Secondary Traumatic Stress in Nurses: A Systematic Review

doi:10.1016/j.apnu.2010.05.005

Archives of Psychiatric Nursing

Volume 25, Issue 1, February 2011, Pages 1-10

https://doi.org/10.1016/j.apnu.2010.05.005 Get rights and content

Background

Is there a “cost of caring” for health care providers of traumatized patients?

Objectives

The aim of this study is to review the literature on secondary traumatic stress in nurses in order to answer the following questions: What studies have been conducted on secondary traumatic stress in nurses in all clinical specialties? What instruments were used to measure secondary traumatic stress in nurses and what psychometric properties were reported?

Design

A systematic review.

Data Sources

CINAHL, PubMed, and PsycINFO databases were searched for the years 1981 to the present. Keywords used in the database searches included secondary traumatic stress, compassion fatigue, vicarious traumatization, secondary trauma, PTSD, and nurses.

Review Methods

Research studies were reviewed for the following inclusion criteria: the sample included nurses, the secondary traumatic stress symptoms were measured, and the language was English.

Results

Seven studies were found in which researchers examined secondary traumatic stress in nurses. The samples in five of these studies consisted of all nurses, whereas in the remaining two studies, nurses were included in the samples but the results were not specifically reported for the subgroup of nurses. Presence of secondary traumatic stress was reported in forensic nurses, emergency department nurses, oncology nurses, pediatric nurses, and hospice nurses. Three instruments were identified that measured secondary traumatic stress in practitioners who care for traumatized populations: Secondary Traumatic Stress Scale, Compassion Fatigue Self Test for Helpers, and the Compassion Fatigue Scale—Revised.

Conclusions

Presence of secondary traumatic stress in nurses was reported in all of the studies included in this literature review. The use of small samples and a number of different instruments to measure secondary traumatic stress symptoms, however, hindered the ability to make comparisons across studies and to draw conclusions. None of the studies conducted to date have focused on secondary traumatic stress in psychiatric nurses. Suggestions for future research and clinical implications for what can be done to protect nurses from secondary traumatic stress are addressed.

Section snippets

Conceptual clarification

Research on secondary traumatic stress has been hampered by lack of conceptual clarity. The use of different terminology at times to refer to the same concept contributes to this confusion. Closely related concepts of secondary traumatic stress (compassion fatigue), burnout, and vicarious traumatizaton need to be differentiated.

Literature review

In this literature review, the following databases were searched for the years 1981 to the present: CINAHL, PubMed, and PsycINFO. Keywords used in the database searches were secondary traumatic stress, compassion fatigue, vicarious traumatization, secondary trauma, PTSD, and nurses. Inclusion criteria for the studies to be included in this literature review were the following: the sample included nurses, secondary traumatic stress symptoms were measured, and the language was English.

Seven

Instruments

In this section, instruments that assess secondary traumatic stress symptoms specifically in practitioners who care for traumatized populations are described. These instruments include the Secondary Traumatic Stress Scale, the Compassion Fatigue Self Test for Helpers, and the Compassion Fatigue Scale—Revised (CF-R).

Discussion

What can be done to protect nurses from secondary traumatic stress? Nurses need to be educated about their vulnerability when working with traumatized patients about the signs and symptoms of secondary traumatic stress, risk factors, and secondary traumatic stress-related coping behaviors such as avoidant and numbing responses (Gates & Gillespie, 2008). Continuing education should be instituted whereby nurses learn about ways to prevent the secondary traumatic stress symptoms and factors that

Conclusion

In the seven studies found in this literature, review researchers reported the presence of secondary traumatic stress in nurses in a number of different clinical specialties. Reported rates of elevated secondary traumatic stress symptoms ranged from 25% in forensic nurses (Townsend & Campbell, 2009) to 78% in hospice nurses (Abendroth & Flannery, 2006). Data regarding personal trauma histories of the nurses in the studies were not collected. Small samples and the use of different instruments in

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Despite being less recognized as a specific subdomain of Psychology in French-speaking countries, forensic psychologists do face the same challenges as their Anglo-Saxon counterparts. Among these, the literature identifies the quality of life in the workplace, which can be divided into Compassion Satisfaction, and Compassion Fatigue, the latter being composed of Burn-out and Secondary Traumatic Stress. Previous research has acknowledged the role of emotional competence, especially the management of emotions, as a central factor of healthcare professionals’ relationship with their work assignments. However, Pirelli and collaborators recently highlighted the lack of empirical research among forensic psychologists. As an answer to their call, this study investigates the association and predictive factors of emotional competence, difficulties in emotional management, and the quality of professional life.
An online survey (Lime Survey) was used to collect data regarding socio-demographic variables such as age, gender, years of experience, and training. The following self-questionnaires were then given to the subjects: Profile of Emotional Competence, Difficulties in Emotion Regulation Scale, and Professional Quality of Life. Descriptive, correlational, and regressive analyses were undertaken to, respectively: (1) describe our sample and compare it to available norms (Student's t), (2) associate (Bravais-Pearson r) the mean scores of the three scales, and (3) evaluate the prediction (simple and multiple linear regression) of emotional competence and emotional dysfunction on the quality of professional life. These predictions were then reversed. Both regression analyses used the backward method.
The sample was composed of 44 French-speaking forensic psychologists (79.50% female), median age 34.20 (SD = 7.96). They were mainly trained in clinical psychology (84.10%), followed by forensic psychology (18.20%). The majority of the sample worked as carceral psychologists (59.10%), and their main missions were support and guidance (78.70%), followed by recidivism risk assessment (52.30%) and crisis management (50.00 %). Descriptive results. The participants exhibited significantly higher emotional dysfunction scores (total score, p ≤ .001; Lack of Emotional Clarity, p = .10; Impulse Control Difficulties,p ≤ .001; Difficulties Engaging in Goal-Directed Behavior,p ≤ .001) when compared to available norms. Regarding their perceived quality of life, all scores were either significantly lower or higher based on the norms used. A similar analysis was not possible for emotional competence as available norms were gender-specific, and the sample gender distribution was clearly unbalanced. Associations and regression relations were confirmed between emotional competence, emotional dysfunction, and the quality of professional life, especially between Compassion Satisfaction and emotional competence (r = .33–.56) on the one hand and between Burn-out and emotional dysfunction on the other hand (r = .41–.65). Unexpectedly, Secondary Traumatic Stress was only predicted by emotional dysfunction (Impulse Control Difficulties, β = .39, t = 2.71, R² = .13, p = .010).
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Secondary Traumatic Stress in Nurses: A Systematic Review

Background

Objectives

Design

Data Sources

Review Methods

Results

Conclusions

Section snippets

Conceptual clarification

Literature review

Instruments

Discussion

Conclusion

Child Abuse & Neglect

Journal of Obstetric, Gynecologic, and Neonatal Nursing

Journal of Pediatric Health Care

Journal of Pediatric Health Care

Journal of Pediatric Nursing

Pediatric Clinics of North America

Predicting the risk of compassion fatigue: A study of hospice nurses

Journal of Hospice and Palliative Nursing

Compassion fatigue nursing support group in ambulatory care gynecology/oncology nursing

Journal of Gynecologic Oncology Nursing

Compassion fatigue and psychological distress among social workers: A validation study

American Journal of Orthopsychiatry

The Compassion Fatigue Scale: Its use with social workers following urban disaster

Research in Social Work Practice

Diagnostic and statistical manual of mental disorders

Diagnostic and statistical manual of mental disorders—text revision

Interventions to manage compassion fatigue in oncology nursing

Clinical Journal of Oncology Nursing

Hospital social workers and indirect trauma exposure: An exploratory study of contributing factors

Health and Social Work

Social work students' treatment termination

Clinical Supervisory

Strengths and secondary trauma in family violence work

Social Work

Prevalence of secondary traumatic stress among social workers

Social Work

Development and validation of the Secondary Traumatic Stress Scale

Research on Social Work Practice

Secondary traumatic stress: An investigation of Canadian mental health workers

Traumatology

Vicarious trauma, secondary traumatic stress or simply burnout? Effects of trauma therapy on mental health professionals

Australian and New Zealand Journal of Psychiatry