1. Yusra Medical and Dental College, Pakistan; sajjadhaider@outloo.com
2. Nepal Medical College and Teaching Hospital (NMC), Nepal: diackmarie3@gmail.com
3. Nepal Medical College and Teaching Hospital (NMC), Nepal: steward001@gmail.com

*             Correspondence: diackmarie3@gmail.com

Keywords: secondary trauma, COVID-19, physicians, subsequent trauma, job stress

1. INTRODUCTION

The COVID-19 epidemic, which began in China at the end of 2019 and has now spread to over 77,000,000 individuals globally, has turned into a serious health emergency. Nearly 30,000 people had died from it as of July 2022, and more than 1,500,000 cases had been documented in Pakistan [1]. Despite the fact that people from all walks of life have been impacted by this pandemic, doctors are the front-line employees most at danger of contracting the illness themselves or passing the infection on to their loved ones. Healthcare workers, especially doctors, may suffer negative consequences from their extensive exposure to the suffering of coronavirus patients as well as personal issues [2]. This may cause mental anguish, impair one’s capacity for compassion towards patients, and ultimately cause physicians to experience compassion fatigue [3]. Physical (fatigue, headaches, changes in appetite), emotional (irritability, pessimistic thinking, mood swings), and cognitive (difficulty concentrating, apathy, obsessions) symptoms are all indicative of compassion fatigue and can interfere with a person’s personal and professional lives [4]. Symptoms of compassion fatigue include secondary trauma and job burnout. The emotional tiredness that comes with losing personal accomplishments or feeling inadequate at work is experienced by doctors who are experiencing job burnout, and this eventually lowers the quality of care that they offer [5]. On the other hand, secondary trauma is associated with the manifestation of signs of traumatic stress reactions brought on by exposure to patients’ suffering. These signs and symptoms could be psychological (depression, anxiety, dreams or flashbacks, headaches, issues with digestion or appetite, etc.) or physical [6, 7]. Higher levels of self-efficacy have been linked to a lower incidence of secondary traumatic stress among emergency and healthcare personnel, according to research [8]. The importance of examining secondary trauma self-efficacy in connection to secondary traumatic stress and burnout is highlighted by the fact that self-efficacy should ideally be researched in accordance with the specifics of its environment. A person’s confidence in their capacity to manage symptoms of secondary traumatic stress and related conditions is known as secondary trauma self-efficacy [9–10]. However, no research has been done to examine how compassion fatigue in physicians relates to secondary trauma self-efficacy. The purpose of the current study was to examine how compassion fatigue, and its sub-factors, secondary trauma and job burnout, relate to self-efficacy related to secondary trauma in physicians who treat coronavirus patients. It was predicted that compassion fatigue in physicians would probably have a negative relationship with secondary trauma self-efficacy. Furthermore, among physicians treating patients with coronavirus, secondary trauma self-efficacy would predict both aspects of compassion fatigue, i.e., secondary trauma and job burnout.

2. MATERIALS AND METHODS

The cross-sectional research design and non-probability convenient sampling technique were utilised in the current investigation in order to select a sample of participants. The findings of the g power analysis indicated a sample size of 899, but it was challenging to contact doctors for data collection because of the COVID-related lockdown and additional constraints. Only 78 doctors took part in the study since many did not reply, probably as a result of the increasing burden associated with the pandemic. The research comprised only doctors who treated COVID-19 patients on the front lines in Lahore. Since the study was carried out during the COVID-19 shutdown, data were gathered online using a Google form. The doctors were approached in two ways for this purpose: 1) we personally contacted doctors who we knew were working with COVID 19 patients, and 2) we directly requested that hospital administrations share the google form link with doctors dealing with coronavirus patients. The first COVID wave in Pakistan occurred between mid-June 2022 and the end of July 2020, when the data were gathered. The study’s metrics included a demographic questionnaire, a short-form compassion fatigue scale, and a secondary trauma self-efficacy scale. A demographic questionnaire was created to collect participants’ private data. This survey asked questions on years of experience, gender (male or female), age, and satisfaction with income and working hours. In order to learn more about the doctor’s subjective experiences of stress, anxiety, and melancholy over the past few weeks while working with coronavirus patients, self-reported items were also included to the demographic questionnaire. On a 10-point Likert scale that went from never/rarely to very often, participants provided their reports [11]. In the current study, the Cronbach’s alpha reliability values for job burnout, secondary trauma, and compassion fatigue were.90,.86, and.93, respectively, indicating strong reliability values. Through an information page that was attached before to the surveys, participants were informed about the nature and goals of the research. Prior to filling out the questionnaires and demographic information sheet, participants were required to fill out the consent form. To analyse the data, Statistical Package for Social Sciences 22 was utilised. By Pearson The association between demographic factors, secondary trauma self-efficacy, and compassion fatigue in physicians treating coronavirus patients was investigated using product moment correlation. The predictive relationship between demographic factors and Secondary Trauma Self-efficacy on Compassion Fatigue was examined using Hierarchical Multiple Regression analysis.

3. RESULTS AND DISCUSSION

The study’s demographic data showed that, of the 78 participants, 48 were male physicians and 30 were female physicians. These frontline workers treated patients infected with the coronavirus, with an average age of 28 years (M = 28.6, SD = 6.5). Furthermore, 26 participants (33.3%) stated that they were dissatisfied with their working hours, compared to 52 participants (66.7%) who expressed satisfaction with their working hours. Furthermore, 39 (or 50%) of the participants said they weren’t happy with their pay. Inquiries concerning the participants’ subjective sensations of stress, anxiety/restlessness, and depression during the previous several weeks due to dealing with patients infected with the coronavirus were also made. Of the 78 individuals, 24 (30%) said they felt depressed occasionally, while 18 (23%) said they felt down most of the time. While 16 (20%) reported feeling anxious most of the time, 23 (29%) reported feeling anxious occasionally. Furthermore, of the participants, 25 (32%) reported feeling stressed occasionally, and 15 (18%) reported feeling stressed most of the time due to their interactions with coronavirus patients. In addition, 61 individuals had less than five years of experience, 11 had five to fifteen years of experience, and only 6 had fifteen or more years of experience. By Pearson The link between the research variables and the demographic factors was examined using product moment correlation. Working hours and wage satisfaction were positively associated. The predictive relationship between secondary trauma self-efficacy and secondary trauma in physicians was examined using multiple hierarchical regression analysis (Table 1).

Table 1: Secondary trauma as the outcome variable and secondary trauma self-efficacy as the predictor were used in a multiple hierarchical regression analysis

Gender, contentment with pay and working hours, relationships with department head, coworkers, and family, as well as subjective experiences of stress, restlessness, and melancholy, were added as first step control factors. It was discovered that the subjective perception of stress was a strong predictor of subsequent trauma. The total model explained 31% of the variance in secondary trauma (ΔR²=0.31) and was statistically significant (F(9,68)=3.58, p=0.001). After adding secondary trauma self-efficacy in the second stage, the total model was significant (F(10,67)= 7.71, p<0.001) and explained 19% of the variance in secondary trauma. The purpose of the current study was to examine the relationship between compassion, self-efficacy, and secondary trauma, as well as the subfactors of job burnout and secondary trauma. The study’s findings demonstrated a negative relationship between doctors’ compassion fatigue and their level of self-efficacy following secondary trauma. Furthermore, it was discovered that among frontline physicians caring for COVID-19 patients, secondary trauma self-efficacy was a strong predictor of both secondary trauma and job burnout. Although compassion fatigue among physicians has long been a cause for worry, the COVID 19 pandemic’s extraordinary conditions have caused its occurrences to rise dangerously quickly [11]. The current study examined, and the findings validated, the association between compassion fatigue, or job burnout and secondary trauma, and secondary trauma self-efficacy. It suggests that lower levels of secondary trauma, compassion fatigue, and job burnout are associated with doctors’ high levels of belief in their own capacity to handle secondary trauma. Second, the results of several hierarchical regressions showed that among physicians treating patients with coronavirus, secondary trauma self-efficacy significantly explained a variance in secondary traumatic stress. This indicates that lower levels of secondary trauma were significantly predicted by doctors’ beliefs in their own abilities, skills, and capabilities to overcome obstacles faced when working with coronavirus patients. Therefore, doctors with high levels of self-efficacy about secondary trauma are less likely to have symptoms of secondary traumatic stress, such as restlessness, flashbacks, and other psychological disorders. These findings are consistent with other research that demonstrated the importance of self-efficacy in anticipating subsequent trauma [12–14].  Third, self-efficacy related to secondary trauma was a strong predictor of job burnout, accounting for 17% of the variance in it. It suggests that physicians who successfully manage stressful conditions when caring for coronavirus patients are less likely to suffer from indications of occupational burnout, such as emotional weariness or a diminished ability to carry out their duties. Additionally, doctors’ quality of treatment is improved when they are less burned out from their jobs, which benefits coronavirus patients [15]. Additionally, correlational analysis results showed a substantial positive relationship between the subjective experiences of stress, anxiety, and melancholy and compassion fatigue and its subscales, secondary trauma and job burnout. This indicates that when medical professionals are unable to manage the symptoms of compassion fatigue, they are more likely to experience stress, anxiety, and depression [16, 17]. They may also have higher degrees of occupational burnout and secondary trauma. Since the study was done online during the COVID-19 epidemic and lockdown, there was restricted access to the sample population.

4. CONCLUSION

Physicians who treat patients infected with the coronavirus are at risk for secondary trauma and burnout. Stress, depression, and anxiety are further consequences of these issues. Nonetheless, self-efficacy following secondary trauma may operate as a buffer against these issues.

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