Stress and Coping of Critical Care Nurses After Unsuccessful Cardiopulmonary Resuscitation

Abstract

Background Participation by a critical care nurse in an unsuccessful resuscitation can create a unique heightened level of psychological stress referred to as postcode stress, activation of coping behaviors, and symptoms of posttraumatic stress disorder (PTSD). Objectives To explore the relationships among postcode stress, coping behaviors, and PTSD symptom severity in critical care nurses after experiencing unsuccessful cardiopulmonary resuscitations and to see whether institutional support attenuates these repeated psychological traumas. Methods A national sample of 490 critical care nurses was recruited from the American Association of CriticalCare Nurses' eNewsline and social media. Participants completed the Post-Code Stress Scale, the Brief COPE (abbreviated), and the Impact of Event Scale-Revised, which were administered through an online survey. Results Postcode stress and PTSD symptom severity were weakly associated (r = 0.20, P = .01). No significant associations between coping behaviors and postcode stress were found. Four coping behaviors (denial, selfdistraction, self-blame, and behavioral disengagement) were significant predictors of PTSD symptom severity. Severity of postcode stress and PTSD symptoms varied with the availability of institutional support. Conclusions Critical care nurses show moderate levels of postcode stress and PTSD symptoms when asked to recall an unsuccessful resuscitation and the coping behaviors used. Identifying the critical care nurses most at risk for PTSD will inform the development of interventional research to promote critical care nurses' psychological well-being and reduce their attrition from the profession. (American Journal of Critical Care. 2017; 26:128-135) [1][2][3][4] It is estimated that between 40% and 84% of all resuscitation attempts within critical care units result in immediate or imminent death of the patient within 24 hours. [1][2][3]5,6 Because critical care nurses have frequent and cumulative exposures to unsuccessful cardiopulmonary resuscitations, psychological trauma often ensues. 7 The literature in this area is nascent. Despite a growing workforce demand for registered nurses in critical care, turnover and vacancy rates are high.7,8 Investigation of the cumulative psychological injuries associated with unsuccessful cardiopulmonary resuscitation is warranted and may offer new insights on strategies to attenuate the psychological morbidity associated with providing life-sustaining care and highlight a need for psychological support processes that may aid in the retention of critical care nurses in the workforce.The influence of postcode stress and coping behaviors on the psychological health of critical care nurses is unclear. However, it is hypothesized that critical care nurses who are exposed to the psychological trauma of cardiopulmonary resuscitation efforts that fail to prolong the patient's life will perceive heightened states of postcode stress, coping behaviors, and lower states of psychological health. Therefore the aims of this art...

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