Correlates of post-traumatic growth among nursing professionals: A cross-sectional analysis

Status quo and influencing factors of posttraumatic growth of nurses exposed to nurse-to-nurse horizontal violence: a cross-sectional multicenter study

BACKGROUND

Post-Traumatic Growth (PTG) relieves physical and psychological stress symptoms in nurses who exposed to nurse-to-nurse horizontal violence (HV), has great intervention potential to reverse the negative effects of HV events. Therefore, in-depth exploration of the overall characteristics of PTG in HV-exposed nurses and its influencing factors are of great practical significance to provide them with precise psychological adaptive interventions.

OBJECTIVE

This study aims to describe the current state of PTG of HV-exposed nurses and its influencing factors.

METHODS

The staged cluster sampling method used to recruit nurses. Nurses completed the Chinese version of the nurse-to-nurse Negative Acts Questionnaire (NAQ-R), the Posttraumatic Growth Inventory-Short Form (PTGI-SF), Colquitt's Organizational Justice Measure (OJM), Inclusive Leadership Scale (ILS), 10-item Connor-Davidson Resilience Scale (CD-RISC-10), Dysexecutive Questionnaire (DEX) and provided their sociodemographic characteristics. Data were collected between February, 2023 ~ March, 2024, and were analyzed using correlation analysis, t-test, ANOVA, and multivariate linear stepwise regression analyses.

RESULTS

The prevalence of HV within eight tertiary hospitals in Shandong Province amounted to 45.03%. On average, nurses scored 18.30 ± 14.33 in PTGI-SF. There were significant differences in PTGI-SF score according to departments (F = 2.589, p < 0.01), and educational background (F = 4.587, p < 0.01). The results of correlation analysis showed that there was a significant correlation between score in CD-RISC-10 (r = 0.120, p < 0.01), DEX (r=-0.069, p < 0.05), and PTGI-SF. The results of multivariate linear stepwise regression showed that resilience, dysexecutive, educational background, and type of department might be the influencing factors of PTG in HV-exposed nurses (R2 = 0.045).

CONCLUSIONS

Exposure to HV posed a moderate risk for nurses, while PTG levels among HV-exposed nurses were low to moderate. Overall, the current study suggests that educational background, department type, resilience, and dysexecutive were the main factors influencing PTG in HV-exposed nurses. The study found that resilience had a positive effect on PTG, while dysexecutive had a slight negative effect. Consolidation of resilience and alleviation of dysexecutive, while dialectically looking at educational background and department type, is necessary to improve PTG in HV-exposed nurses.

The prevalence and factors of posttraumatic growth among nurses based on the PTGI: A systematic review and meta-analysis

BACKGROUND

The urgency and risk of clinical nursing may cause nurses to experience traumatic stress, but it may also lead to posttraumatic growth. However, no study has comprehensively analyzed the prevalence of posttraumatic growth among nurses using a unified outcome measure and a validated assessment tool.

AIM

This study aims to systematically assess the prevalence and factors of posttraumatic growth among nurses based on the Posttraumatic Growth Inventory (PTGI).

METHODS

Ten databases, including The Cochrane Library, PubMed, Web of Science, CINAHL, Springerlink, Embase, Chinese Biomedical (CBM), China National Knowledge Infrastructure (CNKI), WanFang, and VIP databases, were searched as of December 31, 2022. The prevalence of posttraumatic growth was pooled using Stata 17.0 software. The PRISMA guideline was used to report the systematic review and meta-analysis. PROSPERO registration number: CRD42022365620.

RESULTS

A total of 30 studies were included in this systematic review and meta-analysis, consisting of 14,022 nurses worldwide from four countries. In our study, the pooled mean score of posttraumatic growth among nurses was 66.34 (95% CI: 61.25-71.43). From 2015 to 2022, nurses' posttraumatic growth levels gradually increased. In addition, Turkey nurses have the lowest posttraumatic growth levelnurses who experienced workplace violence have a lower posttraumatic growth level compared with other nurses; while nurses aged over 30 and male have higher posttraumatic growth levels.

CONCLUSIONS

While several studies on the prevalence of posttraumatic growth among nurses have been published, the reported data are quite different. Our systematic review and meta-analysis found that nurses' posttraumatic growth level was "moderate," and nurses' posttraumatic growth may vary based on publication year, country, traumatic event, age, and gender.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Our findings may provide a theoretical basis for hospital administrators and policy makers to scientifically manage human resources, comprehensively evaluate nurses' mental health, and promote nurses' posttraumatic growth in different traumatic events, which is conducive to the formulation and implementation of relevant policy guidelines.

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.

Personal and work-related factors associated with post-traumatic growth in nurses: A mixed studies systematic review

INTRODUCTION

Nurses, assuming a wide range of clinical and patient care responsibilities in a healthcare team, are highly susceptible to direct and indirect exposure to traumatic experiences. However, literature has shown that nurses with certain traits developed a new sense of personal strength in the face of adversity, known as post-traumatic growth (PTG). This review aimed to synthesize the best available evidence to evaluate personal and work-related factors associated with PTG among nurses.

DESIGN

Mixed studies systematic review.

METHODS

Studies examining factors influencing PTG on certified nurses from all healthcare facilities were included. Published and unpublished studies were identified by searching 12 databases from their inception until 4th February 2023. Two reviewers independently screened, appraised, piloted a data collection form, and extracted relevant data. Meta-summary, meta-synthesis, meta-analysis, as well as subgroup and sensitivity analyses were performed. Integration of results followed result-based convergent design.

RESULTS

A total of 98 studies with 29,706 nurses from 18 countries were included. These included 49 quantitative, 42 qualitative, and seven mixed-methods studies. Forty-six influencing factors were meta-analyzed, whereas nine facilitating factors were meta-summarized. A PTG conceptual map was created. Four constructs emerged from the integration synthesis: (a) personal system, (b) work-related system, (c) event-related factors, and (d) cognitive transformation.

CONCLUSION

The review findings highlighted areas healthcare organizations could do to facilitate PTG in nurses. Practical implications include developing intervention programs based on PTG facilitators. Further research should examine the trend of PTG and its dynamic response to different nursing factors.

CLINICAL RELEVANCE

Research on trauma-focused therapies targeting nurses' mental health is lacking. Therefore, findings from this review could inform healthcare organizations on the PTG phenomenon and developing support measures for nurses through healthcare policies and clinical practice.

The levels and related factors of posttraumatic growth among nurses: A systematic review and meta-analysis

WHAT IS KNOWN ON THE SUBJECT?: Nurses often encounter traumatic events in their clinical practice. Trauma can have both negative effects, such as post-traumatic stress disorder and positive effects, such as growth and positive emotions. Posttraumatic growth is beneficial for nurses, as it contributes to positive mental health outcomes and increases life satisfaction. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Our study confirms that nurses commonly experience posttraumatic growth after being exposed to traumatic events, and the level of growth is moderate. We have identified individual, work-related, and social and organizational factors that may influence the occurrence of posttraumatic growth among nurses. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Our findings provide valuable insights for interventions aimed at promoting posttraumatic growth among nurses. It is crucial to consider individual factors, work-related factors, and social and organizational factors when designing these interventions. By addressing these factors, healthcare professionals can support nurses in coping with trauma and facilitate their posttraumatic growth.

ABSTRACT

INTRODUCTION: While the negative effects of trauma on nurses have been well-documented, it is equally important to focus on ways to promote posttraumatic growth (PTG) among nurses.

AIM

This study aims to explore the levels and related factors of PTG among nurses.

METHOD

A comprehensive search was conducted across nine databases up to 26 December 2022. The pooled mean score for PTG was calculated and presented with a 95% confidence interval. Subgroup and meta-regression analyses were performed to identify potential moderators of PTG among nurses.

RESULTS

A total of 55 studies, involving 35,621 nurses from 11 countries and regions, were included in this review. The pooled scores of the PTG indicated that nurses experienced a moderate level of PTG (55.69, 95% CI: 50.67-60.72).

DISCUSSION

Nurses commonly experience PTG following exposure to traumatic events, with a moderate level of PTG. Our systematic review highlights the potential determinants of PTG among nurses, including individual, work-related, and social and organizational factors.

IMPLICATIONS FOR PRACTICE

Targeting these factors in interventions can provide nurses with the necessary resources and support to effectively cope with stress and trauma, and potentially facilitate PTG.

Trauma-informed care: Insights from a Q-methodology study of advanced practice registered nursing students

BACKGROUND

Trauma-informed care (TIC) aims to create a safe and supportive healthcare environment that empowers patients and cultivates understanding of the role trauma plays in short-term and long-term health. TIC also has the potential to improve health outcomes and foster clinician wellness. Nurse educators must design evidence-based instruction to develop advanced practice registered nurses (APRNs) who deliver high-quality TIC while also protecting their own wellbeing.

OBJECTIVES

To identify patterns in subjective viewpoints about TIC among APRN students and describe how those patterns influence their learning experience in an advanced health assessment course.

DESIGN

Q methodology was used to explore student perceptions of TIC.

SETTING

A virtual advanced health assessment course at a large, midwestern university in the United States.

PARTICIPANTS

Ninety-five APRN students from six specialty APRN programs.

METHODS

Students completed an online Q-sort activity by ranking 32 TIC statements according to how well the statements aligned with their own perspectives. Q-sorts were analyzed using factor analysis and narrative responses to open-ended questions.

RESULTS

Four factors were extracted that revealed different student viewpoints on TIC and their learning experiences: Comfortable/Confident Learners, Uncomfortable/Apprehensive Learners, Empathetic/Hesitant Learners, and Inexperienced/Uncertain Learners.

CONCLUSIONS

All students acknowledged the need to learn about TIC to implement it effectively in practice. It is important for faculty to understand the potential range of divergent student viewpoints about TIC and acknowledge, accept, and support students who have anxiety related to learning about TIC.

Investigation of grief and posttraumatic growth related to patient loss in pediatric intensive care nurses: a cross-sectional study

BACKGROUND AND AIM

Pediatric Intensive Care Units (PICUs) are clinical settings where patient loss is frequently experienced. A sense of professional grief and posttraumatic growth in nurses who have experienced patient loss has a significant impact on psychological and physical health, work satisfaction, turnover rates, as well as on personal and professional relations, and employee loyalty. The aim of this study was to investigate grief and posttraumatic growth in PICU nurses and to examine related factors.

METHODS

The study is of cross-sectional design and was conducted with 200 nurses who were working in 87 PICU's around Turkey during the period March 30 - June 30, 2021. Data were collected with a Descriptive Information Form, the Texas Revised Inventory of Grief (TRIG), the Posttraumatic Growth Inventory (PTGI), and an open-ended question asking for suggestions as to how nurses can cope with loss. Online questionnaires were used in the data collection. Descriptive statistics, the student t-test, one-way analysis of variance, and post-hoc tests were employed in the analysis of the data.

RESULTS

The nurses' mean scores were 49.425 ± 10.868 on TRIG and 61.450 ± 24.934 on PTGI. A negative weak correlation was found between the intensity of the nurses' grief and their posttraumatic growth (r = 0.144, p = 0.041). Receiving training on dealing with a patient's terminal stage (t=-2.688, p = 0.001), feeling comfortable about providing the patient's care (t = 2.624, p = 0.009) and providing the family with emotional support during patient care (t = 1.979, p = 0.049), and the presence of supporting health professionals reduced levels of grief (t = 2.797, p = 0.000). Being a woman (t = 3.299, p = 0.001), willingness to work in the unit (t=-3.219, p = 0.002), and being given enough time to accept the loss (t = 3.986, p = 0.000) were correlated with higher levels of posttraumatic growth. The nurses most commonly wanted more time allotted to recuperate after a loss (n = 35) and professional support (n = 22).

CONCLUSIONS

Nurses experience a moderate sense of grief after a patient's loss. As levels of grief decrease, posttraumatic growth increases. Healthcare administrators and future researchers can benefit from these findings when planning supportive interventions to help nurses cope with their feelings of grief and achieve posttraumatic growth.

STRENGTHS AND LIMITATIONS

A limitation of the study is that it was conducted only with nurses who were Association members.

Factors Associated with Post-Traumatic Growth in Healthcare Professionals: A Systematic Review of the Literature

Post-traumatic growth (PTG) research is flourishing across various disciplines; however, it is only emerging in healthcare. Recently, a flurry of studies assessed PTG among healthcare professionals. However, to date, no systematic review has identified the factors that predict their experiences of PTG among healthcare professionals. The current paper aims to address this gap. Of 126 papers, 27 were selected for this systematic review. The analysis identified a range of demographic, individual (work-related and personal), interpersonal and environmental factors that contributed to healthcare professionals' experiences of PTG. Analysis of findings offers a novel perspective on individual factors by dividing them into personal and work-related factors. Results also highlight a variety of psychological interventions that can be used in healthcare to cultivate PTG. In addition, the gaps in current research, implications for further research, policy and practice that can facilitate the experience of PTG among healthcare professionals are discussed.

Disease-based traumas transform lives: A qualitative study focused on healthcare professionals

RATIONALE

Traumas occur at unexpected moments and become a turning point in life and can cause people to experience transformations. While these transformations can progress negatively, it is also possible for people to experience positive transformations after trauma (post-traumatic growth).

OBJECTIVE

This study aims to reveal how the physicians and nurses with disease-based traumas make sense of their experiences to provide better insights into the transformative power of these traumas. Both social life and work-life were evaluated from the social dimensions of trauma. Also, the advantages and disadvantages of being a health professional in this process were examined.

METHODS

Qualitative research method was used in the study and data were obtained through interviews with 23 participants who experienced the case of disease-based trauma. As a result of the interviews, 253 pages of data were obtained. The data were subjected to thematic analysis and the Maxqda Program was used.

RESULTS

The data obtained through the interviews conducted within this attempt were categorized into parent themes such as being a health worker, post-traumatic transformations, changes in business life, and changes in the role of a service provider.

CONCLUSIONS

As a result of the study, it was seen that the social relations, philosophy of life, belief systems, and self-perceptions of healthcare professionals were transformed after the disease-based trauma and innovations occurred in their lives. Also, positive and negative changes have been determined in the relationships of healthcare professionals who have experienced disease-based trauma with their colleagues and managers their sense of belonging to the organization, the way they provide health services, and their approach to patients.

Prevalence and influencing factors of posttraumatic growth among nurses suffering from workplace violence: A cross-sectional study

The purpose of this study was to (i) identify the level of posttraumatic growth among nurses suffering from workplace violence, (ii) clarify the relationship between nurses' posttraumatic growth and compassion satisfaction, burnout, secondary traumatic stress, and (iii) determine the influencing factors for posttraumatic growth among nurses suffering from workplace violence. A cross-sectional study was conducted to investigate 726 nurses suffering from workplace violence in 10 tertiary hospitals by using demographic, work-related information, lifestyle questionnaire, simplified Chinese version of the Posttraumatic Growth Inventory, and professional quality of life scale. In the findings, (i) the participants' posttraumatic growth scores were 57.29 ± 21.56, while the compassion satisfaction, burnout, and secondary traumatic stress scores were 32.82 ± 6.80, 27.17 ± 5.53, and 26.67 ± 5.29, respectively, (ii) posttraumatic growth was positively correlated with compassion satisfaction and secondary traumatic stress, and negatively correlated with burnout, and (iii) compassion satisfaction, sleep hours per day, department, scheduling, alcohol, secondary traumatic stress, children, and work hours per day were influencing factors of posttraumatic growth, which explained 36.3% of the total variance. Our study indicates that Chinese nurses may experience moderate levels of compassionate satisfaction, burnout, secondary traumatic stress, and low levels of posttraumatic growth after suffering from workplace violence, while the posttraumatic growth of nurses suffering from workplace violence is more affected by work-related variables and lifestyle-related variables, but less affected by other sociodemographic variables. Therefore, it is necessary to strengthen the psychological evaluation of nurses and adopt targeted strategies to promote nurses' posttraumatic growth.

An approach to trauma-informed education in prelicensure nursing curricula introduction

BACKGROUND

Trauma-informed care (TIC) is an evolving concept that acknowledges the prevalence and impacts of trauma on health; however, knowledge related to implementation for nursing students remains limited.

PURPOSE

The purpose of this study is to understand the learning perspectives of nursing students and develop an innovative conceptual model to guide educators in implementing teaching and learning strategies related to TIC, consistent with the trauma and resiliency competencies for nurses.

METHODS

Qualitative analysis of student responses after an online module to educate students on adverse childhood experiences (ACEs), trauma, and their impact on health through the lifespan.

RESULTS

Three persistent themes emerged from the data: Growing in Self-Awareness, Filling Learning Needs, and Envisioning Future Roles. From these themes, we developed a framework for TIC content for nursing and other healthcare curricula.

CONCLUSIONS

Our findings demonstrate a model to embed ACE education, TIC competencies, secondary traumatic stress awareness, and methods of self-care, including resiliency skills, into undergraduate nursing education.

Coping and Post-traumatic Growth Among COVID-19 Patients: A Qualitative Study

Pandemic diseases have caused dramatic changes in people's lives throughout history. Today, the COVID-19 virus spreads rapidly and affects human beings around the globe. This study aimed to discover the coping strategies and post-traumatic growth (PTG) experiences of persons who were infected by the COVID-19 virus using the qualitative research method. The research involved 17 individuals, nine of whom were female. All had been diagnosed with COVID-19. Face-to-face and online interviews were conducted with participants. In the analysis of the data, the thematic analysis method was performed by developing themes and sub-themes. The created themes include coping strategies, existential growth, lessons learned from disease, new opportunities, and social growth. These themes indicated positive changes in the lives of persons who were infected by the COVID-19 virus after the COVID-19 disease. Findings and implications for the practice were discussed.

Factors Associated With Post-traumatic Growth Among Healthcare Workers Who Experienced the Outbreak of MERS Virus in South Korea: A Mixed-Method Study

Background: Infectious disease outbreaks such as COVID-19 and MERS pose a major threat to healthcare workers' (HCWs) physical and mental health. Studies exploring the positive changes gained from adapting to traumatic events, known as post-traumatic growth (PTG), have attracted much attention. However, it is unclear which factors or experiences lead to PTG among HCWs. The purpose of this mixed-method study was to investigate factors associated with PTG among HCWs who experienced the MERS outbreak in South Korea, and fully describe their experience of developing PTG.

Methods: Quantitative data from 78 participants were collected using psychometric tools for Psychological distress, Resilience, and Support for coping, and Post-traumatic growth. Qualitative interviews were conducted with seven nurses. Data were analyzed using the qualitative content analysis method according to the sub-themes of resilience, which was the main factor associated with PTG.

Results: We found resilience to have a significant impact on PTG (ß =0.486, p = 0.001). Thus the qualitative interviews were analyzed using the core concepts of resilience. Qualitative interviews with nurses illustrated how participants experienced the development of resilience in terms of its sub-factors: hardiness, persistence, optimism, and support.

Conclusion: HCWs who endured the MERS outbreak showed high levels of PTG, and the analysis of the interview data provided a fuller understanding on the experience of remaining resilient and developing PTG. These results provide practical and pragmatic information helpful for developing intervention strategies and protocols that can help HCWs transform adversity into growth and development.

Association of Nursing Work Environment, Relationship with the Head Nurse, and Resilience with Post-Traumatic Growth in Emergency Department Nurses

Emergency department nurses are confronted with unpredictable diseases and disasters and work-related traumatic stress events. This study aimed to examine the relationship between nursing work environment, relationship with the head nurse, resilience, and posttraumatic growth among emergency department nurses. Data were collected from December 2018 to February 2019 through a self-administered survey questionnaire. Participants comprised 127 nurses working in the emergency department. The collected data were analyzed using t-test, analysis of variance with Scheffé’s test, Pearson’s correlations, and hierarchical multiple regression. The mean posttraumatic growth score of emergency department nurses was 2.59 ± 0.64 out of a possible 5.00. The posttraumatic growth showed a statistically significant difference according to age in the emergency department nurse. Resilience was the most significant variable controlling other variables, accounting for 29% of the variability. The findings support that intervention programs should be developed to encourage a positive relationship with the head nurse and enhance resilience in emergency department nurses.