1. Jenna Ruimveld Secondary Traumatic Stress Disorder in ER Nurses

2. 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

3. Inferences/Consequences –Effects of STS in nurse and patient safety Recommendations for Quality and Safety Improvement –QSEN Competencies –ANA Standards –Interventions Presentation Outline continued

4. Objectives Identify 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

5. PTSD vs STSD? Post Traumatic Stress Disorder (PTSD) Secondary Traumatic Stress Disorder (STS)

6. 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

7. 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 self 3.Multiple trauma with massive bleeding or dismemberment 4.Death of a child 5.Providing care to traumatized patient who resembles yourself or family members in age and appearance 6.Caring for severely burned patients

8. Managing the Unthinkable Jane Metzgar, RN, PhD

9. 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

10. Maslow’s Heirarchy of Needs Self -actualization Esteem Love/Belonging Safety Physiological

11. Bronson Crisis Debriefing Team Staff volunteers 24/7 availability Critical Incident Stress Management Voluntary OSHA Recommendations The Health Care Enviornment

12. 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

13. Progression of STS Environment Organization Personal Staffing

14. 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

15. Significance to Nursing Profession Compassion Fatigue Job Dissatisfaction Burnout

16. 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

17. 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

18. 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

19. 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

20. Badger, J. (2001). Understanding secondary traumatic stress.American Journal Of Nursing, 101(7), 26-33. Beck, C. (2011). Secondary traumatic stress in nurses: a systematic review. Archives Of Psychiatric Nursing, 25(1), 1-10. doi:10.1016/j.apnu.2010.05.005 Brattberg, G. (2006). PTSD and ADHD: underlying factors in many cases of burnout. Stress & Health: Journal Of The International Society For The Investigation Of Stress, 22(5), 305-313. Brysiewicz, P., & Bhengu, B. (2000). Exploring the trauma care nurse's lived experiences of dealing with the violent death of their clients. Curationis, 23(4), 15-21. Coetzee, S., & Klopper, H. (2010). Compassion fatigue within nursing practice: a concept analysis. Nursing & Health Sciences, 12(2), 235-243. doi:10.1111/j.1442-2018.2010.00526.x Czaja, A. S., Moss, M., & Mealer, M. (2012). Symptoms of Posttraumatic Stress Disorder Among Pediatric Acute Care Nurses. Journal Of Pediatric Nursing, 27(4), 357-365. doi:10.1016/j.pedn.2011.04.024 Dominguez-Gomez, E., & Rutledge, D. (2009). Prevalence of secondary traumatic stress among emergency nurses. JEN: Journal Of Emergency Nursing, 35(3), 199-204. doi:10.1016/j.jen.2008.05.003 Flarity, K., Eric Gentry, J. J., & Mesnikoff, N. (2013). The Effectiveness of an Educational Program on Preventing and Treating Compassion Fatigue in Emergency Nurses. Advanced Emergency Nursing Journal, 35(3), 247-258. doi:10.1097/TME.0b013e31829b726f Laposa, J., Alden, L., & Fullerton, L. (2003). Work stress and posttraumatic stress disorder in ED nurses/personnel. JEN: Journal Of Emergency Nursing, 29(1), 23. Mealer, M., Jones, J., Newman, J., McFann, K. K., Rothbaum, B., & Moss, M. (2012). The presence of resilience is associated with a healthier psychological profile in intensive care unit (ICU) nurses: Results of a national survey. International Journal Of Nursing Studies, 49(3), 292-299. doi:10.1016/j.ijnurstu.2011.09.015 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 Von Rueden, K., Hinderer, K., McQuillan, K., Murray, M., Logan, T., Kramer, B., &... Friedmann, E. (2010). Secondary traumatic stress in trauma nurses: prevalence and exposure, coping, and personal/environmental characteristics. Journal Of Trauma Nursing, 17(4), 191-200. doi:10.1097/JTN.0b013e3181ff2607 Badger, J. (2001). Understanding secondary traumatic stress.American Journal Of Nursing, 101(7), 26-33. Beck, C. (2011). Secondary traumatic stress in nurses: a systematic review. Archives Of Psychiatric Nursing, 25(1), 1-10. doi:10.1016/j.apnu.2010.05.005 Brattberg, G. (2006). PTSD and ADHD: underlying factors in many cases of burnout. Stress & Health: Journal Of The International Society For The Investigation Of Stress, 22(5), 305-313. Brysiewicz, P., & Bhengu, B. (2000). Exploring the trauma care nurse's lived experiences of dealing with the violent death of their clients. Curationis, 23(4), 15-21. Coetzee, S., & Klopper, H. (2010). Compassion fatigue within nursing practice: a concept analysis. Nursing & Health Sciences, 12(2), 235-243. doi:10.1111/j.1442-2018.2010.00526.x Czaja, A. S., Moss, M., & Mealer, M. (2012). Symptoms of Posttraumatic Stress Disorder Among Pediatric Acute Care Nurses. Journal Of Pediatric Nursing, 27(4), 357-365. doi:10.1016/j.pedn.2011.04.024 Dominguez-Gomez, E., & Rutledge, D. (2009). Prevalence of secondary traumatic stress among emergency nurses. JEN: Journal Of Emergency Nursing, 35(3), 199-204. doi:10.1016/j.jen.2008.05.003 Flarity, K., Eric Gentry, J. J., & Mesnikoff, N. (2013). The Effectiveness of an Educational Program on Preventing and Treating Compassion Fatigue in Emergency Nurses. Advanced Emergency Nursing Journal, 35(3), 247-258. doi:10.1097/TME.0b013e31829b726f Laposa, J., Alden, L., & Fullerton, L. (2003). Work stress and posttraumatic stress disorder in ED nurses/personnel. JEN: Journal Of Emergency Nursing, 29(1), 23. Mealer, M., Jones, J., Newman, J., McFann, K. K., Rothbaum, B., & Moss, M. (2012). The presence of resilience is associated with a healthier psychological profile in intensive care unit (ICU) nurses: Results of a national survey. International Journal Of Nursing Studies, 49(3), 292-299. doi:10.1016/j.ijnurstu.2011.09.015 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 Von Rueden, K., Hinderer, K., McQuillan, K., Murray, M., Logan, T., Kramer, B., &... Friedmann, E. (2010). Secondary traumatic stress in trauma nurses: prevalence and exposure, coping, and personal/environmental characteristics. Journal Of Trauma Nursing, 17(4), 191-200. doi:10.1097/JTN.0b013e3181ff2607 References