Iran Journal of Nursing

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Jafar Jalal E, Aziz Mohammadi F, Seyyed Fatemi N, Haghani H. Secondary Traumatic Stress and Resilience of the Nurses at the Psychiatric Centers in Tehran City, Iran. IJN 2019; 32 (120) :36-49
URL: http://ijn.iums.ac.ir/article-1-3013-en.html

Background & Aims: Secondary traumatic stress (STS) can be described as an occupational hazard for those providing care to victims of trauma. In health professions, there are times when individuals are in constant and close contact with trauma survivors and experience significant emotional disturbance, thereby becoming indirect trauma victims. Some of STS symptoms include increased negative emotions, the existence of annoying thoughts, failure to separate work from personal life, decreased frustration tolerance, increased anger, depression, disabling and selfish behaviors, fear of working with certain people, self-blame, keeping on one’s toes, decreased sense of competence at work, lack of goal, lack of enjoying the profession, decreased performance in unprofessional conditions, and loss of hope in life. Numerous factors such as environmental factors (e.g., work style, perceived organizational support, workload, client needs, and relationships with colleagues) and individual factors (e.g., level of education, level of experience, and coping styles) contribute to STSS. Nurses in psychiatric wards are faced with severe and complicated challenges in the workplace to provide mental health care. In addition, they should be aware of the risk factors and symptoms of STS. Nurses need to skillfully develop resilience in order to cope with occupational problems and ensure their mental health since resilience and the associated behaviors help overcome negative experiences and turn them into positive experiences. The present study aimed to investigate STS and resilience in the nurses at the psychiatric medical centers affiliated to Tehran University of Medical Science in 2018.
Materials & Methods: This cross-sectional, descriptive study was conducted on 200 nurses working in the psychiatric medical centers affiliated to Iran University of Medical Sciences, Shahid Beheshti University of Medical Sciences, and Tehran University of Medical Sciences. In this regard, Iran Psychiatry Center included 35% of the total sample size (n=70), whereas Roozbeh Psychiatry Center, Imam Hossein Medical Center, and Rasoul Akram Medical Center encompassed 47% (n=94), 12% (n=25), and 6% (n=11) of the total sample size, respectively. Data were collected using an STS scale and resilience questionnaire. The research objectives and methods of filling the questionnaires were explained to the participants, and each questionnaire was completed within 20-30 minutes. Sampling was carried out from August to November 2018. Moreover, data analysis was performed in SPSS version 16 using descriptive statistics (mean, standard deviation, frequency, and frequency percentage), independent t-test, analysis of variance, and Mann-Whitney U in order to determine the relationship between demographic characteristics and STS and resilience.
Results: In this study, most nurses (81%) were female, and the mean age of the participants was 36.69 ± 8.01 years. Moreover, more than half of the subjects (57%) were married. Regarding the level of education, most nurses (83.5%) had a BSc. In terms of employment status, 38% of the subjects had permanent employment, which had the highest frequency, compared to other levels. Furthermore, the mean work experience of nurses was 11.28 ± 7.22 years. On the other hand, the average experience of working in the ward was 4.9±4.21 years. More than half of the subjects (58.5%) were clinical nurses, and the mean working hours of nurses was 173.99 ± 28.43. Most nurses in this study (74.5%) reported moderate economic status, and three-quarters of them had liability insurance. On average, the ratio of nurse to the patient was 9.63 ± 3.03 in the morning, 11.67 ± 4.29 in the evening, and 12.25 ± 4.31 in the evening. In total, 30%, 21.5%, and 26% of the nurses reported high and severe, moderate, and mild secondary traumatic stress, respectively. Furthermore, the mean score of STS and resilience was 37.64 ± 10.03 and 69.71 ± 13.63, respectively. According to the results, there was a significant but reverse correlation between resilience and STS, meaning that those with higher STS had lower resilience (r=-0.513, P≤0.001).
Conclusion: According to the results, the mean score of STS was moderate in the nurses, while the mean score of resilience was above the median of the questionnaire. According to the results, there was a significant relationship between STS and resilience of psychiatry nurses as a dimension of psychological health. In addition, there was a considerable association between psychological health and resilience. Nurses in the psychiatric ward are at greater risk of experiencing stress because they work in direct contact with clients with mental disorders in highly stressful and difficult conditions in psychiatric hospitals. In this study, more than 50% of nurses working in psychiatric wards reported symptoms of STS. Reporting this experience of the population will help support nurses' mental health by promoting awareness and training programs. Moreover, it may prevent their turnover due to work-related stress. Suggestions for preventing and treating STS include strategies such as reducing workload, increasing staff supervision, improving staff support, increasing staff leisure and providing opportunities for nurses to receive mental health services. The resilience of nurses working in psychiatric wards can also be improved by managing their physical and mental stress and promoting their mental health.