____________ Management of Post-Traumatic and Secondary Traumatic Stress in Healthcare Professionals
Perceived Threat. PTSD originates from a perceived direct threat to an individual’s own safety and well-being. In contrast, STS arises from exposure to traumatic events that are not directly experienced but involve others. Healthcare profession- als may empathize with their patients, leading to emotional distress and trauma-related symptoms associated with STS. Symptoms of PTSD and STS PTSD was known by many names in the past, such as shell shock during the years of World War I and combat fatigue after World War II, but PTSD does not just happen to com- bat veterans. PTSD can happen to anyone of any ethnicity, nationality, or culture—at any age. It affects approximately 3.5% of U.S. adults every year. An estimated 1 in 11 people will be diagnosed with PTSD in their lifetime (Taylor-Desir, 2022). PTSD is a psychiatric disorder that can affect people who have experienced or witnessed a traumatic event. They may relive the event through flashbacks or nightmares, and they may feel sadness, fear, or anger. Those experiencing PTSD may feel detached or estranged from other people. These symptoms could impact the lives of healthcare professionals at the personal, professional, and relational levels (Saladino et al., 2021). Healthcare professionals are somewhat prepared to deal with the psychological trauma of witnessing illness and death in close quarters, but the increasingly overwhelming conditions in the healthcare environment can leave many healthcare providers unprepared for the mental health reper- cussions. PTSD symptoms include intrusive thoughts; avoid- ing situations that are reminders of the trauma; and altered cognition, mood, arousal, and reactivity. Other common conditions those suffering from PTSD experience include acute stress disorder and adjustment disorder. Acute stress disorder is a reaction to a traumatic event where symptoms occur within one month of the event. Adjustment disorder is a response to a stressful life event where symptoms are more intense and severe than what would be expected. The need to make agonizing life-and-death decisions in a demanding and unpredictable environment can put healthcare professionals at risk of developing PTSD. Healthcare professionals who are experiencing burnout symptoms are physically and emotionally exhausted. Healthcare professionals with PTSD often have other problems, such as chronic pain with depression, weight gain, sleep problems, or opioid dependence. PTSD symptoms can make it very challenging for healthcare professionals to do their jobs (Saladino et al., 2021).
• Avoidance of feelings or memories: Trying to keep extra busy, avoiding reminders of the trauma, being unable to remember details of the trauma, feeling emotionally numb, performing self- destructive behaviors • Difficult beliefs or feelings: Can’t trust anyone, nowhere is safe, nobody understands me, self- blaming Some of the consequences of PTSD in health professionals include: • Depression and anxiety • Emotional numbing and avoidance • Sleep disturbance (insomnia) • Excessive alcohol use • Suicidal ideation
• Chronic pain and opioid dependence • Difficulty maintaining relationships • Lack of ability to cope with change • No longer enjoyment of leisure time
The symptoms of STS may include feelings of isolation, anxi- ety, dissociation, physical ailments, and sleep disturbances. Staff acquire different ways to cope—some are adaptive, while others are not. STS can decrease staff functioning and create challenges in the work environment. Some of the documented negative organizational effects that can result from STS are increased absenteeism, impaired judgment, low productivity, poorer quality of work, higher staff turnover, and greater staff friction (Puckett-Trotter, 2022). Stress can affect a healthcare professional’s physical health, causing high blood pressure, gastritis, peptic ulcers, and fatigue. Some common symptoms of STS include: • Cognitive: Apathy, perfectionism, preoccupation with trauma • Emotional: Guilt, anger, numbness, sadness, helplessness • Behavioral: Withdrawal, appetite change, hypervigilance • Physical: Increased heart rate, difficulty breathing, muscle and joint pain, lowered immune system Some of the consequences of STS in healthcare professionals include: • Increase in the number of sick days • Indecision • Difficulty with problem solving • Isolation or withdrawal • Behavioral outbursts
Some common symptoms of PTSD include: • Reliving the trauma: Flashbacks, intrusive thoughts, nightmares • Alertness/feeling on edge: Panicking when reminded of trauma, easily upset, irritable, difficulty concentrating, easily startled
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