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Meditating in Nature

Traumatic Stress in
Nursing Education

What is Traumatic Stress? 

  • Traumatic stress is an intense form of stress that can result from exposure to a singular, isolated traumatic event or an ongoing series of traumatic events that can affect emotional, psychological, and physical dimensions 

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  • Traumatic event(s) are characterized as singular or repeated exposure to actual or threatened death, serious injury, or sexual violence; this can result from directly experiencing a traumatic event or witnessing a traumatic event experienced by another, including the context of one’s work or education

Compared to the general population, nursing students regularly exposed to trauma, especially those working in Emergency Room and ICU settings, report experiencing symptoms consistent with traumatic stress at much higher rates. Additionally, when students face other sources of trauma outside their academic experience, such as poverty, abuse, life-threatening illnesses, limited access to quality education, death in the family, or natural disasters, they risk experiencing higher degrees of exhaustion, which acts as a gateway to traumatic stress.

Traumatic Stress Disorders

Post Traumatic Stress Disorder (PTSD)

  • PTSD is a chronic condition where symptoms persist for at least a month and can last for years after the event

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  • Reexperiencing the trauma (intrusive thoughts, flashbacks, feelings, and perceptions)

  • Sleep disturbances and nightmares

  • Hyperarousal

  • Avoidant and numbing coping patterns (dissociation)

  • Disruption of the self and ego processes

  • Difficulty concentrating

  • Changes in interpersonal patterns of attachment, bonding, intimacy, and love 

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  • Affects individuals’ well-being, quality of life, and ability to function at appropriate levels 

Secondary Traumatic Stress (STS)

  • STS parallels symptoms of PTSD, but is caused by exposure to someone else’s trauma or life-threatening experience (e.g., patient trauma).

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  • Reexperiencing of events related to witnessed trauma

  • Heightened physiological responses

  • Avoidance of reminders of work (e.g., clinical practice) and patients

  • Stress resulting from helping or wanting to help a traumatized or suffering patient

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  • Associated with decreased empathy, feeling unable to provide ethical care (e.g., moral distress), and stigmatization

Causes + Contributing Factors of Traumatic Stress in
Nursing Education

Traumatic Events Nursing Students Encounter

  • Medical emergencies

  • Witnessing end-of-life care and patient death

  • Participating in cardiopulmonary resuscitation

  • Assisting with critical wounds

  • Verbal or physical abuse from aggressive patients, family members, and staff

  • Poor relationships with professors and instructors

Risk Factors

  • Negative preexisting attitudes and behaviors

  • Higher levels of perceived stress

  • Prior psychological diagnoses

  • Higher allostatic load (accumulated stress)

  • Anxiety sensitivity

  • Intolerance of uncertainty

  • Limited clinical experience

  • Fear of making mistakes

  • Combined pressures from career planning, academics, and personal life

  • Emotional exhaustion related to burnout

 Predictors of traumatic stress included low empathy, low resilience, high levels of passive coping, age, fewer sleep hours, and low compassion satisfaction. (Oakley et al., 2024)

Effects of Traumatic Stress on Nursing Students

Physical

  • Cardiovascular problems

  • Metabolic and respiratory diseases

  • Behavioral and mental health disorders (e.g., anxiety, depression)

  • Alcohol abuse

  • Ability to work efficiently, leading to:

    • Reduced work hours

    • Higher absenteeism rates,

    • Decreased commitment to professional roles 

Pyschological

  • Cognitive Abilities​

    • Memory​

    • Attention

    • Decision-making

    • Fear processing

    • Learning

  • Insomnia

  • Negative Emotions

    • Shame​

    • Low self-esteem

    • Fear

    • Guilt

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