Prevalence and associated factors of secondary traumatic stress in emergency nurses: a systematic review and meta-analysis

Background: Nurses in emergency departments are at a high risk of experiencing secondary traumatic stress because of their frequent exposure to trauma patients and high-stress environments.Objective: This systematic review and meta-analysis aimed to determine the overall prevalence of secondary traumatic stress among emergency nurses and to identify the contributing factors.Method: We conducted a systematic search for cross-sectional studies in databases such as PubMed, Web of Science, Embase, CINAHL, Wanfang Database, and China National Knowledge Internet up to October 21, 2023. The Joanna Briggs Institute's appraisal checklists for prevalence and analytical cross-sectional studies were used for quality assessment. Heterogeneity among studies was assessed using Cochrane's Q test and the I2 statistic. A random effects model was applied to estimate the pooled prevalence of secondary traumatic stress, and subgroup analyses were performed to explore sources of heterogeneity. Descriptive analysis summarized the associated factors.Results: Out of 345 articles retrieved, 14 met the inclusion criteria, with 11 reporting secondary traumatic stress prevalence. The pooled prevalence of secondary traumatic stress among emergency nurses was 65% (95% CI: 58%-73%). Subgroup analyses indicated the highest prevalence in Asia (74%, 95% CI: 72%-77%), followed by North America (59%, 95% CI: 49%-72%) and Europe (53%, 95% CI: 29%-95%). Nine studies identified associated factors, including personal, work-related, and social factors. In the subgroup of divided by recruitment period, emergency department nurses in the COVID-19 outbreak period had a higher prevalence of secondary traumatic stress (70%, 95% CI: 62%-78%).Conclusions: Secondary traumatic stress prevalence is notably high among emergency department nurses, with significant regional variations and period differences. The factors affecting secondary traumatic stress also varied across studies. Future research should focus on improving research designs and sample sizes to pinpoint risk factors and develop prevention strategies.Registration: PROSPERO CRD42022301167. Secondary traumatic stress is considered an occupational hazard for nurses. Emergency department nurses, in particular, face a greater risk of secondary traumatic stress compared to other professions.While various studies have investigated the prevalence of secondary traumatic stress among these nurses, findings have been inconsistent.The pooled prevalence of secondary traumatic stress among emergency nurses is 65%. Subgroup analysis by region shows that Asia experiences the highest combined prevalence at 74%, with North America at 59% and Europe at 53%. Emergency department nurses in the COVID-19 outbreak period had a higher prevalence of secondary traumatic stress (70%, 95% CI: 62%-78%). Antecedentes: Las enfermeras en los departamentos de emergencia tienen un alto riesgo de experimentar estres traumatico secundario debido a su exposicion frecuente a pacientes traumatizados y a entornos de alto estres.Objetivo: Esta revision sistematica y metaanalisis tuvo como objetivo determinar la prevalencia general del estres traumatico secundario en las enfermeras de emergencia e identificar los factores contribuyentes.Metodos: Realizamos una busqueda sistematica de estudios transversales en bases de datos como PubMed, Web of Science, Embase, CINAHL, Wanfang Database y China National Knowledge Internet, hasta el 21 de octubre de 2023. Para la evaluacion de la calidad se utilizaron los listados de verificacion de evaluacion del Instituto Joanna Briggs para estudios de prevalencia y estudios transversales analiticos. La heterogeneidad entre los estudios se evaluo mediante la prueba Q de Cochrane y el indice estadistico I2. Se aplico un modelo de efectos aleatorios para estimar la prevalencia agrupada del estres traumatico secundario, y se realizaron analisis de subgrupos para explorar las fuentes de heterogeneidad. El analisis descriptivo resumio los factores asociados.Resultados: De los 345 articulos recuperados, 14 cumplieron los criterios de inclusion, de los cuales 11 reportaron la prevalencia de estres traumatico secundario. La prevalencia agrupada de estres traumatico secundario en las enfermeras de urgencia fue del 65% (IC 95%: 58%-73%). Los analisis de subgrupos indicaron la prevalencia mas alta en Asia (74%; IC 95%: 72%-77%), seguida de America del Norte (59%; IC 95%: 49%-72%) y Europa (53%; IC 95%: 29%-95%). Nueve estudios identificaron factores asociados, incluyendo factores personales, laborales y sociales. En el subgrupo dividido por periodo de reclutamiento, las enfermeras del departamento de emergencia en el periodo del brote de COVID-19 tuvieron una mayor prevalencia de estres traumatico secundario (70%; IC 95%: 62%-78%).Conclusiones: La prevalencia del estres traumatico secundario es notablemente alta entre las enfermeras del servicio de emergencia, con importantes variaciones regionales y diferencias entre periodos. Los factores que afectan el estres traumatico secundario tambien variaron entre los estudios. Las investigaciones futuras deberian centrarse en mejorar los disenos de investigacion y los tamanos de las muestras para identificar los factores de riesgo y desarrollar estrategias de prevencion.