Aim To explore neonatal nurses’ perceptions of the prevalence of post-traumatic stress disorder (PTSD) among mothers and fathers whose infants are admitted to neonatal units (NNUs) in Northern Ireland, and to identify stressors nurses believe contribute to parental trauma. Methods A purposive sample of 61 neonatal nurses attending a regional Neonatal Nurses Association conference in April 2024 completed an anonymous five-question digital survey via QR code. Quantitative responses were summarised descriptively. Open-text responses (n = 121) were analysed using inductive content analysis to identify perceived trauma triggers. Results Response rates ranged from 42/61 (68.9%) to 51/61 (83.6%). All respondents (42/42; 100%) agreed that parents experience trauma during NNU admission. Most nurses estimated maternal PTSD prevalence within the 71–80% range and paternal prevalence within the 61–70% range. Content analysis identified five domains of perceived trauma: Separation and Disconnection from the Baby (42/121; 35%), Clinical Procedures and Interventions (33/121; 27%), Unexpected and Critical Situations (23/121; 19%), Emotional Responses to Neonatal Parenting (14/121; 12%), and Neonatal Environment and Stimuli (9/121; 7%). The majority (45/51; 88%) perceived perinatal mental health provision for neonatal parents in Northern Ireland to be inadequate. Conclusion Neonatal nurses perceive high levels of parental distress and identify separation, invasive procedures, and emergency events as key contributors to trauma. Although findings reflect professional perception rather than measured prevalence, they highlight awareness of parental psychological vulnerability and perceived gaps in mental health support within neonatal services.

STUDY QUESTION:What are experiences of infertility-related traumatic events and are these associated with symptoms of Post-Traumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD)? SUMMARY ANSWER:Infertility-related trauma results from the interplay between a strong unfulfilled desire for children, negative reproductive events and (lack of) associated care, with 9% and 32% of those reporting a traumatic event meeting criteria for PTSD and CPTSD, respectively. WHAT IS KNOWN ALREADY:There is worldwide recognition that fertility treatment is highly stressful, but limited understanding of its potential to trigger traumatic responses like PTSD and CPTSD. PTSD is a mental health disorder characterized by reexperiencing the traumatic event, avoidance of traumatic reminders, and a sense of ongoing threat. CPTSD is diagnosed when trauma also leads to difficulty managing emotions, negative self-concept, and disturbances in relationships. We aimed to document infertility-related traumatic events and how these are associated with symptoms of PTSD and CPTSD. STUDY DESIGN, SIZE, DURATION:Mixed-methods online survey co-produced with and disseminated by the charity Fertility Network UK. Inclusion criteria were being an adult, having suffered from infertility or attended a fertility clinic within the last 5 years, and the ability to read/write English. Eight hundred and sixty-five consented, and 590 (68%, final sample) reported on their most troubling infertility experience. PARTICIPANTS/MATERIALS, SETTING, METHODS:Most participants were highly educated white heterosexual women in a relationship. The average age was 37.54% had children, 65% were trying to have (more) children, and 30% were undergoing treatment. Infertility-related trauma experiences and symptoms were assessed with the International Trauma Questionnaire (ITQ, Cloitre et al, 2018, 2021), a validated questionnaire that asks people to describe the experience that troubles them the most and to rate how much 18 trauma-related symptoms bothered them in the past month (Likert scale, from 1-none at all to 5-extremely). The ITQ is used to identify participants meeting criteria for PTSD, CPTSD, or both. We replaced 'experience' with 'infertility experience'. Participants also reported on other traumatic experiences, on 12 negative reproductive events (e.g. failed cycle, treatment, [recurrent] miscarriage, stillbirth, and experiences of care). MAIN RESULTS AND THE ROLE OF CHANCE:Descriptions of infertility troubling experiences yielded 31 categories, 7 themes and 3 meta-themes. Themes showed that suffering and distress are omnipresent in fertility care due to the stressful nature of fertility treatment journeys (e.g. emotional burden, invasive procedures), reproductive loss (e.g. cycle failures, miscarriages), and lack of control (e.g. over access to treatment and its outcomes). This repeated accumulation of distress was compounded by care perceived as dismissive (e.g. insensitive and unsupportive care) and medical trauma (e.g. complications, errors) and had a functional impact at the individual and social level. Fifty-three (9%) participants met criteria for PTSD, 189 (32%) for CPTSD, with 242 (41%) meeting criteria for PTSD or CPTSD. Three-hundred and twenty-eight (56%) participants reported other traumatic events, the 3 most frequent referring to achievement (45%, health and parenthood goals, for example, adoption disruption, recurrent miscarriage), survival (27%, e.g. accidents, traumatic birth) and autonomy (17%, e.g. rape, domestic abuse). The most reported negative reproductive events were unsuccessful cycle (79%), miscarriage (57%), and unsuccessful treatment (52%). Ninety (16%) participants reported that staff discussed trauma with them, 154 (28%) that staff put in place support, and 334 (61%) that the care received made their distress worse. Logistic regression (χ2 = 78.600, df = 11, P < .001) explained 21.7% of variance in meeting criteria for CPTSD. Participants who met criteria for CPTSD were less likely to have children (OR = 0.461 [0.280, 0.759]), more likely to report a strong child desire (OR = 1.202 [1.036, 1.395]), to have experienced their troublesome infertility experience within the last year (ref category within last year, 1 to 5 years OR = 0.557[0.339, 0.917]), having ended treatment without children (OR = 1.630 [1.051, 2.529], having experienced recurrent miscarriage (OR = 2.2028 [1.109, 3.709]), and reporting that care received made trauma worse (OR = 1.788 [1.124, 2.845]). Background factors (e.g. ethnicity, sexual orientation) were not associated with CPTSD and none of the factors measured were associated with PTSD. LIMITATIONS, REASONS FOR CAUTION:The survey may have attracted people self-identifying as having experienced traumatic events, but the sample is overall representative of the typical fertility care population and at risk-groups (e.g. ethnicity, sexual orientation, asylum seekers) were unrepresented. Participants meeting criteria for PTSD and CPTSD diagnoses were identified using a self-reporting questionnaire, but which is validated, sound and internationally used. WIDER IMPLICATIONS OF THE FINDINGS:Many fertility patients have experienced or will experience traumatic events prior to and/or during treatment, and trauma responses can be compounded by poor care and psychosocial contexts. Traumatic events and symptoms must be recognised in clinical practice to prevent (re)traumatising patients, as many will return for treatment and risk re-exposure. STUDY FUNDING/COMPETING INTEREST(S):None. TRIAL REGISTRATION NUMBER:Not applicable.

Aim The aim of this review is to identify the risk factors for post-traumatic stress disorder (PTSD) in parents of infants admitted to the neonatal intensive care unit (NICU). Design A This study is a systematic review of articles examining PTSD risk factors in parents of NICU-admitted infants. PTSD diagnoses were made using the DSM-IV, DSM-5, ICD-11, or DSM-IV-TR A1 criteria. This review does not address PTSD risk factors in the general population, other family members, or NICU patients. Regardless of the child's gestational age or gender, the focus is exclusively on NICU parents or primary caregivers. All other family members are excluded from the review. Methods A comprehensive literature review was conducted using multiple search algorithms to identify all relevant studies. The databases PTSDpubs, CINAHL, PsycINFO, and Web of Science were systematically searched. The study selection process was documented using the PRISMA flow diagram. Each study was independently assessed using the Critical Appraisal Skills Programme (CASP) framework. The selected articles were critically evaluated, and data were extracted and synthesised for analysis. Results A total of 286 previously published papers met the inclusion and exclusion criteria. Of these, eight studies were included in the systematic evaluation of PTSD risk factors among parents of NICU-admitted infants. Five key risk factors were identified: (1) Being female, (2) Having, or perceiving to have, a sick newborn, (3) Parents with previous obstetric problems, (4) Having mental health-related problems/diagnosis, and (5), Lack of psychological Support in the NICU. Discussion The synthesis of the selected studies reveals a multifaceted risk landscape. Being female was the most commonly reported risk factor, consistent with broader research indicating that women are generally at higher risk of developing PTSD. The presence of a sick newborn significantly heightened parental risk, likely due to the acute stress associated with managing a child's severe health challenges. A history of obstetric complications also emerged as a significant predictor, with past traumas compounding the emotional burden of the NICU experience. Pre-existing mental health conditions further increased susceptibility to PTSD, underscoring the importance of addressing underlying psychological vulnerabilities. Crucially, the lack of psychological support in NICU settings was identified as a systemic deficiency, exacerbating parental stress. This finding highlights gaps in family-centred and family-integrated care strategies, which fail to sufficiently address parents' psychological needs during critical periods of their child's hospitalisation. Conclusion This review underscores the complex interplay of factors contributing to PTSD in NICU parents and offers important clinical insights for developing targeted interventions. Healthcare systems must prioritise comprehensive psychosocial support for all NICU parents, not solely primary caregivers, to alleviate the immense stress that can lead to PTSD. The findings advocate for policy changes and the integration of robust psychological support structures within NICUs to bolster parental resilience during and after their infants’ hospitalisation.

Integrating parental input into neonatal research development is crucial for producing ethically sound, practically applicable, studies with real-world context based on lived experiences. Parents, as primary caregivers, offer invaluable insights into the daily realities and emotional aspects of neonatal care that healthcare professionals may overlook. Their lived experiences can highlight subtle, yet significant, impacts of medical conditions and treatments on their children, thereby enriching the research with a deeper understanding of infant's needs. Parental involvement ensures that research questions and outcomes are aligned with family priorities, enhancing the relevance and applicability of the studies. Moreover, the ethical design of studies benefits greatly from parental input, as it grounds the research in the lived experiences of those most affected, fostering greater empathy and sensitivity. This approach also helps build trust between researchers and the study participants, which is essential for improving recruitment and retention rates. The Neo-SILT study demonstrated this by significantly revising its Post Traumatic Stress Disorder (PTSD) measurement timelines, shaping the research question, adjusting the methodology and highlighting potential barriers and facilitators to participation based on parental feedback, ensuring a more accurate depiction of symptom onset and trajectory. Additionally, the co-design of recruitment materials and parent information leaflets resulted in resources that were not only informative but also emotionally mindful and visually appealing, further facilitating parental engagement. Reflective practice has provided the nurse researcher with the framework to share the value and importance of integrating parental perspectives into neonatal research that can address potential oversights and biases, ensuring that studies are scientifically rigorous, ethically sound, and practically relevant.

Minimal research has explored the personal experience of burnout in doctors from any medical speciality. Consequently, we aimed to provide a relatable description and understanding of this globally recognised problem. We employed an interpretative phenomenological analysis (IPA) of face-to-face interviews with seven general practitioners (GPs) in Northern Ireland, having selected interviewees best able to speak about burnout. We sought to understand how these GPs understood their burnout experiences. Our participants’ continuous work involved more than their busy weekdays and also working on supposedly off evenings and weekends. In addition, draining intrusive thoughts of work filled most, if not all, of their other waking moments. There was no respite. Work was ‘always there.’ Being constantly busy, they had no time to think or attend to patients as doctors. Instead, participants were going through the motions like GP automatons. Their effectiveness, efficiency, and caring were failing, while their interactions with patients had changed as they tried to conserve their now-drained energy and empathy. There was no time left for their families or themselves. They now “existed” to continuously work rather than “living” their previous, more balanced lives that at one time included enjoying being a doctor. Worryingly, participants were struggling, isolated, and vulnerable, yet unwilling to speak to someone they trusted. We intend our burnout narrative to promote discussion between medical colleagues and assist in its recognition by GPs and other doctors. Our findings warn against working excessively, prioritising work ahead of family and oneself, and self-isolation rather than seeking necessary support.

Abstract Background Playing Tetris is a relatively new concept when considering how to treat or prevent post-traumatic stress symptoms (PTSS). Benefits have been identified regarding how playing the game can influence traumatic memory processing and storage. However, the concept is under-explored and can potentially help populations who are at risk of and are known to experience post-traumatic stress, such as parents of preterm infants in the Neonatal Unit. The aim of the review was to establish if preterm parents playing Tetris was a feasible option to potentially minimise PTSS. Method A scoping review was conducted using PRISMA-ScR guidance. Databases searched were Cinahl, Medline and PsychInfo, over a 20 year period (2003-2023). Titles and abstracts were screened before analysis of full-text articles. A variety of clinical and experimental studies were examined, with differing trauma exposure experienced by participants. Results Thirteen articles were reviewed and four common themes identified. These were memory consolidation, playing Tetris and its effect on intrusive memories (IMs), the effect on the brain and the acceptability as a technique to minimize PTSS in clinical trials. Conclusion Tetris, in theory, is a first-aid intervention and has the potential to minimise the impact of trauma. Based on the findings of the review, Tetris has been effective in other clinical areas and deemed acceptable by participants. Therefore, Tetris is worthy of consideration for use in the population of preterm parents.

Objective Frontline mental health, emergency, law enforcement, and social workers have faced unprecedented psychological distress in responding to the COVID-19 pandemic. The purpose of the RCT (Randomized Controls Trial) study was to investigate the effectiveness of a Group EMDR (Eye Movement Desensitization and Reprocessing) therapy (Group Traumatic Episode Protocol—GTEP) in the treatment of Post-Traumatic Stress Disorder (PTSD) and Moral Injury. The treatment focus is an early intervention, group trauma treatment, delivered remotely as video-conference psychotherapy (VCP). This early intervention used an intensive treatment delivery of 4x2h sessions over 1-week. Additionally, the group EMDR intervention utilized therapist rotation in treatment delivery. Methods The study’s design comprised a delayed (1-month) treatment intervention (control) versus an active group. Measurements included the International Trauma Questionnaire (ITQ), Generalized Anxiety Disorder Assessment (GAD-7), Patient Health Questionnaire (PHQ-9), Moral Injury Events Scale (MIES), and a Quality-of-Life psychometric (EQ-5D), tested at T0, T1: pre—treatment, T2: post-treatment, T3: 1-month follow-up (FU), T4: 3-month FU, and T5: 6-month FU. The Adverse Childhood Experiences – International version (ACEs), Benevolent Childhood Experience (BCEs) was ascertained at pre-treatment only. N = 85 completed the study. Results Results highlight a significant treatment effect within both active and control groups. Post Hoc comparisons of the ITQ demonstrated a significant difference between T1 pre (mean 36.8, SD 14.8) and T2 post (21.2, 15.1) (t11.58) = 15.68, p < 0.001). Further changes were also seen related to co-morbid factors. Post Hoc comparisons of the GAD-7 demonstrated significant difference between T1 pre (11.2, 4.91) and T2 post (6.49, 4.73) ( t = 6.22) = 4.41, p < 0.001; with significant difference also with the PHQ-9 between T1 pre (11.7, 5.68) and T2 post (6.64, 5.79) ( t = 6.30) = 3.95, p < 0.001, d = 0.71. The treatment effect occurred irrespective of either ACEs/BCEs during childhood. However, regarding Moral Injury, the MIES demonstrated no treatment effect between T1 pre and T5 6-month FU. The study’s findings discuss the impact of Group EMDR therapy delivered remotely as video-conference psychotherapy (VCP) and the benefits of including a therapist/rotation model as a means of treatment delivery. However, despite promising results suggesting a large treatment effect in the treatment of trauma and adverse memories, including co-morbid symptoms, research results yielded no treatment effect in frontline/emergency workers in addressing moral injury related to the COVID-19 pandemic. Conclusion The NICE (2018) guidance on PTSD highlighted the paucity of EMDR therapy research used as an early intervention. The primary rationale for this study was to address this critical issue. In summary, treatment results for group EMDR, delivered virtually, intensively, using therapist rotation are tentatively promising, however, the moral dimensions of trauma need consideration for future research, intervention development, and potential for further scalability. The data contributes to the emerging literature on early trauma interventions. Clinical Trial Registration: Clinicaltrials.gov , ISRCTN16933691.

Backgound Nurses working in care homes face significant challenges that are unique to that context. The importance of effective resilience building interventions as a strategy to enable recovery and growth in these times of uncertainty have been advocated. The aim of this rapid review was to inform the development of a resource to support the resilience of care home nurses. We explored existing empirical evidence as to the efficacy of resilience building interventions. undertaken with nurses. Methods We undertook a rapid review using quantitative studies published in peer reviewed journals that reported resilience scores using a valid and reliable scale before and after an intervention aimed at supporting nurse resilience. The databases; Cumulative Index to Nursing and Allied Health Literature, Medline and PsychInfo. and the Cochrane Library were searched. The searches were restricted to studies published between January 2011 and October 2021 in the English language. Only studies that reported using a validated tool to measure resilience before and after the interventions were included. Results Fifteen studies were included in this rapid review with over half of the studies taking place in the USA. No studies reported on an intervention to support resilience with care home nurses. The interventions focused primarily on hospital-based nurses in general and specialist contexts. The interventions varied in duration content and mode of delivery, with interventions incorporating mindfulness techniques, cognitive reframing and holistic approaches to building and sustaining resilience. Thirteen of the fifteen studies selected demonstrated an increase in resilience scores as measured by validated and reliable scales. Those studies incorporating ‘on the job,’ easily accessible practices that promote self-awareness and increase sense of control reported significant differences in pre and post intervention resilience scores. Conclusion Nurses continue to face significant challenges, their capacity to face these challenges can be nurtured through interventions focused on strengthening individual resources. The content, duration, and mode of delivery of interventions to support resilience should be tailored through co-design processes to ensure they are both meaningful and responsive to differing contexts and populations.

Resilience is considered a core capability for nurses in managing workplace challenges and adversity. The COVID-19 pandemic has brought care homes into the public consciousness; yet, little is known about the resilience of care home nurses and the attributes required to positively adapt in a job where pressure lies with individuals to affect whole systems. To address this gap, an online survey was undertaken to explore the levels of resilience and potential influencing factors in a sample of care home nurses in Northern Ireland between January and April 2022. The survey included the Connor–Davidson Resilience Scale, demographic questions and items relating to nursing practice and care home characteristics. Mean differences and key predictors of higher resilience were explored through statistical analysis. A moderate level of resilience was reported among the participants (n = 56). The key predictors of increased resilience were older age and higher levels of education. The pandemic has exposed systemic weakness but also the strengths and untapped potential of the care home sector. By linking the individual, family, community and organisation, care home nurses may have developed unique attributes, which could be explored and nurtured. With tailored support, which capitalises on assets, they can influence a much needed culture change, which ensures the contribution of this sector to society is recognised and valued.

Abstract BACKGOUND The COVID 19 pandemic has exposed and further exacerbated systemic weaknesses in the health and social care system, placing an inordinate pressure on nurses. The importance of effective resilience building interventions as a strategy to enable recovery and growth in these times of uncertainty have been advocated. The aim of this rapid review was to inform the development of a resource to support the resilience of care home nurses by extracting empirical evidence as to the efficacy of resilience building interventions undertaken with nurses METHODS We undertook a rapid review using quantitative studies published in peer reviewed journals that reported resilience scores using a valid and reliable scale before and after an intervention aimed at supporting nurse resilience. The databases; Cumulative Index to Nursing and Allied Health Literature, Medline and PsychInfo. and the Cochrane Library were searched. The searches were restricted to studies published between January 2011 and October 2021 in the English language. Only studies that that reported using a validated tool to measure resilience before and after the interventions were included. RESULTS Fifteen studies were included in this rapid review with over half of the studies taking place in the USA. No studies reported on an intervention to support resilience with care home nurses. The interventions focused primarily on hospital-based nurses in general and specialist contexts. The interventions varied in duration content and mode of delivery, with interventions incorporating mindfulness techniques, cognitive reframing and holistic approaches to building and sustaining resilience. Thirteen of the fifteen studies selected demonstrated an increase in resilience scores as measured by validated and reliable scales. Those studies incorporating ‘on the job,’ easily accessible practices that promote self-awareness and increase sense of control reported significant differences in pre and post intervention resilience scores. CONCLUSION Nurses continue to face significant challenges, their capacity to face these challenges can be nurtured through interventions focused on strengthening individual resources. The content, duration, and mode of delivery of interventions to support resilience should be tailored to specific populations and responsive to their unique contexts.

BACKGROUND:Several studies have been undertaken regarding civilian and military nurses' training, deployment, and experiences during missions in war and conflict areas. However, no review study regarding the experiences of nurses in serving in war and conflict areas has been published. AIM:This review aims to identify the views, experiences, and support needs of Registered Nurses when caring for patients in war and conflict areas. METHOD:Four electronic databases-MEDLINE, CINAHL, PsycINFO, and general BC PubMed-were searched in this systematic review. Study screening and selection, data extraction, quality appraisal, and narrative synthesis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist. RESULTS:Twenty-five studies were included in the final review. The findings were categorised based on four main themes: Challenges in nursing practice, Meaning of experience, Scope of practice, and Nursing support pre- and post-conflict. CONCLUSIONS:Registered Nurses play a critical role in prehospital care and have a significant impact on the survival of wounded military personnel and civilians and on their mortality. Registered Nurses play important roles in military deployment, with barriers to their successful implementation experienced due to a lack of information at the decision-making level, and the need for psychological supports and role-appropriate medical readiness training. IMPLICATIONS:Registered Nurses who are military-ready need to be effective in war and conflict areas. Using the experiences of military or civilian Registered Nurses to assess the pre-deployment preparation needs of these nurses will be beneficial to the effectiveness of the nursing workforce. There are elements that demand more attention during the pre-deployment preparation phase of nurses required to serve in war and conflict areas.

EMDR therapy is recommended in several guidelines in the International field of psychological trauma. The dual attention stimuli/alternating bilateral stimulation (DAS/ABS) element of EMDR therapy has no proposed mechanism of action agreed upon, which explains the rapid shifts in cognitions and dysfunctional traumatic memory networks that are central to its observable efficacy. This paper discusses an innate, biological mechanism found in biological systems, including the human nervous system that may explain the efficacy of DAS/ABS. This mechanism is stochastic resonance (SR). SR is observed to make unintelligible, subthreshold signals intelligible and facilitates signal transmission. It provides a potential mechanism for discrimination and the selective focusing of attention, which are important factors in effective psychotherapy for the psychologically traumatised individual. The body/mind complex aims to achieve the functional encoding of memories in the neocortex and a key structural crossroads in this process is the thalamus. Activity in the thalamus is decreased in Post-Traumatic Stress Disorder (PTSD) compared to non-PTSD patients and a form of ‘gating’ is known to occur at the thalamic level. This ‘gating’ is adaptive and it is postulated to protect the higher neocortical systems in times of trauma. Although the model is initially somewhat counterintuitive, Stochastic Resonance; a form of random ‘noise’, can be considered ‘helpful randomness’ and when present in the thalamus SR can help filter and control sensitivity to incoming signals; helping to discriminate what is communicated. Naturally occurring SR is normally present as a result of descending cortico-thalamic activity, but appears attenuated as a result of exposure to trauma. The view of ‘noise’ in the current era of cell phones and High Definition is generally negative with science going to significant lengths to clean up signals: i.e. removing noise from them. We do not want white noise in our music or during our cell phone calls. However, some researchers invite us to consider that not all noise is bad and the downward cortico-thalamic ‘noise’ is an example of this category of ‘helpful noise’. This paper will discuss the potential role of SR, as the mechanism by which DAS/ABS generates a random (stochastic) signal, facilitating a return to functional memory processing, where there is a lack of naturally occurring noise from the descending cortico-thalamic connections because of exposure to trauma. Modelling the mechanism as SR will facilitate further study into EMDR therapy and this will hopefully encourage perspicacity, where there has previously been derision.

This chapter contains sections titled: Introduction A guiding paradigm The National Service Framework The principles of community mental health nursing Conclusion References