Prevalence and associated factors of secondary traumatic stress in emergency nurses: a systematic review and meta-analysis

ABSTRACT

Background: Nurses in emergency departments are at a high risk of experiencing secondary traumatic stress because of their frequent exposure to trauma patients and high-stress environments.

Objective: This systematic review and meta-analysis aimed to determine the overall prevalence of secondary traumatic stress among emergency nurses and to identify the contributing factors.

Method: We conducted a systematic search for cross-sectional studies in databases such as PubMed, Web of Science, Embase, CINAHL, Wanfang Database, and China National Knowledge Internet up to October 21, 2023. The Joanna Briggs Institute’s appraisal checklists for prevalence and analytical cross-sectional studies were used for quality assessment. Heterogeneity among studies was assessed using Cochrane’s Q test and the I² statistic. A random effects model was applied to estimate the pooled prevalence of secondary traumatic stress, and subgroup analyses were performed to explore sources of heterogeneity. Descriptive analysis summarized the associated factors.

Results: Out of 345 articles retrieved, 14 met the inclusion criteria, with 11 reporting secondary traumatic stress prevalence. The pooled prevalence of secondary traumatic stress among emergency nurses was 65% (95% CI: 58%–73%). Subgroup analyses indicated the highest prevalence in Asia (74%, 95% CI: 72%–77%), followed by North America (59%, 95% CI: 49%–72%) and Europe (53%, 95% CI: 29%–95%). Nine studies identified associated factors, including personal, work-related, and social factors. In the subgroup of divided by recruitment period, emergency department nurses in the COVID-19 outbreak period had a higher prevalence of secondary traumatic stress (70%, 95% CI: 62%–78%).

Conclusions: Secondary traumatic stress prevalence is notably high among emergency department nurses, with significant regional variations and period differences. The factors affecting secondary traumatic stress also varied across studies. Future research should focus on improving research designs and sample sizes to pinpoint risk factors and develop prevention strategies.

Registration: PROSPERO CRD42022301167.

HIGHLIGHTS

• Secondary traumatic stress is considered an occupational hazard for nurses. Emergency department nurses, in particular, face a greater risk of secondary traumatic stress compared to other professions.

• While various studies have investigated the prevalence of secondary traumatic stress among these nurses, findings have been inconsistent.

• The pooled prevalence of secondary traumatic stress among emergency nurses is 65%. Subgroup analysis by region shows that Asia experiences the highest combined prevalence at 74%, with North America at 59% and Europe at 53%. Emergency department nurses in the COVID-19 outbreak period had a higher prevalence of secondary traumatic stress (70%, 95% CI: 62%–78%).

Antecedentes: Las enfermeras en los departamentos de emergencia tienen un alto riesgo de experimentar estrés traumático secundario debido a su exposición frecuente a pacientes traumatizados y a entornos de alto estrés.

Objetivo: Esta revisión sistemática y metaanálisis tuvo como objetivo determinar la prevalencia general del estrés traumático secundario en las enfermeras de emergencia e identificar los factores contribuyentes.

Métodos: Realizamos una búsqueda sistemática de estudios transversales en bases de datos como PubMed, Web of Science, Embase, CINAHL, Wanfang Database y China National Knowledge Internet, hasta el 21 de octubre de 2023. Para la evaluación de la calidad se utilizaron los listados de verificación de evaluación del Instituto Joanna Briggs para estudios de prevalencia y estudios transversales analíticos. La heterogeneidad entre los estudios se evaluó mediante la prueba Q de Cochrane y el índice estadístico I2. Se aplicó un modelo de efectos aleatorios para estimar la prevalencia agrupada del estrés traumático secundario, y se realizaron análisis de subgrupos para explorar las fuentes de heterogeneidad. El análisis descriptivo resumió los factores asociados.

Resultados: De los 345 artículos recuperados, 14 cumplieron los criterios de inclusión, de los cuales 11 reportaron la prevalencia de estrés traumático secundario. La prevalencia agrupada de estrés traumático secundario en las enfermeras de urgencia fue del 65% (IC 95%: 58%-73%). Los análisis de subgrupos indicaron la prevalencia más alta en Asia (74%; IC 95%: 72%–77%), seguida de América del Norte (59%; IC 95%: 49%–72%) y Europa (53%; IC 95%: 29%–95%). Nueve estudios identificaron factores asociados, incluyendo factores personales, laborales y sociales. En el subgrupo dividido por período de reclutamiento, las enfermeras del departamento de emergencia en el período del brote de COVID-19 tuvieron una mayor prevalencia de estrés traumático secundario (70%; IC 95%: 62%–78%).

Conclusiones: La prevalencia del estrés traumático secundario es notablemente alta entre las enfermeras del servicio de emergencia, con importantes variaciones regionales y diferencias entre períodos. Los factores que afectan el estrés traumático secundario también variaron entre los estudios. Las investigaciones futuras deberían centrarse en mejorar los diseños de investigación y los tamaños de las muestras para identificar los factores de riesgo y desarrollar estrategias de prevención.

KEYWORDS:

• Meta-analysis
• nursing
• prevalence
• secondary traumatic stress
• emergency

PALABRAS CLAVE:

• Metaanálisis
• enfermería
• prevalencia
• estrés traumático secundario
• emergencia

Disclosure statement

No potential conflict of interest was reported by the author(s).