Secondary traumatic stress is defined as “intrusion, avoidance and arousal symptoms resulting from indirect exposure to traumatic events by means of a professional helping relationship with a person or persons who have directly experienced the events” (Bride, Robinson, Yegidis, & Figley, 2004, p. 28). STS has been documented as occurring in many caring professions, including several nursing specialties, and may cause nurses to leave their specialties or the profession (Beck & Gable, 2012; Perry, Toffner, Merrick, & Dalton, 2011). A recent study of 338 pediatric nurses working in many pediatric specialties found 50.3% (n=170) suffered from moderate, high, or severe secondary traumatic stress (Kellogg, Knight, Dowling & Crawford, 2018). This statistic is alarming as pediatric nurses present with higher traumatic stress levels than several other specialties including oncology nurses (Quinal et al., 2009), sexual assault nurse examiners (Wies & Coy, 2013), labor and delivery nurses (Beck & Gable, 2012), surgical intensive care trauma nurses (Mason et al., 2014), nurses who work with patients with cardiac and vascular disorders (Young et al., 2011) and liver and kidney transplant nurse coordinators (Kim, 2013).
STS resulting from patient care can have a long-term psychological impact on the nurse, affecting not only the health of the nurse but also the nurse’s ability to care for patients effectively. Recent documentation of the problem in pediatric nursing by Kellogg and colleagues (2018) determines that more information is needed to identify which patient events are traumatizing for nurses. A deeper understanding of what causes STS in pediatric nurses, and how they cope may lead to the development and implementation of appropriate and effective interventions to help mitigate the problem.
Nurses often suffer emotional consequences after caring for patients. They may have recurrent negative thoughts or upsetting dreams, or flashbacks of difficult patient experiences; they may have trouble performing their jobs due to psychological distress. These traumatic experiences may cause nurses to avoid work, or consider leaving their specialties or the profession (Beck & Gable, 2012; Perry et al., 2011). Additionally, witnessing, and at times participating in interventions that are traumatic to their patients may lead to long-term psychological consequences or diagnoses in nurses. To protect nurses’ psychological and physical health, and prevent nurses from leaving the profession due to STS, it is essential to acknowledge and better understand this subjective experience in pediatric nurses.
Guided by phenomenology, this research describes the traumatic work experiences of pediatric nurses to gain a richer understanding of how these experiences affect their work as pediatric nurses. Secondly, the study identifies the coping mechanisms that pediatric nurses have successfully utilized to cope with traumatic work experiences. Nurses encounter many internal and external stressors during their work, including staffing levels, patient acuity, patients’ and families’ psychosocial needs, interprofessional needs, all while attending to their own physical and emotional needs. Addressing nursing stress will not only benefit the psychological health of the nurse it will also enhance the nurse's ability to take better care of their pediatric patients. With support, and appropriate self-care, nurses are not only more likely to stay in their roles at the bedside, but they are better able to care for their patients, improving patient outcomes. Understanding the experiences that are traumatizing may lead to the development of interventions that can assist and support the pediatric nurse and mitigate the psychological impact of STS.
Subjects
Data collection is currently ongoing and will be complete in summer 2019. Participants are pediatric nurses, with at least one year of nursing experience, who have had at least one patient experience which they felt was traumatizing, or has affected them outside of work. Pediatric nurses whom the researcher were recruited for individual interviews. Further participants were recruited through purposeful “snowball sampling.” Those who agree to participate were asked if they know other pediatric nurses who may be interested in participating. Following recommendations for phenomenological research, the sample size will be about ten participants, data collection will continue, and participants will be enrolled until data saturation occurs (Creswell, 2013).
Procedure
Before conducting participant interviews, the researcher utilized reflexive journaling to attempt to put aside, or bracket personal experience and focus on the experiences of the participants. It was necessary for the interviewer to acknowledge previous stressful work experiences with pediatric patients before the beginning of the study. The researcher took field notes throughout the project to help monitor personal reactions and to inform data analysis.
Each interview utilizes a semi-structured interview guide and is approximately 60-90 minutes. Interviews take place at a location chosen by the participant, allowing for the participant to feel most comfortable. Interviews are recorded using a digital audio recorder. Pseudonyms are used to identify each participant during audio recording to protect confidentiality. Interviews will be transcribed utilizing a professional transcriptionist. Summaries of interviews will be shared with study participants for accuracy of information and validation.
Data Analysis
Data will be analyzed following the phenomenological approach described by Creswell (2013). After bracketing personal experience, and reading and rereading the interview transcripts, the researcher will find significant statements that describe which patient events are most traumatizing for nurses, as well as the circumstances surrounding those events. These statements will then be grouped into themes. Descriptions of what the nurse experienced will be written, including direct quotes. Next, a description of how the experience occurred will be written. Finally, complete descriptions will be formed explaining what the participant felt and the context of the situation. Triangulation will be employed to improve the validity of the study by using multiple experts to review findings; this will allow the researcher to see the data from other perspectives.
Implications for Nursing
This research is currently ongoing; it gleans insight into the experiences of pediatric nurses that lead to STS as well as to nurses’ coping strategies. STS is an occupational hazard for the pediatric nurse, which can lead to the development of burnout or psychological disorders. It is essential to better understand the experiences that pediatric nurses find traumatizing so that effective interventions can be developed to support the nurse. With support, and appropriate self-care, nurses are not only more likely to stay in their roles at the bedside, but they are better able to care for their patients, improving patient outcomes.
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