Kendall-Tackett Kathleen, Beck Cheryl Tatano
School of Medicine, Texas Tech University Health Science Center Amarillo, Amarillo, TX, United States.
School of Nursing, University of Connecticut, Storrs, CT, United States.
Front Glob Womens Health. 2022 May 4;3:835811. doi: 10.3389/fgwh.2022.835811. eCollection 2022.
A significant percentage of maternity providers have experienced secondary traumatic stress following a traumatic birth. Previous studies identified it as an issue, but this literature review is 5-9 years old. In addition, the construct of moral injury has significantly increased our understanding of secondary trauma for military veterans. In the wake of COVID-19, this construct also applies to healthcare providers.
The present article updates these reviews and compares findings for three groups: labor and delivery nurses, midwives, and obstetricians. The second portion of this review re-examines previously published qualitative research to determine whether moral injury might more accurately describe the experiences of maternity personnel.
A comprehensive review of PubMed, Scopus, Web of Science, PsychINFO, and CINAHL was conducted in June 2021 using search terms such as compassion fatigue, secondary trauma, moral injury, labor and delivery, nurses, midwives, and obstetricians. Forty articles were identified, but only 16 focused on secondary trauma or moral injury.
Secondary trauma is a significant concern affecting at least 25% of maternity staff. However, some countries have very low rates, which correspond to low rates in childbirth-related trauma in mothers. Secondary trauma can lead to several symptoms, including re-experiencing, avoidance, negative changes in mood and cognitions, and hyperarousal, which can cause significant impairment. As a result, many providers decide to leave the field in the wake of a traumatic birth. The incidence of moral injury is unknown, but a re-examination of previously published qualitative data suggests that this construct, generally used to describe combat veterans, does describe some of what providers have reported. Acts of omission, i.e., failure to stop the harmful acts of others had long-term negative effects on labor and delivery nurses, consistent with data from military samples. Two possible mediators were proposed: hierarchical and gendered relationships in hospitals and agency of care.
The effects of traumatic birth on providers can be severe, including possible psychological sequelae, impaired job performance, and leaving the field. Moral injury expands upon the construct of secondary traumatic stress. This construct better describes the experiences of maternity staff in non-primary roles who witness traumatic births and are often haunted by events that they could not prevent, but often question whether they should have.
相当比例的产科医护人员在经历创伤性分娩后遭受了继发性创伤应激。以往研究已将其确定为一个问题，但这些文献综述已有5至9年历史。此外，道德伤害这一概念极大地增进了我们对退伍军人继发性创伤的理解。在新冠疫情之后，这一概念也适用于医护人员。
本文更新了这些综述，并比较了三组人员的研究结果：分娩护士、助产士和产科医生。本综述的第二部分重新审视了此前发表的定性研究，以确定道德伤害是否能更准确地描述产科人员的经历。
2021年6月，对PubMed、Scopus、科学网、心理学文摘数据库和护理学与健康领域数据库进行了全面检索，使用了诸如同情疲劳、继发性创伤、道德伤害、分娩、护士、助产士和产科医生等检索词。共识别出40篇文章，但只有16篇关注继发性创伤或道德伤害。
继发性创伤是一个重大问题，至少影响25%的产科工作人员。然而，一些国家的发生率很低，这与母亲分娩相关创伤的低发生率相对应。继发性创伤可导致多种症状，包括反复体验、回避、情绪和认知的消极变化以及过度警觉，这些症状可造成严重损害。因此，许多医护人员在经历创伤性分娩后决定离开该领域。道德伤害的发生率尚不清楚，但对先前发表的定性数据的重新审视表明，这个通常用于描述退伍军人的概念确实描述了一些医护人员所报告的情况。不作为行为，即未能阻止他人的有害行为，对分娩护士有长期负面影响，这与来自军人样本的数据一致。提出了两个可能的中介因素：医院中的等级和性别关系以及护理机构。
创伤性分娩对医护人员的影响可能很严重，包括可能出现的心理后遗症、工作表现受损以及离开该领域。道德伤害扩展了继发性创伤应激的概念。这个概念能更好地描述非主要角色的产科工作人员的经历，他们目睹创伤性分娩，常常被自己无法预防但又常常质疑自己是否本应预防的事件所困扰。
