The mental health of emergency nurses exposed to unexpected death: an integrative review
Abstract
Background Emergency nurses face high-intensity situations that heighten their risk of mental health concerns, including compassion fatigue and post-traumatic stress symptoms. They report significantly higher levels of depression, anxiety, and secondary stress syndrome than other health care workers, which can negatively affect their well-being and patient care, leading to increased burnout and medical errors. This integrative review aimed to examine the mental health concerns of emergency nurses who care for patients who die unexpectedly.Methods This integrative review followed Whittemore and Knafl's 5-step framework. A narrative synthesis was then completed, and data were analyzed using the Mixed Methods Appraisal Tool to mitigate biases. Four databases were systematically searched with specified search terms and without date restrictions.Results Fifteen studies were included, focusing on clinical events such as traumas, gunshot wounds, and motor vehicle accidents. The themes identified throughout the studies included coping mechanisms, end-of-life care education, and peer and managerial support. Symptoms reported by nurses included avoidance, substance abuse, and sleep disturbances.Conclusion Emergency nurses are vulnerable to the psychological impact of unexpected or traumatic deaths, increasing their risk of mental health concerns that affect their own health and patient outcomes. There is a need for intervention studies to address these issues and improve outcomes for nurses facing unexpected death.
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Nurses have been reported as experiencing poor psychological outcomes; grief and guilt from exposure to death may be detrimental to their mental health.
“Nurses have been reported as experiencing poor psychological outcomes; facing death can be challenging, and the grief and guilt of exposure to death may be detrimental to their mental health (DesJardin, 2025; Roche et al., 2025).”
From Nurses' and midwives' experiences of supporting parents following perinatal bereavement: A qualitative systematic review (2026) · cites this paper as DesJardin, 2025
Cites
The integrative review: updated methodology
Whittemore, R., & Knafl, K. (2005) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2005.03621.x · Cited by 10,241 · see citing works
The impact of traumatic events on emergency room nurses: Findings from a questionnaire survey
Adriaenssens, J., Gucht, V. D., & Stan Maes, A. (2012) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2012.07.003 · Cited by 238 · see citing works
Stress in emergency departments: experiences of nurses and doctors
Healy, S., & Tyrrell, M. (2011) · Emergency Nurse · doi:10.7748/en2011.07.19.4.31.c8611 · Cited by 156 · see citing works
Secondary traumatic stress in the emergency department
Morrison, L., & Joy, J. P. (2016) · Journal of Advanced Nursing · doi:10.1111/jan.13030 · Cited by 125 · see citing works
Loss, stress, and mental health
Caplan, G. (1990) · Community Mental Health Journal · doi:10.1007/bf00752675 · Cited by 122 · see citing works
End-of-Life Nursing Education Consortium (ELNEC) Training Program
FERRELL, B. R., Dahlin, C. M., Campbell, M., et al. (2007) · Critical Care Nursing Quarterly · doi:10.1097/01.cnq.0000278920.37068.e9 · Cited by 83 · see citing works
Peters, L., Cant, R., Payne, S., O’Connor, M., McDermott, F., Hood, K., Morphet, J., & Shimoinaba, K. (2013) · Australasian Emergency Nursing Journal · doi:10.1016/j.aenj.2013.08.001 · Cited by 78 · see citing works
Xie, W., Liu, M., Okoli, C. T. C., Zeng, L., Huang, S., Ye, X., Liu, F., & Wang, J. (2023) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2023.104613 · Cited by 68 · see citing works
Stressors and coping strategies of emergency department nurses and doctors: A cross-sectional study
Xu, H. G., Johnston, A. N. B., Greenslade, J. H., Wallis, M. C., Elder, E. G., Abraham, L., Thom, O., Carlström, E., & Crilly, J. L. (2019) · Australasian Emergency Care · doi:10.1016/j.auec.2018.10.005 · Cited by 65 · see citing works
Awareness of secondary traumatic stress in emergency nursing
Barleycorn, D. (2019) · Emergency Nurse · doi:10.7748/en.2019.e1957 · Cited by 45 · see citing works
Zhang, H., Hu, M., Zeng, L., et al. (2019) · Nurse Education Today · doi:10.1016/j.nedt.2019.104264 · Cited by 28 · see citing works
Factors Affecting Posttraumatic Stress Disorder in South Korean Trauma Nurses
Kim, S. J., & Yeo, J. H. (2019) · Journal of Trauma Nursing · doi:10.1097/jtn.0000000000000482 · Cited by 26 · see citing works
The psychological impact of motor vehicle accidents on emergency service workers
Maia, Â., & Ribeiro, E. (2010) · European Journal of Emergency Medicine · doi:10.1097/mej.0b013e3283356213 · Cited by 20 · see citing works
Houghtaling, D. L. H. (2012) · Journal of Trauma Nursing · doi:10.1097/jtn.0b013e318261d2dc · Cited by 17 · see citing works
Woo, M., & Kim, D.-H. (2020) · Journal of Emergency Nursing · doi:10.1016/j.jen.2020.08.006 · Cited by 17 · see citing works
Benefits of Using The Pause after Death in Emergency Departments: A Delphi Study
Cunningham, T., & Ducar, D. (2019) · Southern Medical Journal · doi:10.14423/smj.0000000000001012 · Cited by 15 · see citing works
Shimoinaba, K., McKenna, L., & Copnell, B. (2021) · International Emergency Nursing · doi:10.1016/j.ienj.2021.101102 · Cited by 15 · see citing works
Quantifying Compassion Fatigue in Ancillary and Clinical Staff in an Adult Emergency Department
Bales, M., DeAlmeida, K., Oei, C. E., Hampton, D., & Bohr, N. L. (2022) · Western Journal of Emergency Medicine · doi:10.5811/westjem.2022.8.57733 · Cited by 15 · see citing works
Abu-Alhaija, D. M., & Gillespie, G. L. (2022) · Journal of Emergency Nursing · doi:10.1016/j.jen.2022.05.001 · Cited by 14 · see citing works
“Was Definitely Different Because They Were Kids”: Caring for Patients From a School Shooting
McCall, W. T., Anderson, J. G., Myers, C. R., Sagherian, K., & Bamwine, P. (2022) · Journal of Trauma Nursing · doi:10.1097/jtn.0000000000000673 · Cited by 9 · see citing works
Providing end of life care in the emergency department: A hermeneutic phenomenological study
Burnitt, E., Grealish, L. A., Crilly, J. L., May, K., & Ranse, J. (2024) · Australasian Emergency Care · doi:10.1016/j.auec.2024.01.002 · Cited by 9 · see citing works
Influencing factors of nurses’ short-term bereavement reactions after patient death
Chen, C., & Chow, A. Y. M. (2023) · Death Studies · doi:10.1080/07481187.2023.2230552 · Cited by 7 · see citing works
García, D. V., Escuín, M. D. L. R., Bes, C. G., & Caballero-Navarro, A.-L. (2023) · Enfermería Clínica · doi:10.1016/j.enfcli.2023.03.002 · Cited by 5 · see citing works
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Gao, H., Iwunze, C. J., An, X., Zhou, T., & Curtin, M. (2026) · International Journal of Nursing Studies Advances · doi:10.1016/j.ijnsa.2026.100538 · Cited by 2 · see citing works
“Nurses have been reported as experiencing poor psychological outcomes; facing death can be challenging, and the grief and guilt of exposure to death may be detrimental to their mental health (DesJardin, 2025; Roche et al., 2025).”
- Authors
- DesJardin, A.
- Corresponding author
- DesJardin, Austin
- Venue
- Journal of Emergency Nursing
- Publisher
- Elsevier BV
- Published
- 2025-11
- Volume
- 51
- Issue
- 6
- Pages
- 1054-1069
- ISSN
- 0099-1767 (ISSN-L)
- OpenAlex
- W4414163572
- Cited by
- 2
- References
- 23
- Citations by year
- 2026: 2
- FWCI
- 3.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Emergency Nursing (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Saint Louis University
- Topics
- Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Burnout
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Keywords
- emergency department nurses, mental health, unexpected death, compassion fatigue, posttraumatic stress symptoms, secondary traumatic stress, burnout, coping strategies, end-of-life education, substance abuse, sleep disorders, trauma care
- MeSH terms
- Compassion Fatigue, Adaptation, Psychological, Burnout, Professional, Death, Sudden, Humans, Mental Health, Nursing Staff, Hospital, Emergency Nursing
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