Secondary traumatic stress among emergency nurses: Prevalence, predictors, and consequences

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.

Stress and Coping in Emergency Nurses Following Trauma Patient Care: A Qualitative Grounded Theory Approach

BACKGROUND

Experiencing symptoms of traumatic stress may be the cost of caring for trauma patients. Emergency nurses caring for trauma patients are at risk for traumatic stress reactions.

OBJECTIVE

This study explored the stress and coping behaviors experienced by emergency nurses who provide trauma care.

METHODS

Focus groups were held at three urban trauma centers in the Midwestern United States: a Level I pediatric trauma center, a Level I adult trauma center, and a Level III adult trauma center. Data were collected between December 2009 and March 2010. Data analysis was guided by the principles of grounded theory. Line-by-line coding and constant comparative analysis techniques were used to identify recurring constructs.

RESULTS

A total of 48 emergency nurses participated. Recurring constructs emerged in the data analysis and coding, revealing four major themes: care of the trauma patient, professional practice, personal life, and support.

CONCLUSIONS

Nurse job engagement, burnout, and professional and personal relationships are influenced by trauma patient care. The study's resulting themes of care of the trauma patient, professional practice, personal life, and support resulted in the development of the "trauma nursing is a continual experience theory" that can be used as a framework to address these effects. Intentional support and timely interventions based on this new theory can help mitigate the effects of traumatic stress experienced by trauma nurses.

Reliability of Moral Distress Scale, Secondary Traumatic Stress Scale, and Jefferson Scale of Empathy Among Greek Nurses: A Pilot Study

Background and Purpose: Moral distress (MD), secondary traumatic stress (STS), and empathy are of particular interest to the nursing profession. The availability of validated tools for the assessment of these parameters is of high importance. The primary aim of this pilot study was to evaluate the reliability of the Greek version of the MD Scale or the revised version (MDS-R), the Jefferson Scale of Empathy for Health Professionals (JSE-HP), and the STS Scale (STSS) in Greek nurses working in open and psychiatric wards. Methods: To assess the reliability of scales, internal consistency (coefficient alphas) and test-retest (interclass correlation coefficients [ICCs]) were calculated. Results: A total of 38 nurses took part in the study. All scales and subscales presented excellent stability (.876 ≤ ICC ≤ .963, p < .0001) and acceptable to excellent internal consistency reliability (first measurement, .796 ≤ coefficient alpha ≤ .959; second measurement, .794 ≤ coefficient alpha ≤ .956). Conclusions: The Greek version of MDS-R, STSS, and JSE-HP may be proposed for the assessment of relevant variables in Greek nursing staff.

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.

Post-Traumatic Stress Disorder Symptoms among Pediatric Healthcare Workers

Post-traumatic stress disorder symptoms related to work in pediatric departments aremajor public health problems, as they directly affect health organizations, healthcare workers, and, due to the poor quality of care, the patients as well. The post-traumatic symptoms that a healthcare worker may experience are related to intrusion, avoidance, negative changes in cognition and mood, and changes in arousal and reactivity. The aim of the present investigation was to identify risk factors that contribute to the development of PTSD in pediatric healthcare workers, in order to implement necessary workplace measures. A sample of four hundred and forty-five pediatric workers at seven Greek public hospitals consented to participate in the survey. Socio-demographic data and a post-traumatic checklist (5th edition) were used to diagnose post-traumatic stress disorder. According to the results, risk factors for the development of post-traumatic symptoms include medical or nursing errors, threats to a child's life, and incidents of workplace bullying. More specifically, 25.2% of the participants had a provisional PTSD diagnosis, 72.8%of the sample experienced an incident involving a medical or nursing error in their workplace related to the treatment or care of a child, 56% experienced an incident involving a child's death or a threat to a child's life due to a serious illness or injury, and 55.5% experienced an incident of workplace bullying. In addition, it was found that having a university-level education, master's, or PhD, working in a circular shift, being assigned to a department by management rather than the worker, and dissatisfaction with salary were associated with post-traumatic stress disorder. The high rates of PTSD symptoms among participants highlight the need for prevention and management measures to protect and support the mental health of workers in pediatric departments. We propose frequent evaluations of the mental health of employees, more time for rest, incentives for professional development, utilization of their specializations and specialties, support from mental health specialists when symptoms are diagnosed, and the option for employees to change departments if they wish or if they show symptoms of mental trauma.

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.

Compassion Satisfaction, Burnout, and Secondary Traumatic Stress Among Nursing Staff at an Academic Medical Center: A Cross-Sectional Analysis

BACKGROUND

Although several studies have recently described compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS) in nurses, few to date have examined these issues across nursing specialties. Such examination is needed to inform future nursing-subspecialty tailored interventions.

AIMS

To examine (1) differences in CS, BO, and STS across nursing specialties and (2) differences associated with demographic, work-related, and behavioral factors among nurses.

METHOD

A secondary analysis of survey responses from nurses (N = 350) at an academic medical center. Demographic, behavioral, work-related, and professional quality of life variables were analyzed using hierarchical regression analyses.

RESULTS

CS, BO, and STS scores significantly varied across specialties with emergency nurses experiencing significantly elevated rates of BO and STS, and lowest rates of CS; scores were also differentially associated with demographic, work-related, behavioral, and workplace violence variables.

CONCLUSIONS

Key differences in CS, BO, and STS by nursing specialty suggests the importance of tailoring BO and STS mitigative interventions. BO and STS risk factors should be assessed in nurses (e.g., behavioral health problems and poor sleep quality) and specialty-specific interventions (e.g., reducing workplace violence exposure in emergency settings) may be considered to improve CS while reducing BO and STS among nurses.

Exploring the meaning of peer support used by undergraduate nursing students who have experienced clinical-related critical incidents: A hermeneutic study

BACKGROUND

Undergraduate nursing students may access support from peers after having experienced critical incidents during experiential learning opportunities. While researchers have addressed peer support relative to academic or day-to-day stress in undergraduate nursing students, there is a paucity of data on the context of clinical related critical incidents.

OBJECTIVE

To better understand undergraduate nursing students' experiences of using peer support after clinical related critical incidents.

DESIGN

Experiential learning places undergraduate nursing students at risk of encountering critical incidents. Gadamer's philosophical hermeneutics was the research approach used to explore the meaning of peer support accessed by undergraduate nursing students who had experienced clinical related critical incidents.

SETTING

Participants were recruited from a Canadian university.

PARTICIPANTS

A purposive sample was used to recruit nine students who were enrolled in a baccalaureate nursing program. Data collection involved conducting semi-structured interviews over 12 months in 2021-2022.

METHOD

The interviews with participants were recorded and transcribed and the data was analyzed using the interpretive method of hermeneutics.

RESULTS

Findings from this research revealed that peer support was an effective informal method of providing immediate assistance to undergraduate nursing students. Inherent in this support was a safe space where students experienced a sense of belonging which normalized the incident and minimized isolation. Support was perceived by some participants as reciprocal as both the traumatized individual and the peer supporter benefited from the organic connection.

CONCLUSIONS

This study highlighted the importance of nurturing a psychologically safe clinical learning environment where students who experience critical incidents may seek timely support from peers and clinical instructors.

Trauma and the perinatal period: A review of the theory and practice of trauma-sensitive interactions for nurses and midwives

AIM

With high rates of trauma in the population, known links between trauma and perinatal distress, and the intimate and close nature of the nursing and midwifery roles, ensuring awareness and understandings of trauma is crucial for guiding practice. This paper aims to explore the relationship of trauma to the perinatal period, based on theory and practice, to consider on how nurses and midwives can deliver trauma-sensitive interactions.

DESIGN AND METHODS

This discursive discussion draws on relevant research from the fields of trauma therapy, attachment theory and nursing and midwifery practice to consider elements of trauma-sensitive practice in the perinatal period.

RESULTS

Nurses and midwives can foster safety for people who have experienced trauma through noticing and responding to triggers, supporting awareness of attachment and its relationships to trauma, undertaking psychosocial screening with care, supporting linearity and cohesion in narratives and developing collaborative care plans that maximise safety and agency. For nurses and midwives, understandings of the relationship between trauma, pregnancy, birth, early parenting and distress is crucial for effective care delivery. Delivering perinatal nursing or midwifery care of any kind, without universal trauma precautions risks reinforcing, misinterpreting or re-enacting dynamics of trauma. To be trauma-sensitive in this period requires nurses and midwives to have awareness of the dynamics of trauma in relation to pregnancy, birth and attachment.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This paper fills a gap in the translation of theory to practice for trauma-sensitive care in the perinatal period, with a focus on the therapeutic relationship formed by nurses and midwives. The findings highlight that nurses and midwives can foster safety for people who have experienced trauma within their practice, when they hold a robust understanding of the relationship between trauma, pregnancy, birth, early parenting and distress.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Secondary Traumatic Stress Disorder in the Surgical Profession

INTRODUCTION

The psychological impact of treating individuals who have undergone severely traumatic experiences is known as secondary traumatic stress (STS). It has been well characterized by mental health therapists and social workers. Analysis of STS in surgeons and medical students is limited to merely a handful of studies, with only 1 paper describing STS in trauma surgeons and two describing STS in medical students. This review aims to provide a comprehensive account of existing work on STS, identify gaps in knowledge of STS in surgeons and medical students, and distinguish STS from other similar phenomena that have been commonly misidentified by recent works.

MATERIALS AND METHODS

A review of the literature in English was conducted through PubMed. MeSH terms included "STS, compassion fatigue, vicarious traumatization, and secondary trauma." All papers referenced in the identified works were screened and assessed for relevance.

RESULTS

Only two studies that directly assess STS in surgeons were identified. STS levels reported varied widely between the two. Similar studies were identified that focused on burnout, compassion fatigue, or post-traumatic stress disorder, which are similar but not identical. Only 1 study evaluated STS in trauma surgeons and found that 65% of those in the study had at least 1 symptom of STS. Only two studies were identified that studied STS in medical students, but with conflicting results on prevalence. It was identified that there are various measuring tools to assess for STS symptoms but no established standard of assessment that allows for cross-comparisons.

CONCLUSION

Knowledge of STS is extremely limited in surgeons and medical students, not only due to a general lack of awareness of STS but also due to confusion and misuse of other related terms. This review calls for more efforts to identify and address STS in surgeons and medical students while also standardizing methodologies that screen for STS symptoms.

Effects of compassion satisfaction and compassion fatigue on posttraumatic growth of psychiatric nurses: A cross-sectional study

AIMS

This study aimed to explore the effects of compassion satisfaction and compassion fatigue on the posttraumatic growth of psychiatric nurses.

BACKGROUND

Psychiatric nurses' prolonged and repeated exposure to trauma and complex situations in the work environment can lead to negative emotions such as compassion fatigue, but they also experience positive consequences such as posttraumatic growth, and the relationship between compassion fatigue and posttraumatic growth is not unclear.

METHODS

A total of 336 nurses from psychiatry departments of seven tertiary hospitals in Sichuan Province, China, were administered an online questionnaire. Participants were recruited through convenience sampling. The posttraumatic growth level was measured with the Simplified Chinese version of the Posttraumatic Growth Inventory. The Professional Quality of Life Scale-Chinese version was used to assess compassion satisfaction, burnout and secondary traumatic stress. T-test and one-way variance analysis, Pearson correlation analysis and hierarchical linear regression were used for data analysis. A STROBE checklist was used to guide the reporting of the research.

RESULTS

Psychiatric nurses' posttraumatic growth is at a low level, influenced by demographic and occupational factors, whereas compassion satisfaction, burnout and secondary traumatic stress are at a moderate level. Hierarchical regression analysis suggested that compassion satisfaction and secondary traumatic stress had a positive impact on posttraumatic growth, whereas burnout had a negative impact on posttraumatic growth.

CONCLUSIONS

Findings suggest that nursing managers should attach importance to the mental health of psychiatric nurses, improve compassion satisfaction, alleviate burnout and promote posttraumatic growth.

Japanese public health nurses classified based on empathy and secondary traumatic stress: variable-centered and person-centered approaches

BACKGROUND

Healthcare providers frequently help traumatized people and are regularly exposed to indirect trauma from their work, resulting in negative psychological responses, such as secondary traumatic stress. Empathy has been associated with patient's quality of care and secondary traumatic stress among healthcare providers. However, the relationship between dispositional empathy and secondary traumatic stress has not been fully elucidated. This study used person- and variable-centered approaches to explore the nature of this relationship.

METHODS

A total of 1,006 Japanese public health nurses working in the Tohoku region and Saitama prefecture completed questionnaires that included scales assessing dispositional empathy, secondary traumatic stress, and burnout. First, we examined predictors of secondary traumatic stress using multiple linear regression analysis. Then, we conducted a latent profile analysis to classify participants into unique groups based on four subscales of dispositional empathy (i.e., empathic concern, perspective taking, personal distress, fantasy) and secondary traumatic stress. Finally, we compared the mean values of the study variables across these groups.

RESULTS

The multiple regression indicated that in those working in Saitama prefecture, lifetime traumatic experiences, work-related distress, and personal distress were positively related to secondary traumatic stress, but perceived support was negatively related to secondary traumatic stress. Latent profile analysis extracted four unique subgroups. Group 1 displayed the highest secondary traumatic stress levels. Group 2 was characterized by the highest level of empathic concern, personal distress, and fantasy and the lowest perspective taking. Group 3 had a moderate secondary traumatic stress level. Group 4 had the lowest secondary traumatic stress and personal distress scores. In these four groups, the burnout scale (exhaustion, cynicism, and professional efficacy) showed a pattern similar to the secondary traumatic stress scale.

CONCLUSIONS

Our person-centered approach showed that this sample of public health nurses could be classified into four unique groups based on their empathy and secondary traumatic stress scores. Although this group of public health nurses was not large, one group displayed high personal distress levels and high secondary traumatic stress levels. Further research is needed to determine effective interventions for this group.

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.

Traumatic and Routine Stressors in Emergency Nurses: A Turkish Validity and Reliability Study

INTRODUCTION

Emergency nurses face traumatic and stressful events of many different forms and severity. The aim of this study is to test the validity and reliability of the Traumatic and Routine Stressors Scale on Emergency Nurses in Turkey.

METHODS

This methodological study was conducted with 195 nurses who had been working in the emergency service for at least six months and could be reached via an online questionnaire. Opinions of 9 experts were obtained with the translation-back translation method for linguistic validity, and the Davis technique was used for testing content validity. Test-retest analysis was used to test the time-invariance of the scale. Construct validity was evaluated with exploratory and confirmatory factor analyses. The reliability of the scale was evaluated based on item-total correlation and Cronbach's alpha coefficients.

RESULTS

The expert opinions were found to be in agreement with each other. Factor analysis results were acceptable, the Cronbach's alpha coefficients of the scale were 0.890 for the frequency factor, 0.928 for the impact factor, and 0.866 for the total scale. It was determined that the correlation values for the time-invariance of the scale were 0.637 for the frequency factor and 0.766 for the effect factor, and the scale had good test-retest reliability.

DISCUSSION

The Turkish version of the Traumatic and Routine Stressors Scale on Emergency Nurses, has high levels of validity and reliability. We recommend that the scale be used to evaluate the state of being affected by traumatic and routine stressors among emergency service nurses.

The relationship between perceived management commitment to safety, psychological empowerment, and safety performance among emergency nurses in Jordan

PURPOSE

Nurses are susceptible to unfavorable effects of workplace accidents and injuries, therefore, perceived management commitment to safety and psychological empowerment can help nurses to participate in safety measures and adhere to safety performance. Thus, this study aimed to examine the relationship between perceived management commitment to safety, psychological empowerment, and safety performance among emergency nurses in Jordan.

METHODS

A cross-sectional, descriptive correlational design was used and 306 registered nurses working in the emergency department in Jordanian governmental hospitals were recruited. A self-structured questionnaire consisting of the perceived management commitment to safety scale, psychological empowerment scale, and safety performance scale was used to collect data during the period from July 2022 to August 2022.

RESULTS

The findings demonstrated that the levels of study variables revealed as follows: the perceived management commitment to safety mean was 3.1 (SD = 0.66) out of 5, which indicated an acceptable level, the mean score of psychological empowerment was 5.37 (SD = 0.94) out of 7, which reflected that the nurses perceived the work environment to be psychologically empowered, and the mean score for safety performance was 4.02 (SD = 0.56) out of 5, which indicated an acceptable level of safety performance among the participants, and the mean for subscales (safety compliance and participation) was 4.07 (SD = 0.57) and 3.93 (SD = 0.69) out of 5, respectively. Also, there was a positive correlation between safety performance and perceived management commitment to safety (r = 0.334, p < 0.001), and psychological empowerment (r = 0.592, p < 0.001).

CONCLUSION

It is necessary to implement continuous interventions centered on empowering emergency nurses psychologically, which has a positive effect on safety performance. Given management's commitment to safety as a priority topic of discussion at group meetings creating a work environment that encourages nurses' safety performance should be encouraged.

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.

The Risk of the Development of Secondary Post-Traumatic Stress Disorder among Pediatric Health Care Providers: A Systematic Review

Background: Secondary PTSD is defined as the natural, consequential behaviors and emotions that result from knowledge about a traumatic event experienced by a significant other deriving from working with suffering individuals. Pediatric health providers with symptoms of PTSD report problems with relationships and general life dissatisfaction as well as and anxiety, depression and burnout syndrome. Aim: The aim of this systematic review was to estimate the risk of developing secondary PTSD among pediatric health care providers as well as all additional contributing factors. In more detail, we investigated the PTSD symptomatology between pediatric health care providers and the extent to which parameters such as the job, gender, department and other factors had an impact on the mental health status of pediatric health care providers. Methodology: We searched all published English papers in PubMed, Google Scholar and the Cochrane Library from September to November 2022. We excluded reviews, systematic reviews and meta-analyses as well as letters to editors. From a total of 748 papers, we included only 12 research articles that met the admission criteria. Results: According to our results, the prevalence of secondary PTSD ranges from 13% to 94%. Burnout, nurses, the female gender, intensive care units, past traumatic life events and a psychiatric history identified as factors contributing to the development of secondary PTSD. Conclusions: Health policy-makers should take the specificity in the working environment of the pediatric sector seriously into consideration, especially emergency departments.

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.

Evaluation of compassion fatigue and compassion satisfaction among emergency nurses in Jordan: A cross-sectional study

BACKGROUND

Nurses working in emergency departments are overworked and exposed to frequent stressors over time, leading to compassion fatigue, burnout, and secondary traumatic stress.

AIMS

This study aimed to assess the levels of compassion fatigue and compassion satisfaction, and examine the relationship of these two variables with specific demographic, health-related, and work-related factors among emergency nurses in Jordan.

METHODS

This is a cross-sectional study. The Professional Quality of Life Scale Version 5 was used to collect data.

RESULTS

A convenience sampling method was used to recruit 203 registered nurses from emergency departments in Jordan. The mean compassion fatigue and satisfaction scores were moderate. There was a significant but negligible correlation between compassion satisfaction and educational levels (r = 0.15, p < 0.05) and between secondary traumatic stress and comorbid diseases (r = -0.16, p < 0.05).

CONCLUSIONS

Although the levels of compassion fatigue and satisfaction were moderate, both may negatively affect nurses' care and patient outcomes. Conversely, compassion satisfaction should be improved in order to overcome the negative effects of compassion fatigue.

The mediating role of self-efficacy between workplace violence and PTSD among nurses in Liaoning Province, China: A cross-sectional study

Purpose

Nurses are at high risk for workplace violence, which can lead to psychological problems. The purpose of this study was to determine the relationship between workplace violence, self-efficacy, and PTSD, and to further explore whether self-efficacy mediates the relationship between workplace violence and PTSD among Chinese nurses.

Materials and methods

This cross-sectional study was conducted in Liaoning Province, China in 2020. A total of 1,017 valid questionnaires were returned. Each questionnaire included the Workplace Violence Scale, the General Self-Efficacy Scale, the Post-traumatic Stress Disorder Scale (PTSS-10), and demographics information. A hierarchical multiple regression approach was used to explore the mediating role of self-efficacy in the relationship between workplace violence and PTSD. The mediation model was then tested by the PROCESS macro in SPSS.

Results

A total of 1,017 nurses were included in this study, and the average score of PTSD among Chinese nurses was 26.85 ± 13.13 (mean ± SD). After further adjustment for control variables, workplace violence was positively associated with PTSD, explaining 13% of the variance. High self-efficacy was associated with low PTSD, explaining 18% of the variance. Self-efficacy partially mediated the role of workplace violence and PTSD.

Conclusion

The high scores of PTSD among Chinese nurses demand widespread attention. Workplace violence is an important predictor of PTSD in nurses. Self-efficacy is a significant factor in improving PTSD in nurses and mediates the relationship between workplace violence and PTSD. Measures and strategies to improve self-efficacy may mitigate the effects of workplace violence on PTSD in nurses.

The role of secondary traumatic stress breakthrough champions in reducing worker trauma and improving organizational health using a configurational analysis approach

Background

Emerging research has demonstrated that organizational efforts at becoming secondary traumatic stress (STS)-informed can improve the overall well-being of the workforce, especially when implementation activity by a champion team is high. Questions remain, however, regarding the mechanisms that enable these improvements.

Method

This study uses configurational analysis to determine necessary and sufficient conditions to produce reductions in STS symptoms in workers as well as organizational improvements toward being more STS-informed in a cohort survey of 6,033 professionals working with individuals exposed to trauma representing 52 organizations. The Secondary Traumatic Stress Informed Organizational Assessment (STSI-OA) was used to measure professional's perceptions of how well the unit addressed secondary trauma in the workplace, and the Secondary Traumatic Stress Scale (STSS) assessed traumatic stress symptoms in respondents. Champions' activity was scored using the categories suggested by Shea.

Results

For the STSS outcome, either a STSI-OA positive increase of 10 or more points or high levels of champion problem-solving were independently sufficient for an improvement in the outcome. The STSI-OA model had two pathways: high levels of peer engagement via the scaling up of innovations using PDSAs or the combination of facilitation of peer knowledge and skills together with working in a child welfare organization. Either pathway was sufficient by itself to yield the STSI-OA outcome.

Conclusions

Identifying and cultivating the champions' use of problem-solving and peer engagement strategies can transform the threat posed by indirect trauma exposure into an opportunity for shared experience and healing.

Plain Language Summary

Organizational champions are individuals or teams that strive to promote change within their workplace. These champions are integral to spreading innovative ideas and strategies and creating organization-wide changes ( Powell et al., 2015). However, little is known about the processes or specific strategies that make champions successful. One area in which champions are needed is in improving organizations' response to and understanding of secondary traumatic stress (STS), among those in helping professions that are indirectly exposed to trauma through the traumatic stories of those they work with. In fact, research has shown that organizational efforts to address STS improve the well-being of individual professionals within that organization ( Sprang et al., 2021). The present study sought to better understand what champion-related processes or conditions led to organizational change in addressing the effects of indirect exposure and improving symptoms related to STS. Results showed that organizational change in addressing STS and champions' problem-solving strategies resulted in reductions in individual professionals' STS symptoms. Furthermore, champions' use of peer engagement or sharing of knowledge among peers in child welfare settings led to improvements at an organizational level. These results show that organization-level change can have a direct impact on individual well-being and there are specific champion activities that can promote this change. Specifically, results demonstrate a need to identify and support champions' use of problem-solving and peer engagement strategies to turn the individual and organizational threat posed by indirect trauma into an opportunity for shared healing.

Quantifying Compassion Fatigue in Ancillary and Clinical Staff in an Adult Emergency Department

Introduction: Emergency department (ED) staff are at a high risk for compassion fatigue (CF) due to a work environment that combines high patient acuity, violence, and other workplace stressors. This multifaceted syndrome has wide-ranging impacts which, if left untreated, can lead to adverse mental health conditions including depression, anxiety, and substance use disorders. However, the majority of studies examining CF look solely at clinicians; as a result, there is little information on the impact of CF across other roles involved in supporting patient care. We conducted this study to establish the prevalence of CF across both clinical and non-clinical roles in the adult ED setting. Methods: For this single institution, cross-sectional study, all full- and part-time ED staff members who worked at least 50% of their shifts in the ED or within the adult trauma service line were eligible to participate. Using the Professional Quality of Life Scale, which measures CF via compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS), we assessed for group differences between roles using non-parametric one-way ANOVA. Results: A total of 152 participants (response rate = 38.0%) completed the survey. This included attending physicians (n = 15, 9.7%), resident/fellow physicians (n = 23, 15.1%), staff nurses (n = 54, 35.5%), emergency technicians (n = 21, 13.8%), supportive clinical staff (n = 28, 18.4%), and supportive ancillary staff (n = 11, 7.2%). Across all roles, the majority of respondents had average levels of BO (median = 25.0, interquartile range [IQR] 20.0-29.0) and STS (median = 23.0, IQR 18.0-27.0) coupled with high levels of CS (median = 38.0, IQR 33.0-43.0). There was a difference in CS by role (P = .01), with nurses reporting lower CS than attending physicians. Secondary traumatic stress also differed by role (P = .01), with attending physicians reporting lower STS than both emergency technicians and nurses. Group differences were not seen in BO. Conclusions: Rates of compassion fatigue subcomponents were similar across all ED team members, including non-clinical staff. Programs to identify and mitigate CF should be implemented and extended to all roles within the ED.

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.

Occupational stress and its relationship with spiritual coping among emergency department nurses and emergency medical services staff

Introduction

Emergency Department (ED) nurses and Emergency Medical Services (EMS) Staff are faced with several stressors daily, such as the COVID 19 pandemic situation, which affects the health and the quality of services to patients. Spiritual coping with stress is an attempt to overcome the stress on the basis of what is transcendent. The use of spiritual coping strategies helps a person to overcome tensions caused by the work environment.

Objective

The current study aimed to investigate occupational stress and its relationship with spiritual coping among ED nurses and EMS staff.

Materials and methods

This study was descriptive-correlational research. Using convenience sampling methods, 516 ED nurses and EMS staff were enrolled in the study. The study instruments included demographic information, HSE Occupational Stress, and spiritual coping questionnaires. Data were analyzed using SPSSv.22 software and the descriptive statistics, Pearson correlation test, t-test, ANOVA, and multiple linear regression.

Results

The highest and lowest levels of occupational stress were the dimensions of “demand” (2.96 ± 0.65) and “role” (3.89 ± 0.81) respectively. Multiple linear regression analysis showed that positive spiritual coping, negative spiritual coping, workplace, service location, type of employment, and work position were important factors affecting the occupational stress of ED nurses and EMS staff, which accounted for 0.34% of the variance.

Conclusion

The findings showed the need to improve the work environment for ED nurses and EMS staff, including changes in physical working conditions, salaries, and better employment conditions. Training programs are recommended to reduce stress through the use of positive spiritual coping strategies.

The Moderation Effect of Affective Commitment on the Relationship between Job Stress and Presenteeism among Obstetric Healthcare Workers during COVID-19 Pandemic

Background:

Presenteeism is a significant factor that affects the quality of care provided by obstetric healthcare workers, including nurses, that needs further investigation of its connection to job stress and affective commitment during COVID-19 pandemic.

Aim:

The aim of this study is to examine the moderation effect of affective commitment on the relationship between job stress and presenteeism among obstetric healthcare workers during COVID-19 pandemic.

Methods:

Two hundred and seven Egyptian obstetric healthcare workers participated in a cross-sectional, descriptive study using a web-based questionnaire to collect data on sociodemographic, presenteeism, challenge stress, hindrance stress, and affective commitment.

Results:

More than 50% of obstetric healthcare workers had a moderate level of presenteeism, while job stress and affective commitment were at moderate to high levels. Affective commitment had a significant moderating effect on the relationship between job stress and presenteeism (p< .001). Challenges and affective commitment had a positive effect on presenteeism, while hindrances had a negative effect.

Conclusion:

Obstetric healthcare workers need to recognize the connection between job stress and presenteeism and the buffering role of affective commitment.

Implications for Nursing Practice:

Nurses need to recognize the effect of pandemic COVID-19 on job stress and presenteeism among obstetrics nurses and healthcare workers. Developing innovative protocols would enable them to improve their functionality and productivity at work.

Validity and Reliability of the Secondary Traumatic Stress Scale—Chinese Version

Objectives

To test the validity and reliability of the Secondary Traumatic Stress Scale—Chinese version in clinical nurses.

Methods

According to the translation principles of the Brislin Scale, the original scale was translated, back translated and cross-culturally adapted to form the Chinese version of the Secondary Traumatic Stress Scale. Nurses in three general hospitals in Changsha, Hunan province were surveyed by convenient sampling method from July 2020 to September 2021. Exploratory factor analysis, confirmatory factor analysis, content validity and criterion validity was used to evaluate the validity of the scale. Internal consistency Cronbach's α coefficient, split-half reliability and test-retest reliability were used to evaluate the reliability of the scale.

Results

A total of 678 nurses were included in the study. There were 460 people in sample 1 and 218 people in sample 2. Two common factors were extracted by exploratory factor analysis. The cumulative contribution was 65.560%. The two-factor structure model was good (χ2/df = 3.137, CFI = 0.928, IFI = 0.929, GFI = 0.842, TLI = 0.917, RMSEA = 0.099). The I-CVI of the scale was 0.8–1.0. The S-CVI/Ave was 0.94. The Cronbach's alpha coefficient is 0.956. The broken half reliability is 0.920. The retest reliability is 0.910.

Conclusion

This study identified two components of the Secondary Traumatic Stress Scale—Chinese version, which has 2 dimensions and 17 items. With good validity and reliability, it is suitable for the assessment of secondary traumatic stress among clinical nurses in the Chinese context.

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.

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.

Peer assessment after clinical exposure (PACE): an evaluation of structured peer support for staff in emergency care

BACKGROUND

There is an increasing body of evidence that identifies psychological stressors associated with working in emergency medicine. Peer Assessment After Clinical Exposure (PACE) is a structured programme designed to support staff following traumatic or chronic work-related stressful exposure. The first author of this study created the PACE programme and implemented it in one emergency department (ED).

AIM

A service evaluation designed to explore the thoughts and experiences of the staff who accessed the PACE support service.

METHOD

Participants were selected by a non-probability convenience strategy to represent the ED staff population. The study cohort ranged from junior staff nurse level to emergency consultant. Data were collected using a semi-structured interview and examined by the method of interpretative phenomenological analysis.

FINDINGS

This study confirmed the findings of previous research that current pressures within the ED include crowding, time pressure and working within an uncontrollable environment. Eight participants identified an absence of previous emotional support resulting in dissociation and avoidance behaviours following traumatic exposure. Overall, the PACE service was well received by the majority of staff (11/12). There was a positive association with the one-to-one element and the educational component helped to reduce the stigma associated with stress reactions after work-related exposure.

CONCLUSION

PACE received a positive response from staff. This service presently does not exist elsewhere in the NHS so further research will be needed to evaluate its long-term impact and effectiveness on a wider scale.

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.

The symptoms and factors associated with post-traumatic stress disorder for burns nurses: a cross-sectional study from Guangdong province in China

BACKGROUND

The symptoms of post-traumatic stress disorder (PTSD) among medical staff has become a significant issue. Environments related to burns are highly stressful for nurses and can lead to PTSD, thus affecting their mental health. It is vital to consider that the quality of burns care, and the outcomes of such treatments, may be threatened if nurses experience PTSD. We evaluated PTSD symptoms in burns nurses and explored the correlations between demographic characteristics, work-related characteristics, professional identity, turnover intention, and PTSD symptoms.

METHODS

This was a cross-sectional study involving 273 nurses working in burns unit from Guangdong, China, between July and August 2019. Nurses were recruited from 30 hospitals and completed three validated psychological questionnaires: Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C), Professional Identity Scale for Nurses (PIS), and Turnover Intention Questionnaire (TIQ). We also collated information relating to socio-demographic and work-related characteristics.

RESULTS

The cut-off point for the PCL-C was defined as 38 points; 17.22% (n=47) of participants scored higher than or equal to 38. The PCL-C score was negatively correlated with professional identity level (P < 0.01) and positively correlated with turnover intention (P < 0.01). The workplace, mean monthly income, experience of workplace violence, and professional identity level, were important factors and all associated with the severity of PTSD.

CONCLUSION

PTSD symptoms were common in burns nurses. Attention should be paid to the mental wellbeing of these staff. Screening processes need to be initiated to identify individuals suffering from PTSD and take appropriate early interventional action.

A National Survey of Secondary Traumatic Stress and Work Productivity of Emergency Nurses Following Trauma Patient Care

BACKGROUND

Secondary traumatic stress is common for emergency nurses working in trauma care, but it is unknown whether this secondary traumatic stress negatively correlates to work productivity.

OBJECTIVE

The purpose of this research was to examine the relationship between secondary traumatic stress and work productivity of emergency nurses who provide trauma patient care in the emergency department.

METHODS

This study used a cross-sectional survey design with a systematic random sample of emergency nurses. Respondents (N = 255) completed the Impact of Events Scale-Revised (IES-R) and the Healthcare Productivity Survey (HPS) on the basis of trauma patient care within the preceding 30 days. A 2-tailed Pearson correlation was calculated to explore the relationship between secondary traumatic stress and work productivity for emergency nurses providing trauma patient care.

RESULTS

Mean IES-R score was 19.1, and HPS score was 2.7. About 38% of respondents reported high secondary traumatic stress, and 29% reported decreased work productivity. Although overall correlation between IES-R and HPS was not significant, IES-R-Intrusion was significantly correlated with HPS-Cognitive Demands (p = .003) and HPS-Safety and Competency (p = .011), IES-R-Avoidance with HPS-Safety and Competency (p = .003), and IES-R-Hyperarousal with HPS-Cognitive Demands (p = .002) and HPS-Handle/Manage Workload (p = .015).

CONCLUSIONS

Secondary traumatic stress and decreased work productivity were significant problems for some emergency nurses. To address this problem, employers can provide stress reduction and management techniques to emergency nurses providing trauma patient care. In addition, emergency nurses need to be proactive in seeking social support and using stress mitigation and reduction programs.

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.

Moral Distress, Mattering, and Secondary Traumatic Stress in Provider Burnout: A Call for Moral Community

Burnout incurs significant costs to health care organizations and professionals. Mattering, moral distress, and secondary traumatic stress are personal experiences linked to burnout and are byproducts of the organizations in which we work. This article conceptualizes health care organizations as moral communities-groups of people united by a common moral purpose to promote the well-being of others. We argue that health care organizations have a fundamental obligation to mitigate and prevent the costs of caring (eg, moral distress, secondary traumatic stress) and to foster a sense of mattering. Well-functioning moral communities have strong support systems, inclusivity, fairness, open communication, and collaboration and are able to protect their members. In this article, we address mattering, moral distress, and secondary traumatic stress as they relate to burnout. We conclude that leaders of moral communities are responsible for implementing systemic changes that foster mattering among its members and attend to the problems that cause moral distress and burnout.

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 determinants of secondary posttraumatic growth following trauma work among medical personnel: a cross sectional study

Background: People helping trauma victims as a part of their work may experience positive results, known as Secondary Posttraumatic Growth (SPTG). Aim: The present study aimed to determine the prevalence and determinants of SPTG among medical personnel, considering occupational load, job satisfaction, social support, and cognitive processing of trauma, understood as cognitive coping strategies. Methods: Subjects comprised 419 representatives of the medical profession, including paramedics and nurses. The age of the subjects varied from 19 to 65 (M = 39.60; SD = 11.03). Four standard measurement tools were utilized: the Secondary Posttraumatic Growth Inventory, the Job Satisfaction Scale, the Social Support Scale, which measured four support sources, and the Cognitive Processing of Trauma Scale to assess five cognitive coping strategies. Pearson's correlation coefficients were applied to analyse the connections between the variables. A linear stepwise regression analysis was used to identify the determinants of SPTG. Pearson's correlation coefficients with confidence intervals were applied to analyse the connections between the variables. Results: As many as 40% of participants experienced high levels of growth, with only 27.4% indicating a low level. The obtained results showed positive links between job satisfaction, all social support dimensions (from supervisors, co-workers, family, friends), all cognitive coping strategies (positive cognitive restructuring, downward comparison, resolution/acceptance, denial, regret), and SPTG. No significant connection between workload and SPTG total was discovered. The primary determinant of SPTG in the examined group of medical personnel is the cognitive processing of trauma, chiefly the strategy of positive cognitive restructuring. Conclusions: Paramedics and nurses, despite their exposure to secondary trauma, experience positive posttraumatic consequences of the profession that entails helping the injured parties. It is advisable to encourage the medical personnel to apply positive coping strategies, find satisfaction in their work, and benefit from social support to promote posttraumatic growth.

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.

Caring for Patients From a School Shooting: A Qualitative Case Series in Emergency Nursing

Introduction

Emergency nurses are at risk for secondary traumatic stress, compassion fatigue, and burnout as a result of witnessing the trauma and suffering of patients. The traumatic events perceived as being most stressful for emergency nurses involve sudden death, children, and adolescents. Multicasualty, school-associated shooting events are, therefore, likely to affect emergency nurses, and recent reports indicate an increase in multicasualty, school-associated shootings. This research is necessary to learn of emergency nurses’ experiences of caring for patients from a school shooting event in an effort to benefit future preparedness, response, and recovery. This manuscript describes these experiences and provides opportunities for nurses, peers, and leaders to promote mental health and resilience among emergency nurses who may provide care to patients after such events.

Methods

A qualitative case series approach, a theory of secondary traumatic stress, and the compassion fatigue resilience model guided the research. The emergency nurses who provided care to patients who were injured during a 2018 multicasualty, school-associated shooting in the Southeastern United States were invited to participate.

Results

The themes identified by this research with 7 participants were preparation and preparedness, coping and support mechanisms, and reflections and closure.

Discussion

The results identified through this research may be translated to policies and practice to improve emergency nurses’ welfare, coping, resilience, and retention. Patient outcomes may also be improved through planning and preparedness.

Nurses' Knowledge and Skills to Manage Patients with Psychological Distress in Emergency Departments

Background:

Identifying and managing patients with psychological distress is a challenge to nurses at emergency departments at hospitals not specialized in psychiatric mental health. This requires that nurses must be equipped with knowledge and skills to fulfill patients’ needs.

Objectives:

The purpose of this study is to identify the knowledge and skills of nurses to manage patients with psychological distress in emergency departments.

Methods:

A convenience sample of 307 registered nurses working at emergency departments completed and returned a package of surveys regarding knowledge and skills to manage patients with psychological distress in emergency departments.

Results:

Although nurses were found to have a high level of knowledge about managing psychological distress, their level of skills was lower. Nurses were found to encounter difficulty in identifying signs and symptoms of patients with psychological distress at emergency departments. A significant and positive correlation was found between nurses’ knowledge and skills (r =.68, p < .001). Statistical and significant differences were found in the knowledge of nursesin relation to their previous experience of receiving training and courses in managing psychological distress (p < .05).

Conclusion:

Nurses need to improve the level of knowledge in order toidentify the psychological and physical signs and symptoms of psychological distress, as well as to be equipped with skills that make them capable tof providing proper care and meeting patients’ needs with psychological distress at emergency departments.

Secondary Traumatic Stress, Mental State, and Work Ability in Nurses-Results of a Psychological Risk Assessment at a University Hospital

Psychological risk assessment is a legal obligation for companies and part of occupational safety and employment protection in Germany. However, data from psychological risk assessments in nursing staff are scarce, although this population is at increased risk for secondary traumatic stress by patient experienced trauma. Therefore, our study aimed at examining the frequency of reported secondary trauma events, secondary traumatic stress, and its possible consequences for psychological well-being and work ability in nurses. N = 320 nurses (n = 280 female) were assessed at a University Hospital in Germany as part of the psychological risk assessment. Secondary traumatic events, secondary traumatic stress, and symptoms of depression and anxiety were measured using self-report questionnaires (PHQ-2, GAD-2), and work ability was assessed using a modified version of the questionnaire for workplace analysis (KFZA). Of 320 nurses, 292 (91.2%) experienced secondary trauma, and 74 nurses (25.3%) reported secondary traumatic symptoms. Nurses with secondary traumatic symptoms reported higher depression (p < 0.001) and anxiety scores (p < 0.001) compared to nurses without secondary trauma experience, and to nurses with secondary trauma experience but without secondary traumatic stress (both p < 0.001). Further, nurses with secondary traumatic stress reported significantly reduced work ability, social support and control over work, and increased emotional strain and labor time. Nurses with secondary traumatic stress may be at increased risk of developing major depression and anxiety disorders, and particularly need support in overcoming secondary traumatic experiences. Psychological risk assessment is a useful tool to identify groups at risk, and pave the way to implement strategies to improve mental well-being and prevent work ability in high risk groups.