Experiences and influencing factors of secondary traumatic stress in neonatal intensive care unit nurses: A mixed-methods study

Abstract

Background: Nurses in neonatal intensive care units witness the suffering of critically ill infants and the emotional distress of their families, which can lead to psychological strain. Objective: This study examined individual and organizational factors contributing to secondary traumatic stress among neonatal intensive care unit and explored their experiences of this stress. Methods: A convergent mixed-methods design was employed. A total of 147 nurses from Level III neonatal intensive care units across South Korea participated, and in-depth interviews were conducted with 13 nurses. Results: Many nurses reported moderate to severe psychological stress related to repeated exposure to traumatic events. The emotional impact was influenced by both individual sensitivity and the organizational context of care. Conclusion: Emotional challenges in neonatal intensive care units constitute both a psychological burden and an ethical complexity of nursing. Institutional support is essential to address these challenges, fostering nurses' emotional well-being and professional sustainability. Implication to practice: Future strategies to reduce secondary traumatic stress should integrate individual-level coping and emotional regulation strategies. In addition, organizational approaches should address unit-specific traumatic events and promote trauma-informed work environments in neonatal intensive care units. (c) 2026 Published by Elsevier Inc.