Five-Year Changes in Nurses' Compassion Competence and Associated Factors: A Longitudinal Study Using Explainable...

To examine 5-year changes in nurses' compassion competence and identify personal and job-related factors associated with these changes within the Job Demands-Resources framework.

Compassion competence is a dynamic professional competency shaped by individual capacities and work environments, but its long-term change has rarely been examined.

In this secondary analysis of a national Korean cohort, 332 hospital nurses who responded in 2018 (T1) and 2022 (T5) with complete data were analyzed using paired t-tests, simultaneous multiple linear regression, and linear mixed-effects growth models. Random Forest, eXtreme Gradient Boosting (XGBoost), and Light Gradient Boosting Machine (LightGBM) models were evaluated using 100 repetitions of 5-fold cross-validation, and feature importance was quantified using mean absolute SHapley Additive exPlanations (SHAP) values.

Compassion competence increased from T1 to T5 (mean change = 0.09, p < 0.001; 0.023 points per year in the growth model). The regression model explained 10.3% of the variance, and only baseline age was significantly (negatively) associated with change. The ensemble models showed higher in-sample fit (R² = 0.33-0.41) but negative mean cross-validated R² values. Changes in nurse participation in hospital affairs (positive direction) and in staffing and resource adequacy (negative direction) were the most important features in all ensemble models, with rankings and directions that were stable across folds, although their regression coefficients were not statistically significant.

Nurses' compassion competence increased modestly over 5 years, supporting its conceptualization as a dynamic professional competency. Nursing work environment features were the most prominent, but exploratory, model-based contributors.

Nurse managers may consider nurses' participation in hospital affairs and staffing when supporting compassionate practice; however, these factors should be evaluated in intervention studies before being adopted as management targets.