Heart Rate Variability and Stress in the Intensive Care Unit Nursing Workplace

Intensive care unit (ICU) nurses work in a demanding environment, facing repeated encounters with trauma and ethical issues when caring for patients. Psychological stressors can include death of patients, violent acts by patients or their families, caring for suffering patients, and moral distress from performing futile care. These factors place ICU nurses at increased risk of developing post-traumatic stress disorder (PTSD). Suffering from chronic PTSD symptoms can negatively impact nurses’ psychological and physical health. There are also consequences for patients and hospitals, including increased risk for substandard care, decreased government reimbursements from poor patient satisfaction scores, and retention issues. Few studies have reported types of workplace events that lead to occupational stress and PTSD in ICU nurses. Moreover, few studies have examined PTSD and stress in ICU nurses using the objective measure of heart rate variability (HRV). Therefore, the purpose of this dissertation was to investigate the association between PTSD and psychological stress in ICU nurses and events experienced in the workplace. Three manuscripts were produced: (a) a concept analysis review paper examining the phenomenon of PTSD in ICU nurses, (b) a qualitative study exploring the lived experiences of ICU nurses who cared for COVID-19 patients during the height of the iv pandemic, and (c) an observational, correlational study examining the association between PTSD (and psychological stress) and HRV. This research advances health science knowledge through in-depth, novel findings on PTSD and psychological stress in ICU nurses from workplace experiences. Manuscript One described the concept of PTSD as it applied specifically to ICU nurses. Manuscript Two developed an intricate understanding of stress and trauma ICU nurses experienced caring for COVID-19 patients and its impact on their professional and personal lives. Manuscript Three revealed ICU nurses had reduced HRV due to events at work and new nurses had greater reductions in HRV than experienced nurses. Additionally, over half of the ICU nurses had low resilience and increased peritraumatic dissociative experiences, both of which signal risk for development of PTSD. More prospective research is needed with large cohorts, including ICU nurses with and without depression, and a longitudinal design to confirm these findings.