Aims The main goal of this study was to explore the relationships between empathy, empathy-based pathogenic guilt and professional quality of life (burnout and compassion fatigue). We aim to test a model in which we hypothesize that when empathic feelings are related to pathogenic guilt, burnout and compassion fatigue symptoms may be increased. Background Empathy is at the core of nursing practice, and has been associated with positive outcomes not only for the healthcare provider but also for the patient. However, empathy is also at the core of guilt feelings that, when excessive and misdirected, can lead to pathogenic guilt beliefs. We focused on two types of empathy-based guilt characterized by excessive responsibility over others' well-being and how these can be related to professional quality of life. Methods and participants This study is a cross-sectional self-report survey. Data were collected during 2014 and 2015. Two hundred ninety-eight nurses from public hospitals in Portugal's north and center region were surveyed. Professional quality of life (burnout and compassion fatigue), empathy, and empathy-based guilt were measured using validated self-report measures. Results Correlation analyses showed that empathy-based guilt was positively associated with empathy, and with burnout and compassion fatigue. Results from multiple mediation models further indicated when empathy is associated with empathy-based guilt, this leads to greater levels of burnout and compassion fatigue. Conclusions Given the nature of their work, nurses who experience pathogenic guilt feelings may have compromised well-being, and this should be addressed in training programs aiming at preventing or treating burnout and compassion fatigue.
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