Skip to main content

A qualitative study of resilience and posttraumatic stress disorder in United States ICU nurses

Abstract

Purpose

Intensive care unit (ICU) nurses are at increased risk of developing psychological problems including posttraumatic stress disorder (PTSD). However, there are resilient individuals who thrive and remain employed as ICU nurses for many years. The purpose of this study was to identify mechanisms employed by highly resilient ICU nurses to develop preventative therapies to obviate the development of PTSD in ICU nurses.

Methods

Qualitative study using semi-structured telephone interviews with randomly selected ICU nurses in the USA. Purposive sampling was used to identify ICU nurses who were highly resilient, based on the Connor–Davidson Resilience Scale and those with a diagnosis of PTSD, based on the posttraumatic diagnostic scale. New interviews were conducted until we reached thematic saturation.

Results

Thirteen highly resilient nurses and fourteen nurses with PTSD were interviewed (n = 27). A constructivist epistemological framework was used for data analysis. Differences were identified in four major domains: worldview, social network, cognitive flexibility, and self-care/balance. Highly resilient nurses identified spirituality, a supportive social network, optimism, and having a resilient role model as characteristics used to cope with stress in their work environment. ICU nurses with a diagnosis of PTSD possessed several unhealthy characteristics including a poor social network, lack of identification with a role model, disruptive thoughts, regret, and lost optimism.

Conclusion

Highly resilient ICU nurses utilize positive coping skills and psychological characteristics that allow them to continue working in the stressful ICU environment. These characteristics and skills may be used to develop target therapies to prevent PTSD in ICU nurses.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Buerhaus PI, Auerbach DI, Staiger DO (2009) The recent surge in nurse employment: causes and implications. Health Aff (Millwood) 28:w657–w668

    Article  Google Scholar 

  2. 2.

    Aiken LH, Clarke SP, Sloane DM, Sochalski JA, Busse R, Clarke H, Giovannetti P, Hunt J, Rafferty AM, Shamian J (2001) Nurses’ reports on hospital care in five countries. Health Aff (Millwood) 20:43–53

    Article  CAS  Google Scholar 

  3. 3.

    Mealer M, Burnham EL, Goode CJ, Rothbaum B, Moss M (2009) The prevalence and impact of post traumatic stress disorder and burnout syndrome in nurses. Depress Anxiety 26:1118–1126

    PubMed  Article  Google Scholar 

  4. 4.

    Mealer ML, Shelton A, Berg B, Rothbaum B, Moss M (2007) Increased prevalence of post-traumatic stress disorder symptoms in critical care nurses. Am J Respir Crit Care Med 175:693–697

    PubMed  Article  Google Scholar 

  5. 5.

    Charney DS (2004) Psychobiological mechanisms of resilience and vulnerability: implications for successful adaptation to extreme stress. Am J Psychiatry 161:195–216

    PubMed  Article  Google Scholar 

  6. 6.

    Connor KM, Davidson JR (2003) Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety 18:76–82

    PubMed  Article  Google Scholar 

  7. 7.

    Milne D (2007) People can learn markers on road to resilience. Psychiatric News 42:5–10

    Google Scholar 

  8. 8.

    Mealer M, Jones J, Newman J, McFann K, Rothbaum B, Moss M (2012) The presence of resilience is associated with a healthier psychological profile in intensive care unit (ICU) nurses: results of a national survey. Int J Nurs Stud 49:292–299

    PubMed  Article  Google Scholar 

  9. 9.

    Checker S (2009) Cognitive behavioral therapy. The Mayo Foundation. http://www.mayoclinic.com/health/c-b-t/MY00194. Accessed 3 May 2012

  10. 10.

    Mueser KT, Salyers MP, Rosenberg SD, Ford JD, Fox L, Carty P (2001) Psychometric evaluation of trauma and posttraumatic stress disorder assessments in persons with severe mental illness. Psychol Assess 13:110–117

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Sheeran T, Zimmerman M (2002) Screening for posttraumatic stress disorder in a general psychiatric outpatient setting. J Consult Clin Psychol 70:961–966

    PubMed  Article  Google Scholar 

  12. 12.

    Foa E, Cashman L, Jaycox L, Perry K (1997) The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. Psychol Assess 9:445–451

    Article  Google Scholar 

  13. 13.

    Campbell-Sills L, Forde DR, Stein MB (2009) Demographic and childhood environmental predictors of resilience in a community sample. J Psychiatr Res 43:1007–1012

    PubMed  Article  Google Scholar 

  14. 14.

    Mealer M, Jones J, Moss M (2011) Psychological characteristics of highly resilient ICU nurses: results of a qualitative study. Am J Respir Crit Care Med 183:A4114

    Google Scholar 

  15. 15.

    Thorne S, Reimer Kirkham S, O’Flynn-Magee K (2004) The analytic challenge in interpretive description. Int J Qual Methods 3:1–11

    Google Scholar 

  16. 16.

    Thorne S (2008) Interpretive description. Left Coast, California

    Google Scholar 

  17. 17.

    Thomas DR (2006) A general inductive approach for analyzing qualitative evaluation data. Am J Eval 27:237–246

    Article  Google Scholar 

  18. 18.

    Hanna DR, Romana M (2007) Debriefing after a crisis. Nurs Manage 38:38–47

    PubMed  Article  Google Scholar 

  19. 19.

    Quenot JP, Rigaud JP, Prin S, Barbar S, Pavon A, Hamet M, Jacquiot N, Blettery B, Hervé C, Charles PE, Moutel G (2012) Suffering among carers working in critical care can be reduced by an intensive communication strategy on end-of-life practices. Intensive Care Med 38:55–61

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Ozbay F, Johnson DC, Dimoulas E, Morgan CA, Charney D, Southwick S (2007) Social support and resilience to stress: from neurobiology to clinical practice. Psychiatry (Edgmont) 4:35–40

    Google Scholar 

  21. 21.

    Ozbay F, Fitterling H, Charney D, Southwick S (2008) Social support and resilience to stress across the life span: a neurobiologic framework. Curr Psychiatry Rep 10:304–310

    PubMed  Article  Google Scholar 

  22. 22.

    Jensen HI, Ammentorp J, Erlandsen M, Ording H (2011) Withholding or withdrawing therapy in intensive care units: an analysis of collaboration among healthcare professionals. Intensive Care Med 37:1696–1705

    PubMed  Article  Google Scholar 

  23. 23.

    Sharkansky EJ, King DW, King LA, Wolfe J, Erickson DJ, Stokes LR (2000) Coping with Gulf War combat stress: mediating and moderating effects. J Abnorm Psychol 109:188–197

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Haden S, Scarpa A, Jones R, Ollendick T (2007) Posttraumatic stress disorder symptoms and injury: the moderating role of perceived social support and coping for young adults. Personality Individ Differ 42:1187–1198

    Article  Google Scholar 

  25. 25.

    Aldwin CM, Levenson MR, Spiro A III (1994) Vulnerability and resilience to combat exposure: can stress have lifelong effects? Psychol Aging 9:34–44

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Davis M (1998) Are different parts of the extended amygdala involved in fear versus anxiety? Biol Psychiatry 44:1239–1247

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Yehuda R, Flory JD, Southwick S, Charney DS (2006) Developing an agenda for translational studies of resilience and vulnerability following trauma exposure. Ann N Y Acad Sci 1071:379–396

    PubMed  Article  Google Scholar 

  28. 28.

    Dollinger SJ (1986) The measurement of children’s sleep disturbances and somatic complaints following a disaster. Child Psychiatry Hum Dev 16:148–153

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Brissette I, Scheier MF, Carver CS (2002) The role of optimism in social network development, coping, and psychological adjustment during a life transition. J Pers Soc Psychol 82:102–111

    PubMed  Article  Google Scholar 

  30. 30.

    Rasmussen HN, Wrosch C, Scheier MF, Carver CS (2006) Self-regulation processes and health: the importance of optimism and goal adjustment. J Pers 74:1721–1747

    PubMed  Article  Google Scholar 

  31. 31.

    Carver CS, Pozo-Kaderman C, Harris SD, Noriega V, Scheier MF, Robinson DS, Ketcham AS, Moffat FL Jr, Clark KC (1994) Optimism versus pessimism predicts the quality of women’s adjustment to early stage breast cancer. Cancer 73:1213–1220

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    Scheier MF, Matthews KA, Owens JF, Schulz R, Bridges MW, Magovern GJ, Carver CS (1999) Optimism and rehospitalization after coronary artery bypass graft surgery. Arch Intern Med 159:829–835

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Waite PJ, Richardson GE (2003) Determining the efficacy of resiliency training in the work site. J Allied Health 33:178–183

    Google Scholar 

  34. 34.

    Burton N, Pakenham K, Brown W (2010) Feasibility and effectiveness of psychosocial resilience training: a pilot study of the READY program. Psychol Health Med 15:266–277

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

This study was sponsored by the National Institutes of Health and grant number K24 HL-089223.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Meredith Mealer.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 28 kb)

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Mealer, M., Jones, J. & Moss, M. A qualitative study of resilience and posttraumatic stress disorder in United States ICU nurses. Intensive Care Med 38, 1445–1451 (2012). https://doi.org/10.1007/s00134-012-2600-6

Download citation

Keywords

  • Posttraumatic stress disorder
  • Resilience
  • Critical care nursing