's ‘’Indifference’’, ‘’Separation’’ and ‘’Disengagement’’ compassion subgroup average scores were found to be lower than men (7.736±2.560 versus 8.740±3.323; 77.666±2.502 versus 9.222±2.939; 7.350±2.371 versus 9.407±3.388). Emergency Nurses' "Kindness", "Common humanity" and "Mindfulness" compassion subgroup scores were higher than Emergency Doctors (16.510±2.509 versus 14.285±3.044; 17.163±2.124 versus 15.800±3.411; 16.0816±2.0997 versus 15.3429±2.8382). Emergency Nurses' ‘’Indifference’’, ‘’Separation’’ ve ‘’Disengagement’’ compassion subgroup scores were lower than Emergency Doctors (7.061±2.135 versus 9.457±3.146; 7.591±2.317 versus 8.971±3.082; 7.122±2.412 versus 9.257±3.061). Conclusion: The compassion levels of female ED health workers were higher than that of male ED health workers and the level of compassion of Emergency Nurses was higher than that of Emergency Doctors.
Compassion is an attitude that motivates the individual to understand and support the inner world of the individual in need. Compassion was defined by Gilbert as a form of benevolence and kindness that includes a deep awareness of self and others' distress, a desire and effort to alleviate suffering [1].
Compassion is also defined as the emotional state that lies between an individual's objective and emotional understanding (empathy) towards other people and subjective reactions towards oneself (sympathy), [2].
Compassion, which is one of the fundamental values of health care, is defined as the desire to understand and alleviate the suffer or misfortune of others [2,3]. Compassion is frequently used by healthcare professionals while performing their duties [4].
Compassion is one of the emotions that healthcare professionals most need and feel while performing their duties. It is one of the most important virtues expected from medical professionals in medicine and expected by patients. In the UK, compassion is cited as one of the six core values in the NHS constitution [5,6].
In the healthcare field, compassion is believed to have numerous practical advantages. Treating patients with compassion has been claimed to be beneficial in improving clinical outcomes, increasing patient satisfaction with services and improving the quality of patient information [7].
More studies on compassion insufficiency have been conducted in the literatüre [8-10].
The Compassion Scale, developed by Elizabeth Pommier in 2011, is used to determine the level of compassion. Compassion scale consists of 6 subgroups ("Kindness", "Indifference", "Common humanity", "Separation", "Mindfulness" and "Disengagement") and a total of 24 items [11].
In the literature, there are few studies on the level of compassion studied in different business areas.
In a study conducted with teachers, the differences between "Indifference", "Separation" and "Disengagement" compassion subgroup levels between female teachers and male teachers were found to be statistically significant (p<0.05). In this study, there were no statistically significant differences between married and single teachers, between those with and without children and between age groups (p>0.05), [12].
In the compassion study of Çingöl et al. [13] with 494 students, the level of compassion in students was found to be high (compassion scale mean score 4.19±0.44).
In the compassion study conducted by Doğar et al. [14] with 508 sports sciences students, 191 women and 317 men, it was determined that the students' level of compassion was moderate.
In the study conducted by Arkan et al. [15] with 227 nurses working in a university hospital, no statistically significant difference was found between gender, marital status, weekly working hours and total compassion score averages and total subscale score averages (p>0.05).
There is not enough study in the literature about the level of compassion in ED workers. The aim of this study is to determine the level of compassion and the factors affecting the level of compassion among emergency health workers (doctors and nurses) working in crowded ED.
After the ethics committee approval of the compassion level of ED healthcare professionals (Bakırköy Dr.Sadi Konuk Education and Research Hospital Ethics committee- Date: 12.02.2018-Decision no: 2018-03-10), Bakırköy Dr. Sadi Konuk Training and Research Hospital was carried out with the employees of the Adult ED.
The Compassion Scale, which was developed by Pommier in 2011 and adapted to Turkish in 2016 by Seher Akdeniz and Mehmet Engin Deniz, was used to assess the level of compassion of ED workers [11,16].
Compression Scale; It consists of six sub-groups: "Kindness", "Indifference", "Common humanity", "Separation", "Mindfulness" and "Disengagement". The scale consists of 24 items. Each subgroup consists of 4 items. These items are in different ranks on the compassion scale. Scoring of the 6th, 8th, 16th, 24th items for the "Kindness" subgroup, scoring of the 2nd, 12th, 14th, 18th items for the "Indifference" subgroup, scoring of items 11, 15, 17, 20 for the "Common humanity" subgroup, scoring of the 3rd, 5th, 10th, 22nd items for the "Separation" subgroup, scoring the 4th, 9th, 13th and 21st items for the "Mindfulness" subgroup, for the "Disengagement" subgroup, the scoring of the 1st, 7th, 19th and 23rd items is calculated. Reverse scoring is done in the items "Indifference", "Separation" and "Disengagement". The answering system is a five-point Likert scale for each statement: "(5) Always", "(4) Often", "(3) Sometimes", "(2) Rarely" and "(1) Never". The scores of each item range from "5 to 1". The factor loadings of the items belonging to the subgroups vary (0.61-0.74 for the ''Kindness'' subgroup, 0.56-0.69 for ''Indifference'', 0.54-0.83 for ''Common humanity'', 0.51-0.73 for ''Separation'', 0.55-0.72 for “Mindfulness” and 0.58-0.68 for “Disengagement”). The fit indices of the scale were found as (CFI = 0.97; NNFI = 0.96; SRMR = 0.05 and RMSEA=0.06). Internal consistency reliability coefficients ranged from 0.57 to 0.77 for subgroups.
The mean age of 84 ED health workers included in the study was 27.20±5.430 (Median: 25-Min:19-Max:46). The mean age of men (n = 27) (28.07±5.830) was higher than the mean age of women (n = 57) (26.79±5.233), (p = 0.314).
About 41.7% (n = 35) of the ED health workers participating in the study were Emergency Doctors and 58.3% (n = 49) were Emergency Nurses (2 Emergency Medical Technicians working in the ED were evaluated in the nurse class because they started and continued their profession as Emergency Nurses). 57.1% (n = 20) of the Emergency Doctors were female, 42.9% (n = 15) were male, 75.5% of the Emergency Nurses were female (n = 37), 24.5% (n = 12) were male, (p = 0.076).
While the ED health workers participating in the study worked in the hospital for an mean of 46.2857±54.1787 months (Median: 26; Min: 1; Max: 330), they worked in the ED for an mean of 34.5595±42.2038 months (Median: 15; Min: 1; 192).
An average of 9.6548±3.21328 (Median 10; Min: 0; Max: 19) ED health workers was on duty.
About 29.8% (n = 25) of the ED health workers participating in the study were married and 84.5% (n = 71) did not have children. 50% (n = 42) of the employees were undergraduate graduates and 58.3% (n = 49) were Emergency Nurses. 51.2% of the employees were working in shifts, 75% of them chose to work in the ED. 39.3% of the employees had been working in the ED for 1 year, 95.2% were on duty and 66.7% were on duty for 10 or more per month (Table 1) .
Table 1: Characteristics of the ED Health Workers Participating in the Study
Characteristics | n | % | |
Sex | Female | 57 | 67.9 |
Male | 27 | 32.1 | |
Marital status | Married | 25 | 29.8 |
Single | 59 | 70.2 | |
Number of children | No | 71 | 84.5 |
1 | 8 | 9.5 | |
2 | 4 | 4.8 | |
≥3 | 1 | 1.2 | |
Education | Health vocational high school | 8 | 9.5 |
Associate degree | 5 | 6 | |
Bachelor's degree | 42 | 50 | |
Master degree | 21 | 25 | |
Doctorate | 8 | 9.5 | |
Profession | Doctor | 35 | 41.7 |
Nurse | 49 | 58.3 | |
Position | Emergency nurse | 49 | 58.3 |
General practitioner | 6 | 7.1 | |
Emergency resident | 21 | 25 | |
Emergency physician | 8 | 9.5 | |
Working type | Daytime | 4 | 4.8 |
Night shift | 37 | 44 | |
Shift | 43 | 51.2 | |
Working in the ED is your own choice | Yes | 63 | 75 |
No | 21 | 25 | |
Working times in ED (month) | ≤12 | 33 | 39.3 |
13-60 | 29 | 34.5 | |
61-120 | 14 | 16.7 | |
≥121 | 8 | 9.5 | |
Night shift | No | 4 | 4.8 |
Yes | 80 | 95.2 | |
Number of night shift | ≤9 | 28 | 33.3 |
≥10 | 56 | 66.7 | |
About 88.6% (n = 31) of the Emergency Doctors stated that they worked in the ED voluntarily. 3 of the 4 doctors who did not work in the ED voluntarily were general practitioners. 95.2% of the Emergency Residents and 100% of the Emergency Physician were working in the ED voluntarily. While 63% (n = 32) of the Emergency Nurses were working in the ED voluntarily, 34.7% (n = 17) of them stated that they did not work in the ED voluntarily.
The responses of the ED health workers to the compassion scale items are shown in Table 2.
Table 2: Responses of ED Health Workers to the Compassion Scale
| Compassion scale items | 1-Never n | 2-Rarely n | 3-Sometimes n | 4-Often n | 5-Anytime n | Total Scores n | Mean±SD | |
When people cry in front of me, I often don’t feel anything at all | 31 | 25 | 20 | 6 | 2 | 175 | 2.0833±1.05520 | |
Sometimes when people talk about their problems, I feel like I don’t care | 31 | 28 | 18 | 6 | 1 | 170 | 2.0238±0.99367 | |
I don’t feel emotionally connected to people in pain | 36 | 25 | 15 | 5 | 3 | 166 | 1.9762±1.08635 | |
I pay careful attention when other people talk to me | 4 | 4 | 5 | 48 | 23 | 334 | 3.9762±0.98147 | |
I feel detached from others when they tell me their tales of woe | 40 | 27 | 15 | 1 | 1 | 148 | 1.7619±0.87287 | |
If I see someone going through a difficult time, I try to be caring toward that person | 3 | 1 | 4 | 44 | 32 | 353 | 4.2024±0.87509 | |
I often tune out when people tell me about their troubles | 48 | 25 | 8 | 2 | 1 | 135 | 1.6071±0.85048 | |
I like to be there for others in times of difficulty | 7 | 6 | 11 | 39 | 21 | 313 | 3.7262±1.16527 | |
I notice when people are upset, even if they don’t say anything | 2 | 4 | 15 | 49 | 14 | 321 | 3.8214±0.85250 | |
When I see someone feeling down, I feel like I can’t relate to them | 24 | 34 | 18 | 3 | 5 | 183 | 2.1786±1.07726 | |
Everyone feels down sometimes, it is part of being human | 1 | 2 | 10 | 18 | 53 | 372 | 4.4286±0.88203 | |
Sometimes I am cold to others when they are down and out | 32 | 32 | 17 | 3 | 0-0 | 159 | 1.8929±0.85048 | |
I tend to listen patiently when people tell me their problems | 2 | 2 | 10 | 50 | 20 | 336 | 4.0000±0.82140 | |
I don’t concern myself with other people’s problems | 34 | 27 | 21 | 2 | 0-0 | 159 | 1.8929±0.86453 | |
It’s important to recognize that all people have weaknesses and no one’s perfect | 1 | 4 | 0-0 | 23 | 56 | 381 | 4.5833±0.69782 | |
My heart goes out to people who are unhappy | 1 | 5 | 19 | 45 | 14 | 318 | 3.7857±0.83697 | |
Despite my differences with others, I know that everyone feels pain just like me | 7 | 9 | 21 | 36 | 11 | 287 | 3.4167±1.11083 | |
When others are feeling troubled, I usually let someone else attend to them | 17 | 39 | 20 | 6 | 2 | 189 | 2.2500±0.94263 | |
I don’t think much about the concerns of others | 18 | 41 | 17 | 6 | 2 | 185 | 2.2024±0.94144 | |
Suffering is just a part of the common human experience | 1 | 7 | 13 | 19 | 44 | 350 | 4.1667±1.05091 | |
When people tell me about their problems, I try to keep a balanced perspective on the situation | 3 | 2 | 6 | 46 | 27 | 344 | 4.0952±1.05091 | |
I can’t really connect with other people when they’re suffering | 18 | 36 | 24 | 4 | 2 | 188 | 2.2381±0.92644 | |
I try to avoid people who are experiencing a lot of pain | 26 | 31 | 19 | 5 | 3 | 180 | 2.1429±1.04297 | |
When others feel sadness, I try to comfort them | 4 | 3 | 11 | 47 | 19 | 326 | 3.8810±0.96199 | |
Total point | 391 | 838 | 1011 | 2052 | 1780 | 6072 | 3.0119 | |
The mean scores of the compassion subscale were analyzed according to the responses of the ED health worker to the compassion scale items.
The average of 24 compassion scale items was found to be 3.0119, according to the Likert scale of ED health workers. The average of the "Kindness" subgroup (items: 6, 8, 16, 24) was found to be 3.8988. The mean of "Indifference" subgroup (items: 2, 12, 14, 18) was found to be 2.0149. The mean of "Common humanity" subgroup (items: 11, 15, 17, 20) was found to be 4.1488. The mean of the "Separation" subgroup (items: 3, 5, 10, 22) was found to be 2.0387. The mean of the "Mindfulness" subgroup (items: 4, 9, 13, 21) was found to be 3.9732. The mean of the "Disengagement" subgroup (items: 1, 7, 19, 23) was found to be 2.0089.
Total compassion scale subgroup mean scores of ED health workers were investigated. The mean score of the "Kindness" subgroup was 15.5833±2.9420 (Median:16-Min:4-Max:20). The mean score of the "Indifference" subgroup was 8.0595±2.8469 (Median:8-Min:4-Max:17). The mean score of the "Common humanity" subgroup was 16.5952±2.7989 (Median:17-Min:4-Max:20). The mean score of the "Separation" subgroup was 8.1667±2.7323 (Median:8-Min:4-Max:19). The mean score of "Mindfulness" subgroup was 15.7738±2.4463 (Median:16-Min:4-Max:20).
The mean score of the “Disengagement” subgroup was 8.0119±2.853 (Median:7.5-Min:4-Max:19) (Table 3).
Table 3: Comparison of characteristics and compassion subgroup scores of ED health workers participating in the study
|
| Kindness Mean±SD: 15.5833±2.9420 | Indifference Mean±SD: 8.0595±2.8469 | Common humanity Mean±SD: 16.5952±2.7989 | Separation Mean±SD: 8.1667±2.7323 | Mindfulness Mean±SD: 15.7738±2.4463 | Disengagement Mean±SD: 8.0119±2.8853 | |||||||
|
| Items no: 6, 8, 16, 24 | Items no: 2, 12, 14, 18 | Items no: 11, 15, 17, 20 | Items no: 3, 5, 10, 22 | Items no: 4, 9, 13, 21 | Items no: 1, 7, 19, 23 | |||||||
Characteristics | n | Mean±SD | p | Mean±SD | p | Mean±SD | p | Mean±SD | p | Mean±SD | p | Mean±SD | p | |
Sex | Female | 57 | 15.859±2.538 | .213 | 7.736±2.560 | .132 | 16.859±2.488 | .210 | 7.666±2.502 | .014 | 16.245±1.606 | .044 | 7.350±2.371 | .002 |
Male | 27 | 15.000±3.637 | 8.740±3.323 | 16.037±3.345 | 9.222±2.939 | 14.777±3.467 | 9.407±3.388 | |||||||
Profession | Nurse | 49 | 16.510±2.509 | .000 | 7.061±2.135 | .000 | 17.163±2.124 | .041 | 7.591±2.317 | .022 | 16.081±2.099 | .174 | 7.122±2.412 | .001 |
Doctor | 35 | 14.285±3.044 | 9.457±3.146 | 15.800±3.411 | 8.971±3.082 | 15.342±2.838 | 9.257±3.061 | |||||||
ED own choice | Yes | 63 | 15.301±3.180 | .129 | 8.333±2.896 | .128 | 16.444±3.004 | .396 | 8.381±2.853 | .215 | 15.634±2.641 | .371 | 8.301±3.024 | .111 |
No | 21 | 16.428±1.886 | 7.238±2.586 | 17.047±2.060 | 7.523±2.711 | 16.190±1.721 | 7.142±2.264 | |||||||
Duty | No | 4 | 17.500±1.914 | .183 | 6.250±2.629 | .194 | 17.250±2.217 | .635 | 8.250±3.095 | .951 | 16.250±0.500 | .692 | 5.500±1.290 | .074 |
Yes | 80 | 15.487±2.959 | 8.150±2.842 | 16.562±2.832 | 8.162±2.734 | 15.750±2.503 | 8.137±2.889 | |||||||
Number of duty | ≤9 | 28 | 15.928±2.259 | .450 | 7.928±2.463 | .768 | 16.357±2.683 | .585 | 7.642±1.928 | .216 | 15.607±1.728 | .662 | 7.785±2.529 | .614 |
≥10 | 56 | 15.410±3.234 | 8.125±3.039 | 16.714±2.871 | 8.428±3.038 | 15.857±2.746 | 8.125±3.063 | |||||||
Marital status | Single | 59 | 15.491±3.098 | .663 | 7.794±2.731 | .558 | 16.440±2.908 | .440 | 8.033±2.559 | .497 | 15.779±2.546 | .973 | 7.745±2.636 | .196 |
Maried | 25 | 15.800±2.581 | 8.320±3.145 | 16.960±2.541 | 8.840±3.137 | 15.760±2.241 | 8.640±3.377 | |||||||
Having children | No | 71 | 15.408±3.031 | .205 | 8.140±2.894 | .544 | 16.549±2.801 | .727 | 8.225±2.788 | .648 | 15.718±2.536 | .630 | 8.096±2.913 | .523 |
Yes | 13 | 16.538±2.258 | 7.615±2.631 | 16.846±2.882 | 7.846±2.478 | 16.076±1.938 | 7.538±2.787 | |||||||
The characteristics of the ED health workers and the mean of the compassion scale subgroups were compared (Table 3).
The mean "Separation" score of women (7.666±2.502) was found to be statistically significantly lower than the mean score of "Separation" of men (9.222±2.939) (p = 0.014). The mean score of "Mindfulness" of women (16,245±1,606) was found to be statistically significantly higher than the mean score of "Mindfulness" of men (14.777±3.467) (p = 0.044). The mean "Disengagement" score of women (7.350±2.371) was found to be statistically significantly lower than the mean "Disengagement" score of men (9.407±3.388) (p = 0.002). However, it was found that "Kindness"(15.859±2.538 versus 15.000±3.637) ''Indifference'' (7.736±2.560 versus 8.740±3.323) ''Common humanity'' (16,859±2.488 versus 16.037±3.345) male and female ED health workers mean scores and gender were not statistically significant (p>0.05) (Table 3).
The "Kindness" mean score of the Emergency Nurses (16.510±2.509) was found to be statistically significantly higher than the "Kindness" mean score of the Emergency Doctors (14,285±3.044), (p = 0.000). The "Indifference" mean score of the Emergency Nurses (7.061±2.135) was found to be statistically significantly lower than the "Indifference" mean score of the Emergency Doctors (9.457±3.146), (p = 0.000). The mean score of "Common humanity" of Emergency Nurses (17.163±2.124) was found to be statistically significantly higher than the mean score of "Common humanity" of Emergency Doctors (15.800±3.411), (p = 0.041). The mean “Separation” score of the Emergency Nurses (7.591±2.317) was found to be statistically significantly lower than the “Separation” mean score of the Emergency Doctors (8.971±3.082), (p = 0.022). The "Disengagement" mean score of the Emergency Nurses (7.122±2.412) was found to be statistically significantly lower than the "Disengagement" mean score of the Emergency Doctors (9.257±3.061), (p = 0.001). The difference between the mean "Mindfulness" scores of Emergency Nurses and Emergency Doctors (16.0816±2.0997) versus 15.3429±2.8382) was not statistically significant (p = 0.174) (Table 3).
There was no statistically significant difference between the mean of all compassion subgroups among ED health workers, who voluntarily worked in the ED and those who did not work voluntarily (p>0.05). There was no statistically significant difference between the mean of all compassion subgroups among the ED health workers and those who were on duty and those who were not on duty (p>0.05). There was no statistically significant difference between the mean of all compassion subgroups among the ED health workers with ≤9 night shifts and ≥10 night shifts (p>0.05). There was no statistically significant difference between the mean of all compassion subgroups among married and single ED health workers (p>0.05). There was no statistically significant difference between the mean of all compassion subgroups among the ED health workers and those who have children and those who do not have children (p>0.05) (Table 3).
A one-way anova test was performed to determine whether there was a statistical difference between the education levels, professions, statuses and duration of work in the ED and the mean compassion subgroups of the ED health workers. The "Benferroni test" was performed to determine the difference between the education levels of the emergency service workers and the compassion subgroups. The difference between the "Kindness" mean score of the bachelor's degree ED health workers (16.2143±2.7277) and the "Kindness" mean score (13.8571±3.4247) of the master's graduate ED health workers was found to be statistically significant (p = 0.023). The difference between the "Separation" mean score of the bachelor's degree ED health workers (7.3810±2.1859) and the "Separation" mean score of the master's graduate ED health workers (9.7143±3.5375) was found to be statistically significant (p = 0.013). The difference between the "Disengagement" mean score of the bachelor's degree ED health workers (7.0714±2.5123) and the "Disengagement" mean score (9.4286±3.4288) of the master's graduate ED health workers was found to be statistically significant (p = 0.020). There was no statistically significant difference between the mean scores of other compassion subgroups and education levels of ED health workers (p>0.05). "Benferroni test" was performed to determine the difference between the status status of emergency service workers and compassion subgroups. The difference between the "Kindness" mean score of the Emergency Nurses (16.5102±2.5093) and the Emergency Residents "Kindness" mean score (13.8571±3.4247) was found to be statistically significant (p = 0.002). The difference between the "Indifference" mean score of the Emergency Nurses (7.0612±2.1351) and the Emergency Residents "Indifference" mean score (9.4571±3.15152) was found to be statistically significant (p = 0.003). The difference between the "Separation" mean score of the Emergency Nurses (7.15918±2.3176) and the Emergency Residents "Separation" mean score (9.7143±3.5375) was found to be statistically significant (p = 0.016). The difference between the "Disengagement" mean score of the Emergency Nurses (7.1224±2.4120) and the Emergency Residents "Disengagement" mean score (9.4286±3.4288) was found to be statistically significant (p = 0.011). There was no statistically significant difference between the mean scores of other compassion subgroups and Emergency Physician, Emergency Residents, General Practitioner and Emergency Nureses.
No statistically significant difference was found between the duration of working in the ED and the mean scores of the compassion subgroups (p>0.05).
The average "Kindness" scores of female doctors were higher than male doctors and the average "Kindness" scores of male nurses were higher than female nurses. The mean "Indifference" scores of female doctors were lower than male doctors and the average "Indifference" scores of female nurses were found to be lower than male nurses. The average "Common humanity" scores of female doctors were higher than male doctors and the average "Common humanity" scores of female nurses were higher than male nurses. The average "Separation" scores of female doctors were higher than that of male doctors and the average "Separation" scores of male nurses were higher than female nurses. The average "Mindfulness" scores of female doctors were higher than that of male doctors and the average "Mindfulness" scores of female nurses were higher than male nurses. The mean "Disengagement" scores of female doctors were lower than male doctors and the average "Disengagement" scores of female nurses were lower than male nurses.
In our study, there was no statistically significant difference between the mean scores of both "Common humanity" and "Mindfulness" subgroups and Emergency Physician, Emergency Residents, General Practitioner and Emergency Nureses. The mean "Kindness" score of Emergency Nurses (16.5102±2.5093) was found to be higher than the Emergency Residents "kindness" score (13.8571±3.4247). The mean scores of the Emergency Nurses' ''Indifference'' (7.0612±2.1351), ''Separation'' (7.15918±2.3176) and ''Disengagement'' (7.1224±2.4120) from Emergency Residents mean scores (respectively: 9.4571±3.15152; 9.7143±3.5375); 9.4286±3.4288) were found to be low.
Emergency Nurses have the highest "Kindness" compassion subgroup mean score (16.5094±2.5093), the highest "Common humanity" compassion subgroup mean score (17.1633±2.1247) and the highest "Mindfulness" compassion subgroup mean score. score (16.0816±2.0997). Emergency Nurses received the lowest "Indifference" compassion subgroup mean score (7.0612±2.1351) and the lowest "Disengagement" compassion subgroup mean score (7.1224±2.4120). However, General Practitioners had the lowest "Separation" compassion subgroup mean score (7.3333±1.7511).
Emergency Physician had the lowest "Kindness" compassion subgroup mean score (13.8571±3.4247). General Practitioners received the lowest "Common humanity" compassion subgroup mean score (15.1667±2.7868). Emergency Physician received the lowest "Mindfulness" compassion subgroup mean score (15.0000±2.1380). General practitioners received the highest "Indifference" compassion subgroup mean score (10.0000±2.5298). Emergency Residents had the highest "Separation" compassion subgroup mean score (9.7143±3.5375). Emergency Residents had the highest "Disengagement" compassion subgroup mean score (9.4286±3.4288).
Compassion is a process followed to ensure the well-being of patients through specific, ethical actions to find solutions as an empathetic response to suffer [17]. Thus, compassion is a process that requires sensitivity to understand the suffering of others, a willingness to help find a solution to the current situation and to enhance the well-being of the sufferer [3,4,17].
While there are a few studies in the literature about the fatigue of compassion in ED health workers, studies on the level of compassion are insufficient [8-10].
The "Compassion Scale" developed by Pommier in 2011 is used to evaluate the level of compassion [11]. After Akdeniz et al. [16] completed the validity and reliability study by translating the "Compassion Scale" into Turkish in 2016, compassion studies were conducted in different fields in Turkey. Although there are not many in the literature, studies on the level of compassion have been carried out in different fields [12-15].
In the compassion study of Çingöl et al. [13] conducted with 494 students, the students' level of compassion was found to be high (compassion scale mean score 4.19±0.44). A difference was found between students' compassion levels in terms of gender, class and income status variables. While there was no difference between male (n = 81) and female (n = 413) students in the other subgroups, there were differences between the average levels of "Indifference", "Separation", "Mindfulness" and "Disengagement" statistically significant (respectively: p = 0.000, p = 0.000, p = 0.013, p = 0008, p = 0.000).
In the compassion study we conducted with 84 ED health workers, the mean score of compassion levels (3.0119) according to the Likert scale (Min:1-Max:5) of ED health workers was found lower (4.19±0.44) than the study of Çingöl et al. [13] with nursing students. The mean of “Kindness” subgroup items (3.8988) was lower than that of nursing students (4.26±0.61). The mean of "Indifference" subgroup items (2.0149) was higher than that of nursing students (1.79±0.64). The mean of the "Common humanity" subgroup items (4.1488) was found to be similar to that of nursing students (4.13±0.65). The mean of "Separation" subgroup items (2,0387) was found to be higher than that of nursing students (1.84±0.59). The mean of "Mindfulness" subgroup items (3.9732) was found to be lower than that of nursing students (4.08±0.57). The mean of "Disengagement" subgroup items (2.0089) was higher than that of nursing students (1.71±0.62).
In our study (35 doctors and 49 nurses), the "Kindness" and "Mindfulness" subgroup scales of the ED health workers were found to be lower than the nursing students in this study, however, "Indifference", "Separation" and "" Disengagement subgroup scales were higher than those of nursing students. It makes one think that working life itself is one of the main factors that cause a decrease in compassion levels.
A compassion study was conducted by Çalışoğlu [12] with a total of 227 primary school classroom teachers, 132 women and 95 men, in Turkey. In this study, the mean "Indifference" level of male teachers (7,7053±2.99245) was found to be higher than the mean "Indifference" level of female teachers (6.1970±2.34257), (p = 0.000). The mean "Separation" level of male teachers (7.6737±2,45141) was found to be higher than the mean "Separation" level of female teachers (6.7045±2.29083), (p = 0.003). The mean ‘’Disengagement’' level of male teachers (6.7579±2.89429) was found to be higher than the mean ‘’Disengagement’’ level of female teachers (6.0379±2.13443), (p = 0.032). The difference between the mean levels of "Kindness", "Common humanity" and "Mindfulness" between female teachers and male teachers was not statistically significant (p>0.05). In Çalışoğlu's study, there were no statistically significant differences between married and single teachers, between those with and without children and between age groups and between Compassion subgroups (p>0.05), [12].
In the compassion study conducted by Doğar Y and his friends with 191 female and 317 male Sports Science Faculty students, it was determined that the students' level of compassion was moderate. In the 'Indifference' subgroup, the mean level of men (9.71±3.57) was higher than the mean level of women (8.91±3.70), (p = 0.016), in the 'Disengagement' subgroup the mean level of men (9.28±3.62) was higher than the mean level of women (8.48±3.68), (p = 0.017). The differences between the mean of other compassion subgroups and gender were not significant. Also, there was no significant difference between the place of residence of the students' families and the age variable (p>0.05), [14].
Differences were found between the compassion subgroup levels of female (n = 57) and male (n = 27) ED health workers in our study. The mean “Kindness” score of female ED health workers was found to be higher than the mean “Kindness” score of male ED healthcare workers (15.859±2.538 versus 15,000±3.637). The mean "Common humanity" score of female ED health workers was found to be higher than the mean "Common humanity" score of male ED health workers (16,859±2,488 versus 16,037±3.345). The mean "Mindfulness" score of female ED health workers was found to be higher than the mean "Mindfulness" score of male ED health workers (16,245±1,606 versus 14,777±3.467). In our study, the mean “Indifference” score of female ED health workers was found to be lower than the mean “Indifference” score of male ED healthcare workers (7.736±2.560 versus 8.740±3.323). The mean “Separation” score of female ED health workers was found to be lower than the mean “Separation” score of male ED health workers (7.666±2.502 versus 9.222±2.939). The mean “Disengagement” score of female ED health workers was found to be lower than the mean “Disengagement” score of male ED health workers (7.350±2.371 versus 9.407±3.388).
In our study, the "Kindness", "Common humanity" and "Mindfulness" subgroup score mean of female ED health workers were found to be higher than the mean scores of male ED healt workers. But, the mean scores of "Indifference", "Separation" and "Disengagement" compassion subgroups of female ED health workers were found to be lower than the mean scores of male ED health workers. These findings showed that women had higher levels of compassion than men.
In our study, the differences between gender differences and compassion subgroup question averages were different from the findings of the study conducted by Çalışoğlu M with male and female teachers, [12].
The mean "Indifference" score of female ED health workers was found to be higher than the average "Indifference" score of female teachers (7.736±2.560 versus 6.1970±2.34257). The mean "Separation" score of female ED health workers was found to be higher than the average "Separation" score of female teachers (7.666±2.502 versus 6.7045±2.29083). The mean "Disengagement" score of female ED health workers was found to be higher than the average "Disengagement" score of female teachers (7.350±2.371versus 6.0379± 2.13443). The mean "Indifference" score of male ED health workers was found to be higher than the average "Indifference" score of male teachers (8.740±3.323 versus 7.7053±2.99245). The mean "Separation" score of male ED health workers was found to be higher than the mean "Separation" score of male teachers (9.222±2.939 versus 7.6737±2.45141). The mean "Disengagement" score of male ED health workers was found to be higher than the average "Disengagement" score of male teachers (9.407±3.388 versus 6.0379± 2.13443).
Compassion subgroup averages of both female and male teachers were found to be higher than the compassion subgroup averages of both female and male ED health workers. These differences showed that compassion also changed according to occupational conditions.
In the study conducted by Arkan B15 and his friends with 227 nurses working in a university hospital, the mean total compassion level score was found to be 97.02±10.67. In this study, the mean of the 'Kindness' subgroup was 16.44±2.47, the mean of the ''Indifference'' subgroup was 7.44±2.40, the mean of the ''Common humanity'' subgroup was 15.46±2.80, the mean of the ''Separation'' subgroup was 7.76±2.29, The mean of "Mindfulness" subgroup was 16.03±2.47 and the mean of "Disengagement" subgroup was 7.70±2.23. No statistically significant difference was found among nurses between gender, marital status, weekly working hours and total compassion score averages and total subscale mean scores (p>0.05), [15].
The "Kindness" subgroup score of 49 Emergency Nurses who participated in our study was found to be higher than the "Kindness" mean score (16.510±2.509 versus 16.44±2.47) of Arkan et al. [15]'s study with 227 university hospital nurses. The mean score of the "Indifference" subgroup of the Emergency Nurses was found to be lower than the mean score of the university nurses (7.061±2.135 versus 7.44±2.40). The "Common humanity" subgroup mean score of Emergency Nurses was found to be higher than the mean score of university nurses (17.163±2.124 versus 15.46±2.80). The mean score of the "Separation" subgroup of the Emergency Nurses was found to be lower than the mean score of the university nurses (7.591±2.317 and 7.76±2.29). The mean score of the "Mindfulness" subgroup of Emergency Nurses was found to be higher than the mean score of university nurses (16.0816±2.09973 versus 16.03±2.47). The mean score of the "Disengagement" subgroup of Emergency Nurses was found to be lower than the mean score of university nurses (7.122±2.412 versus 7.70±2.23).
In the study of Arkan et al. [15], 42.7% of the 227 nurses working at the university in the Marmara region worked in medical clinics, 33.5% in surgical clinics and 23.8% in intensive care units. In contrast, 100% of the nurses participating in our study were working in the ED.
Emergency Nurses' "Kindness", "Common humanity" and "Mindfulness" subgroup mean scores were higher than university nurses, on the other hand, Emergency Nurses' "Indifference", "Separation" and "Disengagement" subgroup scores '' subgroup mean scores were lower than university nurses. This finding shows that working conditions adversely affect the level of compassion.
Our study was conducted with ED health workers working in one of the training and research hospitals in Turkey and Istanbul, which received the most crowded emergency patient admissions. The number of patients admitted to training and research hospitals in Turkey per day is much higher than the number of patients admitted to university hospitals. However, the working conditions of nurses working in other clinics, including intensive care, are better than the working conditions of Emergency Nurses in Turkey. The fact that the level of compassion of the nurses working in more numbers and in more difficult conditions is better than the nurses working in other clinics is an indication that the feeling of compassion emerges more in difficult conditions.
In our study, female doctors' mean scores of "Kindness", "Common humanity" and "Mindfulness" compassion subgroup were higher than male doctors, while the mean scores of "Indifference" and "Disengagement" subgroups were higher than men. It shows that women's feelings of compassion are higher than men's.
In this study, we investigated the level of compassion and the affecting factors in crowded ED health workers; There were no statistically significant differences between the mean of all compassion subgroups between those who voluntarily worked and those who did not work in the ED, those who were on duty and those who did not, those with ≤9 night shifts and those with ≥10 night shifts, those who were married and single, those who had children and those who did not. On the other hand, the compassion levels of female ED health workers were higher than that of male ED health workers and the level of compassion of Emergency Nurses was higher than that of Emergency Doctors.
Authors’ Contributions
SC, DNO were involved in the study's design, methodology, ethical process, data collection, data analysis and article writing. All authors have read and approved the final article. All authors accept responsibility for the accuracy and completeness of the work.
Conflict of Interests
The authors declare that they have no conflict of interests.
Financial Support
No support has been received.
Ethical Approval
(Bakırköy Dr. Sadi Konuk Education and Research Hospital Ethics committee- Date: 12.02.2018-Decision no: 2018-03-10)
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