Date of Award

Spring 2023

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Bekhet, Abir K.

Second Advisor

Jerofke-Owen, Theresa

Third Advisor

Johnson, Norah L.


Despite the association between nursing students’ exposure to suffering and the development of compassion fatigue, little research exists regarding promoting nursing students’ adaptation to caring for suffering patients and families. As a possible nursing shortage is projected, it is imperative to better understand the factors that impact this adaptation to ensure that nursing students can successfully transition into their nursing role. Although beliefs about the reasons for human suffering affect their ability to cope with their exposure to the suffering of others, there is no empirical data regarding nursing students’ views of suffering. Nursing students also report using positive reframing to cope with exposure to suffering. Guided by resilience theory, a cross-sectional, correlational design was used to investigate the potential moderating effect of positive thinking skills on the relationships between views of suffering and compassion fatigue and compassion satisfaction in undergraduate nursing students. A link to an online survey was distributed via email listserv within colleges of nursing at two Midwestern universities resulting in a sample of 157 junior and senior level nursing students. Multiple regressions revealed that views of suffering and positive thinking explained 23.8% of the variance in compassion satisfaction (F (11, 145) = 4.121, p < .001), and 21.9% of the variance in burnout (F (11, 144) = 3.786, p< .001). The Suffering God view of suffering (β = 0.349, p = .025) and positive thinking (β = 0.309, p < .001) had significant main effects on compassion satisfaction. Positive thinking (β = -0.280, p < .001) and the Suffering God (β = -0.392, p = .014) and Random (β = -0.206, p = .014) views of suffering had significant main effects on burnout. The Unorthodox view of suffering had a significant main effect on secondary traumatic stress (β = 0.232, p = .027). Positive thinking did not moderate any of the relationships between the views of suffering and compassion satisfaction, burnout, or secondary traumatic stress. Knowledge of these relationships can aid in the assessment of nursing students at risk for poor outcomes and can guide intervention development to promote their professional quality of life.

Included in

Nursing Commons