Post traumatic stress in nurses 1

Running Head: POST TRAUMATIC STRESS IN NURSES

Post traumatic stress in nurses

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27th April, 2011

Introduction

Post traumatic stress is the deep emotional wounds after a trauma (Glenn, 2009.

p.4). An overview on post traumatic stress reveals that people who are not usually at

direct risk during traumatic moments nevertheless become traumatized. Treating people

who are traumatized is the major connector that does link traumatic feelings as well as

emotions to the secondary victims. The purpose of this paper is therefore to give an in

depth analysis on views of different authors on the causes, effects, symptoms, prevention

and treatment of post traumatic stress in nurses. It gives the extent to which the nurses are

affected. However, preventive measures are lacking thus the medical fraternity should

come up with rational strategies to curb post traumatic stress in both the nurses and

patients.

Bracken, Patrick. 2001. Post modernity and post traumatic stress disorder. Social science

and medicine journal. 53(6): 733-743.

Qualitative research

Patrick gives a deep insight of post traumatic stress. Patrick uses a rational choice

theory approach to give a deep analysis of post traumatic stress disorder. He starts with a

rational approach of the meaning to the symptoms then the effects of post traumatic

stress. I used articles and research database strategy to get to this article. The search

terms were ‘meaning of post traumatic stress’. I got 5, 879 articles that were related to

this article. The article is credible, relevant and reliable because the author has given

credit to other authors through citation. Also the fact that the date when the article was
 Post traumatic stress in nurses 3

published is quite recent, I figured out that the content was not outdated. Patrick affirms

that post traumatic stress is the later effects of trauma. His definition differs from some

authors like (Glenn 2009. p.4) who in his book confirms that post traumatic stress usually

refer to the immense emotional wounds. Patrick has also given the effects of trauma as

well as the meaning of post traumatic stress helps us tackle the rest of the paper knowing

what we are really dealing with. The author asserts that that the symptoms of post

traumatic stress are flashbacks, nightmares and persistent memories. He calls this as the

intrusive symptoms.

There are also the avoidance symptoms which are withdrawal from other people,

emotional numbing and avoidance of the reminders of past events. There are also

overarousal symptoms which include irritability and insomnia. The author affirms that

there are many people who have been affected by post traumatic strategy and thus a

working strategy is highly needed.

His understanding of the symptoms of post traumatic disorder relate with that of

Glenn (2009, p.23) though Patrick’s views are more detailed. Glenn affirms that the

effects of post traumatic stress disorder is anxiety, physical, emotional, mental and

spiritual fatigue, dissociation, memory breakdown and insomnia.

Patrick in his qualitative research attempts to answer the question why there have

been so many cases of trauma. He uses theories and cites Mcfarlane (1990) who affirmed

that the decline in psychoanalytic theory has led to increase of post traumatic stress. The

Freudian theory is also comprehended to be the reason behind conflicts that usually leads

to post traumatic stress.

Michael, Rene., Mistss, Macisa & Jenkins Heather. 2008. Work related trauma the
 Post traumatic stress in nurses 4

experiences of perioperative nurses. Collegian: Journal of the royal college of

nursing Australian. 8(1): 19-25

Quantitative article

Rene et al have written a comprehensive article on post traumatic stress as far as

the nurses are concerned. To get to this journal I used a database search strategy (library

strategy). My search terms were “post traumatic stress in nurses” and I got 4, 975 articles

to choose from. The author uses medical theory in helping us understand some of the

experiences that the nurses go through in their working areas.

The reason I used this article is because the content was in line with the issue of

post traumatic stress in nurses. The article is relevant on the grounds that it analyzes the

issue of post traumatic stress on nurses and offers a solution. Also the information

presented is recent thus it is reliable. Rene et al asserts that the nurses go through

traumatic experiences in their workplaces. They assert that the nurses who suffer from

post traumatic stress usually feel different and intense. They even go through trauma.

However, their analysis of what the nurses go through is not as detailed as other authors.

(Helen and Conal 2007, p.348-356) give an immense analysis of what the nurses go

through. According to them, nurses dealing with traumatized patients go through

psychological, mental, social and physical disturbances. They are usually accompanied

by anxiety, insomnia, fatigue and avoidance.

Rene et al confirms that the workplace experiences usually subjects them to

impaired functioning as well as distress. In a survey that was done on 233 nurses

analyzing on the types of the traumatic work experiences that they usually handle and the

number of people that were affected, it showed that 69% of the nurses usually faced
 Post traumatic stress in nurses 5

traumatic experiences and usually affected their whole well being. They recommended

for an environment that was conducive for the nurses to work and be functional to avoid

stress.

Sinclair, Helen & Hamili, Conal. 2007. Does vicarious traumatisation affect oncology

nurses? A literature review. European journal of oncology nursing. 11(4): 348-

356

Literature review:

Helen et al in their literature review article gives a deep analysis on what the main

reasons why Oncology nurses are at risk of been affected by traumatic stress. To get to

this journal I used the Uni library database. My strategy was to know the benefits that the

nurses enjoyed in their profession to the problems they face as well as the solutions as

far as post traumatic stress is concerned. The search terms were “ causes of post traumatic

stress in nurses”. There were 3, 652 related articles. The article is relevant on the grounds

that it reveals some of the problems that the nurses usually go through as they handle the

patients. The reason why I used it is because it is quite detailed and reliable source on the

grounds that it has been properly cited thus showing credibility. It also reveals the other

side of the coin that as much as people when they are traumatized go to the nurses, the

nurses also have a cost to pay for caring for these patients. The article is rich of necessary

material that are quite relevant to this topic.

The authors affirm that the nurses also have to pay a cost for listening to their

patient’s stories of pain, fear and suffering. Their reasoning is similar to that of Charles

(1995, p.1) who also asserts that there is always a cost in caring. Charles also asserts that

the professionals who do listen to the sad stories of their client are prone to stress due to
 Post traumatic stress in nurses 6

the fact that they care. All these authors use utilitarian theory of doing good for the

benefit of all. They assert that the nurses might also be at a risk of feeling similarly the

same way as much as their intention is genuine. The model that is used in this article is

sociological model. The authors are not just after how to treat but start with revealing the

cause of the problem. Helen et al asserts that there are many benefits of being a nurse one

being the professional development. There is however another potential negative side of

the coin that affects their psychological, physical and environmental domain. When

patients are diagnosed with a traumatizing illness, then the people to whom they share the

experience with are also secondarily affected.

The nurses hence become aloof to their friends because of the trauma and have

little to enjoy suffering from vicarious traumatisation. There should be educational

strategies that offer sessions on ways of dealing with trauma at the workplace. The other

recommendation is a reactive strategy that debriefs sessions by psychologists who will

also cater for the nurses. Charles (1995, p.209) gives a contrary recommendation from

the one given by Helen et al asserting that the nurses who are affected should be offered

social support as well as team approach to prevent secondary trauma. Helen et al also

reveal that recently, vicarious traumatisation is being accepted as the normal responses to

nurses and health professional working indirectly with other people’s trauma.

Dominguez, Elvira & Rutledge, Dana. 2008. Prevalence of secondary traumatic stress

among emergency nurses. Journal of emergency nursing. 35(3): 199-204

Quantitative study:
 Post traumatic stress in nurses 7

Elvira and Dana give a quantitative analysis of the number of nurses

who are affected by traumatic stress. They have conducted a research to show the effects

of traumatic stress among the nurses. To get to this article, I used the science direct

database. The search terms were the ‘effects of post traumatic stress in nurses’. I got 4,

434 related articles. I refined the article to be relevant to the topic since the content given

was in line with nurses and post traumatic stress and was current. It was also well cited

and legible. The article is crucial as it involves a research conducted up to the results on

emergency nurses. Elvira et al asserts that the role of the emergency nurses is to care for

those people who are exposed to traumatic circumstances. However the role of the

emergency nurses according to Elvira et al is brief as compared to (Kristine et al 2005, p.

107-113) as they put it clearly that the role of emergency nursing is broad on the ground

that it ranges from surgery support to preventive health care. During their empathetic

caring they usually suffer from traumatic stress or fatigue. The article is relevant as it also

offers the symptoms of nurses who are suffering from post traumatic stress. The

symptoms are avoidance of people, arousal and intrusion which hence may lead to

dissatisfaction on their jobs and burnout. The main purpose of the study was to show the

prevalence of secondary traumatic stress in nurses. An exploratory comparative design of

67 emergency nurses showed that 54% of nurses were showing signs of irritability and

arousal. The survey instruments comprised of STS survey and demographic tools. 52%

were avoiding patients and those who had intrusion symptoms were 46%. The majority

reported some minor symptoms. The final results revealed that majority of the nurses

were experiencing some adverse negative results. The authors recommend for

amplification of understanding on post traumatic stress through identifying of the

symptoms and coming up with coping strategies. Increase of awareness may reduce

emotional exhaustion.

Su, Tung., Lien, Te-Cheng., Yang, Chih., Su, Yiet., Wang, Jia., Tsai, Sing &Yin, Jeo.

2007. Prevalence of psychiatry morbidity and psychological adaptation of the

nurses in a structured SARS caring unit outbreak: A prospective and periodic

assessment study in Taiwan. Journal of psychiatric research. 41(2): 119-130

Quantitative study:

Tung et al article gives an in depth analogy on the prevalence of post traumatic

stress in nurses in their quantitative research. The authors use a case study to explore on

the number of health workers affected and the reason behind it. I used the science direct

research database. The search terms used were ‘the prevalence of nurses suffering from

post traumatic stress’. There were 1, 151 related articles. The article is relevant because

it offers a detailed and a well cited case study of the SARS outbreak and how the nurses

got affected. Tung et al in his quantitative article, asserts that the SARS outbreak in the

year 2003 left health workers traumatized. 44 nurses were used as a sample in a survey to

evaluate how they got affected.

The results revealed that 38.5% of them suffered from depression, 37% from

insomnia, and others were equally highly affected psychologically. SARS sickened

approximately 8000 people globally killing around 744 (WHO, 2003). The infected

nurses from that incident ranged from around 3% in USA to around 22% in Hong-Kong

as well as 51% in Toronto. There was a great psychological impact. Problems that were

experienced were high rates of insomnia in patients, varying rates of mood, depression

and avoidance. The authors assert that natural disasters for example earthquakes are
 Post traumatic stress in nurses 9

usually associated with mental disturbances, insomnia and major depression. They

recommend for enhancement of understanding strategies of post traumatic stress in

providing the ability to offer assistance. The final results of the case study showed that

approximately 1/3 of the nurses who cared for SARS patients had developed depression

and insomnia and mood changes. Finally they advocate for immediate management in

facing future problems. The nurses ought to be cautious and for those who are less

experienced, there should be psychological counseling and support that should be offered

to them.

Hogberg, Goran., Pagani, Marco., Sundin, Orjan., Soares, Joaquim., Wistedt, Anna.,

Tarnell, Berit and Hallstrom, Tore. 2007. Treatment of post traumatic stress

disorder with eye movement desensitization and reprocessing: Outcome is stable

in 35 month follow up. Psychiatry research. 159 (1-2): 101-108.

Literature review

Goran et al write a literature review article on how to treat post traumatic stress.

The authors use the biomedical model in the article as they put much emphasis on the

treatment rather than the causes. The authors uses transcultural theory of nursing as they

also affirm that there is a connection between the culture and post traumatic stress and

when issues of the culture are neglected then that leads to stress. The model used in this

article is biopsychosocial model where they realize that the body and mind interlink. The

search terms were ‘treatment of post traumatic stress’ where I got 4, 406 related articles. I

settled on this article because of its credibility. The authors have recognized that there is a

need to define what is to be treated and has not only suggested the need for medication

but has offered the treatment itself. The article is also well detailed thus enabling you
 Post traumatic stress in nurses 1

access what you need with ease. Goran et al asserts that post traumatic stress is usually

an anxiety disorder that comes after a psychological trauma. It involves derangement of

the memory as well as mood regulation. It causes mental suffering (Kessler, 2000). The

disorder is usually longstanding and at times chronic thus there ought to be effective

treatment. A number of meta analyses of medication shows that cognitive behavioral

therapy as well as eye movement reprocessing and desensitization have a major positive

effects in half of the cases that have been done as they also favor with pharmacotherapy

(van & Taylor, 1998). According to (Macklin, et al, 2000) there should be a follow up of

about two years in order to register equivocal results. In an interview that was done

among 330 subjects, 83 of the subjects answered showed that eye movement

desensitization and reprocessing treatment was affective after 35 months of follow up.

These treatments are necessary as they decrease the levels of anxiety and depression

within the first 35 months of follow up. The affected health workers should seek for

treatment to avoid more harm. Finally they recommend for an additional attention to

treatments of those people who are non responders.

Chandler, E., Div, M 2004. Can post traumatic stress disorder be prevented? Accident

and emergency nursing. 1(2): 87-91.

Literature review:

Chandler et al in their literature review article gives a brief view on whether apart

from treating post traumatic stress it can be prevented. The strategy used in the article is a

rational strategy on experiences of the nurses to prevention of post traumatic stress. The

search terms were ‘prevention of post traumatic stress in nurses’ where I got 2, 539

articles. I used the Ebscohost database research strategy. The reason I chose this article is
 Post traumatic stress in nurses 1

because the title of the article triggers curiosity. Also the article though brief ends with a

direct answer on whether or not post traumatic stress can be prevented.

They assert there are no effectual means to prevent distress or stress but the only

thing that can be done is alteration of the duration and intensity of stress based trauma by

recognizing our enemies and struggling to create healing environments for the nurses as

well as the patients. Their view is similar to that of (Charles 1995, p.178), as he also

asserts that post traumatic stress cannot be prevented because it is a universal and a

normal response to the unusual disasters though it can be prevented from becoming a

disorder.

Conclusion

It is clear that post traumatic stress prevails among nurses. Elvira and Dana

(2008, p.199-204) assert that nurses who suffer from stress usually feel fatigued. They

also suffer from insomnia and avoidance as well as withdrawal symptoms. There need to

be a detailed strategy to prevent the occurrence of post traumatic stress since so far there

are no preventive measures (Charles1995, p.178). There is a wide range of nurses

affected and the sooner the preventive measures are gotten the better. The good thing is

that there are treatments. The treatments which are effectual are cognitive behavioral

therapy and eye movement reprocessing and desensitization (Goran et al 2007, 101-108).
 Post traumatic stress in nurses 1

References

Alpi, Kristine., AHIP. 2005. Mapping the literature of emergency nursing. Journal of the

medical library association. 94(2): 107-113

Bracken, Patrick. 2001. Post modernity and post traumatic stress disorder. Social science

and medicine journal. 53(6): 733-743.

Chandler, E., Div, M 2004. Can post traumatic stress disorder be prevented? Accident

and emergency nursing. 1(2): 87-91.

Dominguez, Elvira & Rutledge, Dana. 2008. Prevalence of secondary traumatic stress

among emergency nurses. Journal of emergency nursing. 35(3): 199-204

Figley, Charles. 1995. Compassion fatigue: coping with secondary traumatic disorder in

those who treat the traumatized. USA: Psychology press.

Hogberg, Goran., Pagani, Marco., Sundin, Orjan., Soares, Joaquim., Wistedt, Anna.,

Tarnell, Berit and Hallstrom, Tore. 2007. Treatment of post traumatic stress

disorder with eye movement desensitization and reprocessing: Outcome is stable

in 35 month follow up. Psychiatry research. 159 (1-2): 101-108.

Michael, Rene., Mistss, Macisa & Jenkins Heather. 2008. Work related trauma the

experiences of perioperative nurses. Collegian: Journal of the royal college of

nursing Australian. 8(1): 19-25

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Su, Tung., Lien, Te-Cheng., Yang, Chih., Su, Yiet., Wang, Jia., Tsai, Sing &Yin, Jeo.

2007. Prevalence of psychiatry morbidity and psychological adaptation of the

nurses in a structured SARS caring unit outbreak: A prospective and periodic

assessment study in Taiwan. Journal of psychiatric research. 41(2): 119-130

Sinclair, Helen & Hamili, Conal. 2007. Does vicarious traumatisation affect oncology

nurses? A literature review. European journal of oncology nursing. 11(4): 348-

356

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