Exposure to secondary traumatic stress and its related factors among emergency nurses in Saudi Arabia: a mixed method study

Bushra Alshammari; Nada F Alanazi; Fatmah Kreedi; Farhan Alshammari; Sameer A Alkubati; Awatif Alrasheeday; Norah Madkhali; Ammar Alshara; Venkat Bakthavatchaalam; Mahmoud Al-Masaeed; Sabah Kaied Alshammari; Nwair Kaied Alshammari; Mukhtar Ansari; Arshad Hussain; Ahmed K Al-Sadi

doi:10.1186/s12912-024-02018-4

Exposure to secondary traumatic stress and its related factors among emergency nurses in Saudi Arabia: a mixed method study

BMC Nurs. 2024 May 18;23(1):337. doi: 10.1186/s12912-024-02018-4.

Authors

Bushra Alshammari¹, Nada F Alanazi², Fatmah Kreedi³, Farhan Alshammari⁴, Sameer A Alkubati^{5

6}, Awatif Alrasheeday⁷, Norah Madkhali⁸, Ammar Alshara⁷, Venkat Bakthavatchaalam⁹, Mahmoud Al-Masaeed^{10

11}, Sabah Kaied Alshammari¹², Nwair Kaied Alshammari¹³, Mukhtar Ansari¹⁴, Arshad Hussain¹⁴, Ahmed K Al-Sadi⁵

Affiliations

¹ Medical Surgical Nursing Department, College of Nursing, University of Hail, Hail, 2440, Saudi Arabia. bu.alshammari@uoh.edu.sa.
² Hail General Hospital, Hail Health Cluster, Hail, Saudi Arabia.
³ Public Authority of Disabled, Kuwait City, 34R5+25Q 212, Kuwait.
⁴ Department of Pharmaceutics, College of Pharmacy, University of Hail, Hail, 2440, Saudi Arabia.
⁵ Medical Surgical Nursing Department, College of Nursing, University of Hail, Hail, 2440, Saudi Arabia.
⁶ Department of Nursing, Faculty of Medicine and Health Sciences, Hodeida University, Hodeida, Yemen.
⁷ Nursing Administration Department, College of Nursing, University of Hail, Hail, Saudi Arabia.
⁸ Department of Nursing, College of Nursing, Jazan University, Jazan, 45142, Saudi Arabia.
⁹ School of Engineering, Cardiff University, Cardiff Wales, UK.
¹⁰ Faculty of Medicine and Health Sciences, Faculty of Health and Medicine, University Putra Malaysia, University of Newcastle, Serdang, Selangor, Malaysia.
¹¹ Faculty of Health and Medicine, University of Newcastle, Callaghan, 2308, Australia.
¹² Total quality and patient safety department, King Salman Specialist Hospital- Cardiac Center, Hail Health Cluster, Hail, Saudi Arabia.
¹³ Outpatient department, King Salman Specialist Hospital- Cardiac Center, Hail Health Cluster, Hail, Saudi Arabia.
¹⁴ Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, Saudi Arabia.

Abstract

Background: Emergency department (ED) nurses are exposed to the risk of secondary traumatic stress (STS), which poses a threat not only to nurses' health and psychological well-being but also adversely affects the execution of their professional duties. The quality and outcome of their nursing services are negatively affected by STS.

Purpose: The purpose of this study is to comprehensively investigate the prevalence and intensity of Secondary Traumatic Stress (STS) among Emergency Department (ED) nurses. It aims to identify and analyze the socio-demographic, occupational, and psychological factors that influence the severity and variation of STS experienced by these nurses.

Methods: The study utilized a sequential explanatory mixed methods approach, including two phases. Phase 1 employed a cross-sectional study design, utilizing a convenience sample of 181 nurses to explore the levels of STS and the factors associated with it. Following this, Phase 2 was structured as a qualitative descriptive study, which involved conducting semi-structured interviews with a purposefully selected group of ten ED nurses. Data collection took place at three major hospitals in Saudi Arabia during the period from January to June 2022.

Results: A total of 181 participants were included in the study. The mean STSS score reported by the nurses was 51 (SD = 13.23) out of the maximum possible score of 85, indicating severe STS among ED nurses. Factors associated with an increase in the levels of STS among ED nurses included being female, older in age, married, possessing higher education and experience, having a positive relationship with colleagues, receiving organisational support, and dealing with a higher number of trauma cases. Several themes emerged from the qualitative interviews including: ED Characteristics: Dual Impact on STS, Emotional Resonance and Vulnerability, Personal Life Stressors, The Ability to Cope, and Social Support.

Conclusion and implications for practice: Future strategies and interventions targeting STS should be prioritized to effectively manage its impact on ED nurses. It is crucial to develop targeted interventions that address the specific factors contributing to STS, as identified in this study. Additionally, these findings aim to enhance awareness among nursing administrators, managers, and supervisors about the critical factors associated with STS. This awareness is essential for accurately assessing and developing interventions that mitigate STS among nursing staff.

Keywords: ED nurses; STS; STSS; Secondary traumatic stress; Socio-demographic; Stress.