This study investigates the impact of earthquake trauma on compassion fatigue among nurses working in emergency services following the devastating earthquakes on 6 February 2023, in Kahramanmaraş, Turkey. These earthquakes, with magnitudes of approximately 7.7 and 7.6, affected 11 provinces and resulted in over 50,000 deaths and 100,000 injuries, placing emergency service nurses at the forefront of dealing with the aftermath and trauma. The concept of compassion fatigue, characterised by a reduced capacity for empathy after repeated exposure to traumatic events, is a significant concern for nurses who have been directly involved in the care of earthquake victims. This study aims to explore the extent of earthquake trauma and compassion fatigue among these nurses, examining the relationship between these two conditions and their long-term effects. Given the limited research on post-traumatic stress disorder and compassion fatigue among emergency service nurses, this study seeks to contribute valuable insights into the psychological impacts of disaster response on healthcare professionals. The hypotheses tested aim to better understand the risks and psychological burdens faced by nurses in the wake of such natural disasters.

On 6 February 2023, two earthquakes with magnitudes of approximately 7.7 Mw and 7.6 Mw occurred at 04:17 and 13:24 local time, centred in Kahramanmaraş, Turkey. These earthquakes affected a wide geographical area encompassing 11 provinces of Turkey (Kahramanmaraş, Hatay, Adıyaman, Gaziantep, Malatya, Kilis, Diyarbakır, Adana, Osmaniye, Şanlıurfa, and Elâzığ), leading to significant destruction. As a result of this disaster, more than 50,000 people lost their lives, and over 100,000 were injured. Emergency service nurses, in particular, were at the forefront of this catastrophe, witnessing moments of intense trauma. Nurses working in emergency services had to care for patients with open wounds, closed and open fractures, vascular injuries, compartment syndrome, crush syndrome, amputations, and more. Such traumatic experiences have caused emergency service nurses to suffer from earthquake trauma to a greater extent. Consequently, stress disorders following trauma caused by the earthquake are a serious and common condition among emergency service nurses working in the earthquake zone.

Another issue encountered by emergency service nurses serving people exposed to trauma during the earthquake is compassion fatigue. Compassion fatigue, a term coined by Joinson (1992) to describe the state of burnout experienced by nurses working in emergency services, is known in the international literature as "compassion fatigue" and is referred to as "şefkat yorgunluğu," "merhamet yorgunluğu," and "eş duyum yorgunluğu" in Turkey. Compassion fatigue is also known as secondary traumatic stress disorder, secondary victimisation, and indirect trauma. It is characterised by a reduced capacity for empathy following repeated exposure to traumatic situations experienced by others.

Exposure to such stressful and traumatic workplace events can lead to burnout, post-traumatic stress disorders, depression, anxiety, and other mental health issues related to trau. A systematic review reported significant symptoms of post-traumatic stress disorder and psychological distress among nurses working in the earthquake zone. Another study showed that 25% of emergency service nurses experienced severe depression and sleep disorders, with their anxiety levels being higher than those of nurses working in other unit. A systematic review covering the years 1989-2019 reported that 25.8% of emergency service nurses showed symptoms of post-traumatic stress disorder following experienced traumas. Looking at related studies on compassion fatigue, it is indicated that professionals exposed to trauma victims, such as emergency service workers, disaster workers, emergency service nurses, doctors, and social workers, are at a high risk of compassion fatigue.

In light of the current information, it is clearer that nurses serving in emergency services are at high risk for earthquake trauma and compassion fatigue. Especially in disaster situations like earthquakes, exposure to such conditions reaches its peak, significantly increasing this risk. It has been shown that nurses experiencing psychological health problems may have a decrease in care quality and an increased likelihood of making medical errors. Therefore, determining the level of earthquake trauma and compassion fatigue symptoms among nurses exposed to the 6 February Kahramanmaraş earthquakes, identifying the relationship between these two conditions, and determining their long-term effects will make significant contributions to the effective and efficient implementation of rehabilitation efforts. Given the limited number of studies examining post-traumatic stress disorder and compassion fatigue issues among emergency service nurses, this study is expected to make a significant contribution by identifying the level of earthquake trauma and compassion fatigue among nurses who experienced the 6 February Kahramanmaraş earthquakes and determining the relationship between them. The aim of this study is to determine the impact of earthquake trauma on compassion fatigue among nurses working in emergency services following the 6 February Kahramanmaraş earthquakes.

The following hypotheses will be tested within the scope of the research.

Inclusion Criteria:

• Working in the emergency department of a hospital located in a province affected by the
• February 6 Kahramanmaraş earthquakes,
• Having worked in the emergency department for at least one year,
• Not having any psychiatric illness that could increase anxiety and stress levels in the last year,
• Not taking any medication that could affect anxiety and stress levels in the last year,
• Volunteering to participate in the study.

Exclusion Criteria:

• Data from nurses who wish to withdraw from the study after inclusion will not be considered for the research.

The study targets emergency department nurses in areas affected by the February 6 Kahramanmaraş earthquakes in Turkey. These nurses, with at least one year of experience, have faced the disaster's challenges firsthand. The focus is on those actively involved in disaster response and recovery, excluding individuals with recent psychiatric conditions or medication that could influence stress levels. Participation is voluntary, ensuring data integrity and ethical standards. Nurses withdrawing from the study will have their data excluded.

Informed Consent: Participants will be briefed about data sharing, including purposes and data types shared.

De-identification: Data will be anonymized to remove personal identifiers, ensuring privacy.

Data Repository: A secure platform will host the data, with access controlled through a data access request system.

Data Use Agreement: Users must agree to use the data solely for research, adhere to data security protocols, and acknowledge the original study in publications.

Monitoring: Compliance with the data use agreement will be monitored to prevent misuse.

Timeframe: IPD will be available for a specified period after the study's main findings are published, with eventual secure archiving or destruction of the data.