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Failed Resuscitations Leave Marks on Nurses

Analysis  |  By Jennifer Thew RN  
   March 21, 2017

Critical care nurses who participate in unsuccessful resuscitation attempts report moderate levels of postcode stress and PTSD symptoms, research shows.

Resuscitation attempts in critical care units are not unusual and, unfortunately, not always successful. Often, RNs are involved in these life-saving efforts.

"I was curious to know if there was any published literature on the emotional or psychological consequences on nurses specifically related to resuscitation attempts," says Dawn E. McMeekin, RN, DNP, CNE, advanced clinical education specialist at Baycare Health System in Dunedin, FL.

Published literature on the topic was limited, but McMeekin's recent study, published in the American Journal of Critical Care is shedding some light on the topic.

Its aim was "to explore if participation in an unsuccessful cardiopulmonary resuscitation attempt created a heightened level of stress, referred to as postcode stress, and if coping behaviors individuals utilized influenced the development of a more chronic psychological distress as evidenced by PTSD symptom severity or stress as a result of a traumatic event," McMeekin says.

Additionally, study participants were asked if institutional support in the form of debriefing was available. The relationship between debriefing and the levels of psychological distress was also assessed.

The results of the study were somewhat surprising.

Debriefing's Effectiveness Varies
The study found that when asked to recall an unsuccessful resuscitation, critical care nurses showed moderate levels of postcode stress and PTSD symptoms.

It also found, however, that postcode stress and PTSD symptom severity were weakly associated. In other words, just because a nurse experiences postcode stress, that doesn't mean that he or she will necessarily develop PTSD symptoms.

"I was somewhat surprised that the association between postcode stress and PTSD symptom severity was not stronger," McMeekin says. "Perhaps this demonstrates how critical the coping behaviors are in diminishing the development of chronical psychological distress."

While there were no significant associations between coping behaviors and postcode stress, four coping behaviors (denial, self-distraction, self-blame, and behavioral disengagement) were significant predictors of PTSD symptom severity.

Nurses who had institutional debriefing support reported significantly lower postcode stress scores than those who did not have debriefing support yet this did not hold true for PTSD symptom severity.

"I was somewhat surprised PTSD symptom severity was higher in those nurses with institutional debriefing," McMeekin says.

Study of Interventions Needed
These results point to the need for further study of the effectiveness of various interventions to support nurses after failed resuscitation, McMeekin says.

"The aim of the study wasn't to look at interventions. This was an initial study to see what the psychological distress levels and factors were. Hopefully this is going to open the door for some interventional research into what institutions and nurse leaders can do," she says.

In the meantime, understanding that nurses face very real after-effects after a failed resuscitation is a step in the right direction.

"My advice for nurse leaders would be to acknowledge the potential for psychological distress" under these circumstances, and to understand that "this may compound the burden of emotions and psychological stressors that nurses encounter in daily practice," she says.

Fostering a healthy work environment and being aware of evidence-based tools such as the AACN Standards for Establishing and Sustaining Healthy Work Environments is important as well.

"[Nurses] have to be enabled not to hesitate to seek assistance from trained professionals. Nurses need to open a dialogue on this topic with peers and nurse managers on available support for traumatic event exposure," she says.

"As nurses we're not invincible, we're human, and it's OK when we need help."

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.

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