A Study of the Relationship between Compassion Fatigue, Somatization and Silencing Response among Hospital Nurses: Focusing on the Mediating Effects of Silencing Response

Sun Hwa Kim; Tae Wha Lee

doi:10.7475/kjan.2014.26.3.362

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Study of the Relationship between Compassion Fatigue, Somatization and Silencing Response among Hospital Nurses: Focusing on the Mediating Effects of Silencing Response

Sun Hwa Kim¹, Tae Wha Lee²

Korean Journal of Adult Nursing 2014;26(3):362-371.
Published online: June 30, 2014

DOI: https://doi.org/10.7475/kjan.2014.26.3.362

¹Hanyang University Hospital, Seoul

²College of Nursing, Yonsei University, Seoul, Korea

Corresponding author: Lee, Tae Wha College of Nursing, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea. Tel: +82-2-2228-3305, Fax: +82-2-392-5440, E-mail: 79ssunhwa@hanmail.net

• Received: November 26, 2013 • Accepted: June 3, 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
REFERENCES

Abstract

Purpose
The purpose of this study was to identify Compassion Fatigue (CF), Somatization, and Silencing Response (SR) among nurses and understand intermediate effects between the variables.
Methods
The sample of 240 nurses who were working three shifts in medical and surgical wards, and emergency room were recruited in three hospitals with over 700 beds. A structured questionnaire was used which included CF, Somatization and SR scales. The data were analyzed using descriptive statistics, ANOVA, Pearson's correlation coefficients and stepwise multiple regression.
Results
There were statistically significant differences in CF, Somatization and SR depending on perceived personal health condition, experience of turnover, co-worker support. There were significant correlations between those study variables. The result also indicated that burnout (ß=.81, p<.001) which is a part of Secondary Traumatic Stress and Somatization (ß=.79, p<.001) have the role of partial mediator in the relationship between Secondary Traumatic Stress and Silencing response.
Conclusion
The results of study show that an intermediary role by Burnout and Somatization in Silencing response of nurses is important for effective human resource management in hospital nursing staffs. Effective human resource management which includes mentoring and social support system can enhance the professional quality of life of nurses, which will eventually contribute to the quality of care by those care providers and counselors.
Key Words: Compassion fatigue; Somatization; Silencing response; Hospital nurse

Table 1.

Differences of Compassion Fatigue, Somatization, Silencing Response according to General Characteristics (N=240)

Variables	Categories	n(%)	Compassion fatigue				Somatization		Silencing response
			STS		Burnout		Somatization		Silencing response
			M±SD	t or F(p) Scheffé	M±SD	t or F (p) Scheffé	M±SD	t or F(p) Scheffé	M±SD	t or F(p) Scheffé
Gender	Male	4(1.7)	2.00±0.82	8.62	2.65±0.60	2.14	2.13±0.92	0.00	4.70±1.22	0.42
Gender	Female	236(98.3)	2.81±0.55	(.004)	3.01±0.48	(.145)	2.11±0.71	(.961)	5.12±1.29	(.517)
Age(year)	20~29^a	125(52.1)	2.85±0.59	2.05	3.11±0.51	8.26	2.18±0.72	2.26	5.31±1.15	8.56
	30~39^b	85(35.4)	2.80±0.49	(.131)	2.92±0.39	(＜.001)	2.08±0.67	(.072)	5.07±1.36	(＜.001)
	≥40^c	30(12.5)	2.62±0.58		2.77±0.52	a＞c	1.86±0.71	a＞c	4.30±1.29	a, b＞c
Marital status	Unmarried	160(66.7)	2.79±0.60	0.09	2.92±0.40	3.52	2.09±0.70	.23	5.10±1.22	0.06
Marital status	Married	80(33.3)	2.82±0.46	(.768)	3.04±0.52	(.062)	2.14±0.72	(.636)	5.14±1.41	(.801)
Religion	Yes	135(56.2)	2.80±0.54	0.00	2.95±0.46	4.33	2.13±0.77	.19	5.01±1.25	2.10
Religion	No	105(43.8)	2.80±0.58	(.976)	3.08±0.51	(.038)	2.09±0.66	(.664)	5.25±1.32	(.148)
Education	College^a Universitiy^b ≥Master^c	111(46.3) 105(43.7) 24(10.0)	2.87±0.55 2.76±0.58 2.68±0.50	1.63 (.199)	3.10±0.50 2.97±0.46 2.70±0.39	7.81 (＜.001) a, b＞c	2.21±0.78 2.03±0.60 2.00±0.78	2.06 (.130)	5.29±1.26 5.03±1.26 4.69±1.40	2.68 (.071)
On duty average sleeping tim	＜5hrs	53(22.1)	2.69±0.58	2.90	2.94±0.53	2.12	2.22±0.62	3.48	5.10±1.25	0.12
	≥5hrs	87(36.3)	2.91±0.49	(.057)	3.09±0.45	(.123)	2.21±0.73	(＜.032)	5.17±1.37	(.885)
	≥6hrs	100(41.6)	2.77±0.59		2.96±0.49		1.97±0.71	a＞b, c	5.07±1.24
Off duty average sleeping time	＜7hrs	85(35.4)	2.75±0.47	1.13	2.97±0.44	0.45	2.16±0.70	0.77	5.03±1.23	0.63
Off duty average sleeping time	≥7hrs	155(64.6)	2.83±0.60	(.288)	3.02±0.51	(.505)	2.08±0.71	(.381)	5.16±1.32	(.427)
Subjective health status	UnHealthy^a Usually^b Healthy^c	78(32.5) 121(50.4) 41(17.1)	2.91±0.57 2.85±0.50 2.45±0.58	10.74 (＜.001) a, b＞c	3.26±0.46 2.94±0.41 2.69±0.50	24.36 (＜.001) a＞b＞c	2.46±0.79 2.02±0.60 1.69±0.50	20.34 (＜.001)	5.48±1.17 5.08±1.31 4.51±1.21	8.28 (＜.001) a, b＞c
Work unit	Medical	103(42.9)	2.82±0.57	1.48	2.99±0.49	1.41	2.11±0.74	1.27	4.91±1.28	2.28
	Surgical	108(45.0)	2.83±0.53	(.230)	3.05±0.49	(.247)	2.16±0.72	(.282)	5.25±1.29	(.105)
	ER	29(12.1)	2.63±0.59		2.89±0.47		1.92±0.48		5.32±1.23
Clinical experience (year)	＞5^a	113(47.1)	2.82±0.61	0.15	3.05±0.49	2.62	2.17±0.69	0.77	5.34±1.18	6.47
	≥5^b	54(22.5)	2.78±0.50	(.862)	3.05±0.51	(.075)	2.07±0.73	(.466)	5.25±1.24	(＜.001)
	≥10^c	73(30.4)	2.78±0.53		2.89±0.46		2.04±0.71		4.67±1.38	a, b＞c
Experience in current unit (year)	＞3	97(40.4)	2.81±0.57	1.52	3.04±0.51	1.03	2.09±0.70	0.40	5.18±1.23	0.69
	≥3	42(17.5)	2.92±0.61	(.221)	3.04±0.56	(.357)	2.20±0.66	(.688)	5.24±1.35	(.504)
	≥5	101(42.1)	2.75±0.52		2.95±0.43		2.08±0.73		5.00±1.32
Position	Staff	209(87.1)	2.80±0.57	0.00	3.02±0.49	2.24	2.12±0.69	0.60	5.18±1.27	4.60
Position	Charge	31(12.9)	2.80±0.48	(.989)	2.88±0.42	(.136)	2.02±0.80	(.441)	4.66±1.33	(.033)
Turn over experience	Yes	46(4.2)	2.58±0.55	9.37	2.86±0.51	5.04	1.85±0.54	7.80	4.62±1.18	8.85
Turn over experience	No	194(80.8)	2.85±0.55	(.002)	3.04±0.48	(.026)	2.17±0.73	(.006)	5.23±1.28	(.003)
Co-work support	Yes	125(52.1)	2.71±0.56	7.32	2.91±0.48	10.74	1.94±0.58	15.31	4.93±1.14	5.20
Co-work support	No	115(47.9)	2.90±0.54	(.007)	3.11±0.47	(＜.001)	2.29±0.78	(＜.001)	5.31±1.40	(＜.023)

STS=secondary traumatic stress.

Table 2.

The Descriptive Statistics of Compassion Fatigue, Somatization, Silencing Response of Participants. (N=240)

Variables		Categories	n (%)	M±SD	Range
Compassion fatigue	Secondary traumatic stress	≤22 (low)	37 (15.4)	28.01±5.59	10~50
		23~41 (moderate)	201 (83.8)
		≥42 (high)	2 (0.8)
	Burnout	≤22 (low)	7 (2.9)	27.49±4.67	10~50
		23~41 (moderate)	232 (96.7)
		≥42 (high)	1 (0.4)
Somatization				23.58±7.85	12~60
Silencing response		0~20 (minimal risk)	0 (0.0)	76.71±19.26	0~150
		21~40 (some risk)	6 (2.5)
		41~94 (moderate risk)	193 (80.4)
		95~150 (high risk)	41 (17.1)

Table 3.

Correlations among Variables (N=240)

Variables	Compassion fatigue		Somatization
	Secondary traumatic stress	Burnout	Somatization
	r (p)	r (p)	r (p)
Burnout	.60 (＜.001)
Somatization	.48 (＜.001)	.49 (＜.001)
Silencing response	.46 (＜.001)	.48 (＜.001)	.42 (＜.001)

Table 4.

Burnout in Mediating Effects of the Relationship between STS and SR (N=240)

IV=independent variable; DV=dependent variable; PV=parameter variable; STS=secondary traumatic stress; BO=burnout; SR=silencing response;

^*p＜.001.

Table 5.

Somatization in Mediating Effects of the Relationship between STS and SR (N=240)

IV=independent variable; DV=dependent variable; PV=parameter variable; STS=secondary traumatic stress; SR=silencing response;

^*p＜.001.

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Study of the Relationship between Compassion Fatigue, Somatization and Silencing Response among Hospital Nurses: Focusing on the Mediating Effects of Silencing Response

Korean J Adult Nurs. 2014;26(3):362-371. Published online June 30, 2014

DOI: https://doi.org/10.7475/kjan.2014.26.3.362

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Study of the Relationship between Compassion Fatigue, Somatization and Silencing Response among Hospital Nurses: Focusing on the Mediating Effects of Silencing Response

Korean J Adult Nurs. 2014;26(3):362-371. Published online June 30, 2014

DOI: https://doi.org/10.7475/kjan.2014.26.3.362

Study of the Relationship between Compassion Fatigue, Somatization and Silencing Response among Hospital Nurses: Focusing on the Mediating Effects of Silencing Response

Table 1.

Differences of Compassion Fatigue, Somatization, Silencing Response according to General Characteristics (N=240)

Variables	Categories	n(%)	Compassion fatigue				Somatization		Silencing response
			STS		Burnout		Somatization		Silencing response
			M±SD	t or F(p) Scheffé	M±SD	t or F (p) Scheffé	M±SD	t or F(p) Scheffé	M±SD	t or F(p) Scheffé
Gender	Male	4(1.7)	2.00±0.82	8.62	2.65±0.60	2.14	2.13±0.92	0.00	4.70±1.22	0.42
Gender	Female	236(98.3)	2.81±0.55	(.004)	3.01±0.48	(.145)	2.11±0.71	(.961)	5.12±1.29	(.517)
Age(year)	20~29^a	125(52.1)	2.85±0.59	2.05	3.11±0.51	8.26	2.18±0.72	2.26	5.31±1.15	8.56
	30~39^b	85(35.4)	2.80±0.49	(.131)	2.92±0.39	(＜.001)	2.08±0.67	(.072)	5.07±1.36	(＜.001)
	≥40^c	30(12.5)	2.62±0.58		2.77±0.52	a＞c	1.86±0.71	a＞c	4.30±1.29	a, b＞c
Marital status	Unmarried	160(66.7)	2.79±0.60	0.09	2.92±0.40	3.52	2.09±0.70	.23	5.10±1.22	0.06
Marital status	Married	80(33.3)	2.82±0.46	(.768)	3.04±0.52	(.062)	2.14±0.72	(.636)	5.14±1.41	(.801)
Religion	Yes	135(56.2)	2.80±0.54	0.00	2.95±0.46	4.33	2.13±0.77	.19	5.01±1.25	2.10
Religion	No	105(43.8)	2.80±0.58	(.976)	3.08±0.51	(.038)	2.09±0.66	(.664)	5.25±1.32	(.148)
Education	College^a Universitiy^b ≥Master^c	111(46.3) 105(43.7) 24(10.0)	2.87±0.55 2.76±0.58 2.68±0.50	1.63 (.199)	3.10±0.50 2.97±0.46 2.70±0.39	7.81 (＜.001) a, b＞c	2.21±0.78 2.03±0.60 2.00±0.78	2.06 (.130)	5.29±1.26 5.03±1.26 4.69±1.40	2.68 (.071)
On duty average sleeping tim	＜5hrs	53(22.1)	2.69±0.58	2.90	2.94±0.53	2.12	2.22±0.62	3.48	5.10±1.25	0.12
	≥5hrs	87(36.3)	2.91±0.49	(.057)	3.09±0.45	(.123)	2.21±0.73	(＜.032)	5.17±1.37	(.885)
	≥6hrs	100(41.6)	2.77±0.59		2.96±0.49		1.97±0.71	a＞b, c	5.07±1.24
Off duty average sleeping time	＜7hrs	85(35.4)	2.75±0.47	1.13	2.97±0.44	0.45	2.16±0.70	0.77	5.03±1.23	0.63
Off duty average sleeping time	≥7hrs	155(64.6)	2.83±0.60	(.288)	3.02±0.51	(.505)	2.08±0.71	(.381)	5.16±1.32	(.427)
Subjective health status	UnHealthy^a Usually^b Healthy^c	78(32.5) 121(50.4) 41(17.1)	2.91±0.57 2.85±0.50 2.45±0.58	10.74 (＜.001) a, b＞c	3.26±0.46 2.94±0.41 2.69±0.50	24.36 (＜.001) a＞b＞c	2.46±0.79 2.02±0.60 1.69±0.50	20.34 (＜.001)	5.48±1.17 5.08±1.31 4.51±1.21	8.28 (＜.001) a, b＞c
Work unit	Medical	103(42.9)	2.82±0.57	1.48	2.99±0.49	1.41	2.11±0.74	1.27	4.91±1.28	2.28
	Surgical	108(45.0)	2.83±0.53	(.230)	3.05±0.49	(.247)	2.16±0.72	(.282)	5.25±1.29	(.105)
	ER	29(12.1)	2.63±0.59		2.89±0.47		1.92±0.48		5.32±1.23
Clinical experience (year)	＞5^a	113(47.1)	2.82±0.61	0.15	3.05±0.49	2.62	2.17±0.69	0.77	5.34±1.18	6.47
	≥5^b	54(22.5)	2.78±0.50	(.862)	3.05±0.51	(.075)	2.07±0.73	(.466)	5.25±1.24	(＜.001)
	≥10^c	73(30.4)	2.78±0.53		2.89±0.46		2.04±0.71		4.67±1.38	a, b＞c
Experience in current unit (year)	＞3	97(40.4)	2.81±0.57	1.52	3.04±0.51	1.03	2.09±0.70	0.40	5.18±1.23	0.69
	≥3	42(17.5)	2.92±0.61	(.221)	3.04±0.56	(.357)	2.20±0.66	(.688)	5.24±1.35	(.504)
	≥5	101(42.1)	2.75±0.52		2.95±0.43		2.08±0.73		5.00±1.32
Position	Staff	209(87.1)	2.80±0.57	0.00	3.02±0.49	2.24	2.12±0.69	0.60	5.18±1.27	4.60
Position	Charge	31(12.9)	2.80±0.48	(.989)	2.88±0.42	(.136)	2.02±0.80	(.441)	4.66±1.33	(.033)
Turn over experience	Yes	46(4.2)	2.58±0.55	9.37	2.86±0.51	5.04	1.85±0.54	7.80	4.62±1.18	8.85
Turn over experience	No	194(80.8)	2.85±0.55	(.002)	3.04±0.48	(.026)	2.17±0.73	(.006)	5.23±1.28	(.003)
Co-work support	Yes	125(52.1)	2.71±0.56	7.32	2.91±0.48	10.74	1.94±0.58	15.31	4.93±1.14	5.20
Co-work support	No	115(47.9)	2.90±0.54	(.007)	3.11±0.47	(＜.001)	2.29±0.78	(＜.001)	5.31±1.40	(＜.023)

STS=secondary traumatic stress.

Table 2.

The Descriptive Statistics of Compassion Fatigue, Somatization, Silencing Response of Participants. (N=240)

Variables		Categories	n (%)	M±SD	Range
Compassion fatigue	Secondary traumatic stress	≤22 (low)	37 (15.4)	28.01±5.59	10~50
		23~41 (moderate)	201 (83.8)
		≥42 (high)	2 (0.8)
	Burnout	≤22 (low)	7 (2.9)	27.49±4.67	10~50
		23~41 (moderate)	232 (96.7)
		≥42 (high)	1 (0.4)
Somatization				23.58±7.85	12~60
Silencing response		0~20 (minimal risk)	0 (0.0)	76.71±19.26	0~150
		21~40 (some risk)	6 (2.5)
		41~94 (moderate risk)	193 (80.4)
		95~150 (high risk)	41 (17.1)

Table 3.

Correlations among Variables (N=240)

Variables	Compassion fatigue		Somatization
	Secondary traumatic stress	Burnout	Somatization
	r (p)	r (p)	r (p)
Burnout	.60 (＜.001)
Somatization	.48 (＜.001)	.49 (＜.001)
Silencing response	.46 (＜.001)	.48 (＜.001)	.42 (＜.001)

Table 4.

Burnout in Mediating Effects of the Relationship between STS and SR (N=240)

IV=independent variable; DV=dependent variable; PV=parameter variable; STS=secondary traumatic stress; BO=burnout; SR=silencing response;

^*p＜.001.

Table 5.

Somatization in Mediating Effects of the Relationship between STS and SR (N=240)

IV=independent variable; DV=dependent variable; PV=parameter variable; STS=secondary traumatic stress; SR=silencing response;

^*p＜.001.

Table 1. Differences of Compassion Fatigue, Somatization, Silencing Response according to General Characteristics (N=240)

STS=secondary traumatic stress.

Table 2. The Descriptive Statistics of Compassion Fatigue, Somatization, Silencing Response of Participants. (N=240)

Table 3. Correlations among Variables (N=240)

Table 4. Burnout in Mediating Effects of the Relationship between STS and SR (N=240)

IV=independent variable; DV=dependent variable; PV=parameter variable; STS=secondary traumatic stress; BO=burnout; SR=silencing response;

p＜.001.

Table 5. Somatization in Mediating Effects of the Relationship between STS and SR (N=240)

IV=independent variable; DV=dependent variable; PV=parameter variable; STS=secondary traumatic stress; SR=silencing response;

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Study of the Relationship between Compassion Fatigue, Somatization and Silencing Response among Hospital Nurses: Focusing on the Mediating Effects of Silencing Response

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