THE PSYCHOLOGICALLY TRAUMATIC EXPERIENCES OF RURAL REGISTERED NURSES WHO LIVE AND WORK IN THE SAME COMMUNITY
Rural RNs are exposed to a variety of traumatic and life-threatening events that involve injury, suffering, death, and dying on a daily basis, in geographical isolation, and with limited support. The events commonly involve individuals of all ages who are known to them personally, such as family, friends, or neighbors. Exposure can have a negative effect on their physical and psychological health, and place them at risk for such things as secondary traumatic stress, vicarious trauma, and post-traumatic stress disorder. The purpose of this study was to explore how rural practicing Registered Nurses (RNs) deal with exposure to psychologically traumatic events in the context of living and working in the same rural agricultural community over time. The aims were to a) describe the psychologically distressing traumatic events experienced by rural RNs who live and work in the same rural community, b) develop a reflexive understanding of the psychological impact of exposure to distressing traumatic events on rural RNs, and to c) construct a substantive theory focusing on psychologically distressing traumatic events in the context of rural nursing practice. Charmaz’s constructivist grounded theory methodology was utilized to inform the research process. Purposeful theoretical sampling of RNs practicing in six rural acute care hospitals in the western Canadian province of Saskatchewan resulted in a sample of 19 participants. Data were generated through 33 interviews (19 face-to-face and 14 telephone follow-up), and 14 reflective journals. All audiotaped interviews and journals were transcribed verbatim and analyzed using the constant comparison method. Findings illuminated the fact that rural nurses were intertwined with trauma-related events for life because they often live and work in the same community their entire career and are embedded in the sociocultural aspects of rural community life. Participants dealt with this through a process of ‘staying strong’ by relying upon others, seeking inner strength, attempting to leave the past behind, and by experiencing transformational change over time. The influence of the social context illuminated the fact that it was crucial for nurses to stay strong over time in order to continue to cope and deal with traumatic events in their community in the future. This research also highlights that current organizational psychological support is inadequate, and policies, programs, and processes do not meet the specific needs of nurses in rural practice settings. An improved response with interventions and supports that are designed to meet the unique needs of nurses in the rural practice context is required.
rural, remote, nurses, trauma, vicarious trauma, secondary traumatic stress, post-traumatic stress disorder, compassion fatigue, burnout
Doctor of Philosophy (Ph.D.)