Effect of Professional Ownership on Compassion Fatigue and Quality of Life among Midwives

Objective: Most of the midwives who are responsible for maternal and child health are employed in many areas other than their own clinic and their sense of professional belonging is destroyed. Removing midwives from the units where they should be the most active negatively affects both women's health and the occupational belonging status of midwives. In such a case, it is thought that midwives will lose their professional roles, their professional belonging will be negatively affected and their quality of life may be negatively affected. For this reason, the research was conducted to determine the effect of professional belonging on the quality of life of midwives. Method: The descriptive and cross-sectional design to study was conducted in primary and secondary healthcare institutions in a province located in eastern Turkey. The research was conducted with 525 midwives between January 2020 and April 2021. The data of the study were collected with the personal introduction form, the midwifery belonging scale and the quality of life scale for the employees. In statistical analysis; number, percentage, mean and correlation analysis were used. Results: The average age of the midwives was 33.02 ± 7.51, 76.6% of midwives are undergraduate, 62.4% of them are married, It was determined that 46.8% of them were equal to the expenses of their income levels. The mean total score of the midwives' belonging scale was determined as 75.99 ± 18.94. Compassion satisfaction from the subdimensions of the midwives' quality of life scale; 28.91 ± 10.06, compassion fatigue; 23.18 ± 9.55, burnout; it was found that they had a mean score of 23.23 ± 5.89. In addition, it was determined that there is a moderate positive correlation with professional satisfaction, which is one of the sub-dimensions of the quality of life scale, with the mean total score of midwifery belonging, and a low level of significant relationship in the negative direction with burnout. There was no relationship between midwifery belonging and compassion fatigue, which is the last sub-dimension of quality of life. Conclusion: In our study, it was determined that there is a significant relationship between midwifery belonging and professional satisfaction and burnout in midwives. It was concluded that midwifery belonging is an important concept in increasing professional satisfaction and reducing burnout in midwives. It is thought that the result of the research is important in terms of being a guide for studies on midwifery belonging.


Introduction
The midwifery profession, which was far from being scientific and applied with traditional methods in primitive ages, has developed with the advances in the medical world and has become a professional health profession that combines science and art, based on ethical and human values. As a matter of fact, he states that midwives, who are health members, have a great responsibility to achieve the goals of "health for All for All in the 21st Century", especially "reducing maternal and infant mortality rate and reducing the rate of sexually transmitted diseases" (Karahan, 2020).
According to the report prepared by the United Nations Population Fund, it is emphasized that thanks to the effective work of midwives, the health outcomes of mothers and newborns are directly affected positively, and it is stated that two-thirds of maternal deaths (75%) can be prevented thanks to the planned midwifery workforce of a health sector without resource shortages. The report also includes statements that investing in midwives is a commitment to a healthy and wealthy nation (UNFPA, 2021). In the light of professional values, midwives contribute to the health development of mother and newborn, improve, protect, and provide continuous individualized service to women and families (Yıldırım et al., 2014). Midwives provide qualified care by advocating for women's rights, leading, providing training, counseling, scanning new developments related to their profession, ensuring confidentiality and respecting cultural and ethical values in the light of evidence-based practices (Yıldırım et al., 2014).
Many factors affect an individual's professional belonging. These factors are; caring about the values of the business organization and the institution, feeling oneself belonging to the institution, adopting the institution, being satisfied with the choice of profession, seeing oneself in the right place in the profession, identification with the profession, management and attitude of the administration, the view of the society, relations with colleagues, social and economic needs, demands and demands of the employee. It can be listed as meeting the demands (Keskin & Pakdemirli, 2016;Başkaya et al., 2020;İlhan, 2015).
A midwife's adopting her profession and doing it with pleasure while doing it, owning it, assimilating it and trying to continue it are seen as an indicator of midwifery belonging (Aktürk et al., 2021). As a matter of fact, the concept of professional belonging is of great importance for the midwifery profession, which is one of the health fields that require self-sacrificing work (Gaskin, 2021;Bilgin et al., 2017;Yılmaz et al., 2014). It has been determined that there are a limited number of studies in the literature dealing with the quality of life in midwives (Durmuş et al., 2018;Czekirda et al., 2017). There is a need for studies examining the quality of life among midwives, who have an important place among health professionals. As a matter of fact, when evaluating the health statistics of the working population, not only the number of deaths and births, but also their quality of life is considered (Saygın & Kundakçı, 2020;Arslan, 2017).
Fatigue experienced by midwives due to working conditions, worries about the future, exposure to traumatic births and events, burnout, dissatisfaction with work life, communication problems, poor management, inability to participate in decisions, inadequate reward systems, irregular and excessive working hours and forms, Situations such as economic problems, inadequate physical conditions, and job dissatisfaction can create stress and negatively affect their quality of life (Kılıç & Keklik., 2012;Cohen et al., 2017;Yıldırım & Hacıhasanoğlu, 2011;Muliira & Ssendikadiwa, 2016). In order to increase the quality of life in midwives; It is stated that it is necessary to improve working conditions, reduce the intense work tempo, allow rest hours, arrange appropriate shift lists, provide social support relations and institutional support, make sense of the individual's life, know that he is respected and valued, and have an active life (Durmuş et al. , 2018, Muliira & Ssendikadiwa, 2016. As a matter of fact, it is thought that the care given by the midwife, who has a high quality of life, while providing health services, will be of higher quality and healthier.

Method
This study was conducted with descriptive and cross-sectional study design to determine the effect of professional belonging on professional quality of life. This research was carried out between July 2020 and 2021 in primary and secondary healthcare institutions affiliated to the center in a province in the east of Turkey. The universe of the research consisted of 525 midwives working in hospitals and FHCs affiliated to the center in the determined province. The sample of the study was completed with 410 midwives who met the inclusion criteria and agreed to participate. Data were collected by the researcher using the Personal Information Form, Professional Belonging Scale and Professional Quality of Life Scale.

Results and Discussion
The findings of the research conducted to examine the effect of professional belonging on the quality of life of midwives are given below. Distribution of Descriptive Characteristics of Midwives is given in The lowest and highest values of the midwives from the scale of professional belonging and quality of working life scale and the distribution of the total score averages are given in Table 2. The midwifery belonging scale mean score of the midwives was determined as 75.99 ± 18.94. According to the midwives' quality of work life scale, the mean occupational satisfaction sub-dimension score was 28.91 ± 10.06, the mean burnout subdimension score was 23.23 ± 5.89, and the mean emotion fatigue sub-dimension score was 23.18 ± 9.55 (Table  2). The relationship between the professional belonging of midwives and their professional life quality is given in Table 3. There was a weak positive correlation between professional belonging and job satisfaction, and a weak negative correlation with burnout in midwives. It was determined that there was no significant relationship between professional belonging and empathy fatigue in midwives (Table 3).

Discussion
Professional belonging is an important concept that affects the attitude, behavior and motivation of working individuals towards business life (Keskin & Pakdemirli, 2016). It is thought that the concept of professional belonging will affect the quality of the relationship between compassion fatigue and quality of life and the working efficiency of midwives. The aim of this study is to examine the effect of professional belonging on quality of life in midwives. It is thought that professional belonging in midwives is an important concept in terms of increasing the quality of patient care. As a matter of fact, it has been reported that a midwife with a high professional belonging will be more patient with patients, increase the efficiency of the service they provide, and be more understanding in the care, support and consultancy they provide (Başkaya, 2018). In order to increase professional belonging in the field of health, it is thought that ensuring legal regulations regarding Occupational Quality of Life scale sub-dimensions Midwifery Belonging Scale Professional satisfaction 0.450** 0.000 Burnout -0.297** 0.000 Compassion fatigue 0.031 0.534 the salary of midwives, improving working conditions, arranging working hours and enabling them to work in areas where they can fulfill their independent roles most, such as the delivery room, will be important steps in increasing the belonging (Gümüşdaş et al., 2021;Başkaya, 2018). In addition, it is thought that initiatives that increase motivation such as rewarding, appreciating, establishing emotional bonds, and implementing a supportive management style in order to increase professional belonging in this field will also be beneficial (Aydınol & Üredi, 2020). In this study, it was seen that there was a positive and significant relationship between occupational satisfaction, which is one of the sub-dimensions of midwives' quality of life, and midwifery belonging. In order to increase professional satisfaction in employees, initiatives are needed on factors such as regulating monthly working hours, reducing stress, improving working conditions, and the management's sensitivity to employee demands (Yüksel, 2014;Kılıç, 2018). It has been determined that employees with high occupational satisfaction in the field of health can provide more qualified care to their patients, their desire to continue their profession is strong, they are happy at work, their job stress decreases, and their level of wellbeing in terms of physical, mental, psychological and social needs increases (Kılıç, 2018;Stamm, 2005). ; Küçük & Çakıcı, 2018;Karakurt & Oral, 2021). In our study, a significant negative correlation was found between the total score of midwifery belonging and burnout. In a study conducted with teachers, it was reported that teachers who love their profession experience less emotional exhaustion (Cemaloğlu & Şahin, 2007). In the studies conducted, it has been determined that the professional commitment of teachers who experience burnout is less ( Tümkaya & Uştu, 2016). Similarly, in the study of Başkaya (2018), it was determined that as the midwifery belonging in midwives increases, burnout decreases (Başkaya, 2018). In a study, it was determined that there is a negative relationship between burnout and organizational commitment (Bay & Ataş, 2021). In the study of Newton et al. with midwives, it was determined that midwives who work with a focus on maternal satisfaction in labor with the awareness of professional belonging experience less burnout than midwives who provide normal standard care (Ulusal, 2021).

Conclusion
It was determined that as the professional belonging of the midwives increased, burnout, which is the subdimension of the professional life quality, decreased. It has been determined that as the professional belonging of the midwives increases, the professional satisfaction also increases.

Recommendations
In the study, it was determined that as the professional belonging of midwives increases, burnout, which is the sub-dimension of the professional life quality, decreases and professional satisfaction increases. For this reason, it is recommended to focus on the concepts of burnout and professional satisfaction and to regulate institutional policies in this regard in order to increase professional belonging in midwives.