Jenna Ruimveld

Secondary Traumatic

Stress Disorder

in ER Nurses

• Objectives• Background

– PTSD vs STS– Signs and Symptoms– Occurrences

• “Managing the Unthinkable”• Theory

– Dorothy Orem’s Self Care Model– Maslow's Hierarchy of Needs

• Health Care Environment– Current policies– Case Study/Root Cause Analysis

Presentation Outline

• Inferences/Consequences– Effects of STS in nurse and patient safety

• Recommendations for Quality and Safety Improvement– QSEN Competencies– ANA Standards– Interventions

Presentation Outline continued

ObjectivesIdentify and Define Post Traumatic

Stress Disorder & Secondary Traumatic Stress (STS)

Recognize the significance of STS to nursing

Identify ways STS can affect patient care

Identify preventative measures to reduce the risk of STS occurrence

PTSD vs STSD?

Post Traumatic Stress Disorder (PTSD)

Secondary Traumatic Stress Disorder (STS)

• Recurrent recollections• Distressing dreams• Psychological distress—anxiety• Reminders of the events• Anger, depression, hopelessness• Feeling on the edge• Irritability, difficulty concentrating, and insomnia

Signs and Symptoms of Secondary Traumatic Stress

Top 6 most upsetting events

1. Providing care to a patient who is a relative or close friend and is dying or in serious condition

2. Threatened physical assault of self3. Multiple trauma with massive bleeding or

dismemberment4. Death of a child5. Providing care to traumatized patient who

resembles yourself or family members in age and appearance

6. Caring for severely burned patients

Managing the UnthinkableJane Metzgar, RN, PhD

Self Care Deficit Theory

Theory of self-care

Theory of self-care

deficit

Theory of nursing system

• Self-reliance and responsibility for one’s own care

• Knowledge of potential health problems is necessary to promote self-care behaviors

• Self care is a learned behavior

Dorthea Orem

Maslow’s Heirarchy of Needs

Self-actualization

Esteem

Love/Belonging

Safety

Physiological

• Bronson Crisis Debriefing Team

• Staff volunteers

• 24/7 availability

• Critical Incident Stress Management

• Voluntary

• OSHA Recommendations

The Health Care Enviornment

Mark is a new graduate ER nurse in Rhode Island. He has just moved

to the state and lives alone. He was working the night of the fire and

cared for many of the first patients to arrive at the hospital, most of

which suffered the most severe injuries, Mark lost 8 patients that night.

Due to the high volume of patients, there was minimal staff to care for

the patients. There was no debriefing or counseling available for staff

following the crisis. A few weeks after the event had passed Mark

began to have difficulties sleeping, waking at night frequently with

nightmares about the incident. He is unable to concentrate and on two

separate occasions mixed up patients. He told a fellow co-worker could

still smell the smoke and burned flesh when he comes into work and he

didn’t think he could do it anymore, she told him to just “let it go and do

his job”.

When requesting to talk to a hospital consoler he was informed that

there was not one specifically assigned to staff and he needed to call a

psychiatrist to make an appointment

Root Cause Analysis

Root Cause Analysis

Progression of STS

Environment Organization

Personal Staffing

Signs and Symptoms of STS• Recurrent recollections• Distressing dreams• Anxiety• Reminders of the events• Anger, depression,

hopelessness• Feeling on the edge• Irritability, difficulty

concentrating, and insomnia

Consequences- Patient Care

CONSEQUENCES??

Significance to Nursing Profession

Compassion Fatigue

Job Dissatisfaction

Burnout

• ANA Standards– Standard 12: Leadership

• ““The registered nurse demonstrates in the professional practice setting and the profession”

– Standard 14: Professional Practice Evaluation

• “The registered nurse evaluates her or his own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations.”

– Standard 16: Environmental Health

• “The registered nurse practices in an environmentally safe and healthy manner. “

Recommendations for Quality and Safety Improvements

• Safety– “Minimizes risk of harm to patients and providers

through both system effectiveness and individual performance”

• Knowledge: Examine human factors and other basic safety design principles as well as commonly used unsafe practices

• Skills: Demonstrate effective use of strategies to reduce risk of harm to self or others

• Attitudes: Appreciate the cognitive and physical limits of human performance

QSEN Competencies

Interventions

Debriefing

Individual counseling and follow-up

Continuous evaluation for PTSD/STS

Education

Support from management

Team building activities to boost moral

Stress relief strategies

Building Resilience

“We have an obligation to our clients, as well as

ourselves, our colleagues and our loved ones, not be

damaged by the work we do” -anonymous

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their clients. Curationis, 23(4), 15-21.• Coetzee, S., & Klopper, H. (2010). Compassion fatigue within nursing practice: a concept analysis. Nursing & Health

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Treating Compassion Fatigue in Emergency Nurses. Advanced Emergency Nursing Journal, 35(3), 247-258. doi:10.1097/TME.0b013e31829b726f

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• Meadors, P., Lamson, A., Swanson, M., White, M., & Sira, N. (2009). Secondary traumatization in pediatric healthcare providers: compassion fatigue, burnout, and secondary traumatic stress. Omega: Journal Of Death & Dying, 60(2), 103-128. doi:10.2190/OM.60.2.a

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References