Nursing is well-recognized as a high-stress job with potential for negative psychological impact such as anxiety, depression and burnout syndrome (BOS). Acute care nurses, however, may be at particular risk for post-traumatic stress disorder (PTSD) given their exposure to life-threatening situations such as mass casualties or dying patients. The diagnosis of PTSD, defined by the Diagnostic and Statistical Manual of Mental Disorders version 4 (DSM-IV), requires either directly experiencing threat to oneself or witnessing a threat to others with feelings of intense fear, helplessness and horror(APA, 1994). Although originally described in combat victims, PTSD may result from a wider range of exposures than in its original conception.
Mealer et al found 20–30% of adult critical care nurses surveyed had PTSD symptoms related to their work, a rate significantly higher than the estimated prevalence among the general U.S. adult population of 3.5% and lifetime prevalence of 6.8% (Kessler, Berglund, et al., 2005; Kessler, Chiu, Demler, Merikangas, & Walters, 2005; Mealer, Burnham, Goode, Rothbaum, & Moss, 2009; Mealer, Shelton, Berg, Rothbaum, & Moss, 2007). As situations involving children are often seen as having greater psychological impact, pediatric nurses may be at particular risk for PTSD (Figley, 1995; O’Connor & Jeavons, 2003). Prior research has demonstrated that nurses may be at risk of secondary traumatic stress (STS) related to their work (Badger, 2001; Beck, In press; Maytum, Heiman, & Garwick, 2004; Meadors & Lamson, 2008; 'PTSD in nurses': the March viewpoint strikes a chord, 2005; Robins, Meltzer, & Zelikovsky, 2009). STS has been defined as “the natural, consequent behaviors and emotions resulting from knowledge about a traumatizing event experienced by a significant other…resulting from helping or wanting to help a traumatized or suffering person” (Figley, 1995). Individuals with evidence of STS may have PTSD-like symptoms. However, unlike PTSD, the chronicity and degree of functional impairment with STS has not been clearly defined (Elwood, Mott, Lohr, & Galovski, 2010). The Secondary Traumatic Stress Scale, the only scale to specifically focus on STS, only asks about symptoms within the past 7 days without a focus on functional impairment (Bride, Robinson, Yegidis, & Figley, 2004). In fact, among a sample of interviewed trauma workers, a majority did not have any interference with their work due to secondary traumatic symptoms (Ortlepp & Friedman, 2002). Despite these differences, much of the literature has focused upon STS rather than PTSD among pediatric nurses. Yet, PTSD could have a significant impact on the individual nurse’s well-being, nursing retention and potentially the care of patients.
Thus, we conducted this study to better understand the prevalence of potential PTSD among pediatric nurses, work-related risk factors, and impact on perceived job satisfaction. Because burnout has clearly been demonstrated among the nursing workforce and is a large component of compassion fatigue (which includes both STS and burnout symptoms), we also sought to measure the presence of burnout syndrome within this cohort and the impact of having potential PTSD with and without BOS (Acker, 1993; Devilly, Wright, & Varker, 2009; Firth, McIntee, McKeown, & Britton, 1985; Kanste, Miettunen, & Kyngas, 2006; Kennedy & Barloon, 1997; Maytum, et al., 2004; Oehler & Davidson, 1992; Ostacoli, et al., 2010; Poghosyan, Aiken, & Sloane, 2009; Poncet, et al., 2007). We would expect that the rate of burnout syndrome, with feelings of emotional exhaustion, depersonalization and lack of personal accomplishment, to be significant but separate from PTSD symptoms (Maslach, Jackson, & Leiter, 1996; Maslach, Schaufeli, & Leiter, 2001). Furthermore, as other anxiety disorders as well as depression are risk factors for PTSD, we screened for the presence or absence of these co-existing symptoms. Our hypothesis was that BOS would be significant among all units surveyed but that nurses working in high intensity areas such as oncology, the intensive care unit (ICU) and the emergency room (ER) would have significantly higher rates of potential PTSD.