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Dissertation
Secondary traumatic stress in NICU nurses: risk and protective factors
Doctor of Philosophy (Ph.D.), Drexel University
Jun 2025
DOI:
https://doi.org/10.17918/00011021
Abstract
Nurses in neonatal intensive care units (NICUs) are frequently faced with many stressors, including care for medically complex infants, exposure to parental trauma and grief, discordance between multiple disciplines regarding care decisions, ethical and moral dilemmas, and infant suffering and death. Consequently, NICU nurses are at risk for experiencing secondary traumatic stress (STS), which has implications for their health, well-being, retention, and the quality of care provided. Although previous studies have identified risk factors for STS in non-NICU professionals and providers, existing research on risk factors associated with STS among NICU nurses is limited. The current study examined the prevalence and severity of STS in NICU nurses, evaluated individual and organizational factors as predictive risk factors for STS in NICU nurses, and evaluated resilience as a protective factor. A national sample of 168 registered nurses employed in level III and IV NICUs self-reported socio-demographics, STS, burnout, moral distress, nursing practice environment, and resilience data using an online survey with validated questionnaires. All participants reported experiencing some level of STS, with 67.9% reporting moderate levels and 1.2% reporting high levels. Hierarchical multiple regression analyses controlling for demographic covariates (e.g., employment status, lifetime trauma exposure, NICU region, NICU beds, income, and personal NICU experience) revealed that higher levels of burnout ([beta] = .575, p < .001), higher levels of moral distress ([beta] = .481, p < .001), and less favorable nursing practice environments ([beta] = -.163, p = .033) were associated with higher levels of STS. Contrary to hypotheses, years of NICU nursing experience showed no significant association with STS ([beta] = -.028, p = .734). Higher levels of resilience were associated with lower levels of STS ([beta] = -.389, p < .001). Exploratory analyses examining resilience as a moderator revealed complex interactions. Simple slope tests showed that resilience appeared to be more protective for nurses with lower levels of moral distress than for nurses with higher levels of moral distress, and that resilience enhanced the protective effect of favorable nursing practice environments. Results from the current study can be used to inform future empirical studies and the development of STS prevention measures, interventions, and policy recommendations.
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Details
- Title
- Secondary traumatic stress in NICU nurses
- Creators
- Leah B. Sodowick
- Contributors
- Pamela A. Geller (Advisor)
- Awarding Institution
- Drexel University
- Degree Awarded
- Doctor of Philosophy (Ph.D.)
- Publisher
- Drexel University; Philadelphia, Pennsylvania
- Number of pages
- ix, 106 pages
- Resource Type
- Dissertation
- Language
- English
- Academic Unit
- Psychological and Brain Sciences (Psychology); College of Arts and Sciences; Drexel University
- Other Identifier
- 991022058837104721