Interventions for Compassion Fatigue, Burnout, and Secondary Traumatic Stress in Nurses: A Systematic Review and Network Meta-Analysis.

Probably not a substantial claim: may not pass S3 (load-bearing).

The network meta-analysis was conducted following the PRISMA guideline.

“We conducted this network meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline”

• cites Sarkis-Onofre et al. 2021 sourceDisputed

  The Editorial explicitly identifies using PRISMA as a methodological guideline for conducting reviews as an inappropriate use (passage 7). It says PRISMA guides reporting, while separate methodological guidelines guide how reviews are conducted (passages 4 and 8). The source therefore does not support describing the network meta-analysis as conducted following PRISMA. (LLM, conf=0.88)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

The Professional Quality of Life (ProQOL) scale is the most widely used tool to assess compassion fatigue in nurses.

“The most widely used tool to assess CF in nurses is the Professional Quality of Life (ProQOL) scale (Ruiz-Fernández, Pérez-García, and Ortega-Galán 2020).”

• cites Ruiz-Fernández, Pérez-García, and Ortega-Galán 2020 sourcePartly supported

  The Instruments section (2.3; page not provided) describes ProQOL as a scale used with healthcare professionals and identifies its compassion-fatigue subscale. The paper uses it to assess nurses, but does not say it is the most widely used tool for that purpose. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Psychological interventions significantly address nurses' emotional distress and trauma memories, offering personalized support and care.

“that psychological interventions significantly address nurses' emotional distress and trauma memories, offering personalized support and care (Zhang, Pang, and Duan 2023).”

• cites Zhang, Pang, and Duan 2023 sourceCould not verify

  The Results section, ‘Effects of different intervention types on empathy’ (page unavailable), evaluates medical-humanities education and empathy, not psychological treatment for nurses. Searches for emotional distress, trauma memories, and psychological interventions found no passage addressing the claimed outcomes or personalized support. (LLM, conf=0.76)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Aromatherapy uses essential oils and other aromatic substances to induce relaxation through olfactory stimulation, relieving emotional tension and stress.

“Aromatherapy uses essential oils and other aromatic substances to induce relaxation through olfactory stimulation, relieving emotional tension and stress (Zhang et al. 2018).”

• cites Zhang et al. 2018 sourceCould not verify

  The Discussion addresses nurses’ stress, compassion fatigue, and self-care strategies, but it does not discuss aromatherapy or how it might work. Searches for essential oils, aromatic substances, scent, and olfactory stimulation found no relevant passage in our copy. (LLM, conf=0.76)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Relaxation training uses techniques such as progressive muscle relaxation and deep breathing to alleviate physical and psychological tension, promoting overall relaxation.

“Relaxation training uses techniques such as progressive muscle relaxation and deep breathing to alleviate physical and psychological tension, promoting overall relaxation (Zhang, Pang, and Duan 2023).”

• cites Zhang, Pang, and Duan 2023 sourceCould not verify

  The Results sections on intervention types and trial characteristics describe medical humanities courses, reflective writing, clinical practice, and their effects on empathy. Searches for progressive muscle relaxation, deep breathing, and relaxation training found no passage addressing those techniques or their effects on physical and psychological tension. No page numbers are available in our copy. (LLM, conf=0.78)

  Experimental — accuracy not yet measured

May combine two claims.

Behavioral training is the most effective intervention for reducing compassion fatigue in nurses, with the highest SUCRA probability of 85.2%.

“Behavioral training significantly reduced compassion fatigue and improved compassion satisfaction.”

• Also stated in: § 3.4.1 | Net Meta-Analysis of CF · hedged

  “The probability analysis in Figure 4a indicates that behavioral training is the most effective treatment for relieving CF, with the highest probability of 85.2%, as reflected by the curve under the surface.”

• Also stated in: § 4 | Discussion Nurses often face high-intensity emotional labor and stress while providing care, which can easily lead to CF. Prolonged CF can result in issues such as BO, depression, and anxiety, potentially leading to job turnover (Delgado et al. 2023).Therefore, implementing effective interventions to alleviate nurses' CF is essential not only for improving their mental health and job satisfaction but also for enhancing the overall quality of nursing services.Our study found that conventional interventions generally have relatively weak effectiveness, consistent with conclusions Many studies focus on exploring the effectiveness of various interventions in alleviating nurses' CF.These interventions include psychological, behavioral, and sensory approaches.Psychological interventions primarily aim to support and improve nurses' mental health (Franza et al. 2020).Various psychotherapies and counseling techniques help nurses identify and understand the causes of CF, enhance emotional regulation skills, alleviate stress, prevent BO, and improve psychological resilience and coping abilities (Xie et al. 2021).Behavioral interventions aim to change nurses' behavior patterns and work habits.By adjusting behaviors and employing self-management techniques, these interventions reduce sources of stress, enhance work efficiency and healthy behaviors, and alleviate CF (Dumit and Honein-AbouHaidar 2019).Sensory interventions focus on regulating and optimizing nurses' sensory experiences, such as vision, hearing, and smell.By creating a comfortable and relaxing environment, these interventions improve work comfort, promote physical and mental relaxation, and reduce the negative impacts of CF.Comprehensive interventions combine psychological, behavioral, and sensory measures (Giuliani 2019).By employing a multifaceted approach, these interventions work synergistically to enhance nurses' overall mental and physical health.Existing literature presents a variety of interventions for nurses' CF, with effectiveness varying across different studies.However, there is currently a lack of systematic and comprehensive evidence to assess the relative effectiveness of these interventions.Traditional meta-analyses typically compare the effects of interventions in pairs and do not account for the relative effects of multiple interventions simultaneously.Therefore, this study aims to provide a more comprehensive and reliable evidence base for clinical practice by comparing the relative effectiveness of various interventions for nurses' CF, including psychological, behavioral, conventional, and comprehensive approaches. Our study found that behavioral interventions significantly alleviate nurses' CF and improve CS, aligning with international research findings.Behavioral interventions, such as stress management training and emotional support groups, help nurses identify and address emotional stress at work (Partlak Günüşen et al. 2022).These interventions enable nurses to better manage their emotions, reduce emotional exhaustion, and enhance CS.Teaching effective emotional regulation techniques, such as deep breathing, mindfulness meditation, and positive thinking, helps nurses maintain emotional stability when facing patients' suffering, reduce the accumulation of negative emotions, and improve CS (Trumello et al. 2020). · plain

  “Our study found that behavioral interventions significantly alleviate nurses' CF and improve CS, aligning with international research findings.”

May combine two claims.

Behavioral training is the most effective intervention for improving compassion satisfaction in nurses, with the highest SUCRA probability of 79.3%.

“Behavioral training significantly reduced compassion fatigue and improved compassion satisfaction.”

• Also stated in: § 3.4.2 | Net Meta-Analysis of CS · plain

  “Based on the probability analysis in Figure 4b, behavioral intervention had the highest volume of 79.3% curve under the surface, making it the most effective intervention to improve nurses' CS.”

• Also stated in: § 4 | Discussion Nurses often face high-intensity emotional labor and stress while providing care, which can easily lead to CF. Prolonged CF can result in issues such as BO, depression, and anxiety, potentially leading to job turnover (Delgado et al. 2023).Therefore, implementing effective interventions to alleviate nurses' CF is essential not only for improving their mental health and job satisfaction but also for enhancing the overall quality of nursing services.Our study found that conventional interventions generally have relatively weak effectiveness, consistent with conclusions Many studies focus on exploring the effectiveness of various interventions in alleviating nurses' CF.These interventions include psychological, behavioral, and sensory approaches.Psychological interventions primarily aim to support and improve nurses' mental health (Franza et al. 2020).Various psychotherapies and counseling techniques help nurses identify and understand the causes of CF, enhance emotional regulation skills, alleviate stress, prevent BO, and improve psychological resilience and coping abilities (Xie et al. 2021).Behavioral interventions aim to change nurses' behavior patterns and work habits.By adjusting behaviors and employing self-management techniques, these interventions reduce sources of stress, enhance work efficiency and healthy behaviors, and alleviate CF (Dumit and Honein-AbouHaidar 2019).Sensory interventions focus on regulating and optimizing nurses' sensory experiences, such as vision, hearing, and smell.By creating a comfortable and relaxing environment, these interventions improve work comfort, promote physical and mental relaxation, and reduce the negative impacts of CF.Comprehensive interventions combine psychological, behavioral, and sensory measures (Giuliani 2019).By employing a multifaceted approach, these interventions work synergistically to enhance nurses' overall mental and physical health.Existing literature presents a variety of interventions for nurses' CF, with effectiveness varying across different studies.However, there is currently a lack of systematic and comprehensive evidence to assess the relative effectiveness of these interventions.Traditional meta-analyses typically compare the effects of interventions in pairs and do not account for the relative effects of multiple interventions simultaneously.Therefore, this study aims to provide a more comprehensive and reliable evidence base for clinical practice by comparing the relative effectiveness of various interventions for nurses' CF, including psychological, behavioral, conventional, and comprehensive approaches. Our study found that behavioral interventions significantly alleviate nurses' CF and improve CS, aligning with international research findings.Behavioral interventions, such as stress management training and emotional support groups, help nurses identify and address emotional stress at work (Partlak Günüşen et al. 2022).These interventions enable nurses to better manage their emotions, reduce emotional exhaustion, and enhance CS.Teaching effective emotional regulation techniques, such as deep breathing, mindfulness meditation, and positive thinking, helps nurses maintain emotional stability when facing patients' suffering, reduce the accumulation of negative emotions, and improve CS (Trumello et al. 2020). · plain

  “Our study found that behavioral interventions significantly alleviate nurses' CF and improve CS, aligning with international research findings.”

May combine two claims.

Behavioral training compared with routine intervention has some effect in reducing compassion fatigue in nurses but does not reach statistical significance (overall effect size = 2.76, 95% CI [-0.14, 5.66], p = 0.06).

“behavioral training has some effect in reducing CF but does not reach statistical significance (Figure 5a, overall effect size = 2.76, 95% CI [-0.14, 5.66], p = 0.06).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Six of the 11 included studies were published in English and 5 in Chinese, and all were published in the past 5 years.

“Six of the 11 included studies were published in English and 5 in Chinese, and all of these articles were published in the past 5 years.”

Classified as probably not a substantial claim.

The outcome indicators assessed in the included studies included compassion fatigue, compassion satisfaction, burnout, and secondary traumatic stress.

“The outcome indicators assessed included CF, CS, BO, and STS.”

May combine two claims.

The network funnel plots were nearly symmetrical, but some nodes fell outside the funnel, suggesting potential heterogeneity or publication bias, possibly due to small sample sizes.

“The network funnel plots for the included studies displayed nearly symmetrical distributions; however, some nodes were outside the funnel, suggesting potential heterogeneity or publication bias, possibly due to small sample sizes.”

May combine two claims. The quote only partly states this claim.

Eleven studies were included in the review, with a total of 774 participants.

“ultimately, 11 studies were deemed eligible for inclusion.”

• Also stated in: § 3.2 | Characteristics of the Included Studies · plain

  “In total, 774 participants were included across the 11 studies.”

Probably not a substantial claim: may not pass S3 (load-bearing).

No other evidence of bias was identified in the included studies.

“No other evidence of bias was identified in the included studies.”

May combine two claims.

Comprehensive intervention is the most effective intervention for reducing burnout in nurses, with the highest SUCRA probability of 87.5%.

“Comprehensive interventions were most effective in reducing burnout”

• Also stated in: § 3.4.3 | Net Meta-Analysis of Burnout · plain

  “The probability analysis in Figure 4c shows that comprehensive intervention has the highest likelihood of reducing job BO, with 87.5% of the curve below the surface.”

May combine two claims.

The risk of bias was generally low or unclear regarding incomplete outcome data and selective reporting.

“The risk of bias was generally low or unclear regarding incomplete outcome data and selective reporting.”

May combine two claims.

For compassion fatigue, psychological interventions rank second after behavioral training, and routine interventions rank third.

“Psychological interventions follow behavioral training, while routine interventions come next, after psychological interventions.”

May combine two claims. The quote only partly states this claim.

Psychological intervention is the most effective intervention for alleviating secondary traumatic stress in nurses, with the highest SUCRA probability of 91.6%.

“psychological interventions alleviated secondary trauma”

• Also stated in: § 3.4.4 | Net Meta-Analysis of Secondary Post-Traumatic Stress · plain

  “According to the probability analysis in Figure 4d, psychological intervention ranks highest among all interventions, with 91.6% of the curve under the surface, making it the most effective treatment for alleviating posttraumatic stress syndrome in nurses.”

• Also stated in: § 4 | Discussion Nurses often face high-intensity emotional labor and stress while providing care, which can easily lead to CF. Prolonged CF can result in issues such as BO, depression, and anxiety, potentially leading to job turnover (Delgado et al. 2023).Therefore, implementing effective interventions to alleviate nurses' CF is essential not only for improving their mental health and job satisfaction but also for enhancing the overall quality of nursing services.Our study found that conventional interventions generally have relatively weak effectiveness, consistent with conclusions Many studies focus on exploring the effectiveness of various interventions in alleviating nurses' CF.These interventions include psychological, behavioral, and sensory approaches.Psychological interventions primarily aim to support and improve nurses' mental health (Franza et al. 2020).Various psychotherapies and counseling techniques help nurses identify and understand the causes of CF, enhance emotional regulation skills, alleviate stress, prevent BO, and improve psychological resilience and coping abilities (Xie et al. 2021).Behavioral interventions aim to change nurses' behavior patterns and work habits.By adjusting behaviors and employing self-management techniques, these interventions reduce sources of stress, enhance work efficiency and healthy behaviors, and alleviate CF (Dumit and Honein-AbouHaidar 2019).Sensory interventions focus on regulating and optimizing nurses' sensory experiences, such as vision, hearing, and smell.By creating a comfortable and relaxing environment, these interventions improve work comfort, promote physical and mental relaxation, and reduce the negative impacts of CF.Comprehensive interventions combine psychological, behavioral, and sensory measures (Giuliani 2019).By employing a multifaceted approach, these interventions work synergistically to enhance nurses' overall mental and physical health.Existing literature presents a variety of interventions for nurses' CF, with effectiveness varying across different studies.However, there is currently a lack of systematic and comprehensive evidence to assess the relative effectiveness of these interventions.Traditional meta-analyses typically compare the effects of interventions in pairs and do not account for the relative effects of multiple interventions simultaneously.Therefore, this study aims to provide a more comprehensive and reliable evidence base for clinical practice by comparing the relative effectiveness of various interventions for nurses' CF, including psychological, behavioral, conventional, and comprehensive approaches. Our study found that behavioral interventions significantly alleviate nurses' CF and improve CS, aligning with international research findings.Behavioral interventions, such as stress management training and emotional support groups, help nurses identify and address emotional stress at work (Partlak Günüşen et al. 2022).These interventions enable nurses to better manage their emotions, reduce emotional exhaustion, and enhance CS.Teaching effective emotional regulation techniques, such as deep breathing, mindfulness meditation, and positive thinking, helps nurses maintain emotional stability when facing patients' suffering, reduce the accumulation of negative emotions, and improve CS (Trumello et al. 2020). · plain

  “Our analysis found that psychological interventions were particularly effective in alleviating secondary trauma, consistent with both domestic and international research findings.”

May combine two claims.

This multifaceted approach addresses the various factors that contribute to nurses' burnout and significantly improves their physical and mental health.

“This multifaceted approach addresses the various factors that contribute to nurses' BO and significantly improves their physical and mental health.”

• AssumptionRests on an assumption: Burnout is typically caused by multiple factors, including work overload, emotional exhaustion, and lack of support.

May combine two claims.

Compassion fatigue causes nurses to feel exhausted, helpless, and emotionally numb, and decreases work efficiency, increases medical errors, and contributes to professional burnout.

“This condition not only causes nurses to feel exhausted, helpless, and emotionally numb but also decreases work efficiency, increases medical errors, and contributes to professional BO (Sinclair et al. 2017).”

• cites Sinclair et al. 2017 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Psychological counseling provides one-on-one support, assisting nurses in identifying and resolving emotional stress in their work, thereby enhancing psychological resilience and emotional regulation.

“Psychological counseling provides one-on-one support, assisting nurses in identifying and resolving emotional stress in their work, thereby enhancing psychological resilience and emotional regulation (Sinclair et al. 2017).”

• cites Sinclair et al. 2017 sourceNot checked — no full text of the source

May combine two claims.

Most of the included studies had intervention durations of less than 6 months, which limits the evaluation of the long-term sustainability of the interventions.

“Most of the included studies had intervention durations of less than 6 months, which limits the evaluation of the longterm sustainability of the interventions.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The mechanisms underlying compassion fatigue are complex, involving factors such as emotional resonance, workload, and occupational stress.

“The mechanisms underlying CF are complex, involving factors such as emotional resonance, workload, and occupational stress (Maytum, Heiman, and Garwick 2004).”

• cites Maytum, Heiman, and Garwick 2004 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Overall, cultural differences may influence the effectiveness of interventions.

“Overall, cultural differences may influence the effectiveness of interventions”

• AssumptionRests on an assumption: Nursing practices, work pressures, and cultural approaches to coping with compassion fatigue and secondary trauma vary across countries.
• AssumptionRests on an assumption: Studies from Iran and Turkey focus on behavioral training and emotional regulation, which may be more suitable for managing stress in these regions.
• AssumptionRests on an assumption: In China, mindfulness therapy is widely applied, aligning with cultural values of introspection and balance, enhancing its effectiveness.
• AssumptionRests on an assumption: In Korea, sensory interventions such as inhalation of patchouli essential oil are used to reduce compassion fatigue, while China is also exploring multisensory interventions for comprehensive effects.

Probably not a substantial claim: may not pass S3 (load-bearing).

The protocol for this network meta-analysis is registered on the INPLASY platform under registration number INPLASY202470116.

“This protocol is registered on the INPLASY platform (International Platform of Registered Systematic Review and Meta-analysis Protocols) under the registration number INPLASY202470116.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Two reviewers independently screened the retrieved studies.

“Two reviewers, Huiling Zhang and Zheyuan Xia, independently screened the retrieved studies.”

May combine two claims.

This study only included articles in English and Chinese, potentially excluding relevant research in other languages and impacting the comprehensiveness of the global evaluation.

“this study only included articles in English and Chinese, potentially excluding relevant research in other languages and impacting the comprehensiveness of our global evaluation.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Differences in cultural and nursing backgrounds may significantly impact the effectiveness of interventions.

“differences in cultural and nursing backgrounds may significantly impact the effectiveness of these interventions.”

• AssumptionRests on an assumption: Nursing practices, work pressures, and cultural approaches to coping with compassion fatigue and secondary trauma vary across countries.

Probably not a substantial claim: may not pass S3 (load-bearing).

Comprehensive support programs emphasize the combined application of various methods to holistically improve nurses' physical and mental health.

“Compared to single interventions, comprehensive support emphasizes the combined application of various methods to holistically improve nurses' physical and mental health (Pehlivan and Güner 2020).”

• cites Pehlivan and Güner 2020Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Specific nursing environments and cultural backgrounds could significantly influence the results.

“specific nursing environments and cultural backgrounds could significantly influence the results.”

• AssumptionRests on an assumption: Nursing practices, work pressures, and cultural approaches to coping with compassion fatigue and secondary trauma vary across countries.

May combine two claims.

Behavioral interventions, including stress management training and emotional support groups, help nurses identify and manage emotional stress, thereby improving their emotional regulation and overall job satisfaction.

“These interventions, including stress management training and emotional support groups, help nurses identify and manage emotional stress, thereby improving their emotional regulation and overall job satisfaction.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The variation in follow-up times across studies could affect the comprehensive assessment of short-term and long-term effects.

“The variation in follow-up times across studies could also affect the comprehensive assessment of short-term and long-term effects.”

• Also stated in: § 6 | Conclusions · plain

  “The variability in follow-up times also affects the assessment of short-and long-term effects.”

Classified as probably not a substantial claim.

The two reviewers independently assessed the risk of bias in the included studies using the Cochrane risk of bias tool.

“The two reviewers independently assessed the risk of bias in the included studies using the risk of bias tool provided by the Cochrane Collaboration, ensuring the anonymity of study authors.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Any discrepancies between the two reviewers were resolved by a third reviewer.

“Any discrepancies between the two reviewers were resolved by a third reviewer.”

Probably not a substantial claim: may not pass S3 (load-bearing).

A funnel plot was used to examine small sample effect and publication bias.

“A funnel plot was employed to examine the included studies' small sample effect and publication bias.”

May combine two claims.

Compassion fatigue affects nurses' physical and mental health and reduces the quality of care, thereby impacting patient recovery and satisfaction.

“This condition not only affects nurses' physical and mental health but also reduces the quality of care, thereby impacting patient recovery and satisfaction (Kong and Ganapathy 2022).”

• cites Kong and Ganapathy 2022Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Data extraction was conducted independently by both reviewers using a standardized extraction form.

“Data extraction was conducted independently by both reviewers using a standardized extraction form.”

May combine two claims.

Nurses are prone to professional burnout, particularly compassion fatigue, due to high-intensity work pressure, emotional challenges, and prolonged occupational exposure.

“However, due to high-intensity work pressure, emotional challenges, and prolonged occupational exposure, nurses are prone to professional burnout (BO), particularly compassion fatigue (CF) (Horner et al. 2014).”

• cites Horner et al. 2014 sourceNot checked — no full text of the source

May combine two claims.

Short-term interventions may yield immediate effects but cannot fully reflect the durability and stability of the interventions in the face of the complexity and long-term impact of compassion fatigue in nurses.

“While short-term interventions may yield immediate effects, they cannot fully reflect the durability and stability of the interventions in the face of the complexity and long-term impact of CF in nurses.”

May combine two claims.

Comprehensive interventions, which combine psychological, behavioral, organizational, and environmental measures, address stressors more effectively, thus reducing burnout more efficiently.

“Comprehensive interventions, which combine psychological, behavioral, organizational, and environmental measures, address these stressors more effectively, thus reducing BO more efficiently (Horner et al. 2014).”

• cites Horner et al. 2014 sourceNot checked — no full text of the source

• AssumptionRests on an assumption: Burnout is typically caused by multiple factors, including work overload, emotional exhaustion, and lack of support.

Classified as probably not a substantial claim.

A comprehensive search was conducted across six electronic databases from January 2000 to August 2024.

“We conducted a comprehensive search across six electronic databases-PubMed, Embase, Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Database (VIP), Cochrane Library, CNKI, and Wanfang Database-spanning from January 2000 to August 2024.”