Newswise — Understanding how nurses cope following the death of a patient after CPR may help identify nurses most at risk for postcode stress and posttraumatic stress disorder (PTSD), according to new research published in the American Journal of Critical Care (AJCC).

Stress and Coping of Critical Care Nurses After Unsuccessful Cardiopulmonary Resuscitation” explores the relationship between postcode stress, PTSD symptom severity and coping behaviors after an unsuccessful attempt to resuscitate a patient.

“Finding ways to minimize distress and improve resiliency not only helps the individual nurse but may also help combat high turnover and vacancy rates for critical care nurses,” said lead author Dawn E. McMeekin, RN, DNP, CNE, advanced clinical education specialist at Baycare Health System, Dunedin, Florida. “These results underscore the importance of maintaining a healthy work environment and nursing workforce.”

When the study was conducted, McMeekin was a DNP student at Frances Payne Bolton School of Nursing at Case Western Reserve University, Cleveland. For the study, she worked with faculty members Ronald L. Hickman Jr., Carol G. Kelley and Sara L. Douglas, who serve as co-authors of the AJCC article.

The researchers conducted an online survey that included the Post-Code Stress Scale, the Brief COPE and the Impact of Event Scale-Revised. A national sample of 490 critical care nurses participated in the study.

The study found that critical care nurses show moderate levels of postcode stress and PTSD symptoms when asked to recall an unsuccessful resuscitation.

Nurses who had institutional debriefing support reported significantly lower postcode stress scores than their colleagues without such support.

The researchers also analyzed how 10 study variables influenced the participants’ self-reported severity of PTSD symptoms. The four negative coping behaviors included in the survey (denial, self-distraction, self-blame and behavioral disengagement) were significant predictors of PTSD symptom severity.

“We found that both effective and ineffective coping behaviors influenced the severity of PTSD symptoms but showed no correlation with postcode stress,” McMeekin said. “Coping behaviors could be a link in the progression from acute postcode stress to states of chronic unresolved stress, such as PTSD.”

To access the article and its full-text PDF, visit the AJCC website at

The research adds to the growing body of evidence that confirms the link between healthy work environments and patient safety, clinical outcomes, staff retention and other measures related to the quality of care.

The American Association of Critical-Care Nurses (AACN) offers multiple resources related to healthy work environments, including “AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence” and a no-cost AACN Healthy Work Environment Assessment Tool.

About the American Journal of Critical Care: The American Journal of Critical Care (AJCC), a bimonthly scientific journal published by the American Association of Critical-Care Nurses, provides leading-edge clinical research that focuses on evidence-based-practice applications. Established in 1992, the award-winning journal includes clinical and research studies, case reports, editorials and commentaries. AJCC enjoys a circulation of more than 107,000 acute and critical care nurses and can be accessed at

About the American Association of Critical-Care Nurses: Founded in 1969 and based in Aliso Viejo, California, the American Association of Critical-Care Nurses (AACN) is the largest specialty nursing organization in the world. AACN represents the interests of more than half a million acute and critical care nurses and includes more than 200 chapters in the U.S. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution.;;

Journal Link: American Journal of Critical Care, March-2017