Exposure to secondary traumatic stress and its related factors among emergency nurses in Saudi Arabia: a mixed method study

BACKGROUND

Emergency department (ED) nurses are exposed to the risk of secondary traumatic stress (STS), which poses a threat not only to nurses' health and psychological well-being but also adversely affects the execution of their professional duties. The quality and outcome of their nursing services are negatively affected by STS.

PURPOSE

The purpose of this study is to comprehensively investigate the prevalence and intensity of Secondary Traumatic Stress (STS) among Emergency Department (ED) nurses. It aims to identify and analyze the socio-demographic, occupational, and psychological factors that influence the severity and variation of STS experienced by these nurses.

METHODS

The study utilized a sequential explanatory mixed methods approach, including two phases. Phase 1 employed a cross-sectional study design, utilizing a convenience sample of 181 nurses to explore the levels of STS and the factors associated with it. Following this, Phase 2 was structured as a qualitative descriptive study, which involved conducting semi-structured interviews with a purposefully selected group of ten ED nurses. Data collection took place at three major hospitals in Saudi Arabia during the period from January to June 2022.

RESULTS

A total of 181 participants were included in the study. The mean STSS score reported by the nurses was 51 (SD = 13.23) out of the maximum possible score of 85, indicating severe STS among ED nurses. Factors associated with an increase in the levels of STS among ED nurses included being female, older in age, married, possessing higher education and experience, having a positive relationship with colleagues, receiving organisational support, and dealing with a higher number of trauma cases. Several themes emerged from the qualitative interviews including: ED Characteristics: Dual Impact on STS, Emotional Resonance and Vulnerability, Personal Life Stressors, The Ability to Cope, and Social Support.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

Future strategies and interventions targeting STS should be prioritized to effectively manage its impact on ED nurses. It is crucial to develop targeted interventions that address the specific factors contributing to STS, as identified in this study. Additionally, these findings aim to enhance awareness among nursing administrators, managers, and supervisors about the critical factors associated with STS. This awareness is essential for accurately assessing and developing interventions that mitigate STS among nursing staff.

Changes in harm reduction service providers professional quality of life during dual public health emergencies in Canada

BACKGROUND

Harm reduction (HR) is a critical response to the pronounced toxicity deaths being experienced in Canada. HR providers report many benefits of their jobs, but also encounter chronic stress from structural inequities and exposure to trauma and death. This research study sought to quantify the emotional toll the toxicity emergency placed on HR providers (Cycle One; 2019). Study objectives were later expanded to determine the impact of the ongoing toxicity as well as the pandemic's impact on well-being (Cycle Two; 2021).

METHODS

Standardized measures of job satisfaction, burnout, secondary traumatic stress, and vulnerability to grief were used in an online national survey. Open-ended questions addressed resources and supports. HR partners across Canada validated the findings and contributed to alternative interpretations and implications.

RESULTS

651 respondents in Cycle One and 1,360 in Cycle Two reported moderately high levels of job satisfaction; they reported finding great meaning in their work. Yet, mean levels of burnout and secondary traumatic stress were moderate, with the latter significantly increasing in Cycle Two. Reported vulnerability to grief was moderate but increased significantly during COVID. When available, supports lacked the quality necessary to respond to the complexities of HR workers' experiences, or an insufficient number of sessions were covered through benefits. Respondents shared that their professional quality of life was affected more by policy failures and gaps in the healthcare system than it was by the demands of their jobs.

CONCLUSION

Both the benefits and the strain of providing harm reduction services cannot be underestimated. For HR providers, these impacts are compounded by the drug toxicity emergency, making the service gaps experienced by them all the more critical to address. Implications highlight the need for integration of HR into the healthcare system, sustainable and reliable funding, sufficient counselling supports, and equitable staffing models. Support for this essential workforce is critical to ensuring the well-being of themselves, the individuals they serve, and the health of the broader healthcare system.

Effective interventions to reduce burnout in nurses: A meta-analysis

BACKGROUND

To examine the effectiveness of interventions to ameliorate burnout, secondary traumatic stress, and emotional exhaustion in nurses and midwives. The systematic review was completed with all available studies that reported data on the effect of interventions that targeted burnout using the outcome measures of the Professional Quality of Life scale (ProQOL), or the Maslach Burnout Inventory (MBI).

METHODS

We used a systematic review methodology, which included a meta-analysis. A total of 2103 articles resulted from the systematic search; 688 were removed as duplicates, and 1415 articles were reviewed by the title and abstract, of which 255 were eligible for full-text screening. Only 66 met the inclusion criteria and were included in the analysis. The final meta-analysis consisted of 33 reports divided into 12 studies for ProQOL and 21 studies for the MBI.

RESULTS

The results provide an overall effect in studies using the ProQOL measurement was Z = 2.07 (P = 0.04) and a positive improvement mean difference of 9.32. The overall effect in studies using MBI was Z = 3.13 (P = 0.002) and a positive improvement mean difference of 6.58.

CONCLUSIONS

Whilst most studies indicated a positive difference, the most effective interventions included clinical supervision or activities that addressed the personal physical and mental well-being of nurses. Less effective interventions were managerial interventions or ones that used a strictly educational approach.

Psychological pathway to emotional exhaustion among nurses and midwives who provide perinatal bereavement care in China: a path analysis

BACKGROUND

A lack of confidence in perinatal bereavement care (PBC) and the psychological trauma experienced by nurses and midwives during bereavement care leads to their strong need for sufficient organisational support. The current study intended to test a hypothesised model of the specific impact paths among organisational support, confidence in PBC, secondary traumatic stress, and emotional exhaustion among nurses and midwives.

METHODS

A descriptive, cross-sectional survey was conducted in sixteen maternity hospitals in Zhejiang Province, China, from August to October 2021. The sample (n = 779) consisted of obstetric nurses and midwives. A path analysis was used to test the relationships among study variables and assess model fit.

RESULTS

Organisational support directly and positively predicted confidence in PBC and demonstrated a direct, negative, and significant association with secondary traumatic stress and emotional exhaustion. Confidence in PBC had a positive direct effect on secondary traumatic stress and a positive indirect effect on emotional exhaustion via secondary traumatic stress. Secondary traumatic stress exhibited a significant, direct effect on emotional exhaustion.

CONCLUSIONS

This study shows that nurses' and midwives' confidence in PBC and mental health were leadingly influenced by organisational support in perinatal bereavement practice. It is worth noting that higher confidence in PBC may lead to more serious psychological trauma symptoms in nurses and midwives. Secondary traumatic stress plays an essential role in contributing to emotional exhaustion. The findings suggest that support from organisations and self-care interventions were required to improve confidence in PBC and reduce negative psychological outcomes among those providing PBC. The development of objective measures for assessing competence in PBC and organizational support are essential.

Secondary traumatic stress in working nurses studying part time in a bachelor or Master's nursing program in Croatia: a cross-sectional study

BACKGROUND

Nurses are more likely to be exposed to human suffering than other healthcare professionals. Persons exposed to indirect trauma can experience symptoms of posttraumatic stress disorder, symptoms of avoidance, arousal and intrusion. Secondary traumatic stress (STS) occurs when a person hears about the firsthand traumatic experiences of another. This study aimed to explore the prevalence of STS among working nurses enrolled at a university nursing program.

METHODS

A cross-sectional study was conducted among nurses working in healthcare enrolled in university bachelor's or Master's nursing studies at the Catholic University of Croatia in November 2017. Data were collected using the Secondary Traumatic Stress Scale (STSS) and two items from the World Health Organization quality of life brief version (WHOQOL-BREF).

RESULTS

The study included 151 students; the response rate was 70%. The mean STS score was 38, indicating that the students on average suffered from moderate STS. Half of participating nurses met the criteria for STS. Working nurses enrolled in Master's studies had lower STS scores than those enrolled into bachelor studies (t = 4.14, df = 149, p < 0.01). The level of STS had a negative correlation with participants' quality of life assessment (r=-0.392, p < 0.01) and satisfaction with their health (r=-0.387, p < 0.01). We also found a significant positive correlation between subjective assessment of quality of life and satisfaction with personal health (r = 0.432, p < 0.01). We did not find a significant association between the level of STS and sex (r=-0.094) or years of nursing work experience (r=-0.069). Level of STS varied depending on the participants' workplace, years of experience in that workplace and their work shifts. The highest levels of STS were seen in nurses working in the internal medicine department, those with 10-14 years of work experience in the current workplace, and those who work block shifts (12-hr shift followed by 24-hour shift).

CONCLUSION

Over half of working nurses attending university studies had at least moderate STS. Furthermore, STS was negatively associated with participants' perception of quality of life and satisfaction with their health. Prevention and alleviation interventions could reduce the burden of STS among nurses.

Japanese public health nurses classified based on empathy and secondary traumatic stress: variable-centered and person-centered approaches

BACKGROUND

Healthcare providers frequently help traumatized people and are regularly exposed to indirect trauma from their work, resulting in negative psychological responses, such as secondary traumatic stress. Empathy has been associated with patient's quality of care and secondary traumatic stress among healthcare providers. However, the relationship between dispositional empathy and secondary traumatic stress has not been fully elucidated. This study used person- and variable-centered approaches to explore the nature of this relationship.

METHODS

A total of 1,006 Japanese public health nurses working in the Tohoku region and Saitama prefecture completed questionnaires that included scales assessing dispositional empathy, secondary traumatic stress, and burnout. First, we examined predictors of secondary traumatic stress using multiple linear regression analysis. Then, we conducted a latent profile analysis to classify participants into unique groups based on four subscales of dispositional empathy (i.e., empathic concern, perspective taking, personal distress, fantasy) and secondary traumatic stress. Finally, we compared the mean values of the study variables across these groups.

RESULTS

The multiple regression indicated that in those working in Saitama prefecture, lifetime traumatic experiences, work-related distress, and personal distress were positively related to secondary traumatic stress, but perceived support was negatively related to secondary traumatic stress. Latent profile analysis extracted four unique subgroups. Group 1 displayed the highest secondary traumatic stress levels. Group 2 was characterized by the highest level of empathic concern, personal distress, and fantasy and the lowest perspective taking. Group 3 had a moderate secondary traumatic stress level. Group 4 had the lowest secondary traumatic stress and personal distress scores. In these four groups, the burnout scale (exhaustion, cynicism, and professional efficacy) showed a pattern similar to the secondary traumatic stress scale.

CONCLUSIONS

Our person-centered approach showed that this sample of public health nurses could be classified into four unique groups based on their empathy and secondary traumatic stress scores. Although this group of public health nurses was not large, one group displayed high personal distress levels and high secondary traumatic stress levels. Further research is needed to determine effective interventions for this group.

TF-CBT Training Augmented with a Self-Care Focus: Understanding Facilitators and Barriers to Treatment Implementation

Clinicians working with youth exposed to trauma may be at increased risk for experiencing elevated levels of stress and symptoms of secondary traumatic stress, which can negatively impact clinician wellbeing and ultimately contribute to reduced access to quality care for clients. An innovative Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) training incorporating self-care practices (i.e., Practice What You Preach; PWYP) was developed to help facilitate the implementation of TF-CBT and to enhance clinicians' coping and decrease stress. The primary purpose of this study was to determine whether the PWYP-augmented training met three Objectives: (1) increase clinicians' feelings of TF-CBT competency; (2) improve clinicians' coping abilities/reduce clinicians' stress; and (3) increase clinicians' insight into the benefits and/or challenges clients may experience in treatment. An exploratory aim was also developed to identify additional facilitators and barriers of TF-CBT implementation. The written reflections of 86 community-based clinicians who participated in the PWYP-augmented TF-CBT training were examined using qualitative methods. The majority of clinicians indicated increased feelings of competency and improved coping abilities and/or stress levels; almost half mentioned increased insight into clients' experiences. The most frequently mentioned additional facilitators were related to elements of the TF-CBT treatment model. Anxiety/self-doubt was the barrier most frequently mentioned, though all clinicians who mentioned this barrier indicated it lessened or resolved over the course of the training. Incorporating self-care strategies into trainings may serve as a facilitator for TF-CBT implementation by enhancing the competency and well-being of clinicians. The additional insights into barriers and facilitators can be used to further improve the PWYP initiative and future training and implementation efforts.

Secondary traumatic stress and death anxiety in healthcare professionals: Moderating role of social support

Background & Objective

It's hard to deny the buffering impact of social support as it provides much-needed assistance to counter untoward circumstances that individuals face in their daily life. By focusing on the moderating role of social support, the present investigation studied the relationship between secondary traumatic stress and death anxiety that healthcare professionals encounter in their regular work life.

Method

Through a cross-sectional correlational design, 200 participants were included from various hospitals in Lahore (from June-August, 2022) by employing a non-probability purposive sampling technique. They provided basic sociodemographic information along with their responses on self-reported questionnaires for the current investigation.

Results

Results were analyzed through SPSS 21 which indicated that secondary traumatic stress had a positive association with death anxiety, unlike social support which had a negative relationship with death anxiety. Findings also revealed social support as a significant moderator for secondary traumatic stress and death anxiety.

Conclusions

It can be concluded that increased social support could benefit healthcare professionals as it weakened the association between secondary traumatic stress and death anxiety. Other than academia and research, these findings have implications across a variety of professional settings including physical and mental healthcare professionals who can benefit from these indigenous findings.

Secondary traumatic stress and posttraumatic growth in newly graduated nurses: the mediating role of compassion satisfaction

BACKGROUND

Nurses' secondary traumatic stress, compassion satisfaction and posttraumatic growth are closely related, but for newly graduated nurses, there are few reports to evaluate the specific path between these three. The aim of this study was to investigate examine the mediating role of compassion satisfaction in secondary traumatic stress and posttraumatic growth among newly graduated nurses.

METHODS

From March 2021 to May 2021, a total of 330 newly graduated nurses from five tertiary hospitals in China were enrolled, and asked to complete questionnaires regarding secondary traumatic stress, compassion satisfaction and posttraumatic growth. Descriptive statistics, independent-samples T-test, one-way analysis of variance (ANOVA), Pearson correlation analysis and structural equation model were used in this study. A STROBE checklist was used to report findings.

RESULTS

The scores of secondary traumatic stress, compassion satisfaction and posttraumatic growth of newly graduated nurses were 27.11 ± 4.94 (score range: 10-50), 31.89 ± 6.22 (score range: 10-50) and 56.47 ± 20.41 (score range: 0-100), respectively. Additionally, structural equation modeling showed that compassion satisfaction mediated the relationship between secondary traumatic stress and posttraumatic growth with the partial mediating effect of 0.089.

CONCLUSIONS

Newly graduated nurses may experience moderate secondary traumatic stress, but their posttraumatic growth is at a low level, and compassion satisfaction significantly affects the relationship between the two. Nursing managers should strengthen psychological evaluation, and promote their posttraumatic growth by improving their level of compassion satisfaction.

Using Project ECHO to Keep Professionals Well at Work: Individual and Organizational Outcomes

OBJECTIVE

The toll of COVID-19 stress on the mental health of the workforce has been well-documented. The present study examined the use of the Project ECHO framework to provide practices and resources on stress management and emotion regulation to increase individual and organizational health and well-being.

METHODS

Three independent ECHOs were designed and conducted over an 18-month period. Data was collected on the implementation of new learning and comparisons of organizational efforts toward being more secondary trauma responsive from baseline to post initiative, using cloud-based survey methods.

RESULTS

Findings suggest that the use of micro-interventions at the organizational level improved over time in the areas of resilience-building and policy-making, and that individuals were actively integrating skills related to managing their stress.

CONCLUSIONS

Lessons learned adapting and implementing ECHO strategies in the midst of a pandemic are offered, as well as how to cultivate wellness champions in the workforce.

Assessment of Psychological Well-being Among Medical Professionals Working with Patients Who Suffer from Physical Trauma: An Observational Study from India

Background

Healthcare providers working with victims of physical trauma are exposed to significant human suffering at work. This may place them at risk of burnout, secondary traumatic stress (STS), and other psychological disturbances. This study aimed to evaluate the professional quality of life and psychological well-being among trauma professionals.

Methodology

This was a cross-sectional study conducted among 153 staff members (nursing officers, resident doctors, and faculty) of a Level 1 trauma center in North India. The Professional Quality of Life (ProQoL-5) and Depression, Anxiety, and Stress (DASS-21) Scales were used.

Results

More than 50% of the participants had a moderate risk of burnout and STS. In addition, 54% of participants reported having anxiety, 40% stress, and 36% depressive symptoms. Depression, anxiety, and stress were all strongly predicted by burnout and STS.

Conclusion

Psychological distress symptoms were seen in a significant portion of professionals working in the trauma center. Workplace interventions for the promotion of psychological well-being among trauma professionals are recommended.

How to cite this article

Gupta S, Bhatia G, Sagar R, Sagar S. Assessment of Psychological Well-being Among Medical Professionals Working with Patients Who Suffer from Physical Trauma: An Observational Study from India. Indian J Crit Care Med 2023;27(7):493-502.

Exploring the demographics of teachers who experience secondary traumatic stress

BACKGROUND

Over the last decade, the prevalence of childhood and adolescent trauma has continued to gain public notice, forcing educational systems to explore the impact of these traumas on students, teachers, and schools. Some have implemented trauma-informed practices that are purported to be effective for supporting students in classrooms. Researchers have explored the possibility of its adverse effect on teachers as secondary traumatic stress. This study aimed to explore Secondary Traumatic Stress (STS) in classroom teachers in one small urban school district. STS is said to capture how professionals working closely with traumatized populations are impacted by witnessing their clients' experiences. This phenomenon has adversely affected attrition in other helping professions yet is only recently the focus of educational research.

METHODS

The author administered an attitudinal survey to measure levels of STS in one small, urban school district in the U.S. The population sample in this study mirrored that of the district's population and that of national demographics of teachers in the U.S. Descriptive statistics were used to run regression analysis against the STS data.

RESULTS

The findings showed that most teachers experience STS levels within the normal range. White, working-class elementary school teachers experienced higher levels of STS than their K-12 classroom teacher peers.

IMPLICATIONS

The results support a need to continue research on the impact of STS on teachers. Further investigations could inform teacher preparation programs and professional development to identify practices that can help mitigate STS in teachers.

Labor and Delivery Clinician Perspectives on Impact of Traumatic Clinical Experiences and Need for Systemic Supports

OBJECTIVES

Few studies have elucidated the impact of work-related trauma on labor and delivery clinician or considered whether it may be a cause of burnout. This study aims to elicit labor and delivery clinician perspectives on the impact of exposure to traumatic births on their professional quality of life.

METHODS

Labor and delivery clinicians (physicians, midwives, nurse practitioners, and nurses; n = 165) were recruited to complete an online questionnaire on experiences with traumatic births. The questionnaire contained measures from the Maslach Burnout Inventory and the professional quality of life scale version 5. Some participants completed an optional free-text prompt to recommend ways to support clinicians after traumatic births (n = 115). Others opted into a semi-structured phone interview (n = 8). Qualitative data was analyzed using a modified grounded theory approach.

RESULTS

Self-reported adequate institutional support for clinicians after a traumatic birth was positively correlated with compassion satisfaction (r = 0.21, p < 0.01) and negatively correlated with secondary traumatic stress (r = - 0.27, p < 0.01), and burnout (r = - 0.26, p < 0.01). Qualitative themes included lack of system-wide and leadership support, lack of access to mental health resources, and suboptimal workplace culture as contributors toward secondary traumatic stress and burnout. Participants recommended proactive leadership, consistent debriefing protocols, trauma education, and improved access to counseling.

CONCLUSIONS FOR PRACTICE

Multi-level barriers prevented labor and delivery clinicians from accessing needed mental health support after exposure to traumatic births. Proactive investment in healthcare system supports for clinicians may improve clinician professional quality of life.

The relationship between psychological resilience and professional quality of life among mental health nurses: a cross-sectional study

BACKGROUND

Mental health nursing is a demanding and stressful profession that impacts nurses' professional quality of life. Psychological resilience can be a protective factor. However, the relationship has not been extensively studied. This study aims to examine the relationship between psychological resilience and professional quality of life and identify potential predictors of ProQOL subscales among mental health nurses.

METHODS

The study employed a cross-sectional design to collect data from 179 mental health nurses. Data was collected using two standardized questionnaires: the Connor-Davidson resilience scale and the professional quality of life scale. Participants were recruited through convenient sampling during a 3-month period from April to June 2022, and the data were collected using an online survey tool called QuestionPro.

RESULTS

The study found a strong positive correlation between psychological resilience and compassion satisfaction (r = 0.632, P < 0.001). However, there was a negative significant correlation between resilience with burnout (r = -0.470, P < 0.001) and secondary traumatic stress (r = -0.210, P = 0.005). The study also found that higher resilience levels were associated with higher levels of compassion satisfaction and lower levels of secondary traumatic stress. Additionally, higher burnout scores were associated with higher levels of secondary traumatic stress. The study also identified that age and the number of children had weak associations with compassion satisfaction, while workplace was a significant predictor of burnout and secondary traumatic stress.

CONCLUSION

The study emphasizes the importance of resilience, burnout, and secondary traumatic stress in the well-being of healthcare professionals, especially nurses. The findings suggest that assessing nurses' resilience and professional quality of life can raise psychological resilience awareness and help managers create the necessary working conditions to improve nurses' professional quality of life.

Analysis of implementation drivers of secondary traumatic stress (STS)-informed organizational change and experiences of STS and burnout in child welfare

BACKGROUND

STS and burnout (BO) are significant problems for child welfare professionals (Bride, 2007; Craig & Sprang, 2010). A challenge for at-risk professions is to understand how both individuals and organizations can address the potential impact of these conditions.

OBJECTIVE

This study explores the influence of organizational factors on individual experiences of STS and BO in child welfare settings.

PARTICIPANTS AND SETTING

Study participants were 382 child welfare professionals in the United States who were participating in an organizational assessment of STS and related activities.

METHOD

The Secondary Traumatic Stress Informed Organizational Assessment (STSI-OA) tool (Sprang et al., 2014) was administered to evaluate the use of policies, practices and training activities that address STS and BO (Sprang et al., 2014). The National Implementation Research Network's (NIRN) implementation framework was applied to the STSI-OA and domain activities loaded onto the three implementation drivers of competency, organization and leadership (Sprang, Ross, & Miller, 2018). Regression analyses were conducted to determine the strength of associations between the implementation drivers of STS informed organizational activity and individual ratings of STS and BO.

RESULT

Increased use of STS-informed activities affiliated with all three implementation drivers was significantly associated with lower individual STS and BO scores. STS-informed activities associated with the organization driver seemed particularly effective for addressing STS.

CONCLUSION

This study supports the utility of the integrated framework for enacting STS-informed change in child welfare contexts. Recommendations for organizations and future research are provided.

Stress Disorders: the Trauma Surgeon as the Second Victim

Purpose of Review

We review the vocabulary and studies regarding stress disorders, as it relates to trauma care providers, specifically trauma surgeons. In addition, we make recommendations regarding strategies to address the needs identified and future areas of research to assess the adequacy of these strategies.

Recent Findings

Stress disorders in trauma are common and constant, identified at levels similar to those seen among first-responders to mass-casualty events. These disorders are identified at every level-from trainee to the most experienced. Trauma surgeons experience the trauma firsthand, as well as through forced re-traumatization as a part of routine care. High levels of cumulative stress result due to the volume of patients that can be difficult to process due to the frequency of shifts and disrupted sleep patterns. This level of chronic stress can lead to a cycle of burnout and increased stress, which is harmful to surgeons and patients.

Summary

Stress disorders are common and poorly understood. Treatment options are infrequently encountered. In order to more adequately respond to this, systematic change is necessary.

Prevalence and predictors of compassion satisfaction, secondary traumatic stress, and burnout among Chinese hospice nurses: A cross-sectional study

AIM

To explore the prevalence and predictors of compassion satisfaction, secondary traumatic stress, and burnout among Chinese hospice nurses.

BACKGROUND

Because of prolonged and continual contact with suffering, deaths, and grief, hospice nurses may be vulnerable to emotional burdens and have difficulty maintaining their professional quality of life.

METHODS

A cross-sectional study was conducted. A total of 478 hospice nurses were selected from 24 medical institutions in Sichuan province. Demographic, work-related information and work-related trauma questionnaire, the Chinese version of the Interpersonal Reactivity Index, the Chinese version of the Emotion Regulation Questionnaire, and the Chinese version of the Professional Quality of Life Scale for Nurses were used for collecting data.

RESULTS

The mean scores of compassion satisfaction, secondary traumatic stress, and burnout were 34.89 ± 6.21, 26.35 ± 5.24, and 24.49 ± 5.01, respectively. Job satisfaction, perspective-taking, empathic concern, working in tertiary hospitals, and adopting cognitive reappraisal strategy were positively associated with compassion satisfaction, while personal distress was a negative factor, all variables explaining 50.7 % of the variance. Higher burnout was found among nurse who had higher personal distress, worked in secondary or primary hospitals, worked >8 h per day and caring for >10 dying patients last month. In addition, job satisfaction, social support, perspective-taking, empathic concern, and cognitive reappraisal were identified as significant protectors, explaining 50.1 % of the variance. We also found that lower job satisfaction, higher personal distress, higher expressive suppression, lack of social support, senior nurses, and cared for >10 dying patients last month, were positively related to secondary traumatic stress. However, cognitive reappraisal had negative associations. These seven factors explained 32.0 % of the variance.

CONCLUSIONS

Hospice care has specific characteristics and hospice nurses may suffer from more work-related stressors compared with other nurses. Our study may provide clues to help nursing administrators identify hospice nurses who are at higher risk of compassion fatigue and design targeted interventions focused on potential risk factors and protectors to improve hospice nurses' compassion satisfaction, while reducing compassion fatigue.

A Qualitative Investigation into the Trauma Exhibited by First Responders Impacted by the Opioid Epidemic

This qualitative study aimed to capture the lived experiences of first responders (FRs) combatting the opioid epidemic in an effort to better understand how the increase in opioids, opioid-related harm, and opioid-related death has affected the FR profession. FRs (N = 30) from Tennessee partook in semi-structured interviews investigating the impact of responding to opioid-related incidents. Using a phenomenological approach, three response themes emerged including (1) opioid epidemic burden on FR mental health, (2) variable availability and effectiveness of resources, and (3) identified roles of FRs in reducing the impact of the epidemic. The findings indicate that FRs are experiencing posttraumatic stress and secondary traumatic stress symptoms due to a shift in their duties, as well as repeated exposures to the adverse impacts of opioid use. This study finds a deficit in resources and support to combat the mental health repercussions FRs have experienced due to the epidemic. Given that FRs are often directly involved in preventing opioid-related deaths, ensuring that they are well resourced is an essential component of harm reduction and will ultimately augment care for individuals experiencing opioid-related harm.

Application of a Model of Workforce Resilience to the Education Workforce: Expanding Opportunities for Support

The current study analyzed 502 responses from members of the education workforce on the Resilience at Work (RAW) scale and other measures of health and job satisfaction as part of an initiative offering training and technical assistance to support student and staff well-being. A latent profile analysis using scores on components of the RAW identified three resilience profiles: lower, moderate, and higher capacities for resilience. Profiles were differentiated across components related to resilience capacity including alignment of work and personal values, level of social support, and ability to manage stress. Differences between profiles were observed across days of poor physical health, days of poor mental health, days of activity restriction, general health rating, and domains of burnout, compassion satisfaction, and secondary traumatic stress. These findings reinforce calls to support the education workforce through changes that allow access to meaningful work, an evaluation of demands including workload, relevant training on emotional wellness, positive experiences, connections with others, and stress management.

Secondary traumatic stress and dissociative coping strategies in nurses during the COVID-19 pandemic: The protective role of resilience

During the COVID-19 pandemic, nurses are repeatedly exposed to acute stress at their workplace, and therefore, they are at high risk for developing mental health symptoms. The prolonged exposure of healthcare professionals may lead to Secondary Traumatic Stress (STS). STS is an aspect of "cost of care", the natural consequence of providing care to people who suffer physically or psychologically. The purpose of this study was to investigate the levels of STS in nurses during the first phase of the COVID-19 pandemic in Greece and to detect aggravating and protective factors. Participants were 222 nurses (87.4 % women; mean age 42.3 years) who completed an online survey. The questionnaire comprised of the Secondary Traumatic Stress Scale, the Brief Resilience Scale, and the Brief Coping Orientation to Problems Experienced Inventory. Nurses had high levels of STS. The hierarchical regression analyses showed that STS and its dimensions Avoidance and Arousal were positively predicted mainly by denial and self-distraction coping strategies and inversely by resilience. Resilience exhibited a protective (partial mediation) effect on the strong relationship between the dissociative coping strategies (denial, self-distraction, venting and behavioral disengagement) and STS. Trauma-informed care psychosocial interventions are needed to support the already overburdened nursing staff during the coronavirus pandemic.

The experience of secondary traumatic stress among community violence interventionists in Chicago

Community violence intervention strategies are rising in prominence as promising alternatives to traditional criminal justice responses to gun violence. Although such approaches may offer policy advantages and yield societal benefits, the costs to the practitioners of this work-owing to the intimate proximity to violence required by the job-have generally been overlooked. Using a first of its kind survey of nearly the entire population of community-based violence interventionists in Chicago, Illinois (United States), this study assesses the extent to which violence intervention workers experience Secondary Traumatic Stress (STS). Responses to a series of 17 items on a Secondary Traumatic Stress Scale revealed alarmingly high levels of STS among violence interventionists: 94% of workers reported at least one STS indicator in the past 7 days and a full 50% reported experiencing 9 out of the 17 STS items. Our analysis further showed that the STS responses of interventionists were impacted by on-the-job traumatic experiences, particularly the death of a client. These results offer an important first systematic analysis of the trauma and mental health risks associated with community violence intervention practice and suggest that policymakers and practitioners should monitor and address worker risk of traumatic stress within this important public health profession.

An Investigation of Secondary Traumatic Stress and Trauma-informed Care Utilization in School Personnel

Trauma-informed practices in schools are designed to address the impacts of trauma on students and increase supports for school personnel who are delivering this care The impact of a trauma-informed school-based intervention. Journal of Adolescence, 43, 142-147, Mendelsonet al., 2015. Research has established that professionals trained to implement the approach may have secondary traumatic stress (STS) reactions that could interfere with successful implementation (Stevens al., 2020). In this study it was hypothesized that increased use of trauma-informed care strategies would be associated with decreases in total STS scores, as well as all STS subscale scores at the end of a system's transformation initiative, controlling for sex, age, education, years worked in schools, and exposure to student trauma awareness at baseline. The Trauma Sensitive Schools Checklist (TSSC) and the Secondary Traumatic Stress Scale (STSS) were used to measure study outcomes in a sample of 205 school personnel at baseline and follow up. Statistically significant improvement in STSS scores and TSSC score were noted from Time 1 to Time 2. As hypothesized, improvements in TSSC scores were associated with decreased levels of STS over time, controlling for the covariates. However, the symptom domains of intrusion and arousal impacted this relationship in a differential manner than avoidance and alterations in cognitions and mood. This study provides evidence that increased use of trauma-informed care practices can positively impact the STS levels of school personnel, though special attention should be paid to those with high levels of intrusion or arousal.

Passionate healthcare workers in demanding intensive care units: its relationship with daily exhaustion, secondary traumatic stress, empathy, and self-compassion

This study focuses on Intensive Care Units (ICU) and aims to test whether daily job demands are related to daily emotional exhaustion and secondary traumatic stress (STS) after work through the experience of passion at work and whether personal resources in ICU, such as empathy and self-compassion, moderate these relationships. A diary study was designed to assess day-level job demands, passion, empathy, self-compassion at work; and day-level emotional exhaustion and STS after work. The sample was 97 healthcare workers from ICU from different Spanish hospitals being selected by the snowball technique. This sample was assessed 5 days x two moments per day through a diary questionnaire. The multilevel analysis showed a negative mediational effect of harmonious passion between daily job demands and both emotional exhaustion and STS. Also, in predicting emotional exhaustion, a moderator effect of empathy on harmonious passion was found, as well as a moderator effect of self-compassion on obsessive passion. In predicting STS, a direct positive effect was found in empathy. Our findings highlight the vocational work of these healthcare workers, considering job demands as challenging and enhancing their harmonious passion to overcome the drawbacks. Moreover, empathy revealed to have a negative effect whereas self-compassion the contrary. Thus, increase the awareness on these personal resources and how to train them could be considered as valuable preventative measures.

Investigating the relationship between the depression levels of midwives and nurses and their emotional labor and secondary traumatic stress levels in the COVID-19 pandemic period with structural equation modelling

In this study, it was aimed to investigate the relationship between depression levels in midwives and nurses and their emotional labor and secondary traumatic stress levels in the COVID-19 pandemic process structural equation modelling. This cross-sectional study was conducted with 313 midwives and nurses. According to the model formed based on the presence of depression, as the Emotional Labor scores of the participants increased, their Beck Depression scores decreased 0.947-fold, while as their Secondary Traumatic Stress Scale scores increased, their Beck Depression scores increased 1.116-fold. It was determined that the scores of the participants in the Emotional Labor and Secondary Traumatic Stress Scales explained 42.8% of their Beck Depression Inventory scores. It was concluded that the depression statuses of the participants were affected by their emotional labor and secondary traumatic stress statuses.

Influencing factors of perinatal bereavement care confidence in nurses and midwives: A cross-sectional study

BACKGROUND

Most nurses and midwives are not prepared to provide bereavement care. The conflict between the need for high-quality care of bereaved parents and the lack of confidence in providing perinatal bereavement care among nursing staff is becoming increasingly prominent in China.

OBJECTIVE

To describe the current situation and identify influencing factors of perinatal bereavement care confidence (PBCC) among nurses and midwives in China.

METHODS

This descriptive and cross-sectional survey was conducted in 2021. A convenience sample was created by recruiting 571 nurses and midwives in 11 hospitals in Zhejiang Province. Collected the data of PBCC, secondary traumatic stress (STS) and emotional exhaustion (EE) in this study.

RESULTS

The average score of the PBCC was 67.83 ± 10.78. Average levels of STS were (23.32 ± 7.39) and EE (17.87 ± 8.62). PBCC was found to be most often associated with self-awareness, organisational support and training in perinatal bereavement care.

CONCLUSIONS

Managers should take measures to improve PBCC and optimise perinatal bereavement care practice from the perspective of enhancing self-awareness of nursing staff, strengthening organisational support and providing training in perinatal bereavement care. The mental health of nursing professionals in the context of perinatal bereavement care needs to be emphasised. Nursing managers should make clear policies and establish a communication platform for nursing staff. Professional training should be conducted in the future.

The Role of Children's PTSD Symptomatology in Non-Offending Caregivers' Secondary Traumatic Stress Symptomatology Following Disclosures of Sexual or Physical Abuse

This research examined factors influencing levels of secondary traumatic stress (STS) in non-offending caregivers (NOCs) of children with histories of sexual or physical abuse. These factors included the nature of the abuse, NOCs' relationships with the initiators of the abuse, children's ages and genders, NOCs' trauma histories, and the elapsed time between children's disclosures of abuse and their trauma assessments. As a secondary objective, this research examined the interactions between children's self-reports of their own posttraumatic stress disorder (PTSD) symptomatology, NOCs' estimates of their children's PTSD symptomatology, and NOCs' self-reports of their own STS symptomatology. Participants from a clinical sample (N = 300, children = 150, NOCs = 150; child age M = 9.89, SD = 4.08; NOC age M = 37.87, SD = 9.23) completed structured intake interviews, the PTSD Checklist for the DSM-5 (PCL-5) and the Child PTSD Symptom Scale (CPSS; Child-Report and NOC-Report). Analytic strategies included point-biserial correlation coefficient calculations, linear regression analyses, and Analyses of Covariance (ANCOVAs). NOCs' levels of STS were impacted by their relationships with the initiators of the abuse and their own trauma histories. NOCs' self-reported STS symptomatology mirrored their estimates of their children's PTSD symptomatology. The discrepancy scores between children's self-reports of their PTSD symptomatology and NOCs' estimates of children's PTSD symptomatology were impacted by children's ages and genders. Clinical practitioners should note the importance of examining children's PTSD symptomatology and NOCs' STS symptomatology concurrently when making recommendations for trauma-informed evidence-based treatments.

An Evaluation of Whole-School Trauma-Informed Training Intervention Among Post-Primary School Personnel: A Mixed Methods Study

Students' ability to reach their potential in school-both behaviourally and academically - is linked to their educator's knowledge of child and adolescent development, childhood adversity and trauma, and how these impact learning and behaviour. However, teacher pre-service training programmes often offer inadequate instruction to meet the needs of trauma-impacted students. The purpose of the study was to investigate the benefits of professional development training in trauma-informed approaches on school personnel attitudes and compassion fatigue. There is a paucity of research on whole-school trauma-informed approaches and most have methodological limitations via the absence of a control group. In addressing this gap, the study is one of the first to utilise a control group in the research design to ensure findings are robust. The study utilised a quasi-experimental wait-list control pre-post intervention design to evaluate the efficacy of trauma-informed professional development training. We compared attitudes and compassion fatigue among 216 school personnel (n = 98 intervention, n = 118 comparison) utilising the Attitudes Related to Trauma-Informed Care (ARTIC) scale and the Professional Quality of Life scale (Pro-QoL). Quantitative data was supplemented by qualitative focus group data. Findings demonstrated that school-personnel within the intervention group reported significant improvements in attitudes related to trauma-informed care, and a significant decrease in burnout at 6-month follow-up. Our findings demonstrate that with minimum training on the dynamics of trauma, personnel attached to a school can become more trauma-informed and have more favourable attitudes towards trauma-impacted students and consequently be less likely to experience burnout.

Empathy and Cognitive Processing as Factors Determining the Consequences of Secondary Exposure to Trauma Among Roman Catholic Clergymen

By helping individuals after traumatic experiences, the helper is also exposed to the consequences of trauma. The aim of this study was to determine the predictors of consequences of secondary exposure to trauma among clergymen and therapists (N = 140) helping victims of trauma in Poland. Symptoms of secondary traumatic stress (STS) were identified in 22.9% of the clergymen and 8.6% of therapists, and secondary posttraumatic growth (SPTG) in 61.4% of the clergymen and 42.9% of therapists. STS and SPTG predictors were identified based on regression models. In the case of clergymen, regret is a determinant of STS, and positive cognitive restructuring of SPTG. Research findings highlight the need to increase awareness of exposure to secondary trauma among the clergy, and for them to acquire greater skills for coping with stress.

Secondary traumatic stress in iranian midwives: stimuli factors, outcomes and risk management

BACKGROUND

The present qualitative study was conducted to explain the experiences of secondary traumatic stress (STS) and its related factors in midwives working in maternity wards.

METHODS

Data were collected using semi-structured interviews with 11 midwives working in the maternity wards of hospitals in Urmia, Iran, through in-depth interviews with open-ended questions. Data were analyzed using the conventional content analysis approach.

RESULTS

The results of data analysis led to the extraction of three themes, seven main categories, and 18 subcategories. The first theme was "STS stimuli," with the two categories of "Discriminatory approach to midwifery" and "The nature of the midwifery profession". The second theme was "Traumatic outcomes", which included the subcategories of "Psychological-emotional trauma", "Physical trauma" and "Social trauma". The third theme was "Risk management", which had the two subcategories of "Reactive approach" and "Proactive approach".

CONCLUSIONS

The results showed that, in addition to the traumatic nature of events that midwives experience during work as the secondhand victims, factors such as governance-organizational structure, unbalanced distribution of power, and poor supportive laws undermine their professional role and provide conditions conducive to STS. Therefore, avoiding traumatic situations and scientific and skill self-empowerment were the most important strategies adopted by the midwives in this study to prevent risky situations and cope with the consequences of STS. The participation of midwifery stakeholders in policy-making and adopting supportive legislation in redefining the position and role of midwives can play a major role in reducing STS and sustaining their role and position in maternal care.

Co-constructing a Conceptual Understanding of System Enactment

System enactments are co-created phenomena characterized by confounding and emotionally charged multi-person interactions that emerge through the convergence of patients' complex psychopathology, staff vulnerabilities, and the organizational dynamics of the clinical system in which all are embedded. There is ample literature about the psychoanalytic construct of enactment in the therapeutic dyad. Though systems-based clinicians often experience system enactments which transcend the dyad and occur within the projective field of the system, there is no comparable literature that discusses this phenomenon. This paper describes a qualitative study that investigated how psychodynamic clinicians understood the phenomenology and impact of system enactments on clinicians, treatment processes and organizational climate. Major themes were identified through qualitative analysis of the data. The following four key findings were distilled from the resulting themes of the study's two research questions: (1) Clinicians conceptualize system enactments from a classical perspective; (2) System enactments have an experiential impact on clinicians in the domains of affect, cognition, behavior, and physiological arousal, which may be related to secondary traumatic stress responses; (3) Clinicians demonstrate a collapse of mentalizing associated with ruptures in the patient's treatment, conflict in the working relationships between staff, and problematic organizational dynamics; and (4) Interconnected and reciprocal interactions among all levels of the system including patient subsystem, individual staff subsystem, intra-staff subsystem and organizational subsystem, are shaped by the impact of system enactments. A conceptual understanding of system enactmentis outlined, and implications for clinical social work education and practice, organizational policy-making and research are addressed.

Secondary traumatic stress, anxiety, and depression among emergency healthcare workers in the middle of the COVID-19 outbreak: A cross-sectional study

Background

This study aims to determine the secondary traumatic stress (STS), anxiety, and depression levels of the emergency healthcare workers (HCWs) and to identify the factors associated with the mental health of the emergency HCWs.

Methods

This prospective cross-sectional study was performed between April 1 and May 1, 2021. Emergency nurses and auxiliary staff who gave informed consent were included in the study. Participants who answered the questions incompletely were excluded from the study. Demographic information, working and living conditions, STS, anxiety, depression scores, and coping strategies were recorded.

Results

A total of 363 HCWs were included in the study. STS was detected in 261 (71.9%) of the participants, anxiety in 148 (40.8%), and depression in 203 (55.9%) participants. Vaccination against COVID-19 was not associated with STS, anxiety, and depression among emergency HCWs (p > 0.05). Having financial difficulties was the most important factor in the development of anxiety, depression, and STS (OR: 3.68 (95% CI 1.96–6.90), p < 0.001; OR: 4.36 (95% CI 2.52–7.53), p < 0.001; OR: 5.35 (95% CI 3.06–9.37), p < 0.001, respectively). We found significantly reduced levels of STS, anxiety, and depression among participants reporting coping strategies that engaging in hobbies, healthy nutrition, and reading books.

Conclusion

High levels of STS, anxiety, and depression were determined among emergency nurses and auxiliary staff during the pandemic. Poor job satisfaction and financial difficulties were associated with the mental health of emergency HCWs. The mental health of the emergency HCWs should be evaluated regularly. In addition to professional psychological support, social and financial support should be provided as well.

Stress Coping Strategies, Burnout, Secondary Traumatic Stress, and Compassion Satisfaction Amongst Israeli Dentists: A Cross-sectional Study

Objective

Being a member of the dental profession is often associated with stress and high levels of burnout. Stress coping strategies may significantly help mediate burnout. The present cross-sectional study sought to examine the role of stress coping strategies on burnout, secondary traumatic stress, and compassion satisfaction amongst Israeli dentists.

Methods

The study was carried out amongst Israeli dentists with the use of the following questionnaires: (1) the Professional Quality of Life Scale 5 (ProQOL), referring to burnout, compassion satisfaction, and level of secondary traumatic stress; (2) the Coping Inventory for Stressful Situations–Situation Specific Coping Inventory (CISS-SSC), referring to coping strategies (task-focused, emotion-focused, or avoidance-focused coping); and (3) demographic and professional variables (eg, specialisation, workload). Participants included 243 Israeli dentists. Univariate analyses and linear regressions were conducted to evaluate the relationships amongst coping strategies and burnout, secondary traumatic stress, and compassion satisfaction.

Results

Female dentists had higher emotion-focused and avoidance coping scores than male dentists. Burnout could be explained by higher emotion-focused coping scores and lower task-focused and avoidance-focused coping. Secondary traumatic stress could be explained by higher emotion-focused scores, having fewer years of professional experience, and younger ages. Compassion satisfaction could be explained by lower emotion-focused coping as well as by higher task-focused coping and workload scores, specialisation, and gender.

Conclusions

The findings suggest that emotional coping may cause dentists to be vulnerable to burnout and to secondary traumatic stress.

Reliability and Validity of the Greek Version of the Professional Quality of Life Scale (ProQOL-V)

Background

Compassion constitutes a central element of all health and social care professions. The Professional Quality of Life Questionnaire is the most widely used instrument to measure compassion fatigue worldwide.

Objective

The aim of this study was to provide evidence for the reliability and the validity of ProQOL-V for Greece.

Methods

A total of 261 nurses selected by convenience sampling and required to complete the ProQOL and Secondary Traumatic Stress Scale (STSS). The reliability and validity of the scale was evaluated by correlation analysis, t-test, and confirmatory factor analysis.

Results

The overall Cronbach's a for Compassion Satisfaction was 0.87 ranging from 0.86 to 0.87 with individual items deleted, for Burn-out was 0.73 ranging from 0.71 to 0.79 with individual items deleted and for Secondary Traumatic Stress was 0.83 ranging from 0.81 to 0.84 with individual items deleted. Additionally, the Pearson correlation r for Compassion Satisfaction, Burn-out and Secondary Traumatic Stress showed strong correlations between test-retest measurements (p<0.001). Secondary Traumatic Stress and Burn-out were positively correlated to STSS as expected (r=0.69 for Secondary Traumatic Stress and r=0.57 for Burn-out) implying sufficient convergent validity. In contrast, Compassion Satisfaction was negatively correlated to STSS as expected (r=-0.25) implying sufficient divergent validity. Goodness-of-fit indices included TLI=0.856, CFI=0.895, and RMSEA=0.063 supporting the construct validity of the three-dimensional instrument.

Conclusion

ProQOL-V has good reliability and validity among nurses in Greece. The implications of relevant future research are important in relation to the health care management and the support and continuous education of front-line health and social care workers.

Finnish paramedics' professional quality of life and associations with assignment experiences and defusing use - a cross-sectional study

Background

Paramedics experience traumatic events and social emergencies during assignments while also being subjected to verbal and physical threats. Consequently, they are at risk for burnout and secondary traumatic stress, factors inherent to professional quality of life. Defusing and peer-support potentially decrease such symptoms; however, perceived defusing needs and use are not always balanced. Our aim was to explore Finnish paramedics’ professional quality of life, using the Professional Quality of Life Scale, with associations to EMS assignment experiences as well as formal and informal defusing need and use over a 12-month period.

Methods

A quantitative study of 257 Finnish paramedics using a cross-sectional design. Study outcomes were secondary traumatic stress (STS), compassion satisfaction (CS), and burnout (BO) scores using the modified 9-item Short Professional Quality of Life scale (ProQOL). Likert-type scales were used to collect participants’ recollections of assignment experiences and defusing from a 12-month period. Associations were explored using Spearman’s correlation coefficients.

Results

Short ProQOL score medians were STS 4.00 (IQR 3), BO 6.00 (IQR 3) and CS 13.00 (IQR 3). STS and BO correlated to experiences of social emergencies and traumatic events while BO correlated to experiences of threat situations (r = 0.206, p = .001). Paramedics perceived a need for defusing in general associated with STS (r = 0.178, p < .001) and participated in informal defusing. Participation in defusing of any form did not associate with ProQOL scores.

Conclusions

Finnish paramedics’ more frequent experiences of social emergencies, traumatic events, and paramedic-directed threat situations were associated with higher levels of STS and BO. STS was also associated with paramedics’ increased need for defusing and use of informal peer defusing, although neither STS, BO or CS scores associated to any defusing form. Managing paramedics STS and BO, while fostering CS, could therefore be a future research focus.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11851-0.

Troubling/trouble in the academy: posttraumatic stress disorder and sexual abuse research

The potential and actual impact of traumatic research work on researchers has been of focus in academic literature for at least the past 30 years (Alexander et al., Violence and Victims, 4(1), 57-62, 1989; Bahn and Weatherill, Qualitative Research, 13(1), 19-35, 2012; Coles et al., Violence Against Women, 20(1), 95-117, 2014; Coles and Mudaly, Child Abuse Review, 19, 56-69, 2010; Connolly and Reilly, Qualitative Inquiry, 13(4): 522-540, 2007; McCosker et al., Forum: Qualitative Social Research, 2(1): 1-13, 2001). This period of time-over 30 years ago-is approximately same age I was when I commenced writing this paper as a result of my direct experience with posttraumatic stress disorder (PTSD) as a consequence of academic research. For the entirety of my life, researchers have been writing their accounts of trauma, and yet it is an experience that I, and many others, still endure. In this piece, an autoethnographic account is used to explore my diagnosis of PTSD as a consequence of involvement on an academic project examining particular aspects of sexual abuse. In doing so, I examine how PTSD is approached and addressed within the academy, the serious impact that working with traumatic material can have, and suggest a number of approaches that can be considered to address this. These include outlining how we can plan for trauma in research, how considerations of trauma should be built into institutional review boards and ethics applications, and how we can best understand and address the unfair impact that trauma has on fixed-term and casual staff members.

Law Enforcement Pathways to Mental Health: Secondary Traumatic Stress, Social Support, and Social Pressure

The mental health of law enforcement officers (LEO) is critical to the safety and well-being of the officers and the public they serve. However, LEO face significant on-the-job stressors that undermine mental health, and there is a lot to be learned about when and how LEO seek and enter mental health services. The present study sought to explore variables related to mental health seeking behavior, the role of social engagement and social pressure in the decision to seek mental health services, and the most common pathways into mental health utilized by LEO. A small sample of 86 LEO were recruited from the social media page of a law enforcement nonprofit support organization to take several self-report measures on past mental health service usage and intentions to seek future services, the Inventory of Attitudes Toward Seeking Mental Health Services, the Professional Quality of Life Survey, and a measure of social engagement on mental health topics. Results indicate that while a number of factors are associated with intentions to seek future services, the primary factor in past mental health seeking behavior was secondary traumatic stress. Those who sought mental health services reported higher social engagement and social pressure to seek help. LEO entered mental health services for a variety of reasons and through a variety of provider options, such that no one provider source was preferred. Though the present study was limited by a small sample size, reliance on self-report measures, and occurred during a time of civil unrest that sparked the "defund the police" movement, the results serve as a starting point for understanding the pathways into mental health services for LEO and the roles of secondary trauma and prior mental health service experience.

Are Perfectionistic Standards Associated with Burnout? Multidimensional Perfectionism and Compassion Experiences Among Professional MFTs

The current study addressed the role that perfectionism plays among professionals in this field of marriage and family therapy (MFT). Specifically, this study provides information about PS (personal standards) perfectionism and EC (evaluative concerns) and their relationship with both compassion satisfaction and compassion fatigue. The sample included 247 marriage and family therapists who answered demographic questions along with completing the professional quality of life scale (ProQOL; as reported by Stamm, B. H. (2009). Professional Quality of Life: Compassion Satisfaction and Fatigue Version 5 (ProQOL). Retrieved from http://www.proqol.org/ProQol_Test.html; Stamm in The concise ProQOL manual, ProQOL.org, 2010;) and the multidimensional perfectionism scale (MPS; Hewitt and Flett, Journal of Personality and Social Psychology 60:456–470, 1991). Results indicated three significant findings: (1) higher levels of both self-oriented and socially oriented perfectionism are correlated with higher levels of both burnout and secondary traumatic stress; (2) as years of work as an MFT increase, level of burnout decreases; and (3) women demonstrated statistically significantly higher scores in PS perfectionism than men. Limitations, implications, and future directions are discussed.

Building skills and resilience in child abuse pediatricians: A novel program to address Secondary Traumatic Stress

BACKGROUND

Secondary traumatic Stress (STS) is an increasingly recognized phenomenon experienced by clinicians working with patients who have experienced trauma firsthand. STS is experienced in a range of clinical settings; medical trainees and those working in Child Abuse Pediatrics (CAP) are at particular risk of experiencing STS. To date, there are no interventions described to address STS experienced by medical trainees in the context of CAP training.

OBJECTIVE

The aim of this project was to design and pilot an innovative program to increase resilience and address STS symptoms among fellows in a CAP training program.

PARTICIPANTS AND SETTING

The Therapeutic Group Sessions (TGS) program was developed for CAP fellows at the Hospital for Sick Children, Toronto, Canada.

METHODS

The intervention involved mandatory, monthly small group sessions facilitated by a consistent mental health professional throughout fellowship. Sessions included low intensity focusing activities, sharing impactful work-related experiences, mental health professional-led discussion of strategies and reflection on the session. Written evaluations were completed to understand the perceived impact on fellows and were analyzed for themes.

RESULTS

Fellows reported improvements in perceived STS symptoms and increased feelings of resilience. Unanticipated positive outcomes were described including, a highly bonded fellowship group and transferrable skills gained in supportive communication. Programs developed to support clinicians in other settings are reviewed and compared to the TGS program.

CONCLUSIONS

This is the first program aimed at improving resilience and addressing STS among child abuse fellows. Outcomes demonstrated numerous positive impacts that are widely applicable to the broader clinical setting.

Secondary traumatic stress and compassion satisfaction mediate the association between stress and burnout among Korean hospital nurses: a cross-sectional study

Background

Burnout among nurses is a worldwide public health epidemic that adversely affects nurses’ quality of life as well as the patient’s outcomes. The aim of this study was to evaluate the influence of stress on nurses’ burnout and to identify the mediating effects of secondary traumatic stress and compassion satisfaction among clinical nurses in South Korea.

Methods

A quantitative, cross-sectional study evaluated the survey data from 10,305 female registered hospital nurses who participated in the Korea Nurses’ Health Study (KNHS) Module 5. The survey included a demographic questionnaire and the Professional Quality of Life version 5 (ProQOL 5). Bootstrap analyses (using the PROCESS macro) were employed to evaluate the mediating effect between variables.

Results

Stress was significantly associated with burnout and mediated by secondary traumatic stress and compassion satisfaction (β_{indirect 1} = 0.185, Bootstrap confidence interval (BS CI) [0.175, 0.194]; β_{indirect 2} = 0.226, BS CI [0.212, 0.241], respectively). In addition, the magnitude of the indirect effects of compassion satisfaction was significantly greater than the magnitude of the indirect effects of secondary traumatic stress (β_{indirect 1}-β_{indirect 2} = − 0.042, BS CI [− 0.058, − 0.026]). The findings of this study indicate that the positive aspect (compassion satisfaction) of work experiences can offset the negative aspects (secondary traumatic stress), consequently reducing burnout level.

Conclusions

Our study findings suggest that a multidimensional approach to assessing nurse burnout and implementation of proper management will improve quality of life for nurses and help maintain positive attitudes and quality of patient care.

The prevalence of compassion satisfaction and compassion fatigue among nurses: A systematic review and meta-analysis

BACKGROUND

Compassion fatigue is a consequence of chronic work-related stress exposure among healthcare providers. Nursing is a high-risk, stressful profession which increases nurses' vulnerability to compassion fatigue symptoms compared to other healthcare workers. Compassion fatigue has serious consequences for nursing staff, patients and healthcare organizations. Though several studies on the prevalence of compassion fatigue among nurses have been published, the reported data vary considerably across studies; and few meta-analysis have examined the prevalence of compassion satisfaction and compassion fatigue among nurses with large sample sizes.

OBJECTIVES

To systematically assess the prevalence of compassion satisfaction and compassion fatigue among nurses, and to evaluate the effect of different geographical regions, years and departments on the prevalence of compassion fatigue.

DESIGN

Systematic review and meta-analysis DATA SOURCES: The Cochrane Library, PubMed, EMbase, Web of Science, CINAHL, PsyclNFO, China Knowledge Resource Integrated Database (CNKI), Wanfang Database, Weipu Database (VIP), and Chinese Biomedical Database (CBM) were searched in the systematic review. The time frame for the searches included all literature before January 31st, 2020.

REVIEW METHODS

The reviewers independently completed study selection, quality assessments, data extraction and analysis of all included literature. The mean scores and standard deviations of the three subscales of the Professional Quality of Life (ProQOL) scale were pooled using random effects meta-analysis in Stata 16.0 software package. Finally, subgroup analyses were conducted to explore the sources of between-study heterogeneity.

RESULTS

A total of 79 studies were included in the systematic review and meta-analysis, consisting of 28,509 nurses worldwide from 11 countries. In our studies, the pooled mean scores of compassion satisfaction, burnout and secondary traumatic stress were 33.12 (95% CI: 32.22-34.03), 26.64 (95% CI: 26.01-27.27) and 25.24 (95% CI: 24.69-25.79), respectively. In addition, the Asian region had the lowest levels of compassion satisfaction but the highest levels of compassion fatigue symptoms, while the Americas and Europe had the lowest levels of compassion fatigue but highest compassion satisfaction. Levels of compassionate fatigue in nurses increased gradually from 2010 to 2019, reaching the highest level in 2019; and nurses from ICU had the highest levels of compassion fatigue symptoms among all nurses.

CONCLUSION

The levels of compassion satisfaction and compassion fatigue among nurses are moderate. Nurses from the Asian region and in ICUs suffer from severe compassion fatigue symptoms, and the prevalence of compassion fatigue has increased over time. These findings may provide hospital administrators with the theoretical basis for the management and treatment of compassion fatigue.

REGISTRATION NUMBER

PROSPERO [CRD42020164327].

Effects of end-of-life care on medical health professionals: A dialectical approach

OBJECTIVE

The provision of end-of-life (EOL) care has complex effects on both the professional and personal well-being of medical health personnel (MHP). Previous studies have mostly focused on negative or positive influences as mutually exclusive effects. This study offers a new conceptualization by applying a dialectical lens, looking at secondary traumatic stress (STS) and post-traumatic growth (PTG) as dual possible coexisting phenomena. The creation of four theoretically possible profiles, based on the combinations of high or low levels in each dimension, offers a practical translation of this idea toward intervention development.

METHOD

Data were collected at a large tertiary pediatric medical center (n = 1,123) aiming at assessing all personnel. Research methods included collecting demographic data and using validated scales to assess STS, PTG, burnout, compassion satisfaction, and both personal and professional social support.

RESULTS

We classified four response profiles according to the STS and PTG levels: (1) Dialectical-impact, high STS/high PTG, (2) Growth-dominant, high PTG/low STS, (3) Stress-dominant, high STS/low PTG, and (4) Limited-impact, low STS/low PTG. The four profiles differed based on profession, but not other demographics. Physicians were represented significantly higher in the Stress-dominant profile; nurses were highly represented in the Dialectical-impact profile. A significant difference was found when adding reported EOL care as a distinct factor with a higher relative proportion of the "dialectical" response among those reporting providing EOL care.

SIGNIFICANCE OF RESULTS

Findings from this study point toward the recognition and understanding of the complexity resulting from the provision of EOL care. A more complex profile classification, including the dialectical profile, may reflect a broader tendency to ways that MHP are affected by their work. Introducing "dialectical thinking" can lead to more personalized and precise intervention planning for MHP. Tailored interventions promoting personal and professional well-being, based on individual profiles, can contribute to more effective interventions and better resource utilization.

Translation and Cultural Adaptation of the Professional Quality of Life Scale (ProQOL V) for Greece

Introduction:

Compassion constitutes a central element of all health and social care professions. The Professional Quality of Life Questionnaire is the most widely used instrument to measure compassion fatigue worldwide.

Aim:

The aim of this study was to culturally adapt the ProQOL V for Greece.

Method:

Forward-translations and back-translations were conducted by two bilingual translators (English-Greek) grown up in English speaking countries (USA, Australia) while cross-cultural adaptation followed strictly the recent WHO guidelines.

Results:

A five-member expert-panel convened by the first author in order to identify and discuss inadequate expressions/concepts of the forward/backward translation resolved all discrepancies and reached consensus after two panel meetings. Overall, 90.0% of participants considered the instrument very good or good, and items were found relevant, easy to understand and with appropriate alternative answer categories for the three dimensions of CF.

Conclusion:

High quality self-report measures are necessary in evidence-based health and social care research and practice. Participants in a pre-test of the latest cross-culturally adapted version of ProQOL V verified the readability, comprehensibility and suitability of the instruments’ items. After completion of the validation of the ProQOL V, it will become available to Greek researchers.

Secondary traumatic stress, vicarious posttraumatic growth and their association in emergency room physicians and nurses

Background: Emergency room personnel are indirectly exposed to many traumas. Few studies have examined secondary traumatic stress in emergency room nurses and only a single study examined emergency room physicians. The extent of vicarious post-traumatic growth, i.e., the growth associated with such trauma, has also hitherto not been examined in emergency room personnel. Objective: Our first goal was to examine secondary traumatization in both emergency room nurses and physicians. Our second goal was to examine vicarious post-traumatic growth in emergency room personnel. Finally, we also address the association (linear and curvilinear) between secondary traumatization and vicarious traumatic growth. Methods: A questionnaire comprising demographic variables, secondary traumatic stress and vicarious post-traumatic growth was administered electronically to a sample of emergency room personnel from the Wolfson Hospital, Holon, Israel. Results: There were no differences between nurses and physicians in overall secondary trauma or vicarious post-traumatic growth levels. For physicians, there was both a linear and a curvilinear association between secondary trauma and vicarious post-traumatic growth; for nurses, there was no overall association. Further sub-group analyses revealed that emergency room nurses with low workload, in conjunction with low work experience, did show a linear association. Conclusion: Results indicate that while vicarious post-traumatic growth is linked to secondary traumatic stress for emergency room physicians, it is not so for nurses. Theoretical implications concerning the role of trauma symptoms in vicarious post-traumatic growth are discussed. Clinical implications are raised regarding the identification of excessive secondary traumatic stress levels and the need for interventions to both decrease stress levels, and to increase vicarious post-traumatic growth levels.

Vicarious traumatization among child welfare and child protection professionals: A systematic review

BACKGROUND

Many individuals and organizations experience vicarious trauma, defined as exposure to traumatic experiences of others. Those who work with children traumatized by abuse and/or neglect, including, but not limited to, child welfare, child protection, counselors, healthcare providers, advocates, law enforcement, and prosecutors investigating crimes against children, are exposed to traumatic stories daily in their work. Negative reactions to this witnessing of other people's trauma results in vicarious traumatization (also referred to as secondary traumatic stress) which can manifest as mental, physical, emotional, spiritual, work-related and/or social consequences.

METHODS

A review of research literature on the epidemiology of vicarious traumatization among child welfare professionals was conducted. A systematic search strategy was employed using relevant research databases (PubMed, PsychInfo, PILOTS, and EBSCO) for publications from 1995 to 2018. A four-phase PRISMA selection process was employed. Search terms included vicarious trauma/related terms and child welfare/child protection professions. Trained reviewers considered articles meeting inclusion criteria including: (1) child welfare professions; (2) vicarious traumatization/related terms; and (3) analysis of epidemiological data on prevalence, risk/protective factors, or manifestation of vicarious traumatization.

RESULTS

Initially 7,895 unique manuscripts were identified. After multi-stage screening, a total of 39 articles were included. Findings regarding the epidemiology of vicarious traumatization are summarized.

CONCLUSIONS

While exposure to traumatic narratives of those they serve is inevitable for those working in child welfare and child protection professions, the growing research base shows potential for preventing negative impacts and promoting positive outcomes of this empathic work. Identification of additional risk/protective factors and future development and evaluation of evidence-based interventions are important next steps.

An exploration of child welfare caseworkers' experience of secondary trauma and strategies for coping

BACKGROUND

The use of coping strategies can protect against the detrimental effects of many work-related stressors. Given the stressful nature of casework with traumatized children and families, there is a need to better understand how to prevent the experience of secondary trauma.

OBJECTIVE

The goal of this study is to examine child welfare caseworkers' experience of secondary traumatic stress (STS) and the extent to which coping strategies act as a buffer.

PARTICIPANTS AND SETTING

This study utilizes both cross-sectional (N = 1968 at baseline) and longitudinal (N = 653 at 3-year follow-up) data from child welfare caseworkers in three states.

METHODS

Participants were recruited as part of a larger workforce study and invited to complete an online survey.

RESULTS

Results indicated relatively high levels of secondary trauma, with 29.6 % of caseworkers scoring in the "severe" range. Caseworkers' experience of STS was positively associated with burnout and negatively associated with organizational support and coping. Those who utilized coping strategies reported fewer symptoms of secondary traumatic stress both concurrently and three years later. Of the 15 coping strategies explored, the more proficient copers were most likely to have a clear self-care plan, participate in activities or hobbies, and have a work-to-home transition plan.

CONCLUSIONS

Study results point to the importance of developing a self-care plan and having organizational supports that help protect child welfare caseworkers from the negative effects of secondary trauma exposure, both concurrently and over time.

Identifying compassion satisfaction, burnout, & traumatic stress in Children's Advocacy Centers

BACKGROUND

Little research exists examining burnout related to the multidisciplinary team (MDT) working in a Children's Advocacy Center (CAC) setting.

OBJECTIVES

To measure compassion satisfaction, burnout, and secondary traumatic stress (STS) among CAC MDT professionals; identify work and worker characteristics that may impact compassion satisfaction, burnout, and STS; understand professional and personal impacts of occupational stress; and explore coping responses.

PARTICIPANTS AND SETTING

A cross sectional survey was sent electronically to child abuse professionals working in CAC settings across the United States.

METHODS

Demographics and work characteristics were collected. Participants completed the Professional Quality of Life (ProQOL) to evaluate compassion satisfaction, burnout, and STS and answered open-ended questions regarding professional and personal impacts of occupational stress. Upon completion, participants received their ProQOL scores and additional stress management resources.

RESULTS

A total of 885 participants completed the ProQOL (mean age = 42.07; 85% female). Overall mean scores were average for compassion satisfaction, high average for burnout, and in the top quartile for STS. All three scales differed significantly by MDT professional role (ps < 0.001 to 0.01) and employment length (ps < 0.001 to 0.003). Child welfare workers had significantly higher burnout scores than all other professions except law enforcement and prosecutors and significantly lower compassion satisfaction scores than most others. Professionals providing on-call services had significantly higher burnout (p <  0.001).

CONCLUSIONS

These results contribute to our understanding of MDT professions who might be at higher risk for burnout and STS and help inform future interventions to support the MDT.

Secondary trauma and impairment in clinical social workers

BACKGROUND

Secondary traumatic stress (STS), symptomatology resulting from indirect exposure to trauma, is one potential negative effect from engaging in clinical social work. Yet, little is known about the relationship between STS and workers' distress and impairment due to their work.

OBJECTIVE

The purpose of this paper was to explore STS in a national sample of clinical social workers (N = 539).

METHOD AND RESULTS

A structural equation model demonstrating good model fit indicated that STS mediated the association between trauma exposure at work and reports of significant distress and impairment (β = .08, p < .01; 95 % CI = .03, .12). Likewise, STS mediated the association between working with children aged 13 and under and reports of significant distress and impairment (β = .05, p < .05; 95 % CI = .02, .09). Results indicated that the model accounted for 25 % of the variance in significant distress and impairment (R² = .25, p < .001) and 5% of the variance in STS (R² = .05, p < .05).

CONCLUSIONS

Implications for agencies working with child welfare are provided, including a discussion of addressing STS and significant distress and impairment at the individual and larger agency levels.

Disseminating Trauma-Focused Cognitive Behavioral Therapy with a Systematic Self-care Approach to Addressing Secondary Traumatic Stress: PRACTICE What You Preach

This pilot study evaluated the effectiveness of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) training programs augmented with a systematic "PRACTICE What You Preach" (PWYP) self-care focus, which has trainees personally utilize the coping skills they teach their clients. Participants were 115 clinicians/supervisors who completed a PWYP TF-CBT training program. Pre- to post-training analyses documented significant increases in participants' competency and fidelity in implementing TF-CBT (ps < .001), significantly more frequent use of coping skills including instrumental social support (p < .01), active coping (p < .001), humor (p < .01), and restraint (p < .01), and significant decreases in secondary traumatic stress (STS; p < .001). Children's symptoms of PTSD (ps < .001) and behavior problems (p < .05) also decreased significantly. This preliminary evidence suggests that training augmented with PWYP may enhance clinicians'/supervisors' personal coping and reduce their levels of STS without compromising treatment implementation efforts and client outcomes.

Baseline well-being, perceptions of critical incidents, and openness to debriefing in community hospital emergency department clinical staff before COVID-19, a cross-sectional study

BACKGROUND

Emergency department personnel routinely bear witness to traumatic experiences and critical incidents that can affect their own well-being. Peer support through debriefing has demonstrated positive impacts on clinicians' well-being following critical incidents. This study explored community hospital emergency department staff's perceptions of critical incidents, assessed openness to debriefing and measured baseline well-being. Our analysis provides a baseline of provider well-being immediately prior to the local onset of COVID-19. The potential need for additional resources to support frontline providers during the pandemic can be evaluated.

METHOD

We conducted a cross-sectional study for 4-weeks prior to the first COVID-19 case in Connecticut using a survey offered to an interprofessional group of emergency department clinical staff. The main outcome measures were the Hospital Anxiety and Depression Scale (HADS) and the Professional Quality of Life (ProQOL) scale. Pearson's chi-square test was used to identify significant differences in perceptions of critical incidents and debriefings between professional categories. One-way ANOVA and Tukey's test were used to analyze significant differences in well-being between professional categories.

RESULTS

Thirty-nine clinical personnel from St. Vincent's Emergency Department responded to the survey. Events frequently selected as critical incidents were caring for critically ill children (89.7%), mass casualty events (84.6%), and death of a patient (69.2%). Critical incidents were commonly reported (81.6%) as occurring once per week. Additionally, 76.2% of participants reported wanting to discuss a critical incident with their team. Across all respondents, 45.7% scored borderline or abnormal for anxiety, 55.9% scored moderate for burnout, and 55.8% scored moderate to high for secondary traumatic stress.

CONCLUSIONS

At baseline, providers reported caring for critically ill children, mass casualty events, and death of a patient as critical incidents, which typically occurred once per week. Death of a patient occurs at increased frequency during the protracted mass casualty experience of COVID-19 and threatens provider well-being. Receptiveness to post-event debriefing is high but the method is still underutilized. With nearly half of staff scoring borderline or abnormal for anxiety, burnout, and secondary traumatic stress at baseline, peer support measures should be implemented to protect frontline providers' well-being during and after the pandemic.