The Impact of Critical Care Incident Stressors on Critical Care Nurses and Their Work Environment

2.50
Hdl Handle:
http://hdl.handle.net/10755/157066
Category:
Abstract
Type:
Presentation
Title:
The Impact of Critical Care Incident Stressors on Critical Care Nurses and Their Work Environment
Author(s):
Yehl, Gary P.
Author Details:
Gary P. Yehl, RN,MS, GEORGETOWN UNIVERSITY HOSPITAL, WASHINGTON, DC, USA, email: gary.dc1@gmail.com
Abstract:
POSTER PURPOSE: To identify and describe stressors and traumatic events in the work environment of critical care nurses. BACKGROUND/SIGNIFICANCE:Critical care nurses are continually faced with the challenges of caring for acutely ill patients and their families. By their very nature, critical care units exude an environment of stress and tension through repetitive exposure to events outside the normal realm of human experience. Critical care nurses are frequently exposed to situations that may be emotionally charged, including patient mortality, ethical dilemmas, cardiopulmonary resuscitation, and the withdrawal of life support. Support to assist critical care nurses in identifying and dealing with these stressors may not be provided or sufficient. Hospitals that fail to provide services to ameliorate these negative psychological and behavioral effects or repeated exposure to such incidents leave critical care nurses at risk and feeling dissatisfied with their jobs. In turn, nurses' performance and turnover may be affected, thus adversely affecting patient care and outcomes. The patient care situations just mentioned, in addition to many other issues related to work environment that were not mentioned, cause stress in critical care nurses. Some events generate so much stress on the nurse that normal coping mechanisms are overwhelmed. Previous research indicates that 24% of critical care nurses have symptoms of posttraumatic stress disorder, compared with 14% of other nurses. METHOD: This study used a mixed method design. Phase 1 used a nonexperimental descriptive survey, the Critical Care Nursing Stress Scale. This electronic self-administered questionnaire was used with permission and included 40 multiple-choice questions in 5 areas: (1) management of the unit, (2) interpersonal relationships, (3) patient care, (4) knowledge and skills, and (5) physical work environment. A convenience sample of 73 critical care nurses in an acute hospital setting were instructed to select an answer to each of the questions by using a 5-point Likert scale to indicate the frequency, intensity, threat, and challenge level of a given stressor. Phase 2 used a phenomenological approach to study the lived experiences of 9 critical care nurses who had first-hand knowledge of a traumatic event while working in an ICU. Following the consent process, 1-on-1 semistructured interviews were conducted and audiotaped by a behavioral health practitioner in a location and time chosen by the participants. An interview guideline, comprising 9 questions developed by the researchers, was used to guide the interview process. Van ManenÆs method of thematic analysis was used to analyze the data collected in the interviews. RESULTS: Findings were not statistically significant; however, they were clinically significant. Although the respondents rated stressors in 5 areas, the highest responses reported were from only 2 of these areas: patient care and management of the unit. The stressor with the highest frequency was routine procedures: 51% (patient care); the stressor with the highest intensity was emergencies and arrests: 39% (patient care); the stressor that was the greatest challenge was patients in critical, unstable condition: 36% (patient care); the stressor that was the greatest threat was apathetic, incompetent medical staff: 34% (management of the unit). The response rate was 70% with a mean age range of 20û30 years (67%) and the majority (90%) of respondents were female. Sixty-four percent (64%) of respondents reported having been a nurse for <5 years and 76% reported having worked in critical care <5 years. The 9 interviews yielded rich responses, providing insight to how traumatic events in the work environment affect many aspects of nursesÆ lives. When categorizing events that critical care nurses consider traumatic, the following key themes emerged: the nurseÆs level of experience, peer support, self-doubt, and need for validation of actions. Responses revealed that a wide range of stressors adversely affect the work performance of critical care nursing staff, and 80% of respondents reported that a critical incident debriefing program would be beneficial to them. CONCLUSIONS: Nurses working in critical care will experience stressors and critical incidents. A healthy critical care work environment is made up of healthy nurses and an alert, responsive management team that supports them. Nurses who experience high stressors without resolution can adversely affect the health care team, patient care delivery, the work environment, retention and recruitment, and ultimately patientsÆ outcomes. Implications for practice could include the development and implementation of a debriefing program in which nurses could openly share their thoughts and feelings after a traumatic event, which could help to ameliorate the negative effects of the stressors. Providing education to the management team on how best to support their staff, providing education for critical care nurses that includes a variety of simple relaxation and coping strategies and development of critical communication skills, would also be beneficial. More research could be done on larger nursing populations to explore the physical and psychological impact on nurses who work in an environment with high stressors, as well as on the effectiveness of debriefing programs in the critical care unit. Potentially, a debriefing program could increase job satisfaction, decrease burnout, increase retention, and promote a healthier work environment with healthier nurses.
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866
Conference Date:
2010
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
Washington, D.C., USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleThe Impact of Critical Care Incident Stressors on Critical Care Nurses and Their Work Environmenten_GB
dc.contributor.authorYehl, Gary P.en_GB
dc.author.detailsGary P. Yehl, RN,MS, GEORGETOWN UNIVERSITY HOSPITAL, WASHINGTON, DC, USA, email: gary.dc1@gmail.comen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157066-
dc.description.abstractPOSTER PURPOSE: To identify and describe stressors and traumatic events in the work environment of critical care nurses. BACKGROUND/SIGNIFICANCE:Critical care nurses are continually faced with the challenges of caring for acutely ill patients and their families. By their very nature, critical care units exude an environment of stress and tension through repetitive exposure to events outside the normal realm of human experience. Critical care nurses are frequently exposed to situations that may be emotionally charged, including patient mortality, ethical dilemmas, cardiopulmonary resuscitation, and the withdrawal of life support. Support to assist critical care nurses in identifying and dealing with these stressors may not be provided or sufficient. Hospitals that fail to provide services to ameliorate these negative psychological and behavioral effects or repeated exposure to such incidents leave critical care nurses at risk and feeling dissatisfied with their jobs. In turn, nurses' performance and turnover may be affected, thus adversely affecting patient care and outcomes. The patient care situations just mentioned, in addition to many other issues related to work environment that were not mentioned, cause stress in critical care nurses. Some events generate so much stress on the nurse that normal coping mechanisms are overwhelmed. Previous research indicates that 24% of critical care nurses have symptoms of posttraumatic stress disorder, compared with 14% of other nurses. METHOD: This study used a mixed method design. Phase 1 used a nonexperimental descriptive survey, the Critical Care Nursing Stress Scale. This electronic self-administered questionnaire was used with permission and included 40 multiple-choice questions in 5 areas: (1) management of the unit, (2) interpersonal relationships, (3) patient care, (4) knowledge and skills, and (5) physical work environment. A convenience sample of 73 critical care nurses in an acute hospital setting were instructed to select an answer to each of the questions by using a 5-point Likert scale to indicate the frequency, intensity, threat, and challenge level of a given stressor. Phase 2 used a phenomenological approach to study the lived experiences of 9 critical care nurses who had first-hand knowledge of a traumatic event while working in an ICU. Following the consent process, 1-on-1 semistructured interviews were conducted and audiotaped by a behavioral health practitioner in a location and time chosen by the participants. An interview guideline, comprising 9 questions developed by the researchers, was used to guide the interview process. Van Manen&AElig;s method of thematic analysis was used to analyze the data collected in the interviews. RESULTS: Findings were not statistically significant; however, they were clinically significant. Although the respondents rated stressors in 5 areas, the highest responses reported were from only 2 of these areas: patient care and management of the unit. The stressor with the highest frequency was routine procedures: 51% (patient care); the stressor with the highest intensity was emergencies and arrests: 39% (patient care); the stressor that was the greatest challenge was patients in critical, unstable condition: 36% (patient care); the stressor that was the greatest threat was apathetic, incompetent medical staff: 34% (management of the unit). The response rate was 70% with a mean age range of 20&ucirc;30 years (67%) and the majority (90%) of respondents were female. Sixty-four percent (64%) of respondents reported having been a nurse for <5 years and 76% reported having worked in critical care <5 years. The 9 interviews yielded rich responses, providing insight to how traumatic events in the work environment affect many aspects of nurses&AElig; lives. When categorizing events that critical care nurses consider traumatic, the following key themes emerged: the nurse&AElig;s level of experience, peer support, self-doubt, and need for validation of actions. Responses revealed that a wide range of stressors adversely affect the work performance of critical care nursing staff, and 80% of respondents reported that a critical incident debriefing program would be beneficial to them. CONCLUSIONS: Nurses working in critical care will experience stressors and critical incidents. A healthy critical care work environment is made up of healthy nurses and an alert, responsive management team that supports them. Nurses who experience high stressors without resolution can adversely affect the health care team, patient care delivery, the work environment, retention and recruitment, and ultimately patients&AElig; outcomes. Implications for practice could include the development and implementation of a debriefing program in which nurses could openly share their thoughts and feelings after a traumatic event, which could help to ameliorate the negative effects of the stressors. Providing education to the management team on how best to support their staff, providing education for critical care nurses that includes a variety of simple relaxation and coping strategies and development of critical communication skills, would also be beneficial. More research could be done on larger nursing populations to explore the physical and psychological impact on nurses who work in an environment with high stressors, as well as on the effectiveness of debriefing programs in the critical care unit. Potentially, a debriefing program could increase job satisfaction, decrease burnout, increase retention, and promote a healthier work environment with healthier nurses.en_GB
dc.date.available2011-10-26T19:23:26Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:23:26Z-
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.conference.date2010en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationWashington, D.C., USAen_GB
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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