Secondary Traumatic Stress Among Emergency Nurses: A Cross-Sectional Study

This research study by Duffy, Avalos and Dowling (2015) mainly focused on the issue of secondary traumatic stress among emergency nurses. The purpose of the paper was to measure self-reported level of secondary traumatic stress (STS) among emergency department nurses. The research used quantitative methodology and cross-sectional research design. The study found that STS level is high in emergency department nurse in Ireland compared to US. The study recommended building coping skills of emergency staffs so that they can professional handle such situations.

Running head: RESEARCH IN NURSING
Research in nursing
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Introduction:
The research study by Duffy, Avalos and Dowling (2015) mainly focused on the issue of
secondary traumatic stress among emergency nurses. The title of the research article is
appropriate as it depicts the main topic of interest as well as the research design used to conduct
the study. The main purpose of the paper was to measure self-reported level of secondary
traumatic stress (STS) among emergency department nurses. Hence, STS is the central research
topic for this paper. STS is defined as a natural consequence of stress experienced when wanting
to help a traumatised person. Emergency department nurse are directly exposed to situation
where they need to tackle violence against staff or deal with death of a patient. This form of
encounter creates the condition for STS and result in symptoms of stress and feelings of
depression and sadness among nurses. Ratrout and Hamdan-Mansour (2017) explains that
emergency nurses are exposed to traumatized patients as part of their job as they act as the
frontline personnel in dealing with wounded patients, traumatized patients dying patients. Hence,
this form of exposure to trauma seriously affects psychosocial well-being of nurse and their
quality performance.
The background of any research paper mainly defines the research problem and the
rationale for research. Hence, review of background section can help to understand the
significance of research in this area. Duffy, Avalos and Dowling (2015) mainly discussed about
several research papers that evaluated the effect of stress on emergency nurses. However,
research papers mainly investigated about the impact of stress in the emergency department of
U.S and lack of research done in emergency settings of Ireland made the research on the topic
necessary. This research is also important to understand the level of stress experienced by nurse
in Ireland and identify appropriate strategies to improve well-being for emergency nurses.

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Methodology and design:
Duffy, Avalos and Dowling (2015) used quantitative methodology to investigate about
level of stress in emergency department. Quantitative research methodology emphasize on
objective measurements of research variables through questionnaires or survey which can
analyzed through manipulation of statistical data. This type of research methodology is based on
positivists philosophies. Positivist philosophy is based on the view that nothing but only factual
knowledge obtained through observation is trustworthy and credible data source. Hence, studies
with positivism approach focus on data collection and interpretation using observable and
quantifiable data. Research with positivism philosophy proceeds with ontological view of the
world and this view is based on the assumption that event in the world can be analyzed as a
discrete and observable element that interact in a regular manner (Rahi, 2017). This
philosophical underpinning is reflected in the research by Duffy, Avalos and Dowling (2015) as
observation related to the frequency of secondary stress in nurse was evaluate by the use of
secondary traumatic stress scale (STSS).
Duffy, Avalos and Dowling (2015) used cross sectional research design to investigate
about the level of stress in emergency department nurse. Cross sectional research design is a type
of observational study in which information about subjects are collected without manipulating
the study environment. Another feature of cross-sectional research design is that it measures
events in a group at a particular time (Hirschi and Selvin, 2017). The advantage of cross-
sectional research design is that it helps to analyze different variables at the same time. Different
population group can also be analyzed at the same time leading to cost-effectiveness of research.
However, one potential disadvantage of this research design is that cause and effect relationship
cannot be explored through cross-sectional research design. In the context of the study by Duffy,

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Avalos and Dowling (2015), this research design is considered appropriate because as the main
purpose was to measure secondary traumatic stress among emergency nurse and not find causal
relationship between two variables. In the selected article, registered nurse working in
emergency departments was recruited and frequency of STS symptom observed in them was
evaluated using secondary traumatic stress scale (STSS). However, one weakness in the research
design is that only geographic region in Ireland was taken as the sample and this may affect the
reliability of the evidence for all emergency departments in Ireland.
Data collection:
The strength of data collection in a research study is dependent on consideration of
validity and reliability of the research instrument or tool used to collect data. Duffy, Avalos and
Dowling (2015) collected data related to the frequency of STS using the STSS scale. The
advantage of using this scale in research is that it is the only tool that exclusively measures STS.
It consists of 17 item questionnaire that measures intrusion, avoidance and arousal symptoms in
response to traumatic events for a health care profession. The strength of data collection is that
validity and reliability of the research instrument was considered and the research cited research
papers that depcted the validity of the STSS scale. Kellogg et al. (2018) also supports that STSS
is specifically designed to measures negatives effect of practice with traumatized individuals and
the tool is reliable and valid for investigation about secondary traumatic stress.
Literature review and sampling design:
Literature review:
Duffy, Avalos and Dowling (2015) conducted review of the research literature to identify
gaps in research and find out the need for research on the topic. This was done in the background

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section of the article. The articles used are considered appropriate as they reported about the
effect of stress on nurses working in emergency department. For example, the literature review
mentioned about studies where stress was associated with emotional exhaustion, irritability,
sleep disorder, depressive mood and use of illegal drugs. Another strength of the literature
review was that both old and new research papers published in the past 15 years were explored
thus suggesting that STS is a significance issues for nurse both in the past as well as in the
present. The literature review explored psychological effects of direct exposure to traumatic
events for nurse and rationalized research on this topic by stating that indirect effects of
traumatic events has not been explored in research.
Sampling design:
The strength of a sampling design is understood from the sampling technique employed
and the approach taken to take a sample representative of the population group. In the research
by Duffy, Avalos and Dowling (2015), the main target population group was emergency
department nurse or nurses working in emergency department setting. Accordingly, samples for
the study were recruited by inviting all registered nurses working in three emergency
departments in hospitals of the western region of Ireland. The inclusion criteria was recruitment
of only registered nurse and exclusion criteria was excluding student nurse on placement to the
emergency department. This sampling technique is an example of convenience sampling
technique as in this research all registered nurse where in emergency department were selected
based on their convenient accessibility. This form of sampling technique reduces time involved
in recruiting samples (Etikan, Musa & Alkassim, 2016).. However, some limitation of this
sampling technique is that there may be sampling biases as it does not represent the entire
population. Instead of focusing on sample selection only from the western region of Ireland, the

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researcher should have recruited samples from different regions of Ireland. This would have
increased the credibility and reliability of research finding. However, ethical elements such as
taking approval for research from relevant ethics committee were considered. Duffy, Avalos and
Dowling (2015), took the approval from the ethics committee of the three hospitals. Furthermore,
ethical consent related to participation in research and maintaining confidentiality of
participant’s data was also considered by sending questionnaires to each nurse.
Findings and recommendation:
The statistical analysis of participant’s response in relation to the score obtained from the
STSS scale questionnaire gave many important results. The criteria set for participants to
experience STS symptoms included display of at least one intrusion, three avoidance and two
hyper-arousal symptoms. Majority of the participants met the criteria for STS. In addition, the
score for individual symptoms revealed that intrusive thoughts about clients and psychological
distress was the most frequently reported symptoms among emergency nurse. In case of
avoidance symptoms, the most frequently reported symptom was feeling of being discouraged
about the future. In case of arousal symptom, complaints related to irritability was common
among research participants. This result is indicative of the fact that nurses in emergency setting
are exposed to high level of STS. Similar conclusion was made by the author too. The author
supported this result by supporting it with past research done on the topic. However, the result
may not be generalized for all setting as the study was done only in western part of Ireland. This
is also said because severe level of STS has not been reported for emergency nurse in all setting.
Machado (2018) investigating about traumatic stress revealed that emergency nurse experience
little or moderate symptoms of stress in emergency department.

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The significance of the findings reported by Duffy, Avalos and Dowling (2015) is that
the author not only presented figures on STS, but also gave explanation on the reasons for high
level of STS. This was linked to lack of psychological first-aid strategy in Irish emergency
departments and chronic overcrowding in the ward. Using this judgement, the final conclusion
made by the author was that STS level is high in emergency department nurse in Ireland
compared to US. In response to the above findings, the recommendation made was to create a
supportive and safe environment for nurses where they can express their feelings and difference
approach are used to provide appropriate intervention to such nurse. The study also
recommended building coping skills of emergency staffs so that they can professional handle
such situations. This is a useful recommendation made by the author as exposure to traumatic
patients cannot be minimized for emergency nurse. However, building resilience and coping
skills of emergency nurse is possible. Jones (2016) argues that nursing education curriculum and
professional development course do not focus on coping and resilience training for registered
nurse working in the emergency department. Hence, developing coping skills and resilience
skills can act as an effective strategy to mitigate the effects of occupational traumatic stress.
The use of cross-sectional study design favoured getting idea about the level of STS
experience by emergency nurse in Irish emergency departments. However, certain limitation in
research design has also been seen that limits generalizability of the work for other setting. For
example, convenience sampling approach was used to select samples thus reducing the
likelihood of taking a sample that is representative of the population group. Hence, this depicts
presence of selection bias which influences the validity and reliability of the study findings.
Hence, in future research on the same topic, selection bias needs to be eliminated by taking a
strong sampling technique that is representative of the population of interest.

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References:
Duffy, E., Avalos, G., & Dowling, M. (2015). Secondary traumatic stress among emergency
nurses: a cross-sectional study. International emergency nursing, 23(2), 53-58.
Etikan, I., Musa, S. A., & Alkassim, R. S. (2016). Comparison of convenience sampling and
purposive sampling. American journal of theoretical and applied statistics, 5(1), 1-4.
Hirschi, T. & Selvin, H.C., (2017). Delinquency research: An appraisal of analytic methods.
Routledge.
Jones, S.L., (2016). Nurses' Occupational Trauma Exposure, Resilience, and Coping Education.
Retrieved from: https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?referer=https://
scholar.google.co.in/&httpsredir=1&article=3463&context=dissertations
Kellogg, M. B., Dowling, J. S., Knight, M., & Crawford, S. L. (2018). Validating the Secondary
Traumatic Stress Scale for Pediatric Nurses. Journal of nursing measurement, 26(3),
E114-E126.
Machado, M. (2018). Secondary Traumatic Stress Among Emergency Department Nurses.
Retrieved from: https://digitalcommons.ric.edu/cgi/viewcontent.cgi?
article=1269&context=etd
Rahi, S. (2017). Research design and methods: A systematic review of research paradigms,
sampling issues and instruments development. International Journal of Economics &
Management Sciences, 6(2), 1-5.
Ratrout, H. F., & Hamdan-Mansour, A. M. (2017). Factors associated with secondary Traumatic
Stress among Emergency Nurses: An Integrative Review. Open J Nurs, 7, 1209-1226.

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