# The Dual-Path Analysis of the Effect of Difficult Nurse-Patient Relationship on Compassion Fatigue and Compassion Satisfaction in Nurses

## TL;DR

This study explores how difficult nurse-patient relationships affect compassion fatigue and satisfaction in nurses, revealing key psychological mechanisms and potential interventions.

## Contribution

The study introduces a moderated mediation model to explain the dual impact of difficult nurse-patient relationships on compassion outcomes.

## Key findings

- Empathic concern and personal distress mediate the relationship between difficult nurse-patient relationships and compassion outcomes.
- Self-reflection moderates the effect of difficult relationships on empathic concern.
- Structural model differences were found between nurses with and without hospital traumatic experiences.

## Abstract

Although compassion fatigue has received significant attention in nursing management, compassion satisfaction has been less studied.

This study was designed to elucidate the positive and negative trends in nursing empathy from a dialectical perspective and investigate the impact of difficult nurse-patient relationship on compassion fatigue and satisfaction, and the underlying mechanisms.

A cross-sectional study was conducted from November to December 2022 at a tertiary hospital in a northeastern province of China on 1,756 nurses. A moderated mediation model was constructed using structural equation modeling, and multi-group comparative analysis was used to examine the differences in the proposed model.

After adjusting for controlled variables, empathic concern and personal distress were shown to mediate the relationship between difficult nurse-patient relationship and, respectively, compassion satisfaction and burnout. Personal distress was found to mediate the relationship between difficult nurse-patient relationship and secondary traumatic stress, while self-reflection was found to moderate the effect of difficult nurse-patient relationship on empathic concern. Finally, differences in the structural model were detected between those with and without hospital traumatic experience.

The findings reveal the mechanisms and boundary conditions underlying difficult nurse-patient relationship that influence compassion fatigue and compassion satisfaction. Interventions that increase the level of self-reflection and empathic concern may help reduce burnout and increase compassion satisfaction in nurses.