Academic paper titleA qualitative study of resilience and posttraumatic stress disorder in United States ICU nurses  

Mealer, Meredith, Jacqueline Jones, and Marc Moss. “A qualitative study of resilience and posttraumatic stress disorder in United States ICU nurses.” Intensive care medicine38, no. 9 (2012): 1445-1451.  
Synopsis of paperMain Aim:
1. To identify mechanisms employed by highly resilient ICU nurses 
2. To develop preventative therapies to prevent the development of PTSD in ICU nurses.  

Results organised in themes:
Worldview
Social Network
Cognitive flexibility
Self-care and balance  

Participants:

Study interviewed 13 ICU nurses with high resilience & 14 ICU nurses with PTSD.     
Prominent experiences identified Data collected:
Their thoughts, experiences of working in a stressful environment, witnessing traumatic events (death, illness…), their way of coping (healthy & unhealthy)  

Theme 1: Worldview (how the nurses understand and perceive nursing care)  

1. Highly resilient nurses:
a. Their worldview accepted death as part of life, and an uncontrollable outcome.
b. Acceptance doesn’t reduce their hope for the patient. 
c. As a result,some used optimism and humour in their work.

2. PTSD nurses:
a. Expressed regret about patients’ negative outcomes (death) 
b. unable to let go of negative experiences
c. expressing self-blame- feeling that more could have been done for the patient.  

Theme 2: Social network (emotional support organisation, communication & connectivity)

1. Highly resilient nurses:
a. Has a positive social network with close relationships
b. strong collegial relationships with physicians + nurses
c. Variety of relationships= presence of relationships that are not work related

2. PTSD nurses:
a. Little to no family/ friend support
b. Described a hostile work environment
c. Lack of support and poor communication with coworkers  

Theme 3: Cognitive flexibility (modifying response to situations e.g. ways of looking at a situation)  

1. Highly resilient nurses:
a. Use of emotional intelligence to guide decision making
b. Positive reframing, critical reflection & optimism
c. Trauma seen as a learning/ growing experience

2. PTSD nurses:
a. Lack of cognitive flexibility
b. Experiencing trauma-related disruptive thoughts
c. Disruptive thoughts interfered with treating patients that triggered their trauma
d. Avoided reminders of the traumatic event  

Theme 4: Self-care & Balance (mechanisms in daily living to maintain a healthy & balanced lifestyle)  

1. Highly resilient nurses:
a. Life outside of work
b. Exercising
c. Engaged in prayer & spiritual rituals
d. Maintain good sleep
e. Use of available social resources
f. Highly rated having positive role models, active coping skills & optimism

2. PTSD nurses:
a. Difficult sleeping
b. Difficulty engaging in positive coping skills
c. Alcohol used to sleep, a means to escape (maladaptive coping mechanisms)
d. Less likely to identify with: spirituality, social support, a positive role model & optimism
e. Identified with: disruptive thoughts, regret and loss of optimism.  
What do these prominent experiences mean?The findings showed factors which lead to the development of PTSD:
E.g. lack of social support, lack of healthy coping skills  

And factors which can prevent PTSD + build resilience:
Role models, social support, colleague support, making time for their health (exercise), cognitive flexibility (positive reframing) …


These findings inform therapy to address these factors and promote resilience building skills to prevent PTSD & maintain HCPs wellbeing.  

Whilst certain skills the HCPs can work on individually (coping skills) others such as colleague support need to be addressed on an organisational level (helpful seniors, offering therapy sessions, making spaces which promote wellbeing e.g. meditation room/ a calming room)  
Impactful anecdotesi. Statements on worldview: nurses’ thoughts on death  

Nurse with resilience:
“I also believe that I am not meant to understand why certain people die and certain things happen to people. I have to accept it, but I don’t have to understand it…”  

Nurse with PTSD:
“Often times I do think, what could I have done differently? Did I miss something? Was there a better way to have handled the situation? I think I do play it over in my head, after the crisis has passed…”  

ii. Statements on self-care & balance: nurse thoughts on coping skills, daily habits  

Nurse with resilience:
“I exercise because I think that one of the things about nursing, it is a giving profession and I think that you have to do things that renew yourself so that you don’t…so that you have that to give the next day  

Nurse with PTSD:
“I don’t really have good coping mechanisms. I analyse and almost over analyse the situation. I make my analysis and then I feel awful But I just wonder if my health would be better if I had not chosen a career that was quite so stressful for me


More insightful quotes can be found here: https://link.springer.com/article/10.1007/s00134-012-2600-6/tables/3  

PTSD

Sathwikaw; Research contributed by LAGOM Research Team

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