Doctoral Dissertations

Date of Award


Degree Type


Degree Name

Doctor of Philosophy



Major Professor

Joel G. Anderson

Committee Members

Joel G. Anderson, Carole R. Myers, Knar Sagherian, Patricia Bamwine, Kristina W. Kintziger


Secondary traumatic stress describes symptoms consistent with post-traumatic stress disorder but that result from witnessing or experiencing the trauma of another individual through a helping relationship. The associated symptoms include intrusions, avoidance, and hyperarousal. Secondary traumatic stress is also associated with the development of compassion fatigue and burnout. The current state of the science identifies that secondary traumatic stress may affect those nurses who provide care to critically ill or injured patients. Research has most commonly examined the prevalence of secondary traumatic stress, compassion fatigue, and burnout among nurses in emergency department settings. While attention is frequently given to the actual and projected shortages in the nursing workforce in support of increasing the number of graduate nurses, there is a need to foster increased efforts to promote welfare, resilience, and retention of nurses in clinical settings.

The purpose of this research was to explore the phenomena of secondary traumatic stress through the experiences of emergency department and trauma unit nurses who provided care to patients injured in a multi-casualty, school-associated shooting event to understand the psychosocial effects on their roles with these patients and to identify opportunities for strategies and interventions to mitigate secondary traumatic stress. Emergency nurses would typically experience a shorter duration of exposure to these patients but these encounters would be in the most acute phases of the traumatic event. In contrast, trauma specialty nurses would routinely experience longer exposure to these patients across the clinical work shift with additional exposure to family members of the patients.

Using qualitative case series methodology, this research identified themes and findings that have implications for nursing practice and education, public policy, social change, and future research. These implications may translate to the development and implementation of primary, secondary, and tertiary prevention strategies to alleviate the prevalence of secondary traumatic stress among nurses and mitigate the incidence of mass shooting events. Benefits of this research may ultimately include improved mental health among nurses who care for critically ill and injured patients, better patient outcomes from the receipt of care from proficient nurses, retention of tenured nurses to serve as mentors for nurses entering clinical specialties, and abatement of rising health care costs through decreased expenses associated with nurse burnout and turnover.

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