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Posttraumatic Stress Disorder in hospital emergency room personnel
November 2005
| Principal Investigator: |
Lynn Alden ( University of British Columbia) |
For more information about this development grant project, please contact Dr. Lynn Alden.
Issue
Hospital emergency room (ER) workers routinely witness life-threatening situations experienced by their patients, and increasingly have to deal with physical and verbal aggression directed toward them. Previous research studies have found ER workers to be at increased risk for posttraumatic stress symptoms, and identified severe work impairment and a desire to leave the profession as potential consequences.
This study used a questionnaire and interviews to explore traumatic stress in Vancouver area ER workers, in order to compile information that can be used in prevention and treatment programs.
Key findings
- 21.7% of participants reported clinically significant posttraumatic stress symptoms. This included 7.5% whose symptoms met the criteria for either Posttraumatic Stress Disorder (PTSD) or Acute Stress Disorder and an additional 3.5% who had five of the six symptoms required for a clinical diagnosis.
- The work events most frequently cited as distressing were those involving assault or threats of assault, and the second most frequently cited were events involving severe injuries to children.
- High posttraumatic stress symptom severity was associated with ER situations in which staff had to confront a sequence of distressing events without letup.
- 49% of those surveyed had participated in post-event interventions aimed at reducing emotional distress. The most common reason for not seeking treatment was concern about potential career damage.
Objectives
To examine PTSD in ER workers, including:
- the prevalence of PTSD in ER workers
- workplace factors that contribute to posttraumatic stress symptoms and PTSD
- work-related consequences of emotionally traumatic events
- ER workers' assessments of PTSD interventions
- the applicability of existing cognitive models of PSTD to understanding and reducing posttraumatic stress symptoms in ER workers.
Method
A total of 107 ER workers from Vancouver General Hospital , Saint Paul 's Hospital and Mount Saint Joseph Hospital completed a questionnaire about their experiences with emotionally distressing events at work. A smaller group of participants were also interviewed to explore questionnaire topics in greater depth.
Results
21.7% of the ER workers participating in the study reported clinically significant posttraumatic stress symptoms. This included 7.5% whose symptoms met the criteria for either Posttraumatic Stress Disorder (PTSD) or Acute Stress Disorder and an additional 3.5% who had five of the six symptoms required for a clinical diagnosis.
The work events most frequently cited as distressing were those involving assault or threats of assault. The second most frequently cited were events involving severe injuries to children.
Four characteristics featured prominently in participants' descriptions of stressful events: a breakdown in teamwork and communication; a sense of personal helplessness; concern about their own or the patient's family; and having to deal with a series of traumatic events without letup and with inadequate resources.
High posttraumatic stress symptom severity was associated with ER situations in which staff had to confront a sequence of distressing events without letup. Traumatic events produced three types of negative work consequences: increases in negative attitudes toward the hospital; reduction in work hours; and increases in health complaints.
Cognitive factors, such as dissociation and ruminating about a distressing event afterwards, were also found to be associated with posttraumatic stress symptom severity.
49% of participants had taken part in post-event interventions aimed at reducing emotional distress. The intervention most frequently used was Critical Incident Stress Debriefing. Reasons cited for not seeking treatment were: a belief that treatment was unnecessary, concern about others' opinions, and fear of potential career damage. Participants with higher posttraumatic stress symptom severity reported greater concern about what others would think and a sense of personal failure for requesting help.
Suggestions from participants included developing in-house preventive education programs for traumatic stress as well as certain procedural changes following traumatic events.
Conclusions
The findings suggest that posttraumatic stress symptoms may lead to ongoing anxiety-related problems in ER workers and contribute to poor staff morale. In particular, threatened and actual physical assault by hospital patients and visitors takes a psychological toll on ER staff.
There is a need to increase staff awareness of the nature of posttraumatic stress symptoms, their risk factors, and the usefulness of treatment options.
Future directions
Further studies are needed to confirm these findings with larger samples of ER workers. More research is also needed to adapt cognitive models of PTSD to understanding and preventing PTSD in emergency settings. Future work could also include developing and evaluating preventive educational programs that include cognitive treatment strategies found to be effective in reducing posttraumatic stress symptoms.