No nurse wants to lose a patient. But in acute and critical care high-stakes settings, the likelihood of a failed patient resuscitation is higher — putting critical care nurses at increased risk of postcode posttraumatic stress disorder (PTSD).
How can nurses, who are often the primary providers of cardiopulmonary resuscitation (CPR), protect themselves? A new study suggests that how nurses cope with the death of a patient an after unsuccessful CPR attempt may predict whether they will go on to experience severe PTSD.
The study, published in the March issue of the American Journal of Critical Care, focused on a national sample of 490 critical care nurses. Participants completed an online survey that included the Post-Code Stress Scale, the Brief COPE, and the Impact of Event Scale – Revised.
According to the study, postcode stress and PTSD symptoms are not rare. When asked to recall a failed resuscitation, the critical care nurses surveyed showed moderate levels of stress and PTSD symptoms.
The study found a weak association between postcode stress and PTSD symptom severity. Perhaps more eye opening, though, was the finding that how critical care nurses dealt with the patient’s postcode death strongly affected their experience with PTSD.
“We found that both effective and ineffective coping behaviors influenced the severity of PTSD symptoms but showed no correlation with postcode stress,” said lead author Dawn E. McMeekin, RN, DNP, CNE, advanced clinical education specialist at Baycare Health System in Dunedin, FL. “Coping behaviors could be a link in the progression from acute postcode stress to states of chronic unresolved stress, such as PTSD.”
The negative coping factors that were significant predictors of PTSD symptom severity were:
“These study findings are supported by previous studies demonstrating that ineffective coping behaviors are associated with higher PTSD symptom severity when compared across various populations of health care workers,” researchers wrote. “It is postulated that critical care nurses may use multiple behaviors simultaneously and that maladaptive or ineffective coping behaviors blunt the effects of the positive behaviors.”
The study also found that nurses who had institutional debriefing support reported significantly lower postcode stress scores than nurses who did not have such support.
“However,” researchers quickly added, “the same critical care nurses who had access to institutional debriefing had a significantly higher magnitude of PTSD symptom severity than did those critical care nurses who lacked this support. In a Cochrane review, Rose et al substantiated these findings and concluded that at best debriefing shows no benefit in decreasing PTSD and may actually perpetuate an increased risk for PTSD.”
Understanding how nurses cope following unsuccessful CPR may help identify those likely to experience postcode stress and PTSD, according to the study.
Such insight offers benefits for the nurses themselves as well as the units and hospitals that employ them.
“Finding ways to minimize distress and improve resiliency not only helps the individual nurse but may also help combat high turnover and vacancy rates for critical care nurses,” said Dr. McMeekin. “These results underscore the importance of maintaining a healthy work environment and nursing workforce.”