Workplace humour, compassion, and professional quality of life among medical staff

ABSTRACT

Background: Professional quality of life pertains to the balance between compassion fatigue and compassion satisfaction. In recent years, there was an increase in compassion fatigue among medical staff due to the pandemic, all over the world, while compassion satisfaction was reported at a moderate level.

Objectives: The aim of this study was to identify the relationship between workplace humour and professional quality of life among medical staff, as well as the moderating role of compassion in this relationship.

Method: The sample consisted of 189 participants (Mage = 41.01; SD = 9.58). Of the total sample, 57.1% are physicians, 32.3% are nurses and 6.9% are clinical psychologists. The participants completed scales measuring compassion, workplace humour, and professional quality of life.

Results: The results showed that self-enhancing and affiliative humour were positively related, while self-defeating humour was negatively related to compassion satisfaction. Burnout and secondary traumatic stress were negatively related to self-enhancing humour and positively related to self-defeating humour. Compassion moderated the relationship between affiliative humour and secondary traumatic stress.

Conclusions: Encouraging coping strategies based on adaptive humour (i.e. affiliative humour, self-enhancing) and raising awareness about negative humour strategies (i.e. self-defeating) could contribute to an increase of quality of life among healthcare providers. Another conclusion derived from the present study sustains that compassion is a valuable personal resource positively related to compassion satisfaction. Compassion also facilitates the relationship between affiliative humour and low secondary traumatic stress. Thus, encouraging compassionate skills could be beneficial for the optimal professional quality of life.

HIGHLIGHTS

• Self-enhancing and affiliative humour were positively related, while self-defeating humour was negatively related to compassion satisfaction.

• Burnout and secondary traumatic stress were negatively related to self-enhancing humour and positively related to self-defeating humour.

• Compassion moderated the relationship between affiliative humour and secondary traumatic stress.

Antecedentes: La calidad de vida profesional hace referencia al equilibrio entre la fatiga por compasión y la satisfacción por compasión. En los últimos años, ha habido un incremento, en todo el mundo, de la fatiga por compasión entre el personal médico debido a la pandemia, mientras que la satisfacción por compasión se reportó en un nivel moderado.

Objetivos: El objetivo de este estudio fue identificar la relación entre el humour en el lugar de trabajo y la calidad de vida profesional entre el personal médico, así como el rol moderador de la compasión en esta relación.

Métodos: La muestra consistió de 189 participantes (Media = 41.01; DS = 9.58). Del total de la muestra, el 57.1% son médicos, el 32,3% enfermeras y el 6.9% son psicólogos clínicos. Los participantes completaron escalas que medían la compasión, el humour en el lugar de trabajo, y la calidad de vida profesional.

Resultados: Los resultados mostraron que un humour de superación personal y un humour afiliativo se relacionaron positivamente, mientras que un humour autodestructivo se relacionó negativamente a la satisfacción por compasión. El burnout y el estrés traumático secundario se relacionaron negativamente a un humour de superación personal y positivamente a un humour autodestructivo. La compasión moderó la relación entre un humour afiliativo y el estrés traumático secundario.

Conclusión: Fomentar estrategias de afrontamiento basadas en un humour adaptativo (por ejemplo, un humour afilitativo y de superación personal) y crear conciencia sobre las estrategias de un humour negativo (por ejemplo, el humour autodestructivo) podrían contribuir a un incremento en la calidad de vida entre los proveedores de la salud. Otra conclusión derivada del presente estudio, sostiene que la compasión es un recurso personal valioso relacionado positivamente a la satisfacción por compasión. La compasión también facilita la relación entre un humour afiliativo y un nivel bajo de estrés traumático secundario. Por lo tanto, fomentar habilidades relacionadas a la compasión podrían ser de beneficio para una calidad de vida profesional óptima.

背景：职业生活质量与共情疲劳和共情满意度之间的平衡有关。 近年来，由于全球疫情，医务人员的共情疲劳有所增加，而共情满意度则处于中等水平。

目的：本研究旨在确定职场幽默与医务人员职业生活质量之间的关系，以及共情在这种关系中的调节作用。

方法：样本由 189 名参与者组成（平均年龄 = 41.01；SD = 9.58）。 在总样本中，57.1% 是医生，32.3% 是护士，6.9% 是临床心理学家。 参与者完成了测量共情、职场幽默和职业生活质量的量表。

结果：结果表明，自我提升和亲和型幽默与共情满意度呈正相关，而自我挫败型幽默与共情满意度呈负相关。 倦怠和继发性创伤应激与自我增强型幽默呈负相关，与自我挫败型幽默呈正相关。 共情调节了亲和型幽默和继发性创伤应激之间的关系。

结论：鼓励基于适应性幽默（即亲和型幽默、自我提升）的应对策略和提高对消极幽默策略（即自我挫败）的认识可能有助于提高医护工作者的生活质量。 本研究得出的另一个结论表明，共情是一种宝贵的个人资源，与共情满意度呈正相关。 共情也促进了亲和型幽默和低继发性创伤应激之间的关系。 因此，鼓励富有共情的技能可能有利于最佳的职业生活质量。

KEYWORDS:

• Workplace humour
• compassion
• compassion satisfaction
• burnout
• secondary traumatic stress

PALABRAS CLAVE:

• Humour en el lugar de trabajo
• compasión
• satisfacción por compasión
• burnout
• estrés traumático secundario

关键词:

• 职场幽默
• 共情
• 共情满足
• 倦怠
• 继发性创伤应激

Healthcare workers may suffer from physical and emotional exhaustion caused by the care of seriously ill patients, the difficulty in communicating a diagnosis to both patients and their relatives, as well as the concern to provide the best care and treatment to patients (Figley & Figley, 2017; Stamm, 2010). On the other hand, offering help to traumatised people, understanding and ameliorating their pain is gratifying (Stamm, 2010). In this context, professional quality of life pertains to the balance between compassion fatigue and compassion satisfaction.

Compassion fatigue incorporates two dimensions: burnout and secondary traumatic stress (Stamm, 2010). STS describes the effect that witnessing human suffering can have on the clinician, while burnout involves feelings of hopelessness and perceived difficulties in dealing effectively with the demands of the job. Both manifestations can lead to inefficiency, self-doubt, depression, and detachment (Yu et al., 2021) and, in the long run, both can have a negative impact on patient care (Gribben et al., 2019), low productivity and high staff turnover (Berger et al., 2015). Compassion satisfaction is the emotional fulfilment of caring for others (Stamm, 2002; Wang et al., 2020), which balances the exposure to human suffering (Circenis & Millere, 2011).

In recent years, there was an increase in compassion fatigue among medical staff due to the pandemic all over the world (Bruyneel et al., 2021; Corlade-Andrei et al., 2022). Recent literature reviews and meta-analysis documented higher rates of burnout among nurses during the COVID-19 pandemic compared to the pre-pandemic period (Sullivan et al., 2022), as well as the presence of compassion fatigue and compassion satisfaction at moderate levels (Xie et al., 2021). Other empirical evidence shows low levels of compassion satisfaction among medical staff, along with a moderate risk of burnout and an extremely high risk of compassion fatigue (Jarrad & Hammad, 2020). Emergency physicians experienced high levels of psychological distress during the COVID 19 pandemic, but humour and positive reframing proved to be effective coping strategies for them, contributing to a reduction of depression and anxiety, and even of post-traumatic stress syndrome (Dehon et al., 2021). Further, another study shows that when coping strategies based on humour are adopted, the perceived stress of healthcare personnel during the pandemic decreases (Canestrari et al., 2021). In this context, the aim of the present study is to assess the relationship between workplace humour and the three dimensions of professional quality of life, represented by secondary traumatic stress, burnout, and compassion satisfaction. We also explored the role of compassion in the relationship between workplace humour and professional quality of life.

1. Workplace humour and professional quality of life

Humour is a way of verbal and nonverbal communication that produces a cognitive or affective response to those who perceive it (Martin et al., 2003). Some people use humour for personal development (self-enhancing humour) or for improving relationships with others, increasing cohesion and attraction with colleagues and patients through jokes and other funny things (affiliative humour). Other people use humour for personal growth but to the detriment of others (aggressive humour), while others use humour to improve relationships with others but to their own detriment (self-defeating humour).

Workplace humour increases employees’ solidarity and contributes to better team cooperation, reduces stress and increases job satisfaction (Romero & Arendt, 2011; for a meta-analysis, see Mesmer-Magnus et al., 2012). Self-enhancing humour helps people keep problems at bay in stressful situations, acting as a regulator of emotions. Affiliative humour facilitates relationships between people through jokes and fun games. Both styles are positively related to social competence, work involvement, and emotional well-being (Martin et al., 2003), ensuring an adaptive function in the work context (Scheel et al., 2016). On the other hand, negative humour styles (aggressive and self-defeating) are positively related to emotional exhaustion (Guenter et al., 2013) and negatively related to resilience and social competence (Yip & Martin, 2006).

In the health care system, the ability to cope with adversity through humour has also been recognised as a way to cope with stress at work, with unpleasant situations that cause health problems (Fang et al., 2019; Nunes et al., 2018). To cope with stress at work, nurses often use specific forms of humour like witty or clever language, silly or absurd humour or a general expression of happiness and optimism, which seems to be influenced by their humour orientation. Nurses try to be funny about daily medical routines, difficult patients and their families, mistakes they made on the job, and even imminent death. Importantly, this does not seem to denigrate either the patient or the seriousness of the situation, in this case humour being a method by which nurses cope with difficult situations while still remaining effective at their job (Wanzer et al., 2005).

The use of self-improving humour leads to optimism and hope, which allows medical staff to cope with difficult situations with a greater sense of control and positive expectations, that contributes to a more positive perception of losses (Cann & Etzel, 2008). At the same time, for humour to have favourable effects on both patients and health care workers, it is necessary that it be used in previously known patients, sparingly but taking into account the socio-cultural condition of the patients (de Almeida & Nunes, 2020). It is also very important to know how to use humour because, when used incorrectly, it can harm patients (Franzini, 2001).

However, the majority of workplace humour research has focused on positive, successful humour (Mesmer-Magnus et al., 2012). In order to advance the understanding of how different humour styles are related to professional quality of life, the first aim of this present study is to analyse the relationship between both positive and negative humour styles and the dimensions of professional quality of life. Based on previous literature (e.g. Martin et al., 2003; Mesmer-Magnus et al., 2012), we anticipate that: self-enhancing humour and affiliative humour will be positively related to compassion satisfaction and negatively related to burnout and secondary traumatic stress; self-defeating and aggressive humour will be negatively related to compassion satisfaction and positively related to burnout and secondary traumatic stress.

2. The role of compassion

Compassion is the sensitivity of one person to the suffering of another person, having a deep desire to alleviate their suffering (Figley & Figley, 2017). Pommier et al. (2020) considered four aspects when operationalising compassion, namely: kindness (a motivation to alleviate suffering), common humanity (an understanding of the universality of suffering), mindfulness (an acknowledgment of suffering and tolerance regarding the uncomfortable feelings it entails) and indifference (seen as a detachment from the suffering of others). In general, those who work in the medical field are motivated by the desire to provide compassionate care. Studies have shown that compassionate care for cancer patients has been associated with high levels of compassion fatigue (Wu et al., 2016). Similar results were obtained from a survey of participants in the field of mental health, which included psychologists, psychiatrists, counsellors and social workers (Mantelou & Karakasidou, 2019). Other studies conducted on samples of nurses or students in the last year of cognitive–behavioral and counselling psychotherapy showed that compassion for others were positively associated with compassion satisfaction (Beaumont et al., 2016). Further, concern for others is positively associated with both compassion satisfaction and compassion fatigue, and negatively related to burnout (Duarte et al., 2016). Other empirical evidence showed that a high level of compassion for others is related to a low level of burnout and compassion fatigue (Beaumont et al., 2016). The buffering role of compassion in the relationship between negative factors (i.e. stress) and well-being was also highlighted (Poulin et al., 2013). Given the limited literature about the role of compassion in the healthcare field, the second aim of the present study is to analyse the relationship between compassion and professional quality of life. We expect that compassion will be positively related to compassion satisfaction and negatively related to burnout and secondary traumatic stress. Moreover, we also aim to assess the interaction between compassion and humour style in predicting professional quality of life, anticipating that compassion will moderate the relationship between humour style, compassion satisfaction, and compassion fatigue.

3. Method

3.1. Participants

The invitation to participate to the study was presented to 203 participants. The final sample consisted of 189 medical staff from several sections of hospitals in Romania, including emergency units, oncology, neurosurgery. Of the total sample, 57.1% are physicians, 32.3% are nurses and 6.9% are clinical psychologists. The participants age was between 24 and 64 years old (Mage = 41.01; S = 9.58). Our convenience sample was largely comprised of women (87.3%). The inclusion criteria consisted of: working in a hospital, having interaction with patients on a daily basis. No exclusion criteria based on demographic variables (e.g. age, gender, professional experience) was used.

3.2. Measures

The scales for measuring compassion and workplace humour were translated into Romanian using the forward translation design, following the guidelines given by the literature (Sousa & Rojjanasrirat, 2011). The translation method retained the conceptual meaning of the original measures.

3.2.1. Compassion

The Compassion Scale (Pommier et al., 2020) is a self-reporting instrument designed to measure compassion for others. This scale has 16 items rated on a 5-point Likert scale, from 1 (almost never) to 5 (almost always). The scale includes four factors: kindness (e.g. I like to be there for others in times of difficulty.), common humanity (e.g. Everyone feels down sometimes; it is part of being human.), mindfulness (e.g. I pay careful attention when other people talk to me.), indifference (e.g. I don’t concern myself with other people’s problems.). In this present study, a total score was computed (α = 0.71). Higher scores indicate high level of compassion.

3.2.2. Workplace humour

Workplace humour was measured by the short Work-related Humour Styles Questionnaire (swHSQ, Scheel et al., 2016). The scale consists of 12 items measured on a 5-point Likert response format from 1 (not at all) to 5 (completely). The swHSQ measures four personal humour styles: self-enhancing (e.g. If Ím at work and Ím feeling unhappy, I make an effort to think of something funny to cheer myself up. α = 0.73), affiliative (e.g. I enjoy making my colleagues laugh. α = 0.67), self-defeating (e.g. Letting others laugh at me is my way of keeping my colleagues in good spirits. α = 0.80) and aggressive humour (e.g. If someone makes a mistake at work, I will often tease them about it. α = 0.72). The confirmatory factorial analysis sustains the model with the four factors: χ²(45) = 66.61, p = .02; CFI = .97; RMSEA = .05, 95% CI [.02–.07].

3.2.3. Professional quality of life

The Professional Quality of Life Scale (ProQOL, Stamm, 2010) adapted for Romanian population (Măirean, 2016) is a 30-item scale designed to measure one’s professional quality of life on three dimensions: compassion satisfaction (e.g. I like my work as a helper. α = 0.80), burnout (e.g. I feel trapped by my job as a helper. α = 0.67) and secondary traumatic stress (e.g. I jump or am startled by unexpected sounds. α = 0.78). The confirmatory factorial analysis sustains the model with three factors: χ2(258) = 411.96, p < .001; CFI = .91; RMSEA = .05, 95% CI [.04–.06]. This instrument has been used extensively and found to be reliable and valid as a measure of the three concepts, in samples comprised of medical staff (e.g. Berger et al., 2015; Măirean, 2016).

Demographic variables were collected via a questionnaire that covered age, gender, hospital unit and professional category.

3.3. Procedure

The protocol for this study was approved by the Ethical Committee of the university where the authors are affiliated (approval code: 23 January 2021). The participants were invited to participate in a study about their perceptions about daily professional life and ways to deal with day to day challenges. They were informed about the fact that participation is voluntary and the information will be kept confidential. The survey was completed in an anonymous version after signing the informed consent. After completing the demographic section, the scales were presented in the following order: compassion scale, workplace humour scale and professional quality of life. Some of the participants completed the scales in paper and pencil format, while other participants completed the online version of the same survey. The average time for filling in the scales was 10–15 min.

3.4. Overview of statistical analysis

We conducted a preliminary analysis to examine how the demographic variables (i.e. age, gender) were related to professional quality of life. Further, we analysed the associations among the study variables. Then, we simultaneously tested the relationship between humour styles, compassion and professional quality of life, as well as the moderating role of compassion using a structural equation model (SEM) framework in AMOS Graphics 22 (Arbuckle, 2011). The product terms of the centred scores from the four humour styles and compassion were computed and entered in the model. Commonly-used fit indices were employed to assess the overall model fit (Hu & Bentler, 1999).

4. Results

4.1. Preliminary analyses

Descriptive statistics for the main study variables were presented in Table 1. The participants’ age was significantly related only with self-defeating humour (r = −.14, p = .042). Independent samples t-tests indicated significant differences in the participants’ secondary traumatic stress (t(187) = −3.23, p = .001), aggressive humour (t(187) = 4.30, p < .001) and compassion (t(187) = −2.88, p = .008). Women presented higher levels of secondary traumatic stress (M = 2.69, SD = 0.53) and compassion (M  = 4.02, SD = 0.41), as well as lower levels of aggressive humour (M = 1.85, SD = 0.75) than men (STS: M = 2.31, SD = 0.51; compassion: M = 3.62, SD = 0.65; aggressive humour: M = 2.58, SD = 0.91).

Table 1. Descriptive statistics and zero-order correlations among the main study variables.

Variables	1.	2.	3.	4.	5.	6.	7.	8
1. Self-enhancing humour
2. Affiliative humour	.60***
3. Self-defeating humour	.38***	.52***
4. Aggressive humour	.35***	.33**	.60***
5. Compassion	.14*	.23**	.09	−.08
6. Compassion satisfaction	.27***	.27***	−.01	−.04	.33***
7. Burnout	−.29***	−.14*	.10	.03	−.09	−.63***
8. Secondary stress	−.17*	−.07	.15*	−.03	.12	−.14*	.63***
9. Age	.06	−.01	−.14*	.03	.01	.04	−.02	−.01
Mean	3.16	3.44	2.12	1.94	3.97	4.13	2.35	2.64
SD	0.73	0.72	0.93	0.81	0.46	0.45	0.47	0.54

Note. *p < .05, **p < .01, ***p < .001.

4.2. Associations among the main study variables

Compassion satisfaction was positively related to self-enhancing humour, affiliative humour and compassion, while burnout was negatively related to self-enhancing humour and affiliative humour. Further, secondary traumatic stress was negatively related to self-enhancing humour and positively related to self-defeating humour. These relations were small to medium (Cohen, 2013) and are presented in Table 1.

4.3. Testing for direct relations and moderation

The fit for our overall path model was satisfactory (Figure 1): χ²(28) = 55.10, p = .002; CFI = .96; NFI = .93; RMSEA = .07 (CI: .04, .10), and the model explained 19.2% of the variance in compassion satisfaction, 15% in burnout, and 19.3% in secondary traumatic stress. Our results showed that compassion satisfaction was positively related to compassion, self-enhancing humour, and affiliative humour. Moreover, compassion satisfaction was negatively related to self-defeating humour. Further, burnout was negatively related to self-enhancing humour and positively related to self-defeating humour. Similarly, secondary traumatic stress was negatively related to self-enhancing humour and positively related to self-defeating humour. Compassion acted as a moderator in the relationship between affiliative humour and secondary traumatic stress. The other interaction terms between compassion and humour styles were non-significant.

Figure 1. Path analysis of the factors related to each dimension of professional quality of life. Standardised path coefficients are reported. Non-significant paths are indicated with dotted lines. For readability, only the significant interaction was represented in the model.

The simple slope analysis indicated that participants that reported a high level of affiliative humour also reported the lowest level of secondary traumatic stress, only when they also reported a high level of compassion (Dawson, 2014) (Figure 2)

Figure 2. Graphical representation of the interaction between affiliative humour and compassion in predicting secondary traumatic stress.

5. Discussion

This present study aims to identify the relationship between positive humour, negative humour, compassion, and professional quality of life, in a sample of medical staff.

Our results showed that compassion satisfaction is positively related to self-enhancing humour and affiliative humour. Moreover, compassion satisfaction was negatively related to self-defeating humour. Further, burnout and secondary traumatic stress were negatively related to self-enhancing humour and positively related to self-defeating humour. These results bring more support for previous studies that also found that negative humour styles were positively related to emotional exhaustion (Guenter et al., 2013), while affiliative and self-enhancing humour improved relationships, were related to emotional well-being (Martin et al., 2003). The ability to find something funny in a difficult, sad situation that a medical professional faces at a given time can help him/her to overcome that moment and better manage stressful situations, like difficult patients and their families, mistakes they have made at work, even imminent death (de Almeida & Nunes, 2020; Wanzer et al., 2005).

Negative humour may be a proxy factor related to secondary traumatic stress and burnout among medical staff. From a practical point of view, raising awareness about different types of humour strategies, like self-defeating, could also be encouraged for healthcare workers to protect themselves and decrease the risks associated with a low quality of life. Previous evidence sustain that self-defeating humour is related to neuroticism and low esteem (Kuiper et al., 2004), thus increasing self-esteem could be an efficient way to decrease this detrimental humour style. Future studies could address the link between different humour styles and other personal factors that can be targeted in interventions (e.g. self-esteem, self-efficacy).

In our study, compassion was positively related to compassion satisfaction. Previous studies have shown that medical staff able to provide competent and compassionate care also present high levels of compassion satisfaction (Radey & Figley, 2007). Other studies have also shown that a high level of compassion for others is related to a high level of compassion satisfaction and a high level of well-being (Beaumont et al., 2016; Duarte et al., 2016). Further, the results showed that compassion also moderates the relation between affiliative humour and secondary traumatic stress. Thus, the participants that reported a high level of affiliative humour also reported the lowest level of secondary traumatic stress, only when they also reported a high level of compassion. Thus, encouraging an organisation to create a safe and supporting climate that would foster coping styles based on positive humour, and also implementing training programs designed to increase compassion (e.g. compassionate mind training model for healthcare practitioners, Beaumont, 2016), can be considered together given their associations with quality of life indicators. Encouraging compassionate skills (e.g. focusing on the present, without criticism, training the mind to think in a helpful way, Gilbert, 2009) could be an effective way to foster positive relations with a good quality of life.

Several limitations should be noted. First, the large number of female participants compared to male participants decrease the external validity of the results. This difference may be due, however, to the large number of women who are employed in the medical system. Second, the cross-sectional nature of the study represents another limitation. The relationship between compassion, humour, secondary traumatic stress, burnout and compassion satisfaction were analysed at a single point in time. Therefore, we cannot formulate and observe causal relationships among the variables. Third, self-compassion, not only compassion for others, may be involved in determining professional quality of life and may be considered in future studies. The literature has shown that self-compassion is positively associated with life satisfaction, being a strong predictor in reducing severe symptoms of anxiety and depression (MacBeth & Gumley, 2012; Van Dam et al., 2011). Thus, showing gentleness towards oneself in situations of suffering, not having a self-critical attitude, recognising that pain and failure are common to the human experience and having a balanced awareness of one’s painful thoughts and feelings instead of ruminating on them (Neff, 2003), the medical staff will be able to reduce their professional stress.

Moreover, the factors associated with a personal humour style, as well as with witnessed humour strategies could help us better understand the implications of workplace humour and could be explored in further studies. Finally, we only used self-report measures, that may be limited by specific biases, such as social desirability. In order to decrease or remove this limitation, future studies could use measures from different sources (e.g. colleagues), not only scales based on self-reports.

Despite the limitations presented, the results of this study add to previous ones sustaining the specific relationships among compassion, humour, burnout, secondary traumatic stress and compassion satisfaction. In addition, they specifically present the relationship between both positive and negative humour styles and quality of life of medical professionals.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.