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Appraisal Synopsis #2: Qualitative Research – Turnitin Instructions
The purposes of this assignment is to read a qualitative research study article which is provided and to
demonstrate a critical appraisal of the evidence.
Exposing Compassion Fatigue and Burnout Syndrome in a Trauma Team – A Qualitative Study.pdf
1. Read the quantitative research study article.
2. Write a 3-page narrative plus the title (create you own title), abstract (for your written
paper), and reference page. Use 7th edition APA format.
Title page
Use the heading: Purpose
Use the heading: Methods
â–ª Use the Subheading: Study Design
â–ª Use the Subheading: Sample/Sampling Methods
â–ª Use the Subheading: Instruments/Measurements/Tools
â–ª Use the Subheading: Data Analysis
Use the heading: Major Findings
Use the heading: Credibility
Reference page
Turnitin will be used to check for plagiarism. Do not use quotes. Practice paraphrasing.
Rubric down below:
Exposing Compassion Fatigue and Burnout
Syndrome in a Trauma Team: A Qualitative Study
Gina M. Berg, PhD , MBA â–  Jenni L. Harshbarger, PhD â–  Carolyn R. Ahlers-Schmidt, PhD â– 
Diana Lippoldt, MBA, RN
Compassion fatigue (CF) and burnout syndrome (BOS) are
identified in trauma, emergency, and critical care nursing
practices. The purpose of this qualitative study was to
measure CF and BOS in a trauma team and allow them
to share perceptions of related stress triggers and coping
strategies. Surveys to measure CF and BOS and a focus
group allowed a trauma team (12 practitioners) to share
perceptions of related stress triggers and coping strategies.
More than half scored at risk for CF and BOS. Stress triggers
were described as situation (abuse, age of patient) versus
injury-related. Personal coping mechanisms were most often
reported. Both CF and BOS can be assessed with a simple
survey tool. Strategies for developing a program culturally
sensitive to CF and BOS are provided.
Key Words
Burnout syndrome, Compassion fatigue, Focus group,
Trauma teams
ew would dispute that caring for traumatized people
is stressful, chaotic, and dramatic (Chase, 2005; Figley,
1995). Over the last 30 years, there has been a surge
of research dedicated to the effects and prevention of
traumatic stress. Most research published in the field
of traumatic stress has been focused on those who experi­
ence trauma firsthand, such as first responders in disaster­
relief situations (Figley, n.d.; Fullerton, Ursano, & Wang,
2004; Roberts, Flannelly, Weaver, & Figley, 2003) or those
in helping professions such as therapists and social work­
ers (Figley, 1995). However, the literature does acknowl­
edge that those individuals who experience trauma indi­
rectly are also vulnerable to secondary traumatic stress
(STS; Figley, 1995), also known as compassion fatigue
Author Affiliations: Wesley Medical Center, Wichita, Kansas (Dr Berg
and Ms Lippoldt); Department of Family and Community Medicine,
University of Kansas School of Medicine-Wichita (Dr Berg); Department
of Psychology, Wichita State University, Wichita, Kansas (Dr Harshbarger);
and Office of Research, University of Kansas School of Medicine-Wichita
(Dr Ahlers-Schmidt).
No authors have any declared conflicts of interest or sources of funding.
Correspondence: Gina M. Berg, PhD, MBA, Wesley Medical Center, 550
N. Hillside, Wichita, KS 67214 (gberg@kumc.edu).
DOI: 10.1097/JTN.0000000000000172
(CF; Figley, 1995; Joinson, 1992). Those suffering from
CF present as emotionally exhausted (Figley, n.d.), report
sadness, depression, sleeplessness, and general anxiety
[Figley, 1995), and often feel as if they have failed at their
profession (Pfifferling & Gilley, 2000) and as a result no
longer have the capacity to nurture Qoinson, 1992). Con­
stant and prolonged exposure to trauma leading to CF may
result in personal symptoms including cognitive reexpe­
riencing (e.g., nightmares, intrusive thoughts), avoidance
behaviors, increased arousal, depression, suicidal ideation,
anxiety, irritability, lack of confidence, decreased function­
ing in both professional and nonprofessional settings, a
diminished sense of purpose or enjoyment in work, and an
increase in self-destructive behaviors (American Psychiatric
Association, 2005; Collins & Long, 2003; Figley, 1995; Mea­
dors & Lamson, 2008; Pfifferling & Gilley, 2000; Stamm,
1999). Studies regarding CF often also discuss burnout syn­
drome (BOS; Maslach, Jackson, & Leiter, 1996), defined as
long-term exhaustion and diminished interest (Embriaco,
Papazian, Kentish-Barnes, Pochard, & Azoulay, 2007), as
well as detachment and low levels of personal effective­
ness (Epp, 2012). Commonly reported symptoms of BOS
include fatigue, headaches, eating disorders, insomnia,
emotional instability, and excessive rigidity in interpersonal
relations (Quenot et al., 2012).
Both CF and BOS have been described as common
in varying nursing practices (Beck, 2011; Coetzee &
Klopper, 2010), emergency departments (Adriaenssens,
De Gucht, van der Doef, & Maes, 2011; Dominquez­
Gomez & Rutledge, 2009; Duffy, Avalos, & Dowling,
2015; Hooper, Craig, Janvrin, Wetsel, & Reimels, 2010),
trauma (Hinderer et al., 2014), and critical care nursing
professions (Bakker, LeBlanc, & Schaufeli, 2005; Em­
briaco et al., 2007; Epp, 2012; Mason et al. 2014; Mea­
dors & Lamson, 2008; Poncet et al., 2007; Slocum-Gori,
Hemsworth, Chan, Carson, & Kazanjian, 2011). Trauma
(Hinderer et al., 2014), emergency (Duffy et al., 2015;
Hooper et al., 2010), and critical care nurses (Hurst, 2005;
Meadors & Lamson, 2008) have been identified as at high
risk for development of CF or BOS due to prolonged ex­
posure (volume and acuity) (Chase, 2005; Figley, 1995),
caregiver empathy, unresolved trauma in personal lives,
and cases involving suffering children (Figley, 1999).
Hinderer et al. (2014) report that as many as 27.3% and
35.9% of trauma nurses have scores consistent with CF
Copyright© 2016 Society of Trauma Nurses. Unauthorized reproduction of this article is prohibited.
and BOS, respectively. Poncet et al. (2007) found severe
BOS symptoms in one third of more than 2,000 critical
care nursing survey respondents.
Moreover, the effects of CF or BOS in individual mem­
bers can be corrosive to trauma teams and affect patient
care (Embriaco et al., 2007). Professional stress has been
associated with decreased personal productivity (Pfiffer­
ling & Gilley, 2000), impaired concentration, inability to
pay attention to detail (Slocum-Gori et al., 2011), absen­
teeism (Wright, 2004), decreased morale, high turnover
(Hurst, 2005; Pfifferling & Gilley, 2000), diminished work
engagement (Mason et al., 2014), and medical errors (Jen­
kins & Warren, 2012; Wright, 2004), all of which can com­
promise the quality of care (Meadors & Lamson, 2008).
In a national study examining critical care nurses, one
third of participants experiencing CF also experienced
high levels of depersonalization. Those experiencing
depersonalization have an increased risk of misinterpret­
ing or not appropriately documenting information, which
affects how the trauma team responds to the patient (Jen­
kins & Warren, 2012). Furthermore, BOS has been noted
to be contagious in intensive care settings (Bakker et al.,
2005) and can cause concern about team members’ abil­
ity to fulfill responsibility in highly interdependent tasks
(Piquette, Reeves, & LeBlanc, 2009). Yet, although CF and
BOS are becoming pervasive, professionals are often re­
luctant to discuss them for fear of judgment by colleagues
(Elkonin & van der Vyver, 2011; Gentry, Baranowsky, &
Dunning, 2002; Showalter, 2010).
Although the causes and effects of CF and BOS have
been extensively described, trauma staff may not be
aware of its insidious nature (Schroeter, 2014). Previous
studies have focused on specific disciplines regarding the
susceptibility to, risk factors for, and effects of CF and/
or BOS; however, there has been little focus on cop­
ing within trauma teams as a unit. The aim of this study
was to gain insight into a trauma team regarding CF and
BOS using qualitative methods, thereby allowing them
to share perceptions of related stress triggers and coping
This study employed focus group methodology with
approvals from appropriate institutional review boards.
Focus group participants were older than 18 years and
currently employed as a member of the trauma team in
a Midwestern Level I trauma center. Participant recruit­
ment was an invitation to participate issued at several
trauma operation meetings. Participation was voluntary,
and informed consent was obtained at the beginning of
the session. Participants completed surveys for demo­
graphic information, perceived quality of life, and a life
stress inventory. Three assessment tools were used.
• The Holmes-Rahe Life and Stress Inventory
(Holmes & Rahe, 1967) is a 43-item scale used to
examine how stressful life events can contribute to
illness. Scores fall into four categories: 0-149 = no
significant stress; 150-199 = mild stress; 200-299
= moderate stress; and 300-600 = major stress.
• The Professional Quality of Life Scales, the
ProQOL (Stamm, 2010), is a tool used to measure
compassion satisfaction (defined as feeling
satisfied by one’s job and from the helping itselD
and CF (defined as feeling overwhelmed by work).
Compassion fatigue is separated into two scales:
Burnout (defined as feelings of unhappiness,
disconnectedness, and insensitivity to the work
environment) and STS (feeling trapped, on edge,
exhausted, and overwhelmed by others’ trauma).
It comprises 30 statements, which are rated on a
5- point Likert scale from “never” to “very often,”
based on the last 30 days. Compassion satisfaction,
burnout, and STS are all scored on the following
scale: 0-43 = low; 44-56 = moderate; and 57 and
more = high. The desired scores for compassion
satisfaction are high, whereas the desired scores
for burnout and STS are low.
• The demographic survey included items related
to age, sex, ethnicity, religion, and professional
• Focus group script included questions about (1)
compassion satisfaction (positive aspects of job
and ability to contribute to work or society); (2)
CF (trauma events that are upsetting to self, team,
and trigger reactions); (3) STS (experience with
and event triggers); and (4) self-care (coping
mechanisms, trauma-specific education on STS,
and institutional resources).
The focus group was 1.5 hr in length and was led by
a trained facilitator. Two trained researchers took notes
during the session, which was also audiotaped and tran­
scribed. A chaplain was available for debriefing following
the focus group due to the sensitive nature of the content.
Notes and transcripts were independently reviewed by
two research team members, and themes were identified.
Disparities in theme categorization were addressed by
mutual consensus. Data were summarized using means
(standard deviation) for interval data and frequencies
(percentages) for categorical data.
The focus group (N = 12) largely comprised White
(83.3%), female (66.7%) nurses (50%) who were older
than 40 years (83.3%) (Table 1). Just over half (58.3%) re­
ported no significant problems in the Holmes-Rahe Life
Volume 23 I Number 1 I January-February 2016
Copyright© 2016 Society of Trauma Nurses. Unauthorized reproduction of this article is prohibited.
42.6 (7.5)
Years of clinical practice
14.7 (4.1)
Years in current position
9.3 (4.7)
Participate in religious activities (times per
2.9 (5.7)
10 (83.3)
2 (16.7)
8 (66.7)
4 (33.3)
Clinical position
Trauma surgeon
1 (8.3)
Physician assistant
2 (16.7)
6 (50.0)
3 (25.0)
Religious affiliation
8 (66.7)
2 (16.7)
2 (16.7)
Note. SD = standard deviation.
aother position includes physical therapy and social workers.
bQther religious affiliation includes Jewish, Muslim, or Other.
Stress Inventory (Holmes & Rahe, 1967), whereas the rest
(41.7%) reported mild stress. None of the participants
reported moderate or major stress (Table 2). Regarding
the individual ProQOL (Stamm, 2010; Table 3), one third
(33.3%) scored a combination of low compassion satis­
faction and high burnout and another 25% scored mod-
No significant problem
Moderate stress
Major stress
Mild stress
erate burnout. Most (75%) scored at risk, either with high
(25%) or moderate (50%) STS. Interpreting the ProQOL
scales (Stamm, 2010) in combination (Table 3), almost
half (42%) were identified as at risk, with 25% being
distressed, overwhelmed, or useless in job and (16.7%)
scored at high risk due to burnout.
Focus Group Results
Four themes were identified in the transcription analysis
and included positive aspects of job, stress triggers, stress
symptoms, and coping with stress.
Positive Aspects of Job
Team members expressed positive aspects of being part
of the trauma team including “saving lives,” “know­
ing you made a difference,” and “touching a [patient’s]
family member.” In addition, satisfaction was derived
from pride in being part of a team. “It’s like an esprit
de corps, do you know what I’m saying, and you have
a sense of cohesiveness as a team that makes us spe­
cial.” A benefit of being part of the trauma team identi­
fied by all participants was the excitement of the job,
one participant stated, “You never know what’s going
to happen next. It’s an adrenalin rush.” In addition to
pride in their team, participants also expressed pride
in their ability to educate both in-house (e.g., medical
students and residents) and outside of the institution
at conferences and in peer-reviewed publications. “I
think that what makes us a neat group; we realize that
we are not perfect, but we keep pushing for perfection,
knowing that we probably won’t ever get there but we
keep getting a little closer.”
Stress Triggers
Team members appeared to be in agreement regard­
ing events of abuse as stress triggers. Specifically, they
identified both pediatric abuse and geriatric abuse,
although any case involving a child was a trigger. Also
identified were trauma scenarios where multiple family
members were injured, injuries from avoidable situations
and “senseless” deaths. Several participants agreed that
7 (58.3)
5 (41.7)
0 (0.0)
0 (0.0)
Note. From “The social readjustment rating scale” by T. Holmes and R. Rahe, 1967,
Journal of Psychosomatic Research , 11, pp. 213-218. Copyright 1967 by the American Psychological Association.
aRisk of illness/health change.
Copyright© 2016 Society of Trauma Nurses. Unauthorized reproduction of this article is prohibited.
Positive, no significant concernsa
Positive, but moderate, concerns
3 (25.0)
4 (33.3)
At risk, high burnout’
2 (16.7)
Distressed, overwhelmed, and uselessd
3 (25.0)
Compassion satisfaction• (high score desired)
4 (33.3)
Burnout (low score desired)
Secondary trauma stressg (low score desired)
5 (41.7)
5 (41.7)
3 (25.0)
3 (25.0)
6 (50.0)
3 (25.0)
4 (33.3)
3 (25.0)
Note. Bold indicates areas of concern.
From The concise ProQOL manual (2nd ed. ), by B. H. Stamm, 2010, Pocatello, ID: ProQOL.org.
aHigh compassion satisfaction and moderate to low burnout and secondary trauma stress.
bModerate to low compassion satisfaction, burnout, and secondary stress.
c High burnout, low or moderate compassion satisfaction, and secondary trauma stress.
High burnout and secondary traumatic stress with low compassion satisfaction.
esatisfied with job and helping.
‘Unhappiness, disconnectedness, and insensitivity
8 Feeling trapped, on edge, exhausted, overwhelmed.
situations that were more personal could have an adverse
effect. One stated,
I think that sometimes people will be able to see some­
thing that has happened in their life, like if they have had
a death of a child, or if they have had an accident and if
they see something very identical come in that they have
experienced in their own personal life that is really tough.
Interacting with family members of patients was an­
other stressor identified by participants; “whether they
are negative conversations or not, families can be over­
whelming and stressful.” While another participant stat­
ed, “It’s not always in the trauma bay, at least half my
stress is in the ICU or the waiting room outside the ICU.”
Failure to act as a cohesive team was identified as a
stress trigger. One participant explained, “It might just be
somebody yelling or somebody that is upset about some­
thing, or maybe someone is just not in the greatest of
moods when they walk in the trauma bay.” Perceived in­
efficiencies in the system or processes also were stressors
for participants. As one participant put it, “If our system is
broken, then we have no control over it.” While another
expanded, saying,
My biggest button, that makes me get the angriest, is
when I see bureaucracy take precedence over patient
care … It could be lack of equipment because it is still
on order or lack of a call schedule list [indicates specialist
availability], it is so multi-factorial.
Stress Symptoms
Participants reported a variety of symptoms related to
stress including nightmares, flashbulb memories regard­
ing disturbing cases that went really well or really badly,
and second-guessing clinical decisions. In addition, par­
ticipants described an increased perception of risk of
serious injury for their own children or family members.
One stated, “My daughter calls me the Safety (Seatbelt)
Psycho,” whereas another said, “One of the fears that I
have is a drive-by shooting, which I never had prior to
working in trauma”. Many participants reported restrict­
ing their own and their children’s activities for fear of
injury. On the contrary, although participants reported
hypervigilance regarding major injury, they also report­
ed being desensitized to injury when it occurred. One
mother stated,
There was a time when my son, he and his friend were
playing with sticks and he cut his elbow open, and the kid
wanted to run in and tell me but my son said my mom’s
not going to care unless there is a bone sticking out or I’m
bleeding to death.
Volume 23 I Number 1 I January-February 2016
Copyright© 2016 Society of Trauma Nurses. Unauthorized reproduction of this article is prohibited.
Coping With Stress
Participants did not feel they experienced CF often,
and when they did, coping strategies appeared to differ
between respondents. No participants reported receiv­
ing any training during their education on how to handle
STS, yet trauma workers felt they had the ability to deal
with stress themselves. Most were aware of institutional
options available but felt uncomfortable or unwilling to
engage such services. In addition, coping strategies may
differ on the basis of the details of a particular case. One
participant shared,
I think [in] our normal situations with adults that we are
used to, we are sarcastic and we joke to filter it out a lit­
tle bit. But with children it is different. Particularly with
abused patients we don’t have the sarcasm, there is no
filter there, and you have to cope with that.
However, coping strategies fell within two themes:
group or independent.
Some participants preferred to process in small groups.
We talk amongst ourselves. I think because you un­
derstand. Somebody … that you trust, they understand
where you are coming from so it is easier to talk to
them. They know what you go through. It is hard to
talk to someone who has no idea what you go through.
If you are talking to someone on the trauma service,
they know what you are experiencing. So they can re­
late to you.
These spontaneous debriefing sessions were described
as informal and often occurred outside of the hospital.
A few participants reported relying on talking (in gen­
eralizations) with significant others outside of the work
environment. For other group members, coping strate­
gies were engaged independently and were described as
I go straight for the bathroom [at home], I fill up the tub
and I get in the tub and I sit in there and shut the door.
I make sure no one sees me [in the chapel], I don’t want
them to think I am weird.
Because team members engaged in different cop­
ing strategies, and this was recognized by the group, no
recommendations or suggestions for how the institution
could facilitate or improve current processes were identi­
fied by participants.
This study sought to uncover the existence of, and
coping skills with, CF and/or burnout within a trauma
team, using simple measurement tools and focus group
methodology. Findings included that one fourth of the
trauma team members scored at high levels of STS and
one third scored at high levels of burnout. These percent­
ages are similar to other findings in the trauma environ­
ment (Hinderer et al., 2014). There was consensus that
certain events (situational rather than injury-based) were
more stressful than others. Events identified as high stress
were consistent with the literature and involved children
(Figley, 1995), abuse (Figley, 1995), family members (Ma­
son et al., 2014), avoidable situations, and those similar to
personal experiences (Figley, 1999). Administrative con­
flict, a non-patient-related theme, was also noted to be
consistent with literature (Mason et al., 2014).
Despite identifying many stress-inducing events,
participants reported CF as an infrequent experience.
This initially appeared to be supported by results of the
Holmes-Rahe Life Stress Inventory (Holmes & Rahe,
1967), which indicated that no participants fell into the
moderate or major stress ranges and less than half fell
into the mild stress category. In addition, focus group
discussions identified several group and individual
strategies for dealing with traumatic events. Following
examination of the ProQOL (Stamm, 2010), however,
most participants (75%) were scored in the moderate or
high range for STS and more than half (58.3%) scored
in the moderate or high range for burnout. This sug­
gests that trauma team members may not be as adept
at managing work stressors as well as they perceive. In
addition, the lack of reference to, or use of, institution­
al resources for coping may be concerning. Although
first responder teams are often required to attend criti­
cal incident debriefings after direct exposure to trauma,
this may not be the case for those who experience it
indirectly. Thus, internal mechanisms to advocate for
team coping may be necessary.
I have bubbles in my drawer, and I go out to the court­
yard and blow bubbles when I am stressed so if you see
bubbles out there in the courtyard that’s me out there.
TI1at is my alone time and you will either find me there
or in the chapel just sitting there by myself.
Recommendations for acknowledging coping as teams
within trauma programs can include several strategies:
I would put some serious miles on the treadmill, that’s
how I burn it off.
1. As a program, acknowledge and accept that CF and
BOS not only exist but also are an expected reality
Copyright© 2016 Society of Trauma Nurses. Unauthorized reproduction of this article is prohibited.
in trauma-related professions (Schroeter, 2014).
It may take a champion (similar to performance
improvement and outreach) to educate the team
to accept the normalcy of experiencing patient
care-related stress while setting boundaries for
professional behavior.
2. Educate the team on how to recognize symptoms
in themselves (Fearon & Nicol, 2011). Consider
introducing and adopting the ProQOL (Stamm,
2010), or other work stress inventories, to assess
and score CF and BOS. The ProQOL is a 30-item
questionnaire evaluating compassion satisfaction
and CF (burnout and secondary trauma) that can
be self-scored. The ProQOL is free to use (with
permission) and is available at www.ProQOL.org.
Suggest team members self-evaluate on an annual
basis, maybe to coincide with annual performance
evaluations. Using a standardized tool is especially
important, as self-report underestimates the
incidence of CF. If a team member discloses
the need for additional help, provide resources.
Both CF and BOS should be used discretely and
only for self-awareness, although, collectively,
this may be an indicator of health of the trauma
team (Embriaco et al., 2007) and could be used
for screening to determine need for preventive
interventions (Adriaenssens et al., 2011).
3. Embody professional stress relief coping skills
as a team. Professional social support or positive
coworker relationships can alleviate CF (Gutierrez,
2005; Hinderer et al., 2014). Encourage trauma
team members to engage in self-soothing
activities, yet recognize they are not alone in their
distress. Arrange time for team members to access
internal social support from colleagues who have
experienced similar feelings.
4. Make social support a priority in leadership
development. Job satisfaction has been noted to
be strongly associated with social support from
(Adriaenssens et al., 2011), or positive working
relationships (Poncet et al., 2007) with, supervisors.
5. Engage in team discussions about coping as part
of regularly scheduled meetings, rather than just
in response to crisis or unprofessional behavior.
Use questions similar to those presented here.
Use caution and have a professional (counselor
or chaplain) be available in the event normal
conversations trigger stress responses. Be
cognizant of those who do not contribute to the
conversations, as CF is positively correlated with
silence (Elkonin & van der Vyver, 2011). Strive to
make the discussion nonjudgmental.
6. Be proactive in responding to identified high crisis
situations (e.g., abuse, pediatric, or fatality) with
interventions. Organizational interventions can be
as informal, as making a counselor or chaplain
available for conversation or more structured
in terms of time-limited group therapy, critical
incident debriefings, or stress-prevention training.
If the trauma team resists institutional debriefings,
consider immediate technical debriefings that
recap what went well in unsuccessful patient
encounters, as reflecting can have a positive
benefit (Berg et al., 2014; Fearon & Nicol, 2011)
for those who may second-guess their clinical
7. Emphasize the positive aspects of patient care.
Encourage mindfulness and celebration of
successful patient care encounters.
8. Consider preemployment screening with stand­
ardized questionnaires to identify personalities
that naturally exhibit strong coping traits (Burgess,
Irvine, & Wallymahmed, 2010).
The use of these strategies can contribute to a de­
veloping a culture in which both CF and BOS are ac­
cepted realities for trauma care workers and allow staff
to participate in support without fear of collegial judg­
ment (Elkonin, & van der Vyver, 2011; Gentry et al.,
This study is limited for generalizability by the qualita­
tive nature, but it rather represents the perceptions and
ideas of a Level I trauma team. Responses are catego­
rized by discipline of team members for identity pro­
tection within small sample. Focus group findings are
limited by the phrasing of questions and skill of modera­
tor. Although focus group members were invited with
instructions that honest and open participation was nec­
essary, responses could have been biased by social de­
sirability and desire to not appear weak in front of team
members (Elkonin, & van der Vyver, 2011; Gentry et al.,
2002; Showalter, 2010).
Results of this study indicated that both CF and BOS are
not just complex concepts described in the literature
but can also be identified as real and present in the
midst of an unsuspecting trauma team. Using simple
tools and qualitative methodology, a trauma program
can conduct a modest, but effective, needs assessment
for education, intervention, or even surveillance of CF
and BOS within the team. Although data from this study
were collected from a small focus group, they give
voice to the evidence that describes and quantifies pro­
fessional stress. Furthermore, the team can self-manage
stress by creating a culture that acknowledges, accepts,
and proactively supports staff to prevent or control CF
and burnout.
Volume 23 I Number 1 I January-February 2016
Copyright© 2016 Society of Trauma Nurses. Unauthorized reproduction of this article is prohibited.
• Positive aspects of being part of the trauma team included
saving lives, being part of a team, excitement of job, and
teaching new clinicians.
• Stress triggers reported included situational rather than
injury-based cases (children, the elderly, abuse), interacting
with family members, events similar to personal situations,
failure to act as a cohesive team, and conflicts with
• Trauma programs can develop a culture sensitive to CF and
BOS by educating team on prevalence and recognition, self­
evaluation, boundary setting, setting time for internal social
support, social support within leadership development,
nonjudgmental team discussions, responses to high crisis
situations, be proactive in responding to identified high crisis
situations, emphasize positive aspects of care, and consider
preemployment screening for coping traits.
The authors thank the Wesley Medical Center trauma
team, for allowing them to share their thoughts, and Jane
Siebert, RPh, MACM, Erin Geux-Clark, MD, Robin Crowe,
MA, and Jamie LoCurto, MA, for their contributions to the
Adriaenssens J. , De Gucht V. , Van Der Doef M., Maes S. (2011).
Exploring the burden of emergency care: Predictors of stress­
health outcomes in emergency nurses. Journal c!f’ Advanced
Nursing, 67(6), 1317-1328.
American Psychiatric Association. (2005). Diagnostic and statistical
manual a/mental disorders (4th ed., text revision) (DSM-IV TR).
Washington, DC: Author.
Bakker A. B . , LeBlanc P. M., Schaufeli W. B. (2005). Burnout
contagion among intensive care nurses. Journal of Advanced
Nursing, 51(3), 276-287.
Beck C. T. (2011). Secondary traumatic stress in nurses: A systematic
review. Archives ofPsychiatric Nursing, 25(1), 1-10.
Berg G. M., Hervey A. M. , Basham-Saif A. , Parsons D., Acuna D.
L., Lippolt D . (2014). Acceptability and implementation of
debriefings after trauma resuscitation. Journal c!f’ Trauma
Nursing, 21(5), 201-208.
Burgess L., Irvine F. , Wallymahmed A. (2010). Personality, stress and
coping in intensive care nurses: A descriptive exploratory study.
Nursing in Critical Care, 15(3), 129-140.
Chase M. M. (2005). Emergency department nurses ‘ lived
experiences with compassion fatigue (Master’s thesis). Florida
State University, Tallahassee, FL.
Coetzee S. K. , Klopper H. C. (2010). Compassion fatigue within
nursing practice: A concept analysis. Nursing and Health
Science, 12(2), 235-243.
Collins S., Long A. (2003). Too tired to care? The psychological
effects of working with trauma. Journal c!f’ Psychiatric and
Mental Health Nursing, 10, 17-27.
Dominquez-Gomez E . , Rutledge D. N. (2009). Prevalence of
secondary traumatic stress among emergency nurses. Journal
ofEmergency Nursing, 35(3), 199-204.
Duffy E . , Avalos G . , Dowling M. (201 5). Secondary traumatic stress
among emergency nurses: A cross-sectional study. International
Emergency Nursing, 23(2), 53-58.
Elkonin D . , van der Vyver L. (20 1 1). Positive and negative emotional
responses to work-related trauma of intensive care nurses in
private health care facilities. Health SA Gesondheid, 16(1), 1-8.
doi: 10.4102/hsag.vl6il .436
Embriaco N., Papazian L., Kentish-Barnes N., Pochard F. , Azoulay
E. (2007). Burnout syndrome among critical care healthcare
workers. Current Opinion Critical Care, 13, 482-488.
Epp K. (2012). Burnout in critical care nurses: A literature review.
Dynamics, 23(4), 25-3 1 .
Fearon C . , Nicol M . (20 1 1). Strategies to assist prevention o f burnout
in nursing staff. Nursing Standard, 26(14), 35-39.
Figley C. R. (1995). Compassion fatigue: Coping with secondary
traumatic stress disorder in those who treat the traumatized.
New York, NY: Routledge.
Figley C. R. (1999). Compassion fatigue: Toward a new understanding
of the costs of caring. In Stamm B. H. (Ed.), Secondary traumatic
stress: Selfcare issuesfor clinicians, researchers, and educators
(pp. 3-28). Baltimore, MD: Sidran Press.
Figley C . R. (n.d.). Compassionfatigue: An introduction .Retrieved from
Fullerton C. S . , Ursano R. ]. , Wang L. (2004). Acute stress disorder,
posttraumatic stress disorder, and depression in disaster or
rescue workers. American Journal c!f’Psychiat1y, 161(8), 1370-1376
Gentry J. E . , Baranowsky A. B . , Dunning K. (2002). ARP: The
accelerated recovery program for compassion fatigue. InFigley
C. R. (Ed.), Treating compassion fatigue (pp. 123-137). New
York, NY: Brunner-Routledge.
Gutierrez K. M. (2005). Critical care nurses’ perceptions of and
responses to moral distress. Dimensions in Critical Care
Nursing, 24, 229-241 .
Hinderer K. A. , VonRueden K. T. , Friedmann E . , McQuillan K. A. ,
Gilmore R. , Kramer B . , Murray M. (2014). Burnout, compassion
fatigue, and secondary traumatic stress in trauma nurses.
Journal of Trauma Nursing, 21(4), 160–169.
Holmes T. , Rahe R. (1967). The social readjustment rating scale.
Journal ofPsychosomatic Research, 1 1 (2), 213-218.
Hooper C., Craig ]., Janvrin D . R. , Wetsel M. A. , Reimels E. (2010).
Compassion satisfaction, burnout, and compassion fatigue
among emergency nurses compared with nurses in other
selected inpatient specialties. Journal of Emergency Nursing,
36(5), 420-427.
Hurst S. (2005). A pilot qualitative study relating to hardiness of ICU
nurses. Dimensions of Critical Care Nursing, 24, 97-100.
Jenkins B., Warren N. A. (2012). Concept analysis: Compassion
fatigue and effects upon critical care nurses. Critical Care
Nursing Quarterly, 35(4), 38&-395.
Joinson C. (1992). Coping with compassion fatigue. Nursing, 22,
Maslach C., Jackson S., Leiter M. (1996). Maslach burnout inventory
manual. Palo Alto, CA: Consulting Psychologists Press.
Mason V. M., Leslie G., Clark K. , Lyons P. , Walker E . , Butler C . ,
Griffin M . (2014). Compassion fatigue, moral distress, and
work engagement in surgical intensive care unit trauma nurses.
Dimensions c!f’Critical Care Nursing, 33(4), 215-225.
Meadors P. , Lamson A. (2008). Compassion fatigue and secondary
traumatization: Provider self-care on intensive care units for
children. Journal ofPediatric Health Care, 22(1), 24-34.
Pfifferling ] . , Gilley K. (2000). Overcoming compassion fatigue.
Family Practice Management, 7, 39-45.
Piquette D . , Reeves S . , LeBlanc V. R. (2009). Stressful intensive care
unit medical crises: How individual responses impact on team
performance. Critical Care Medicine, 37(4), 1251-1255.
Poncet M. C., Toullic P. , Papazian L., Kentish-Barnes N. , Tirnisit ]. F. ,
Pochard F. , Azoulay E. (2007). Burnout syndrome in critical care
nursing staff. American Journal ofRespiratory and Critical Care
Medicine, 175(7), 69&-704.
Copyright© 2016 Society of Trauma Nurses. Unauthorized reproduction of this article is prohibited.
Quenot J. P. , Rigaud J. P. , Prin S . , Barbar S . , Pavon A. , Hamet M.,
Moutel G. (2012). Suffering among carers working in critical
care can be reduced by an intensive conununication strategy on
end-of-life practice. Intensive Care Medicine, 38, 55–6 1 .
Roberts S. B . , Flannelly K . J., Weaver A . J., Figley C. R . (2003).
Compassion fatigue among chaplains, clergy, and other
respondents after September 1 1th. The Journal of Nervous and
Mental Disease, 191(11), 756-758.
Schroeter K. (2014). Compassion fatigue: An unwanted reflection
of your reality [Editorial] . Journal c!f” Trauma Nursing, 21(2),
Showalter S. E. (2010). Compassion fatigue: What is it? Why does
it matter? Recognizing the symptoms, acknowledging the
impact, developing the tools to prevent compassion fatigue,
and strengthen the professional already suffering from the
effects. American Journal ofHospice and Palliative Care, 27( 4),
Slocum-Gori S . , Hemsworth D . , Chan W. W. Y. , Carson A. , Kazanjian
A. (201 1). Understanding compassion satisfaction, compassion
fatigue and burnout: A survey of the hospice palliative care
workforce. Palliative Medicine, 27(2), 172-178.
Stamm B. H. (1999). Secondary traumatic stress: Sef/care issues.for
clinicians, researchers, and educators. Baltimore, MD: Sidran
Stanm1 B. H. (2010). The concise ProQOL manual (2nd ed.).
Pocatello, ID: ProQOL.org.
Wright B. (2004). Compassion fatigue: How to avoid it. Palliative
Medicine, 18, 3-4.
Volume 23 I Number 1 I January-February 2016
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Guidelines to follow for appraisal of qualitive research study
Guidelines to follow for appraisal of qualitive research study
Guide to a Focused Critique of Evidence Quality in a Qualitative Research Report
Aspect of the
Critiquing Questions
What was the study purpose?
Is the identified research tradition (if any) congruent with the
Research design and
research tradition
methods used to collect and analyze data?
Was an adequate amount of time spent in the field or with
study participants?
Sample and setting
Was there evidence of reflexivity in the design?
Was the group or population of interest adequately
described? Were the setting and sample described in
sufficient detail?
Was the best possible method of sampling used to enhance
information richness and address the needs of the study?
Guidelines to follow for appraisal of qualitive research study
• Was the sample size adequate? Was saturation achieved?
Data collection
Were the methods of gathering data appropriate? Were data
gathered through two or more methods to achieve
Did the researcher ask the right questions or make the right
Was there a sufficient amount of data? Were they of
sufficient depth and richness?
Do data collection and recording procedures appear
Were data collected in a manner that minimized bias? Were
the people who collected data appropriately trained?
Enhancement of
Did the researchers use strategies to enhance the
trustworthiness/integrity of the study, and were those
strategies adequate?
Do the researchers’ clinical, substantive, or methodologic
qualifications and experience enhance confidence in the
findings and their interpretation?
Data analysis
Was the data analysis strategy compatible with the research
tradition and with the nature and type of data gathered?
Did the analysis yield an appropriate “product” (e.g., a theory,
taxonomy, thematic pattern, etc.)?
Did the analytic procedures suggest the possibility of biases?
Were the findings effectively summarized, with good use of
excerpts and supporting arguments?
Do the themes adequately capture the meaning of the data?
Does it appear that the researcher satisfactorily
conceptualized the themes or patterns in the data?
Did the analysis yield an insightful, provocative, authentic,
and meaningful picture of the phenomenon under
Guidelines to follow for appraisal of qualitive research study
• Do the study findings appear to be trustworthy—do you have
confidence in the truth value of the results?
Does the study contribute any meaningful evidence that can
be used in nursing practice or that is useful to the nursing

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