UBC Reports | Vol. 50 | No. 3 | Mar.
Shell Shock in the Emergency Room
Not the patients... the staff
By Erica Smishek
A child the same age as your own bleeds profusely from a
wound; her leg has been dismembered. A severely burned patient
stares into your eyes before dying. An irate member of a patient's
family physically accosts you in a moment of rage and despair.
Every day, nurses, doctors and other emergency department
personnel face these and other upsetting events.
It's part of the job -- and for some, it's leading to post-traumatic
stress disorder (PTSD).
"When nurses talk about the things they see, you wonder,
‘how does anyone do this work without emotional damage,'"
says UBC psychology professor Lynn Alden. "Their descriptions
about events are horrible -- treating children that have been
charred, children that have been injured, routinely watching
people die. It's very hard emotionally."
PTSD is an anxiety condition that can develop subsequent
to traumatic events. Symptoms include intrusive memories and
images of the trauma, and behavioural avoidance of cues that
remind the person of the incident. PTSD is known to create
significant life impairment, including occupational dysfunction.
PTSD was first recognized in people who had directly experienced
trauma, such as war veterans and assault victims. But more
recently, researchers have demonstrated that PTSD can develop
in individuals who witness upsetting events in the workplace,
such as ambulance attendants and firefighters.
In the first study of its kind, Alden and doctoral student
Judith Laposa are examining the relationship between work-related
stress and the development of PTSD in emergency department
Preliminary findings suggest that as many as 20 per cent
of emergency department workers surveyed report clinically
significant levels of PTSD symptoms and 12 per cent meet the
full criteria for the disorder -- more than double the rate
found in the general population.
"There is almost a macho attitude. Health care professionals
think they should be tough enough to deal with it," says Alden.
"It comes as a shock to learn that they're human, that to
be subjected to traumas that others do not normally encounter
can have a significant impact on their work and their lives."
In the first of two studies supported by the Social Sciences
and Humanities Research Council, the Natural Sciences and
Engineering Research Council and the B.C. Medical Services
Foundation, 51 emergency department workers at a major hospital
in a large urban B.C. centre completed a questionnaire that
measured sources of stress (organizational characteristics,
patient care and interpersonal conflict) as well as reactions
to traumatic work events, including how they interpreted the
cause of events as well as their state when the events happened.
At least half of the participants reported dissociation --
some degree of going on automatic pilot and feeling unreal
at the time of the traumatic incident.
"They can feel like they're in a dream when these bad things
happen," says Alden. "They process information about the event
differently because of the anxiety."
The majority of participants reported feeling emotionally
upset when reminded of the event, trying not to think, talk
or have feelings about the event and having upsetting thoughts
or images about the event that came into their heads when
they didn't want them to.
Some participants reported a more negative belief system
about the world ("the world is a more dangerous place") and
themselves following a traumatic event.
In a second study, the researchers examined factors that
would increase the likelihood of PTSD. They found an association
between interpersonal conflict and PTSD symptoms.
"After a very difficult incident, you often need to share
the experience. You all go for dinner or a drink and try to
laugh, maybe using black humour to help cope with what you've
just been through," Alden explains. "But if you can't do that,
if you don't feel that sense of support from your colleagues
and hospital administration, traumatic events can be harder
With funding from the Workers' Compensation Board of B.C.,
the pair has embarked on a third, more comprehensive study
in partnership with several B.C. hospitals. It will include
questionnaires and interviews with full-time nurses and will
examine what impact factors like the density of traumatic
experiences and the down time away from traumatic events have
on the development of PTSD.
Ultimately, they hope their findings will help hospital administrations
not only be aware of the extent of workplace stress and PTSD
symptoms in their employees but help them improve the workplace
climate to support employees following traumatic events.
"According to the literature, we haven't hit upon a way to
prevent PTSD," says Alden, "but there are ways to treat it
once it develops."
They would also like to work with educators to develop programs
that prepare nursing students for what they will inevitably
experience in the workplace.
"I've always been fascinated by the resiliency of the human
spirit," says Laposa, who has studied clinical psychology
for four and a half years. "Ultimately, I am interested in
developing strategies that medical personnel can use to minimize
and deal with any negative emotional impact of assisting patients
through medical crises."