title: Stress and Coping of Critical Care Nurses After Unsuccessful Cardiopulmonary Resuscitation.
abstract: BACKGROUND
  Participation by a critical care nurse in an unsuccessful resuscitation can create a unique heightened level of psychological stress referred to as postcode stress, activation of coping behaviors, and symptoms of posttraumatic stress disorder (PTSD).
  
  
  OBJECTIVE
  To explore the relationships among postcode stress, coping behaviors, and PTSD symptom severity in critical care nurses after experiencing unsuccessful cardiopulmonary resuscitations and to see whether institutional support attenuates these repeated psychological traumas.
  
  
  METHODS
  A national sample of 490 critical care nurses was recruited from the American Association of Critical-Care Nurses' eNewsline and social media. Participants completed the Post-Code Stress Scale, the Brief COPE (abbreviated), and the Impact of Event Scale-Revised, which were administered through an online survey.
  
  
  RESULTS
  Postcode stress and PTSD symptom severity were weakly associated (r= 0.20,P= .01). No significant associations between coping behaviors and postcode stress were found. Four coping behaviors (denial, self-distraction, self-blame, and behavioral disengagement) were significant predictors of PTSD symptom severity. Severity of postcode stress and PTSD symptoms varied with the availability of institutional support.
  
  
  CONCLUSIONS
  Critical care nurses show moderate levels of postcode stress and PTSD symptoms when asked to recall an unsuccessful resuscitation and the coping behaviors used. Identifying the critical care nurses most at risk for PTSD will inform the development of interventional research to promote critical care nurses' psychological well-being and reduce their attrition from the profession.
authors.affiliation: Dawn E. McMeekin was a DNP student at Case Western Reserve University, Cleveland, Ohio, when the study was done. She is now an advanced clinical education specialist at Baycare Health System, Dunedin, Florida. Ronald L. Hickman, Jr, is an associate professor, Carol G. Kelley is an assistant professor, and Sara L. Douglas is a professor, Case Western Reserve University. dawn.mcmeekin@baycare.org.
authors.forename: Dawn E
authors.initials: DE
authors.lastname: McMeekin
authors.affiliation: Dawn E. McMeekin was a DNP student at Case Western Reserve University, Cleveland, Ohio, when the study was done. She is now an advanced clinical education specialist at Baycare Health System, Dunedin, Florida. Ronald L. Hickman, Jr, is an associate professor, Carol G. Kelley is an assistant professor, and Sara L. Douglas is a professor, Case Western Reserve University.
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Hickman
authors.affiliation: Dawn E. McMeekin was a DNP student at Case Western Reserve University, Cleveland, Ohio, when the study was done. She is now an advanced clinical education specialist at Baycare Health System, Dunedin, Florida. Ronald L. Hickman, Jr, is an associate professor, Carol G. Kelley is an assistant professor, and Sara L. Douglas is a professor, Case Western Reserve University.
authors.forename: Sara L
authors.initials: SL
authors.lastname: Douglas
authors.affiliation: Dawn E. McMeekin was a DNP student at Case Western Reserve University, Cleveland, Ohio, when the study was done. She is now an advanced clinical education specialist at Baycare Health System, Dunedin, Florida. Ronald L. Hickman, Jr, is an associate professor, Carol G. Kelley is an assistant professor, and Sara L. Douglas is a professor, Case Western Reserve University.
authors.forename: Carol G
authors.initials: CG
authors.lastname: Kelley
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects* / Q000523:psychology*; D003422:Critical Care / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology* / Q000523:psychology*; D013315:Stress, Psychological / Q000209:etiology*; D011795:Surveys and Questionnaires