title: An integrative review of the impact of indirect trauma exposure in health professionals and potential issues of salience for midwives.
abstract: OBJECTIVE
  To explore responses to indirect trauma reported by health professionals and to identify issues of potential salience for midwives.
  
  
  BACKGROUND
  Indirect exposure to a traumatic event can lead to the development of distressing and potentially enduring responses. Little is understood about the impact that perinatal trauma exposure could have on midwives.
  
  
  METHODS
  An integrative review design was used.
  
  
  METHODS
  PsychInfo, Medline, PsychArticles, Web of Knowledge, CINAHL, MIDIRS and Scopus databases were search for papers published between 1980-November 2012.
  
  
  METHODS
  Studies providing quantitative or qualitative exploration of healthcare professionals' responses to indirectly experienced traumatic events were selected.
  
  
  RESULTS
  Forty-two papers fulfilled the inclusion criteria. Four of these studies included professionals engaged in maternity care or exposed to traumatic perinatal events. Findings indicate evidence of intrusion, avoidance and arousal in healthcare professionals, with differing degrees of frequency. Empathy, work-related stress and the extent of professional experience were identified as associated with traumatic stress responses.
  
  
  CONCLUSIONS
  Evidence derived from healthcare professionals suggests that indirect exposure to the traumatic events of recipients of care can sometimes elicit traumatic stress responses. Factors increasing risk for traumatic stress were identified as empathy and organizational stress. These factors hold specific salience in midwifery. Responding to trauma in a midwifery context, as informed by findings from other healthcare professionals, could adversely affect midwives' well-being, care provided to women and contribute to an adverse organizational climate. Large-scale research considering the experiences of midwives is recommended.
authors.affiliation: Institute of Psychology, Health and Society, University of Liverpool, UK.
authors.forename: Kayleigh
authors.initials: K
authors.lastname: Sheen
authors.forename: Pauline
authors.initials: P
authors.lastname: Slade
authors.forename: Helen
authors.initials: H
authors.lastname: Spiby
mesh_terms: D006801:Humans; D009721:Nurse Midwives; D013315:Stress, Psychological; D014947:Wounds and Injuries / Q000503:physiopathology* / Q000523:psychology
keywords: burnout; compassion fatigue; healthcare professionals; integrative review; midwives; posttraumatic stress; secondary traumatic stress; traumatic stress