Featured Article
Article Title
Professional Quality of Life in Forensic Healthcare Staff: The Role of Emotional Intelligence, Emotion Regulation Strategies and Trauma-Related Symptoms
Authors
Annaliese Jowsey DClinPsy; Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
Rachel Collinson DClinPsy; Inpatient Adult Mental Health Services, Lanchester Road Hospital, Durham, UK
Steven M. Gillespie PhD; Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
Abstract
Keywords
Summary of Research
Staff working in healthcare settings are described as facing “increasing pressures and demands within their work environment,” with systems under strain requiring staff to “deliver increasingly high standards of care and work more intensely… whilst under enormous strain.” In forensic settings, these demands are heightened, as staff are “often exposed to disturbing social issues… and significantly challenging behaviors,” alongside “a higher risk of violence, aggression, and stress,” contributing to “higher levels of stress and perceived burnout.” Professional quality of life is conceptualized as a multidimensional construct involving both positive and negative experiences, including “compassion satisfaction” and “compassion fatigue… divided into… burnout… and secondary traumatic stress ” (p. 26-30).
Emotional processes are central to this experience, as “emotions are fundamental to clinical practices of healthcare professionals,” with emotional intelligence (EI) referring to the ability to “identify, express, and understand emotions,” and emotion regulation (ER) reflecting how individuals “effectively manage their emotions.” Prior research suggests EI may act as a “protective psychosocial factor,” while ER strategies show mixed associations with burnout. Given limited research in forensic settings, the study aimed “to explore the relationship of emotional intelligence, emotion regulation strategies and trauma symptoms with professional quality of life in forensic healthcare staff,” with the expectation that EI would be associated with “lower levels of burnout and compassion fatigue, and higher compassion satisfaction,” and that ER strategies would show differential effects (p. 26-30).
Participants were clinical staff recruited from “an NHS Trust within the Northeast of England,” working in forensic inpatient wards with individuals with “severe and enduring mental health difficulty or intellectual disability, who have offended/are at risk of offending.” The final sample included 100 participants following exclusions and attrition. Data were collected via an online survey, with participants completing “four self-report questionnaires” after providing informed consent (p. 30).
Professional quality of life was assessed using the ProQoL, measuring “compassion satisfaction… burnout… [and] compassion fatigue/secondary traumatic stress.” PTSD symptoms were measured using the Los Angeles Symptom Checklist, emotional intelligence using the Trait Meta-Mood Scale (assessing “attention… clarity… and repair”), and emotion regulation using the Emotion Regulation Questionnaire, capturing “cognitive reappraisal” and “expressive suppression.” Analyses included correlations and “hierarchical multiple linear regressions… to understand the effects of EI and ER on self-reported ProQoL,” with PTSD symptoms entered prior to EI and ER variables (p. 31-34).
Correlational findings showed that “self-reported PTSD symptoms were found to correlate with burnout and compassion fatigue strongly positively,” while “compassion satisfaction was found to be moderately negatively correlated with self-reported PTSD symptoms.” Emotional intelligence variables were broadly protective, as “all subscales of EI were found to significantly negatively correlate with… burnout and compassion fatigue and positively with compassion satisfaction.” Emotion regulation showed a more limited pattern, with “expressive suppression… positively associated with burnout and compassion fatigue,” and “cognitive reappraisal… positively associated with compassion satisfaction” (p. 34-39).
Regression analyses further clarified these relationships. PTSD symptoms consistently predicted outcomes, with “greater self-reported PTSD symptoms associated with higher burnout,” higher compassion fatigue, and “lower levels of compassion satisfaction.” When EI variables were added, only “clarity in discrimination of feelings” remained significant, such that “lower clarity… was associated with higher levels of burnout” and compassion fatigue. In contrast, ER strategies “were non-significant” in predicting burnout, compassion fatigue, and compassion satisfaction after accounting for PTSD symptoms (p. 34-39).
The findings indicate that PTSD symptoms play a central role in professional quality of life, with “higher levels of PTSD symptoms… associated with lower levels of compassion satisfaction and higher levels of burnout and compassion fatigue,” suggesting “negative consequences for staff’s sense of meaning and achievement in their working role.” This is consistent with the idea that repeated exposure to trauma in forensic settings contributes to “emotional exhaustion… distress and dissatisfaction within the context of health care” (p. 39-41).
Emotional intelligence demonstrated a more nuanced effect. While multiple EI components were correlated with outcomes, only emotional clarity emerged as a unique predictor, highlighting “the importance of good intrapersonal clarity as a personal resource to prevent burnout.” Individuals with greater clarity may better “identify… emotions and [select] appropriate coping strategies during stressful situations” (p. 39-41).
Although initial correlations suggested links between emotion regulation and professional quality of life, these relationships “were no longer significant after accounting for PTSD symptoms,” indicating that ER effects may reflect “traumatic experiences as a general risk factor for problems in regulating emotions and the experience of burnout.” Overall, the findings emphasize that trauma exposure and emotional processing—particularly clarity of feelings—are central to understanding burnout, compassion fatigue, and satisfaction among forensic healthcare staff (p. 39-41).
Translating Research into Practice
“A forensic work environment is of particular interest in this context given that it is acknowledged that staff are often exposed to disturbing social issues and managing clients with extreme challenging behaviors and increased risk of violence. The findings from the current study suggest that self-reported PTSD symptoms predicted higher levels of burnout and compassion fatigue and lower levels of compassion satisfaction. We would recommend that in similar highly challenging environments, where staff may have encountered numerous traumatic events, including violence and self-harm, that staff training and support should be delivered to improve quality of life in this population.
Previous research has demonstrated that specific interventions can result in a reduction of burnout symptoms and can improve well-being in forensic staff. The development of future intervention and staff training may focus on the development of EI skills, specifically around emotional clarity and supporting staff to have a greater understanding of how they feel. This, in turn, may reduce levels of burnout and compassion fatigue and increase feelings of compassion satisfaction at work. Such findings support recommendations that forensic services should be providing their staff with systems which foster an open and honest culture to ensure staff feel supported to openly express their feelings about work and learn ways to manage their frustrations more effectively. Future research should consider how best to develop and tailor these interventions for this specific population and employ rigorous outcome studies to investigate the therapeutic utility of these interventions.
The results of this study are important to healthcare systems as they indicate an increased need to educate, recruit, and retain effective leaders and managers. EI is recognized as a skill that can be taught and improved and has been shown to be a predictor of leadership and management success. EI may be considered as part of careful recruitment processes, where greater EI among people in leadership roles may aid the creation of a supportive environment and facilitate positive empowerment processes leading to subjective well-being as well as fostering a healthy work environment. Finally, the current study focused primarily on interpersonal factors impacting upon professional quality of life. It is recognized that systemic pressures are also likely to impact the quality of life experienced by healthcare professionals and consequently, the quality of care delivered to patients. Whilst it is recognized that healthcare staff strive to respond emotionally to their patients, if they are unable to deliver good quality care given the increasingly high work demands, they may experience guilt, regret and frustration and may be less likely to emotionally engage with patients. Furthermore, given that healthcare providers often have to deal with unexpected emotions arising from both the patient and themselves, it would be beneficial to identify strategies to manage the stresses and anxieties of confronting illness and suffering. It is therefore highlighted that future research should also focus upon the interplay between the internal and external factors that combine to predict professional quality of life within a forensic staff population. The current study also highlights the need for further organizational research to implement and evaluate the benefits of EI training to support this” (p. 42-43).
