1. Taylor, Elizabeth Johnston

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COVID-19 continues to cause trauma for patients and nurses. Although trauma contributes to difficult outcomes, it can also produce positive personal benefits that reflect an inner transformation-or posttraumatic growth (PTG; Tedeschi & Calhoun, 2008). Because PTG is a response to having one's assumptions about life shattered, PTG involves growth from reconstructing a worldview that is more mature than prior to the trauma. Perhaps PTG is what Paul recognized in Hebrews 12, NIV: "Enduring hardship" (verse 7) allows us to "share in his [God's] holiness" (verse 10).

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What does PTG look like? It manifests in 1) increased appreciation for life; 2) changed priorities; 3) improved relationships with others; 4) increased sense of inner strength; 5) recognition of new possibilities for one's life; and 6) spiritual development (Tedeschi & Calhoun, 2008). Statements that reflect these outcomes include, "I want to now focus on the things that are most important to me-my faith, truest friends, and family" or "I'm amazed that I was able to endure those surges; I'm stronger than I thought!"


Posttraumatic growth occurs for some nurses providing COVID-related care. A study of nearly 12,600 Asian nurses during the early months of COVID found that 39% reported PTG (Chen et al., 2021). Foli et al.'s (2021) findings indicated that PTG among nurses can occur concurrently with the distress of COVID caring.


How one cognitively processes the trauma determines whether distress endures or PTG results (Tedeschi & Calhoun, 2008). Studies examining PTG validate certain coping strategies as effective (Shaw et al., 2005); these approaches include reframing the trauma to include positive meanings, using positive religious coping, and reinforcing the outcomes of PTG. Pointers about implementing these coping strategies are offered for traumatized nurses and the patients they support:


* Reframe the trauma. People naturally have intrusive thoughts after a trauma; these thoughts are a way of processing the distress (Tedeschi & Calhoun, 2008). Although rumination (especially wishing one had responded differently to a trauma) can become mental fibrillation and harmful, rumination can also be harnessed for good. When rumination begins, acknowledge the trauma to be a challenge or teacher. Shape it with questions like, How can I learn from this? How can this help me to be a stronger person? How does this make me more alive or spiritually attuned?


* Practice positive religious coping. Some types of negative religious coping (thinking that the trauma is punishment or that God or a faith community have abandoned you) are inversely related to PTG; other types ascribing the trauma to the devil, asking for a miracle, waiting for God to take control, and reevaluating God's power are weakly correlated with PTG. All types of positive religious coping, however, are associated with PTG (Shaw et al., 2005). Thus, foster perspectives that allow forgiveness, acceptance of oneself as beloved, and collaboration with God. Remain open toward the difficult theological questions. Helpful questions to ask in response to trauma may be, Are my religious beliefs healing? and How is God inviting me to greater understanding?


* Reinforce the PTG. By noticing the manifestations of PTG (listed above) and feeling gratitude for them, one can reinforce growth. This contributes to its sustainability and likely increases emotional well-being.



COVID-19 has caused us to continue to "groan inwardly as we wait eagerly for . . .the redemption of our bodies" (Romans 8:23, NIV). Processing our trauma in ways that nudge us toward PTG, however, may help us to "wait for it patiently" (Romans 8: 25, NIV).


Chen R., Sun C., Chen J. J., Jen H. J., Kang X. L., Kao C. C., Chou K. R. (2021). A large-scale survey on trauma, burnout, and posttraumatic growth among nurses during the COVID-19 pandemic. International Journal of Mental Health Nursing, 30(1), 102-116.[Context Link]


Foli K. J., Forster A., Cheng C., Zhang L., Chiu Y. C. (2021). Voices from the COVID-19 frontline: Nurses' trauma and coping. Journal of Advanced Nursing, 77(9), 3853-3866.[Context Link]


Shaw A., Joseph S., Linley P. A. (2005). Religion, spirituality, and posttraumatic growth: A systematic review. Mental Health, Religion & Culture, 8(1), 1-11.[Context Link]


Tedeschi R. G., Calhoun L. G. (2008). Beyond the concept of recovery: Growth and the experience of loss. Death Studies, 32(1), 27-39.[Context Link]