title: A qualitative study of resilience and posttraumatic stress disorder in United States ICU nurses.
abstract: OBJECTIVE
  Intensive care unit (ICU) nurses are at increased risk of developing psychological problems including posttraumatic stress disorder (PTSD). However, there are resilient individuals who thrive and remain employed as ICU nurses for many years. The purpose of this study was to identify mechanisms employed by highly resilient ICU nurses to develop preventative therapies to obviate the development of PTSD in ICU nurses.
  
  
  METHODS
  Qualitative study using semi-structured telephone interviews with randomly selected ICU nurses in the USA. Purposive sampling was used to identify ICU nurses who were highly resilient, based on the Connor-Davidson Resilience Scale and those with a diagnosis of PTSD, based on the posttraumatic diagnostic scale. New interviews were conducted until we reached thematic saturation.
  
  
  RESULTS
  Thirteen highly resilient nurses and fourteen nurses with PTSD were interviewed (n = 27). A constructivist epistemological framework was used for data analysis. Differences were identified in four major domains: worldview, social network, cognitive flexibility, and self-care/balance. Highly resilient nurses identified spirituality, a supportive social network, optimism, and having a resilient role model as characteristics used to cope with stress in their work environment. ICU nurses with a diagnosis of PTSD possessed several unhealthy characteristics including a poor social network, lack of identification with a role model, disruptive thoughts, regret, and lost optimism.
  
  
  CONCLUSIONS
  Highly resilient ICU nurses utilize positive coping skills and psychological characteristics that allow them to continue working in the stressful ICU environment. These characteristics and skills may be used to develop target therapies to prevent PTSD in ICU nurses.
authors.affiliation: Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA. Meredith.Mealer@ucdenver.edu
authors.forename: Meredith
authors.initials: M
authors.lastname: Mealer
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Jones
authors.forename: Marc
authors.initials: M
authors.lastname: Moss
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D003422:Critical Care; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007362:Intensive Care Units; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D009729:Nursing / Q000592:standards / Q000706:statistics & numerical data*; D016273:Occupational Exposure / Q000009:adverse effects*; D016272:Occupational Health; D011594:Psychometrics; D036301:Qualitative Research; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology; D013315:Stress, Psychological / Q000150:complications*; D013637:Tape Recording; D013997:Time Factors; D014481:United States / Q000453:epidemiology