TY - JOUR
T1 - Factors associated with critical care nurses’ acute stress disorder after patient death
AU - Wang, Chao Ping
AU - Hung, Fang Ming
AU - Ling, Mao Sheng
AU - Chiu, Hsiao Yean
AU - Hu, Sophia
N1 - Funding Information:
Improvements targeting the experience of nurses are usually missed or overlooked by the healthcare system, and thus, nurses not only lose the joy and meaning of their work, but also are at risk of physical and psychological harm while at their job.46 Recent findings have shown an effective end-of-life education program needs to address the affective/emotional component of nursing care and include communication skill training; it should also teach to improve the resilience/coping of nurses, as well as providing an increase in knowledge.47,48 In other words, end-of-life education should be a comprehensive training course that not only empowers nurses with the knowledge and skills to provide end-of-life care but also should support the nurses and help them to cope with the process. Harrington et al.47 further found that small group discussions and debriefings away from the unit were preferred by nurses. Our study reports that nurses with ASD often discuss their stress with family members, indicating informal grief support from colleagues and friends might be a successful and useful approach.49,50 Interestingly, our study findings do not support the idea that ICU nurses with hospice education are less likely to experience ASD. We reviewed the hospice education content of the relevant study site, and we hypothesised that the main reason might be that the content emphasised how to provide quality care to the patient and family, but did not train/support the nurses to take care of themselves. As Sobal and Jaskie46 pointed out, the work experiences of clinicians were missed in an analysis by the Institute for Health Improvement Triple Aim Initiative targeting the U.S. healthcare system, which aimed to optimise performance. It is therefore time to improve nurses? physical and psychology health within the healthcare system.The present study provides an exploratory model that can be used to identify the nurses at risk of ASD after a patient death and pinpoints areas that can be improved; these are particularly the development of a program that not only provides sufficient knowledge and skills in the area of end-of-life care but also provides grief support and coping strategies for the nurses. This will improve the resilience of ICU nurses and help them to cope with the dying process itself as well as the situation after a patient death.This study identifies three factors that contribute to ASD among ICU nurses: nurse, patient, and organisation factors. Our findings will aid the early identification of nurses at high risk of developing ASD and help with the provision of adequate support for these nurses. Additionally, our researcher (C-.P.W.) has developed a long-term and trust-based relationship with the ICU nurses, which means that nurses are willing to participate and answer the survey questionnaire. As a result, we had a 100% enrolment rate and zero questionnaires that were returned incomplete. However, this is a cross-sectional design, and therefore, we are unable to determine what was each nurse's stress level before and after a patient death and thus what was the change that had occurred due to the patient death. Our results might be conservative because nurses returned their survey questionnaire at 2 weeks after their patient death at the most and this might have resulted in an underestimation of the occurrence of ASD. A longitudinal study should be considered with the aim of monitoring changes in the stress levels of nurses and how this is related to the occurrence of ASD and PTSD. Moreover, a qualitative study is also needed to further explore what influence the various types of patient deaths have on nurses. Finally, it needs to be noted that this study was conducted at a single medical centre in Taiwan, which limits the generalisability of the study's findings to other clinical sites.
Publisher Copyright:
© 2021 Australian College of Critical Care Nurses Ltd
PY - 2021
Y1 - 2021
N2 - Background: In intensive care units, patient death can have a negative psychological influence on the patient's nurse. However, how the frequency of events and factors contributed to acute stress among nurses remains unknown. Objective: The objective of this study was to explore the prevalence of and the factors affecting acute stress disorder among intensive care unit nurses after their patient death. Methods: Nurses from five adult intensive care units whose patient had died during the nurses' working shift were recruited from July 2018 to April 2019. Bryant's Acute Stress Disorder Scale, the Beck Anxiety Inventory, and the Beck Depression Inventory-II were used to measure acute stress, depression, and anxiety. Descriptive statistics, chi-square tests, independent sample t-tests, and stepwise logistic regression were used for data analysis. Results: In total, 119 nurses were enrolled. Nearly one in three nurses (29.4%) had suffered from acute stress disorder after their patient had died. Nurses experienced a higher risk of acute stress disorder when their patients underwent cardiopulmonary resuscitation before death (odds ratio [OR] = 13.75, 95% confidence interval [CI]: 2.59–72.95), when their patients died unexpectedly (OR = 4.88, 95% CI: 1.16–20.56), and when they experienced verbal abuse from the patient family at the patient death (OR = 4.61, 95% CI: 1.18–18.05) compared with their counterparts. Conclusion: Intensive care unit nurses often experience acute stress disorder after their patient death. The nurses of patients who underwent cardiopulmonary resuscitation before death and/or who died unexpectedly and/or nurses who were subjected to verbal abuse by the patient's family were at higher risk of acute stress disorder. A comprehensive program aimed at improving the knowledge, skills, and resilience of nurses is needed.
AB - Background: In intensive care units, patient death can have a negative psychological influence on the patient's nurse. However, how the frequency of events and factors contributed to acute stress among nurses remains unknown. Objective: The objective of this study was to explore the prevalence of and the factors affecting acute stress disorder among intensive care unit nurses after their patient death. Methods: Nurses from five adult intensive care units whose patient had died during the nurses' working shift were recruited from July 2018 to April 2019. Bryant's Acute Stress Disorder Scale, the Beck Anxiety Inventory, and the Beck Depression Inventory-II were used to measure acute stress, depression, and anxiety. Descriptive statistics, chi-square tests, independent sample t-tests, and stepwise logistic regression were used for data analysis. Results: In total, 119 nurses were enrolled. Nearly one in three nurses (29.4%) had suffered from acute stress disorder after their patient had died. Nurses experienced a higher risk of acute stress disorder when their patients underwent cardiopulmonary resuscitation before death (odds ratio [OR] = 13.75, 95% confidence interval [CI]: 2.59–72.95), when their patients died unexpectedly (OR = 4.88, 95% CI: 1.16–20.56), and when they experienced verbal abuse from the patient family at the patient death (OR = 4.61, 95% CI: 1.18–18.05) compared with their counterparts. Conclusion: Intensive care unit nurses often experience acute stress disorder after their patient death. The nurses of patients who underwent cardiopulmonary resuscitation before death and/or who died unexpectedly and/or nurses who were subjected to verbal abuse by the patient's family were at higher risk of acute stress disorder. A comprehensive program aimed at improving the knowledge, skills, and resilience of nurses is needed.
KW - Acute stress disorder
KW - Intensive care unit
KW - Nurse
KW - Patient death
UR - http://www.scopus.com/inward/record.url?scp=85113780821&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85113780821&partnerID=8YFLogxK
U2 - 10.1016/j.aucc.2021.06.007
DO - 10.1016/j.aucc.2021.06.007
M3 - Article
AN - SCOPUS:85113780821
SN - 1036-7314
VL - 35
SP - 402
EP - 407
JO - Australian Critical Care
JF - Australian Critical Care
IS - 4
ER -