The Relationship between Compassion Fatigue and Organizational Culture

Transcription

1 Digital Gerge Fx University Dctr f Psychlgy (PsyD) Theses and Dissertatins The Relatinship between Cmpassin Fatigue and Organizatinal Culture Katherine Mariah Cndrey Gerge Fx University, kcndrey11@gergefx.edu This research is a prduct f the Dctr f Psychlgy (PsyD) prgram at Gerge Fx University. Find ut mre abut the prgram. Recmmended Citatin Cndrey, Katherine Mariah, "The Relatinship between Cmpassin Fatigue and Organizatinal Culture" (2015). Dctr f Psychlgy (PsyD). Paper This Dissertatin is brught t yu fr free and pen access by the Theses and Dissertatins at Digital Gerge Fx University. It has been accepted fr inclusin in Dctr f Psychlgy (PsyD) by an authrized administratr f Digital Gerge Fx University. Fr mre infrmatin, please cntact arlfe@gergefx.edu.

2 The Relatinship between Cmpassin Fatigue and Organizatinal Culture by Katherine M. Cndrey Presented t the Faculty f the Graduate Department f Clinical Psychlgy Gerge Fx University in partial fulfillment f the requirements fr the degree f Dctr f Psychlgy in Clinical Psychlgy Newberg, Oregn April 26, 2015

3

4 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE iii Abstract This study examined the relatinship between cmpassin fatigue (CF) and rganizatinal culture in a sample f 16 rganizatins and 193 individual participants. Respndents cmpleted the Prfessinal Quality f Life Scale as well as the Organizatinal Culture Prfile. Results f this study fund an incidence rate f CF f 35-43%. Differences in CF amng the rganizatins surveyed were due, in part, t rganizatinal culture. Individuals wh place a high value n rewards were fund t be at higher risk f develping cmpassin fatigue. Organizatins with less decisiveness and higher variability in their rganizatinal value ratings tend t have mre cmpassin fatigue. Finally, supprtiveness in an rganizatinal culture was fund t be a strng predictr f an individual s ability t resist cmpassin fatigue. Imprtant cnceptual, practical, and plicy refrm implicatins are nted.

5 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE iv Table f Cntents Abstract... iii List f Tables... vi Chapter 1: Intrductin...1 Cmpassin Fatigue...1 Organizatinal Culture...5 The Interactin f Cmpassin Fatigue and Organizatinal Culture...6 Hypthesis...8 Chapter 2: Methds...9 Participants...9 Instruments...10 Prfessinal Quality f Life Scale...10 Organizatinal Culture Prfile...11 Prcedure...13 Chapter 3: Results...14 Descriptive Data...14 Crrelatins...15 Multiple Regressin Analysis...24 Regressin using individual ratings f rganizatinal culture t predict individual CF Regressin using individual ratings f rganizatinal culture and mean scres fr the rganizatin t predict individual CF....25

6 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE v Regressin using individual ratings f rganizatinal culture, mean scres fr the rganizatin, and the cnsistency amngst the raters t predict individual CF Chapter 4: Discussin...28 References...34 Appendix A: OPC Scring... 39Errr! Bkmark nt defined. Appendix B: PrQl Scring... Errr! Bkmark nt defined. Appendix C: Curriculum Vitae...43

7 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE vi List f Tables Table 1. Number f emplyees surveyed respnse rates fr the 16 surveyed rganizatins Table 2. Mean PrQOL scres fr the sixteen rganizatins Table 3. Mean OCP rankings fr sixteen rganizatins Table 4. Crrelatins f CS, burnut, STS, and CF with individual participant OPC scres Table 5. Crrelatins f individuals means n CS, burnut, STS, and CF with rganizatinal means n eight OPC dmains Table 6. Crrelatins f individuals means n CS, burnut, STS, and CF with rganizatinal standard deviatins n eight OPC dmains Table 7. Beta weights fr three regressin mdels predicting individual cmpassin fatigue... 26

8 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 1 Chapter 1 Intrductin Mental health prfessinals wrk diligently t imprve the emtinal wellbeing f the clients with whm they have cntact. In ding s, these prfessinals risk their wn emtinal wellbeing. The lng term, day-t-day cntact with clients and the resulting distress puts mental health prfessinals at risk f their wn mental health deterirating (Newell & MacNeil, 2010). The risks are nt fr nly mental health prfessinals t bear: mental health rganizatins can als be negatively affected by emplyees chrnic expsure t distressed clients. While there has been a cnsiderable amunt f research f the impact that cmpassin fatigue (CF) has n an individual, there has been little research dne n hw the rganizatin that individuals wrk in affects the amunt f CF that they experience. Therefre the purpse f this study is t explre hw rganizatinal culture cntributes t the ability t predict individuals CF. Cmpassin Fatigue Althugh we have been aware f many ways that mental health prfessinals can be injured by their caring fr thers, the field just came t understand that the prcess f listening t accunts f trauma can lead t trauma. This frm f trauma might lead t prblems that prfessinals have nt been trained t detect in themselves, and that rganizatinal and prfessinal standards have nt been develped t avid. Over the curse f the last tw decades, varius terms have been used t identify the stress that results frm helping traumatized clients. Terms used t describe this stress include

9 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 2 vicarius traumatizatin/trauma (VT; Pearlman & Saakvitne, 1995; Schauben & Frazier, 1995), secndary traumatic stress (STS), and cmpassin fatigue (CF; Figley, 1995). These terms have been defined numerus times in the literature (Bber & Regehr, 2006). Originating frm the wrk f Figley (1995), the term CF has been used t identify the experiencing f emtinal and physical fatigue as a result f the nging empathy experienced when treating suffering patients. This result is a cnsequence f wrking with peple wh have experienced extremely stressful events. CF ccurs gradually ver time (Figley, 1995). Sme researchers have emphasized the sciemtinal symptms f clinicians with CF (Jenkins & Baird, 2002). Prfessinals experiencing CF may experience deteriratin in their capacity r desire t be empathic twards clients (Elwd, Mtt, Lhr, & Galvski, 2011). Stamm (2005) later cnceptualizes CF as the negative effects f lng-term cmpassin that is made up f secndary traumatic stress and burnut. He reprts that cmpassin fatigue is the result f being vicariusly expsed t traumatic material and experiencing burnut caused by lng-term use f empathy. Research has prven that higher levels f CF cause clinicians t underg a decrease in effectiveness (Figley, 1995; Sextn, 1999). When experiencing CF, prfessinals run a higher risk f making pr prfessinal judgments such as misdiagnsis, pr treatment planning, r abuse f clients. (Rudlph, Stamm, & Stamm, 1997). It is evident that adequate client care is at risk when clinicians suffer frm CF as it causes prfessinals t experience a decrease in mtivatin, efficacy, and empathy. Because f these negative cnsequences, it can be assumed that clinicians experiencing CF will nt be mtivated t treat patients with adequate amunts f empathy, resulting in less effective treatment (Craig & Sprang, 2010).

10 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 3 In 2005, Stamm cnceptualized cmpassin fatigue as being made up f tw cmpnents. He defined cmpassin fatigue as being the cmbinatin f burnut and STS symptms in an individual. Unlike burnut, cmpassin fatigue requires symptms assciated with STS. Likewise, unlike STS, cmpassin fatigue requires symptms f burnut. These three cncepts are similar yet are distinguishable. The term STS is used t describe the develpment f PTSD symptms in individuals wh play a significant rle in the survivr s life. Any persn wh is in a helping relatinship with the survivr f a traumatic experience is at risk fr develping STS (Figley, 1995). Accrding t Figley (1995), the symptms f secndary traumatic stress are the same as thse f PTSD defined by the Diagnstic and Statistical Manual f Mental Disrders (DSM-5; American Psychiatric Assciatin, 2013). STS and PTSD differ in nly ne way; in STS the affected individual des nt actually experience the traumatic event rather learns abut a traumatizing event that anther has suffered. STS may ccur after expsure t ne, r multiple, traumatic narratives. It is hypthesized t ccur quickly and suddenly and is a likely result f entering int a helping relatinship (Figley, 1995). Research has shwn the symptms f STS include significant disruptins in ne s sense f meaning, cnnectin, identity, and wrldview as well as disruptins in ne s affect tlerance, psychlgical needs, interpersnal relatinships, and sensry memry (Pearlman & Saakvitne, 1995). These disruptins can be accmpanied by emtinal respnses such as anger, sadness, and anxiety, and can lead t psychlgical numbing, denial, and distancing (McCann & Pearlman, 1990).

11 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 4 The secnd cmpnent f cmpassin fatigue as defined by Stamm (2005) is burnut. Stamm (2005) explains that burnut is assciated with feelings f hpelessness and difficulties in dealing with wrk r in ding ne s jb effectively. Burnut is usually f gradual nset and results in the individual feeling as thugh his/her effrts are pintless and he/she cannt make a difference. Burnut is different frm cmpassin fatigue as symptms f STS are nt present (Craig & Sprang, 2010). Althugh Stamm (2005) defined CF as being cmprised f STS and burnut, he als prpsed a prtective factr fr thse wh may be vulnerable t the effects f wrking with traumatized individuals. Stamm (2005) prpsed the cmpassin satisfactin can ffset the effects f CF and prtect individuals frm experiencing negative symptms. He defined cmpassin satisfactin as being the pleasure an individual feels frm being able t cmplete his r her wrk effectively. This may be pleasure due t respect fr clleagues, pleasure derived frm helping thers, r pleasure due t a sense f fulfilling a greater purpse such as ne related t religius beliefs. In their quantitative and qualitative lngitudinal study examining effects caregivers experience when wrking therapeutically with seriusly traumatized peple, Cllins and Lng (2003) fund that CF and CS were negatively crrelated. The mre CF a therapist experiences, the less satisfactin he/she gets frm his/her wrk within the helping field. (Cllins & Lng, 2003). Unlike STS in which prfessinals must wrk with thse wh have suffered a traumatic event, research suggests CF is prevalent amng prfessinals caring fr peple wh suffer in any way. In their study measuring prevalence rates f CF, Cnrad and Keller-Guenther (2006) fund that almst 50% f Clrad cunty child prtectin casewrkers were at high r extremely

12 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 5 high risk fr cmpassin fatigue. In additin, Wee and Myers (2002) fund that within their sample f mental health wrkers, 53.5% had mderate t extremely high risk f CF. Much research has als fcused n the effects that CF has n individuals. Previus studies have fund that prfessinals suffering frm CF have episdes f sadness and depressin, sleeplessness, and general anxiety. They may als suffer frm cgnitive verlad which causes them t lse their ability t be bjective and helpful twards clients. In serius cases, prfessinals suffering frm CF may sink int a deep depressin, resulting in islatin f themselves frm the supprt f thers. They may als be weighed dwn by dreams, nightmares, and intrusive thughts cmparable t what their patients have experienced (Cerney, 1995). Feelings f helplessness and lneliness (Cnrad & Keller-Guenther, 2006) can als be experienced in respnse t CF. In summary; CF decreases a prfessinal s capability r interest in hlding the suffering f thers. (Figley, 2002). T summarize, research has shwn that lng-term expsure t traumatized individuals can cause symptms f burnut and STS. When these symptms present tgether in an individual, the result is cmpassin fatigue. What has yet t be researched is the effects f numerus peple with cmpassin fatigue wrking with ne anther. In studying the impact f rganizatinal culture n a grup f emplyees resulting levels f cmpassin fatigue, the pssibility f rganizatinal cmpassin fatigue will be explred. Organizatinal Culture Organizatinal culture has als been defined numerus times in the literature. These definitins tend t fall int ne f tw ways f cnceptualizing rganizatinal culture. First, many chse t define rganizatinal culture as being the nrms f behavir within an

13 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 6 rganizatin (Kberg & Chusmir, 1987). Secndly, thers chse t define the cnstruct as being a set f cmmn cgnitins shared by members f a scial unit (O'Reilly, Chatman, & Caldwell, 1991). Erkutlu, Chafra, and Bumin (2011) attempt t integrate these by defining rganizatinal culture as encmpassing the values and nrms shared by members f a scial unit. Bryant (2013) reprts an all-encmpassing definitin f rganizatinal culture as being the beliefs, values, attitudes, behavirs, and standards shared by the individuals and grups that make up an rganizatin. These authrs all g n t suggest that an rganizatin s values lead t nrmative behavirs that in turn, make up the rganizatin s culture. The Interactin f Cmpassin Fatigue and Organizatinal Culture Existing findings n whether rganizatinal characteristics predict the emergence f, r reduce, CF have been incnsistent. While few studies have examined the relatinships between STS, rganizatinal culture, and strategic infrmatin (Chi, 2011), the relatinship between rganizatinal culture and cmpassin fatigue is still unknwn. Althugh much research has been dne n the effects f CF n individuals, little is knwn abut hw rganizatinal characteristics cntribute t the experience f cmpassin fatigue in rganizatinal members. Previus research n rganizatinal cnnectins t CF has primarily fcused n prtective factrs rganizatins can emply (Bell, Kulkarni, & Daltn, 2003; Neumann & Gamble, 1995: Pearlman & Saakvitne, 1995; Yassen, 1995). Twnsend and Campbell (2009) fund that when rganizatins had diffused gals, nurses were mre likely t reprt STS. Several STS studies imply that having adequate resurces, such as time, materials, space, funds, knwledge, and skills can prevent STS. Fr example, prviding a cmfrtable physical wrk envirnment, such as a space with cmfrtable furniture (Bell et al.,

14 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE ), private ffice space (Neumann & Gamble, 1995; Yassen, 1995), access t resurces t help clients, and training pprtunities (Pearlman & Saakvitne, 1995) might reduce negative symptms. Interestingly, it has been hypthesized that the unhealthy dynamics f trauma victims culd be transferred int the rganizatinal culture and cwrker relatinships (Chi, 2011; Herman, 1992). Mre knwledge abut the effects f CF n rganizatinal culture may prvide managers with a better understanding f hw burnut rates can be better predicted and cntrlled. Stamm (2005) supprts this idea by suggesting that there is sme relatin between VT, STS, and burnut. McCann and Pearlman (1990) state that burnut may be caused by secndary traumatizatin that a prfessinal cannt cpe with. Research shws that wrkers with psychlgical distress reprted bth higher burnut and CF scres (Rssi et al., 2012). Additinally, higher levels f psychlgical distress will likely lead t lss f energy, cmmitment, and hpefulness amng staff (Sextn, 1999). Furthermre, client care can be negatively affected by high levels f CF because it causes clinicians t distance frm their clients (Herman, 1992). T summarize, research cntributing t an understanding f the relatinship between CF and rganizatinal culture culd be f extrardinary benefit. Managers wh understand the negative impacts f CF may be mtivated t help prtect their emplyees against the risks assciated with chrnic expsure t traumatize clients. In having knwledge abut the effects f CF n rganizatins and implementing plicies t prtect their emplyees, rganizatins may save financial resurces, increase cmpassin satisfactin, decrease burnut rates, and increase the quality f client care.

15 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 8 Hypthesis The purpse f this study is t examine the relatinship between CF and rganizatinal culture. It is hypthesized that rganizatinal culture makes a significant cntributin t the ability t predict an individual s CF. When rganizatinal culture, as defined by the mean rganizatinal ratings, is used as a predictr, a significantly larger percentage f variance in CF will be accunted fr than when using the weekly hurs an emplyee wrks, the weekly hurs each emplyee spends with patients, r an individual s rganizatinal values.

16 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 9 Chapter 2 Methds Participants The ttal sample was 195 emplyees wh represent 16 rganizatins. The rganizatins selected each had between 7 and 60 emplyees and all prvided sme type f service t clients. The rganizatins were selected based n the hypthesis that they wuld have a varied amunt f cmpassin fatigue. This hypthesis was deduced based n the type f clients that emplyees cme int cntact with as well as the type f service that they prvided. The rganizatins surveyed were as fllws: a general psychiatric unit f an inpatient hspital; a chemical dependency unit f an inpatient hspital; an active duty military unit f an inpatient hspital; a mixed chemical dependency and chrnic pain unit f an inpatient hspital; the scial services department f an inpatient hspital; the culinary department f an inpatient hspital; an inpatient hspital intake department; utpatient mental health services primarily serving patients wh have recently cmpleted inpatient treatment; a medical clinic serving patient frm with lw sciecnmic status; a cmmunity mental health clinic; a university health and cunseling center; a natinal bank; a fast fd restaurant; a casual dining restaurant; and a fine dining restaurant. The respndent rate frm the varius rganizatins was between 40% and 100%. See Table 1 fr rganizatin specific respnse rates.

17 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 10 Table 1. Number f Emplyees Surveyed Respnse Rates fr the 16 Surveyed Organizatins Organizatin Ttal Emplyees Respnse Rate (%) Inpatient general psychiatric unit Inpatient chemical dependency unit Inpatient active duty military unit Inpatient chemical dependency and chrnic pain unit Inpatient scial services department Inpatient culinary department Inpatient intake department Outpatient mental health services Lw-SES medical clinic Cmmunity mental health clinic University health and cunseling center Natinal Bank Machine tls sales Fast fd restaurant Casual dining restaurant Fine dining restaurant Instruments Prfessinal Quality f Life Scale (PrQOL; Stamm, 2005). The PrQOL is a measure f cmpassin fatigue and cmpassin satisfactin. The PrQOL measures cmpassin fatigue

18 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 11 by measuring bth burnut and secndary stress. The PrQOL is a 30-item self-reprt, paper and pencil scale. The PrQOL-V cntains three Subscales- Cmpassin Satisfactin, Burnut, and Secndary Traumatic Stress. An individual s scres n the burnut and secndary traumatic stress scales represent his/her level f cmpassin fatigue. The cmpassin satisfactin subscale is defined as being a prtective factr fr the negative effects f cmpassin fatigue. The primary fcus f this study will be the scales representing the cmpnents f cmpassin fatigue althugh the cmpassin satisfactin scale will be calculated and reprted. The cmpassin satisfactin scale has a Crnbach s alpha f.88; the burnut scale has a Crnbach s alpha f.64; and the Secndary traumatic stress scale has a Crnbach s alpha f.75. The PrQOL has excellent face validity as evinced by expert witnesses utilizing this tl n multiple ccasins. Factr analysis f the PrQl was als cmpleted by Stamm (2005) during the creatin f this assessment tl. See Appendix C fr a list f PrQl items by factr placement. The factr analysis resulted in individual scres fr the fllwing categries: cmpassin satisfactin; the pleasure derived frm being able t perfrm wrk respnsibilities well; burnut; assciated with feelings f hpelessness and difficulties in dealing with wrk r in cmpleting jb duties effectively; and secndary traumatic stress; symptms similar t pst-traumatic stress disrder that result frm secndary expsure t the traumatic event usually thrugh wrk with traumatized individuals. Each f these scales has a mean f 50 and a standard deviatin f 10. Stamm (2005) defines cmpassin fatigue as being a cmbinatin f secndary traumatic stress and burnut and the current study emplyed this definitin. Organizatinal Culture Prfile (Abbreviated Versin; OCP; Cable & Judge, 1997) The OCP is a measure f rganizatinal culture. The OCP measures rganizatinal culture by

19 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 12 assessing eight factrs including: innvatin; attentin t detail; utcme rientatin; aggressiveness; supprtiveness; emphasis n rewards; team rientatin; and decisiveness. The OCP is a Q-Srt f 40 items int nine categries ranging frm mst characteristic t least characteristic f the rganizatin. The srt results in individuals ratings f the eight factrs. The rganizatinal culture is characterized as the mean rating fr each f the eight factrs acrss emplyees f that rganizatin. The standard deviatin f the emplyee s ratings n each factr will be used as a measure f rganizatinal hmgeneity. It is self-reprt, paper and pencil scale. The mean inter-item crrelatins fr each factr ranged frm 0.53 t 0.62, in ther wrds, the items lading n each factr were mderately crrelated and thus prvide evidence f cnvergent validity at the item level. The OCP has a reprted verall test-retest reliability f A factr analysis was cmpleted fr items n the OCP. The eight factrs included the fllwing: innvatin; attentin t detail; utcme rientatin; aggressiveness; supprtiveness; emphasis n rewards; team rientatin; and decisiveness. Initially, the factr analysis cmpleted by O Reilly et al. (1991) was used. Due t the fact that the 1995 versin f Cable and Judge s (1997) OPC used in this study had been revised t include 40 items, the initial factr analysis did nt accunt fr all f the items included in the selected versin f the OCP; there was a discrepancy between items included in the tw versins f the OCP that were used by Cable and Judge (1997) versus O Reilly et al. (1991). Specifically, there were 14 items n the selected versin that were nt included in the factr analysis dne by O Reilly et al. (1991) and seven items included in the previus factr analysis that were nt included in the selected versin f the

20 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 13 OCP. The discrepant items were placed int factrs by face validity. See Appendix B fr a list f OCP items by factr placement. Prcedure Organizatinal heads f 16 rganizatins were cntacted t btain permissin t survey individual emplyees. They were infrmed f the benefits f participating in the current study such as the access t data infrming them abut their rganizatins specific culture and strengths; thus, prviding them with valuable infrmatin abut hw t imprve the verall functining f their rganizatin. Each emplyee received a packet which included the OCP, the PrQl, a shrt demgraphic questinnaire which inquired abut hw lng the individual had wrked in the rganizatin, the average number f hurs wrked per week, and the average number f hurs that they are in cntact with clients, patients, r guests. In additin a ne-dllar bill, letter f intrductin, and infrmed cnsent frm was prvided with the packet. Each packet tk an average f 15 minutes t cmplete. The emplyees then returned the surveys t the principal investigatr r their emplyer wh then mailed the surveys t the principle investigatr.

21 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 14 Chapter 3 Results The study invlved creating three regressin equatins. The first equatin predicted individual participants CF scres using the individuals OCP ratings and demgraphic infrmatin. The secnd regressin equatin als predicted individual participants CF scres using the rganizatinal means fr OCP factrs in additin t hw lng the individual has wrked in the rganizatin, the amunt f time that they spend with clients and the average number f hurs that he/she wrks. The third regressin equatin predicted individual participants CF scres using the rganizatinal hmgeny scres (i.e. SD) in additin t the predictrs used in the secnd regressin equatin. The difference in R² fr the first versus the secnd, and third regressin equatins represents the cntributin f rganizatinal culture t individual CF ratings. Descriptive Data The amunt f rganizatinal CS, STS, CF, and burnut differed acrss the rganizatins assessed (Table 2). The rganizatin that experienced the mst cmpassin satisfactin (CS) was the inpatient chemical dependency and chrnic pain unit. The rganizatin that experienced the least CS was the inpatient culinary department. The inpatient culinary department als reprted the highest mean burnut (B) scres. The rganizatin with the lwest amunt f burnut was the fine dining restaurant. Additinally, the rganizatin that reprted the highest amunt f secndary traumatic stress (STS) was the inpatient general psychiatric unit, while the

22 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 15 rganizatin with the lwest rating f STS was the cmmunity mental health clinic. Finally, the inpatient general psychiatric unit als reprted the highest amunt f CF with the cmmunity mental health center reprting the lwest CF rating. Nt nly did the varius rganizatins reprt differing amunts f CF, STS, CS, and burnut, results als indicated that they differed in their crprate culture as measured by the mean OPC ratings f the emplyees wrking in the rganizatin. Table 3 summarizes the mean OPC rankings fr the 16 rganizatins surveyed. Althugh there were different cultures endrsed, the majrity f the rganizatins reprted a culture that valued either attentin t detail r team rientatin. Tw rganizatins reprted a culture that emphasized innvatin, ne reprted a culture that emphasized supprtiveness, and ne rganizatin reprted a culture that had an emphasis n rewards. Table 3 summarizes the means fr 8 OPC scales fr the 16 rganizatins surveyed. Crrelatins The crrelatins amng individual participants PrQOL subscale scres and individual participants OPC scres are summarized in Table 4. There was a large psitive crrelatin between cmpassin fatigue and STS, and between CF and burnut which makes sense because STS and burnut are the tw factrs that cntribute t the verall experience f cmpassin fatigue. The inter-crrelatins amng these PrQl subscales are what we wuld expect given ur knwledge f the cntributin f STS and burnut in determining cmpassin fatigue.

23 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 16 Table 2. Mean PrQOL scres fr the sixteen rganizatins Organizatin IP Gen Psych (n =16) IP CD Unit (n =12) IP Active Duty Unit (n =10) IP CD/Pain Unit (n =10) IP Scial Services (n =16) IP Culinary (n =4) IP Intake (n =12) Outpatient (n =11) Medical Clinic (n =34) CMH (n =12) HCC (n =8) Natinal Bank (n =5) Machine Sales (n =5) Fast Fd (n =18) Casual Dining (n =7) Fine Dining (n =13) Ttal (n =193) PrQOL Cmpassin Satisfactin PrQOL Burnut PrQOL Secndary Traumatic Stress Cmpassin Fatigue M SD M SD M SD M SD

24 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 17 Ntes t Table 2. Organizatin Abbreviatins are as fllws: IP Gen Psych: Inpatient general psychiatric unit; IP CD Unit: Inpatient chemical dependency unit; IP Active Duty Unit: Inpatient active duty military unit; IP CD/Pain Unit: Inpatient chemical dependency and chrnic pain unit; IP Scial Services: Inpatient scial services department; IP Culinary: Inpatient culinary department; IP Intake: Inpatient intake department; Outpatient: Outpatient mental health services; Medical Clinic: Lw SES medical clinic; CMH: Cmmunity mental health clinic; HCC: University health and cunseling center; Natinal Bank: Natinal bank; Machine Sales: Machine tls sales; Fast Fd: Fast fd restaurant; Casual Dining: Casual dining restaurant ; Fine Dining: Fine dining restaurant Crrelatin results als indicated that the OPC scales are rthgnal and measure separate cultural dmains. The exceptins t this were scales measuring supprtiveness, aggressiveness, and decisiveness. There was a negative relatinship between supprtiveness and aggressiveness. There was als a negative crrelatin between decisiveness and aggressiveness. Only tw small crrelatins were discvered between OPC and PrQOL scales ut f thirty-tw pssible relatinships. There was a.2 crrelatin between cmpassin fatigue and reward emphasis and a.25 crrelatin between STS and reward emphasis. This means that fr individuals, there was n relatinship between the PrQOL scres and that individual s OPC ratings. In ther wrds, an individual s rganizatinal values did nt have much influence n the amunt f CF they experienced. Small psitive crrelatins were fund between the numbers f weekly hurs wrked and the weekly time spent with patients, burnut, cmpassin fatigue, and STS. There was n crrelatin between the number f hurs wrked, the number f hurs spent with patients, and cmpassin satisfactin. This shws that wrking mre hurs and spending mre face time with patients did nt increase a persn s experience f cmpassin satisfactin.

25 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 18 Table 3. Mean OCP Rankings fr 16 Organizatins. Organizatin IP Gen Psych (n = 16) IP CD Unit (n = 13) IP Active Duty Unit (n = 10) IP CD/Pain Unit (n =10) IP Scial Services (n =16) IP Culinary (n = 4) IP Intake (n =12) Outpatient (n = 11) Medical Clinic (n =34) CMH (n =12) HCC (n =8) Natinal Bank (n = 5) Machine Sales (n =5) Fast Fd (n =18) Casual Dining (n = 7) Fine Dining (n =13) Innvatin Attentin t Detail Outcme Oriented Aggressiveness M SD M SD M SD M SD

26 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 19 Table 3a Mean OCP Rankings fr 16 Organizatins (cnt.) Organizatin IP Gen Psych (n =16) IP CD Unit (n =13) IP Active Duty Unit (n =10) IP CD/Pain Unit (n = 10) IP Scial Services (n =16) IP Culinary (n =4) IP Intake (n =12) Outpatient (n =11) Medical Clinic (n =34) CMH (n =12) HCC (n =8) Natinal Bank (n = 5) Machine Sales (n =5) Fast Fd (n =18) Casual Dining (n =7) Fine Dining (n =13) Supprtiveness Emphasis n Rewards Team Orientatin Decisiveness M SD M SD M SD M SD Ntes n Table 3. Organizatin Abbreviatins are as fllws: IP Gen Psych: Inpatient general psychiatric unit; IP CD Unit: Inpatient chemical dependency unit; IP Active Duty Unit: Inpatient active duty military unit; IP CD/Pain Unit:

27 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 20 Inpatient chemical dependency and chrnic pain unit; IP Scial Services: Inpatient scial services department; IP Culinary: Inpatient culinary department; IP Intake: Inpatient intake department; Outpatient: Outpatient mental health services; Medical Clinic: Lw SES medical clinic; CMH: Cmmunity mental health clinic; HCC: University health and cunseling center; Natinal Bank: Natinal bank; Machine Sales: Machine tls sales; Fast Fd: Fast fd restaurant; Casual Dining: Casual dining restaurant ; Fine Dining: Fine dining restaurant When analyzing hw the fur PrQOL scales (CS, Burnut, STS and CF) were related t rganizatinal means n the eight OPC dmains (Table 5), we fund that individuals had mre CF if they wrked fr rganizatins that were innvative, had a reward emphasis, and had less attentin t detail, as small crrelatins were fund with these variables. There were sme interesting inter-crrelatins amng the OPC subscales at the rganizatinal level. Fr example, there was a large negative crrelatin between supprtiveness and innvatin. This means that the mre supprtive an rganizatinal culture was, the less innvative it was. There was als a medium negative crrelatin between innvatin and team rientatin, indicating that when an rganizatin s culture was high n innvatin, it was lw n team rientatin and supprtiveness. Additinally, when an rganizatin valued attentin t detail, they als were less utcme riented, aggressive and reward fcused. Finally, there was a medium crrelatin between decisiveness and innvatin. The mre decisive an rganizatin was the mre innvative their culture was.

28 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 21 Table 4 Crrelatins f CS, Burnut, STS, and CF with Individual Participant OPC Scres PrQl Burnut CF.89 Burnut STS IN AD OO AG S RE TO D Weekly Hurs Wrked Weekly Hurs w/ Pt.'s PrQl STS Innvatin (IN) Attentin t Detail (AD) Outcme Oriented (OO) Aggressiveness (AG) Supprtiveness (S) Reward Emphasis (RE) Team Orientatin (TO) Decisiveness (D) Weekly Hurs Wrked Weekly Hurs w/ Pt.'s Mnths wrked

29 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 22 Table 5. Crrelatins f Individuals Means n CS, Burnut, STS, and CF with Organizatinal Means n Eight OPC Dmains. CS Burnut STS CF Org IN Org. AD Org. OO Org AG Org S Org RE Org.TO Org. Innvatin (IN) Org. Attentin t Detail (AD) Org. Outcme riented (OO) Org. Aggressiveness (AG) Org. Supprtive (S) Org. Reward Emphasis (RE) Org. Team Orientatin (TO) Org. Decisiveness ** Crrelatin is significant at the 0.01 level (2-tailed): N = 193.

30 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 23 Table 6. Crrelatins f Individuals Means n CS, Burnut, STS, and CF with Organizatinal Standard Deviatins n Eight OPC Dmains. CS Burnut STS CF SD Org. I SD Org. AD SD Org. OO SD Org. AG SD Org. S SD Org. RE SD Org. TO SD Org. Innvatin (I) SD Org. Attentin t Detail (AD) SD Org. Outcme Oriented (OO) SD Org. Aggressiveness (AG) SD Org. Supprtiveness (S) SD Org. Reward Emphasis (RE) SD Org. Team Orientatin (TO) SD Org. Decisiveness

31 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 24 When analyzing the relatinship between standard deviatins and OPC dmains (see Table 6) we fund tw small relatinships. There was a small relatinship between CF and agreement n the culture s innvativeness. The less agreement there was abut hw innvative their culture, the mre cmpassin fatigue the individuals within that rganizatin experienced. There was als a small negative crrelatin between CF and aggressiveness. There are als several crrelatins amng the Standard Deviatins f rganizatins OPC scales. Fr example, the mre cnsistency there was n the value placed n innvatin within an rganizatin, the less cnsistency was fund in the values f team rientatin, attentin t detail, and reward emphasis. The mre cnsistency there was within and rganizatin n the value f aggressiveness, the mre cnsistency there was in the values f supprtiveness, reward emphasis, and team rientatin. These findings are summarized in Table 6. Multiple Regressin Analysis Three regressin analyses were cnducted. Each attempted t predict individual cmpassin fatigue. All three analyses used a simultaneus entry prcedure (i.e., all f the dependent variables entered the mdel simultaneusly and nne were remved). The simultaneus entry technique allws ne t examine the Beta weights t rank rder cntributin f every predictr. In additin t the demgraphic items f (tell me what they are), the predictrs fr the first regressin analysis were the individual OPC scres, hw lng he/she has wrked in the rganizatin, the average number f hurs that he/she wrks, and the average amunt f time spend in direct cntact with clients. The secnd regressin analysis used all the predictrs f the first regressin as well as the mean scre fr that rganizatin (based n the mean f the individuals in the rganizatin wh rated that dmain). The third regressin

32 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 25 included all the predictrs f the secnd regressin and the standard deviatins f the ratings f each dmain. The standard deviatin tells the variability in ratings f that dmain by all f the individuals within that rganizatin, (i.e., hw much the members f the rganizatin agree n a value). Regressin using individual ratings f rganizatinal culture t predict individual CF. The first regressin mdel accunted fr 7% f the variance in individual cmpassin fatigue, R 2 =.067; p =.11. The beta weights fr the individual ratings n the OPC dmains are shwn in clumn ne f Table 7. Only an individual s emphasis n rewards was fund t be a significant predictr f his r her cmpassin fatigue. Regressin using individual ratings f rganizatinal culture and mean scres fr the rganizatin t predict individual CF. The secnd regressin mdel accunted fr 18% f the variance in individual cmpassin fatigue, R 2 =.179; p =.003. The beta weights fr the individual ratings n the OPC dmains and mean scres fr the rganizatin are shwn in clumn tw f Table 7. The individual s reward emphasis cntinued t be a significant predictr f individual cmpassin fatigue. Mre imprtantly, grup means n the OPC dmains are significant predictrs f individual cmpassin fatigue. The best predictrs are rganizatinallevel supprtiveness fllwed by the rganizatin s culture f innvatin, decisiveness, attentin t detail, and reward emphasis (in that rder).

33 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 26 Table 7. Beta Weights fr Three Regressin Mdels Predicting Individual Cmpassin Fatigue. Regressin 1 Regressin 2 Regressin 3 Beta sig Beta sig Beta sig Innvatin Detail Outcme Oriented Aggressiveness Supprtiveness Reward.Emphasis Team.Orientatin Decisiveness Org.invatin Org.detail rg.utcme rg.aggressiveness rg.supprtive rg.reward.emphasis rg.team rg.decisiveness SD.rg.innvatin SD.rg.detail SD.rg.utcme SD.rg.aggressiveness SD.rg.supprtiveness SD.rg.rewards SD.rg.team SD.rg.decisiveness.02.90

34 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 27 Regressin using individual ratings f rganizatinal culture, mean scres fr the rganizatin, and the cnsistency amngst the raters t predict individual CF. The third regressin mdel accunted fr 24% f the variance in individual cmpassin fatigue, R 2 =.239; p =.001. The beta weights fr the individual ratings n the OPC dmains, mean scres fr the rganizatin, and cnsistency amngst the raters are shwn in clumn three f Table 7. Individuals reward emphasis remained a significant predictr f individual cmpassin fatigue. Organizatinal aggressiveness was als fund t be a significant predictr f individual cmpassin fatigue. Nne f the ther rganizatinal means are significant predictrs. Organizatinal mean OPC ratings and cnsistency within the rganizatinal ratings accunt fr 17% f the variance in individual cmpassin fatigue. This was determined by subtracting the variance accunted fr in the first regressin equatin frm the variance accunted fr in the third regressin. In ther wrds, the demgraphic predictrs and the individual ratings n the eight OPC dmain predictrs frm the first regressin equatin were taken away and the R 2 was recalculated using the rganizatinal means and standard deviatins alne.

35 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 28 Chapter 4 Discussin This study explred the relatinship between rganizatinal culture and cmpassin fatigue. Fr the purpse f this study, rganizatinal culture was cnceptualized as the mean value ratings f individuals within an rganizatin as well as the level f agreement n thse values within the rganizatin. It was hypthesized that rganizatinal culture wuld make a significant cntributin t the ability t predict individual s CF. When the means and standard deviatins f the OPC ratings were used as a predictr, significantly mre variance f an individual s CF was accunted fr than when the individuals respnses alne were used as predictrs (i.e., 17% f the variance). The interrelatinship fund between STS, Burnut, CF, and CS were previusly prpsed by Stamm in Results f this study cnfirm that burnut and STS are the cmpnents that mst make up CF. Further, results f this study were als cnsistent with Stamm s (2005) and Cllins and Lng s (2003) findings suggesting that CS is a prtective factr fr CF. In 2007, Sprang, Clark, and Whitt-Wsley fund a cmpassin fatigue incidence rate f abut 39% in a general ppulatin f mental health prviders during the usual curse f their prfessinal practice. Cnsistently, results f this study fund an incidence rate f CF f abut 38%-45% amng the mental health prfessinals surveyed. Members f rganizatins whse fcus was nt upn mental health care had an incidence rate f CF f 35%-43%. Differences

36 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 29 amng the rganizatins surveyed were due, in small part, t factrs such as rganizatinal culture. Althugh limited research exists n the relatinship between rganizatinal culture and cmpassin fatigue, results f this study were cnsistent with available previus research. Previus research n the relatinship between rganizatinal characteristics that predict the develpment f STS cncluded that rganizatins with diffused gals are mre predictive f STS in emplyees (Twnsend & Campbell, 2009). This is cnsistent with results f this study which fund that rganizatins with less decisiveness and higher variability in their rganizatinal value ratings tended t have mre CF. Additinally, previus research indicates that having adequate resurces such as time, materials, space, funds, knwledge, and skills can reduce the risk f emplyees develping STS (Bell et al., 2003). This is similar t results f this study which indicate that the level f supprtiveness in an rganizatinal culture is a strng predictr f an individual s ability t resist CF. These results are similar given the assumptin that a supprtive rganizatin is mre likely t ffer resurces t an emplyee than a less supprtive rganizatin. Implicatins Implicatins fr the cnceptualizatin f CF, fr practice, and fr plicy refrm can be made frm the current study s results. First, CF is current cnceptualized as being an individual experience and is largely seen as a private matter. The results f this study indicate that the current cnceptualizatin may be limited in that it des nt take int accunt the cmmunity cmpnent f this phenmenn. Current results indicate that CF is nt nly an individual

37 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 30 experience but there is als a cultural r cmmunity cmpnent that has nt been adequately explred. Secnd, these findings have practical implicatins. Varius interventins within rganizatins can be implemented t reduce CF in members f rganizatins and thus imprve emplyee retentin and rganizatinal spending. Early resignatin and higher staff turnver have been prpsed results f secndary stress (Sextn, 1999). High levels f psychlgical distress can lead t burnut which can be prblematic in that it leads t high turnver. A reprt frm the Child Welfare Wrkfrce Survey: State and cunty data and findings (Cyphers, 2001) revealed that in 43 states, child prtectin casewrkers have a 22% median annual turnver rate (Cnrad & Keller-Guenther, 2006). The lss f experienced and skilled staff can demand the use f further financial resurces when training new staff members. In additin, when rganizatins must replace staff with inexperienced trauma therapists, they are challenged with the fact that the nvice emplyees are mre likely t suffer CF than mre experienced prfessinals. These inexperienced emplyees require mre supprt and supervisin than mre experienced prfessinals (Neumann & Gamble, 1995; Pearlman & Mac Ian, 1995). A better understanding f the effects f CF n rganizatinal culture may als prmpt management t require mre evidence-based practices t be used by prviders. Clinicians wh use evidence-based practices have the strngest efficacy in treating trauma in adults. This efficacy causes clinicians t feel mre effective. Utilizing evidence-based practices in clinical wrk may affect the relatinships between secndary traumatic expsure and the develpment f CF. In experienced clinicians, using evidence-based practices has been fund t reduce burnut and CF, and increase CS (Craig & Sprang, 2010).

38 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 31 Mre knwledge abut the harmful effects f CF n an rganizatinal culture may result in plicies t decrease it. These plicies will prtect rganizatins frm cstly legal suits brught against rganizatins. Due t the fact that CF is a severe ccupatinal hazard, it raises damaging ccupatinal health and safety issues in the field. This is particularly likely in circumstances in which an rganizatin has n supprt systems in place t prtect emplyees against the dangers f CF, t assist them in cping with its effects (Sextn, 1999), r t increase their experience f CS. Initially, emplyees must be educated nt nly abut the risks f cmpassin fatigue, but als abut the individual values that can cntribute t its develpment. Emplyees shuld be encuraged t find mtivatin fr their wrk utside r external rewards. Building ne s sense f accmplishment and effectiveness thrugh internal mtivatins can decrease the risk f the develpment f cmpassin fatigue. Emplyees shuld seek supprt systems and wrk t remain cgnscente abut successes and internal rewards gained frm each member f their supprt grup. Organizatins wuld benefit greatly frm increasing resurces such as wrk space, supplies, sufficient time, and apprpriate breaks. Finally, this study has implicatins fr hw rganizatins can develp plicies that will decrease the likelihd that emplyees will develp CF. There are many things that hspital administratrs can d t influence the culture f the rganizatins they run. Imprtantly, hspital administratin shuld seek plices that will increase supprtiveness in the rganizatin and decrease aggressiveness. These plicies culd include mandatry team meetings in which they ffer praise t emplyees and acknwledge achievements. They can als implement prgrams in which emplyees recgnize ne anther fr dedicatin t patient care and supprtive team wrk.

39 COMPASSION FATIGUE AND ORGANIZATIONAL CULTURE 32 Administratrs can set up supprt grups in which member f rganizatins can meet n a weekly r mnthly basis t discuss struggles and successes that they have experienced. Limitatins Limitatins f this study can be fund within the cnceptualizatin and data cllectin stage. The first limitatin stems frm their being tw ways in which rganizatinal culture can be cnceptualized. While this study cnceptualized rganizatinal culture as being made up f values held by the individuals in an rganizatin, anther cnceptualizatin exists in which rganizatinal culture is seen as being made up f behaviral aspects. Due t time cnstraints and study manageability, the current study nly explred ne cnceptualizatin and hw that related t cmpassin fatigue. The secnd limitatin emerged in the data cllectin stage. The OCP was develped as a tl in which emplyees are directed t rate their rganizatin n varius values that they believe it t have. Fr cnsistency in cnceptualizatin, this study requested that participants rate their wn values rather than t hypthesize values f their rganizatin. This may be a limitatin in that results may have been impacted by this methd f data cllectin. T cntrl fr this, the varius scales were evaluated and it was fund that they were in fact measuring different variables. Building n the current research, much future research is warranted. Mst bviusly, future researchers may chse t replicate this study while using the behaviral cnceptualizatin f rganizatinal culture. Future research culd als include the implementatin f plices aimed at changing rganizatinal culture and the determinatin f hw culture was impacted and if levels f CF were altered. Future research may include