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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Network model with significant correlations of the variables of interest&#46; Thickness&#58; it indicates the intensity of the association&#46; Greater thickness&#44; greater intensity&#59; less thickness&#44; less intensity&#46;</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Green color&#58; positive correlations&#59; pink color&#58; negative correlations&#46;</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">1&#58; work-related stressors&#59; 2&#58; self-compassion&#59; 3&#58; empathy&#59; 4&#58; emotional effort&#59; 5&#58; fatigue due to compassion&#59; 6&#58; harmonious passion&#59; 7&#58; obsessive passion&#59; 8&#58; shaken beliefs&#59; 9&#58; traumatic symptoms&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Intensive care is defined as the field of medicine devoted to managing the critically ill patient&#46; In this setting&#44; numerous studies have provided evidence on the emotional burden of this study where&#44; among other factors&#44; there is a continuous exposure to death&#44; pain&#44; disease&#44; and suffering&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Also&#44; there are psychosocial risks like exhausting on-call shifts&#44; continuous inflow of patients&#44; need to prioritize the decision-making process under pressure&#44; small working places&#44; and different professionals having to work together&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> This working history creates stressors that make it a high-risk job prone to developing certain conditions such as labor disatisfaction&#44; wishes to quit&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> depression&#44; anxiety&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and burnout syndrome&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;6</span></a> On the other hand&#44; and although it has not been studied in this context&#44; it may lead to secondary traumatic stress&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Secondary traumatic stress has been defined as post-traumatic symptoms that may be eexperienced by intensivists&#44; that is&#44; the person who helps the victims of a traumatic event&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> In the intensive care setting&#44; the management of critically ill patients means treating unexpected traumatic&#44; painful events&#44; with the associated emotional burden that means having to cope with the family members who are living moments of crisis&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a> The study conducted by Dom&#237;nguez-G&#243;mez and Rutledge<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> shows that 33&#37; of the nursing staff that works in the ER setting meet the criteria for secondary traumatic stress&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">According to Moreno-Jim&#233;nez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> strees leads to 3 different levels of discomfort&#58; &#40;a&#41; compassion fatigue&#44; physical and emotional exhaustion of the healthcare provider&#59; &#40;b&#41; shaken beliefs meaning cognitive changes in beliefs and values in the healthcare provider as a response to the traumatic event lived&#44; and &#40;c&#41; post-traumatic symptoms at cognitive&#44; emotional&#44; and behavioral level as the DSM-V clearly establishes&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Also&#44; they define empathy and the working history such as time overload or the type of traumatic task as risk factors&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;13</span></a> In this study&#44; this history will be referred to as &#171;work-related stressors&#187;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">On the other hand&#44; over last few years the studies conducted on burnout syndrome and nursing&#44; confirm the existence of a modifying variable that would be the love for the job&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> The passion for the job has been defined as a &#171;controllable inclination towards an activity that the person values too much and to which he&#47;she decides to devote time and effort&#187;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> There are 2 different types of passion&#58; &#40;a&#41; harmonious passion where the individual controls the activity while in tune with other activities&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> and &#40;b&#41; obsessive passion&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> where the activity controls the person who feels internal or external pressure while trying to achieve certain external contingencies that take on a disproportionate place in his life&#44; creating conflict with other areas&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Also&#44; both types of passion differ from one another in the associated consequences&#46; In particular&#44; harmonious passion is related to deeper states of concentration &#40;flow for example&#41;&#44; life satisfaction&#44; commitment&#44; psychological wellbeing&#44; and positive affectivity&#44;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;20</span></a> while obsessive passion is associated with psicological processes like pondering and negative affectivity&#44; role conflict&#44; family-work conflict and burnout syndrome&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;19&#44;21</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Finally&#44; there are other emotional variables that may play a significant role in the intensive care setting such as emotional effort and self-compassion&#46; Emotional effort is defined as the discordance experienced by the worker between what he really feels and what he should express in his working environment while interacting with the patients&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> The more common these interactions are the greater the discordance&#44; effort&#44; and emotional exhaustion<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> in his working place&#46; Self-compassion&#44; however&#44; is defined as the ability to see defects and errors as a normal part of human condition&#44; which favors the positive relation with oneself and a non-judgemental attitude towards one&#8217;s mistakes&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> The studies confirm that when it is high it increases the healthcare providers&#8217; capacity of self-care<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> and is associated with a more positive affectivity&#44; psychological health&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> and less stressors of very demanding settings&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">For all this&#44; the goal of this study is to propose a model of secondary traumatic stress predictors to work at an exploratory level&#46; So&#44; for the sake of our model we will be using a job demands and resources &#40;JD-R&#41; model&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> where work-related stressors and emotional effort will be demands associated with the job&#44; while passion for the job&#44; empathy&#44; and self-compassion will be resources of the person capable of favoring or preventing the appearance of secondary traumatic stress&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Method</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Study design</span><p id="par0040" class="elsevierStylePara elsevierViewall">This is a descriptive&#44; transverse study&#46; To achieve maximum efficiency in the evaluation process&#44; the 3 heaviest items in the original confirmatory analysis of the tool were selected for each studied variable&#46; This is the smallest number of items established by statistical models for the representativity of a variable&#46; The weight of an item assesses the degree in which the item measures the construct&#44; which means that the 3 heaviest items were selected&#46; The average time spent to fill out the entire quesionnarie was 15 minunte&#46; The questionnaries used were not validated in the context of an intensive care unit &#40;ICU&#41;&#44; but they had been previously validated out-of-hospital emergency settings&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Study variables</span><p id="par0045" class="elsevierStylePara elsevierViewall">The study variables were sociodemographic variables like genre&#44; age&#44; civil status&#44; working experience&#44; job&#44; working shift&#44; ICU and&#44; finally&#44; whether the staff had had personal traumatic experiences and&#44; if so&#44; which ones&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Questionnaire of Secondary Traumatic Stress&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> This scale includes the assessment of work-related stressors&#44; secondary traumatic stress&#44; and empathy&#46; Regarding these stressors&#44; 4 items from the original scale were included plus 2 items were adapted to the hospital setting &#40;&#171;in our unit&#44; time pressure from having to show up where the emergency is occurring is very high&#187; was already present in the original scale and &#171;in our unit&#44; time pressure during early care of the patient is very high&#187; was added as an adapted version&#46; On the other hand&#44; &#171;I find it hard to forget situations where the victim was a minor or an old person&#187; was already included the original scale and the item &#171;the cases somehow similar to my life truly affect me&#187; was also included&#46; Regarding secondary traumatic stress&#44; 3 items were selected for every subdimension&#46; A total of 9 items were collected &#40;&#171;I am emotionally overwhelmed by this job&#187;&#44; for example&#41;&#46; Regarding empathy&#44; the 3 most overwhelming items were selected &#40;&#171;I feel a transfer of feelings from my patients&#187;&#44; for instance&#41;&#46; The response scale was the Likert scale &#40;from 1 to 4&#41;&#44; being 1 &#171;totally in disagreement&#187; and 4 &#171;totally in agreement&#187;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The Passion for the Job Scale&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> This scale includes 3 items of harmonious passion &#40;for example&#44; &#171;I live all sorts of experiences with my job&#187;&#41; and 3 items of obsessive passion &#40;such as &#171;I emotionally depend on my job&#187;&#41;&#46; The response scale was the Likert scale &#40;from 1 to 7&#41;&#44; being 1 &#171;totally in disagreement&#187; and 7 &#171;totally in agreement&#187;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The Emotional Effort Scale&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> It includes 3 items such as &#171;during the last month&#44; how often did you feel that this job required great effort&#63;&#187;&#46; The response scale went from 1 to 5&#44; being 1 &#171;never&#187; and 5 &#171;always&#187;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The Self-Compassion Scale&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> The 3 most overlwheming items of all from the original short version of 12 items were selected&#46; An example of item here was &#171;I try to see my defects as a normal part of human condition&#187;&#46; The response scale was the Likert scale &#40;from 1 to 5&#41;&#44; being 1 &#171;rarely&#187; and 5 &#171;almost all the time&#187;&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Participants</span><p id="par0070" class="elsevierStylePara elsevierViewall">The study participants were 103 healthcare providers of an intensive care unit from a university tertiary hospital in Madrid&#44; Spain&#46; The study was conducted at the Unit of Intensive Medicine that includes 3 sections&#58; trauma and ER&#44; polyvalent care&#44; and cardiac care unit&#46; The inclusion criteria were being a healthcare provider at an adult ICU with&#44; at least&#44; 2 months of experience&#46; The exclusion criteria were not having spent these 2 months in these ICUs&#46; Before conducting the study&#44; an informative sheet was handed out with the corresponding written informed consent&#46; This project has been approved by the Research Ethics Committee with reference number CEI 71-1276&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Statistical analysis</span><p id="par0075" class="elsevierStylePara elsevierViewall">The statistical analysis was conducted using the SPSS 25&#46;0 software package and included a feasibility analysis of the dimensions of our scale&#44; a descriptive analysis of the variables of interest&#44; a MANOVA analysis to study possible differences of genre&#44; ICU and position in the variables of interest&#46; Finally&#44; one logistics regression analysis using as criterion variables the 3 separate subdimensions of secondary traumatic stress&#58; shaken beliefs&#44; fatigue due to compassion&#44; and traumatic symptoms&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">On the other hand&#44; a network model known as &#171;psychological network&#187; was designed&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> The JASP<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> statistical software package was used&#46; This software builds an interface for R through which this type of model is generated&#46; This model is used to analyze the most significant estimators&#58; strength&#44; nearness and interconnectivity&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> The order from less to greater complexity is&#58; 1&#41; &#171;strength&#187;&#44; meaning the total intensity with which a variable is related to the network measured as the sum of all links different than zero&#59; 2&#41; &#171;nearness&#187;&#44; meaning the tendency of a variable to be connected to others &#40;being &#171;near&#187;&#41; measured as the number of connections other than zero in every variable&#59; and 3&#41; &#171;interconnectivity&#187;&#44; meaning the tendency of a variable to mediate between 2 and measured as the number of pairs other than zero of a variable with 2 different variables&#46; Therefore&#44; a variable with high strength implies that&#44; regardless of how it is distributed&#44; it intensely connects to the rest of the network through a single very intense link&#44; several not so intense links or intermediate links&#46; Variables with high nearness mean they are connected to many other variables in the network&#46; High interconnectivity means that other 2 variables can connect to one another&#46; If a variable has high strength&#44; nearness&#44; and interconnectivity&#44; that means it is a fairly central variable within the network&#44; both numeric and graphically&#44; that it connects to many other variables with intensity&#44; and that it interconnects several variables to one another&#46; To interpret these indicators on <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#44; positive values indicate values above average and the negative ones indicate values below average&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">The total study sample consisted of 103 patients including 36 males &#40;35&#46;3&#37;&#41; and 66 women &#40;64&#46;7&#37;&#41;&#46; The mean age was 37&#46;23 years &#40;TD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#46;47&#41; ranging between 21 and 64 years&#46; Also&#44; 71&#46;8&#37; of the study sample said they were in a stable relation&#44; as opposed to 18&#37;&#44; and 8&#37; who said they were not involved in a sentimental relation&#46; The experience of the sample in the healthcare setting was 13&#46;62 years on average &#40;TD <span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#46;22&#41;&#46; Participants included 35 doctors&#44; 49 nurses&#44; 16 assistants&#44; and 2 porters&#46; Also&#44; a distinction was made on an ICU basis&#58; a sample of 35 staff members working at trauma and ER ICUs was selected&#58; 39 from coronary ICUs and 25 from polyvalent ICUs&#46; Another 3 participants said they worked in these 3 units&#46; Seventy-six participants worked during the morning shift&#44; 16 during the afternoon shift&#44; 5 participants during both shifts&#44; while only 1 reamained on call&#46; On ther other hand&#44; 65&#37; of the sample said they had not had direct personal traumatic experiences before&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the means expressed as the average of the scores obtained for each scale and the main correlations of our variables of interest&#46; No significant differences were seen when differences in the variables of interest based on genre&#44; position&#44; and ICU were analyzed&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Network model</span><p id="par0095" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> shows the final network model with the significant correlations&#46; We can see that self-compassion keeps a negative correlation with obsessive passion and symptoms&#44; meaning that it would be a protective factor&#46; The same thing happens with harmonious passion that keeps a negative correlation with shaken beliefs and symptoms&#46; On the other hand&#44; empathy and emotional effort are risk factors that keep a with positive correlation with symptoms and shaken beliefs unlike harmonious passion&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows centrality estimation&#46; The 2 most significant variables in the 3 estimators that are above the rest are shaken beliefs &#40;&#171;shaken beliefs&#95;1&#187;&#41; and empathy &#40;&#171;empathy&#95;1&#187;&#41;&#46; This points to both variables as especially significant within the network&#46; On the other hand&#44; traumatic symptoms &#40;&#171;symptoms&#95;1&#187;&#41; and fatigue due to compassion &#40;&#171;fatigue&#95;1&#187;&#41; are the next most significant variables with mean centrality&#46; Together with the network&#44; these results provide information on this possible variable core by interconnecting parts of the network with more peripheral parts&#46; In particular&#44; both self-compassion and harmonious passion seem to be more peripheral to the network and keep negative correlations to the rest&#59; that is&#44; they are protective while the remaining variables often keep a positive correlation to one another&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Multiple regression analysis</span><p id="par0105" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows regressions of the different dimensions of secondary traumatic stress&#46; This table shows the values of variance explained for each of the 3 models&#46; The model of symptom variance is the one that presents the greater percentage of variance explained &#40;45&#37;&#41; with significant increases as sociodemographic&#44; work-related stressor&#44; emotional effort&#44; empathy and self-compassion variables were being added to the model&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">When analyzing the beta values standardized on <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#44; we should be looking at the last column of every dimension of secondary traumatic stress referring to the final step of regression&#46; Regarding the first component of secondary traumatic stress&#8212;the variable fatigue due to compassion&#8212;only the years of experience proved to be a positive predictor of the variable&#44; while harmonious passion appears as a negative predictor&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Regarding the second component&#8212;shaken beliefs&#8212;both emotional effort and empathy are positive predictors&#46; This may explain the results of <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> where both variables keep significant and positive correlations&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">If we analyze the third component&#8212;traumatic symptoms&#8212;we will find the years of experience again but&#44; in this case&#44; as a negative predictor&#44; while work-related stressors and empathy appear as positive predictors&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">This study tried to establish a model of significant predictors for secondary traumatic stress obtaining similar information from the network model and the regression analysis&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Regarding fatigue due to compassion&#8212;wear and tear due to empathy from the healthcare provider&#8212;harmonious passion acts as a protector&#44; which is indicative that the more balanced a person is in the different areas of his life &#40;work&#44; family&#44; friends&#44; etc&#46;&#41; the less his wear and tear conflict will be in his job&#46; It can also favor further experiences of recovery and disconnection&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> more self-care&#44; and less fatigue due to compassion&#46; On the other hand&#44; the years of experience in this sector are a risk factor in this dimension&#44; which would not be consistent with with prior studies&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> These results are indicative that this dimension would be associated with the degree of exposure to trauma since longer times of exposure by the professional equal greater wear and tear&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Regarding shaken beliefs&#44; both empathy and emotional effort are risk factors indicative that the greater the capacity of the healthcare provider to understand the emotions of patients and their families and the greater his effort the more changes in values and beliefs&#46; These results are consistent with former studies where they have been proposed as risk factors&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;9&#44;13&#44;22</span></a> Also&#44; gathering qualitative evidence through interviews with the healthcare providers is indicative that&#44; on many occasions&#44; they are aware of cognitive changes in their values and beliefs due to their job &#40;for example&#44; car crashes with young people involved&#44; spinal cord injuries&#44; etc&#46;&#41;&#44; but they are not aware of the emotional impact&#46; For this reason&#44; the shaken beliefs variable can have greater specific weight in this setting&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> as the network model showed&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Also&#44; regarding symptoms&#44; the years of experience are a protective factor that is consistent with what the scientific references tell us&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> The explanation may be that the more exposed healthcare providers are to their job&#44; the less evident their symptoms become&#46; Another alternative may be the parallel development of protective variables as the personnel gains experience &#40;like self-compassion&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> favoring more self-care initiatives and protection from the most psychosomatic features of secondary traumatic stress&#46; On the other hand&#44; regarding the risk factors for post-traumatic symptoms&#44; work-related stressors play an important role here&#44; which would make sense from a theoretical point of view since longer exposure to these stressors lead to more symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Again empathy is a tool for people with negative consequences&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;13</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Lastly&#44; obsessive passion appears in the network model as a risk factor for empathy&#44; symptoms&#44; and shaken beliefs&#46; As Donahue et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> say these results would be relevant if greater obsessive passion were associated with greater processes of pondering and less recovery which would favor the appearance of more symptoms by reviving the discomfort experienced during the working day and never getting a break&#46; Also&#44; the conflict generated by other vital areas<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> may cause greater changes in the workers&#8217; beliefs by letting these traumatic situations have a greater impact in their lives&#46; On the other hand&#44; this passion promotes empathy which is&#44; in turn&#44; a risk factor&#46; We can say that the most obsessive part of passion that &#171;urges&#187; workers to keep on working would have to do with the mechanisms that make a person empathetic to patients and families and facilitate counter-productive emotional contagion&#46; These results would be different from those of other studies where empathy is associated with less burnout syndrome<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> and more wellbeing&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Regarding the limitations of this study&#44; its transversal methodology makes it difficult to establish causal relations&#44; meaning that it is necessary to develop a longitudinal study to establish the models of mediation and moderation of the study variables&#46; Another limitation has to do with the intensive care setting <span class="elsevierStyleItalic">per se</span>&#44; since the flow of patients and changes of activity make it difficult to gather information and respond to the corresponding scales&#46; To mitigate this stressor the number of items in the assessment questionnaire was reduced to avoid saturating the workers&#46; This led to another limitation&#58; the poor reliability of certain items&#44; which made us eliminate a few variables that were initially part of the study&#46; Added to this control a statistical analysis of realiability was conducted in each variable by eliminating an element to select the most reliable items for measuring purposes and&#44; eventually&#44; ameliorate this limitation&#46; This setting is also the origin of another limitation&#58; the small size of sample and center that is an actual threat to the study external validity&#46; However&#44; obtained significant preliminary results for future replicas in other centers&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conclusions</span><p id="par0155" class="elsevierStylePara elsevierViewall">In conclusion&#44; our study is the first one on secondary traumatic stress in the healthcare population of intensive care units&#46; From the data obtained we can go deep into the measures aimed at improving the quality of life of these professionals and impacting the quality of the healthcare provided&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">37&#44;38</span></a> For all this&#44; it is crucial to propose intervention designs to prevent secondary traumatic stress&#44; reduce the risk factors found in this study such as empathy and emotional effort&#44; and increase protective factors like self-compassion and harmonious passion&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Funding</span><p id="par0160" class="elsevierStylePara elsevierViewall">These have been the sources of funding for this project&#58;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Predoctoral contract FPI-UAM 2017 of the <span class="elsevierStyleItalic">Universidad Aut&#243;noma de Madrid</span> and project PSI2015-68011-R of the Spanish Ministry of Economy and Competitivity &#40;MINECO&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Authors&#47;Collaborators</span><p id="par0170" class="elsevierStylePara elsevierViewall">All authors participated in the design&#44; analysis&#44; and development of this study&#46; In particular&#44; Mario Chico&#44; Marisol Mart&#237;nez&#44; and Juan Carlos Montejo participated in the study design and facilitated data mining at the hospital and adapted the measuring tool to their hospital setting&#46; On the other hand&#44; Raquel Rodr&#237;guez-Carvajal and Bernardo Moreno-Jim&#233;nez participated in the design and creation of the measuring tool and its applicability&#46; They also participated in the discussion of the results and implementation in future studis&#46; &#211;scar Lecuona also participated in the design&#44; methodology&#44; and data analysis&#46; Finally&#44; Eva Garrosa directed the applicability study at the hospital and the study&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Conflict of interests</span><p id="par0175" class="elsevierStylePara elsevierViewall">None reported&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Aim</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">To propose a predictive model of secondary traumatic stress &#40;STS&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">A descriptive cross-sectional study was carried out&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Context</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">The study was conducted in the Intensive Care Units of a hospital in Madrid &#40;Spain&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Participants</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">The sample comprised 103 health professionals&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Interventions</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">A series of questionnaires were created and completed by the participants&#46; Network analysis and multiple regression was used for data analysis&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Variables of interest</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Sociodemographic variables such as gender&#44; years of experience and position&#44; STS&#44; passion for work&#44; work stressors&#44; emotional effort&#44; empathy and self-compassion were evaluated&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">The result identified the following&#58; a&#41; years of experience as a risk factor for compassion fatigue &#40;&#946;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;224 and <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;029&#41;&#44; and harmonious passion as a protector &#40;&#946;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;363 and <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#59; b&#41; emotional effort and empathy as risk factors for shattered assumptions &#40;&#946;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;304 and <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;004&#59; &#946;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;394 and <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000&#44; respectively&#41;&#59; and c&#41;&#44; work stressors and empathy as risk factors for symptomatology &#40;&#946;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;189 and <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;039&#59; &#946;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;395 and <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000&#44; respectively&#41;&#44; and years of experience as a protector &#40;&#946;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;266 and <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusions</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">This predictive model of STS identifies protective factors which could be reinforced&#44; such as harmonious passion&#44; and risk factors which should be reduced&#44; such as empathy and emotional effort&#44; with a view to promoting quality of care and quality of life among these professionals&#46;</p></span>"
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        "resumen" => "<span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Objetivo</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Proponer un modelo de predictores del estr&#233;s traum&#225;tico secundario &#40;ETS&#41;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Dise&#241;o</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Se trata de un dise&#241;o transversal descriptivo&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">&#193;mbito</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">El estudio se llev&#243; a cabo en las unidades de cuidados intensivos de un hospital terciario de Madrid&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Participantes</span><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">La muestra estuvo formada por 103 profesionales sanitarios&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Intervenciones</span><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Se cre&#243; una bater&#237;a de cuestionarios que fue rellenada por los profesionales&#46; Respecto al an&#225;lisis de datos&#44; se utiliz&#243; una metodolog&#237;a de redes y an&#225;lisis de regresi&#243;n jer&#225;rquica&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Variables de inter&#233;s</span><p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">Se evaluaron variables sociodemogr&#225;ficas tales como g&#233;nero&#44; a&#241;os de experiencia y puesto&#44; el ETS&#44; la pasi&#243;n por el trabajo&#44; los estresores laborales&#44; el esfuerzo emocional&#44; la empat&#237;a&#44; la autocompasi&#243;n&#46;</p></span> <span id="abst0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">Se establece&#58; a&#41; para la fatiga por compasi&#243;n&#44; los a&#241;os de experiencia como factor de riesgo<span class="elsevierStyleItalic">&#40;&#946;<span class="elsevierStyleHsp" style=""></span>&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;224 <span class="elsevierStyleItalic">y p<span class="elsevierStyleHsp" style=""></span>&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;029&#41;&#44; y la pasi&#243;n armoniosa como protector <span class="elsevierStyleItalic">&#40;&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8211;0&#44;363 <span class="elsevierStyleItalic">y p<span class="elsevierStyleHsp" style=""></span>&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#59; b&#41; para la sacudida de creencias&#44; el esfuerzo emocional y la empat&#237;a como factores de riesgo <span class="elsevierStyleItalic">&#40;&#946;<span class="elsevierStyleHsp" style=""></span>&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;304 <span class="elsevierStyleItalic">y p<span class="elsevierStyleHsp" style=""></span>&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;004<span class="elsevierStyleItalic">&#59; &#946;<span class="elsevierStyleHsp" style=""></span>&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;394 <span class="elsevierStyleItalic">y p<span class="elsevierStyleHsp" style=""></span>&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;000 respectivamente&#41;&#59; y c&#41; para la sintomatolog&#237;a&#44; los estresores laborales y la empat&#237;a como factores de riesgo &#40;<span class="elsevierStyleItalic">&#946;<span class="elsevierStyleHsp" style=""></span>&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;189 <span class="elsevierStyleItalic">y p<span class="elsevierStyleHsp" style=""></span>&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;039<span class="elsevierStyleItalic">&#59; &#946;<span class="elsevierStyleHsp" style=""></span>&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;395 y p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;000 respectivamente&#41; y los a&#241;os de experiencia como protector &#40;<span class="elsevierStyleItalic">&#946;&#61; &#8211;</span>0&#44;266 <span class="elsevierStyleItalic">y p<span class="elsevierStyleHsp" style=""></span>&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46;</p></span> <span id="abst0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusiones</span><p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">Este modelo predictivo del ETS asienta factores protectores que podr&#237;an aumentarse&#44; como la pasi&#243;n armoniosa&#44; y factores de riesgo que ser&#237;a conveniente reducir&#44; como la empat&#237;a y el esfuerzo emocional&#44; con el fin de mejorar la calidad asistencial y de vida de los profesionales&#46;</p></span>"
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          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">&#945;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>Cronbach&#8217;s alpha for the variables of interst&#59; M&#44; mean&#59; TD&#44; typical deviation&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">TD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#945;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Work-related stressor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Emotional effort&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;35<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fatigue due to compassion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;27<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Shaken beliefs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;31<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;46<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;47<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Traumatic symptoms</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pending &#40;&#946;&#41;</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pending &#40;&#946;&#41;</th><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pending &#40;&#946;&#41;</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="13" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Step&#35;1</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Genre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;218<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;182&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;170&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;160&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;171&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;075&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;072&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;042&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;055&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;047&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;027&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;043&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Position&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;023&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;027&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;021&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;029&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;025&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;252<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;206<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;183&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;161&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Years of experience&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;149&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;196&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;207&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;224<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;025&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;044&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;046&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;085&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;368<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;336<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;338<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;266<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="13" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Step&#35;2</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Work-related stressors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;050&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;175&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;173&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;093&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;298<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;282<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;189<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Emotional effort&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;066<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;230<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;191&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;417<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">406&#42;&#42;&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;304<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;189&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;218<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;099&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="13" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Step&#35;3</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Harmonious passion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;343<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;363<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;058&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;119&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;135&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;094&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Obsessive passion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;130&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;092&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;078&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;077&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;057&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="13" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Step&#35;4</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Empathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;141&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;394<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;395<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Self-compassion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;008&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;28&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adjusted R<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;200&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;314&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;450&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#916;R<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;056&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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Original
Risk and protective factors of secondary traumatic stress in Intensive Care Units: An exploratory study in a hospital in Madrid (Spain)
Factores de riesgo y protección del estrés traumático secundario en los cuidados intensivos: un estudio exploratorio en un hospital terciario de Madrid
J.E. Moreno-Jiméneza,
Corresponding author
jennifer.moreno@uam.es

Corresponding author.
, R. Rodríguez-Carvajala, M. Chico-Fernándezb, Ó. Lecuonaa, M. Martínezb, B. Moreno-Jiméneza, J.C. Montejob, E. Garrosaa
a Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain
b Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre de Madrid, Madrid, Spain
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Network model with significant correlations of the variables of interest&#46; Thickness&#58; it indicates the intensity of the association&#46; Greater thickness&#44; greater intensity&#59; less thickness&#44; less intensity&#46;</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Green color&#58; positive correlations&#59; pink color&#58; negative correlations&#46;</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">1&#58; work-related stressors&#59; 2&#58; self-compassion&#59; 3&#58; empathy&#59; 4&#58; emotional effort&#59; 5&#58; fatigue due to compassion&#59; 6&#58; harmonious passion&#59; 7&#58; obsessive passion&#59; 8&#58; shaken beliefs&#59; 9&#58; traumatic symptoms&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Intensive care is defined as the field of medicine devoted to managing the critically ill patient&#46; In this setting&#44; numerous studies have provided evidence on the emotional burden of this study where&#44; among other factors&#44; there is a continuous exposure to death&#44; pain&#44; disease&#44; and suffering&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Also&#44; there are psychosocial risks like exhausting on-call shifts&#44; continuous inflow of patients&#44; need to prioritize the decision-making process under pressure&#44; small working places&#44; and different professionals having to work together&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> This working history creates stressors that make it a high-risk job prone to developing certain conditions such as labor disatisfaction&#44; wishes to quit&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> depression&#44; anxiety&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and burnout syndrome&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;6</span></a> On the other hand&#44; and although it has not been studied in this context&#44; it may lead to secondary traumatic stress&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Secondary traumatic stress has been defined as post-traumatic symptoms that may be eexperienced by intensivists&#44; that is&#44; the person who helps the victims of a traumatic event&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> In the intensive care setting&#44; the management of critically ill patients means treating unexpected traumatic&#44; painful events&#44; with the associated emotional burden that means having to cope with the family members who are living moments of crisis&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a> The study conducted by Dom&#237;nguez-G&#243;mez and Rutledge<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> shows that 33&#37; of the nursing staff that works in the ER setting meet the criteria for secondary traumatic stress&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">According to Moreno-Jim&#233;nez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> strees leads to 3 different levels of discomfort&#58; &#40;a&#41; compassion fatigue&#44; physical and emotional exhaustion of the healthcare provider&#59; &#40;b&#41; shaken beliefs meaning cognitive changes in beliefs and values in the healthcare provider as a response to the traumatic event lived&#44; and &#40;c&#41; post-traumatic symptoms at cognitive&#44; emotional&#44; and behavioral level as the DSM-V clearly establishes&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Also&#44; they define empathy and the working history such as time overload or the type of traumatic task as risk factors&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;13</span></a> In this study&#44; this history will be referred to as &#171;work-related stressors&#187;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">On the other hand&#44; over last few years the studies conducted on burnout syndrome and nursing&#44; confirm the existence of a modifying variable that would be the love for the job&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> The passion for the job has been defined as a &#171;controllable inclination towards an activity that the person values too much and to which he&#47;she decides to devote time and effort&#187;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> There are 2 different types of passion&#58; &#40;a&#41; harmonious passion where the individual controls the activity while in tune with other activities&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> and &#40;b&#41; obsessive passion&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> where the activity controls the person who feels internal or external pressure while trying to achieve certain external contingencies that take on a disproportionate place in his life&#44; creating conflict with other areas&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Also&#44; both types of passion differ from one another in the associated consequences&#46; In particular&#44; harmonious passion is related to deeper states of concentration &#40;flow for example&#41;&#44; life satisfaction&#44; commitment&#44; psychological wellbeing&#44; and positive affectivity&#44;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;20</span></a> while obsessive passion is associated with psicological processes like pondering and negative affectivity&#44; role conflict&#44; family-work conflict and burnout syndrome&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;19&#44;21</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Finally&#44; there are other emotional variables that may play a significant role in the intensive care setting such as emotional effort and self-compassion&#46; Emotional effort is defined as the discordance experienced by the worker between what he really feels and what he should express in his working environment while interacting with the patients&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> The more common these interactions are the greater the discordance&#44; effort&#44; and emotional exhaustion<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> in his working place&#46; Self-compassion&#44; however&#44; is defined as the ability to see defects and errors as a normal part of human condition&#44; which favors the positive relation with oneself and a non-judgemental attitude towards one&#8217;s mistakes&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> The studies confirm that when it is high it increases the healthcare providers&#8217; capacity of self-care<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> and is associated with a more positive affectivity&#44; psychological health&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> and less stressors of very demanding settings&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">For all this&#44; the goal of this study is to propose a model of secondary traumatic stress predictors to work at an exploratory level&#46; So&#44; for the sake of our model we will be using a job demands and resources &#40;JD-R&#41; model&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> where work-related stressors and emotional effort will be demands associated with the job&#44; while passion for the job&#44; empathy&#44; and self-compassion will be resources of the person capable of favoring or preventing the appearance of secondary traumatic stress&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Method</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Study design</span><p id="par0040" class="elsevierStylePara elsevierViewall">This is a descriptive&#44; transverse study&#46; To achieve maximum efficiency in the evaluation process&#44; the 3 heaviest items in the original confirmatory analysis of the tool were selected for each studied variable&#46; This is the smallest number of items established by statistical models for the representativity of a variable&#46; The weight of an item assesses the degree in which the item measures the construct&#44; which means that the 3 heaviest items were selected&#46; The average time spent to fill out the entire quesionnarie was 15 minunte&#46; The questionnaries used were not validated in the context of an intensive care unit &#40;ICU&#41;&#44; but they had been previously validated out-of-hospital emergency settings&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Study variables</span><p id="par0045" class="elsevierStylePara elsevierViewall">The study variables were sociodemographic variables like genre&#44; age&#44; civil status&#44; working experience&#44; job&#44; working shift&#44; ICU and&#44; finally&#44; whether the staff had had personal traumatic experiences and&#44; if so&#44; which ones&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Questionnaire of Secondary Traumatic Stress&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> This scale includes the assessment of work-related stressors&#44; secondary traumatic stress&#44; and empathy&#46; Regarding these stressors&#44; 4 items from the original scale were included plus 2 items were adapted to the hospital setting &#40;&#171;in our unit&#44; time pressure from having to show up where the emergency is occurring is very high&#187; was already present in the original scale and &#171;in our unit&#44; time pressure during early care of the patient is very high&#187; was added as an adapted version&#46; On the other hand&#44; &#171;I find it hard to forget situations where the victim was a minor or an old person&#187; was already included the original scale and the item &#171;the cases somehow similar to my life truly affect me&#187; was also included&#46; Regarding secondary traumatic stress&#44; 3 items were selected for every subdimension&#46; A total of 9 items were collected &#40;&#171;I am emotionally overwhelmed by this job&#187;&#44; for example&#41;&#46; Regarding empathy&#44; the 3 most overwhelming items were selected &#40;&#171;I feel a transfer of feelings from my patients&#187;&#44; for instance&#41;&#46; The response scale was the Likert scale &#40;from 1 to 4&#41;&#44; being 1 &#171;totally in disagreement&#187; and 4 &#171;totally in agreement&#187;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The Passion for the Job Scale&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> This scale includes 3 items of harmonious passion &#40;for example&#44; &#171;I live all sorts of experiences with my job&#187;&#41; and 3 items of obsessive passion &#40;such as &#171;I emotionally depend on my job&#187;&#41;&#46; The response scale was the Likert scale &#40;from 1 to 7&#41;&#44; being 1 &#171;totally in disagreement&#187; and 7 &#171;totally in agreement&#187;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The Emotional Effort Scale&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> It includes 3 items such as &#171;during the last month&#44; how often did you feel that this job required great effort&#63;&#187;&#46; The response scale went from 1 to 5&#44; being 1 &#171;never&#187; and 5 &#171;always&#187;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The Self-Compassion Scale&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> The 3 most overlwheming items of all from the original short version of 12 items were selected&#46; An example of item here was &#171;I try to see my defects as a normal part of human condition&#187;&#46; The response scale was the Likert scale &#40;from 1 to 5&#41;&#44; being 1 &#171;rarely&#187; and 5 &#171;almost all the time&#187;&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Participants</span><p id="par0070" class="elsevierStylePara elsevierViewall">The study participants were 103 healthcare providers of an intensive care unit from a university tertiary hospital in Madrid&#44; Spain&#46; The study was conducted at the Unit of Intensive Medicine that includes 3 sections&#58; trauma and ER&#44; polyvalent care&#44; and cardiac care unit&#46; The inclusion criteria were being a healthcare provider at an adult ICU with&#44; at least&#44; 2 months of experience&#46; The exclusion criteria were not having spent these 2 months in these ICUs&#46; Before conducting the study&#44; an informative sheet was handed out with the corresponding written informed consent&#46; This project has been approved by the Research Ethics Committee with reference number CEI 71-1276&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Statistical analysis</span><p id="par0075" class="elsevierStylePara elsevierViewall">The statistical analysis was conducted using the SPSS 25&#46;0 software package and included a feasibility analysis of the dimensions of our scale&#44; a descriptive analysis of the variables of interest&#44; a MANOVA analysis to study possible differences of genre&#44; ICU and position in the variables of interest&#46; Finally&#44; one logistics regression analysis using as criterion variables the 3 separate subdimensions of secondary traumatic stress&#58; shaken beliefs&#44; fatigue due to compassion&#44; and traumatic symptoms&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">On the other hand&#44; a network model known as &#171;psychological network&#187; was designed&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> The JASP<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> statistical software package was used&#46; This software builds an interface for R through which this type of model is generated&#46; This model is used to analyze the most significant estimators&#58; strength&#44; nearness and interconnectivity&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> The order from less to greater complexity is&#58; 1&#41; &#171;strength&#187;&#44; meaning the total intensity with which a variable is related to the network measured as the sum of all links different than zero&#59; 2&#41; &#171;nearness&#187;&#44; meaning the tendency of a variable to be connected to others &#40;being &#171;near&#187;&#41; measured as the number of connections other than zero in every variable&#59; and 3&#41; &#171;interconnectivity&#187;&#44; meaning the tendency of a variable to mediate between 2 and measured as the number of pairs other than zero of a variable with 2 different variables&#46; Therefore&#44; a variable with high strength implies that&#44; regardless of how it is distributed&#44; it intensely connects to the rest of the network through a single very intense link&#44; several not so intense links or intermediate links&#46; Variables with high nearness mean they are connected to many other variables in the network&#46; High interconnectivity means that other 2 variables can connect to one another&#46; If a variable has high strength&#44; nearness&#44; and interconnectivity&#44; that means it is a fairly central variable within the network&#44; both numeric and graphically&#44; that it connects to many other variables with intensity&#44; and that it interconnects several variables to one another&#46; To interpret these indicators on <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#44; positive values indicate values above average and the negative ones indicate values below average&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">The total study sample consisted of 103 patients including 36 males &#40;35&#46;3&#37;&#41; and 66 women &#40;64&#46;7&#37;&#41;&#46; The mean age was 37&#46;23 years &#40;TD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#46;47&#41; ranging between 21 and 64 years&#46; Also&#44; 71&#46;8&#37; of the study sample said they were in a stable relation&#44; as opposed to 18&#37;&#44; and 8&#37; who said they were not involved in a sentimental relation&#46; The experience of the sample in the healthcare setting was 13&#46;62 years on average &#40;TD <span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#46;22&#41;&#46; Participants included 35 doctors&#44; 49 nurses&#44; 16 assistants&#44; and 2 porters&#46; Also&#44; a distinction was made on an ICU basis&#58; a sample of 35 staff members working at trauma and ER ICUs was selected&#58; 39 from coronary ICUs and 25 from polyvalent ICUs&#46; Another 3 participants said they worked in these 3 units&#46; Seventy-six participants worked during the morning shift&#44; 16 during the afternoon shift&#44; 5 participants during both shifts&#44; while only 1 reamained on call&#46; On ther other hand&#44; 65&#37; of the sample said they had not had direct personal traumatic experiences before&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the means expressed as the average of the scores obtained for each scale and the main correlations of our variables of interest&#46; No significant differences were seen when differences in the variables of interest based on genre&#44; position&#44; and ICU were analyzed&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Network model</span><p id="par0095" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> shows the final network model with the significant correlations&#46; We can see that self-compassion keeps a negative correlation with obsessive passion and symptoms&#44; meaning that it would be a protective factor&#46; The same thing happens with harmonious passion that keeps a negative correlation with shaken beliefs and symptoms&#46; On the other hand&#44; empathy and emotional effort are risk factors that keep a with positive correlation with symptoms and shaken beliefs unlike harmonious passion&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows centrality estimation&#46; The 2 most significant variables in the 3 estimators that are above the rest are shaken beliefs &#40;&#171;shaken beliefs&#95;1&#187;&#41; and empathy &#40;&#171;empathy&#95;1&#187;&#41;&#46; This points to both variables as especially significant within the network&#46; On the other hand&#44; traumatic symptoms &#40;&#171;symptoms&#95;1&#187;&#41; and fatigue due to compassion &#40;&#171;fatigue&#95;1&#187;&#41; are the next most significant variables with mean centrality&#46; Together with the network&#44; these results provide information on this possible variable core by interconnecting parts of the network with more peripheral parts&#46; In particular&#44; both self-compassion and harmonious passion seem to be more peripheral to the network and keep negative correlations to the rest&#59; that is&#44; they are protective while the remaining variables often keep a positive correlation to one another&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Multiple regression analysis</span><p id="par0105" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows regressions of the different dimensions of secondary traumatic stress&#46; This table shows the values of variance explained for each of the 3 models&#46; The model of symptom variance is the one that presents the greater percentage of variance explained &#40;45&#37;&#41; with significant increases as sociodemographic&#44; work-related stressor&#44; emotional effort&#44; empathy and self-compassion variables were being added to the model&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">When analyzing the beta values standardized on <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#44; we should be looking at the last column of every dimension of secondary traumatic stress referring to the final step of regression&#46; Regarding the first component of secondary traumatic stress&#8212;the variable fatigue due to compassion&#8212;only the years of experience proved to be a positive predictor of the variable&#44; while harmonious passion appears as a negative predictor&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Regarding the second component&#8212;shaken beliefs&#8212;both emotional effort and empathy are positive predictors&#46; This may explain the results of <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> where both variables keep significant and positive correlations&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">If we analyze the third component&#8212;traumatic symptoms&#8212;we will find the years of experience again but&#44; in this case&#44; as a negative predictor&#44; while work-related stressors and empathy appear as positive predictors&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">This study tried to establish a model of significant predictors for secondary traumatic stress obtaining similar information from the network model and the regression analysis&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Regarding fatigue due to compassion&#8212;wear and tear due to empathy from the healthcare provider&#8212;harmonious passion acts as a protector&#44; which is indicative that the more balanced a person is in the different areas of his life &#40;work&#44; family&#44; friends&#44; etc&#46;&#41; the less his wear and tear conflict will be in his job&#46; It can also favor further experiences of recovery and disconnection&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> more self-care&#44; and less fatigue due to compassion&#46; On the other hand&#44; the years of experience in this sector are a risk factor in this dimension&#44; which would not be consistent with with prior studies&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> These results are indicative that this dimension would be associated with the degree of exposure to trauma since longer times of exposure by the professional equal greater wear and tear&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Regarding shaken beliefs&#44; both empathy and emotional effort are risk factors indicative that the greater the capacity of the healthcare provider to understand the emotions of patients and their families and the greater his effort the more changes in values and beliefs&#46; These results are consistent with former studies where they have been proposed as risk factors&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;9&#44;13&#44;22</span></a> Also&#44; gathering qualitative evidence through interviews with the healthcare providers is indicative that&#44; on many occasions&#44; they are aware of cognitive changes in their values and beliefs due to their job &#40;for example&#44; car crashes with young people involved&#44; spinal cord injuries&#44; etc&#46;&#41;&#44; but they are not aware of the emotional impact&#46; For this reason&#44; the shaken beliefs variable can have greater specific weight in this setting&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> as the network model showed&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Also&#44; regarding symptoms&#44; the years of experience are a protective factor that is consistent with what the scientific references tell us&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> The explanation may be that the more exposed healthcare providers are to their job&#44; the less evident their symptoms become&#46; Another alternative may be the parallel development of protective variables as the personnel gains experience &#40;like self-compassion&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> favoring more self-care initiatives and protection from the most psychosomatic features of secondary traumatic stress&#46; On the other hand&#44; regarding the risk factors for post-traumatic symptoms&#44; work-related stressors play an important role here&#44; which would make sense from a theoretical point of view since longer exposure to these stressors lead to more symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Again empathy is a tool for people with negative consequences&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;13</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Lastly&#44; obsessive passion appears in the network model as a risk factor for empathy&#44; symptoms&#44; and shaken beliefs&#46; As Donahue et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> say these results would be relevant if greater obsessive passion were associated with greater processes of pondering and less recovery which would favor the appearance of more symptoms by reviving the discomfort experienced during the working day and never getting a break&#46; Also&#44; the conflict generated by other vital areas<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> may cause greater changes in the workers&#8217; beliefs by letting these traumatic situations have a greater impact in their lives&#46; On the other hand&#44; this passion promotes empathy which is&#44; in turn&#44; a risk factor&#46; We can say that the most obsessive part of passion that &#171;urges&#187; workers to keep on working would have to do with the mechanisms that make a person empathetic to patients and families and facilitate counter-productive emotional contagion&#46; These results would be different from those of other studies where empathy is associated with less burnout syndrome<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> and more wellbeing&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Regarding the limitations of this study&#44; its transversal methodology makes it difficult to establish causal relations&#44; meaning that it is necessary to develop a longitudinal study to establish the models of mediation and moderation of the study variables&#46; Another limitation has to do with the intensive care setting <span class="elsevierStyleItalic">per se</span>&#44; since the flow of patients and changes of activity make it difficult to gather information and respond to the corresponding scales&#46; To mitigate this stressor the number of items in the assessment questionnaire was reduced to avoid saturating the workers&#46; This led to another limitation&#58; the poor reliability of certain items&#44; which made us eliminate a few variables that were initially part of the study&#46; Added to this control a statistical analysis of realiability was conducted in each variable by eliminating an element to select the most reliable items for measuring purposes and&#44; eventually&#44; ameliorate this limitation&#46; This setting is also the origin of another limitation&#58; the small size of sample and center that is an actual threat to the study external validity&#46; However&#44; obtained significant preliminary results for future replicas in other centers&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conclusions</span><p id="par0155" class="elsevierStylePara elsevierViewall">In conclusion&#44; our study is the first one on secondary traumatic stress in the healthcare population of intensive care units&#46; From the data obtained we can go deep into the measures aimed at improving the quality of life of these professionals and impacting the quality of the healthcare provided&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">37&#44;38</span></a> For all this&#44; it is crucial to propose intervention designs to prevent secondary traumatic stress&#44; reduce the risk factors found in this study such as empathy and emotional effort&#44; and increase protective factors like self-compassion and harmonious passion&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Funding</span><p id="par0160" class="elsevierStylePara elsevierViewall">These have been the sources of funding for this project&#58;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Predoctoral contract FPI-UAM 2017 of the <span class="elsevierStyleItalic">Universidad Aut&#243;noma de Madrid</span> and project PSI2015-68011-R of the Spanish Ministry of Economy and Competitivity &#40;MINECO&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Authors&#47;Collaborators</span><p id="par0170" class="elsevierStylePara elsevierViewall">All authors participated in the design&#44; analysis&#44; and development of this study&#46; In particular&#44; Mario Chico&#44; Marisol Mart&#237;nez&#44; and Juan Carlos Montejo participated in the study design and facilitated data mining at the hospital and adapted the measuring tool to their hospital setting&#46; On the other hand&#44; Raquel Rodr&#237;guez-Carvajal and Bernardo Moreno-Jim&#233;nez participated in the design and creation of the measuring tool and its applicability&#46; They also participated in the discussion of the results and implementation in future studis&#46; &#211;scar Lecuona also participated in the design&#44; methodology&#44; and data analysis&#46; Finally&#44; Eva Garrosa directed the applicability study at the hospital and the study&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Conflict of interests</span><p id="par0175" class="elsevierStylePara elsevierViewall">None reported&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Aim</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">To propose a predictive model of secondary traumatic stress &#40;STS&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">A descriptive cross-sectional study was carried out&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Context</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">The study was conducted in the Intensive Care Units of a hospital in Madrid &#40;Spain&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Participants</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">The sample comprised 103 health professionals&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Interventions</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">A series of questionnaires were created and completed by the participants&#46; Network analysis and multiple regression was used for data analysis&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Variables of interest</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Sociodemographic variables such as gender&#44; years of experience and position&#44; STS&#44; passion for work&#44; work stressors&#44; emotional effort&#44; empathy and self-compassion were evaluated&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">The result identified the following&#58; a&#41; years of experience as a risk factor for compassion fatigue &#40;&#946;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;224 and <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;029&#41;&#44; and harmonious passion as a protector &#40;&#946;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;363 and <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#59; b&#41; emotional effort and empathy as risk factors for shattered assumptions &#40;&#946;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;304 and <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;004&#59; &#946;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;394 and <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000&#44; respectively&#41;&#59; and c&#41;&#44; work stressors and empathy as risk factors for symptomatology &#40;&#946;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;189 and <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;039&#59; &#946;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;395 and <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000&#44; respectively&#41;&#44; and years of experience as a protector &#40;&#946;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;266 and <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusions</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">This predictive model of STS identifies protective factors which could be reinforced&#44; such as harmonious passion&#44; and risk factors which should be reduced&#44; such as empathy and emotional effort&#44; with a view to promoting quality of care and quality of life among these professionals&#46;</p></span>"
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        "resumen" => "<span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Objetivo</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Proponer un modelo de predictores del estr&#233;s traum&#225;tico secundario &#40;ETS&#41;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Dise&#241;o</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Se trata de un dise&#241;o transversal descriptivo&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">&#193;mbito</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">El estudio se llev&#243; a cabo en las unidades de cuidados intensivos de un hospital terciario de Madrid&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Participantes</span><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">La muestra estuvo formada por 103 profesionales sanitarios&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Intervenciones</span><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Se cre&#243; una bater&#237;a de cuestionarios que fue rellenada por los profesionales&#46; Respecto al an&#225;lisis de datos&#44; se utiliz&#243; una metodolog&#237;a de redes y an&#225;lisis de regresi&#243;n jer&#225;rquica&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Variables de inter&#233;s</span><p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">Se evaluaron variables sociodemogr&#225;ficas tales como g&#233;nero&#44; a&#241;os de experiencia y puesto&#44; el ETS&#44; la pasi&#243;n por el trabajo&#44; los estresores laborales&#44; el esfuerzo emocional&#44; la empat&#237;a&#44; la autocompasi&#243;n&#46;</p></span> <span id="abst0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">Se establece&#58; a&#41; para la fatiga por compasi&#243;n&#44; los a&#241;os de experiencia como factor de riesgo<span class="elsevierStyleItalic">&#40;&#946;<span class="elsevierStyleHsp" style=""></span>&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;224 <span class="elsevierStyleItalic">y p<span class="elsevierStyleHsp" style=""></span>&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;029&#41;&#44; y la pasi&#243;n armoniosa como protector <span class="elsevierStyleItalic">&#40;&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8211;0&#44;363 <span class="elsevierStyleItalic">y p<span class="elsevierStyleHsp" style=""></span>&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#59; b&#41; para la sacudida de creencias&#44; el esfuerzo emocional y la empat&#237;a como factores de riesgo <span class="elsevierStyleItalic">&#40;&#946;<span class="elsevierStyleHsp" style=""></span>&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;304 <span class="elsevierStyleItalic">y p<span class="elsevierStyleHsp" style=""></span>&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;004<span class="elsevierStyleItalic">&#59; &#946;<span class="elsevierStyleHsp" style=""></span>&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;394 <span class="elsevierStyleItalic">y p<span class="elsevierStyleHsp" style=""></span>&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;000 respectivamente&#41;&#59; y c&#41; para la sintomatolog&#237;a&#44; los estresores laborales y la empat&#237;a como factores de riesgo &#40;<span class="elsevierStyleItalic">&#946;<span class="elsevierStyleHsp" style=""></span>&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;189 <span class="elsevierStyleItalic">y p<span class="elsevierStyleHsp" style=""></span>&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;039<span class="elsevierStyleItalic">&#59; &#946;<span class="elsevierStyleHsp" style=""></span>&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;395 y p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;000 respectivamente&#41; y los a&#241;os de experiencia como protector &#40;<span class="elsevierStyleItalic">&#946;&#61; &#8211;</span>0&#44;266 <span class="elsevierStyleItalic">y p<span class="elsevierStyleHsp" style=""></span>&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46;</p></span> <span id="abst0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusiones</span><p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">Este modelo predictivo del ETS asienta factores protectores que podr&#237;an aumentarse&#44; como la pasi&#243;n armoniosa&#44; y factores de riesgo que ser&#237;a conveniente reducir&#44; como la empat&#237;a y el esfuerzo emocional&#44; con el fin de mejorar la calidad asistencial y de vida de los profesionales&#46;</p></span>"
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                  \t\t\t\t">Emotional effort&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Fatigue due to compassion&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Shaken beliefs&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">Steps of the model and variables&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;207&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;224<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;0&#46;336<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;0&#46;338<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;0&#46;266<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;0&#46;020&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;282<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;189<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Emotional effort&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;230<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;191&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;417<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">406&#42;&#42;&#42;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;304<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;189&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;218<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;099&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="13" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Step&#35;3</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Harmonious passion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;343<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;363<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;058&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;119&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;135&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;094&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Obsessive passion&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;130&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;020&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;0&#46;078&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;0&#46;057&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="13" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Step&#35;4</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Empathy&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;394<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;395<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Self-compassion&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#46;008&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;28&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#46;150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adjusted R<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;200&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;314&nbsp;\t\t\t\t\t\t\n
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Article information
ISSN: 21735727
Original language: English
DOI:10.1016/j.medine.2019.06.013
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