Abstract
BACKGROUND: Continuous interaction with patients with cancer is key in the onset of compassion fatigue (CF) among nurses, and cognitive reactions are hypothesized to mediate the relationship between patient interactions and CF. This study develops and evaluates a model addressing traumatic events in patients with cancer, nurses’ cognitive reactions, and professional quality of life, including CF. METHODS: A cross-sectional survey was conducted among nurses working at designated cancer hospitals. The Professional Quality of Life Scale was used to measure CF, while items assessing patient traumatic events and nurses’ cognitive reactions were developed based on previous qualitative findings. Structural equation modeling was employed to examine associations among variables. RESULTS: Data from 536 participants were analyzed. Among five event categories, “bad news from doctors” directly affected CF; the others indirectly affected CF, mediated by four subfactors of cognitive reactions: “reconsideration of the meaning of life,” “desire to avoid one’s professional duties,” “sense of professional mission,” and “compassion for patients and their families.” All effects on CF, except “compassion for patients and their families” (β=-0.357, p = 0.001), were positive. CONCLUSIONS: These findings highlight the significance of specific traumatic events experienced by patients and cognitive reactions to these events at the onset of CF among cancer care nurses. Preventing CF is conceivable by targeting nurses’ cognitive reactions—especially thoughts confronting life’s meaning, desire to avoid or escape professional duties, and a sense of mission as a nurse—while promoting compassionate thoughts toward patients and their families. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12912-025-04050-4.