Healthcare workers’ exposure to work-related traumatic events, secondary traumatic stress and coping: avenues for organisational and individual level intervention

Batchelor, Molly 2024. Healthcare workers’ exposure to work-related traumatic events, secondary traumatic stress and coping: avenues for organisational and individual level intervention. ClinPsy Thesis, Cardiff University. Item availability restricted.

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Abstract

Healthcare workers (HCWs) can be routinely exposed to work-related stressors, traumatic events, and a plethora of difficult decisions in emotionally charged, intensive and, often, trauma-laden environments. Resulting negative impacts can include traumatic stress responses such as Secondary Traumatic Stress (STS), Post-Traumatic Stress Disorder (PTSD) and associated emotional wellbeing and mental health difficulties. This can apply to HCWs working across a range of healthcare settings. An improved understanding of the nature of work-related traumatic events, the resulting negative impacts, as well as risk and protective factors is required for the whole workforce. Such research is important, not only for the wellbeing of the individual healthcare worker, but for the potential unintended and negative consequences to patients in their care. Paper 1 is a systematic review that drew together the available qualitative research to explore and further understand the experiences and perceptions of HCWs working in Paediatric Intensive Care Units (PICUs), with a particular focus on coping. High rates of burnout, traumatic stress and moral distress are reported for HCWs working in PICUs (Jones et al., 2020; Colville et al., 2017), with existing reviews highlighting the negative impact working in PICU can have. Understanding what enables people to cope is important for this at-risk workforce (Highfield, 2019). Five electronic databases were systematically searched, and from the initial 4648 papers found, 15 qualitative studies were reviewed. A series of inter-rater reliability checks were taken throughout the screening, data extraction and quality appraisal stages. In order to meet the aims of the review, data from the 15 studies were synthesised using Thomas and Hardens (2008) thematic synthesis framework. The synthesised findings resulted in five analytical themes, which were generated from the experiences of 223 HCWs working in PICU: (1) Individual-level coping, (2) Interpersonal (dis-)connections, (3), Team-level coping, (4) Organisational resource and (5) The vantage of time. Eleven subthemes were also generated. Connecting to the meaning of the work, acceptance of certain aspects of the work and self-reflection were important in facilitating HCWs coping. A balance of approach and avoidant coping was noted, as were self-nurturing activities, breaks and ventilating one’s emotions. Being listened to and truly heard by others enabled coping, whereas (dis-)connection from social networks outside of PICU was highlighted. Team-level coping was important, as were ideas of ‘collective care.’ Findings suggest there may be a systemic nature to what helps HCWs cope, with existing theories such as the Job-Demand-Resource Model (Demerouti et al., 2001), the Job-Demand-Control-Support Model (Karasak,1979) and Systems Theory (von Bertanlanffy,1967) providing a backdrop to the themes generated. Findings from this review suggest that support for HCWs needs to be flexible and targeted at all levels within an organisational system, especially in relation to adequate resource, control and autonomy. Paper 2 was an empirical research study that investigated rates of exposure to work-related traumatic material and rates of Secondary Traumatic Stress (STS), Post-Traumatic Stress Disorder (PTSD), and Complex Post-Traumatic Stress Disorder (CPTSD) within both clinical and non-clinical HCWs. Whilst the impact of work-related trauma exposure is well documented within clinical HCWs, such as nurses, doctors, psychologists and first-responders, far less research focuses on non-clinical HCWs, such as administrative and clerical staff. Non-clinical HCWs are vital team members in the running of healthcare systems and can also be exposed to traumatic material in the workplace. A cross-sectional online survey was used to collect data from clinical (n = 180) and non-clinical HCWS (n = 74) working in UK-based healthcare settings. Participants reported rates of STS, PTSD, CPTSD and work-related trauma exposure alongside individual and organisational risk factors associated with the development of STS. These factors included perceived preparedness, social support, workplace culture and coping. Data were analysed using descriptive and inferential statistics. The study helped quantify some of the ways HCWs can be exposed to traumatic material, particularly for non-clinical HCWs whom have been under-researched as a professional group. Findings indicate that non-clinical HCWs experience STS associated with work-related traumatic material, of which 35.1% met the threshold for probable STS caseness. Whilst STS severity was significantly higher in clinical compared to non-clinical HCWs, there was no statistical difference in terms of C/PTSD between the two groups. This study helped identify how risk and protective factors typically associated with STS within clinical HCWs are also important for non-clinical HCWs. Potential targets for intervention and future research for all HCWs include developing a supportive workplace culture, minimising trauma exposure, addressing avoidant coping styles and behaviours, and where possible, preparing staff for exposure to work-related traumatic material.

Item Type:	Thesis (DClinPsy)
Date Type:	Completion
Status:	Unpublished
Schools:	Psychology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Date of First Compliant Deposit:	16 September 2024
Last Modified:	17 Sep 2024 08:47
URI:	https://orca.cardiff.ac.uk/id/eprint/172123

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