Depicting occupational trauma concepts impacting nurse well-being during the COVID-19 pandemic

Figures & data

Figure 1. Flow diagram of reviewed articles for analysis.

Table I. Concept antecedents, attributes, and consequences.

Concept	Antecedents	Attributes	Consequences
Burnout	Individual: lack of perceived support, stigma from working in healthcare, distress from caring for severely ill patients	Individual: emotional distress, emotional exhaustion, depersonalization, reduced personal accomplishment, fatigue, insomnia, fear, frustration, anxiety	Individual: risk for long-term mental health conditions (anxiety and depression), risk for physical conditions (heart disease), poor job performance, risk for lower quality of life, risk for medical errors
	Organizational: insufficient staffing, insufficient supplies and resources, increasing workloads, moral or ethical patient dilemmas, lack of support resources		Organizational: risk for increased staff turnover/staffing challenges, risk for increased adverse patient events
Compassion fatigue	Individual: lack of perceived support, stigma from working in healthcare, distress from caring for severely ill patients	Individual: emotional distress, anxiety, intrusive memories, insomnia, fear, frustration, guilt, grief, uncertainty, feeling numb, inability to cope	Individual: burnout, risk for long-term mental health conditions (PTSD), risk for substance abuse (alcohol), risk for medical errors, potential for resiliency and compassion satisfaction
	Organizational: insufficient staffing, insufficient supplies and resources, increasing workloads, moral or ethical patient dilemmas, lack of support resources		Organizational: risk for increased staff turnover/staffing challenges, risk for increased adverse patient events
Moral injury	Individual: witnessing patients die alone, distress from caring for severely ill patients, patients with needs unmet, lack of perceived support	Individual: emotional distress, anxiety, nervousness, anger, frustration, fatigue, fear, insomnia, spiritual conflict, physical symptoms (tachycardia)	Individual: burnout, compassion fatigue, risk for long-term mental health conditions, suicidal ideation, risk for medical errors, intentions to leave the job
	Organizational: insufficient staffing, insufficient supplies and resources, moral and ethical patient dilemmas, increasing workloads, lack of support resources		Organizational: risk for increased staff turnover/staffing challenges, risk for increased adverse patient events
Secondary traumatic stress (STS)	Individual: witnessing patients suffer or die alone, distress from caring for severely ill patients, lack of perceived support, having experienced other traumas	Individual: emotional distress, anxiety, anger, fear, grief, fatigue, insomnia, intrusive memories, easily startled	Individual: burnout, compassion fatigue, risk for long-term mental health conditions, risk for substance abuse (alcohol), risk for cumulative traumas, risk for medical errors, intentions to leave the job, risk for lower quality of life, potential for post-traumatic growth
	Organizational: insufficient staffing, insufficient supplies and resources, moral and ethical patient dilemmas, lack of support resources		Organizational: risk for increased staff turnover/staffing challenges, risk for increased adverse patient events
Second victim	Individual: witnessing patients suffer or die alone, distress from caring for severely ill patients, lack of perceived support, having experienced other traumas	Individual: emotional distress, anxiety, anger, fear, grief, guilt, intrusive memories, fatigue, insomnia	Individual: burnout, compassion fatigue, risk for long-term mental health conditions, risk for cumulative traumas, risk for medical errors, intentions to leave the job, potential for compassion satisfaction and post-traumatic growth
	Organizational: insufficient staffing, insufficient supplies and resources, moral and ethical patient dilemmas, lack of support resources		Organizational: risk for increased staff turnover/staffing challenges, risk for increased adverse patient events

*Findings have been split into two levels for each concept: individual and organizational. Findings that were not found as a commonality among concepts have been italicized to denote variation and potential delineation.

References:

Burnout: Aydin Sayilan et al. (2021); Bellanti et al. (2021); Bisesti et al. (2021); Bruyneel et al. (2021); Butera et al. (2021); Çelmeçe and Menekay (2020); Chen et al. (2021); Clinton and Shehaheh (2021); Cortés-Álvarez and Vuelvas-Olmos (2020); Douglas et al. (2022); Foli et al. (2021); Ferry et al. (2021); Gonçalves et al. (2021); Guttormson et al. (2022); Havaei et al. (2021); Hu et al. (2020); Hu et al. (2021); Huo et al. (2021); Jang et al. (2021); Jose et al. (2020); Kabunga and Okalo (2021); Kakemam et al. (2021); Kameg et al. (2021); Ma et al. (2021); Manzano García and Ayala Calvo (2021); Missouridou et al. (2021); Murat et al. (2021); Naldi et al. (2021); Nishimura et al. (2021); Ohue et al. (2021); Ong et al. (2021); Rivas et al. (2021); Ruiz-Fernández et al. (2020); Sarboozi Hoseinabadi et al. (2020); Seluch et al. (2021); Shah et al. (2021); Shiu et al. (2022); Soto-Rubio et al. (2020); Stocchetti et al. (2021); Vitale and Casolaro (2021); Zare et al. (2021); Zhang, Chai, et al. (2021); Zhang, Jiang, et al. (2021); Zhang, Wang, et al. (2021).

Compassion Fatigue: Akkuş et al. (2021); Carmassi et al. (2021); Foli et al. (2021); Missouridou et al. (2021); Moreno-Mulet et al. (2021); Rossi et al. (2021); Rathnayake et al. (2021); Ruiz-Fernández et al. (2020).

Moral Injury: Donkers et al. (2021); Lake et al. (2022); Malliarou et al. (2021); Moreno-Mulet et al. (2021); Nemati et al. (2021); Petrișor et al. (2021); Piscitello et al. (2021); Rushton et al. (2022); Sheppard et al. (2022); Silverman et al. (2021)

STS: Ariapooran et al. (2022); Erkin et al. (2021); Foli et al. (2021); Lee et al. (2021); Malliarou et al. (2021); Missouridou et al. (2021); Rossi et al. (2021).

Second Victim: Foli et al. (2021); Moreno-Mulet et al. (2021).

Table II. New conceptual definitions.

Concept	Definition
Occupational trauma	Occupational trauma is the psychological, emotional, and physical experience of an individual who is personally or professionally impacted after enduring distressing events at or related to their occupation
Moral injury	Moral injury occurs when an individual experiences distressing or traumatic events that challenge their moral and ethical beliefs and values in a personal or professional environment
Second victim (same as STS)	Second victims are “individuals working within an environment who are offering/providing care and are professionally/personally traumatized by exposure to an emotionally challenging clinical case/event.” (Scott, 2023)
Compassion fatigue	Compassion fatigue is an experience of emotional and physical fatigue stemming from experiences and events that required compassion and empathy in a personal or professional environment
Burnout	Burnout is an experience of stress, exhaustion, and a lack of motivation stemming from excessive demands or stressors in a personal or professional environment

Figure 2. Occupational Trauma Conceptual Model.

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Data availability statement

Data supporting the results and analyses is available upon request.