Psychiatric nurses in Saskatchewan: The effects of exposure to trauma and workplace aggression on posttraumatic stress disorder and cognitions.

摘要

A body of literature has explored exposure to trauma in the workplace and the impact such exposure has on employees. High rates of PTSD have been found in employees who work in high-risk jobs including nurses. Bullying is one form of workplace trauma that has been found to be prevalent especially for nurses. Cognitive models of PTSD propose a relationship between negative cognitions and the development and maintenance of PTSD after exposure to a traumatic event. Foa's Emotional Processing Theory posits when people who have been exposed to a traumatic stressor develop PTSD, they also develop a fear structure that subsequently may be readily activated by circumstances which trigger memories of the trauma.;Exposure to trauma, exposure to bullying and PTSD rates were high in the sample with 69.9% of nurses reporting exposure to a traumatic event at work, 45% of nurses reporting having been bullied at work over the previous year and 25% of nurses reporting probable PTSD. Two factors emerged that were related specifically to the work environment. First, work location was associated with varying rates of exposure to trauma and bullying, varying rates of PTSD and differences in cognitions. Certain work locations were higher risk than other work locations. RPNs who work in correctional facilities reported the highest exposure to trauma and bullying (87.5% and 68.8% respectively) and also reported the highest rates of PTSD (73.3%).;Second, there was a relationship between negative cognitions and PTSD. RPNs who had PTSD reported more negative cognitions of the self and the world. Exposure to bullying was associated with negative cognitions of the self and the world but not with self blame. When RPNs identified the primary perpetrator of bullying to be a co-worker, they also reported more self blaming thoughts. RPNs who reported being bullied in the workplace also reported high rates of PTSD (33%).;There are variables within high risk work environments that contribute in unique ways to the evolution of negative cognitions and to the development and maintenance of PTSD. The work location and the identity of the bully were shown to play a pivotal role. The results of this study indicate a need for future research into specific factors within organizational cultures that are associated with the development and maintenance of PTSD (e.g., primary perpetrators of bullying, types of trauma unique to an environment, management styles). Using organizational factors as a framework, the impact of preexisting negative cognitions on bullying and on PTSD should also be considered. The impact that repeated exposure to bullying and trauma have on cognitions within the organizational culture are important considerations. The development, implementation and assessment of pre-trauma training programs tailored to specific worksites to mitigate the impact of exposure to trauma and aggression are also areas for future research.;It is not clear how trauma (for example, bullying), PTSD, and negative cognitions may interact in the context of a specific work environment and whether certain nurses are at greater risk for developing psychopathology and negative cognitions based on work environment factors such as work location or the identity of a bully. A mail survey was used to evaluate these questions with a sample of 166 Registered Psychiatric Nurses (RPN) in Saskatchewan. Five main primary employing agencies were identified: long term care, hospitals, community mental health, corrections, and residential.