Article: The impact of traumatic events on emergency room nurses: Findings from a questionnaire survey

 

This article examine how often nurses are exposed to the traumatic events in the emergency room and the nature of such traumatic events. It also examined the percentage of nurses reported post-traumatic stress symptoms and how frequency of exposure to traumatic incidences, social support and copying help in the recovery process. In the article, the proportion of nurses who reported Post-traumatic Stress Disorder (PTSD) and other symptoms like fatigue, anxiety, somatic complaints and the contribution of such issues stress. PTSD refers to anxiety disorder which occurs due to experiencing or being confronted with or witnessing events that are lead to traumatic stress (Adriaenssens, De Gucht, & Maes, 2012).  Such an event can be so severe that it can overwhelm an individual’s ability to manage and this leads to abnormally severe behavioral and emotional reactions.  The incidence of this condition is more common among the nurses operating in emergency rooms than any other specialties of nursing. The incidences were mostly found in various studies that have been carried out, examining the exposure type and frequency during emergency. Such research has shown the  events that are most distressing which includes  cases involving children , cot death, dealing with families and patients  of the patients , caring for burn patients and psychiatric patients and even handling the  bodies of the deceased.  Moreover, the chaotic working conditions and even overcrowding can also tamper with recovery process and affect the emergency nurse negatively (Adriaenssens, De Gucht, & Maes, 2012).

 

Nurses working in the emergency rooms encounter severe deaths, injuries, sufferings and even suicide while at the same time, being exposed to physical and verbal aggression. A review of a study found that 75 % of nurses working in emergency rooms in a single year faced aggressive behavior in comparison to 43 percent of nurses working in wards for internal medicine, 23 percent working in surgical words and 9.9 percent working in pediatric words (Adriaenssens, De Gucht, & Maes, 2012).  While not all exposure to traumatic events cause PTSD, it has been found that exposure to such events may lead to considerable psychological effects. It has been shown that such events leads to impacts like depression and irritability, nightmares, difficulties in sleeping and diminished interest in normal life (Gelsema, et. al 2005).  The general effect is a change in attitudes towards the professional and hence more absenteeism and productivity loss and reduced quality in nursing care. However, psychological and physiological responses to such events should be considered a usual way reacting to such situations and in many of the cases the responses reduce as time passes.

 

Lack of enough social support or inadequate coping can lead to worsening and persistence of symptoms of this condition on the involved nurses. Therefore, two strategies for copying are distinguished which includes coping that is task or problem oriented and a strategy that is focused on emotions. Task oriented strategy comprises of attempting dealing with the situation itself while emotion-based strategy comprises of various efforts aimed at regulating emotions that a nurse experiences due to the stressful  occurrence.  Time is an important task in copying strategies which can be incorporated to an active approach of finding solution during the care intervention (Ahwal & Arora, 2015). An emotional copying tactic that is an avoidant like distraction can be necessary in nursing in the emergency rooms so that they continually function, while in the long-run it may affect the recovery and therefore cause PTSD symptoms. A social network that is supportive is seen to prevent the development of such symptoms, while lack of such support combined with poor communication in a team has been known to cause fatigue and post-traumatic stress issues for the emergency workers (Gelsema, et. al 2005).

 

The study involved emergency nurses/respondents of whom 55.6 % were female with a mean age of 33.76 years. Nearly 74 % were in relationships while 42 % did not have resident children. Job experience mean was 11.21 years, nearly one third had fulltime jobs, 88.7 percent worked in shifts and all of them worked in emergency care at health facilities. 13 % had not encountered a traumatic even over the past 6 months , 15 % indicated having  a single event , 32 percent two-three , 23 percent four-five and 17 percent six or above(Adriaenssens, De Gucht, & Maes, 2012) . Hence, the research question on exposure frequency and type of traumatic events showed that many of the nurses had encountered a traumatic even in the emergency healthcare. Compared to other nursing specialties, the general nurse population has fewer cases of traumatic exposures than nurses in emergency care and is more comparable to personnel working with ambulances. As found in other researches, the type of traumatic incidence mostly encountered includes sudden death mainly of small children or adolescents and it is also shown to be the most depressing. In addition, it was found that considerable part of the nurses had somatic complaints and psychological distress that surpassed sub-clinical levels(Adriaenssens, De Gucht, & Maes, 2012). The experience of traumatic events is shown to strongly relate to such PTSD symptoms other outcomes apart from fatigue.

The article shows that nurses in emergency rooms are frequently exposed to traumatic incidents and these have considerable negative impacts on their physical and psychological health.  The findings are important for both the nurses and hospital management given that the effects of such stress can lead to increased sickness off-days, reduced job performance and satisfaction and low quality of nursing care. The finding stresses the need for coming with strategies that will ensure nursing are copying well with the situation and in the recovery process. Over the past decade, intervention strategies have been shown to enhance copying among the health care workers which can also be used for the emergency room nurses.  The article also highlights the need for strategies to consider the behavioral and emotional aspect of the nurses which should also be combined with relaxation techniques.  The importance of enough social support from social network which will ensure good communication and emphatic leadership cannot be downplayed. Hence, interpersonal relationships that are based on good communication can assist in alleviating the situation (Lu et. al 2015).  Given that traumatic stress is experienced more in the emergency rooms than other nursing specialties, it is necessary to pay attention to this field to prevent negative attitude towards the profession.

Ethical considerations

The article observed some standards in conducting this study and included getting approval of Ethical Committee if Leiden University. The values involved while conducting the research involved guaranteeing confidentiality to all the respondents while ensuring an informed consent was obtained from each. This was important to allow participants the freedom to be involved.

References

Adriaenssens, J., De Gucht, V., & Maes, S. (2012). The impact of traumatic events on emergency room nurses: Findings from a questionnaire survey. International journal of nursing studies, 49(11), 1411-1422.

 

Gelsema, T. I., Van Der Doef, M., Maes, S., Akerboom, S., & Verhoeven, C. (2005). Job Stress in the Nursing Profession: The Influence of Organizational and Environmental Conditions and Job Characteristics. International Journal of Stress Management, 12(3), 222.

 

Ahwal, S., & Arora, S. (2015). Workplace Stress for Nurses in Emergency Department. International Journal of Emergency and Trauma Nursing, 1(2).

 

Lu, D. M., Sun, N., Hong, S., Fan, Y. Y., Kong, F. Y., & Li, Q. J. (2015). Occupational stress and coping strategies among Emergency Department Nurses of China. Archives of psychiatric nursing, 29(4), 208-212.