1
|
Pao C, Arbona C, Fan W, Tran J. Duty-related trauma and PTSD symptoms in US urban firefighters. Occup Med (Lond) 2023; 73:324-331. [PMID: 37523669 DOI: 10.1093/occmed/kqad076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Little is known about the multi-dimensional nature of traumatic duty-related events encountered by firefighters in relation to their post-traumatic stress disorder (PTSD) risk. AIMS To describe the types of duty-related events encountered by career firefighters and explore if years in the fire service or total event load moderated the association of trauma exposure to PTSD symptoms. METHODS Participants included 755 career, male firefighters (19% of the department's firefighters and 76% of those who accessed the electronic anonymous survey). The Duty-Related Incident Stressors scale was used to assess exposure to 25 potentially traumatic events (event load) and self-appraisal of the stress associated with these events, grouped by type of event (indirect, direct and colleague-related). The Post-Traumatic Stress Disorder Checklist was used to assess PTSD symptoms. RESULTS Firefighters rated colleague-related events as the most stressful, followed by indirect and direct events. Event load (r = 0.25) and indirect, direct and colleague-related events stress (r = 0.32-0.35) were positively associated with PTSD symptoms. Results of moderation analyses indicated that event load served as a risk factor in the relation of indirect events stress to PTSD symptoms, and as a buffer in the relation of direct events stress to PTSD symptoms. Years in the fire service were not associated with PTSD symptoms nor moderated the relation of event stress to PTSD symptoms. CONCLUSIONS Findings underscored the importance of considering the differential effects that types of duty-related traumatic events and cumulative exposure to trauma may have on firefighters' PTSD symptoms.
Collapse
Affiliation(s)
- C Pao
- Mental Health, South Texas Veterans Healthcare System, San Antonio, TX 78223-1633, USA
| | - C Arbona
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX 77204, USA
| | - W Fan
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX 77204, USA
| | - J Tran
- National Aeronautics and Space Administration (NASA), Houston, TX 77058, USA
| |
Collapse
|
2
|
Vancampfort D, De Soir E, van Winkel R, Louw QA, McKeon G, Rosenbaum S, Seedat S, Pelayo Ramos-Sanchez C. Physical activity, sedentary behaviour and mental health outcomes in firefighters: A cross-sectional study. JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 2023. [DOI: 10.1080/15555240.2023.2191203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Affiliation(s)
- Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Center, KU Leuven, Leuven, Belgium
| | - Erik De Soir
- De Weg Wijzer, Center for Trauma and Griefcounseling, Hasselt, Belgium
| | - Ruud van Winkel
- Department of Neurosciences, Center for Clinical Psychiatry, KU Leuven, Leuven, Belgium
| | - Quinette Abegail Louw
- Department of Health and Rehabilitation Sciences, Physiotherapy Division, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South-Africa
| | - Grace McKeon
- Discipline of Psychiatry and Mental Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Simon Rosenbaum
- Discipline of Psychiatry and Mental Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South-Africa
| | | |
Collapse
|
3
|
Bentz JA, Vanderspank-Wright B, Lalonde M, Tyerman J. 'They all stay with me'-An interpretive phenomenological analysis on nurses' experiences resuscitating children in community hospital emergency departments. J Clin Nurs 2023; 32:701-714. [PMID: 35253290 DOI: 10.1111/jocn.16273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/04/2022] [Accepted: 02/17/2022] [Indexed: 12/01/2022]
Abstract
AIM To understand the lived experiences of nurses resuscitating children in community hospital emergency departments. BACKGROUND Emergency department nurses exposed to paediatric resuscitations are at a high risk of developing post-traumatic stress. This may be especially true in community hospital emergency departments, where nurses have less exposure to, knowledge about, and resources for managing these events. Interventions to proactively prevent nurse trauma in these contexts remain largely uninvestigated. To inform such interventions, a detailed understanding of the largely unknown lived experiences of these nurses is necessary. DESIGN AND METHODS In-depth, semi-structured interviews were conducted with four registered nurses that had experienced at least one paediatric resuscitation while working in a community hospital emergency department in Ontario, Canada. Data were analysed using interpretive phenomenological analysis. Reporting follows the COREQ checklist. RESULTS Analysis revealed three superordinate themes (i.e. 'Conceptualising Paediatric Resuscitations', 'Seeing What I See', and 'Making Sense of What I Saw') and nine corresponding subthemes. CONCLUSION This study provides insight into the infrequent, but profound experiences of nurses resuscitating children in community hospital emergency departments. Nurses, who conceptualise these events as unnatural, emotional, and chaotic, are comforted by those who understand their experiences and are distressed by those who cannot see what they see. To reconcile what they have seen, nurses may reflect and ruminate on the event, ultimately restructuring their experiences of themselves, others, and the world to make room for a new reality where the safety of childhood is not certain. RELEVANCE TO CLINICAL PRACTICE Our findings contribute to pragmatic recommendations for interventions to proactively prevent nurse distress in these contexts, including psychoeducation, psychological support and in-situ simulation activities. Nursing leaders should consider staff that have resuscitated children as valuable sources for information on how to improve practice settings.
Collapse
Affiliation(s)
- Jamie Anne Bentz
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | | | - Michelle Lalonde
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Jane Tyerman
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
4
|
Liao D, Long Y, Yu T, Kang X, Liu S, Yan J, Zhang A. Emergency medical service personnel' post-traumatic stress disorder and psychological detachment: The mediating role of presenteeism. Front Public Health 2023; 11:1030456. [PMID: 36960374 PMCID: PMC10027740 DOI: 10.3389/fpubh.2023.1030456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/17/2023] [Indexed: 03/09/2023] Open
Abstract
Background Emergency medical service personnel are subjected to various stressors, which makes them more likely to develop post-traumatic stress disorder symptoms. Studies have shown that psychological detachment and presenteeism play a role at the level of post-traumatic stress disorder. There is no study to examine the relationship between psychological detachment, presenteeism, and post-traumatic stress disorder among emergency medical service personnel. Objective The main objective of the study is to investigate the effects of presenteeism in explaining the relationship between psychological detachment and post-traumatic stress disorder among emergency medical service personnel. Design A cross-sectional study was conducted among 836 emergency medical service personnel in 51 counties and cities in Hunan Province, China. Methods They were anonymously investigated by using the Impact of Event Scale-Revised (IES-R), the Stanford Presenteeism scale-6 (SPS-6), and the Psychological Detachment Scale. Statistic description, univariate analysis, pearson correlation, and structural equation model were adopted to analyze the data. Results The mean score of IES-R, SPS-6, and the psychological detachment scale were 22.44 ± 16.70, 15.13 ± 4.20, and 11.30 ± 4.24. Post-traumatic stress disorder was positively relevant with presenteeism (r = 0.381, p< 0.01), but negatively correlated with psychological detachment (r = -0.220, p < 0.01). And presenteeism partially mediated the association between psychological detachment and post-traumatic stress disorder. Conclusions The results show a high prevalence of post-traumatic stress disorder symptoms in EMS personnel, presenteeism can statistically significantly predict post-traumatic stress disorder symptoms. If hospital management can reduce the presenteeism of emergency medical service personnel, this will help them reduce post-traumatic stress disorder symptoms.
Collapse
Affiliation(s)
- Dandan Liao
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Yanqiong Long
- Department of Emergency Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Tao Yu
- Department of Emergency Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaoyan Kang
- Department of Emergency Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shulai Liu
- Department of Emergency Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jin Yan
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- *Correspondence: Jin Yan
| | - AiDi Zhang
- Department of Critical Care Medicine, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- AiDi Zhang
| |
Collapse
|
5
|
Sabouri S, Esmailzadeh M, Sadeghinejad A, Eslami Shahrbabaki M, Asadikaram G, Nikvarz N. The Effect of Adjunctive Probiotics on Markers of Inflammation and Oxidative Stress in Bipolar Disorder: A Double-blind, Randomized, Controlled Trial. J Psychiatr Pract 2022; 28:373-382. [PMID: 36074106 DOI: 10.1097/pra.0000000000000660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is a chronic psychiatric illness. Concentrations of inflammatory cytokines are increased in BD. Supplementation with probiotics has shown promising effects in reducing inflammation and producing improvement in clinical symptoms in some psychiatric disorders. Therefore, we designed a clinical trial to assess the effects of adjunctive probiotics on markers of inflammation and oxidative stress in patients with BD. METHODS In this 8-week, double-blind, randomized study, 38 patients suffering from BD type I were given a probiotic or placebo capsule each day. Serum levels of interleukin-6 (IL-6), as the primary outcome measure, and of interleukin-10 (IL-10), tumor necrosis factor-α, and malondialdehyde, as the secondary outcome measures, were obtained before and after the intervention. RESULTS At the end of the study, the 2 groups showed no significant or clinically meaningful differences in the serum concentrations of IL-6 [Hedge g=0.02, 95% confidence interval (CI): -0.6; 0.64, P=0.936], tumor necrosis factor-α (Hedge g=-0.2, 95% CI: -0.82; 0.42, P=0.554), IL-10 (Hedge g=-0.072, 95% CI: -0.071; 0.56, P=0.827), and malondialdehyde (Hedge g=0.27, 95% CI: -0.37; 0.91, P=0.423). CONCLUSIONS This study did not find any significant or conclusive effects of probiotics supplementation on markers of inflammation and oxidative stress in patients with BD. Further studies are needed before a conclusion can be drawn about the efficacy of probiotics in the management of BD.
Collapse
|
6
|
McKinnon A, Lorenz H, Salkovskis P, Wild J. Abstract thinking as a risk factor for the development of posttraumatic stress disorder symptoms in student paramedics. J Trauma Stress 2022; 35:375-385. [PMID: 34708439 DOI: 10.1002/jts.22749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 07/10/2021] [Accepted: 07/12/2021] [Indexed: 11/06/2022]
Abstract
cognitive processing is characterized by "why?" and "what if?" questions and associated with processes such as rumination and worry. The tendency to think abstractly in response to stress has not been examined as a longitudinal risk factor for later stress reactions. The present study evaluated the extent to which an abstract thinking style could represent a risk factor for posttraumatic stress disorder (PTSD) symptoms in student paramedics over a 6-month follow-up period. Student paramedics (N = 89) recruited from universities in the United Kingdom were assessed for baseline symptoms, abstract thinking, and cognitive responses to stressful memories; a follow-up assesment was conducted 6 months later in their training. All participants were exposed to a potentially traumatic event between baseline and follow-up. Baseline symptoms and trauma history accounted for 45% of the variation in follow-up posttraumatic symptoms, with abstract thinking style explaining an additional 2.5% over and above what could be predicted from initial symptom levels. Abstract thinking was moderately related to rumination in response to stressful memories, r = .45, and correlated with follow-up symptoms of PTSD, r = .49; anxiety, r = .40; and depression, r = .27. This study builds on previous work suggesting that abstract processing mode and abstract rumination are risk factors for PTSD. Abstract thinking in response to stress represents a potentially modifiable risk factor that could be targeted by a resilience-focused intervention for individuals likely to encounter traumatic events.
Collapse
Affiliation(s)
- Aimee McKinnon
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Hjördis Lorenz
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Paul Salkovskis
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Jennifer Wild
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| |
Collapse
|
7
|
O'Toole M, Mulhall C, Eppich W. Breaking down barriers to help-seeking: preparing first responders' families for psychological first aid. Eur J Psychotraumatol 2022; 13:2065430. [PMID: 35572389 PMCID: PMC9103391 DOI: 10.1080/20008198.2022.2065430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND First responders regularly encounter both operational stressors and potentially traumatic events, increasing their risk of mental health issues (Declercq et al., 2011). Due to unique cultural complexities, they turn mostly to peers for early psychosocial support (Isaac & Buchanan, 2021). However, peer support and/or mental health assistance may not always be available or easy to access and first responders' mental health suffers. OBJECTIVE We need more accessible routes to crisis intervention to ensure first responder resilience and wellbeing, so they may continue to function in the service of public safety. Family members and close friends may be ideally placed to provide this immediate care. This article outlines the protective role of social support as an early intervention strategy to mitigate the effects of first responder trauma, exploring the potential opportunity for family members and friends to play an increasingly supportive role in their loved one's wellbeing. This paper serves as a call to action for practical educational interventions that will prepare family members for these critical conversations. CONCLUSION We see potential in combining early intervention theory, psychoeducation, and a strengths-based gender specific positive psychology approach. Further study should investigate how best to help first responders break down barriers to support, by bolstering their existing social supports and ultimately reducing the stigma associated with experiencing traumatic stress. HIGHLIGHTS By training family members in psychological first aid, we may strengthen existing social support for first responders, providing more options for, and potentially breaking down stigma associated with help-seeking.
Collapse
Affiliation(s)
- Michelle O'Toole
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Mulhall
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Walter Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| |
Collapse
|
8
|
Mikutta C, Schmid JJ, Ehlert U. Resilience and Post-traumatic Stress Disorder in the Swiss Alpine Rescue Association. Front Psychiatry 2022; 13:780498. [PMID: 35401258 PMCID: PMC8985199 DOI: 10.3389/fpsyt.2022.780498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The present study aimed to assess the frequency of trauma exposure, the prevalence of possible post-traumatic stress disorder (PTSD), the extent of resilience, and sense of coherence among personnel of the Swiss alpine rescue association (ARS). METHODS Using a trilingual online survey approach, 465 mountain rescuers of the ARS were surveyed using the Posttraumatic Diagnostic Scale (PDS), the PTSD Checklist 5 (PCL-5), the Resilience Scale 13 and 14 (RS-13/-14), the Perceived Stress Scale 10 (PSS-10), the General Health Questionnaire 12 (GHQ-12), the Pittsburg Sleep Quality Index (PSQI), the Sense of Coherence Scale 13 (SOC-13), and the Berlin Social Support Scales (BSSS). RESULTS Although the rate of mountain rescuers having witnessed or experienced a traumatic event was high (71%), the prevalence of possible PTSD was low (0.9%). The sample showed high resilience and high sense of coherence. Resilience was positively correlated with work experience. Low perceived stress and high sense of coherence predicted resilience. The severity of PTSD symptoms was mainly predicted by low sense of coherence. Sense of coherence mediated the interaction between resilience and severity of PTSD symptoms. CONCLUSION The findings suggest that resilience and sense of coherence are indicative for the low prevalence of possible PTSD among mountain rescuers, and may therefore represent valuable screening and training parameters for mountain rescue personnel.
Collapse
Affiliation(s)
- Christian Mikutta
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Privatklinik Meiringen, Meiringen, Switzerland
| | - Julia J Schmid
- Department of Clinical Psychology, University of Zurich, Zurich, Switzerland
| | - Ulrike Ehlert
- Department of Clinical Psychology, University of Zurich, Zurich, Switzerland
| |
Collapse
|
9
|
Carmassi C, Dell'Oste V, Bertelloni CA, Pedrinelli V, Barberi FM, Malacarne P, Dell'Osso L. Gender and occupational role differences in work-related post-traumatic stress symptoms, burnout and global functioning in emergency healthcare workers. Intensive Crit Care Nurs 2021; 69:103154. [PMID: 34895972 DOI: 10.1016/j.iccn.2021.103154] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/01/2021] [Accepted: 09/08/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To explore gender and occupational role impact on work-related Post-Traumatic Stress Symptoms, Post-Traumatic Stress Disorder, burnout and global functioning in a sample of emergency healthcare workers. DESIGN A cross-sectional study. PARTICIPANTS/SETTING 126 healthcare workers of the Emergency Department, including Intensive Care Unit, Emergency Room and Emergency Medicine, of a major University Hospital in central Italy were recruited. MAIN OUTCOME MEASURES Participants were assessed by means of the: Trauma and Loss Spectrum-Self Report (TALS-SR) to explore Post-Traumatic Stress Spectrum Symptoms, Professional Quality of Life (ProQOL) Scale to assess Compassion Satisfaction, Burnout and Compassion Fatigue and Work and Social Adjustment Scale (WSAS) to measure global functioning. RESULTS The present findings showed females were more prone to develop Post-Traumatic Stress Symptoms, particularly re-experiencing (p = .010) and hyperarousal (p = .026) symptoms and medical doctors reporting higher Burnout (p < .001) and lower Compassion Satisfaction (p = .009) mean scores than nurses. Higher levels of functioning impairment emerged amongst medical doctors rather than nurses, in both social (p = .029) and private (p = .020) leisure activities. Linear correlations highlighted relationships between the TALS-SR, ProQOL and WSAS scores. Finally, medical doctor status was significantly associated with lower Compassion Satisfaction (p = .029) and higher Burnout (p = .015). CONCLUSION Our results highlight high post-traumatic stress symptoms and burnout levels in emergency healthcare workers with a relevant impact of female gender and occupational role, supporting the need for preventive strategies, also in light of the current COVID-19 pandemic.
Collapse
Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valerio Dell'Oste
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | | | - Virginia Pedrinelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Paolo Malacarne
- Anaesthesia and Intensive Care Unit, Azienda Ospedaliero-Universitaria Pisana (AOUP), Pisa, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| |
Collapse
|
10
|
Mansouri T, Hostler D, Temple JL, Clemency BM. Eating and Physical Activity Patterns in Day and Night Shift EMS Clinicians. PREHOSP EMERG CARE 2021; 26:700-707. [PMID: 34694197 DOI: 10.1080/10903127.2021.1996662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: EMS clinicians work in shifts to provide 24-hour care. Shift work is linked with metabolic disease and over 70% of EMS clinicians report having overweight or obesity. Inability to store food in their vehicles combined with limited overnight dining establishments, and unpredictable job demands leads to reliance on convenience and fast foods. The objective of this study was to describe the eating and physical activity patterns among EMS clinicians on days on and off shift.Methods: EMS clinicians throughout the United States participated in a study involving four 24-hour monitoring periods. Participants wore activity monitors to measure physical activity level and remote food photography was used to collect dietary data on two work days and two days off. Repeated measures analysis of variance was conducted to compare energy and macronutrient intake and activity levels in day and night workers on and off shift.Results: We analyzed data from 39 EMS clinicians (29.7 + 8.5yrs old). Controlling for sex, those working night shifts consumed more kilocalories (p=.037) and total fat (p=.043) compared to day shift workers. Night shift workers had fewer steps (p = 0.045), more sedentary time (p = 0.053), and less moderate activity (p = 0.037) during a shift compared to day workers.Conclusion: Among EMS clinicians, night shift is associated with greater energy intake, and decreased physical activity during shifts. This may contribute to positive energy balance and weight gain overtime, increasing risk for metabolic disease.
Collapse
|
11
|
Nazari G, MacDermid JC, Sinden K, D'Amico R, Brazil A, Carleton N, Cramm H. Prevalence of exposure to critical incidents in firefighters across Canada. Work 2021; 67:215-222. [PMID: 32955483 DOI: 10.3233/wor-203267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Firefighters partake in and are exposed to a range of potentially traumatic events throughout their careers and the impact of such critical events could last a life time. Therefore, capturing such lifetime exposures is necessary for supporting firefighter health. OBJECTIVE To estimate the prevalence of critical incidents in firefighters across Canada and determine whether the number of critical events varied based on age, gender, years of service; and to integrate our prevalence estimates using meta-analysis with previous studies to provide a pooled estimate. METHODS We recruited 464 firefighters. Firefighters were asked to complete a self-report Critical Incident Inventory (CII) survey that included questions on exposure to critical events throughout their firefighting careers. Individual CII items were summarized as percentages, number of exposures, the total number and percentages of exposures to each of the six CII sub-scales. We also performed a multivariate enter regression analysis with the CII total score as dependant variable, and age, gender, years of service as independent variables, to estimate if the number of critical incidents among firefighters varied based on age, gender and years of service. RESULTS Among the 390 full-time firefighters, 376 (96.4%) indicated exposure to some type of critical incident. More specifically, 351 (90%) reported a "respond to incident involving one or two deaths", and 314 (81%) reported a "respond to incident involving multiple serious injuries". Age, gender and years of service accounted for only 37.4% of the variance in the number of critical incidents among firefighters. In addition, our pooled estimate results of previous similar studies indicated an overall prevalence estimate of critical incident exposures was 93.40% (4 studies, 1725 of 1877 firefighters, 95% CI: 82.26 -99.30). CONCLUSIONS Nearly all (96.4%) firefighters were exposed to some form of critical event over the span of their entire firefighting careers. Age, gender and years of service accounted for one-third of the variance in the number of critical incident exposures among firefighters.
Collapse
Affiliation(s)
- Goris Nazari
- School of Physical Therapy, Health and Rehabilitation, Western University, London, ON, Canada.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Joy C MacDermid
- School of Physical Therapy, Health and Rehabilitation, Western University, London, ON, Canada.,Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - Kathryn Sinden
- School of Kinesiology, Lakehead University, Thunder Bay, ON, Canada
| | - Robert D'Amico
- Secretary, Hamilton Professional Fire Fighters Association, Canada
| | - Amanda Brazil
- Faculty of Education, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Nicholas Carleton
- Anxiety and Illness Behaviours Laboratory, University of Regina, Regina, Saskatchewan, Canada
| | - Heidi Cramm
- School of Rehabilitation Therapy & Canadian Institute for Military & Veteran Health Research (CIMVHR), Queen's University, Kingston, ON, Canada
| |
Collapse
|
12
|
Haim-Nachum S, Levy-Gigi E. To Be or Not to Be Flexible: Selective impairments as a means to differentiate between depression and PTSD symptoms. J Psychiatr Res 2021; 136:366-373. [PMID: 33639329 DOI: 10.1016/j.jpsychires.2021.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/31/2021] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
During the course of their lives, most individuals experience at least one potentially traumatic event. For some individuals this experience may result in them developing depression and/or post-traumatic stress disorder (PTSD) symptoms. The aim of the present study was to test the interactive effect of traumatic exposure and impaired cognitive flexibility on the tendency to develop either depression or PTSD symptoms. Eighty-two college students (M age = 25.32, SD age = 4.09) were assessed for exposure to traumatic events, depressive and PTSD symptoms. In addition, they completed a performance-based learning paradigm to evaluate the unique patterns of cognitive flexibility, defined as reduced and enhanced updating of prior knowledge in the face of new information. We predicted and found that for individuals with reduced updating, greater exposure to trauma was associated with elevated depressive symptoms. Contrary to our prediction, for individuals with enhanced updating, greater exposure was associated with elevated PTSD symptoms. While cognitive flexibility is traditionally associated with adaptive outcomes, our results illuminate the important role of a delicate updating balance to adaptively cope with aversive life events. The findings highlight the possible different roles of cognitive flexibility in the development of psychopathology and may serve as a first step toward developing tailored prevention and treatment methods.
Collapse
Affiliation(s)
| | - Einat Levy-Gigi
- School of Education, Bar-Ilan University, Ramat-Gan, 52900, Israel; The Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan, 52900, Israel.
| |
Collapse
|
13
|
Sun L, Sun Z, Wu L, Zhu Z, Zhang F, Shang Z, Jia Y, Gu J, Zhou Y, Wang Y, Liu N, Liu W. Prevalence and risk factors for acute posttraumatic stress disorder during the COVID-19 outbreak. J Affect Disord 2021; 283:123-129. [PMID: 33548905 PMCID: PMC7840403 DOI: 10.1016/j.jad.2021.01.050] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND To examine the prevalence of and risk factors for acute posttraumatic stress disorder (PTSD) shortly after the massive outbreak of COVID-19 in China. METHODS An online anonymous survey was conducted between 30 January and 3 February, 2020. The survey included two self-administered questionnaires: one collected personal information (gender, age, education background), current location, recent epidemic area contact history, the classification of population, and subjective sleep quality; the other was the PTSD Checklist for DSM-5 (PCL-5). RESULTS A total of 2091 Chinese participated in the current study. The prevalence of PTSD among the Chinese public one month after the COVID-19 outbreak was 4.6%. Multiple linear regression analysis revealed that gender (p < 0.001), epidemic area contact history (p = 0.047), classification of population (p < 0.001), and subjective sleep quality (p < 0.001) could be regarded as predictors for PTSD. LIMITATIONS First, the majority of participants in this study were the general public, with confirmed or suspected patients being a small part. Second, the measurement of PTSD in this study might be vulnerable to selection bias because of an online self-report study, such as participants' recruitment. Third, the prevalence of PTSD in this study was estimated by an online questionnaire rather than a clinical interview. CONCLUSIONS The results suggested that some Chinese showed acute PTSD during the COVID-19 outbreak. Therefore, comprehensive psychological intervention needs further implementation. Furthermore, females, people who had recent epidemic area contact history, those at high risk of infection or with poor sleep quality deserve special attention.
Collapse
Affiliation(s)
- Luna Sun
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai 200433, China
| | - Zhuoer Sun
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai 200433, China
| | - Lili Wu
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai 200433, China
| | - Zhenwen Zhu
- Counseling and Psychological Services Center, Fudan University, 220 Handan Road, Shanghai 200433, China
| | - Fan Zhang
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai 200433, China
| | - Zhilei Shang
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai 200433, China
| | - Yanpu Jia
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai 200433, China
| | - Jingwen Gu
- The Battalion 5 of Cadet Brigade, School of Basic Medicine, Naval Medical University, Shanghai 200433, China
| | - Yaoguang Zhou
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai 200433, China
| | - Yan Wang
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai 200433, China
| | - Nianqi Liu
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai 200433, China
| | - Weizhi Liu
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai 200433, China; The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai 200433, China.
| |
Collapse
|
14
|
Armstrong D, Shakespeare‐finch J, Shochet I. Predicting post‐traumatic growth and post‐traumatic stress in firefighters. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12032] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Deanne Armstrong
- School of Psychology and Counselling, Faculty of Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia,
| | - Jane Shakespeare‐finch
- School of Psychology and Counselling, Faculty of Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia,
| | - Ian Shochet
- School of Psychology and Counselling, Faculty of Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia,
| |
Collapse
|
15
|
Casagrande M, Favieri F, Tambelli R, Forte G. The enemy who sealed the world: effects quarantine due to the COVID-19 on sleep quality, anxiety, and psychological distress in the Italian population. Sleep Med 2020; 75:12-20. [PMID: 32853913 PMCID: PMC7215153 DOI: 10.1016/j.sleep.2020.05.011] [Citation(s) in RCA: 420] [Impact Index Per Article: 105.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 01/04/2023]
Abstract
Background The 2019 Coronavirus Disease (COVID-19) pandemic has become a global health emergency. The extreme actions aimed to reduce virus diffusion have profoundly changed the lifestyles of the Italian population. Moreover, fear of contracting the infection has generated high levels of anxiety. This study aimed to understand the psychological impact of the COVID-19 outbreak on sleep quality, general anxiety symptomatology, and psychological distress. Methods An online survey collected information on socio-demographic data and additional information concerning the COVID-19 pandemic. Furthermore, sleep quality, sleep disorders, generalized anxiety symptoms, psychological distress, and post-traumatic stress disorder (PTSD) symptomatology related to COVID-19 were assessed. Results This study included 2291 respondents. The results revealed that 57.1% of participants reported poor sleep quality, 32.1% high anxiety, 41.8% high distress, and 7.6% reported PTSD symptomatology linked to COVID-19. Youth and women, those uncertain regarding possible COVID-19 infection, and greater fear of direct contact with those infected by COVID-19 had an increased risk of developing sleep disturbances, as well as higher levels of anxiety and distress. Finally, a significant relationship between sleep quality, generalized anxiety, and psychological distress with PTSD symptoms related to COVID-19 was evidenced. Conclusions Our findings indicate that the COVID-19 pandemic appears to be a risk factor for sleep disorders and psychological diseases in the Italian population, as previously reported in China. These results should be used as a starting point for further studies aimed to develop psychological interventions to minimize the brief and long-term consequences of the COVID-19 pandemic.
Collapse
Affiliation(s)
- Maria Casagrande
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Italy.
| | | | - Renata Tambelli
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Italy
| | - Giuseppe Forte
- Department of Psychology, Sapienza University of Rome, Italy.
| |
Collapse
|
16
|
Pasin L, Sella N, Correale C, Boscolo A, Mormando G, Zordan M, Landoni G, Navalesi P. Pandemic COVID-19: the residents' resilience. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020120. [PMID: 33525201 PMCID: PMC7927552 DOI: 10.23750/abm.v91i4.10061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/14/2020] [Indexed: 11/29/2022]
Abstract
Background and aim of the work: Healthcare workers are often exposed to secondary traumatic stress. The SARS-CoV-2 outbreak caused intense psychological pressure in various healthcare professionals, with increased risk of post-traumatic stress disorder. Objective of our study was to evaluate the incidence of post-traumatic stress disorder in italian residents in Intensive Care and Emergency Departments facing COVID-19 emergency. Methods: We developed a short, anonymous web-questionnaire to obtain data regarding sociodemographic, professional characteristics, history of psychological trauma, psychotherapy, use of psychiatric medications and the presence of symptoms of post-traumatic stress disorder. Primary outcome was the incidence of post-traumatic stress disorder. Secondary endpoint was to identify possible risk factors associated with the development of post-traumatic stress disorder. Post-traumatic stress disorder symptoms were assessed by the Impact of Event Scale-Revised. A cut-off of 33 identified a probable diagnosis of post-traumatic stress disorder while a cut-off of 22 identified subclinical post-traumatic stress disorder. Results: 503 residents completed the questionnaire. Among residents who were directly involved in the clinical assistance of COVID-19 patients, 34.3% presented a probable diagnosis of post-traumatic stress disorder, while 21.5% presented subclinical post-traumatic stress disorder. Female gender and history of psychological trauma were significantly associated with the development of post-traumatic stress symptoms. Conclusions: Our data suggest a high incidence of post-traumatic stress disorder in Italian residents working in Intensive Care Units and Emergency Departments during the SARS-CoV-2 outbreak. This finding supports the importance of promptly implementing any strategy that might preserve staff mental health. (www.actabiomedica.it)
Collapse
Affiliation(s)
| | - Nicolò Sella
- Department of Anaesthesia and Intensive Care, Azienda ospedaliera-università di Padova.
| | - Christelle Correale
- Department of Anaesthesia and Intensive Care, Azienda ospedaliera-università di Padova.
| | - Annalisa Boscolo
- Department of Anaesthesia and Intensive Care, Azienda ospedaliera-università di Padova.
| | - Giulia Mormando
- Department of Medicine (DIMED), University of Padova, Italy.
| | - Maria Zordan
- Department of Mental Health, Azienda ULSS 7 Pedemontana.
| | | | - Paolo Navalesi
- Department of Medicine (DIMED), University of Padova, Italy.
| |
Collapse
|
17
|
Karrasch S, Hitzler M, Behnke A, Tumani V, Kolassa IT, Rojas R. Chronic and Traumatic Stress Among Emergency Medical Services Personnel. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2020. [DOI: 10.1026/1616-3443/a000600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Abstract. Background: Emergency medical services (EMS) personnel are frequently confronted with multiple stressful and potentially traumatic events as well as adverse working conditions. Objective: This narrative review provides an overview of the impact of adverse mission experiences and working conditions on the mental and physical health of EMS personnel. Methods: We summarize the empirical findings on prevalence rates as well as individual vulnerability factors and resilience. Results: EMS personnel show the highest prevalence rates of stress-related health problems among first responders. The article outlines prevention and intervention approaches that contribute to maintaining and improving the mental and physical health of EMS personnel. Conclusion: In the future, further evidence-based intervention measures should be developed to adequately support this professional group.
Collapse
Affiliation(s)
- Sarah Karrasch
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Germany
| | - Melissa Hitzler
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Germany
| | - Alexander Behnke
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Germany
| | - Visal Tumani
- Department of Psychiatry and Psychotherapy III, Ulm University, Germany
| | - Iris-Tatjana Kolassa
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Germany
| | - Roberto Rojas
- University Psychotherapeutic Outpatient Clinic, Institute of Psychology and Education, Ulm University, Germany
| |
Collapse
|
18
|
Sommer JL, El-Gabalawy R, Taillieu T, Afifi TO, Carleton RN. Associations between Trauma Exposure and Physical Conditions among Public Safety Personnel: Associations entre l'exposition à un traumatisme et les problèmes physiques chez le personnel de la santé publique. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:548-558. [PMID: 32275461 PMCID: PMC7361655 DOI: 10.1177/0706743720919278] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Trauma exposure is associated with adverse health-related correlates, including physical comorbidities, and is highly prevalent among public safety personnel (PSP). The current study (1) examined the association between context of index trauma exposure (part of job vs. other) and physical conditions and (2) established the prevalence of physical conditions according to PSP category (e.g., police, paramedic) and index trauma type (e.g., serious accident, physical assault) in a large Canadian sample of PSP. METHODS PSP completed an online survey between September 2016 and January 2017. Multivariable logistic regressions examined associations between context of index trauma exposure (i.e., part of job vs. other) and physical condition categories. Cross-tabulations with chi-square analyses examined whether the prevalence of physical conditions significantly differed according to PSP category and index trauma type. RESULTS There were 5,267 PSP included in the current study. Results from the most stringent model of logistic regressions demonstrated that, compared to PSP who experienced their index trauma in any other context, PSP who experienced it as part of their job had reduced odds of "other" physical conditions (adjusted odds ratio = 0.73, 95% confidence interval, 0.57 to 0.94, P < 0.05). Results also revealed significant differences in the prevalence of physical conditions across all PSP categories and select index trauma types. CONCLUSION Results highlight the relevance of trauma exposure outside of an occupational context among PSP and may have implications for the positive impact of stress inoculation and resiliency training programs for PSP.
Collapse
Affiliation(s)
- Jordana L. Sommer
- Department of Psychology, University of Manitoba, Winnipeg,
Canada
- Department of Anesthesiology, Perioperative and Pain Medicine,
University of Manitoba, Winnipeg, Canada
| | - Renée El-Gabalawy
- Department of Psychology, University of Manitoba, Winnipeg,
Canada
- Department of Anesthesiology, Perioperative and Pain Medicine,
University of Manitoba, Winnipeg, Canada
- Department of Clinical Health Psychology, University of Manitoba,
Winnipeg, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg,
Canada
| | - Tamara Taillieu
- Department of Community Health Sciences, University of Manitoba,
Winnipeg, Canada
| | - Tracie O. Afifi
- Department of Psychiatry, University of Manitoba, Winnipeg,
Canada
- Department of Community Health Sciences, University of Manitoba,
Winnipeg, Canada
| | | |
Collapse
|
19
|
Park E, Meyer RML, Gold JI. The Role of Medical Specialization on Posttraumatic Symptoms in Pediatric Nurses. J Pediatr Nurs 2020; 53:22-28. [PMID: 32339973 DOI: 10.1016/j.pedn.2020.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Comparison of medical specialization of repeated exposure to secondary trauma and Post-Traumatic Stress Disorder (PTSD) symptoms in pediatric nurses was examined. DESIGN AND METHODS The PTSD Checklist-Civilian Version (PCL-C) was administered to 182 nurses over their first year on the job at a pediatric hospital (three time-points: baseline, 3 month follow-up, and 1 year follow-up). Demographic characteristics (age groups, gender, education, and race) and previous healthcare experience on whether nurses met criteria for no, partial, or full PTSD across all three time-points was examined. Differences in unit assignment on total PTSD symptoms and symptoms of each criterion of PTSD (re-experiencing, avoidance, and arousal) were also examined. RESULTS No significant differences of both demographic characteristics and previous healthcare experience were found on these PTSD categories. However, both ICU and Hematology/Oncology units were more at risk for developing partial and full PTSD, respectively compared to other units. Nurses in the rehabilitation units had significantly higher re-experiencing, avoidance, and arousal symptoms than those assigned to medical/surgical and intensive care units. CONCLUSIONS Results demonstrate a need for hospitals to assess why nurses from certain units are reporting more PTSD symptoms and screen for PTSD symptoms and other mental health concerns throughout their career. PRACTICE IMPLICATIONS Being aware of which units may be more at-risk should inform unit-specific prevention and intervention programs to decrease negative outcomes, including burnout, compassion fatigue, and job dissatisfaction.
Collapse
Affiliation(s)
- Elizabeth Park
- The Saban Research Institute at Children's Hospital Los Angeles, Department of Anesthesiology Critical Care Medicine, University Center of Excellence in Developmental Disabilities, United States of America
| | - Rika M L Meyer
- California State University, Northridge, Department of Child and Adolescent Development, United States of America
| | - Jeffrey I Gold
- The Saban Research Institute at Children's Hospital Los Angeles, Department of Anesthesiology Critical Care Medicine, University Center of Excellence in Developmental Disabilities, United States of America; Keck School of Medicine, Departments of Anesthesiology, Pediatrics, and Psychiatry & Behavioral Sciences, University of Southern California, United States of America.
| |
Collapse
|
20
|
Campillo-Cruz M, González-Gutiérrez JL, Ardoy-Cuadros J, Fernández-Muñoz JJ. The Development and Exploratory Psychometric Properties of the Traumatic and Routine Stressors Scale on Emergency Nurses (TRSS-EN). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061963. [PMID: 32192115 PMCID: PMC7143067 DOI: 10.3390/ijerph17061963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/13/2020] [Accepted: 03/15/2020] [Indexed: 01/05/2023]
Abstract
Emergency nurses are exposed to traumatic events and routine stressors, both of which can lead to the development of PTSD (Post Traumatic Stress Disorder) symptomatology. However, there are currently no instruments designed to assess the impact and frequency of such sources of stress in nurses. The Traumatic and Routine Stressors Scale on Emergency Nurses (TRSS-EN) was built for this purpose. A sample of 147 emergency nurses from three hospitals in Madrid (Spain) completed this 13-item scale. The analyses showed a factorial structure composed of two factors. The first is characterized by items regarding traumatic and stressful events and procedures of severe magnitude (traumatic stressors), and the second by items related to stressful events and procedures of moderate magnitude (routine stressors) but hypothesized to possess a substantial traumatic potential. Analyses provided evidence of both adequate internal consistency (Cronbach’s α = 0.92; first factor α = 0.91 and second factor α = 0.86) and test–retest reliability. In addition, concurrent validity also proved to be satisfactory. In short, TRSS-EN seems to be a reliable and valid tool in a healthcare emergency nursing setting for screening the frequency and impact of exposure to everyday work-related traumatic stressors, either event-related or routine.
Collapse
|
21
|
Anderson NE, Slark J, Gott M. When resuscitation doesn’t work: A qualitative study examining ambulance personnel preparation and support for termination of resuscitation and patient death. Int Emerg Nurs 2020; 49:100827. [DOI: 10.1016/j.ienj.2019.100827] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 10/01/2019] [Accepted: 11/29/2019] [Indexed: 12/12/2022]
|
22
|
Behnke A, Rojas R, Karabatsiakis A, Kolassa IT. Childhood maltreatment compromises resilience against occupational trauma exposure: A retrospective study among emergency medical service personnel. CHILD ABUSE & NEGLECT 2020; 99:104248. [PMID: 31731138 DOI: 10.1016/j.chiabu.2019.104248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/20/2019] [Accepted: 10/25/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Childhood maltreatment (CM) compromises resilience against stress and trauma throughout life. Therefore, it could present a major risk factor for the health of frequently trauma-exposed professionals such as emergency medical service (EMS) personnel. OBJECTIVE We investigated, whether EMS personnel's history of CM increased their risk for mental and physical stress symptoms after occupational trauma exposure. PARTICIPANTS AND SETTING Data from 103 German EMS personnel (age: Mdn±QD = 26.00 ± 8.50 years) were collected as part of a cross-sectional survey distributed among employees of the regional German Red Cross EMS division (response rate 46.6%). The sample corresponded well to the division's entire staff in terms of socio-anagraphic characteristics. METHODS CM and occupational trauma exposure as well as posttraumatic, depressive, and somatic symptoms were assessed with self-report questionnaires. RESULTS Moderation analyses indicated stronger positive associations between occupational trauma exposure and the severity of posttraumatic (β = .30, p < .001), depressive (β = .20, p = .026), and somatic symptoms (β = .18, p = .059) among EMS personnel who reported a higher exposure to CM. CONCLUSIONS Our study provides initial evidence that CM could increase the EMS personnel's vulnerability to the detrimental consequences of critical incidents on duty. Future research is needed (i) to replicate and generalize our observation on various trauma-exposed professions as well as (ii) to develop preventive measures for targeting the mediating and protective factors which influence the relationship between CM and the negative consequences of occupational trauma exposure.
Collapse
Affiliation(s)
- Alexander Behnke
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany.
| | - Roberto Rojas
- University Psychotherapeutic Outpatient Clinic, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Alexander Karabatsiakis
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Iris-Tatjana Kolassa
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| |
Collapse
|
23
|
Behnke A, Rojas R, Karrasch S, Hitzler M, Kolassa IT. Deconstructing Traumatic Mission Experiences: Identifying Critical Incidents and Their Relevance for the Mental and Physical Health Among Emergency Medical Service Personnel. Front Psychol 2019; 10:2305. [PMID: 31695639 PMCID: PMC6817588 DOI: 10.3389/fpsyg.2019.02305] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/27/2019] [Indexed: 12/11/2022] Open
Abstract
Emergency medical service (EMS) personnel frequently encounter emotionally stressful or even traumatic incidents in their line of duty. In this study, a checklist of emotionally stressful events for the German EMS was introduced. A mixed-method approach was used to identify mission events that were critical for the development of mental and physical stress symptoms. Data were collected in a cross-sectional sample of 102 EMS employees. A quantitative content analysis of the participants' worst experiences on duty indicated, traumatic missions to be a concatenation of two to five emotionally stressful events. Rescue missions were experienced as traumatic if (i) EMS personnel became victims of attacks or threats; (ii) certain circumstances caused them to give up their professional detachment from patients; (iii) EMS personnel perceived the overall mission as exceptionally tragic. In subsequent correlation analyses, the corresponding checklist items showed consistent positive associations with the post-traumatic, depressive and physical stress symptoms among the study cohort. Within the exploratory regressions, the sum score of critical on-duty exposures contributed incrementally to the prediction of mental and physical stress symptoms when non-work-related trauma exposure and perceived social support were also considered. Findings point toward the importance of considering the cumulative burden of critical incidents for the long-term health of EMS personnel. Future research is needed to investigate, how on-duty trauma affects the social support EMS personnel received from their work and personal relationships.
Collapse
Affiliation(s)
- Alexander Behnke
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Roberto Rojas
- University Psychotherapeutic Outpatient Clinic, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Sarah Karrasch
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Melissa Hitzler
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Iris-Tatjana Kolassa
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| |
Collapse
|
24
|
Guan R, Gao J, Liu G, Cheng F, Ge B. The Mediating Effect of Perceived Social Acknowledgment on the Relationship Between Patient Assaults and Posttraumatic Stress Reactions in Emergency Nurses. JOURNAL OF INTERPERSONAL VIOLENCE 2019; 34:3833-3849. [PMID: 29294608 DOI: 10.1177/0886260516673627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study explored whether posttraumatic stress symptoms resulted from workplace assaults were mediated by the perception of social acknowledgment by the victim. A sample of 444 emergency room nurses in China completed questionnaires measuring the frequency and types of patient assaults, the severity of physical injury, the perception of social acknowledgment, and the posttraumatic stress symptoms. Cross-sectional design, multiregression, and bootstrapping mediation analyses were used to test the hypotheses. Results showed that general disapproval and family disapproval mediated the relationship between the frequency of patient assaults and the severity of posttraumatic stress symptoms. These two factors also mediated the links between the injury severity of patient assaults and the development of posttraumatic stress symptoms. Implications for clinical practice and future research were discussed.
Collapse
Affiliation(s)
- Ruiyuan Guan
- 1 Peking University Health Science Center, Beijing, China
| | - Jun Gao
- 2 Fudan University, Shanghai, China
| | - Guangzhi Liu
- 3 Peking University People's Hospital, Beijing, China
| | - Fei Cheng
- 4 City University of Hong Kong, Hong Kong
| | - Baolan Ge
- 5 Peking University Third Hospital, Beijing, China
| |
Collapse
|
25
|
Jeruzal JN, Boland LL, Frazer MS, Kamrud JW, Myers RN, Lick CJ, Stevens AC. Emergency Medical Services Provider Perspectives on Pediatric Calls: A Qualitative Study. PREHOSP EMERG CARE 2019; 23:501-509. [PMID: 30482077 DOI: 10.1080/10903127.2018.1551450] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Previous research indicates that 9-1-1 response to incidents involving children is particularly distressing for emergency medical services (EMS) clinicians. This qualitative study was conducted to increase understanding about the difficulties of responding to pediatric calls and to obtain information about how organizations can better support EMS providers in managing potentially difficult calls. Methods: Paramedics and emergency medical technicians from a single U.S. ambulance service were invited to participate in focus groups about responding to 9-1-1 calls involving pediatric patients. A total of 17 providers from both rural and metro service regions participated in six focus groups held in community meeting spaces. A semi-structured focus group guide was used to explore (1) elements that make pediatric calls difficult, (2) pre-arrival preparation practices, (3) experiences with coping after difficult pediatric calls, and (4) perspectives about offered and desired resources or support. Focus groups were audio recorded and transcripts were analyzed using standard coding, memoing, and content analysis methods in qualitative analysis software (NVivo). Results: Responses about elements that make pediatric calls difficult were organized into the following themes: (1) special social value of children, (2) clinical difficulties with pediatric patients, (3) added acuity to already challenging calls, (4) caregivers as secondary patient, and (5) identifying with patient or patient's family. Pre-arrival preparation methods included mental or verbal review of hypothetical scenarios and refocusing nerves or emotions back to the technical aspect of the job. Participants described using available resources that largely took the form of social support. Suggestions for additional resources included: increased opportunities for external feedback; more frequent pediatric clinical training; institutionalization of recovery time after difficult calls; and improved storage and labeling of pediatric equipment. Conclusions: This study provides qualitative data about the difficulties of responding to pediatric calls and resources needed to support clinicians. Findings from this study can be used to guide EMS leaders in designing and implementing institutional initiatives to enhance training and support for prehospital clinicians providing care to children.
Collapse
|
26
|
Behnke A, Conrad D, Kolassa IT, Rojas R. Higher sense of coherence is associated with better mental and physical health in emergency medical services: results from investigations on the revised sense of coherence scale (SOC-R) in rescue workers. Eur J Psychotraumatol 2019; 10:1606628. [PMID: 31164965 PMCID: PMC6534248 DOI: 10.1080/20008198.2019.1606628] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 12/28/2022] Open
Abstract
As rescue workers are regularly confronted with potentially traumatising on-duty events, they have an increased risk to develop trauma-related mental and physical health impairments, including post-traumatic, depressive, and somatic symptoms. For this high-risk group, it could be of particular importance to experience their occupational burden as manageable, meaningful, and coherent. This mindset - called sense of coherence - may be a potential resilience factor against the development of mental and physical health problems. In a cross-sectional cohort of 102 rescue workers (Mdn(QD)age = 26.0 (8.5), age range: 18-61), including 36 women, we investigated whether higher values on the Revised Sense of Coherence Scale (SOC-R) predicted lower post-traumatic, depressive, and somatic symptoms. In addition, we evaluated the factor structure of the SOC-R using confirmatory factor analyses. Linear regressions indicated that higher SOC-R, but particularly manageability scores were associated with less post-traumatic (β = -.31, p = .009), depressive (β = -.44, p < .001), and somatic symptoms (β = -.36, p = .002). Furthermore, we found that all symptom scores significantly increased with occupational and private-life trauma exposure. The SOC-R's factor structure was replicated, comprising the three subscales manageability, reflection, and balance. However, the SOC-R's convergent factor validity was rather low in the present sample. Taken together, a high sense of coherence, and in particular a high manageability conviction, was observed as resilience factors for high-risk groups that are frequently exposed to potentially traumatic events. Future studies might investigate whether strengthening the sense of coherence could be one building block in an effective prevention program for maintaining long-term health in risk groups.
Collapse
Affiliation(s)
- Alexander Behnke
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Daniela Conrad
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany.,Clinical Psychology and Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Iris-Tatjana Kolassa
- Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Roberto Rojas
- Universitary Psychotherapeutic Outpatient Clinic, Institute of Psychology and Education, Ulm University, Ulm, Germany
| |
Collapse
|
27
|
Milligan-Saville J, Choi I, Deady M, Scott P, Tan L, Calvo RA, Bryant RA, Glozier N, Harvey SB. The impact of trauma exposure on the development of PTSD and psychological distress in a volunteer fire service. Psychiatry Res 2018; 270:1110-1115. [PMID: 30190167 DOI: 10.1016/j.psychres.2018.06.058] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 05/17/2018] [Accepted: 06/27/2018] [Indexed: 11/25/2022]
Abstract
Emergency service workers (ESWs) are at increased risk of trauma-related mental disorders. However, volunteer ESWs, who comprise the majority of firefighters in Western countries, have limited access to the necessary support services for mental health problems. This study aimed to examine the impact of the level and types of trauma exposure on the development of mental disorders in a volunteer fire service. Members of an Australian volunteer fire service (N = 459) completed a cross-sectional survey. Information on the number and types of distressing critical incidents involved within the last year was collected. Validated, self-report measures were used to determine probable post-traumatic stress disorder (PTSD) and psychological distress caseness. The risk of probable PTSD was significantly higher for those with the most frequent involvement with distressing incidents and the highest levels of cumulative trauma exposure. Being trapped in a dangerous situation or being assaulted by other people, resulted in the greatest odds of developing a mental disorder. Volunteer fire service members with the highest levels of trauma exposure and involvement with particular types of critical incidents are at elevated risk of mental health problems. The implications for the provision of psychological support measures amongst volunteer emergency services are discussed.
Collapse
Affiliation(s)
- Josie Milligan-Saville
- Black Dog Institute, Sydney, Australia; School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Isabella Choi
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Mark Deady
- Black Dog Institute, Sydney, Australia; School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Paul Scott
- NSW Rural Fire Service, Sydney, Australia
| | - Leona Tan
- Black Dog Institute, Sydney, Australia
| | - Rafael A Calvo
- School of Electrical and Information Engineering, University of Sydney, Sydney, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | | | - Samuel B Harvey
- Black Dog Institute, Sydney, Australia; School of Psychiatry, University of New South Wales, Sydney, Australia.
| |
Collapse
|
28
|
Boland LL, Kinzy TG, Myers RN, Fernstrom KM, Kamrud JW, Mink PJ, Stevens AC. Burnout and Exposure to Critical Incidents in a Cohort of Emergency Medical Services Workers from Minnesota. West J Emerg Med 2018; 19:987-995. [PMID: 30429931 PMCID: PMC6225931 DOI: 10.5811/westjem.8.39034] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/25/2018] [Accepted: 08/03/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction Very little quantitative data on occupational burnout and exposure to critical incidents are available from contemporary United States emergency medical services (EMS) cohorts. Given that burnout has been associated positively with turnover intentions and absenteeism in EMS workers, studies that uncover correlates of burnout may be integral to combating growing concerns around retention in the profession. Methods We administered a 167-item electronic survey that included the Maslach Burnout Inventory (MBI) and a modified version of the Critical Incident History Questionnaire (n=29 incident types) to paramedics, emergency medical technicians (EMTs), and dispatchers of a single ambulance service. We defined the presence of burnout as a high score on either the emotional exhaustion or depersonalization subscales of the MBI. Results Survey respondents who provided regular 911 response at the time of the survey and completed the MBI portion of the survey were included in our analysis (190 paramedics/EMTs, 19 dispatchers; 54% response). The overall prevalence of burnout was 18%, with prevalence reaching 32% among dispatchers. The seven pediatric critical incident types presented in the survey accounted for seven of the top eight rated most difficult to cope with, and severity ratings for pediatric critical incidents did not differ by parental status (all p>0.30). A significant number of respondents reported that they had been threatened with a gun/weapon (43%) or assaulted by a patient (68%) at least once while on duty. Being over the age of 50, a parent, or in a committed relationship was associated with reduced odds of burnout in unadjusted models; however, these associations did not remain statistically significant in multivariate analysis. Increasing tertile of career exposure to critical incidents was not associated with burnout. Conclusion Medical dispatchers may be an EMS subgroup particularly susceptible to burnout. These data also demonstrate quantitatively that in this EMS agency, responders find pediatric critical incidents especially distressing and that violence against responders is commonplace. In this study, a simple measure of career exposure to potentially critical incidents was not associated with burnout; however, individual reactions to incidents are heterogeneous, and assessment tools that more accurately enumerate encounters that result in distress are needed.
Collapse
Affiliation(s)
- Lori L Boland
- Allina Health Emergency Medical Services, St. Paul, Minnesota.,Allina Health, Care Delivery Research, Minneapolis, Minnesota
| | - Tyler G Kinzy
- Allina Health Emergency Medical Services, St. Paul, Minnesota
| | - Russell N Myers
- Allina Health Emergency Medical Services, St. Paul, Minnesota
| | | | | | - Pamela J Mink
- Allina Health, Care Delivery Research, Minneapolis, Minnesota
| | | |
Collapse
|
29
|
Tang L, Pan L, Yuan L, Zha L. Prevalence and related factors of post-traumatic stress disorder among medical staff members exposed to H7N9 patients. Int J Nurs Sci 2016; 4:63-67. [PMID: 31406720 PMCID: PMC6626070 DOI: 10.1016/j.ijnss.2016.12.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 12/07/2016] [Indexed: 12/17/2022] Open
Abstract
Objective This study aimed to evaluate the prevalence and related factors of post-traumatic stress disorder (PTSD) symptoms among doctors and nurses who were exposed to H7N9 patients during the H7N9 influenza epidemic. To provide scientific basis for promoting the physical and psychological health of these staff members. Method The 102 medical staff workers who were exposed to H7N9 patients were recruited through convenient sampling between January 2015 and May 2016. We used a self-reported questionnaire, the PTSD Checklist-Civilian Version (PCL-C), to evaluate the PTSD symptoms among doctors and nurses from an intensive care unit (n = 61), a respiratory department (n = 20), and an emergency department (n = 21). We then analyzed the related factors. Results Around 20.59% of the tested doctors and nurses showed PTSD symptoms. The sample had a mean PCL-C score of 30.00 ± 9.95. The differences in the scores of doctors and nurses with different genders, ages, professional titles, contact frequencies, trainings, and experiences were statistically significant (P < 0.05, P < 0.01). Moreover, t-tests and one-way analysis of variance showed that nurses received higher scores than doctors, female participants received higher scores than male participants, and the participants with low professional title and high contact frequency, aged between 20 years and 30 years, with less than five years of work experience, having not received related training and with no related experience obtained higher PCL-C scores than the others (P < 0.05, P < 0.01). Conclusion The PTSD level of doctors and nurses after their exposure to H7N9 patients was high, which warrant further research. Health and medical institutions should pay attention to the physical and psychological health of these staff members.
Collapse
Affiliation(s)
- Liling Tang
- Nursing Department, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241000, An Hui Province, China
| | - Lingling Pan
- Intensive Care Unit, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241000, An Hui Province, China
| | - Liping Yuan
- Intensive Care Unit, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241000, An Hui Province, China
| | - Lei Zha
- Intensive Care Unit, The Second People's Hospital of Wuhu, Wuhu, 241000, An Hui Province, China
| |
Collapse
|
30
|
Wild J, Smith KV, Thompson E, Béar F, Lommen MJJ, Ehlers A. A prospective study of pre-trauma risk factors for post-traumatic stress disorder and depression. Psychol Med 2016; 46:2571-2582. [PMID: 27348599 PMCID: PMC4988264 DOI: 10.1017/s0033291716000532] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 02/03/2016] [Accepted: 02/20/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND It is unclear which potentially modifiable risk factors best predict post-trauma psychiatric disorders. We aimed to identify pre-trauma risk factors for post-traumatic stress disorder (PTSD) or major depression (MD) that could be targeted with resilience interventions. METHOD Newly recruited paramedics (n = 453) were assessed for history of mental disorders with structured clinical interviews within the first week of their paramedic training and completed self-report measures to assess hypothesized predictors. Participants were assessed every 4 months for 2 years to identify any episodes of PTSD and MD; 386 paramedics (85.2%) participated in the follow-up interviews. RESULTS In all, 32 participants (8.3%) developed an episode of PTSD and 41 (10.6%) an episode of MD during follow-up. In all but nine cases (2.3%), episodes had remitted by the next assessment 4 months later. At 2 years, those with episodes of PTSD or MD during follow-up reported more days off work, poorer sleep, poorer quality of life, greater burn-out; and greater weight-gain for those with PTSD. In line with theories of PTSD and depression, analyses controlling for psychiatric and trauma history identified several pre-trauma predictors (cognitive styles, coping styles and psychological traits). Logistic regressions showed that rumination about memories of stressful events at the start of training uniquely predicted an episode of PTSD. Perceived resilience uniquely predicted an episode of MD. CONCLUSIONS Participants at risk of developing episodes of PTSD or depression could be identified within the first week of paramedic training. Cognitive predictors of episodes of PTSD and MD are promising targets for resilience interventions.
Collapse
Affiliation(s)
- J. Wild
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - K. V. Smith
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | | | - F. Béar
- King's College London, London, UK
| | - M. J. J. Lommen
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - A. Ehlers
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| |
Collapse
|
31
|
Skogstad L, Heir T, Hauff E, Ekeberg Ø. Post-traumatic stress among rescue workers after terror attacks in Norway. Occup Med (Lond) 2016; 66:528-35. [PMID: 27325417 DOI: 10.1093/occmed/kqw063] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND On 22 July 2011, Norway was struck by two terror attacks. Seventy-seven people were killed, and many injured. Rescue workers from five occupational groups and unaffiliated volunteers faced death and despair to assist victims. AIMS To investigate the level of, and associations between, demographic variables, exposure and work-related variables and post-traumatic stress symptoms (PTSS). METHODS A cross-sectional study of general and psychosocial health care personnel, police officers, firefighters, affiliated and unaffiliated volunteers were conducted ~10 months after the terror attacks. The respondents answered a self-reported questionnaire. Post-traumatic stress disorder (PTSD) Checklist - specific (PCL-S) assessed PTSS. RESULTS There were 1790 participants; response rate was 61%. About 70% of the professional rescue workers had previous work experience with similar tasks or had participated in training or disaster drills. They assessed the rescue work as a success. Firefighters and unaffiliated volunteers reported more perceived threat compared with the other groups. Among the professional personnel, the prevalence of sub-threshold PTSD (PCL 35-49) was 2% and possible PTSD (PCL ≥ 50) 0.3%. The corresponding figures among the unaffiliated volunteers were 24% and 15%, respectively. In the multivariate analysis, female gender (β = 1.7), witnessing injured/dead (β = 2.0), perceived threat (β = 1.1), perceived obstruction in rescue work (β = 1.6), lower degree of previous training (β = -0. 9) and being unaffiliated volunteers (β = 8.3) were significantly associated with PTSS. CONCLUSIONS In the aftermath of a terror attack, professional rescue workers appear to be largely protected from post-traumatic stress reactions, while unaffiliated volunteers seem to be at higher risk.
Collapse
Affiliation(s)
- L Skogstad
- Research and Development, Department of Acute Medicine, Oslo University Hospital, 0424 Oslo, Norway, Paramedic Sciences, Oslo and Akershus University College, 0130 Oslo, Norway,
| | - T Heir
- Norwegian Centre for Violence and Traumatic Stress Studies, 0484 Oslo, Norway, Institute of Clinical Medicine, University of Oslo, 0315 Oslo, Norway
| | - E Hauff
- Institute of Clinical Medicine, University of Oslo, 0315 Oslo, Norway, Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway
| | - Ø Ekeberg
- Research and Development, Department of Acute Medicine, Oslo University Hospital, 0424 Oslo, Norway, Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway, Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, 0317 Oslo, Norway
| |
Collapse
|
32
|
Somville FJ, De Gucht V, Maes S. The impact of occupational hazards and traumatic events among Belgian emergency physicians. Scand J Trauma Resusc Emerg Med 2016; 24:59. [PMID: 27121279 PMCID: PMC4848801 DOI: 10.1186/s13049-016-0249-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/19/2016] [Indexed: 11/10/2022] Open
Abstract
Background Emergency Physicians (EPs) are regularly confronted with work related traumatic events and hectic work conditions. Several studies mention a high incidence of post-traumatic stress disorder (PTSD) and psychosomatic complaints in EP. The main objective of this study is to examine the contribution of demographics, traumatic events, life events, the occurrence of occupational hazards and social support to post-traumatic stress symptoms (PTSS), psychological distress, fatigue, somatic complaints and job satisfaction in Emergency Physicians. Methods For this study questionnaires were distributed to Belgian Emergency Physicians, These include, as determinants socio-demographic characteristics, traumatic events, life events, the occurrence of physical hazards, occurrences of violence, occurrence of situations that increase the risk of burnout and social support by supervisors and colleagues (LQWQ-Med), and as outcomes PTSS (IES), psychological distress (BSI), somatic complaints (PHQ 15), perceived fatigue (CIS20 R) and job satisfaction (LQWQ-MD). The response rate was 52.3 %. Hierarchical multiple regression analysis was performed to examine the association between the determinants and each of the outcomes. Results Emergency Physicians are particularly vulnerable to post-traumatic and chronic stress consequences due to repetitive exposure to work related traumatic incidents such as serious injuries or death of a child/adolescent. One out of three Emergency Physicians met sub-clinical levels of anxiety and 14.5 % met a clinical level of PTSD, short for Post-Traumatic Stress Disorder. Levels of fatigue were high but not directly related to traumatic events and occupational hazards. Social support from colleagues was found to have a beneficial effect on these complaints. Job satisfaction seems to have a protective factor. All of these not only affect the Emergency Physicians themselves, but can also have an adverse impact on patient care. Discussion EPs are, according to our and other studies, confronted on a regular basis with significant, potentially traumatizing work related events. There is a higher perception of traumatic events in older Eps. We find out that 36 % of the EPs find dealing with sudden death of a young person and traumatic accident/disease involving a young person the most traumatic experience during their work activity. Three quarter of these EPs have children of their own. The results of the study show that frequency of exposure to traumatic (work) events contributes next to occurrence of situations that increase the risk of burnout to the explanation of variance in posttraumatic stress and psychological distress. The novelty of this study is that it explores the effect of specific determinants of PTSS, psychological distress, fatigue, somatic complaints and job satisfaction in Emergency Physicians. Especially occurrence of situations that increase the risk of burnout seems to have a major impact on all outcomes including job satisfaction, while occurrence of violence contributes especially to psychological distress and perceived fatigue. Lack of social support is a well-known predictor of occupational stress in emergency care workers. In contrast however, good social support of colleagues at work, as we found in our study, can facilitate the recovery process after confrontation with traumatic events and occupational hazards. Conclusion Emergency Physicians are particularly vulnerable to post-traumatic stress and chronic stress consequences due to repetitive exposure to work related traumatic events. Training in dealing with violence and situations that can increase the risk of burnout can reduce detrimental consequences in emergency physicians. In addition, it is suggested that emergency units are screened systematically on determinants of burnout, in view of interventions. Finally, creating a supportive work environment and training the medical staff in supportive skills with backup by experts may also reduce adverse consequences of confrontation with traumatic work events.
Collapse
Affiliation(s)
- Francis J Somville
- Department of Health and Medical Psychology, University of Leiden, Wassenaarseweg 52, Leiden, The Netherlands. .,Department of Emergency and Traumatology, AZ St Dimpna, J.B. Stessenstraat 2, Geel, 2440, Belgium.
| | - Véronique De Gucht
- Department of Health and Medical Psychology, University of Leiden, Wassenaarseweg 52, Leiden, The Netherlands
| | - Stan Maes
- Department of Health and Medical Psychology, University of Leiden, Wassenaarseweg 52, Leiden, The Netherlands
| |
Collapse
|
33
|
Barbee AP, Fallat ME, Forest R, McClure ME, Henry K, Cunningham MR. EMS Perspectives on Coping with Child Death in an Out-of-Hospital Setting. JOURNAL OF LOSS & TRAUMA 2016. [DOI: 10.1080/15325024.2015.1117929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Anita P. Barbee
- Kent School of Social Work, University of Louisville, Louisville, Kentucky, USA
| | - Mary E. Fallat
- Department of Surgery, School of Medicine Work, University of Louisville, Louisville, Kentucky, USA
| | - Richard Forest
- Kosair Children's Hospital Pediatric Bereavement Care Program, Louisville, Kentucky, USA
| | - Mary E. McClure
- Department of Surgery, School of Medicine Work, University of Louisville, Louisville, Kentucky, USA
| | - Katy Henry
- Kent School of Social Work, University of Louisville, Louisville, Kentucky, USA
| | | |
Collapse
|
34
|
Pinto RJ, Henriques SP, Jongenelen I, Carvalho C, Maia ÂC. The Strongest Correlates of PTSD for Firefighters: Number, Recency, Frequency, or Perceived Threat of Traumatic Events? J Trauma Stress 2015; 28:434-40. [PMID: 26389531 DOI: 10.1002/jts.22035] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Firefighters experience a wide range of traumatic events while on duty and are at risk to develop psychopathology and posttraumatic stress disorder (PTSD). According to cognitive models, the person's interpretation of the traumatic event is responsible for the development of PTSD rather than the traumatic event itself. This cross-sectional study aimed to explore the contribution of perceived threat to explain PTSD symptoms in Portuguese firefighters, after adjusting for potential confounding factors. A sample of 397 firefighters completed self-report measures of exposure to traumatic events, psychopathology, and PTSD. Perceived threat explained unique variance in PTSD symptoms, R(2) = .40, ΔR(2) = .02, F(10, 367) = 24.55, p < .001, Cohen's f(2) =.03, after adjusting for psychopathology, number, recency, and frequency of the events, and other potential confounding variables. The association between psychopathology and PTSD was also moderated by perceived threat, R(2) = .43, ΔR(2) = .03, F(11, 366) = 25.33, p < .001, Cohen's f(2) =.05. Firefighters may benefit from interventions that focus on perceived threat to prevent PTSD symptoms.
Collapse
Affiliation(s)
- Ricardo J Pinto
- Faculty of Psychology, University of Lusófona, Porto, Portugal
| | | | - Inês Jongenelen
- Faculty of Psychology, University of Lusófona, Porto, Portugal
| | | | - Ângela C Maia
- School of Psychology, University of Minho, Braga, Portugal
| |
Collapse
|
35
|
Kleim B, Bingisser MB, Westphal M, Bingisser R. Frozen moments: flashback memories of critical incidents in emergency personnel. Brain Behav 2015; 5:e00325. [PMID: 26221567 PMCID: PMC4511283 DOI: 10.1002/brb3.325] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 12/08/2014] [Accepted: 12/22/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Emergency Department personnel regularly face highly stressful situations or critical incidents (CIs) that may subsequently be recalled as unbidden intrusive memories. In their most extreme form, such memories are reexperienced as if they were happening again in the present, as flashbacks. This study examined (1) which CIs are associated with flashback memories; (2) candidate person and work-related features that predict flashback memories; and (3) the association between flashback memories and anxiety, depression, and emotional exhaustion. METHODS Emergency nurses (N = 91; 80.2% female) were recruited from two urban teaching hospitals and filled in self-report questionnaires. RESULTS A majority (n = 59, 65%) experienced intrusive memories; almost half of the sample reported that their memories had flashback character. Those involved in resuscitations in the past week were at a fourfold risk for experiencing flashbacks. Having worked more consecutive days without taking time off was associated with a somewhat lower incidence of flashbacks. Moreover, older individuals who reported more work-related conflicts were at greater risk for experiencing flashback memories than their younger colleagues with heightened work conflict and flashback memory scores, respectively. Flashback memories were associated with heightened symptoms of anxiety, depression, and emotional exhaustion. CONCLUSIONS The present findings have implications for evidence-based health promotion in emergency personnel and other individuals regularly exposed to CIs.
Collapse
Affiliation(s)
- Birgit Kleim
- Department of Experimental Psychotherapy, University of ZurichZurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital ZurichZurich, Switzerland
| | | | - Maren Westphal
- Department of Psychology, Pace UniversityPleasantville, New York
- New York State Psychiatric Institute, Columbia UniversityNew York, New York
| | - Roland Bingisser
- Department of Emergency Medicine, University Hospital BaselBasel, Switzerland
| |
Collapse
|
36
|
Skogstad L, Fjetland AM, Ekeberg Ø. Exposure and posttraumatic stress symptoms among first responders working in proximity to the terror sites in Norway on July 22, 2011 - a cross-sectional study. Scand J Trauma Resusc Emerg Med 2015; 23:23. [PMID: 25888472 PMCID: PMC4462086 DOI: 10.1186/s13049-015-0104-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 02/15/2015] [Indexed: 11/16/2022] Open
Abstract
Background Norway experienced two terror attacks on July 22, 2011. A car bomb exploded in the Oslo government district killing eight people. Shortly after, 69 adolescents gathered at a political youth camp were shot and killed at Utøya Island. First responders were exposed to multiple risk factors for the development of posttraumatic stress symptoms (PTSS). Methods This cross-sectional study investigated the degree of perceived peritraumatic strain among police officers, fire-fighters, and ambulance personnel, as well as the prevalence and predictors of PTSS. A questionnaire was completed by 89 ambulance personnel, 73 fire-fighters, and 76 police officers working close to the terror sites, 8–11 months after the event. PTSS were assessed using the PTSD Check List (PCL-S). Results Merging all groups, 68% reported to have witnessed injured/dead people, but only 5.7% reported this as very/extremely strainful. The PCL-S scores were low and not significantly different among the three professions (Median = 19-20, range 17-64). The prevalence of possible PTSD (cut-off > 50) was 1.3 %, and 2 % had scores indicating sub-threshold PTSD. Dissociation predicted higher PTSS-level in all groups (β 1.6-5.1), witnessing injured/dead among ambulance personnel (β 2.5) and feeling overwhelmed among police officers (β 1.2). Conclusion First responders were exposed to deaths, injuries, and destruction, but few reported this as highly stressful. The prevalence of possible PTSD was low in all occupational groups, and symptoms of dissociation were found to be the most important predictor.
Collapse
Affiliation(s)
- Laila Skogstad
- Department of Acute Medicine, Oslo University Hospital, Ulleval, Box 4956, Nydalen, 0424, Oslo, Norway.
| | - Anja M Fjetland
- Department of Acute Medicine, Oslo University Hospital, Ulleval, Box 4956, Nydalen, 0424, Oslo, Norway.
| | - Øivind Ekeberg
- Department of Acute Medicine, Oslo University Hospital, Ulleval, Box 4956, Nydalen, 0424, Oslo, Norway. .,Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.
| |
Collapse
|
37
|
Jacobowitz W, Moran C, Best C, Mensah L. Post-Traumatic Stress, Trauma-Informed Care, and Compassion Fatigue in Psychiatric Hospital Staff: A Correlational Study. Issues Ment Health Nurs 2015; 36:890-9. [PMID: 26631861 DOI: 10.3109/01612840.2015.1055020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Assault of staff in psychiatric hospitals is a frequent occurrence, and studies indicate that hospital staff are at risk of developing post-traumatic stress disorder (PTSD). We performed a correlational study with a convenience sample of 172 staff in a psychiatric hospital and compared the rate of traumatic events (TEs), resilience, confidence, and compassion fatigue to PTSD symptoms (PTSS). Regression analyses identified two variables that were unique predictors of PTSS: (1) trauma-informed care (TIC) meeting attendance and (2) burnout symptoms. Severe TEs, age, and compassion satisfaction also contributed to the model. Attention to these factors may help reduce PTSS in psychiatric staff.
Collapse
Affiliation(s)
- William Jacobowitz
- a Adelphi University, College of Nursing and Public Health , Garden City , New York , USA
| | | | - Cheryl Best
- a Adelphi University, College of Nursing and Public Health , Garden City , New York , USA
| | - Lucy Mensah
- a Adelphi University, College of Nursing and Public Health , Garden City , New York , USA
| |
Collapse
|
38
|
Sattler DN, Boyd B, Kirsch J. Trauma-exposed firefighters: relationships among posttraumatic growth, posttraumatic stress, resource availability, coping and critical incident stress debriefing experience. Stress Health 2014; 30:356-65. [PMID: 25476961 DOI: 10.1002/smi.2608] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 02/21/2014] [Accepted: 08/05/2014] [Indexed: 11/08/2022]
Abstract
This project examines protective factors associated with resilience/posttraumatic growth and risk factors associated with posttraumatic stress among firefighters exposed to critical incidents. The participants were 286 (257 men and 29 women) volunteer and paid firefighters in Whatcom County, Washington. Participants completed an anonymous survey asking about demographics, critical incident exposure, posttraumatic stress symptoms, posttraumatic growth, resource availability, coping, occupational stress and critical incident stress debriefing experience. Most participants had significant critical incident exposure, and about half had attended critical incident stress debriefing sessions. Posttraumatic growth was associated with being female, critical incident exposure, critical incident stress debriefing attendance, posttraumatic stress symptoms (negative association), occupational support, occupation satisfaction, occupational effort, problem-focused coping, emotion-focused coping and personal characteristic resources. Posttraumatic stress symptoms were positively associated with years of firefighting, burnout, occupational effort and disengagement coping and negatively associated with critical incident stress debriefing attendance, posttraumatic growth, social support, internal locus of control, personal characteristic resources, energy resources and condition resources. The findings support conservation of resources stress theory and show that the maintenance and acquisition of resources can offset losses and facilitate resilience/posttraumatic growth. Implications of the findings for enhancing firefighter resources, facilitating resilience and minimizing occupational stressors are discussed.
Collapse
Affiliation(s)
- David N Sattler
- Department of Psychology, Western Institute for Social Research, Western Washington University, Bellingham, WA, USA
| | | | | |
Collapse
|
39
|
Swedish Ambulance Managers’ Descriptions of Crisis Support for Ambulance Staff After Potentially Traumatic Events. Prehosp Disaster Med 2014; 29:589-92. [DOI: 10.1017/s1049023x14001071] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractIntroductionAmbulance staff face complex and sometimes stressful or potentially traumatic situations, not only in disasters but also in their routine daily work. The aim of this study was to survey ambulance managers’ descriptions of crisis support interventions for ambulance staff after potential traumatic events (PTEs).MethodsSemistructured interviews with a qualitative descriptive design were conducted with six ambulance managers in a health care region in central Sweden. The data was analyzed using content analysis.ResultFive categories were found in the result: (1) description of a PTE; (2) description and performance of crisis support interventions; (3) impact of working in potentially traumatic situations; (4) the ambulance managers’ role in crisis support interventions; and (5) the ambulance managers’ suggestions for improvement. Ambulance managers described crisis support interventions after a PTE as a single, mandatory group meeting with a structure reminiscent of debriefing. The ambulance managers also expressed doubts about the present structures for crisis support and mentioned an alternative approach which is more in line with present evidence-based recommendations.ConclusionThe results indicated a need for increased understanding of the importance of the managers’ attitudes for ambulance staff; a need for further implementation of evidence-based recommendations for crisis support interventions was also highlighted.HugeliusK, BergS, WesterbergE, GiffordM, AdolfssonA. Swedish ambulance managers’ descriptions of crisis support for ambulance staff after potentially traumatic events. Prehosp Disaster Med. 2014;29(6):1-4.
Collapse
|
40
|
Golden LL, Jones RT, Donlon K. Delayed Treatment Seeking Following the April 16th Shootings at Virginia Tech: Impact on a First Responder. Clin Case Stud 2013. [DOI: 10.1177/1534650113512174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This case study discusses the treatment of an emergency responder to the 2007 shooting on Virginia Tech’s campus where 33 students and faculty members were killed. After a thorough assessment, prolonged exposure (PE) was used to treat the emergency worker, referred to as Jack, for posttraumatic stress disorder (PTSD). Assessment measures administered at the conclusion of treatment, 1 month post-treatment, and 6 months post-treatment suggest that the treatment gains were maintained following the culmination of treatment. The primary aim of this article is to provide support for the effectiveness of PE among emergency responders who develop PTSD. In addition, this case presentation is particularly important given the prevalence of mass shootings in the United States. Several complicating factors, including a delay in treatment seeking, arose over the course of treatment and are discussed.
Collapse
|
41
|
Hegg-Deloye S, Brassard P, Jauvin N, Prairie J, Larouche D, Poirier P, Tremblay A, Corbeil P. Current state of knowledge of post-traumatic stress, sleeping problems, obesity and cardiovascular disease in paramedics. Emerg Med J 2013; 31:242-7. [PMID: 23314206 DOI: 10.1136/emermed-2012-201672] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE The impacts of emergency work on firefighters have been well documented and summarised, but this is not the case for paramedics. This paper explores the literature regarding the impact of work stress on paramedics. OBJECTIVE To identify the literature available on the effect of paramedics' jobs on their health status. METHODS Electronic database used: MEDLINE (Ovid, PubMed, National Library of Medicine) between 2000 and 2011. Key words used for the computer searches were: paramedics, emergency responders, emergency workers, shift workers, post-traumatic symptoms, obesity, stress, heart rate variability, physiological response, blood pressure, cardiovascular and cortisol. Exclusion criteria were: studies in which participants were not paramedics, participants without occupational exposure, physical fitness assessment in paramedics and epidemiological reports regarding death at work. RESULTS The electronic databases cited 42 articles, of which we excluded 17; thus, 25 articles are included in this review. It seems clear that paramedics accumulate a set of risk factors, including acute and chronic stress, which may lead to development of cardiovascular diseases. Post-traumatic disorders, sleeping disorders and obesity are prevalent among emergency workers. Moreover, their employers use no inquiry or control methods to monitor their health status and cardiorespiratory fitness. CONCLUSIONS More studies are needed to characterise paramedics' behaviour at work. These studies could allow the development of targeted strategies to prevent health problems reported in paramedics.
Collapse
|
42
|
The impact of traumatic events on emergency room nurses: Findings from a questionnaire survey. Int J Nurs Stud 2012; 49:1411-22. [DOI: 10.1016/j.ijnurstu.2012.07.003] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 06/23/2012] [Accepted: 07/06/2012] [Indexed: 11/13/2022]
|