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Liyanage, S. Addison, S. Ham, E. and Hilton, N.Z. (2021) Workplace interventions to prevent or reduce post-traumatic stress disorder and symptoms among hospital nurses: A scoping review. Journal of Clinical Nursing 00:1-11
Implications for practice
A shared approach between policymakers, organisations and healthcare staff is required to prevent and support those at risk of developing post-traumatic stress disorder (PTSD) in the workplace.
More research focusing on the prevention and management of PTSD in nurses is urgently needed.
Post-traumatic stress disorder (PTSD) occurs following exposure to traumatic events. It is recognised that nurses are at risk of developing PTSD or its symptoms. This can be attributed to several work-related reasons, including witnessing or directly experiencing trauma in the workplace, such as workplace violence, or the repeated exposure to the trauma suffered by those in their care.1 2 Developing PTSD or its symptoms can negatively affect nurses’ physical and psychological well-being and may negatively impact care delivery.1 Therefore, identifying strategies that may prevent the development of PTSD is a priority.
This scoping review from Liyanage et al aimed to identify workplace interventions to prevent or reduce the impact of work-related PTSD and its related symptoms among hospital nurses.2
The review was conducted according to the well-established scoping review framework proposed by Arksey and O’Malley.3 The five steps of this framework include: (1) identifying the research question; (2) the identification of relevant studies; (3) study selection; (4) extraction and documentation of data and (5) collation and synthesis of the reported results. Appropriately, the authors of the review utilised an unregistered protocol and searched 12 databases from 1980 to 2019.
Across 7746 results, 6 studies met the inclusion criteria. Of the studies included, three were randomised controlled trials, one was a quasi-experimental study, one a feasibility study and the other a descriptive correlational study. Interventions such as care debriefing, guided imagery and mindfulness-based interventions appeared to improve signs and symptoms of PTSD across hospital nurses. Limitations of the data included a lack of geographical and participant diversity; all but one study took place in the USA, most studies had small sample sizes, with most participants being Caucasian and female. Further, most interventions focused on the individual healthcare practitioner with limited details around how system-level interventions could potentially support improvements in this area.
The issue of identifying and supporting nurses at risk of developing PTSD and its symptoms is more critical than ever. Since the start of the COVID-19 pandemic, healthcare staff have been working in unprecedented circumstances and mental health-related illness is now a significant issue.4 Moreover, emerging research, exploring the psychological implications of caring for patients with COVID-19, highlights the prevalence of anxiety, depression and peritraumatic dissociation in this group of staff.5
This well-executed scoping review highlights the limited availability of well-designed research available to inform future developmental work in this crucial area. Although the results are not surprising, it emphasises the need to adopt multimodal approaches when tackling this issue.
This review also highlights the complexity of managing work-related mental health and the need for rigorously tested, evidence-based interventions. For example, in one study, a simple intervention of using a brief educational resource, in this case a booklet on trauma and coping, increased the levels of distress compared with that of the control group. This emphasises the need to use interventions with an adequate evidence base, which have been rigorously tested before implementation.
The authors of the review also highlight the crucial role which healthcare organisations and policymakers must take to support clinical staff. From research outside of healthcare, it is understood that by preparing staff for the challenges they may face in their role, work-related mental health issues may be reduced.6 By creating shared ownership between organisations, policymakers and staff, safe, effective and sustainable innovation can blossom in this area.
Patient consent for publication
Funding This study was funded by the Institute of Healthcare Improvement (University of Cambridge) (307748-01/PD-2019-02-16).
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.