Secondary traumatic stress among emergency nurses: a cross-sectional study

A Qualitative Study of School Nurses' Experience of Secondary Trauma

This qualitative descriptive study explored school nurses' experiences of exposure to reports of trauma from those in their care. Online interviews of school nurses practicing in NJ, USA, were recorded and transcribed verbatim. The study found that school nurses were exposed to reports of others' trauma to varying degrees, with those serving in urban settings reporting more stories of exposure than those in suburban settings. Reports included numerous, layered traumas at the community and individual levels, including students' poverty-related adversity and psychological distress. Qualitative content analysis revealed four categories: Health Office as Safe Haven, Challenges Working Within the School Model, Things That We Hear: Reports of Trauma, and The Ripple Effect of Trauma. School-based challenges included a lack of collaboration, misunderstanding of the school nurse's role, and workload issues such as competing demands and limited time and resources. School nurses reported focusing on the individual's immediate needs and processing the experience afterward. They acknowledged they can only do so much, and shared stories of coping and resilience. Additional education, resources, and support in addressing student trauma can enhance the provision of school nursing services and support the well-being of school nurses, students, and staff. Further research is warranted with a larger and more diverse sample of school nurses, including attention to school nurse wellness and resilience strategies.

Relationship between moral resilience and secondary traumatic stress among ICU nurses: A cross-sectional study

BACKGROUND

Since the outbreak of COVID-19, researchers worldwide have focused more on the issue of secondary traumatic stress (STS) experienced by nurses. This stress has an adverse effect on the health of nurses and the quality of nursing care, potentially undermining the stability of the nursing team and hindering the ability to meet the growing demand for nursing services. The impact of the COVID-19 pandemic, and the rise in global demand for ICU nursing, has placed a significant strain on ICU nurses, severely damaging their mental and physical health. Notably, ICU nurses also face high levels of moral distress, and moral resilience can effectively alleviate this distress and improve the quality of care.

AIMS

This study aimed to examine the levels of moral resilience and STS among ICU nurses, to explore their relationship and identify the factors influencing STS.

STUDY DESIGN

This cross-sectional study involved 229 ICU nurses from two tertiary hospitals in Xi'an, China, who participated between November and December 2023. The data were collected through email using anonymous electronic questionnaires, encompassing a self-designed demographic- and work-life-related characteristic questionnaire; the Rushton Moral Resilience Scale; and the Secondary Traumatic Stress Scale. Descriptive statistics, t-tests, analysis of variance and hierarchical regression analysis were performed to analyse the data.

RESULTS

The findings of the study indicated that ICU nurses' moral resilience and STS scores were at an intermediate level. Hierarchical regression analysis indicated that STS was negatively correlated with the subscales of the Rushton Moral Resilience Scale, specifically moral adversity coping (β, -0.156; 95% CI, -1.241 to -0.039) and relational integrity (β, -0.245; 95% CI, -1.453 to -0.388), which are significant predictors of STS. Additionally, good sleep quality (β, -.396; 95% CI, -14.948 to -7.117) and seeking psychological counselling because of work difficulties (β, .107; 95% CI, 0.237-9.624) emerged as significant predictors of STS among ICU nurses, with the model's explanation of the variance in STS increasing to 45.5%, △R2 = .167, F = 16.482 (p < .001).

CONCLUSION

This study found that ICU nurses have moderate levels of moral resilience and STS, which are negatively correlated. This suggests that improving the moral resilience of ICU nurses may help reduce their STS levels.

RELEVANCE TO CLINICAL PRACTICE

The study revealed that ICU nurses' moral resilience and secondary traumatic stress levels were at a moderate level, indicative of the need to take measures to enhance their moral resilience and reduce their secondary traumatic stress, as their presence not only affects the health of ICU nurses but also diminishes the quality of care and increases turnover rates.

Listening to other people's traumatic experiences: What makes it hard and what could protect professionals from developing related distress? A qualitative investigation

Listening to people talk about their trauma experiences involves indirect exposure to trauma (IET) and can trigger emotional distress. Existing studies about the risk factors for post-IET distress have methodological limitations and reported inconsistent results, making their findings difficult to meaningfully synthesise. Also, most of them did not focus explicitly on trauma narratives and did not explore qualitatively the opinions and experiences of professionals who work closely with trauma survivors. The present study involved 36 professionals who worked with trauma survivors and used a qualitative design to investigate: (a) the perceived impact of the survivors' accounts, (b) the factors they deemed as important to be psychologically prepared for trauma accounts, and (c) their strategies for coping with IET. The semi-structured interviews conducted yielded rich data that was analysed thematically and organised in 13 subordinate themes, and 4 master themes. Listening to trauma narratives was thought to lead to emotional distress when it challenges the listener's 'basic assumptions' of safety and justice, when the listener has reduced sense of control and operates outside their 'window of tolerance', when empathic responses are too strong, and psychological preparedness for trauma-narratives is perceived as insufficient. Recommendations for future research and implications for practice are discussed.

Exposure to secondary traumatic stress and its related factors among emergency nurses in Saudi Arabia: a mixed method study

BACKGROUND

Emergency department (ED) nurses are exposed to the risk of secondary traumatic stress (STS), which poses a threat not only to nurses' health and psychological well-being but also adversely affects the execution of their professional duties. The quality and outcome of their nursing services are negatively affected by STS.

PURPOSE

The purpose of this study is to comprehensively investigate the prevalence and intensity of Secondary Traumatic Stress (STS) among Emergency Department (ED) nurses. It aims to identify and analyze the socio-demographic, occupational, and psychological factors that influence the severity and variation of STS experienced by these nurses.

METHODS

The study utilized a sequential explanatory mixed methods approach, including two phases. Phase 1 employed a cross-sectional study design, utilizing a convenience sample of 181 nurses to explore the levels of STS and the factors associated with it. Following this, Phase 2 was structured as a qualitative descriptive study, which involved conducting semi-structured interviews with a purposefully selected group of ten ED nurses. Data collection took place at three major hospitals in Saudi Arabia during the period from January to June 2022.

RESULTS

A total of 181 participants were included in the study. The mean STSS score reported by the nurses was 51 (SD = 13.23) out of the maximum possible score of 85, indicating severe STS among ED nurses. Factors associated with an increase in the levels of STS among ED nurses included being female, older in age, married, possessing higher education and experience, having a positive relationship with colleagues, receiving organisational support, and dealing with a higher number of trauma cases. Several themes emerged from the qualitative interviews including: ED Characteristics: Dual Impact on STS, Emotional Resonance and Vulnerability, Personal Life Stressors, The Ability to Cope, and Social Support.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

Future strategies and interventions targeting STS should be prioritized to effectively manage its impact on ED nurses. It is crucial to develop targeted interventions that address the specific factors contributing to STS, as identified in this study. Additionally, these findings aim to enhance awareness among nursing administrators, managers, and supervisors about the critical factors associated with STS. This awareness is essential for accurately assessing and developing interventions that mitigate STS among nursing staff.

Compassion Satisfaction, Burnout, and Secondary Traumatic Stress among Saudi Nurses at Medical City: A Cross-Sectional Study

Compassion satisfaction, the pleasure gained from assisting others in their recovery from trauma, can help reduce the effects of burnout and secondary traumatic stress. As such, nurses' job satisfaction can be increased by increasing compassion satisfaction and decreasing compassion fatigue. This study examined the incidence of compassion fatigue and other influencing variables, such as compassion satisfaction, burnout, and secondary traumatic stress, among Saudi nurses. This was a cross-sectional study using convenience sampling. Participants comprised 177 registered nurses from various nursing departments. Data collection included the Professional Quality of Life Scale based on lifestyle, demographic details, and occupation-related questions. The averages of scores for the variables, compassion satisfaction, burnout, and secondary traumatic stress, were recorded (37.1 ± 7.4, 25.7 ± 7.5, and 26.7 ± 6.4). Participants aged 36 or older comprised a negative factor for compassion satisfaction, while years of nursing experience and higher job satisfaction were favorable predictors. Together, these three variables accounted for 30.3% of the overall variation. Low job satisfaction and poor sleep negatively affected burnout, accounting for 39.8% of the total variance. The results offer insights into identifying the risks of compassion fatigue in nurses and help design strategies to address burnout and secondary traumatic stress while enhancing their compassion satisfaction levels.

Relationship between transition shock in novice emergency room nurses, quality of nursing care, and adverse patient events: The mediating role of emotional exhaustion

BACKGROUND

Transition shock, experienced during the first two years of employment, has been attributed to decreased clinical performance and an overall decrease in work productivity among newly graduated nurses, as well as compromised patient safety outcomes. This study tested the intermediary effect of emotional exhaustion on the association between transition shock in novice emergency room (ER) nurses, adverse patient events, and nursing care quality.

METHODS

A descriptive study was carried out involving 303 novice ER nurses from various emergency units in five different hospitals in Central Philippines, utilizing four standardized scales. Mediation testing was performed using Hayes' PROCESS macro in SPSS (Model 4).

RESULTS

Transition shock in novice ER nurses was associated with an increased incidence of adverse patient events (β = 0.3897, p = 0.0005) and poorer nursing care quality (β = -0.2146, p = 0.0021). Furthermore, emotional exhaustion partially mediated the association between transition shock and the two patient-related outcomes: adverse patient events (β = 0.0477, 95 % CI = 0.0078-0.0997) and nursing care quality (β = -0.0142, 95 % CI = -0.0412 to -0.0095).

CONCLUSIONS

Transition shock in novice ER nurses contributed to heightened emotional exhaustion, which subsequently led to an increased incidence of adverse patient events and a decline in the quality of nursing care.

Prevalence and associated factors of secondary traumatic stress in emergency nurses: a systematic review and meta-analysis

Background: Nurses in emergency departments are at a high risk of experiencing secondary traumatic stress because of their frequent exposure to trauma patients and high-stress environments.Objective: This systematic review and meta-analysis aimed to determine the overall prevalence of secondary traumatic stress among emergency nurses and to identify the contributing factors.Method: We conducted a systematic search for cross-sectional studies in databases such as PubMed, Web of Science, Embase, CINAHL, Wanfang Database, and China National Knowledge Internet up to October 21, 2023. The Joanna Briggs Institute's appraisal checklists for prevalence and analytical cross-sectional studies were used for quality assessment. Heterogeneity among studies was assessed using Cochrane's Q test and the I2 statistic. A random effects model was applied to estimate the pooled prevalence of secondary traumatic stress, and subgroup analyses were performed to explore sources of heterogeneity. Descriptive analysis summarized the associated factors.Results: Out of 345 articles retrieved, 14 met the inclusion criteria, with 11 reporting secondary traumatic stress prevalence. The pooled prevalence of secondary traumatic stress among emergency nurses was 65% (95% CI: 58%-73%). Subgroup analyses indicated the highest prevalence in Asia (74%, 95% CI: 72%-77%), followed by North America (59%, 95% CI: 49%-72%) and Europe (53%, 95% CI: 29%-95%). Nine studies identified associated factors, including personal, work-related, and social factors. In the subgroup of divided by recruitment period, emergency department nurses in the COVID-19 outbreak period had a higher prevalence of secondary traumatic stress (70%, 95% CI: 62%-78%).Conclusions: Secondary traumatic stress prevalence is notably high among emergency department nurses, with significant regional variations and period differences. The factors affecting secondary traumatic stress also varied across studies. Future research should focus on improving research designs and sample sizes to pinpoint risk factors and develop prevention strategies.Registration: PROSPERO CRD42022301167.

A multi-institute, follow-up, observational study measuring nursing students' adherence to infection prevention and control protocols in Saudi Arabia

Background

Nursing students learn principles of infection prevention and control (IPC) and hand hygiene (HH) in clinical courses, and their learning is reflected in their practice.

Objectives

The knowledge, attitude, and practice of principles of IPC and HH of the students were measured prior to and after attending an educational workshop. The adherence of the students to the IPC and HH protocols at the hospital was also observed.

Methods

This study included a pretest-posttest time series follow-up and an observational part. During the first part of the study, students attended a workshop, which was preceded by a pretest. It was then followed by a posttest directly after finishing the workshop and in 12 weeks. Participants were submitted to an observational part by a trained observer to document certain skills taught earlier during the workshop.

Settings

Students from three nursing schools in Saudi Arabia participated in the study.

Participants

A total number of 130 completed the study protocol, and 100 completed the observation part.

Results

Students were found to experience an improvement in their knowledge, beliefs, and commitment scales after the workshop. The attitude scale remained relatively unchanged over different tests. Most students performed the skills properly and adequately, but some failed to perform certain skills, like hand rub, and the proper use of disinfectants.

Secondary traumatic stress in working nurses studying part time in a bachelor or Master's nursing program in Croatia: a cross-sectional study

BACKGROUND

Nurses are more likely to be exposed to human suffering than other healthcare professionals. Persons exposed to indirect trauma can experience symptoms of posttraumatic stress disorder, symptoms of avoidance, arousal and intrusion. Secondary traumatic stress (STS) occurs when a person hears about the firsthand traumatic experiences of another. This study aimed to explore the prevalence of STS among working nurses enrolled at a university nursing program.

METHODS

A cross-sectional study was conducted among nurses working in healthcare enrolled in university bachelor's or Master's nursing studies at the Catholic University of Croatia in November 2017. Data were collected using the Secondary Traumatic Stress Scale (STSS) and two items from the World Health Organization quality of life brief version (WHOQOL-BREF).

RESULTS

The study included 151 students; the response rate was 70%. The mean STS score was 38, indicating that the students on average suffered from moderate STS. Half of participating nurses met the criteria for STS. Working nurses enrolled in Master's studies had lower STS scores than those enrolled into bachelor studies (t = 4.14, df = 149, p < 0.01). The level of STS had a negative correlation with participants' quality of life assessment (r=-0.392, p < 0.01) and satisfaction with their health (r=-0.387, p < 0.01). We also found a significant positive correlation between subjective assessment of quality of life and satisfaction with personal health (r = 0.432, p < 0.01). We did not find a significant association between the level of STS and sex (r=-0.094) or years of nursing work experience (r=-0.069). Level of STS varied depending on the participants' workplace, years of experience in that workplace and their work shifts. The highest levels of STS were seen in nurses working in the internal medicine department, those with 10-14 years of work experience in the current workplace, and those who work block shifts (12-hr shift followed by 24-hour shift).

CONCLUSION

Over half of working nurses attending university studies had at least moderate STS. Furthermore, STS was negatively associated with participants' perception of quality of life and satisfaction with their health. Prevention and alleviation interventions could reduce the burden of STS among nurses.

Secondary Traumatic Stress Disorder Among Physiotherapists Working in High Morbidity Departments: A Cross-Sectional Study

Purpose

This study's objective was to measure secondary traumatic stress disorder among Saudi Arabian physiotherapists employed in the critical care, neurology, cardiology, pulmonology, and mental health fields. Also, to identify the factors related to secondary traumatic stress.

Methods

Between July 2021 and June 2022, a cross-sectional study involving physiotherapists from the critical care, emergency, neurology, cardiology, pulmonology, and mental health departments was carried out. Data were collected from the participants by using the validated Secondary Traumatic Stress Scale (STSS). Appropriate Statistical analysis (bivariate and multivariate) was carried using SPSS 21.0 software to analyse the data.

Results

We quantified the prevalence of secondary traumatic stress, among 201 healthcare professionals (physiotherapists) in total were assessed; of them, 23.4% worked in the medical/surgical and neurosurgical departments and 5% in the critical care and emergency departments. Twenty-four percent of the participants slept less than five hours each day, and 26.4% worked more than 45 hours per week. Our study subjects had mild STS in 25.4% of cases, moderate stress in 15.9%, high STS in 15.9% and severe STS in 30.9% of cases. The intrusion score (mean = 11.65), avoidance score (mean = 5.5), arousal score (mean = 4.1) and total mean score of 42.50 of the STSS were significantly different across the age groups, marital status and years of experience of study participants. The regression analysis shows age groups and severe stress were independently related to the total STS scores.

Conclusion

The study has found out higher level of STS among physiotherapists which highlights the necessity for a variety of interventional programs to be implemented in hospital settings in order to enhance communication abilities, lessen emotional discomfort, and apply relaxing techniques.

The evolution of mandatory continuing professional development (CPD) for diagnostic radiographers in Ireland - A longitudinal study

INTRODUCTION

This longitudinal research study reports on aspects of CPD immediately before and in the years following the simultaneous introduction of state registration and mandatory CPD for diagnostic radiographers in Ireland.

METHODS

Surveys captured information through closed and open questions distributed nationally across various hospital types in hard copy and online formats. Opinion was gathered over 8-years at three time points, prior to the introduction of mandated changes, post-introduction at the end of the first audit cycle, and as society was emerging from a period of pandemic.

RESULTS

Responses were received across age and grade ranges with response rates in keeping with previous surveys. The overall importance with which radiographers held CPD decreased over time, and while small changes were seen, the narrow focus of what radiographers considered CPD had stayed the same, with attendance-based activities remaining the most popular. Respondents indicated that their enthusiasm for undertaking CPD and willingness to undertake CPD outside of working hours had also decreased, with the perceived primary barrier to CPD shifting from funding to time.

CONCLUSIONS

An appetite to undertake CPD amongst the majority is evident; however, addressing issues such as decreasing importance levels and willingness to use personal time for CPD is crucial. While the perceived cost of CPD has lessened as a barrier, lack of time for CPD is now a principal concern. Further research is recommended to explore the broader impacts of time pressures and optimises CPD for radiographers.

IMPLICATIONS FOR PRACTICE

Findings highlight the need for collaborative engagement and support to optimise CPD opportunities for all radiographers in the future.

An Integrative Review of Measures of Secondary Traumatic Stress

Background and Purpose: Secondary traumatic stress (STS) results in detrimental effects in healthcare professionals, impacting the safety of patients and their care. There are multiple instruments being used to measure STS, reflecting the uncertainty on how to best measure STS. The purpose of this review is to present an overview of the state of measurement of STS. Methods: PubMed, CINAHL, and Cochrane Database of Systematic Reviews databases were searched using the terms "secondary traumatic stress" and "measurement." Results: The search resulted in nine applicable articles and four instruments used to measure STS. Utility and psychometric properties of the instruments are examined. Conclusions: The secondary traumatic stress scale is most appropriate to measure STS given that it is the only instrument intended to measure only STS, but psychometric testing with nurses is needed.

Self-Compassion Interventions to Target Secondary Traumatic Stress in Healthcare Workers: A Systematic Review

Healthcare professionals' wellbeing can be adversely affected by the intense demands of, and the secondary traumatic stress associated with, their job. Self-compassion is associated with positive wellbeing outcomes across a variety of workforce populations and is potentially an important skill for healthcare workers, as it offers a way of meeting one's own distress with kindness and understanding. This systematic review aimed to synthesise and evaluate the utility of self-compassion interventions in reducing secondary traumatic stress in a healthcare worker population. Eligible articles were identified from research databases, including ProQuest, PsycINFO, ScienceDirect, Google Scholar, and EBSCO. The quality of non-randomised and randomised trials was assessed using the Newcastle-Ottawa Scale. The literature search yielded 234 titles, from which 6 studies met the inclusion criteria. Four studies reported promising effects of self-compassion training for secondary traumatic stress in a healthcare population, although these did not use controls. The methodological quality of these studies was medium. This highlights a research gap in this area. Three of these four studies recruited workers from Western countries and one recruited from a non-Western country. The Professional Quality of Life Scale was used to evaluate secondary traumatic stress in all studies. The findings show preliminary evidence that self-compassion training may improve secondary traumatic stress in healthcare professional populations; however, there is a need for greater methodological quality in this field and controlled trials. The findings also show that the majority of research was conducted in Western countries. Future research should focus on a broader range of geographical locations to include non-Western countries.

Piloting Peer Support to Decrease Secondary Traumatic Stress, Compassion Fatigue, and Burnout Among Air Medical Crewmembers

OBJECTIVE

The current research was performed to assess professional quality of life; identify factors associated with secondary traumatic stress, burnout, and compassion satisfaction; and evaluate the effectiveness of a peer support pilot intervention among air medical crewmembers.

METHODS

Quantitative research methods were used to assess secondary traumatic stress, compassion satisfaction, and burnout among flight nurses and paramedics. Demographic variables and secondary traumatic stress, burnout, and compassion satisfaction scores using the Professional Quality of Life Scale were assessed. A comparison of survey scores obtained before and 16 months after the implementation of a piloted peer support program was performed.

RESULTS

Crewmembers with less experience within an air medical program and those without a support system are at the highest risk of developing secondary traumatic stress, burnout, and impaired compassion satisfaction. Observed scores for secondary traumatic stress, burnout, and compassion satisfaction suggest that peer support may be an effective intervention among air medical crewmembers. No statistically significant differences in secondary traumatic stress, burnout, or compassion satisfaction were observed by clinical role, marital status, or years in their profession.

CONCLUSION

Peer support after emotionally challenging or stressful transports may combat secondary traumatic stress, compassion fatigue, and burnout. This intervention would be most beneficial for crewmembers who are newer to the transport organization and lack social or familial support.

Assessing the Prevalence, Predictors, and Consequences of Secondary Traumatic Stress Among Emergency Nurses in Palestine During the COVID-19 Pandemic

Introduction

Emergency nurses who are working in direct contact with COVID-19 patients are at an increased risk of developing secondary traumatic stress disorder. This study aimed to assess the prevalence, predictors, and consequences of secondary traumatic stress among emergency nurses in Palestine during the COVID-19 pandemic.

Methods

The study utilized a cross-sectional design and recruited a total of 189 emergency nurses from multiple healthcare centers in Palestine. Data collected from January 21, 2021, to March 31, 2021.

Results

The study revealed that emergency nurses had a high degree of secondary traumatic stress with the prevalence of high to severe symptoms of secondary traumatic stress being 61% of the total participants. In terms of predictors, the results showed that years of experience, level of education, burnout, and organizational support were significantly correlated with secondary traumatic stress and thus that years of experience and burnout are predictors of secondary traumatic stress.

Conclusion

Based on our findings, nurses in emergency departments in Palestine have a high degree of secondary traumatic stress disorder which impacts their lives on a personal and professional level.

Critical Clinical Events and Resilience Among Emergency Nurses in 3 Trauma Hospital-Based Emergency Departments: A Cross-Sectional Study

INTRODUCTION

Emergency nurses experience occupational stressors resulting from exposures to critical clinical events. The purpose of this study was to identify the critical clinical events for emergency nurses serving 3 patient populations (general, adult, pediatric) and whether the resilience of these nurses differed by the patient population served.

METHODS

This study used a cross-sectional survey design. A total of 48 emergency nurses were recruited from 3 trauma hospital-based emergency departments (general, adult, pediatric). Clinical Events Questionnaire, Connor-Davidson Resilience scale, and an investigator-developed demographic questionnaire were used to collect data from respondents.

RESULTS

All respondents were female (n = 48, 100%), and most were White (n = 46, 96%). The average age of participants was 39.6 years, the average number of years as a registered nurse was 12.7 years, and the average number of years as an emergency nurse was 8.8 years. Clinical events considered most critical were providing care to a sexually abused child, experiencing the death of a coworker, and lack of responsiveness by a colleague during a serious situation. The least stress-provoking event was incidents with excessive media coverage. Nurses were less affected by the critical events they experienced more frequently at work. Nurses in the 3 trauma settings had high level of resilience, with no statistically significant differences between groups.

DISCUSSION

The occupational stress from exposure to significant clinical events varied with the patient population served by emergency nurses. It is important that interventions be adopted to alleviate the effect of work-related stressors and promote the psychological health of emergency nurses.

The positives, the challenges and the impact; an exploration of early career nurses experiences in the Emergency Department

BACKGROUND

The intense working environment of the Emergency Department (ED) is exciting and rewarding; but is renowned for high staff turnover and burnout. The wellbeing and retention of the existing workforce is imperative. The purpose of this study was to explore the experiences of early careers nurses in the ED; identify aspects of ED they enjoyed, the challenges and explore potential coping mechanisms used to mitigate negative situations.

METHODS

A qualitative design was used. Eleven semi-structured interviews were conducted with adult and paediatric emergency nurses who had worked in the ED for less than three years. Data were transcribed, open coded and analysed using thematic analysis.

RESULTS

Four key themes emerged; (1) Drawn to emergency nursing; (2) Teamwork; (3) Time to care; and (4) Reflections on the impact.

CONCLUSION

Opportunities for learning and development and being able to provide good levels of patient care were identified important to participants. Challenging aspects of the job included high workloads, exposure to traumatic incidents, violence and aggression. The psychological impact included feelings of burnout, exhaustion, flashbacks, personal growth and perspective. Teamwork, a strong support network and opportunities for formal and informal debrief were identified as helping to mitigate challenging aspects of the job.

Investigation of the Level and Factors Influencing Emergency Department Nurses Fatigue: A Case Study of the Saudi Arabian Context

Background: Work-related fatigue is a common health problem among nurses which can affect their performance and decision making. Significance and Aim: The study explores the levels of fatigue and its associated factors among emergency department (ED) nurses in Saudi Arabia. Methods: The study was developed through a cross-sectional quantitative study design. This included the collection of primary quantitative data with a questionnaire prepared and published on REDCap. The study questionnaire was adapted from two tools, namely the OFER 15 and the Copenhagen II tools, respectively. Results: The study established that the Saudi Arabian ED nurses have high acute fatigue (OFER 15 score = 81.11), moderate-high chronic fatigue (OFER 15 score = 74.17), and a high inter-shift recovery index (OFER 15 score = 78.01). In terms of the predictor factors, the study established that for the demographic factors, gender has an impact on chronic and acute fatigue, while work experience impacted acute fatigue and the number of dependents impacted on inter-shift recovery index. On the psycho-social factors, chronic fatigue is influenced by emotional demand (which is a variable used to evaluate the levels to which the nurse is invested, gaining education/skills thus increases job satisfaction) (−0.289), influence at work (−0.310), commitment at the workplace (0.376), rewards (−0.187), stress (0.420), and burnout (0.293), respectively. Acute fatigue is influenced by the emotional demands (0.336), role clarity (−0.128), and the nurses’ well-being and health (−0.034). Finally, the inter-shift recovery index is influenced by the ED nurses’ burnout levels (−0.877). Conclusions: The study indicates a high level of nursing fatigue among the Saudi Arabian ED nurses.

Dublin hospital workers' mental health during the peak of Ireland's COVID-19 pandemic

Background

Hospital-based healthcare workers have experienced significant psychological stressors during the COVID-19 pandemic.

Aim

To evaluate the mental health of hospital workers during the third wave of the COVID-19 pandemic in Dublin, Ireland.

Methods

Cross-sectional anonymous online survey of hospital workers (n = 377; 181 doctors (48.0%), 166 nurses (44.0%), 30 radiographers (8.0%)), collecting demographic information, COVID-19 exposure history and mental health measures.

Results

There were significant differences between profession groups in gender, experience, COVID-19 infection history, exposure to COVID-19 positive acquaintances, and work areas. Moderate-severe post-traumatic stress disorder (PTSD) symptoms were found in 45.1% (95% CI 40.1–50.1%) of all participants; significantly fewer doctors reported moderate-severe PTSD symptoms (26%; 95% CI 22–36%). A World Health Organisation-5 Wellbeing Index (WHO-5) score ≤ 32, indicating low mood, was reported by 52% (95% CI 47–57%) of participants; significantly fewer doctors reported low mood (46%; 95% CI 39–53%). One-week suicidal ideation and planning were reported respectively by 13% (95% CI 10–16%) and 5% (95% CI 3–7%) of participants with no between-group differences. Doctors reported significantly less moral injury than other groups. There were no significant between-group differences regarding coping styles. Work ability was insufficient in 39% (95% CI 34–44%) of staff; no between-group differences.

Conclusions

Dublin hospital workers reported high levels of PTSD symptoms, mood disturbance, and moral injury during the COVID-19 pandemic. Concerning levels of suicidal ideation and planning existed in this cohort. Differences in degrees of post-traumatic stress, moral injury, and wellbeing were found between profession groups, which should be considered when planning any supports.

Supplementary information

The online version contains supplementary material available at 10.1007/s11845-022-03056-0.

Nursing Faculty Professional Quality of Life and Resilience in a Changing Educational Environment

BACKGROUND

Growing workload demands of nursing faculty has led to an academic work environment that is stressful with loss of work life balance and occupational burnout.

METHOD

Full-time faculty were surveyed prior to the pandemic at a private school of nursing using the Professional Quality of Life (ProQOL), Bride Secondary Traumatic Stress Scale (STSS), Conner-Davidson Resilience-10 (CDRS-10), and Trauma Informed Climate Scale (TICS-10).

RESULTS

The ProQOL revealed moderate faculty burnout scores (mean score, 25.8). The STSS identified two thirds of faculty experienced secondary traumatic stress in various degrees, with one third of faculty respondents experiencing high to severe STSS symptoms. The CDRS-10 identified 42% of faculty scored within the lowest quartile and 13% of faculty scored within the highest quartile.

CONCLUSION

Faculty must be provided a safe work environment to limit burn-out, promote resilience, and support work life balance to address the current nursing faculty shortage. [J Nurs Educ. 2022;61(6):330-333.].

Hyperacute stroke and the specialist nursing impact: exploring the cause and context of feelings of secondary traumatic stress - a qualitative inquiry

BACKGROUND

Secondary traumatic stress (STS) has been defined as the stress resulting from helping or wanting to help a traumatised or suffering person. The hyperacute nature of stroke specialist nurses' work places them at risk of developing STS.

AIMS

To explore the factors that are influential in stroke specialist nurses' experience of STS development within hyperacute practice.

METHODS

This study is qualitative with a narrative design. Data were collected from a purposive sample of stroke specialist nurses (20 female and 2 male) working in hyperacute services during the years 2016 and 2017. Data were analysed using Polkinghorne's approach.

RESULTS

This research identified four themes: exposure to acute suffering and death- young presentations; moral distress; interactions with relatives and problematic healthcare systems.

CONCLUSION

The findings from this study suggest that stroke specialist nurses are exposed to multiple triggers which are commensurate with the potential for STS development. The findings contribute a new understanding of the emotional burden of hyperacute specialist stroke nursing that has implications for patient safety and satisfaction, services provision and staff well-being.

A Secondary Traumatic Stress Reduction Program in Emergency Room Nurses

Introduction

Secondary traumatic stress is highly prevalent among nurses, especially among nurses working within the emergency department (ED). Reducing healthcare worker secondary traumatic stress is important for ensuring the delivery of high quality, safe patient care. This paper reports on the development and implementation of a secondary traumatic stress reduction program.

Methods

We used an adaption of a 5-week intervention based on the Accelerated Recovery Program to test whether there would be a reduction in secondary traumatic stress in a pilot sample of nine ED nurses. Outcomes were assessed using the Secondary Traumatic Stress Scale (STSS), Somatic Symptoms Scale (SSS), and Compassion Satisfaction subscale (CSS) measures.

Results

Eight of nine nurses were able to complete at least three of the five sessions. Results indicate significant change in STSS (F[5,23]  =  4.22, p  =  .007) and SSS (F[3,15]  =  4.42, p  =  .02) scores, but not CSS (F[5,23]  =  0.83, p  =  .54) scores. Pairwise comparisons revealed that the beneficial effects of the program happened early. For both STSS and SSS, scores at sessions 1 and 2 were generally higher than subsequent sessions. We also found a trend for continued effects on STSS at a four-month follow-up (t₂₃  =  1.95, p  =  .064).

Conclusion

Overall, results indicate the 5-week program was associated with a significant reduction in secondary traumatic stress and related somatic symptoms in healthcare workers.

PREVALENCE AND PREDICTORS OF POSTTRAUMATIC STRESS DISORDER, DEPRESSION, AND ANXIETY IN PERSONNEL WORKING IN EMERGENCY DEPARTMENT SETTINGS: A SYSTEMATIC REVIEW

BACKGROUND

Professionals working in the emergency department (ED) are regularly exposed to traumatic events. Rates of posttraumatic mental health conditions vary widely in the literature and there is no agreement that rates in ED staff are elevated relative to other populations.

OBJECTIVE

We conducted a systematic review of international literature reporting prevalence of posttraumatic stress disorder (PTSD), depression, and anxiety in ED personnel to determine whether prevalence is elevated compared to the general community, and to evaluate convergent evidence across the literature for predictive factors. To our knowledge, there is no comprehensive review on this topic in the literature at this time.

METHODS

Seven databases were searched for studies reporting rates of PTSD, depression, and anxiety in ED personnel. Two independent researchers screened studies and assessed quality using Munn's Prevalence Critical Appraisal Instrument. Best-evidence synthesis determined whether conditions demonstrated elevated prevalence compared to the general population of Canada, a conservative benchmark.

RESULTS

Twenty-four studies from 12 countries and a combined sample size of 4768 were included. PTSD rates ranged from 0% to 23.6% (mean 10.47%), depression ranged from 0.7% to 77.1% (mean 24.8%), and anxiety rates ranged from 2.4% to 14.6% (mean 9.29%). Each condition was elevated compared to the general population. Sociodemographic variables were not consistent predictors. Elevated PTSD seemed most strongly related to workplace exposure and maladaptive coping.

CONCLUSIONS

ED professionals have an elevated risk of experiencing PTSD, depression, and anxiety. Identification of organizational and workplace predictors are needed to inform interventions that will reduce risk and provide optimal treatment and management of PTSD, depression, and anxiety in ED settings.

Depression, anxiety, and suicidal ideation in nurses with and without symptoms of secondary traumatic stress during the COVID-19 outbreak

BACKGROUND

Nurses tend to experience a lot of Secondary Traumatic Stress (STS) during the outbreak of the COVID-19. This study aimed to evaluate the prevalence of STS and comparing depression, anxiety, and Suicidal Ideation (SI) in nurses with and without STS symptoms during the COVID-19 outbreak.

METHOD

The research method of this study was descriptive-comparative. The statistical sample consisted of 315 nurses working in hospitals of Malayer city, western Iran, selected through census method. Data were collected using the STS Scale, Beck's Depression Inventory (BDI-13), Anxiety Inventory (BAI), and SI scale. Data were analyzed using the independent t-test, multivariate analysis of variance (MANOVA), and multivariate analysis of covariance (MANCOVA).

RESULTS

This study showed that 161 nurses (51.11%) had symptoms of STS. The prevalence of STS symptoms in nurses in emergency, ICU/CCU, medical emergencies, and other wards was 62.27%, 62.02%, 51.61%, and 26.32%, respectively. The results of the MANCOVA showed that the nurses with STS symptoms received higher scores in depression, anxiety, and SI than the ones without STS symptoms (p < 0.01).

CONCLUSION

Hospital authorities and nursing psychiatrists should pay more attention to the STS symptoms in nurses during the COVID-19 outbreak, and its effects on depression, anxiety, and SI.

Secondary Traumatic Stress, Depression, and Anxiety Symptoms Among Service Providers Working with Syrian Refugees in Istanbul, Turkey

This paper examines the mental health of service providers working with Syrian refugees. Using the Professional Quality of Life framework, we hypothesize greater stress/less support from the work, person, client environment is associated with symptoms of STS, depression, and anxiety. We surveyed a sample of 104 service providers throughout Istanbul late 2018. Multivariable logistic regression examined associations between work (organizational support, caseload, supervision), person (perceived social support), client environment (trauma disclosure, percent Syrian refugees) on STS, depression, and anxiety. We found rates of moderate-to-severe STS to be 27.88%; depression 40.38%; and anxiety 29.81%. Our hypothesis was partially supported. Lower organizational support was associated with moderate-to-severe STS (aOR 0.91, 95% CI 0.84, 0.99) while lower social support with anxiety (aOR 0.89, 95% CI 0.81, 0.99). Caseload, supervision, trauma disclosure, percent refugees did not show significant associations. Organizations working with Syrian refugees may benefit from enhancing organizational support and promoting social support for staff.

The Role of Satisfaction With Job and Cognitive Trauma Processing in the Occurrence of Secondary Traumatic Stress Symptoms in Medical Providers Working With Trauma Victims

Introduction: As an occupational group, medical providers working with victims of trauma are prone to negative consequences of their work, particularly secondary traumatic stress (STS) symptoms. Various factors affect susceptibility to STS, including work-related and organizational determinants, as well as individual differences. The aim of the study was to establish the mediating role of cognitive trauma processing in the relationship between job satisfaction and STS symptoms among medical providers. Procedure and Participants: Results were obtained from 419 healthcare providers working with victims of trauma (218 nurses and 201 paramedics). Three questionnaires, namely the Secondary Traumatic Stress Inventory, Work Satisfaction Scale, and Cognitive Trauma Processing Scale, were used in the study, as well as a survey developed for this research. Correlational and mediation analyses were applied to assess relations between variables. Results: The results showed significant links between STS symptoms and both job satisfaction and cognitive processing of trauma. Three cognitive coping strategies play the intermediary role in the relationship between job satisfaction and symptoms of secondary traumatic stress. However, this role varies depending on preferred strategies. Conclusion: Nurses and paramedics are significantly exposed to the occurrence of STS. Thus, it is important to engage health care providers in activities aimed at preventing and reducing symptoms of STS.

The SEED Wellness Model: A Workplace Approach to Address Wellbeing Needs of Healthcare Staff During Crisis and Beyond

Workplace wellness has gained new meaning and significance in the healthcare workforce in the face of the COVID-19 pandemic. Healthcare workers across the world have carried the burden of responding to the public health crisis by having to work under new pressures and constantly changing environments, take on additional shifts, risk their own health and lives, and cope with the ongoing psychological and emotional strain. The purpose of this paper is to articulate a workplace wellness model applied across hospitals in the Illawarra Shoalhaven Local Health District, a regional area in New South Wales, Australia. The description of the development, components, and lessons learned from the SEED Wellness Model illustrates one possible solution about how to provide better care for the staff thus not only preventing staff burnout and turnover, but also creating lasting organizational benefits. The detailed model description can assist in developing a larger and more rigorous evidence-base to improve staff wellness in healthcare settings, both within Australia and internationally.

Secondary traumatic stress, anxiety, and depression among emergency healthcare workers in the middle of the COVID-19 outbreak: A cross-sectional study

Background

This study aims to determine the secondary traumatic stress (STS), anxiety, and depression levels of the emergency healthcare workers (HCWs) and to identify the factors associated with the mental health of the emergency HCWs.

Methods

This prospective cross-sectional study was performed between April 1 and May 1, 2021. Emergency nurses and auxiliary staff who gave informed consent were included in the study. Participants who answered the questions incompletely were excluded from the study. Demographic information, working and living conditions, STS, anxiety, depression scores, and coping strategies were recorded.

Results

A total of 363 HCWs were included in the study. STS was detected in 261 (71.9%) of the participants, anxiety in 148 (40.8%), and depression in 203 (55.9%) participants. Vaccination against COVID-19 was not associated with STS, anxiety, and depression among emergency HCWs (p > 0.05). Having financial difficulties was the most important factor in the development of anxiety, depression, and STS (OR: 3.68 (95% CI 1.96–6.90), p < 0.001; OR: 4.36 (95% CI 2.52–7.53), p < 0.001; OR: 5.35 (95% CI 3.06–9.37), p < 0.001, respectively). We found significantly reduced levels of STS, anxiety, and depression among participants reporting coping strategies that engaging in hobbies, healthy nutrition, and reading books.

Conclusion

High levels of STS, anxiety, and depression were determined among emergency nurses and auxiliary staff during the pandemic. Poor job satisfaction and financial difficulties were associated with the mental health of emergency HCWs. The mental health of the emergency HCWs should be evaluated regularly. In addition to professional psychological support, social and financial support should be provided as well.

Validity and reliability of the Secondary Traumatic Stress Scale-Japanese version

AIM

This study assessed the validity and reliability of the Secondary Traumatic Stress Scale-Japanese Version.

METHODS

The original Secondary Traumatic Stress Scale was translated into Japanese, and Japanese items were back-translated to English to confirm the accuracy of the translation. A total of 870 public health nurses from the Tohoku region in Japan completed the Secondary Traumatic Stress Scale-Japanese Version. An exploratory factor analysis was conducted to identify the number of components. Moreover, 351 public health nurses from the Saitama prefecture in Japan also completed the scale. A confirmatory factor analysis was performed with the factor structure identified in the exploratory factor analysis.

RESULTS

The exploratory factor analysis identified two components: one associated with client-related distress and the other with trauma-related distress. The confirmatory factor analysis confirmed the two-factor structure. The two-factor structure model was better than the three-factor model presented in the original validation study for the English version of the scale. The two-factor model had good internal consistency for the overall product and the subscales. Pearson correlations showed that this model had good convergent validity against the Maslach Burnout Inventory, a psychological measure similar to the Secondary Traumatic Stress Scale. Finally, the two-factor model had good discriminant validity against the Maslach Burnout Inventory.

CONCLUSION

This study identified two components of the Secondary Traumatic Stress Scale-Japanese Version that differ from the three components found in the original English version. The differences in the factor structure might indicate that the factor structure was culturally influenced.

Secondary traumatic stress in nurses working with patients with suspected/confirmed COVID-19 in Turkey

PURPOSE

This study aimed to determine the level of secondary traumatic stress in nurses (n = 205) working with patients with suspected or confirmed COVID-19 in Turkey.

DESIGN AND METHODS

Data were collected using the personal information form and Secondary Traumatic Stress Scale.

FINDINGS

Of the total sample, 62% were female and 52% of nurses were in the 20- to 30-years age range. 67.8% of the nurses experienced high and severe secondary traumatic stress symptoms, the mean score was 49.66 ± 0.86. At the level of secondary traumatic stress subscales, the highest average score was avoidance symptom (20.09 ± 5.06).

PRACTICE IMPLICATIONS

More than half of the nurses experienced high and severe secondary traumatic stress where the highest symptom "avoidance." The nurses may need psychosocial support during and after the pandemic.

Prevalence and contextual factors associated with compassion fatigue among nurses in northern Uganda

BACKGROUND

Compassion fatigue is associated with negative consequences that undermine workplace performance. However, literature is scarce on compassion fatigue among nurses in the context of Uganda who are at higher risk of compassion fatigue owed to the nature of their occupation and the unfavorable work environment. We aimed to assess the prevalence and predictors of compassion fatigue among nurses in Northern Uganda.

METHODS

We conducted a cross-sectional survey among 395 randomly selected nurses from two referral and four general hospitals in Northern Uganda. Data was collected using a self-administered questionnaire. Data analysis consisted of descriptive statistics, cross-tabulations, and logistic regression at a 95% level of significance in SPSS version 25.

RESULTS

Of 395 nurses who took part in the study, 58.2% were female, 39.8% had a diploma, 47.1% were single, and 32.4% had worked for between 11-15 years. Close to 50% of the nurses experienced compassion fatigue. The predictors of compassion fatigue among the participants were; workplace bullying (AOR: 3.83; 95% CI: 1.99-7.36; p = <0.001) career enhancement opportunities (AOR: 9.16; 95% CI: 2.32-36.22; p = 0.002; and remuneration (AOR: 7.30; 95% CI: 2.73-19.49; p = <0.001).

CONCLUSION

More than 3 in 4 nurses in Northern Uganda experience compassion fatigue. The Ministry of Health together with other stakeholders should strive to increase career enhancement opportunities for nurses, improve nurses' remuneration and improve the overall workplace environment to prevent compassion fatigue among nurses in the country.

Secondary Traumatic Stress Among Labor and Delivery Nurses

PURPOSE

To describe the prevalence and severity of secondary traumatic stress (STS) among labor and delivery nurses within a Northeastern United States academic health system.

STUDY DESIGN AND METHODS

Using a cross-sectional, descriptive correlational design, a convenience sample of labor and delivery nurses (288 nurses) were invited to complete Secondary Traumatic Stress Scale (STSS), a 17-item Likert-type instrument, that measures intrusion, avoidance, and the arousal symptoms associated with indirect exposure to traumatic events. Five additional questions about potential consequences of STS were also asked.

RESULTS

N = 144 completed the survey (50% response rate). Average STSS score was 33.74 (SD, 11.8), with 35% of respondents meeting symptom severity scores associated with STS. STSS Scores ≥ 38 were significantly correlated with nurses considering leaving their jobs, calling out sick, or requesting an assignment change after witnessing a traumatic birth (p < 0.001). The majority of respondents (84.7%) reported witnessing a traumatic birth. After witnessing a traumatic birth, respondents used co-workers, family, and friends as sources of support.

CLINICAL IMPLICATIONS

This study offers insight into the frequency and severity of STS among labor and delivery nurses, as well as the potential workforce-related consequences and provides a foundation for future work aimed at developing interventions to prevent or alleviate STS.

Protective Predictors Associated With Posttraumatic Stress and Psychological Distress in Chinese Nurses During the Outbreak of COVID-19

Background: The novel coronavirus disease 2019 (COVID-19) posed an unprecedented threat to Chinese healthcare professionals. Nevertheless, few studies notably focused on the mental health conditions of nurses and explored protective factors to prevent posttraumatic stress and psychological distress. This study aimed to explore the prevalence and the predictive factors especially defensive predictors associated with posttraumatic stress and psychological distress in nurses during the COVID-19 pandemic.

Methods: In this online study, 1,728 nurses (~77.5% came from the COVID-19 pandemic frontline) were included in the final analysis. Posttraumatic stress disorder checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (PCL-5) and Self-Reporting Questionnaire (SRQ) was used to assess posttraumatic stress and psychological distress.

Results: The results demonstrated that the prevalence of posttraumatic stress and psychological distress in nurses throughout China between February 1, 2020 and February 13, 2020 was 39.12 and 24.36%, respectively. Multivariate logistic regression indicated that insomnia, high panic intensity, and high impact of the COVID-19 pandemic were risk predictors of posttraumatic stress and psychological distress in nurses. Married participants had a 1.58 times increased risk of having posttraumatic stress when compared with the single participants. Frontline medical staff were more likely to suffer from psychological distress. The adequate exercise was a protective predictor of psychological distress [adjusted odds ratio (AOR) = 0.655, 95% CI = 0.486–0.883], but not with posttraumatic stress. High-quality diet was a protective predictor of posttraumatic stress (AOR = 0.112, 95% CI = 0.037–0.336) and psychological distress (AOR = 0.083, 95% CI = 0.028–0.247).

Conclusions: Our study revealed the prevalence and factors associated with posttraumatic stress and psychological distress in nurses during the COVID-19 pandemic. Low panic intensity, low level of impact, satisfactory sleep, adequate exercise, and better diet were protective factors of posttraumatic stress and psychological distress. It indicated that the psychological status of nurses (particularly those from the COVID-19 pandemic frontline) should be monitored, and protective factors associated with posttraumatic stress and psychological distress should be increased.

Relationship between Emotional Intelligence, Sleep Quality and Body Mass Index in Emergency Nurses

Nurses have long working hours with high psychological burdens. In addition, in the emergency department, nurses are required to quickly adapt emotionally. The aim of this study was to describe and relate emotional intelligence (EI) skills of emergency nurses, their body mass index (BMI) and sleep quality. For this purpose, a cross-sectional was carried out in which the perceived emotional intelligence test and the Pittsburgh sleep quality index were applied. Sixty-two emergency nurses (48 women and 14 men) participated. The results indicated that the majority of them present adequate levels of EI, with no differences by gender. Younger nurses showed a better ability to feel, express and understand emotional states than the older ones, while the ability to regulate emotional states occurred in the opposite way. Nurses who have been working for several years showed a better ability to regulate emotions than those with less experience. Those who were overweight grade II and obese type I expressed their feelings better, also the regulation of emotional states decreased as weight increased. Finally, it has been observed that the quality of sleep of emergency nurses is significantly altered, and that this lack of sleep may affect their ability to process emotions.

Secondary Traumatic Stress in Nursing: A Walker and Avant Concept Analysis

Nurses on the front lines of health care are impacted psychologically by their work and may experience secondary traumatic stress. The literature contains several different terms to explore concepts that describe the impact of traumatic patient experiences on the nurse, making it difficult to differentiate the concepts. Using the Walker and Avant method of analysis, the author reviewed nursing-specific publications within the last 10 years and seminal works to develop a purer meaning of secondary traumatic stress and distinguish it from other related terms. A more precise definition of secondary traumatic stress will allow for the advancement of research related to awareness and prevention in nursing.

Prevalence and predictors of secondary traumatic stress symptoms in health care professionals working with trauma victims: A cross-sectional study

INTRODUCTION

Medical personnel is an occupational group that is especially prone to secondary traumatic stress. The factors conditioning its occurrence include organizational and work-related factors, as well as personal features and traits. The aim of this study was to determine Secondary Traumatic Stress (STS) indicators in a group of medical personnel, considering occupational load, job satisfaction, social support, and cognitive processing of trauma.

MATERIAL AND METHODS

Results obtained from 419 medical professionals, paramedics and nurses, were analyzed. The age of study participants ranged from 19 to 65 (M = 39.60, SD = 11.03). A questionnaire developed for this research including questions about occupational indicators as well as four standard evaluation tools: Secondary Traumatic Stress Inventory, Job Satisfaction Scale, Social Support Scale which measures four support sources (supervisors, coworkers, family, friends) and Cognitive Processing of Trauma Scale which allows to evaluate cognitive coping strategies (positive cognitive restructuring, downward comparison, resolution/acceptance, denial, regret) were used in the study.

RESULTS

The results showed that the main predictor of STS symptoms in the studied group of medical personnel is job satisfaction. Two cognitive strategies also turned out to be predictors of STS, that is regret (positive relation) and resolution/acceptance (negative relation). The contribution of other analyzed variables, i.e., denial, workload and social support to explaining the dependent variable is rather small.

CONCLUSIONS

Paramedics and nurses are at the high risk of indirect traumatic exposure and thus may be more prone to secondary traumatic stress symptoms development. It is important to include the medical personnel in the actions aiming at prevention and reduction of STS symptoms.

Factors associated with secondary traumatic stress and burnout in neonatal care staff: A cross-sectional survey study

INTRODUCTION

High rates of secondary traumatic stress and burnout have been found across nursing populations. However, few studies have focused on neonatal staff.

OBJECTIVE

The objectives of this article are to explore the prevalence and severity of secondary traumatic stress (STS) and burnout in neonatal staff, and identify risk factors and protective factors for STS and burnout within this population with the aim of informing future staff support.

METHODS

A quantitative, cross-sectional study using a survey design was conducted; 246 neonatal staff reported measures of STS, burnout, self-compassion and satisfaction with ward climate.

RESULTS

Neonatal staff reported high rates of moderate-severe STS and burnout. STS and burnout were negatively associated with self-compassion and satisfaction with ward climate, suggesting them to be protective factors against STS and burnout. STS was found to be a risk factor for burnout and vice versa.

CONCLUSION

Interventions that increase understanding of STS and burnout, nurture self-compassion, provide support and enhance stress management could help mitigate the impact of STS and burnout amongst neonatal staff.

Secondary traumatic stress, vicarious posttraumatic growth and their association in emergency room physicians and nurses

Background: Emergency room personnel are indirectly exposed to many traumas. Few studies have examined secondary traumatic stress in emergency room nurses and only a single study examined emergency room physicians. The extent of vicarious post-traumatic growth, i.e., the growth associated with such trauma, has also hitherto not been examined in emergency room personnel. Objective: Our first goal was to examine secondary traumatization in both emergency room nurses and physicians. Our second goal was to examine vicarious post-traumatic growth in emergency room personnel. Finally, we also address the association (linear and curvilinear) between secondary traumatization and vicarious traumatic growth. Methods: A questionnaire comprising demographic variables, secondary traumatic stress and vicarious post-traumatic growth was administered electronically to a sample of emergency room personnel from the Wolfson Hospital, Holon, Israel. Results: There were no differences between nurses and physicians in overall secondary trauma or vicarious post-traumatic growth levels. For physicians, there was both a linear and a curvilinear association between secondary trauma and vicarious post-traumatic growth; for nurses, there was no overall association. Further sub-group analyses revealed that emergency room nurses with low workload, in conjunction with low work experience, did show a linear association. Conclusion: Results indicate that while vicarious post-traumatic growth is linked to secondary traumatic stress for emergency room physicians, it is not so for nurses. Theoretical implications concerning the role of trauma symptoms in vicarious post-traumatic growth are discussed. Clinical implications are raised regarding the identification of excessive secondary traumatic stress levels and the need for interventions to both decrease stress levels, and to increase vicarious post-traumatic growth levels.

Factors Associated With Secondary Traumatic Stress Among Nurses in Regional Trauma Centers in South Korea: A Descriptive Correlational Study

INTRODUCTION

Trauma is a leading cause of death in South Korea. This study aimed to identify the factors associated with secondary traumatic stress of nurses working at regional trauma centers.

METHODS

A survey-based cross-sectional design was utilized. Data were collected through a structured questionnaire consisting of 5 rating scales and demographic data. Data were analyzed via descriptive statistics, t test, analysis of variance, Pearson's correlation, and multiple regression.

RESULTS

One hundred eighty-six nurses participated, and most (84.4%) reported moderate to severe secondary traumatic stress. Exposure to traumatic events averaged 34.33 (SD = 6.25) out of 65 points. Average problem-focused coping was 3.00 (SD = 0.37), emotion-focused coping was 2.57 (SD = 0.26), and dysfunctional coping was 2.17 (SD = 0.41) out of 4 points. Social support from family and friends averaged 5.85 (SD = 0.75), social support from coworkers was 5.78 (SD = 0.83), and social support from supervisors was 4.65 (SD = 1.18) out of 7 points. The factors affecting the respondents' secondary traumatic stress were type D personality (β = 0.39, P < .001), dysfunctional coping (β = 0.28, P < .001), problem-focused coping (β = 0.19, P < .01), desire for job rotation (β = 0.17, P < .01), and social support from supervisors (β = -0.12, P = < .05). This regression model was statistically significant and the explanatory power was 46.7% (F = 33.47, P < .001, Adj R² = 0.47).

DISCUSSION

Along with a personal effort to engage in stress management programs, administrators, managers, and supervisors should prioritize developing practical strategies for reducing secondary traumatic stress of nurses.

Are our nurses healthy? Cardiorespiratory fitness in a very exhausting profession

OBJECTIVES

Low cardiorespiratory fitness (CRF) is related to higher risk of cardiovascular diseases, increase in all-cause mortality and higher risk of different tumors. The reverse is also true; improvement in CRF is related to decrease in mortality. Cardiopulmonary exercise testing (CPET) is a standard and also the most precise test for determination of CRF - the best possibility is the maximal test measuring different parameters including maximal oxygen consumption. Healthcare professionals throughout the developed world have markedly high rates of sickness absence, burnout, and distress compared to other sectors and this leads to higher risk factors. The study aimed to assess CRF in a group of nurses in a big hospital and compare it with population norms and available published results.

METHODS

Nurses over 50 years of age working in one faculty hospital were gradually included in the study from the beginning of 2018. These nurses work in physically demanding positions. A CPET was carried out following the Bruce protocol.

RESULTS

90 nurses (84 females and 6 males), mean age 55.7 years, were evaluated by CPET. The resting blood pressure was within the norm in 58 persons (64.44%), maximal oxygen consumption in 61 persons (67.8%), W/kg in 25 persons (46.2%). We detected a hypertension reaction in 28 persons (31.1%), some types of arrhythmia in 17 persons (18.9%) and signs of ischaemia in 8 persons (8.9%). The result of CPET led to further examination in 42 persons (46.6%). Detailed examination resulted in change of medication in 21 nurses (23.3%). New diseases were diagnosed in 15 nurses (hypertension, atrial fibrillation, mitral valve prolapse indicated for cardiac surgery, coronary artery stenosis, and lipid disorders).

CONCLUSIONS

It was concluded that the usage of CPET during the regular medical check-ups significantly increases detection of hidden diseases and thus improves the care for nurses.

Anxiety, perceived stress and coping strategies in nursing students: a cross-sectional, correlational, descriptive study

BACKGROUND

For many nursing students, clinical training represents a stressful experience. The levels of stress and anxiety may vary during students' educational training, depending on their ability to adopt behavioral strategies for coping with stress, and other factors. This study aimed to investigate the relationship between anxiety, perceived stress, and the coping strategies used by nursing students during their clinical training.

METHODS

A cross-sectional correlational descriptive study. The sample consisted of 190 nursing students enrolled in the Nursing Faculty of Ciudad Real University in Spain. Participants provided data on background characteristics and completed the following instruments: the Perceived Stress Scale; the State-Trait Anxiety Inventory and the Coping Behavior Inventory. Relationships between scores were examined using Spearman's rho.

RESULTS

The mean age of participants was 20.71 ± 3.89 years (range 18-46 years). Approximately half of the students (47.92%) indicated a moderate level of stress with a mean Perceived Stress Scale score of 22.78 (±8.54). Senior nursing students perceived higher levels of stress than novice students. The results showed a significant correlation for perceived stress and state anxiety (r = 0.463, p < .000) and also for trait anxiety (r = 0.718, p < .000). There was also a significant relationship between the total amount of perceived stress and the following domains of the coping behavior inventory: problem solving (r = -.452, p < .01), self-criticism (r = .408 p < .01), wishful thinking (r = .459, p < .01), social support(r = -.220, p < .01), cognitive restructuring (r = -.375, p < .01), and social withdrawal (r = .388, p < .01). In the current study, the coping strategy most frequently used by students was problem-solving, followed by social support and cognitive restructuring.

CONCLUSIONS

Nursing students in our study presented a moderate level of stress, in addition there was a significant correlation with anxiety. Nursing teachers and clinical preceptors/mentors should be encouraged to develop programs to help prepare nursing students to cope with the challenges they are about to face during their clinical placements.

Implementation of a "Serenity Room": Promoting resiliency in the ED

Work-related stress is common within the nursing profession, especially in the ED. Studies have shown that interventions to improve hospital working environments positively impact retention and help prevent burnout. This nursing practice innovation project describes the development, implementation, and evaluation of a restorative space (the "Serenity Room") in a busy regional ED. The evaluation of this project focused on the effectiveness of the room at reducing stress and the value ED staff place on having access to a restorative space. Data were gathered through pre- and postimplementation surveys.

The interaction effect between gender and profession in posttraumatic growth among hospital personnel

Aim:

To explore if there is an interaction effect between gender (men and women) and profession (nurses and physicians) in posttraumatic growth (PTG).

Background:

PTG is defined as a positive psychological change experienced as a result of struggling with highly challenging life circumstances. It may take the form of improved self-image, a deeper understanding of self, increased spirituality, and/or enhanced interpersonal relationships. Gender and profession were found separately to be associated with PTG, but to date were not examined under interaction effect.

Methods:

We employed a cross-sectional study conducted in the tertiary medical center in Israel using a convenience sample. One hundred and twenty-eight nurses and seventy-eight physicians gave their consent and agreed to fill out self-report questionnaires regarding personal and professional data and PTG Inventory.

Findings:

The correlation matrix revealed that being a woman was associated with higher PTG total scale (r = 0.242; P ≤ 0.001) and its subscales except for spiritual change that showed no evidence of statistical effect. Similar pattern was found for being a nurse with PTG total scale (r = 0.223; P ≤0.001) and its subscales except for relating to others that showed no evidence of statistical effect. However, the interaction effect revealed that among men, there was no difference in the level of PTG and its subscales based on profession (Physicians men = 62.54 (20.82) versus Nurses men = 60.26 (22.39); F = 9.618; P = 0.002). Among women, nurses had a significantly higher scores in PTG (Physicians women = 61.81 (18.51) versus Nurses women = 73.87 (12.36); F = 9.618; P = 0.002) and its subscales in comparison to physicians except for subscale relating to other.

Conclusions:

Our findings suggest implications for research and practice namely exploring PTG among nurses and physicians would benefit from applying interaction effect of gender and profession. For practice, advocating PTG within the health care organization is needed to be tailored with gender and professional sensitivity.

A longitudinal assessment of occupational stress in Emergency Department Nursing Staff

AIMS

To examine perceptions of occupational stress in Emergency Department (ED) nurses and measure the impact of interventions to address them.

BACKGROUND

Cross-sectional studies internationally have established that Emergency Department (ED) nursing staff experience high levels of occupational stress. Few however have examined changes in perceptions of stress over time or the impact of interventions to address them.

EVALUATION

A structured questionnaire completed by volunteer nursing staff in one United Kingdom ED assessing perceptions of occupational stress and job satisfaction. Questionnaire rounds were administered in 2014 (T1), 2015 (T2) and 2017 (T3) at 18-month intervals. Statistical analyses were conducted using multivariate regression, t-tests and Mann-Whitney U tests.

KEY ISSUE

Statistically significant improvements in effort-reward balance, relational justice and job satisfaction were seen between T2 and T3 for nurses completing questionnaires at all three time points, but not for other stressors.

CONCLUSION

This study suggests that organisational interventions, supported by robust research data and consistent departmental leadership can positively influence perceptions of organisational stress in ED nurses. Our approach is generic, internationally applicable and can be adopted in all EDs.

IMPLICATIONS OF NURSING MANAGEMENT

These occupational stressors are common to all EDs. Nurse managers should know their distribution amongst their staff. Such data can inform interventions to achieve maximal benefits for staff wellbeing and may be of value when targeting resources in times of financial pressure.

Coping With COVID-19: Emergency Stress, Secondary Trauma and Self-Efficacy in Healthcare and Emergency Workers in Italy

Coping with the coronavirus disease (COVID-19) is a significant risk factor for the psychological distress of health workers. Hence, this study explores the relationship between coping strategies used by healthcare and emergency workers in Italy to manage the stress factors related to the COVID-19 emergency, which may result in the risk of developing secondary trauma. We study differences between healthcare (n = 121) and emergency workers (n = 89) in terms of their coping strategies, emergency stress, and secondary trauma, as well as the relationships of these differences to demographic variables and other stress factors (Instructions and Equipment). For this purpose, we collected data from participants through the following questionnaires online: Secondary Traumatic Stress Scale - Italian Version, The Coping Self-Efficacy Scale - Short Form, an original questionnaire on stressors, and the Emergency Stress Questionnaire (to assess organizational-relational, physical, decisional inefficacy, emotional, cognitive, and COVID-19 stress). We performed a t-test, correlational analysis, and hierarchical regression. The analyses reveal that compared with the emergency worker group, the health worker group has greater levels of emergency stress and arousal and is more willing to use problem-focused coping. Healthcare workers involved in the treatment of COVID-19 are exposed to a large degree of stress and could experience secondary trauma; hence, it is essential to plan prevention strategies for future pandemic situations. Moreover, individual efficacy in stopping negative emotions and thoughts could be a protective strategy against stress and secondary trauma.