An investigation of attachment orientation, compassion fatigue, compassion satisfaction and resilience in hospice and palliative care nursing staff

Abstract

Firstly, the literature exploring associations between attachment orientation, burnout, compassion fatigue and compassion satisfaction in employees was reviewed. This added to a previous review by exploring compassion satisfaction and investigating potential mechanisms to account for any associations between these constructs. Twenty-six empirical studies were identified. Collectively, the reviewed articles suggested that secure attachment style offers protection from burnout and that attachment anxiety is associated with higher levels of burnout and compassion fatigue amongst employees. Results relating to attachment avoidance are less clear and a limited number of studies make it difficult to draw conclusions in relation to compassion satisfaction. In reviewing the proposed mechanisms for associations between the constructs under review, commonalities were identified, including internalised representations of self and others that predispose towards maladaptive coping responses and difficulties with affect regulation. Limitations of the reviewed studies include an array of different measures of attachment and burnout, restricting opportunity for comparisons between studies, cross-sectional designs and lack of clarity around the concepts being measured.

The empirical paper investigated associations between attachment orientation, compassion fatigue (comprising burnout and secondary trauma), compassion satisfaction and resilience in a sample of 64 hospice and palliative care nursing staff. It was predicted that attachment anxiety would be significantly and positively associated with both sub-components of compassion fatigue and negatively related to compassion satisfaction, and that attachment avoidance would be positively associated with burnout and negatively related to compassion satisfaction. The present study sought to explore associations between attachment avoidance and secondary trauma as the current evidence base is inconclusive in this regard. Hypotheses were supported, with the exception of associations between attachment anxiety and compassion satisfaction, which were not significant. It was also hypothesised that resilience would mediate relationships between attachment orientation and burnout, secondary trauma and compassion satisfaction: this hypothesis was not supported. A novel, implicit measure of attachment orientation was administered but failed to significantly correlate with any of the predictor or criterion variables. Suggestions for how this measure may be used in future research are offered. Burnout, secondary trauma, compassion satisfaction and resilience scores remained stable over time, highlighting the importance of establishing appropriate intervention programmes in order to support those experiencing compassion fatigue. Limitations, clinical implications and directions for further research are discussed.

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ORCID for Kathy Carnelley: orcid.org/0000-0003-4064-8576

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