Post-traumatic stress disorder in nurses: An integrative review

Abstract

Aims and objectives: To synthesise literature regarding PTSD among nurses. Two objectives guided this review: (a) describe the prevalence of PTSD in registered nurses and (b) identify factors associated with nursing work-related PTSD.

Background: Post-traumatic stress disorder (PTSD) is a psychiatric disorder that can occur from direct or indirect exposure to traumatic events. Nurses are at risk of developing PTSD due to their indirect and/or direct exposure to traumatic situations while providing care to vulnerable patient populations.

Design: An integrative review.

Methods: A literature search was conducted in PubMed and the Cumulative Index of Nursing and Allied Health Literature (CINAHL). Data extraction and quality assessment were independently performed by two reviewers. Data analysis procedures consisted of four concurrent activities: data reduction, data display, data comparison and conclusion drawing and verification. Conclusions were narratively synthesised and thematically presented by review objective using PRISMA guidelines.

Results: Twenty-four articles met criteria for review. One theme emerged from the synthesis of literature describing the prevalence of PTSD in nurses: All Over the Board. Authors reported vastly different PTSD prevalence rates across studies likely due to variability in measurement. Four themes emerged from the synthesis of factors that influence PTSD among nurses: The Workplace Matters, Relationships Matter, It Hurts to Care and Interpersonal Strengths. These overarching themes captured a multitude of factors that occur across three levels of influence: organisational, interpersonal and intrapersonal.

Conclusions: This integrative review highlights PTSD as a growing concern in the nursing profession. The thematic analysis and associated subthemes provide a framework for the design of interventions to reduce the risk of PTSD symptom development among nurses working in inpatient settings.

Relevance to clinical practice: Multitargeted efforts directed at the organisational, interpersonal and intrapersonal factors identified in this review may help mitigate the harmful impact of PTSD and promote nurse well-being.

Keywords: psychological well-being; registered nurses; review; workforce issues.