Development and Psychometric Validation of the Empathy Fatigue Scale (EFS-HP) for Healthcare Professionals in Critical Care Settings

Abstract

BackgroundEmpathy fatigue represents a significant concern among healthcare professionals working in critical care settings, including intensive care units, emergency departments and neonatal units. It is an established fact that constant exposure to emotionally intense situations may lead to a state of emotional exhaustion, a reduction in job satisfaction and a compromise in the quality of patient care. Despite the prevalence of this phenomenon, there remains a paucity of profession-specific tools with which to assess empathy fatigue in these high-stress environments.AimThe objective of this study was to develop and validate the Empathy Fatigue Scale for Healthcare Professionals (EFS-HP), a psychometric tool designed to assess empathy fatigue among professionals working in critical care settings.Study DesignThe study utilized a multi-phase methodological design, encompassing 296 healthcare professionals who exclusively practised in critical care settings, including intensive care units, emergency departments and neonatal intensive care units. Despite the fact that the sample comprised 60.8% physicians, 27% nurses and midwives and 12.2% other staff, all participants were actively engaged in critical care practice. The 21-item EFS-HP was developed through a rigorous process involving item generation, expert review and pilot testing. The psychometric evaluation comprised exploratory factor analysis (EFA), confirmatory factor analysis (CFA), internal consistency (Cronbach's alpha = 0.958), test-retest reliability (r = 0.891) and criterion validity using the Depression Anxiety Stress Scale (DASS-21). The results of the CFA indicated that the model demonstrated acceptable fit, with a comparative fit index of 0.918, a TLI of 0.907 and an root mean square error of approximation of 0.080.ResultsThe EFA revealed a unidimensional structure, explaining 54.5% of the total variance. Criterion validity analysis demonstrated significant positive correlations between empathy fatigue and depression (r = 0.485), anxiety (r = 0.348) and stress (r = 0.396), thereby supporting the validity of the scale.ConclusionThe EFS-HP is a valid and reliable instrument for the assessment of empathy fatigue among healthcare professionals in critical care environments. Its application is particularly relevant for critical care nurses, who frequently face intense emotional demands and are at increased risk for burnout-related outcomes.Relevance to Clinical PracticeThe EFS-HP is a valuable tool for identifying and managing empathy fatigue specifically among critical care nurses, who form the emotional backbone of intensive care environments. Given their continuous exposure to life-and-death situations, rapid decision-making and patient/family distress, critical care nurses are especially vulnerable to empathy fatigue. The integration of the EFS-HP into clinical practice facilitates the early identification of emotional strain, thereby enabling the implementation of timely, nurse-focused interventions. These interventions have been shown to promote emotional resilience, reduce staff turnover and enhance the overall quality of patient care. Furthermore, the scale's emphasis on the distinctive stressors encountered by nurses in critical care is congruent with the strategic priorities of high-acuity healthcare institutions.