- Email: [email protected]
Evaluating the Relationship Between Burnout Levels and Compassion Fatigue, Emotional Intelligence, and Communication Skills of Organ Transplant Coordinators
Evaluating the Relationship Between Burnout Levels and Compassion Fatigue, Emotional Intelligence, and Communication Skills of Organ Transplant Coordinators Handan Alana, Feride Eskin Bacaksizb, Arzu Kader Harmancı Serenb, and Hasan Anıl Kurtc,* a
Department of Nursing Administration, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Turkey; Department of Nursing Administration, Hamidiye Faculty of Nursing, University of Health Sciences, Istanbul, Turkey; and cMedical Faculty Department of Urology, Canakkale Onsekiz Mart University, Çanakkale, Turkey b
ABSTRACT Aim. The aim was to determine the effects of compassion fatigue, emotional intelligence levels, and communication skills of organ transplant coordinators on burnout. Methods. This descriptive correlational study included 104 organ transplant coordinators. Data were collected via a survey that consisted of demographic information, the Copenhagen Burnout Inventory, the Emotional Intelligence Scale, and the Compassion Fatigue Scale. Findings. A positive relationship was reported between burnout (mean, 39.42 [SD, 19.54]) and compassion fatigue (mean, 2.26 [SD, 0.86]) measurements of the organ transplant coordinators (r ¼ 0.432) and a negative and significant relationship existed between burnout and emotional intelligence (mean, 3.53 [SD, 0.58]) measurements (r ¼ 0.372). However, no correlation was found between communication skills (mean, 4.27 [SD, 0.52]) and burnout (r ¼ 0.184; P > .05) except a negative correlation with client-related burnout measurements (r ¼ 0.222; P < .05). As a result of the 2-step regression analysis, the regression-squared value predicted the joint effect of compassion fatigue and emotional intelligence on burnout (R2 ¼ .285). Conclusions. Organ transplant coordinators reported moderate levels of burnout and compassion fatigue and high levels of emotional intelligence and communication skills. Compassion fatigue caused burnout, while emotional intelligence decreased. Additionally, transplant coordinators’ communication skills were related to client-related burnout.
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MOTIONS experienced in work life can affect people from various perspectives and may lead to positive or negative outcomes. Because the professional labor force is a unique element in the quality of services provided in the health sector, the emotions experienced by the health care professionals in the work environment become more important. Known to have negative effects on personal and organizational outputs, burnout is one of the most recognized and widely studied topics among the emotions experienced in work life. The burnout defined by Maslach and Jackson as “burnout is a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who do ‘people work’ of some kind” [1],
ª 2020 Elsevier Inc. All rights reserved. 230 Park Avenue, New York, NY 10169
Transplantation Proceedings, XX, 1e6 (2020)
it is still a topical issue today. Studies have stated health care professionals to be among the groups most inclined to experience burnout. Therefore, the phenomenon of burnout is frequently studied in various health care professional groups, such as physicians [2,3], nurses [4], and military health personnel [5]. However, there are very little data on burnout in organ transplant coordinators, who are an important component of the health sector [6]. Studies found that coordinators had low levels of emotional exhaustion *Address correspondence to Hasan Anıl Kurt, Medical Faculty Department of Urology, Canakkale Onsekiz Mart University, Çanakkale, Turkey. Tel: þ90 286 263 59 50; Fax: þ90 286 263 5956-57. E-mail: [email protected] 0041-1345/20 https://doi.org/10.1016/j.transproceed.2020.10.030
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and depersonalization [6]. This suggests there is a gap in the literature in terms of factors affecting the burnout levels of organ transplant coordinators, who meet the life stressors of a patient while meeting the death stressors of another. To close this gap, this study examines the relationships between emotional intelligence, compassion fatigue, and communication skills, which are thought to affect the burnout levels of organ transplant coordinators. Organ transplant coordinators either monitor potential donors in intensive care units or follow processes related to patients waiting for organ donations and their families according to their tasks in the institution. In some cases, they need to perform both tasks [7]. Therefore, depending on the workload, coordinators may feel overloaded and burned out. At this point, studies and evidence on the emotional intelligence, compassion fatigue levels, and communication skills of organ transplant coordinators gain importance. Compassion fatigue is defined as the emotional effect of indirect trauma while helping people who are directly experiencing traumatic stress [8]. It is described as the constant depletion of physical, mental, emotional, and spiritual resources [9]. Organ transplant coordinators are at high risk of experiencing compassion fatigue because of the emotional load required by their work. Coordinators experiencing compassion fatigue should focus on what they can do to cope rather than suppress and control their emotions. Here, 2 concepts come on the scene: emotional intelligence [10], which is defined as the ability of people to manage their feelings on purpose, to motivate themselves for their job, and to provide effective communication by understanding the feelings of others, and communication skills, which are necessary for them to understand the emotions of patients and to maintain healthy communication [11]. Thus, considering that burnout represents the depletion of sustaining abilities because of the accumulated effect of long-term and intensive patient care, organ transplant coordinators are thought to have high compassion fatigue levels, and those with high emotional intelligence and communication skills are thought to have lower burnout levels.
MATERIALS AND METHODS Design and Aim In this descriptive and correlational study, we aimed 1. to determine the burnout, emotional intelligence, compassion fatigue, and communication skill levels of organ transplant coordinators; 2. to test the relationships between these concepts; and 3. to reveal the effect of emotional intelligence, compassion fatigue, and communication skills on burnout. In line with the research model given in Fig 1, the hypotheses of the research are as follows: 1. there is a negative relationship between Copenhagen Burnout Inventory and Emotional Intelligence levels of organ transplant coordinators, 2. there is a positive relationship between Copenhagen Burnout Inventory and Compassion Fatigue levels of organ transplant coordinators, and 3. there is a
ALAN, BACAKSIZ, SEREN ET AL
Fig 1. Research model. negative relationship between Copenhagen Burnout Inventory and Communication Skill levels of organ transplant coordinators.
Sample and Participants Participation in this anonymous study was completely voluntary. Participants received no compensation for taking part in this research project. The study measures were filled out by participants of a meeting for transplant coordinators held in Turkey in January 2020. Participants included a total of 104 organ transplant coordinators working in the Ministry of Health hospitals (30.8%), university hospitals (48.0%), and private hospitals (21.2%) in organ transplant (50.0%) or donor centers (50.0%) in various regions of Turkey. Organ transplant or donor centers mostly had coordination offices (65.4%) with a single coordinator working there (63.5%). Kidney (47.1%) and liver (25.0%) transplants were most common operations at these centers. Ages of the organ transplant coordinators ranged between 22 and 64 (mean, 36.85 [SD, 10.16]); most of them were women (59.6%) and married (65.4%). There were 19 physicians, 67 nurses, and 18 other health care professionals. The experience of organ transplant coordinators was mostly varied between 2 to 5 years (51.9%; mean, 4.87 [SD, 4.51]). They were working in surgical units (27.9%) and intensive care units (21.2%) before being organ transplant coordinators. Most of the coordinators completed their certificate training (72.1%) and donated their own organs (90.4%). Most of the physicians who participated in the study stated that they have performed the highest organ removal (63.2%), live donor preparation (57.9%), and receiver preparation (57.9%) in their institutions. Nurses have performed in the top 3 of the most common procedures; they stated family interview (79.1%), donor care (56.7%), and brain death report preparation (44.8%). Other health care professionals stated that they have mostly performed family interviews (100%), organ donation follow-up (88.9%), and donor care and brain death report preparation (66.7%).
Data Collection Tools Data collection tools consisted of 4 parts as follows: Personal information form. This form included a total of 17 questions that revealed the personal (age, sex, marital status, etc), professional (educational level, tenure, organ coordinator certificate), and institutional characteristics (type of institution, number of coordinators, presence of coordination office, etc) of organ transplant coordinators.
ORGAN TRANSPLANT COORDINATOR BURNOUT
Copenhagen Burnout Inventory. Developed by Kristensen et al [12] and adapted to Turkish by Tasci and Harmanci Seren [13], the Copenhagen Burnout Inventory (CBI) scale consists of 3 subdimensions. The 3 separate parts of the questionnaire were designed to be applied in different domains. First subdimension measures personal burnout (CBI_P). The questions on personal burnout were formulated in a way so that all human beings can answer them. This scale is intended to answer the simple question: “How often do you feel tired?” Second is work-related burnout (CBI_WR). The work-related burnout questions assume that the respondent has paid work of some kind. Kristensen et al [12] define work-related burnout as “The degree of physical and psychological fatigue and exhaustion that is perceived by the person as related to his/her work.” Finally, the client-related burnout (CBI_CR) questions include the term “client” (or a similar term when appropriate such as patient, student, inmate, etc) [12]. It is defined as the degree of physical and psychological fatigue and exhaustion that is perceived by the person related to his/her work with clients. The 5-point Likert-type answers are ranked between “never: 0 points” and “always: 100 points,” and high scores indicate a high level of burnout. The internal consistency coefficients of the subdimensions range between 0.85 and 0.87. In this study the internal consistency coefficients of the subdimensions ranged between 0.92 and 0.94, and a ¼ 0.97. Emotional Intelligence Scale. Developed by Petrides and Furnham [14] and adapted to Turkish by Deniz et al [15], the scale consists of 20 items. It is a scale developed to determine the level of self-perception regarding the emotional competence of the individual. On the scale, there are expressions such as “In general, I am a highly motivated person,” “I have the ability to influence other people’s emotions in some way,” and “I generally have difficulty in showing my feelings to my relatives.” The 5point Likert-type answers are ranked between “strongly disagree: 1 point” and “strongly agree: 5 points,” and high scores indicate a high emotional intelligence. The internal consistency coefficient of the scale is reported as a ¼ 0.81 [15]. The internal consistency coefficient of the scale was 0.83 in this study. Compassion Fatigue Scale. We used the compassion fatigue subdimension of the Professional Quality of Life Scale developed by Stamm [16] and adapted to Turkish by Yesil et al [17]. The scale has 10 items. This dimension is a test created to measure the symptoms that occur as a result of encountering a stressful event. Employees who score higher on this scale are recommended to seek support or assistance. There are statements in the scale such as “The people I help occupy my mind overly,” “I find it difficult to distinguish between my helping role and my own private life,” and “I feel depressed as a result of being a helper.” The items in the scale are ranked between “strongly disagree: 1 point” and “strongly agree: 5 points,” and high scores indicate a high compassion fatigue and that the person needs help. The internal consistency coefficient of the compassion fatigue scale is reported as a ¼ 0.84 [17]. In this study, the internal consistency coefficient was 0.94. Communication Skills Scale. Developed by Korkut-Owen and Bugay [18], the scale consists of 25 items. The scale includes basic communication skills (I wait for others to finish their words before I answer), self-expression (I can express my thoughts clearly at any time), nonverbal communication, active listening (I can understand the emotions underlying what is being said when listening to someone), and willingness to communicate (I can easily start a conversation with other people). Answers are ranked
3 between “strongly disagree: 1 point” and “strongly agree: 5 points,” and high scores indicate high communication skills. The internal consistency coefficient of the scale is a ¼ 0.88 [18]. In this study, the internal consistency coefficient was 0.95.
Analyses The data were analyzed using SPSS Version 21 (IBM, Armonk, NY, United States). Cronbach a coefficients were used to determine the internal consistency of the measurements obtained from the scales. Descriptive analyses (frequency, percentage, minimum, maximum, mean scores, SDs) were used to determine the scale scores and the personal, professional, and institutional characteristics of organ transplant coordinators. Correlation analysis (scatter plots and Pearson moment correlation) and multiple regression analysis were used to test the relationships between concepts. The data were analyzed at 95% CI and P < .05 significance level.
Ethical Considerations Approval was obtained from the ethics committee of the social and human sciences of the university (December 16, 2019; no.: 191752). Permissions were obtained from the authors who adapted the scales to Turkish via e-mail. Signed informed consent forms were obtained from all study participants.
FINDINGS Copenhagen Burnout Inventory, Emotional Intelligence, Compassion Fatigue and Communication Skills Levels of Organ Transplant Coordinators
Organ transplant coordinators had a mean total Copenhagen Burnout Inventory score of 39.42 [SD, 19.54], and the burnout component with the highest scores was CBI_P (mean, 40.63 [SD, 20.57]). Conversely, Compassion Fatigue Scale measurements were determined to be below moderate (mean, 2.26 [SD, 0.86]), and Emotional Intelligence Scale (mean, 3.53 [SD, 0.58]) and Communication Skills Scale (mean, 4.27 [SD, 0.52]) scores were above moderate (Table 1). Relationships Between Copenhagen Burnout Inventory With Emotional Intelligence, Compassion Fatigue, and Communication Skills
The relationship between total Copenhagen Burnout Inventory and subdimensions and the Emotional Intelligence Scale was found to be negative, and it was determined to be significant in CBI_P and highly significant in other subdimensions and in the total scale (0.312 > r > 0.384; P < .001, P < .05). Therefore, hypothesis 1 was accepted. With the relations between the concepts in this study, total Copenhagen Burnout Inventory and subdimensions were determined to have a positive and highly significant relationship with the Compassion Fatigue Scale (0.463 > r > 0.355; P < .001). Therefore, hypothesis 2 was accepted. Finally, in the relationship between the total Copenhagen Burnout Inventory and subdimensions and Communication Skills Scale levels, a negative relationship was determined between the 2 concepts, but only the relation with CBI_CR
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ALAN, BACAKSIZ, SEREN ET AL Table 1. Correlations Between the Concepts (N [ 104) P_R
CBI CBI_P CBI_WR CBI_CR CFS EIS CSS
0-100 0-100 0-100 0-100 1-5 1-5 1-5
Mean (SD)
39.42 40.63 38.30 39.35 2.26 3.53 4.27
CBI
a¼ .97
(19.54) (20.57) (21.99) (20.22) (.86) (.58) (.52)
.937* .934* .936* .432* -.372* -.184
CBI_P
CBI_WR
a¼ .94
a¼ .94
.827* .816* .463* -.313† -.156
.797* .355* -.341* -.134
CBI_CR
a¼ .92 .399* -.384* -.222†
CFS
a¼ .94 -.143 -.264†
EIS
a¼ .83 .389*
CSS
a¼ .95
Abbreviations: CBI, Copenhagen Burnout Inventory; CBI_CR, Copenhagen Burnout Inventory Client-Related; CBI_P, Copenhagen Burnout Inventory Personal; CBI_WR, Copenhagen Burnout Inventory Work-Related; CFS, Compassion Fatigue Scale; CSS, Communication Skills Scale; EIS, Emotional Intelligence Scale; P_R, possible range. *P < .001. † P < .05.
was statistically significant (r ¼ 0.222; P < .05). Therefore, hypothesis 3 was accepted. In the 2-step regression analysis performed after the correlation analysis (included Emotional Intelligence Scale, Compassion Fatigue Scale, and Communication Skills Scale together in Model 1), the 3 variables were found to explain 28.7% of the Copenhagen Burnout Inventory. However, because Communication Skills Scale measurements did not significantly contribute to the model, they were removed from the model and were reanalyzed (Model 2). When tested together, the Emotional Intelligence Scale and Compassion Fatigue Scale predicted 28.5% of Copenhagen Burnout Inventory, and the contribution of each variable to the model was significant (Table 2). The results obtained from the analyses are schematized in Fig 2. DISCUSSION
In this study the burnout levels of organ transplant coordinators were examined, and the relationships between burnout with emotional intelligence, compassion fatigue, and communication skills scores were tested. Although burnout is a concept that is frequently studied among health care professionals, it has not been researched among transplant coordinators. This study aimed to contribute to the literature via providing new findings related to burnout among transplant coordinators in Turkey, where thousands of solid organ and tissue transplants are being performed each year.
Copenhagen Burnout Inventory, Emotional Intelligence, Compassion Fatigue, and Communication Skill Levels of Organ Transplant Coordinators
The mean scores of the Copenhagen Burnout Inventory and its subdimensions were low among organ transplant coordinators. Low burnout levels were also reported by Harmanci Seren et al [6] in Turkey, by Gruener [19] in Israel, and by Mao et al [20] in China. Another study by Yang et al [21] in China reported moderate levels of burnout. On the other hand, 40% of the transplant surgeons [4] in America and 31% of the transplant surgeons in Europe [22] were reported to experience high levels of burnout. Modern problems such as staff shortages, legal requirements, physical and psychological demands, and ethical dilemmas, which are present and on the rise throughout health care institutions, are believed to be the reasons for the burnout in organ transplant coordinators. Although there are many studies on compassion fatigue of professionals working in various fields (oncology, intensive care units, pediatrics, etc) providing health care services, similar to burnout, there are not enough studies on organ transplant coordinators. According to the results obtained from the present study, Compassion Fatigue Scale levels, similar to the Copenhagen Burnout Inventory, were found slightly below moderate. Studies on organ transplant coordinators indicate moderate compassion fatigue levels, similar to the results of this study[23]. In the systematic review and meta-analysis of Cavanagh et al [24] on 71
Table 2. Regression Models (N [ 104) Model Summary
Model 1 CBI (constant) CFS EIS CSS Model 2 CBI (constant) CFS EIS
Coefficients
R
R2
Adj. R2
B
SE
b
t
P Value
0.535
0.287
0.265
50.254 9.062 11.177 1.920
16.930 1.998 3.068 3.565
0.398 0.334 0.051
2.968 4.536 3.643 .538
.004 < .001 < .001 .591
0.534
0.285
0.270
56.858 8.816 10.570
11.629 1.938 2.843
0.387 0.316
4.889 4.549 3.718
< .001 < .001 < .001
Abbreviations: Adj., adjusted; CBI, Copenhagen Burnout Inventory; CFS, Compassion Fatigue Scale; CSS, Communication Satisfaction Scale; EIS, Emotional Intelligence Scale.
ORGAN TRANSPLANT COORDINATOR BURNOUT
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Fig 2. Study results according to the research model. Variables that have a significant relationship or difference are indicated by bold lines, and nonsignificant relationship or difference are indicated by dashed lines. *P < .05. y P < .001.
studies on compassion fatigue, they stated that the compassion fatigue levels of health care professionals were generally at a medium level, while they were higher in health care professionals providing direct care to patients. It is important that people working in transplant centers are empathetic, compassionate, optimistic, and have strong relationship and communication skills [25]. The emotional intelligence and communication skill levels of the coordinators who participated in this study were above moderate, which is desired for organ transplant coordinators. The emotional transition between giving the patients hope of life while also communicating news of death to patients’ relatives can be very challenging. Most of the organ transplant coordinators participating in this study previously worked in intensive care units or surgical units. This may cause them to experience emotional difficulties with the roles of both patients’ “lifeguards” and “organ claimants” [26]. Coordinators with high emotional intelligence and communication skill levels can achieve more durable attitudes and overcome this process more successfully. Relationships Between Copenhagen Burnout Inventory With Emotional Intelligence, Compassion Fatigue, and Communication Skills
In this study, a positive correlation was found between the burnout levels and compassion fatigue measurements of organ transplant coordinators. A study by Cavanagh et al [24] on health professionals working in different fields reported a correlation between burnout and compassion fatigue. In addition, the authors emphasized that the samples of studies on compassion fatigue mostly consisted of nursing professionals and that the comparison was lacking in terms of other health care professionals [24]. For this reason, the results of this study are thought to make an important contribution to the literature. Although the organ transplant coordinators participating in the study seemed to have low burnout levels, the fact that they had high personal burnout levels can be considered an important finding. Burnout is characterized by chronic tension caused by inconsistency and incompatibility between
employees and work [27] and is triggered by various characteristics of the work or organization [28]. Therefore, the psychological and socially challenging duties of organ transplant coordinators, such as requesting organ donation, may create important dilemmas in individuals [29], which may lead to burnout, causing negative outcomes in donation interviews [30]. However, training programs for organ transplant coordinators generally aim to increase donation rates and are not specifically designed to prepare them to express or manage their emotions [31]. This is an important requirement for organ transplant coordinators, who constantly encounter situations of death, pain, and grief and who must work in a psychologically and emotionally challenging environment [32]. In fact, organ transplant coordinators need to be able to separate their personal lives from their work and maintain emotional distance, develop interpersonal relationships and communication skills, and be empathetic and compassionate positive thinkers [25]. Additionally, it is possible for organ transplant coordinators with high emotional intelligence and communication skills to experience higher levels of donation with less burnout. Choosing topics that protect the psychological and emotional health of organ transplant coordinators and organizing activities that develop their communication skills during their basic training will reflect positively on the service. CONCLUSION AND SUGGESTIONS
Organ transplant coordinators’ Copenhagen Burnout Inventory and Compassion Fatigue Scale scores were below moderate and Emotional Intelligence Scale and Communication Skills Scale scores were above moderate. Copenhagen Burnout Inventory measurements were positively correlated with Compassion Fatigue Scale’s and negatively correlated with Emotional Intelligence Scale’s. This study concluded that organ transplant coordinators experienced relatively less burnout and compassion fatigue and had strong emotional intelligence and communication skills. In addition to the previous findings, emotional intelligence and compassion fatigue are also important predictors of burnout, and communication skills have a relatively low effect on burnout. Based on the possibility
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that the burnout experienced by organ transplant coordinators is considered an obstacle to improving organ transplantation outputs and increasing donation rates, it is important to conduct in-service training programs to offer psychological and social support. Findings suggest that increasing motivation and satisfaction levels of organ transplant coordinator is essential, which may lead to improving organ donation and transplantation rates. REFERENCES [1] Maslach C, Jackson SE. The measurement of experienced burnout. J Organiz Behav 1981;2:99e113. [2] Zheng Q, Yang K, Wang X, Ou Z, et al. Burnout among doctors in China through 2018: a protocol of systematic review and meta-analysis. Medicine (Baltimore) 2019;98:e17117. In this issue. [3] Clough BA, March S, Leane S, Irlanda MJ. What prevents doctors from seeking help for stress and burnout? A mixed-methods investigation among metropolitan and regional-based Australian doctors. J Clin Psychol 2018;75:418e32. [4] Jesse MT, Abouljoud MS, Hogan K, Eshelman A. Burnout in transplant nurses. Prog Transplant 2015;25:196e202. [5] Adler AB, Adrian AL, Hemphill M, Scaro NH, Sipos ML, Thomas JL. Professional stress and burnout in U.S. military medical personnel deployed to Afghanistan. Mil Med 2017;182:1669e76. [6] Harmancı Seren AK, Cakıroglu A, Kemaloglu B, Kahveci E, Bozaklar A. Burnout syndrome in organ transplantation coordinators in Turkey. Organ Tissues Cells 2013;16:59e63. [7] Berg G, Harshbarger J, Ahlers-Schmidt C, Lippoldt D. Exposing compassion fatigue and burnout syndrome in a trauma team: an educational intervention project. J Trauma Nurs 2016;23:3e10. [8] Joinson C. Coping with compassion fatigue. Nursing 1992;22: 116e22. [9] Van Mol MMC, Kompanje EJO, Benoit DD, Bakker J, Nijkamp MD. The prevalence of compassion fatigue and burnout among healthcare professionals in intensive care units: a systematic review. PLoS One 2015;10:E0136955. [10] Dulewicz V, Higgs M. Emotional intelligenceea review and evaluation study. J Manag Psychol 2000;15:341e72. [11] Segal J, Jaffe J. The language of emotional intelligence: the five essential tools for building powerful and effective relationships. New York: McGraw-Hill; 2008. p. 2. [12] Kristensen TS, Borritz M, Villadsen E, Christensen KB. The Copenhagen Burnout Inventory: a new tool for the assessment of burnout. Work Stress 2005;19:192e207. _ Bir üniversite hastanesinde çalıs¸an hems¸irelerde is¸ [13] Tas¸çı I. stresi ve tükenmis¸lik arasındaki ilis¸kinin degerlendirilmesi [Relationships between job stress and burnout in nurses working in a university hospital]. Okan University Institute of Health Sciences, Master Thesis; 2019 [in Turkish]. [14] Petrides KV, Furnham A. On the dimensional structure of emotional intelligence. Pers Individ Dif 2000;29:313e20.
ALAN, BACAKSIZ, SEREN ET AL [15] Deniz ME, Ozer E, Isık E. Trait emotional intelligence questionnaireeshort form: validity and reliability studies. Educ Sci 2013;38:407e19. [16] Stamm BH. Professional quality of life scale IV tests. https:// proqol.org/ProQol_Test.html. Accessed December 21, 2019. [17] Yesil A, Ergun U, Amasyali C, Er F, Olgun NN, Aker AT. Çalıs¸anlar için Yas¸am Kalitesi Ölçegi Türkçe uyarlaması geçerlik ve güvenilirlik çalıs¸ması [Adaptation of the Professional Quality of Life Scale into Turkish: a reliability and validity study]. Nöropsikiyatri Ars¸ivi 2010;47:111e7 [in Turkish]. _ ¸im Becerileri Ölçegi’nin [18] Korkut Owen F, Bugay A. Iletis gelis¸tirilmesi: geçerlik ve güvenirlik çalıs¸ması [Developing a communication skills scale: validity and reliability studies]. Mersin Univ J Fac Educ 2014;10:51e64 [in Turkish]. [19] Gruener N. Burnout among Israeli transplantation coordinators. Harefuah 2006;145:495e8. [20] Mao P, Cai P, Luo A, Huang P, Xie W. Factors in organ donation coordinators: a cross-sectional study in China. Ann Transplant 2018;23:647e53. [21] Yang G, Liu J, Liu L, Wu X, Ding S, Xie J. Burnout and resilience among transplant nurses in 22 hospitals in China. Transplant Proc 2018;50:2905e10. [22] Jesse MT, Abouljoud M, Eshelman A, Reyck De C, Lerut J. Professional interpersonal dynamics and burnout in European transplant surgeons. Clin Transplant 2017;31:1e8. [23] Altınısık HB, Alan H. Compassion fatigue, professional quality of life, and psychological endurance among organ transplant coordinators. Transplant Proc 2019;51:1038e43. [24] Cavanagh N, Cockett G, Heinrich C, Doig L, et al. Compassion fatigue in healthcare providers: a systematic review and meta-analysis. Nurs Ethics 2019;12:1e27. [25] Blumenthal PA. It’s not a job; it’s a lifestyle: the experience of being a donation coordinator. Prog Transplant 2007;17:8e22. [26] Sanner MA. Two perspectives on organ donation: experiences of potential donor families and intensive care physicians of the same event. J Crit Care 2007;22:296e304. [27] Abendroth M, Flannery J. Predicting the risk of compassion fatigue. J Hosp Palliat Nurs 2006;8:346e56. [28] Circenis K, Millere I. Compassion fatigue, burnout and contributory factors among nurses in Latvia. Procedia Soc Behav Sci 2011;159:2042e6. [29] Kim JR, Elliott D, Hyde C. Korean health professionals’ attitudes and knowledge toward organ donation and transplantation. Int J Nurs Stud 2004;41:299e307. [30] Bocci MG, D’alo C, Barelli R, Inguscio S, Prestifilippo A, Di Paolo S, et al. Taking care of relationships in the intensive care unit: positive impact on family consent for organ donation. Transplant Proc 2016;48:3245e50. [31] Hakanson E. Discussing tissue donation with relatives of deceased patients is difficult. Interview study among physicians. Lakartidningen 2002;99:180e4. [32] Jensen AMB. Guardians of ‘‘the gift’’: the emotional challenges of heart and lung transplant professionals in Denmark. Anthropol Med 2017;24:111e26.
Department of Nursing Administration, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Turkey; Department of Nursing Administration, Hamidiye Faculty of Nursing, University of Health Sciences, Istanbul, Turkey; and cMedical Faculty Department of Urology, Canakkale Onsekiz Mart University, Çanakkale, Turkey b
ABSTRACT Aim. The aim was to determine the effects of compassion fatigue, emotional intelligence levels, and communication skills of organ transplant coordinators on burnout. Methods. This descriptive correlational study included 104 organ transplant coordinators. Data were collected via a survey that consisted of demographic information, the Copenhagen Burnout Inventory, the Emotional Intelligence Scale, and the Compassion Fatigue Scale. Findings. A positive relationship was reported between burnout (mean, 39.42 [SD, 19.54]) and compassion fatigue (mean, 2.26 [SD, 0.86]) measurements of the organ transplant coordinators (r ¼ 0.432) and a negative and significant relationship existed between burnout and emotional intelligence (mean, 3.53 [SD, 0.58]) measurements (r ¼ 0.372). However, no correlation was found between communication skills (mean, 4.27 [SD, 0.52]) and burnout (r ¼ 0.184; P > .05) except a negative correlation with client-related burnout measurements (r ¼ 0.222; P < .05). As a result of the 2-step regression analysis, the regression-squared value predicted the joint effect of compassion fatigue and emotional intelligence on burnout (R2 ¼ .285). Conclusions. Organ transplant coordinators reported moderate levels of burnout and compassion fatigue and high levels of emotional intelligence and communication skills. Compassion fatigue caused burnout, while emotional intelligence decreased. Additionally, transplant coordinators’ communication skills were related to client-related burnout.
E
MOTIONS experienced in work life can affect people from various perspectives and may lead to positive or negative outcomes. Because the professional labor force is a unique element in the quality of services provided in the health sector, the emotions experienced by the health care professionals in the work environment become more important. Known to have negative effects on personal and organizational outputs, burnout is one of the most recognized and widely studied topics among the emotions experienced in work life. The burnout defined by Maslach and Jackson as “burnout is a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who do ‘people work’ of some kind” [1],
ª 2020 Elsevier Inc. All rights reserved. 230 Park Avenue, New York, NY 10169
Transplantation Proceedings, XX, 1e6 (2020)
it is still a topical issue today. Studies have stated health care professionals to be among the groups most inclined to experience burnout. Therefore, the phenomenon of burnout is frequently studied in various health care professional groups, such as physicians [2,3], nurses [4], and military health personnel [5]. However, there are very little data on burnout in organ transplant coordinators, who are an important component of the health sector [6]. Studies found that coordinators had low levels of emotional exhaustion *Address correspondence to Hasan Anıl Kurt, Medical Faculty Department of Urology, Canakkale Onsekiz Mart University, Çanakkale, Turkey. Tel: þ90 286 263 59 50; Fax: þ90 286 263 5956-57. E-mail: [email protected] 0041-1345/20 https://doi.org/10.1016/j.transproceed.2020.10.030
1
2
and depersonalization [6]. This suggests there is a gap in the literature in terms of factors affecting the burnout levels of organ transplant coordinators, who meet the life stressors of a patient while meeting the death stressors of another. To close this gap, this study examines the relationships between emotional intelligence, compassion fatigue, and communication skills, which are thought to affect the burnout levels of organ transplant coordinators. Organ transplant coordinators either monitor potential donors in intensive care units or follow processes related to patients waiting for organ donations and their families according to their tasks in the institution. In some cases, they need to perform both tasks [7]. Therefore, depending on the workload, coordinators may feel overloaded and burned out. At this point, studies and evidence on the emotional intelligence, compassion fatigue levels, and communication skills of organ transplant coordinators gain importance. Compassion fatigue is defined as the emotional effect of indirect trauma while helping people who are directly experiencing traumatic stress [8]. It is described as the constant depletion of physical, mental, emotional, and spiritual resources [9]. Organ transplant coordinators are at high risk of experiencing compassion fatigue because of the emotional load required by their work. Coordinators experiencing compassion fatigue should focus on what they can do to cope rather than suppress and control their emotions. Here, 2 concepts come on the scene: emotional intelligence [10], which is defined as the ability of people to manage their feelings on purpose, to motivate themselves for their job, and to provide effective communication by understanding the feelings of others, and communication skills, which are necessary for them to understand the emotions of patients and to maintain healthy communication [11]. Thus, considering that burnout represents the depletion of sustaining abilities because of the accumulated effect of long-term and intensive patient care, organ transplant coordinators are thought to have high compassion fatigue levels, and those with high emotional intelligence and communication skills are thought to have lower burnout levels.
MATERIALS AND METHODS Design and Aim In this descriptive and correlational study, we aimed 1. to determine the burnout, emotional intelligence, compassion fatigue, and communication skill levels of organ transplant coordinators; 2. to test the relationships between these concepts; and 3. to reveal the effect of emotional intelligence, compassion fatigue, and communication skills on burnout. In line with the research model given in Fig 1, the hypotheses of the research are as follows: 1. there is a negative relationship between Copenhagen Burnout Inventory and Emotional Intelligence levels of organ transplant coordinators, 2. there is a positive relationship between Copenhagen Burnout Inventory and Compassion Fatigue levels of organ transplant coordinators, and 3. there is a
ALAN, BACAKSIZ, SEREN ET AL
Fig 1. Research model. negative relationship between Copenhagen Burnout Inventory and Communication Skill levels of organ transplant coordinators.
Sample and Participants Participation in this anonymous study was completely voluntary. Participants received no compensation for taking part in this research project. The study measures were filled out by participants of a meeting for transplant coordinators held in Turkey in January 2020. Participants included a total of 104 organ transplant coordinators working in the Ministry of Health hospitals (30.8%), university hospitals (48.0%), and private hospitals (21.2%) in organ transplant (50.0%) or donor centers (50.0%) in various regions of Turkey. Organ transplant or donor centers mostly had coordination offices (65.4%) with a single coordinator working there (63.5%). Kidney (47.1%) and liver (25.0%) transplants were most common operations at these centers. Ages of the organ transplant coordinators ranged between 22 and 64 (mean, 36.85 [SD, 10.16]); most of them were women (59.6%) and married (65.4%). There were 19 physicians, 67 nurses, and 18 other health care professionals. The experience of organ transplant coordinators was mostly varied between 2 to 5 years (51.9%; mean, 4.87 [SD, 4.51]). They were working in surgical units (27.9%) and intensive care units (21.2%) before being organ transplant coordinators. Most of the coordinators completed their certificate training (72.1%) and donated their own organs (90.4%). Most of the physicians who participated in the study stated that they have performed the highest organ removal (63.2%), live donor preparation (57.9%), and receiver preparation (57.9%) in their institutions. Nurses have performed in the top 3 of the most common procedures; they stated family interview (79.1%), donor care (56.7%), and brain death report preparation (44.8%). Other health care professionals stated that they have mostly performed family interviews (100%), organ donation follow-up (88.9%), and donor care and brain death report preparation (66.7%).
Data Collection Tools Data collection tools consisted of 4 parts as follows: Personal information form. This form included a total of 17 questions that revealed the personal (age, sex, marital status, etc), professional (educational level, tenure, organ coordinator certificate), and institutional characteristics (type of institution, number of coordinators, presence of coordination office, etc) of organ transplant coordinators.
ORGAN TRANSPLANT COORDINATOR BURNOUT
Copenhagen Burnout Inventory. Developed by Kristensen et al [12] and adapted to Turkish by Tasci and Harmanci Seren [13], the Copenhagen Burnout Inventory (CBI) scale consists of 3 subdimensions. The 3 separate parts of the questionnaire were designed to be applied in different domains. First subdimension measures personal burnout (CBI_P). The questions on personal burnout were formulated in a way so that all human beings can answer them. This scale is intended to answer the simple question: “How often do you feel tired?” Second is work-related burnout (CBI_WR). The work-related burnout questions assume that the respondent has paid work of some kind. Kristensen et al [12] define work-related burnout as “The degree of physical and psychological fatigue and exhaustion that is perceived by the person as related to his/her work.” Finally, the client-related burnout (CBI_CR) questions include the term “client” (or a similar term when appropriate such as patient, student, inmate, etc) [12]. It is defined as the degree of physical and psychological fatigue and exhaustion that is perceived by the person related to his/her work with clients. The 5-point Likert-type answers are ranked between “never: 0 points” and “always: 100 points,” and high scores indicate a high level of burnout. The internal consistency coefficients of the subdimensions range between 0.85 and 0.87. In this study the internal consistency coefficients of the subdimensions ranged between 0.92 and 0.94, and a ¼ 0.97. Emotional Intelligence Scale. Developed by Petrides and Furnham [14] and adapted to Turkish by Deniz et al [15], the scale consists of 20 items. It is a scale developed to determine the level of self-perception regarding the emotional competence of the individual. On the scale, there are expressions such as “In general, I am a highly motivated person,” “I have the ability to influence other people’s emotions in some way,” and “I generally have difficulty in showing my feelings to my relatives.” The 5point Likert-type answers are ranked between “strongly disagree: 1 point” and “strongly agree: 5 points,” and high scores indicate a high emotional intelligence. The internal consistency coefficient of the scale is reported as a ¼ 0.81 [15]. The internal consistency coefficient of the scale was 0.83 in this study. Compassion Fatigue Scale. We used the compassion fatigue subdimension of the Professional Quality of Life Scale developed by Stamm [16] and adapted to Turkish by Yesil et al [17]. The scale has 10 items. This dimension is a test created to measure the symptoms that occur as a result of encountering a stressful event. Employees who score higher on this scale are recommended to seek support or assistance. There are statements in the scale such as “The people I help occupy my mind overly,” “I find it difficult to distinguish between my helping role and my own private life,” and “I feel depressed as a result of being a helper.” The items in the scale are ranked between “strongly disagree: 1 point” and “strongly agree: 5 points,” and high scores indicate a high compassion fatigue and that the person needs help. The internal consistency coefficient of the compassion fatigue scale is reported as a ¼ 0.84 [17]. In this study, the internal consistency coefficient was 0.94. Communication Skills Scale. Developed by Korkut-Owen and Bugay [18], the scale consists of 25 items. The scale includes basic communication skills (I wait for others to finish their words before I answer), self-expression (I can express my thoughts clearly at any time), nonverbal communication, active listening (I can understand the emotions underlying what is being said when listening to someone), and willingness to communicate (I can easily start a conversation with other people). Answers are ranked
3 between “strongly disagree: 1 point” and “strongly agree: 5 points,” and high scores indicate high communication skills. The internal consistency coefficient of the scale is a ¼ 0.88 [18]. In this study, the internal consistency coefficient was 0.95.
Analyses The data were analyzed using SPSS Version 21 (IBM, Armonk, NY, United States). Cronbach a coefficients were used to determine the internal consistency of the measurements obtained from the scales. Descriptive analyses (frequency, percentage, minimum, maximum, mean scores, SDs) were used to determine the scale scores and the personal, professional, and institutional characteristics of organ transplant coordinators. Correlation analysis (scatter plots and Pearson moment correlation) and multiple regression analysis were used to test the relationships between concepts. The data were analyzed at 95% CI and P < .05 significance level.
Ethical Considerations Approval was obtained from the ethics committee of the social and human sciences of the university (December 16, 2019; no.: 191752). Permissions were obtained from the authors who adapted the scales to Turkish via e-mail. Signed informed consent forms were obtained from all study participants.
FINDINGS Copenhagen Burnout Inventory, Emotional Intelligence, Compassion Fatigue and Communication Skills Levels of Organ Transplant Coordinators
Organ transplant coordinators had a mean total Copenhagen Burnout Inventory score of 39.42 [SD, 19.54], and the burnout component with the highest scores was CBI_P (mean, 40.63 [SD, 20.57]). Conversely, Compassion Fatigue Scale measurements were determined to be below moderate (mean, 2.26 [SD, 0.86]), and Emotional Intelligence Scale (mean, 3.53 [SD, 0.58]) and Communication Skills Scale (mean, 4.27 [SD, 0.52]) scores were above moderate (Table 1). Relationships Between Copenhagen Burnout Inventory With Emotional Intelligence, Compassion Fatigue, and Communication Skills
The relationship between total Copenhagen Burnout Inventory and subdimensions and the Emotional Intelligence Scale was found to be negative, and it was determined to be significant in CBI_P and highly significant in other subdimensions and in the total scale (0.312 > r > 0.384; P < .001, P < .05). Therefore, hypothesis 1 was accepted. With the relations between the concepts in this study, total Copenhagen Burnout Inventory and subdimensions were determined to have a positive and highly significant relationship with the Compassion Fatigue Scale (0.463 > r > 0.355; P < .001). Therefore, hypothesis 2 was accepted. Finally, in the relationship between the total Copenhagen Burnout Inventory and subdimensions and Communication Skills Scale levels, a negative relationship was determined between the 2 concepts, but only the relation with CBI_CR
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ALAN, BACAKSIZ, SEREN ET AL Table 1. Correlations Between the Concepts (N [ 104) P_R
CBI CBI_P CBI_WR CBI_CR CFS EIS CSS
0-100 0-100 0-100 0-100 1-5 1-5 1-5
Mean (SD)
39.42 40.63 38.30 39.35 2.26 3.53 4.27
CBI
a¼ .97
(19.54) (20.57) (21.99) (20.22) (.86) (.58) (.52)
.937* .934* .936* .432* -.372* -.184
CBI_P
CBI_WR
a¼ .94
a¼ .94
.827* .816* .463* -.313† -.156
.797* .355* -.341* -.134
CBI_CR
a¼ .92 .399* -.384* -.222†
CFS
a¼ .94 -.143 -.264†
EIS
a¼ .83 .389*
CSS
a¼ .95
Abbreviations: CBI, Copenhagen Burnout Inventory; CBI_CR, Copenhagen Burnout Inventory Client-Related; CBI_P, Copenhagen Burnout Inventory Personal; CBI_WR, Copenhagen Burnout Inventory Work-Related; CFS, Compassion Fatigue Scale; CSS, Communication Skills Scale; EIS, Emotional Intelligence Scale; P_R, possible range. *P < .001. † P < .05.
was statistically significant (r ¼ 0.222; P < .05). Therefore, hypothesis 3 was accepted. In the 2-step regression analysis performed after the correlation analysis (included Emotional Intelligence Scale, Compassion Fatigue Scale, and Communication Skills Scale together in Model 1), the 3 variables were found to explain 28.7% of the Copenhagen Burnout Inventory. However, because Communication Skills Scale measurements did not significantly contribute to the model, they were removed from the model and were reanalyzed (Model 2). When tested together, the Emotional Intelligence Scale and Compassion Fatigue Scale predicted 28.5% of Copenhagen Burnout Inventory, and the contribution of each variable to the model was significant (Table 2). The results obtained from the analyses are schematized in Fig 2. DISCUSSION
In this study the burnout levels of organ transplant coordinators were examined, and the relationships between burnout with emotional intelligence, compassion fatigue, and communication skills scores were tested. Although burnout is a concept that is frequently studied among health care professionals, it has not been researched among transplant coordinators. This study aimed to contribute to the literature via providing new findings related to burnout among transplant coordinators in Turkey, where thousands of solid organ and tissue transplants are being performed each year.
Copenhagen Burnout Inventory, Emotional Intelligence, Compassion Fatigue, and Communication Skill Levels of Organ Transplant Coordinators
The mean scores of the Copenhagen Burnout Inventory and its subdimensions were low among organ transplant coordinators. Low burnout levels were also reported by Harmanci Seren et al [6] in Turkey, by Gruener [19] in Israel, and by Mao et al [20] in China. Another study by Yang et al [21] in China reported moderate levels of burnout. On the other hand, 40% of the transplant surgeons [4] in America and 31% of the transplant surgeons in Europe [22] were reported to experience high levels of burnout. Modern problems such as staff shortages, legal requirements, physical and psychological demands, and ethical dilemmas, which are present and on the rise throughout health care institutions, are believed to be the reasons for the burnout in organ transplant coordinators. Although there are many studies on compassion fatigue of professionals working in various fields (oncology, intensive care units, pediatrics, etc) providing health care services, similar to burnout, there are not enough studies on organ transplant coordinators. According to the results obtained from the present study, Compassion Fatigue Scale levels, similar to the Copenhagen Burnout Inventory, were found slightly below moderate. Studies on organ transplant coordinators indicate moderate compassion fatigue levels, similar to the results of this study[23]. In the systematic review and meta-analysis of Cavanagh et al [24] on 71
Table 2. Regression Models (N [ 104) Model Summary
Model 1 CBI (constant) CFS EIS CSS Model 2 CBI (constant) CFS EIS
Coefficients
R
R2
Adj. R2
B
SE
b
t
P Value
0.535
0.287
0.265
50.254 9.062 11.177 1.920
16.930 1.998 3.068 3.565
0.398 0.334 0.051
2.968 4.536 3.643 .538
.004 < .001 < .001 .591
0.534
0.285
0.270
56.858 8.816 10.570
11.629 1.938 2.843
0.387 0.316
4.889 4.549 3.718
< .001 < .001 < .001
Abbreviations: Adj., adjusted; CBI, Copenhagen Burnout Inventory; CFS, Compassion Fatigue Scale; CSS, Communication Satisfaction Scale; EIS, Emotional Intelligence Scale.
ORGAN TRANSPLANT COORDINATOR BURNOUT
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Fig 2. Study results according to the research model. Variables that have a significant relationship or difference are indicated by bold lines, and nonsignificant relationship or difference are indicated by dashed lines. *P < .05. y P < .001.
studies on compassion fatigue, they stated that the compassion fatigue levels of health care professionals were generally at a medium level, while they were higher in health care professionals providing direct care to patients. It is important that people working in transplant centers are empathetic, compassionate, optimistic, and have strong relationship and communication skills [25]. The emotional intelligence and communication skill levels of the coordinators who participated in this study were above moderate, which is desired for organ transplant coordinators. The emotional transition between giving the patients hope of life while also communicating news of death to patients’ relatives can be very challenging. Most of the organ transplant coordinators participating in this study previously worked in intensive care units or surgical units. This may cause them to experience emotional difficulties with the roles of both patients’ “lifeguards” and “organ claimants” [26]. Coordinators with high emotional intelligence and communication skill levels can achieve more durable attitudes and overcome this process more successfully. Relationships Between Copenhagen Burnout Inventory With Emotional Intelligence, Compassion Fatigue, and Communication Skills
In this study, a positive correlation was found between the burnout levels and compassion fatigue measurements of organ transplant coordinators. A study by Cavanagh et al [24] on health professionals working in different fields reported a correlation between burnout and compassion fatigue. In addition, the authors emphasized that the samples of studies on compassion fatigue mostly consisted of nursing professionals and that the comparison was lacking in terms of other health care professionals [24]. For this reason, the results of this study are thought to make an important contribution to the literature. Although the organ transplant coordinators participating in the study seemed to have low burnout levels, the fact that they had high personal burnout levels can be considered an important finding. Burnout is characterized by chronic tension caused by inconsistency and incompatibility between
employees and work [27] and is triggered by various characteristics of the work or organization [28]. Therefore, the psychological and socially challenging duties of organ transplant coordinators, such as requesting organ donation, may create important dilemmas in individuals [29], which may lead to burnout, causing negative outcomes in donation interviews [30]. However, training programs for organ transplant coordinators generally aim to increase donation rates and are not specifically designed to prepare them to express or manage their emotions [31]. This is an important requirement for organ transplant coordinators, who constantly encounter situations of death, pain, and grief and who must work in a psychologically and emotionally challenging environment [32]. In fact, organ transplant coordinators need to be able to separate their personal lives from their work and maintain emotional distance, develop interpersonal relationships and communication skills, and be empathetic and compassionate positive thinkers [25]. Additionally, it is possible for organ transplant coordinators with high emotional intelligence and communication skills to experience higher levels of donation with less burnout. Choosing topics that protect the psychological and emotional health of organ transplant coordinators and organizing activities that develop their communication skills during their basic training will reflect positively on the service. CONCLUSION AND SUGGESTIONS
Organ transplant coordinators’ Copenhagen Burnout Inventory and Compassion Fatigue Scale scores were below moderate and Emotional Intelligence Scale and Communication Skills Scale scores were above moderate. Copenhagen Burnout Inventory measurements were positively correlated with Compassion Fatigue Scale’s and negatively correlated with Emotional Intelligence Scale’s. This study concluded that organ transplant coordinators experienced relatively less burnout and compassion fatigue and had strong emotional intelligence and communication skills. In addition to the previous findings, emotional intelligence and compassion fatigue are also important predictors of burnout, and communication skills have a relatively low effect on burnout. Based on the possibility
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that the burnout experienced by organ transplant coordinators is considered an obstacle to improving organ transplantation outputs and increasing donation rates, it is important to conduct in-service training programs to offer psychological and social support. Findings suggest that increasing motivation and satisfaction levels of organ transplant coordinator is essential, which may lead to improving organ donation and transplantation rates. REFERENCES [1] Maslach C, Jackson SE. The measurement of experienced burnout. J Organiz Behav 1981;2:99e113. [2] Zheng Q, Yang K, Wang X, Ou Z, et al. Burnout among doctors in China through 2018: a protocol of systematic review and meta-analysis. Medicine (Baltimore) 2019;98:e17117. In this issue. [3] Clough BA, March S, Leane S, Irlanda MJ. What prevents doctors from seeking help for stress and burnout? A mixed-methods investigation among metropolitan and regional-based Australian doctors. J Clin Psychol 2018;75:418e32. [4] Jesse MT, Abouljoud MS, Hogan K, Eshelman A. Burnout in transplant nurses. Prog Transplant 2015;25:196e202. [5] Adler AB, Adrian AL, Hemphill M, Scaro NH, Sipos ML, Thomas JL. Professional stress and burnout in U.S. military medical personnel deployed to Afghanistan. Mil Med 2017;182:1669e76. [6] Harmancı Seren AK, Cakıroglu A, Kemaloglu B, Kahveci E, Bozaklar A. Burnout syndrome in organ transplantation coordinators in Turkey. Organ Tissues Cells 2013;16:59e63. [7] Berg G, Harshbarger J, Ahlers-Schmidt C, Lippoldt D. Exposing compassion fatigue and burnout syndrome in a trauma team: an educational intervention project. J Trauma Nurs 2016;23:3e10. [8] Joinson C. Coping with compassion fatigue. Nursing 1992;22: 116e22. [9] Van Mol MMC, Kompanje EJO, Benoit DD, Bakker J, Nijkamp MD. The prevalence of compassion fatigue and burnout among healthcare professionals in intensive care units: a systematic review. PLoS One 2015;10:E0136955. [10] Dulewicz V, Higgs M. Emotional intelligenceea review and evaluation study. J Manag Psychol 2000;15:341e72. [11] Segal J, Jaffe J. The language of emotional intelligence: the five essential tools for building powerful and effective relationships. New York: McGraw-Hill; 2008. p. 2. [12] Kristensen TS, Borritz M, Villadsen E, Christensen KB. The Copenhagen Burnout Inventory: a new tool for the assessment of burnout. Work Stress 2005;19:192e207. _ Bir üniversite hastanesinde çalıs¸an hems¸irelerde is¸ [13] Tas¸çı I. stresi ve tükenmis¸lik arasındaki ilis¸kinin degerlendirilmesi [Relationships between job stress and burnout in nurses working in a university hospital]. Okan University Institute of Health Sciences, Master Thesis; 2019 [in Turkish]. [14] Petrides KV, Furnham A. On the dimensional structure of emotional intelligence. Pers Individ Dif 2000;29:313e20.
ALAN, BACAKSIZ, SEREN ET AL [15] Deniz ME, Ozer E, Isık E. Trait emotional intelligence questionnaireeshort form: validity and reliability studies. Educ Sci 2013;38:407e19. [16] Stamm BH. Professional quality of life scale IV tests. https:// proqol.org/ProQol_Test.html. Accessed December 21, 2019. [17] Yesil A, Ergun U, Amasyali C, Er F, Olgun NN, Aker AT. Çalıs¸anlar için Yas¸am Kalitesi Ölçegi Türkçe uyarlaması geçerlik ve güvenilirlik çalıs¸ması [Adaptation of the Professional Quality of Life Scale into Turkish: a reliability and validity study]. Nöropsikiyatri Ars¸ivi 2010;47:111e7 [in Turkish]. _ ¸im Becerileri Ölçegi’nin [18] Korkut Owen F, Bugay A. Iletis gelis¸tirilmesi: geçerlik ve güvenirlik çalıs¸ması [Developing a communication skills scale: validity and reliability studies]. Mersin Univ J Fac Educ 2014;10:51e64 [in Turkish]. [19] Gruener N. Burnout among Israeli transplantation coordinators. Harefuah 2006;145:495e8. [20] Mao P, Cai P, Luo A, Huang P, Xie W. Factors in organ donation coordinators: a cross-sectional study in China. Ann Transplant 2018;23:647e53. [21] Yang G, Liu J, Liu L, Wu X, Ding S, Xie J. Burnout and resilience among transplant nurses in 22 hospitals in China. Transplant Proc 2018;50:2905e10. [22] Jesse MT, Abouljoud M, Eshelman A, Reyck De C, Lerut J. Professional interpersonal dynamics and burnout in European transplant surgeons. Clin Transplant 2017;31:1e8. [23] Altınısık HB, Alan H. Compassion fatigue, professional quality of life, and psychological endurance among organ transplant coordinators. Transplant Proc 2019;51:1038e43. [24] Cavanagh N, Cockett G, Heinrich C, Doig L, et al. Compassion fatigue in healthcare providers: a systematic review and meta-analysis. Nurs Ethics 2019;12:1e27. [25] Blumenthal PA. It’s not a job; it’s a lifestyle: the experience of being a donation coordinator. Prog Transplant 2007;17:8e22. [26] Sanner MA. Two perspectives on organ donation: experiences of potential donor families and intensive care physicians of the same event. J Crit Care 2007;22:296e304. [27] Abendroth M, Flannery J. Predicting the risk of compassion fatigue. J Hosp Palliat Nurs 2006;8:346e56. [28] Circenis K, Millere I. Compassion fatigue, burnout and contributory factors among nurses in Latvia. Procedia Soc Behav Sci 2011;159:2042e6. [29] Kim JR, Elliott D, Hyde C. Korean health professionals’ attitudes and knowledge toward organ donation and transplantation. Int J Nurs Stud 2004;41:299e307. [30] Bocci MG, D’alo C, Barelli R, Inguscio S, Prestifilippo A, Di Paolo S, et al. Taking care of relationships in the intensive care unit: positive impact on family consent for organ donation. Transplant Proc 2016;48:3245e50. [31] Hakanson E. Discussing tissue donation with relatives of deceased patients is difficult. Interview study among physicians. Lakartidningen 2002;99:180e4. [32] Jensen AMB. Guardians of ‘‘the gift’’: the emotional challenges of heart and lung transplant professionals in Denmark. Anthropol Med 2017;24:111e26.