Lived Experiences and Professional Quality of Life among Filipino Emergency Medical Service Nurses Deployed in Conflict-Affected Regions: A Mixed-Methods Meta-Synthesis
Description
Emergency medical service (EMS) nurses operating in war-torn environments are exposed to extreme psychological and ethical stressors that heighten their vulnerability to compassion fatigue and burnout. Filipino humanitarian nurses deployed across the Middle East and Africa face prolonged exposure to trauma and moral conflict, which threaten their professional quality of life (ProQOL). Despite the widespread application of the Professional Quality of Life Scale (ProQOL-V), few studies have integrated its psychometric outcomes with lived experiences of caregiving in armed-conflict settings. Objectives: This mixed-methods meta-synthesis aimed to (1) synthesize qualitative evidence describing the lived experiences of Filipino EMS nurses in conflict-affected regions, (2) integrate these findings with quantitative ProQOL outcomes from comparable studies, and (3) develop an Integrated Compassion–Resilience Framework depicting how stress, meaning, and wellbeing interact. Methods: Following PRISMA 2020 and JBI 2020 guidelines, PubMed, Scopus, CINAHL, PsycINFO, and Web of Science were systematically searched (2010–2025). Eligible studies included Filipino or expatriate EMS nurses in war or disaster zones, reporting either ProQOL-V subscale data or phenomenological accounts. Qualitative data were synthesized thematically, while quantitative subscale means were pooled using a DerSimonian–Laird random-effects model. Integration employed a convergent-segregated design linking themes and ProQOL indices. Results: Thirteen studies (n = 1,240) were included. Six major themes emerged: Bearing Witness to Suffering, Moral Conflict in Care, Faith as Sustenance, Collective Resilience, Emotional Numbness, and Redefining Purpose. Pooled data showed moderate Compassion Satisfaction (M = 38.4), high Burnout (M = 26.2), and elevated Secondary Traumatic Stress (M = 27.9). Meaning-making and peer solidarity mitigated fatigue and sustained professional purpose. Conclusion: This meta-synthesis offers the first integrated account of Filipino EMS nurses’ psychological wellbeing in conflict zones. The Compassion–Resilience Framework highlights how spirituality, solidarity, and moral reframing protect against compassion fatigue, underscoring the need for structured debriefing and resilience programs. Keywords: Compassion fatigue; burnout; resilience; moral distress; mixed-methods meta-synthesis; Filipino nurses; conflict zones; ProQOL-V.