The current situation and influencing factors of vicarious traumatization among trauma nurses: A latent profile analysis

The current situation and influencing factors of vicarious traumatization among trauma nurses: A latent profile analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The current situation and influencing factors of vicarious traumatization among trauma nurses: A latent profile analysis Mei Feng, Zijing Huang, Yufen Zhang, La Xie, Xiangping Liu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7253913/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Aim Trauma nurses are susceptible to vicarious traumatization, which may substantially undermine their physical and mental well-being, as well as their capacity to provide high-quality care. This study employed latent profile analysis to examine the latent profiles of vicarious traumatization among trauma nurses and to identify the factors influencing these profiles. Methods The study employed a cross-sectional design. A convenience sampling method was used to select 930 trauma nurses from 22 provincial administrative regions in China, with data collection occurring from August 2024 to February 2025. Data were gathered using a general information questionnaire, the Vicarious Traumatization Questionnaire, the Utrecht Work Engagement Scale, the Stressor Scale for Emergency Nurses, and the Trait Coping Style Questionnaire. Latent profile analysis was applied to assess the characteristics of vicarious traumatization among trauma nurses, and the factors influencing these latent profiles were determined through univariate analysis and multinomial logistic regression. Data analysis was conducted using Mplus version 8.3 and SPSS version 26.0. Results The study included a total of 930 trauma nurses, achieving an effective questionnaire response rate of 96.37%. The vicarious traumatization score among these nurses was 70.50 (interquartile range: 57.00, 80.25). Vicarious traumatization was categorized into three latent groups: low vicarious traumatization group (35.38%), medium vicarious traumatization group (52.37%), and high vicarious traumatization group (12.25%). Disordered multi-class logistic regression analysis identified several influencing factors for the latent profiles of vicarious traumatization, including female gender, stressors, work engagement, positive coping style, and negative coping style (all p < 0.05). Conclusions The study identified substantial heterogeneity in the vicarious traumatization experienced by trauma nurses. Nursing managers are encouraged to use the identified profiles and influencing factors of vicarious traumatization to prioritize support for trauma nurses who are female, experience high levels of stressors, demonstrate low work engagement, utilize negative coping strategies, and lack psychological trauma training. It is recommended that hospital administrators implement targeted intervention strategies to mitigate the levels of vicarious traumatization among nursing staff. This study's findings illuminated the potential characteristics and influencing factors of vicarious traumatization among trauma nurses, providing a new perspective for the formulation of customized intervention strategies. Vicarious traumatization Nurse༛Latent profile analysis Stressor Work engagement Coping style Figures Figure 1 Background Trauma care, a critical component of emergency medicine, faces significant challenges due to the escalating incidence of trauma on a global scale. The World Health Organization (WHO) [ 1 ] identifies trauma as the leading cause of mortality among individuals under the age of 45 worldwide, with traffic accidents, violence, and natural disasters being the primary contributors. Within this context, the trauma nurse, as a certified clinical nurse specialist, plays a pivotal role in emergency response, multidisciplinary coordination, clinical decision-making, and providing psychosocial support. These professionals are integral to the management of trauma patients during the "golden hour," a crucial period for lifesaving interventions. This management encompasses rapid primary assessment, prioritized therapeutic interventions, and essential psychosocial care [ 2 ]. Trauma patients frequently experience panic due to abrupt and unforeseen traumatic events, necessitating that trauma nurses promptly identify and address the psychological issues and needs of these patients [ 3 ]. To deliver optimal care, trauma nurses must not only administer timely, precise, and swift nursing interventions but also engage empathetically with both patients and their families who have encountered diverse traumatic experiences [ 4 ]. When trauma nurses engage with individuals who have undergone or are undergoing traumatic experiences, they are at an elevated risk of experiencing vicarious traumatization. Research indicates that emergency nurses may develop somatic symptoms, including anxiety and depression, as a consequence of prolonged exposure to patients with traumatic histories. Notably, 8.5% of these nurses exhibit clinical levels of Posttraumatic Stress Disorder (PTSD) [ 5 ]. Vicarious traumatization is a psychological process wherein the intrinsic experiences of professional helpers are adversely altered due to their empathic engagement with the traumatic experiences of those they assist [ 6 ]. This concept is grounded in the constructivist self-development theory and elucidates the stress and trauma experienced by helpers across five dimensions: frame of reference, self-capacities, ego resources, psychological needs and cognitive schemas, and memory and perception. Within the nursing profession, vicarious traumatization has not been extensively explored. It pertains to a psychological trauma that impacts a nurse's cognitive schemas and can occur in clinical settings or via social media. This trauma arises from profound empathy for the physical or emotional suffering of patients, family members, or colleagues, such as a patient's physical injury or death [ 7 ]. Vicarious traumatization exerts a comprehensive impact on nurses, manifesting not only in a spectrum of physical and psychological issues but also indirectly contributing to extensive, cumulative, and enduring adverse effects on their cognitive schemas [ 8 ]. Consequently, this phenomenon diminishes the quality of care and patient satisfaction, elevates the incidence of medical and nursing errors, adversely affects clinical care outcomes, and contributes to nurse turnover [ 9 ]. Research on the vicarious traumatization of healthcare professionals commenced in the 1990s. Over the years, significant theoretical and empirical advancements have been achieved in this field [ 10 ]. Existing studies have indicated that the level of vicarious traumatization among nurses in Australia, the United States, and China ranges from moderate to high, particularly among emergency nurses, intensive care unit (ICU) nurses, oncology nurses, hospice nurses, and nurses involved in public health incident response [ 11 ]. Currently, there is a notable paucity of research focusing on trauma nurses. These nurses frequently engage closely with patients who have undergone traumatic events, and sustained empathy for such experiences may result in enduring cognitive alterations in their personal experiences and worldviews [ 9 ]. A study conducted by Zheng et al. [ 12 ] demonstrated that nurses who had encountered the death of a patient exhibited higher overall vicarious traumatization scores compared to those who had not. Trauma nurses, who are consistently exposed to the adverse emotions of patients undergoing trauma, are susceptible to excessive empathy, leading to empathy fatigue and subsequently developing into occupational hazards such as vicarious traumatization. This occupational hazard adversely impacts nurses' ability to deliver high-quality care to patients [ 13 ]. Given the unique nature of trauma nurses' responsibilities, it is imperative to assess their levels of vicarious traumatization, as this is directly related to both the mental health of the nurses and the quality of care provided to patients. Vicarious traumatization is an inherent aspect of nursing practice when engaging with patients and represents an unavoidable occupational hazard for nurses [ 14 ]. This phenomenon is influenced by a multitude of factors, including sociodemographic and work-related variables, among others [ 11 ]. The impact of sociodemographic factors on the extent of vicarious traumatization is associated with health policies, cultural influences, and educational backgrounds across different countries and regions [ 4 , 15 ]. Consequently, sociodemographic factors were identified through the analysis of region- and country-specific data. Within the framework of positive psychology, work engagement is defined as a persistent, fulfilling, and positive emotional and cognitive state, characterized by the degree of vitality, dedication, and concentration an individual exhibits in their professional activities [ 16 ]. The literature has documented a negative correlation between work engagement and compassion fatigue among hemodialysis nurses [ 17 ]. In contrast, the relationship between work engagement and compassion fatigue among emergency nurses is contingent upon their proactive commitment to their roles. Nurses who demonstrate proactive engagement in their work tend to derive a sense of fulfillment and are consequently less susceptible to compassion fatigue [ 18 ]. While existing research has established a link between work engagement and compassion fatigue, the connection between work engagement and vicarious traumatization remains underexplored. Trauma nurses have been consistently exposed to high levels of stress and secondary traumatic stress in the context of trauma care [ 19 , 20 ]. Stressors are defined as any factors or events that threaten an individual's health or impair their normal functioning [ 21 ]. A study conducted by Yuwanich et al. [ 21 ] demonstrated that elevated levels of stressors can result in both physical and mental health issues, including fatigue and burnout. For trauma nurses, these stressors often involve complex events influenced by multiple factors, which can lead to vicarious traumatization. Hao et al. [ 22 ] highlighted that coping styles significantly impact the mental stress experienced by high-level emergency nurses. According to Wang [ 23 ], coping styles encompass the attitudes and strategies that nurses employ when confronting stressful situations in their professional environment. Li et al. [ 24 ] suggested that positive coping styles can enhance nurses' job satisfaction and improve patient safety. Furthermore, Li et al. [ 25 ] identified a positive correlation between negative coping styles and vicarious traumatization, while positive coping styles were negatively correlated with vicarious traumatization. Despite these findings, research remains limited regarding the influence of stressors and coping styles on vicarious traumatization among trauma nurses. This study investigates the extent of vicarious traumatization among trauma nurses and examines the mechanisms through which sociodemographic factors, work engagement, stressors, and coping styles influence this phenomenon. Previous quantitative research on vicarious traumatization in trauma nurses has predominantly relied on aggregate scores from measurement scales, which inadequately address the heterogeneity within the nursing population. Latent Profile Analysis (LPA) offers a methodological approach that employs latent variable models to assess the relationships between observed variables and latent constructs. By analyzing scores on manifest variables, LPA identifies the latent characteristics of individuals and their distribution within the population [ 26 ]. This study employs a method conducive to an in-depth exploration of the characteristics of various profile groups. However, existing literature lacks investigations into the potential profiles of vicarious traumatization, specifically among trauma nurses. Consequently, this research will utilize LPA to identify potential profile categories of vicarious traumatization within this demographic. Additionally, it will examine the factors influencing these characteristics to offer a reference for managers to develop targeted training programs. The findings of this study aim to provide a more comprehensive and systematic perspective for identifying the distinct categories of vicarious traumatization among trauma nurses, thereby elucidating their inherent heterogeneity and its influencing factors. Methods Aims This study aims to employ LPA to identify the latent profiles of vicarious traumatization among trauma nurses and to examine the impact of sociodemographic factors, stressors, work engagement, and both positive and negative coping styles on these profiles. Design The research adopts a cross-sectional design and adheres to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Participants Trauma nurses were selected as survey participants from 22 provincial administrative regions in China using convenience sampling between August 2024 and February 2025. To ensure the representativeness and comprehensiveness of the sample, trauma nurses from 195 medical institutions across seven distinct regions of China—namely, North China, East China, South China, Central China, Northwest China, and Southwest China—were included. The inclusion criteria were as follows: (a) possession of a nurse's practice qualification certificate, (b) experience in caring for trauma patients, and (c) informed consent and voluntary participation in the survey. The exclusion criteria comprised: (a) being on leave during the investigation period and (b) being a trainee nurse. Sample Size According to Kendall's sample size calculation method, the sample size should be 10 to 20 times the number of variables [ 27 ]. This study included 13 independent variables. Accounting for a 20% rate of invalid questionnaires, the necessary sample size ranges from 156 to 312 cases. Furthermore, based on the principles of LPA, a sample size exceeding 500 is recommended for accurately determining the number of profiles [ 28 ]. Consequently, a total of 930 participants were recruited for this study, thereby satisfying the aforementioned criteria. Instruments Demographic Data A comprehensive literature review identified several factors to be considered as general demographic data, including hospital level, whether or not it is a trauma care center construction unit of the China Trauma Care Alliance, gender, age, marital status, educational background, professional title, years of experience in trauma care, and whether or not you had received psychological trauma training. Vicarious Traumatization The Vicarious Traumatization Questionnaire (VTQ), as developed by Han [ 29 ], was employed to evaluate the extent of vicarious traumatization among trauma nurses. This instrument comprises two main components—physiological and psychological—encompassing a total of 38 items. The physiological section, consisting of 11 items, primarily evaluates the individual's physical response factors. The psychological component is further divided into four dimensions: emotional responses (9 items), behavioral responses (7 items), cognitive responses (5 items), and beliefs about life (6 items). Responses are measured using a 5-point Likert scale, where 1 indicates "never" and 5 indicates "always," yielding a total possible score range of 38 to 190. Higher scores denote more severe levels of vicarious traumatization. The VTQ was designed with consideration of the Chinese cultural context and demonstrates strong reliability and validity, as evidenced by a Cronbach's α coefficient of 0.93 [ 29 ]. In the present study, the scale exhibited an even higher Cronbach's α coefficient of 0.97. Work Engagement The Utrecht Work Engagement Scale (UWES) was employed to assess the level of work engagement among trauma nurses. Originally developed by Schaufeli and Bakker [ 30 ], the scale was subsequently translated and adapted by Zhang and Gan [ 31 ]. The UWES encompasses three dimensions—vigor, dedication, and absorption—comprising a total of 15 items. Responses are recorded on a 7-point Likert scale, ranging from 0 ("never") to 6 ("every day"), yielding a cumulative score between 0 and 90. Higher scores indicate greater levels of work engagement among nurses. The Chinese version of the UWES has demonstrated strong reliability and validity, with an overall Cronbach's alpha coefficient of 0.93 [ 31 ]. In the present study, the Cronbach's alpha coefficient for this scale was 0.963. Stressor The Stressor Scale for Emergency Nurses (SSEN) was employed to identify stressors and evaluate the work stress levels among trauma nurses. Initially developed by Yuwanich et al. [ 21 ], the scale was subsequently translated and revised by Zhang et al. [ 32 ]. The Chinese adaptation of the SSEN encompasses four dimensions with a total of 24 items: facing life and death situations (6 items), patient and family behaviors and reactions (8 items), technical and formal support (3 items), and conflict (7 items). A 6-point Likert scale was utilized, ranging from "not at all" (scored as 0) to "extremely high" (scored as 5), yielding a cumulative score range of 0 to 120. Elevated scores reflected a higher perceived level of stress by the nurses on specific items. The overall Cronbach's alpha coefficient for the Chinese version was reported as 0.96, with a split-half reliability of 0.84 [ 32 ]. In the present study, the Cronbach's alpha coefficient for this scale was found to be 0.979. Coping Style The Trait Coping Style Questionnaire (TCSQ) was employed to evaluate the coping styles of trauma nurses [ 23 ]. The TCSQ comprises two subscales: Negative Coping (NC) and Positive Coping (PC), each containing 10 items, resulting in a total of 20 items. Responses were recorded using a 5-point Likert scale, ranging from 5 ("definitely yes") to 1 ("definitely no"). The NC subscale includes the cumulative scores of items 2, 4, 6, 7, 10, 12, 13, 16, 17, and 19, with scores exceeding 30.26 ± 8.74 indicating negative coping. Conversely, the PC subscale comprises the cumulative scores of items 1, 3, 5, 8, 9, 11, 14, 15, 18, and 20, with scores exceeding 21.25 ± 7.13 indicating positive coping. In the present study, the overall Cronbach's α of the scale was 0.894, with the NC subscale achieving a Cronbach's α of 0.904 and the PC subscale achieving a Cronbach's α of 0.915. Data Collection The study's objectives, informed consent details, and questionnaire content were incorporated into an electronic questionnaire using a free online survey platform ( https://www.wjx.cn ). The survey's purpose, intended demographic, and completion methodology were communicated to the head nurses of trauma centers across the nation. Upon obtaining their consent, the questionnaire link was distributed to these head nurses via WeChat ( https://weixin.qq.com/ ). The head nurses then coordinated the completion of the questionnaire by trauma nurses who met the inclusion criteria. To prevent duplicate responses, restrictions were set to allow each account and IP address to submit only once. To ensure the questionnaire's completeness, all questions were mandatory for submission. After data collection, two postgraduate nursing students reviewed the submissions, excluding those completed in less than three minutes or with evidently illogical responses. Data Analysis The potential profile model was established utilizing Mplus 8.3 software. The average scores of the items across the five dimensions of the TVQ were used as explicit indicators. Profiles were incrementally added, and the parameters of each model were analyzed. The optimal model was then selected based on fit indices. The fit indices for the potential profile model are categorized into three groups: (1) Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), and sample Corrected Bayesian Information Criterion (aBIC), where lower values indicate a better model fit [ 33 ]; (2) information entropy, with values closer to 1 indicating more accurate classification, and an entropy value of 0.8 suggesting classification accuracy exceeding 90% [ 34 ]; and (3) the Lo-Mendell-Rubin adjusted likelihood ratio test (LMRT) and the Bootstrap-based likelihood ratio test (BLRT), where a p-value of less than 0.05 suggests that a model with k categories provides a superior fit compared to a model with k-1 categories [ 35 ]. Upon selecting the optimal profile model, we employed SPSS version 26.0 to conduct descriptive statistical analyses. Data that did not conform to a normal distribution were represented by medians and quartiles, and intergroup comparisons were performed using the Kruskal-Wallis H test. Categorical data were presented as frequencies and percentages, with comparisons between groups conducted using the chi-square (χ²) test and Fisher's exact test. To investigate the factors influencing the potential profiles of varying vicarious traumatization, multiple logistic regression analysis was utilized. The significance level was set at α = 0.05. Results Participant Characteristics A total of 965 questionnaires were administered, of which 930 were deemed valid, resulting in a valid response rate of 96.37%. The survey participants were drawn from 22 provincial-level administrative regions, including Guizhou, Zhejiang, Xinjiang, Jiangsu, Fujian, Anhui, Guangxi, Guangdong, Yunnan, Heilongjiang, Inner Mongolia, Sichuan, Hunan, Hubei, Hebei, Shanghai, Tianjin, Ningxia, Shanxi, Jiangxi, Jilin, and Shandong. The cohort comprised 598 trauma nurses from Level 3A hospitals, 145 from Level 3B hospitals, and 187 from Level 2 and below hospitals. Among the 930 valid respondents, 785 (84.41%) were female, 698 (75.05%) were married, 805 (86.56%) held a bachelor's degree, 475 (51.08%) possessed an intermediate professional title, 466 (50.11%) had 6–10 years of experience in trauma care, and 308 (33.12%) had received psychological trauma training. Further details are provided in Table 1 . Table 1 Demographics of trauma nurses based on different vicarious traumatization profiles (N = 930). Variables Overall (n = 930 C1(n = 329) C2(n = 487) C3(n = 114) Z/χ 2 P Hospital level Level 3A hospital 598 205 310 83 4.291 a 0.368 Level 3B hospital 145 54 78 13 Level 2 and below hospitals 187 70 99 18 Whether or not it is a trauma care center construction unit of the China Trauma Care Alliance Yes 664 232 341 91 4.542 a 0.103 No 266 97 146 23 Gender Male 145 54 65 26 6.543 a 0.038 Female 785 275 422 88 Age years) 20 ~ 30 334 120 172 42 6.971 a 0.137 31 ~ 40 501 166 269 66 ≥ 41 95 43 46 6 Marital status Single 218 72 123 23 2.716 a 0.599 Married 698 253 355 90 Divorced 14 4 9 1 Educational background Junior college degree 107 38 61 8 6.532 a 0.149 Bachelor degree 805 287 417 101 Master degree 18 4 9 5 Professional title Junior nurse 363 129 192 42 4.487 a 0.344 Senior nurse 475 157 255 63 Associate senior and above 78 35 35 8 Years of experience in trauma care 1 ~ 5 466 179 237 50 5.430 a 0.246 6 ~ 10 226 74 124 28 ≥ 11 238 76 126 36 Whether or not you had received psychological trauma training Yes 308 140 141 27 21.618 a 0.000 No 622 189 346 87 Stressor 29.00(13.50, 51.00) 53.00(32.00, 70.00) 70.50(48.00, 80.00) 164.381 b 0.000 Work Engagement 64.00(41.50, 77.50) 45.00(28.00, 63.00) 45.00(30.00, 60.00) 85.700 b 0.000 Negative Coping (NC) 18.00(14.00, 21.00) 23.00(20.00, 28.00) 30.00(27.75, 33.00) 253.213 b 0.000 Positive Coping (PC) 35.00(28.50, 41.00) 30.00(25.00, 35.00) 30.00(28.00, 34.00) 58.148 b 0.000 Note: a: χ 2 , b: z. C1, Low vicarious traumatization group; C2, Medium vicarious traumatization group; C3, High vicarious traumatization group. Latent Profile Analysis of Vicarious Traumatization The item scores for the VTQ among trauma nurses were as follows: the overall score was 1.86 (1.50, 2.11). Specifically, the item score for the emotional response dimension was 1.89 (1.44, 2.22), the behavioral response dimension was 2.00 (1.57, 2.29), the cognitive response dimension was 1.60 (1.00, 2.00), the beliefs about life dimension was 2.00 (1.67, 2.33), and the physical dimension was 1.73 (1.27, 2.09). Five potential profile models were fitted using the mean scores of the five dimensions of the VTQ as exogenous indicators, with the fitting indicators for each model presented in Table 2 . As the number of models increased, the values of AIC, BIC, and aBIC exhibited a decreasing trend. When the number of categories reached five, the AIC, BIC, and aBIC values were minimized; however, the LMRT test was not statistically significant ( p = 0.640). With four categories, the entropy value was maximized, but the probability percentage for one category was only 1.4%. The entropy value for model 3 was 0.897, exceeding the threshold of 0.800, and both the LMRT and BLRT tests were statistically significant ( p < 0.05). After a comprehensive comparison of the fitting indices for each model, model 3 was identified as the best-fitting model for this study. The potential profiles were plotted based on the categorization results, as depicted in Fig. 1 . The three potential profiles of vicarious traumatization among trauma nurses displayed no intersections and exhibited relatively consistent morphological trends across the entries. Table 2 Indexes for fitting the model of LPA in vicarious traumatization. Model AIC BIC aBIC p Entropy Probabilities of classes LMRT BLRT 1 8769.684 8818.036 8786.277 - - - - 2 6769.081 6846.444 6795.630 0.000 0.000 0.940 0.811/0.189 3 5563.405 5669.779 5599.909 0.037 0.000 0.897 0.354/0.524/0.122 4 5088.770 5224.155 5135.230 0.034 0.000 0.927 0.309/0.014/0.527/0.150 5 4804.017 4968.413 4860.433 0.640 0.000 0.915 0.294/0.478/0.129/0.088/0.011 Abbreviations: aBIC, sample-size adjusted Bayesian Information Criterion; AIC, Akaike Information Criterion; BIC, Bayesian Information Criterion; BLRT, Bootstrapped Likelihood Ratio Test; LMRT, Lo–Mendell–Rubin Adjusted Likelihood Ratio Test. The initial profile comprised 35.38% of trauma nurses who exhibited the lowest scores on the cognitive response dimension, and was designated as the low vicarious traumatization group. The subsequent profile encompassed 52.37% of trauma nurses, also scoring lowest on the cognitive response dimension, and was identified as the medium vicarious traumatization group. The final profile consisted of 12.25% of trauma nurses who recorded the lowest scores on both the emotional and behavioral response dimensions, and was termed the high vicarious traumatization group. Analysis of Factors Influencing the Potential Profile of Vicarious Traumatization for Trauma Nurses Table 1 illustrates statistically significant differences among trauma nurses across the three profile categories concerning gender (χ 2 = 6.543, p = 0.038), psychological trauma training (χ 2 = 21.618, p < 0.038), stressor (z = 164.381, p < 0.001), work engagement (z = 85.700, p < 0.001), negative coping (z = 253.213, p < 0.001), and positive coping (z = 58.148, p < 0.001). Subsequently, variables that demonstrated statistical significance were incorporated into an unordered multinomial logistic regression model. The independent variables included stressor (original input), work engagement (original input), negative coping (original input), positive coping (original input), gender (coded as male = 1, female = 2, with "female" serving as the reference group), and psychological trauma training (coded as yes = 1, no = 2, with "no" serving as the reference group). The findings suggest that, when comparing the mid-vicarious traumatization group to the low-vicarious traumatization group, higher scores in psychological trauma training (OR = 0.601, p = 0.005), work engagement (OR = 0.977, p < 0.001), and positive coping (OR = 0.952, p < 0.001) were associated with an increased likelihood of being classified in the low-vicarious traumatization group. Conversely, elevated scores in stressors (OR = 1.029, p < 0.001) and negative coping (OR = 1.128, p < 0.001) were linked to a greater probability of belonging to the mid-vicarious traumatization group. Furthermore, when comparing the high-vicarious traumatization group to the low-vicarious traumatization group, being male (OR = 2.211, p = 0.025), along with higher scores in psychological trauma training (OR = 0.428, p = 0.005), work engagement (OR = 0.968, p < 0.001), and positive coping (OR = 0.896, p < 0.001), were associated with an increased likelihood of classification in the low-vicarious traumatization group. In contrast, higher scores in stressors (OR = 1.050, p < 0.001) and negative coping (OR = 1.300, p < 0.001) were associated with a greater probability of being categorized in the high-vicarious traumatization group. Then, when comparing the mid-vicarious traumatization group to the high-vicarious traumatization group, it was found that higher scores in positive coping (OR = 1.062, p < 0.001) were more likely to be associated with the mid-vicarious traumatization group. Conversely, higher scores in female gender (OR = 0.462, p = 0.008), stressors (OR = 0.979, p < 0.001), and negative coping (OR = 0.867, p < 0.001) were more likely to be associated with the high-vicarious traumatization group. For further details, refer to Table 3 . Table 3 Logistic regression of different vicarious traumatization profiles. Variables B SE Wald X 2 p OR 95%CI C2 (ref. C1) Constant -0.578 0.419 1.903 0.168 - - Stressor 0.028 0.004 57.019 0.000 1.029 1.021 ~ 1.036 Work Engagement -0.023 0.005 23.981 0.000 0.977 0.969 ~ .986 Negative Coping (NC) 0.120 0.014 73.054 0.000 1.128 1.097 ~ 1.159 Positive Coping (PC) -0.049 0.013 14.165 0.000 0.952 0.928 ~ 0.977 Gender 0.020 0.247 0.007 0.935 1.020 0.628 ~ 1.657 Psychological trauma training -0.510 0.182 7.817 0.005 0.601 0.420 ~ 0.859 C3 (ref. C1) Constant -4.959 0.706 49.371 0.000 - - Stressor 0.049 0.006 70.246 0.000 1.050 1.038 ~ 1.063 Work Engagement -0.032 0.008 16.469 0.000 0.968 0.954 ~ 0.984 Negative Coping (NC) 0.263 0.025 111.627 0.000 1.300 1.239 ~ 1.365 Positive Coping (PC) -0.109 0.028 15.295 0.000 0.896 0.848 ~ 0.947 Gender 0.793 0.354 5.015 0.025 2.211 1.104 ~ 4.427 Psychological trauma training -0.850 0.304 7.817 0.005 0.428 0.236 ~ 0.776 C2 (ref. C3) Constant 4.382 0.616 50.559 0.000 - - Stressor -0.021 0.005 17.761 0.000 0.979 0.970 ~ 0.989 Work Engagement 0.009 0.007 1.784 0.182 1.009 0.996 ~ 1.023 Negative Coping (NC) -0.142 0.022 42.998 0.000 0.867 0.831 ~ 0.905 Positive Coping (PC) 0.060 0.026 5.339 0.021 1.062 1.009 ~ 1.118 Gender -0.773 0.293 6.943 0.008 0.462 0.260 ~ 0.820 Psychological trauma training 0.340 0.266 1.632 0.201 1.405 0.834 ~ 2.367 Note : C1, Low vicarious traumatization group; C2, Medium vicarious traumatization group; C3, High vicarious traumatization group; ref., reference group; B , unstandardized coefficient; bold numbers: p < 0.05. Abbreviations: CI, confidence interval; OR, odds ratio. Discussion The study identified significant differences in the profiles of vicarious traumatization among trauma nurses, which can be classified into three distinct categories: low vicarious traumatization group (35.38%), medium vicarious traumatization group (52.37%), and high vicarious traumatization group (12.25%). The findings offer novel empirical insights into how variables such as gender, psychological trauma training, stressors, work engagement, positive coping, and negative coping influence the various levels of vicarious traumatization. These insights provide valuable evidence for the development of targeted interventions aimed at reducing the incidence of vicarious traumatization among nurses. Impact of gender In this study, gender emerged as a significant factor influencing the prevalence of high vicarious traumatization among trauma nurses, aligning with findings from previous research [ 36 ]. This phenomenon may be attributed to the greater sensitivity of female nurses to emotional experiences, which often results in heightened empathy and sympathy. Consequently, female nurses may find it more challenging or time-consuming to detach from negative emotions [ 37 ]. When caring for trauma patients, female nurses tend to exhibit greater empathy than their male counterparts, thereby absorbing more emotional stress from patients and increasing their susceptibility to vicarious traumatization. Therefore, it is imperative to acknowledge and address the gender-based differences in vicarious traumatization within clinical practice to safeguard the mental health of nursing professionals. To more effectively mitigate the incidence of vicarious traumatization among female nurses, it is recommended that management establish robust communication channels tailored specifically for this demographic, conduct regular mental health assessments, and offer essential psychological support services. Furthermore, the implementation of targeted psychological training programs could be beneficial in equipping female nurses with strategies to better manage the psychological challenges encountered in their professional roles. Impact of psychological trauma training In this study, the absence of psychological trauma training emerged as a significant factor influencing both the low and high vicarious traumatization groups among trauma nurses. This may be attributed to the tendency of nurses without such training to harbor unrealistic perceptions regarding clinical and social dimensions, thereby experiencing heightened negative impacts from traumatic events [ 9 ]. According to Social Cognitive Theory [ 38 ], structured training programs can substantially facilitate the deconstruction and reconstruction of individual cognitive schemas through self-regulatory mechanisms and observational learning processes. Implementing psychological trauma training can assist nurses in the early identification of somatization symptoms associated with vicarious traumatization. This understanding allows them to recognize vicarious traumatization as a normal adaptive process and to employ appropriate protective intervention strategies to mitigate the impact of trauma exposure. A scoping review by Kim et al. [ 39 ] highlighted that psychological education, including interventions such as cognitive behavioral therapy, professional skills training, and peer support networks, is effective in addressing vicarious traumatization. Furthermore, research by Pérez et al. [ 40 ] demonstrated that online mindfulness training significantly reduces compassion fatigue and burnout among nurses. Consequently, nursing managers must implement psychological education programs focused on vicarious traumatization to effectively prevent and manage its occurrence among nursing staff. Impact of Work Engagement In this study, a low level of work engagement emerged as a significant factor influencing trauma nurses in both the low and high vicarious traumatization groups. Work engagement, characterized by energy, dedication, and focus, enabled nurses with high engagement levels to deliver superior quality care and achieve improved patient outcomes [ 43 ]. According to the Conservation of Resources Theory (COR) [ 44 ], individuals facing work-related stress evaluate whether to invest additional resources through a process termed "resource trade-off." A decline in work engagement may lead employees to conserve their resources by reducing their organizational resource expenditure, thereby increasing the risk of experiencing vicarious traumatization [ 45 ]. Research has demonstrated a significant negative correlation between work engagement and job burnout, indicating that high job engagement can mitigate the adverse effects of occupational stress on burnout by enhancing psychological capital [ 46 ]. At the organizational level, work engagement has been shown to enhance efficiency and improve performance [ 47 ]. On an individual level, work engagement contributes to increased job satisfaction and a reduction in job burnout [ 48 ]. A cross-sectional survey conducted by Zhong et al. [ 49 ] revealed that nurses in China exhibit a moderate level of work engagement, which is notably lower than that of their international counterparts. Consequently, nursing managers must prioritize the cultivation of trauma nurses' enthusiasm for trauma care, emphasizing its significant impact on patient health and social well-being. By doing so, they can enhance nurses' work engagement and help mitigate the effects of vicarious traumatization. Impact of stressor In this study, stressors emerged as significant influencing factors for vicarious traumatization among trauma nurses. This finding aligns with the research conducted by Li [ 41 ], which identified stress load as a risk factor impacting vicarious traumatization in emergency nurses. Stressors are defined as situations, stimuli, activities, and events that elicit a stress response in individuals [ 21 ]. Trauma nurses are frequently required to deliver prompt care to patients who have undergone traumatic incidents. These patients, confronted with life-threatening conditions, necessitate urgent medical intervention. The high-pressure and rapid nature of this work environment has emerged as a significant stressor for trauma nurses. Additional stressors arise from the patients' family members, who frequently experience anxiety and a sense of helplessness in response to the sudden traumatic events affecting their loved ones. Consequently, trauma nurses are often required to engage in more empathetic interactions with these family members. However, due to the demanding nature of their work, characterized by extended hours and high workloads, trauma nurses typically have limited opportunities for physical and mental relaxation, as well as emotional management. This lack of respite can impede their ability to effectively address the cascade of negative emotions that may arise during the rescue process. The aforementioned factors represent specific stressors encountered by trauma nurses. Prolonged exposure to elevated stress levels can result in job burnout and compassion fatigue [ 42 ], which may subsequently lead to the development of vicarious traumatization. Consequently, it is imperative for management to promptly identify these stressors, offer timely psychological counseling, and implement preventive measures to mitigate the risk of vicarious trauma among trauma nurses. Impact of Coping Style In this study, coping style was identified as a significant factor influencing vicarious traumatization among trauma nurses. This finding aligns with the research conducted by Li et al. [ 25 ], which demonstrated that positive coping was associated with lower levels of vicarious traumatization, whereas negative coping correlated with higher levels. According to the Transactional Model of Stress, individuals facing stressors, such as exposure to others' traumatic events, engage in cognitive appraisal to assess the nature of the stressors and their coping capabilities, subsequently selecting appropriate coping strategies [ 50 ]. Coping styles are categorized into positive and negative types, with each having distinct impacts on the physical and mental well-being of healthcare professionals. Positive coping styles serve as protective mechanisms, facilitating the maintenance of favorable emotional experiences. In contrast, negative coping styles exacerbate negative emotions and can lead to anxiety, depression, and psychological trauma [ 51 ]. A study conducted by Rabie et al. [ 52 ] demonstrated that the coping styles of nurses serve as a fundamental intervention mechanism for alleviating post-traumatic psychological stress and emotional disorders. Positive coping styles are particularly significant for the mental health of nurses as they navigate the adverse effects of traumatic events during epidemics [ 53 ]. The findings of this research further underscore the importance of employing positive coping strategies as essential resources for mitigating psychological distress [ 54 ], thereby aiding healthcare professionals in alleviating the detrimental consequences of vicarious traumatization. Nurses frequently operate in high-pressure environments, such as emergency departments, intensive care units (ICUs), and operating rooms. In the context of dynamically monitoring patients with severe trauma, they are required to make critical clinical decisions while simultaneously addressing the psychological needs of those patients. The ongoing emotional labor involved in this work renders nurses susceptible to vicarious traumatization, highlighting the necessity for positive coping styles to buffer against occupational psychological trauma. Consequently, management must develop and implement strategies aimed at enhancing nurses' coping styles and overall well-being. Strengths and Limitations This research presents several notable advantages. First, it employs a novel research methodology—potential profile analysis. Second, the study was conducted on a national scale, utilizing a large sample size that enhances the reliability and representativeness of the findings. Lastly, the results offer valuable insights for nursing managers, enabling them to develop personalized intervention strategies and implement more effective training and support measures. However, the study is not without its limitations. First, the use of an online survey platform allowed participants to self-evaluate, which may have introduced subjective biases that could compromise the authenticity and accuracy of the data. Second, due to financial constraints, the research employed a convenience sampling method, which may limit the generalizability of the findings. Finally, the study focused solely on a cross-sectional analysis of the vicarious traumatization experienced by trauma nurses, neglecting to account for the temporal dynamics that may influence the trajectory of their vicarious traumatization over time. Conclusions Through a potential profile analysis conducted in this study, three distinct categories of trauma nurses were identified: the low-vicarious traumatization group, the medium-vicarious traumatization group, and the high-vicarious traumatization group. The findings showed a significant prevalence of vicarious traumatization among trauma nurses, with most developing substantial occupational trauma risks during their work in trauma care. These results emphasized the emotional labor involved in trauma care and highlighted the urgent need for implementing appropriate intervention strategies to address the mental health challenges faced by trauma nurses. Additionally, the study identified several factors influencing vicarious traumatization among trauma nurses, including gender, psychological trauma training, stressor, work engagement, and coping style. These insights offered a foundation for developing targeted intervention strategies. Moving forward, it was crucial for management to closely monitor the emotional stress levels of female nurses and provide timely stress-relief resources. Moreover, regular psychological trauma training should be conducted to help nurses understand that vicarious traumatization is a normal adaptive response and to facilitate early detection of related physical symptoms. Abbreviations WHO World Health Organization PTSD Posttraumatic Stress Disorder LPA Latent Profile Analysis STROBE Strengthening the Reporting of Observational Studies in Epidemiology VTQ Vicarious Traumatization Questionnaire UWES Utrecht Work Engagement Scale SSEN Stressor Scale for Emergency Nurses TCSQ Trait Coping Style Questionnaire ICU intensive care unit ICUs intensive care units AIC Akaike Information Criterion BIC Bayesian Information Criterion aBIC sample Corrected Bayesian Information Criterion LMRT Lo-Mendell-Rubin adjusted likelihood ratio test BLRT Bootstrap-based likelihood ratio test COR Conservation of Resources Theory Declarations Ethics approval and consent to participate This study received approval from the Ethics Committee of Tongji Hospital, Tongji Medical College, University of Science and Technology of China (TJ-IRB202405026). Informed consent was deemed to have been obtained from all participants upon their completion and successful submission of the questionnaire, indicating their comprehensive understanding of the study. The questionnaire was administered anonymously, ensuring that participants' data remained confidential and were not disclosed. Furthermore, participants retained the right to withdraw from the study at any point. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Funding The study was not funded. Author Contribution M.F. was the first author. X.L. and X.P.L. contributed equally and shared the corresponding authorship. M.F., X.L., and X.P.L. conceived and designed the study. M.F. and X.L. collected the data. M.F., Z.J.H., and Y.F.Z. analyzed and interpreted the data. M.F. wrote the original draft of the manuscript. All authors contributed to reviewing and editing the final manuscript. Acknowledgement The authors would like to express their gratitude to the clinical nurses who participated in this study. Availability of data and materials The datasets used during the current study are available from the corresponding author on reasonable request. References World Health Organization. Injuries and violence. https://www.who.int/news-room/fact-sheets/detail/injuries-and-violence (2024). Accessed 20 Feb 2025. Liu X, Feng M, Xie L. Simplified Chinese Trauma Advanced Practice Nurses' Core Competency Scale: A development and psychometric validation study. Nurse Educ Today. 2024;143:106384. Baik D, Yi N, Han O, Kim Y. Trauma nursing competency in the emergency department: a concept analysis. BMJ Open. 2024;14(6):e079259. Alshammari B, Alanazi NF, Kreedi F, Alshammari F, Alkubati SA, Alrasheeday A, Madkhali N, Alshara A, Bakthavatchaalam V, Al-Masaeed M, et al. 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The Chinese Version of Utrecht Work Engagement Scale: An Examination of Reliability and Validity. Chin J Clin Psychol 2005(03):268–70. Zhang M, Ke L, Jianxia Z, Ning L, Miao Y, Zhennan Y. Translation and psychometric test of the Chinese version of the Stressor Scale for Emergency Nurses. Chin J Emerg Crit Nurs. 2023;4(12):1105–11. Hu Lt, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equation Modeling: Multidisciplinary J. 1999;6(1):1–55. Asparouhov T, Muthén B. Auxiliary Variables in Mixture Modeling: Three-Step Approaches Using Mplus. Struct Equation Modeling: Multidisciplinary J. 2014;21(3):329–41. Collier ZK, Leite WL. A Comparison of Three-Step Approaches for Auxiliary Variables in Latent Class and Latent Profile Analysis. Struct Equation Modeling: Multidisciplinary J. 2017;24(6):819–30. Duan X, Yuping T, Juan D, Yifan D, Jing H. 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Luna D, Figuerola-Escoto RP, Sienra-Monge JJL, Hernández-Roque A, Soria-Magaña A, Hernández-Corral S, Toledano-Toledano F. Burnout and Its Relationship with Work Engagement in Healthcare Professionals: A Latent Profile Analysis Approach. Healthcare (Basel) 2023, 11(23). Ma F, Wang W, Liu M, Chen H, Zhu Y, Liu Y. The Relationship Between Work Engagement and Safety Behaviour of Oncology Nurses: A Latent Profile Analysis. J Adv Nurs 2025. Liu M, Liu L, Lv Z, Ma F, Mao Y, Liu Y. Effects of burnout and work engagement in the relationship between self-efficacy and safety behaviours-A chained mediation modelling analysis. J Adv Nurs. 2024;80(4):1473–83. Zhong X, Rong X, Li Y, Qing W, Xie G, Dai P, Wu J, He L. Current status and influencing factors of nurses' work engagement in Chinese tertiary hospitals: A latent profile analysis. PLoS ONE. 2025;20(4):e0321398. de Cordova PB, Reilly LL, Pogorzelska-Maziarz M, Gerolamo AM, Grafova I, Vasquez A, Johansen ML. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7253913","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":513196705,"identity":"268f0135-86a5-44ea-a891-edb210025aaf","order_by":0,"name":"Mei Feng","email":"","orcid":"","institution":"Tongji Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mei","middleName":"","lastName":"Feng","suffix":""},{"id":513196706,"identity":"f07de166-0738-40cb-b6fd-4d67a8cfeda4","order_by":1,"name":"Zijing Huang","email":"","orcid":"","institution":"Tongji Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zijing","middleName":"","lastName":"Huang","suffix":""},{"id":513196707,"identity":"2fa39a90-1b18-40ee-8cc6-0f2295562873","order_by":2,"name":"Yufen Zhang","email":"","orcid":"","institution":"Tongji Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yufen","middleName":"","lastName":"Zhang","suffix":""},{"id":513196708,"identity":"9424b4aa-7aa0-467e-9fbe-06a09ab14153","order_by":3,"name":"La Xie","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIie2RIQsCMRTH3xhomZxxguwbCIOBSfwsDkGr8aIizHLXlfsUFqvvWLAIZsHgislw1aC4LMjNZtgv/3/vz3sPIBL5RygQBPliZLVYuCpQAYQUBc3sUvHQIoQjquZ6atosJC4PFPFhLjrfOAMchqI3r1E6y8aozM1NbwptrjMYqz7WKAllEluG6m2hV5ID6l2d0qBJVT69sj+XhrMQxbeAZUeryJoEKn4XabvpRJBM+yPLgF3kyTp3lwP/yoNzVToUtcrnhN/ikUgkEvnCG03HR6ZVo49eAAAAAElFTkSuQmCC","orcid":"","institution":"Tongji Hospital","correspondingAuthor":true,"prefix":"","firstName":"La","middleName":"","lastName":"Xie","suffix":""},{"id":513196709,"identity":"754db4d0-60f2-4625-85dc-98324129cf80","order_by":4,"name":"Xiangping Liu","email":"","orcid":"","institution":"Tongji Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiangping","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2025-07-30 14:23:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7253913/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7253913/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91088906,"identity":"005fb7d3-8aa9-4866-bc64-63da0a4ec1de","added_by":"auto","created_at":"2025-09-11 12:52:04","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":41622,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eLatent profiles for different vicarious traumatization\u003c/strong\u003e. C1, Low vicarious traumatization group; C2, Medium vicarious traumatization group; C3, High vicarious traumatization group.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7253913/v1/571b229b1746ce3b3cc2608b.png"},{"id":92854298,"identity":"ae01d76a-0af2-42b6-8e59-b97c4212946d","added_by":"auto","created_at":"2025-10-06 11:02:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1334591,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7253913/v1/4c29e447-43ad-4755-bbae-88751da3bcb4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The current situation and influencing factors of vicarious traumatization among trauma nurses: A latent profile analysis","fulltext":[{"header":"Background","content":"\u003cp\u003eTrauma care, a critical component of emergency medicine, faces significant challenges due to the escalating incidence of trauma on a global scale. The World Health Organization (WHO) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] identifies trauma as the leading cause of mortality among individuals under the age of 45 worldwide, with traffic accidents, violence, and natural disasters being the primary contributors. Within this context, the trauma nurse, as a certified clinical nurse specialist, plays a pivotal role in emergency response, multidisciplinary coordination, clinical decision-making, and providing psychosocial support. These professionals are integral to the management of trauma patients during the \"golden hour,\" a crucial period for lifesaving interventions. This management encompasses rapid primary assessment, prioritized therapeutic interventions, and essential psychosocial care [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Trauma patients frequently experience panic due to abrupt and unforeseen traumatic events, necessitating that trauma nurses promptly identify and address the psychological issues and needs of these patients [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. To deliver optimal care, trauma nurses must not only administer timely, precise, and swift nursing interventions but also engage empathetically with both patients and their families who have encountered diverse traumatic experiences [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. When trauma nurses engage with individuals who have undergone or are undergoing traumatic experiences, they are at an elevated risk of experiencing vicarious traumatization. Research indicates that emergency nurses may develop somatic symptoms, including anxiety and depression, as a consequence of prolonged exposure to patients with traumatic histories. Notably, 8.5% of these nurses exhibit clinical levels of Posttraumatic Stress Disorder (PTSD) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eVicarious traumatization is a psychological process wherein the intrinsic experiences of professional helpers are adversely altered due to their empathic engagement with the traumatic experiences of those they assist [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This concept is grounded in the constructivist self-development theory and elucidates the stress and trauma experienced by helpers across five dimensions: frame of reference, self-capacities, ego resources, psychological needs and cognitive schemas, and memory and perception. Within the nursing profession, vicarious traumatization has not been extensively explored. It pertains to a psychological trauma that impacts a nurse's cognitive schemas and can occur in clinical settings or via social media. This trauma arises from profound empathy for the physical or emotional suffering of patients, family members, or colleagues, such as a patient's physical injury or death [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Vicarious traumatization exerts a comprehensive impact on nurses, manifesting not only in a spectrum of physical and psychological issues but also indirectly contributing to extensive, cumulative, and enduring adverse effects on their cognitive schemas [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Consequently, this phenomenon diminishes the quality of care and patient satisfaction, elevates the incidence of medical and nursing errors, adversely affects clinical care outcomes, and contributes to nurse turnover [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eResearch on the vicarious traumatization of healthcare professionals commenced in the 1990s. Over the years, significant theoretical and empirical advancements have been achieved in this field [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Existing studies have indicated that the level of vicarious traumatization among nurses in Australia, the United States, and China ranges from moderate to high, particularly among emergency nurses, intensive care unit (ICU) nurses, oncology nurses, hospice nurses, and nurses involved in public health incident response [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Currently, there is a notable paucity of research focusing on trauma nurses. These nurses frequently engage closely with patients who have undergone traumatic events, and sustained empathy for such experiences may result in enduring cognitive alterations in their personal experiences and worldviews [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. A study conducted by Zheng et al. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] demonstrated that nurses who had encountered the death of a patient exhibited higher overall vicarious traumatization scores compared to those who had not. Trauma nurses, who are consistently exposed to the adverse emotions of patients undergoing trauma, are susceptible to excessive empathy, leading to empathy fatigue and subsequently developing into occupational hazards such as vicarious traumatization. This occupational hazard adversely impacts nurses' ability to deliver high-quality care to patients [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Given the unique nature of trauma nurses' responsibilities, it is imperative to assess their levels of vicarious traumatization, as this is directly related to both the mental health of the nurses and the quality of care provided to patients.\u003c/p\u003e\u003cp\u003eVicarious traumatization is an inherent aspect of nursing practice when engaging with patients and represents an unavoidable occupational hazard for nurses [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This phenomenon is influenced by a multitude of factors, including sociodemographic and work-related variables, among others [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The impact of sociodemographic factors on the extent of vicarious traumatization is associated with health policies, cultural influences, and educational backgrounds across different countries and regions [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Consequently, sociodemographic factors were identified through the analysis of region- and country-specific data. Within the framework of positive psychology, work engagement is defined as a persistent, fulfilling, and positive emotional and cognitive state, characterized by the degree of vitality, dedication, and concentration an individual exhibits in their professional activities [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The literature has documented a negative correlation between work engagement and compassion fatigue among hemodialysis nurses [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In contrast, the relationship between work engagement and compassion fatigue among emergency nurses is contingent upon their proactive commitment to their roles. Nurses who demonstrate proactive engagement in their work tend to derive a sense of fulfillment and are consequently less susceptible to compassion fatigue [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. While existing research has established a link between work engagement and compassion fatigue, the connection between work engagement and vicarious traumatization remains underexplored. Trauma nurses have been consistently exposed to high levels of stress and secondary traumatic stress in the context of trauma care [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Stressors are defined as any factors or events that threaten an individual's health or impair their normal functioning [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. A study conducted by Yuwanich et al. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] demonstrated that elevated levels of stressors can result in both physical and mental health issues, including fatigue and burnout. For trauma nurses, these stressors often involve complex events influenced by multiple factors, which can lead to vicarious traumatization. Hao et al. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] highlighted that coping styles significantly impact the mental stress experienced by high-level emergency nurses. According to Wang [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], coping styles encompass the attitudes and strategies that nurses employ when confronting stressful situations in their professional environment. Li et al. [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] suggested that positive coping styles can enhance nurses' job satisfaction and improve patient safety. Furthermore, Li et al. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] identified a positive correlation between negative coping styles and vicarious traumatization, while positive coping styles were negatively correlated with vicarious traumatization. Despite these findings, research remains limited regarding the influence of stressors and coping styles on vicarious traumatization among trauma nurses.\u003c/p\u003e\u003cp\u003eThis study investigates the extent of vicarious traumatization among trauma nurses and examines the mechanisms through which sociodemographic factors, work engagement, stressors, and coping styles influence this phenomenon. Previous quantitative research on vicarious traumatization in trauma nurses has predominantly relied on aggregate scores from measurement scales, which inadequately address the heterogeneity within the nursing population. Latent Profile Analysis (LPA) offers a methodological approach that employs latent variable models to assess the relationships between observed variables and latent constructs. By analyzing scores on manifest variables, LPA identifies the latent characteristics of individuals and their distribution within the population [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. This study employs a method conducive to an in-depth exploration of the characteristics of various profile groups. However, existing literature lacks investigations into the potential profiles of vicarious traumatization, specifically among trauma nurses. Consequently, this research will utilize LPA to identify potential profile categories of vicarious traumatization within this demographic. Additionally, it will examine the factors influencing these characteristics to offer a reference for managers to develop targeted training programs. The findings of this study aim to provide a more comprehensive and systematic perspective for identifying the distinct categories of vicarious traumatization among trauma nurses, thereby elucidating their inherent heterogeneity and its influencing factors.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cb\u003eAims\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study aims to employ LPA to identify the latent profiles of vicarious traumatization among trauma nurses and to examine the impact of sociodemographic factors, stressors, work engagement, and both positive and negative coping styles on these profiles.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDesign\u003c/b\u003e\u003c/p\u003e\u003cp\u003e The research adopts a cross-sectional design and adheres to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTrauma nurses were selected as survey participants from 22 provincial administrative regions in China using convenience sampling between August 2024 and February 2025. To ensure the representativeness and comprehensiveness of the sample, trauma nurses from 195 medical institutions across seven distinct regions of China—namely, North China, East China, South China, Central China, Northwest China, and Southwest China—were included. The inclusion criteria were as follows: (a) possession of a nurse's practice qualification certificate, (b) experience in caring for trauma patients, and (c) informed consent and voluntary participation in the survey. The exclusion criteria comprised: (a) being on leave during the investigation period and (b) being a trainee nurse.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSample Size\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAccording to Kendall's sample size calculation method, the sample size should be 10 to 20 times the number of variables [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. This study included 13 independent variables. Accounting for a 20% rate of invalid questionnaires, the necessary sample size ranges from 156 to 312 cases. Furthermore, based on the principles of LPA, a sample size exceeding 500 is recommended for accurately determining the number of profiles [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Consequently, a total of 930 participants were recruited for this study, thereby satisfying the aforementioned criteria.\u003c/p\u003e\u003cp\u003e\u003cb\u003eInstruments\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eDemographic Data\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA comprehensive literature review identified several factors to be considered as general demographic data, including hospital level, whether or not it is a trauma care center construction unit of the China Trauma Care Alliance, gender, age, marital status, educational background, professional title, years of experience in trauma care, and whether or not you had received psychological trauma training.\u003c/p\u003e\u003cp\u003e\u003cb\u003eVicarious Traumatization\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe Vicarious Traumatization Questionnaire (VTQ), as developed by Han [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], was employed to evaluate the extent of vicarious traumatization among trauma nurses. This instrument comprises two main components—physiological and psychological—encompassing a total of 38 items. The physiological section, consisting of 11 items, primarily evaluates the individual's physical response factors. The psychological component is further divided into four dimensions: emotional responses (9 items), behavioral responses (7 items), cognitive responses (5 items), and beliefs about life (6 items). Responses are measured using a 5-point Likert scale, where 1 indicates \"never\" and 5 indicates \"always,\" yielding a total possible score range of 38 to 190. Higher scores denote more severe levels of vicarious traumatization. The VTQ was designed with consideration of the Chinese cultural context and demonstrates strong reliability and validity, as evidenced by a Cronbach's α coefficient of 0.93 [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In the present study, the scale exhibited an even higher Cronbach's α coefficient of 0.97.\u003c/p\u003e\u003cp\u003e\u003cb\u003eWork Engagement\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe Utrecht Work Engagement Scale (UWES) was employed to assess the level of work engagement among trauma nurses. Originally developed by Schaufeli and Bakker [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], the scale was subsequently translated and adapted by Zhang and Gan [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The UWES encompasses three dimensions—vigor, dedication, and absorption—comprising a total of 15 items. Responses are recorded on a 7-point Likert scale, ranging from 0 (\"never\") to 6 (\"every day\"), yielding a cumulative score between 0 and 90. Higher scores indicate greater levels of work engagement among nurses. The Chinese version of the UWES has demonstrated strong reliability and validity, with an overall Cronbach's alpha coefficient of 0.93 [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. In the present study, the Cronbach's alpha coefficient for this scale was 0.963.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStressor\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe Stressor Scale for Emergency Nurses (SSEN) was employed to identify stressors and evaluate the work stress levels among trauma nurses. Initially developed by Yuwanich et al. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], the scale was subsequently translated and revised by Zhang et al. [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. The Chinese adaptation of the SSEN encompasses four dimensions with a total of 24 items: facing life and death situations (6 items), patient and family behaviors and reactions (8 items), technical and formal support (3 items), and conflict (7 items). A 6-point Likert scale was utilized, ranging from \"not at all\" (scored as 0) to \"extremely high\" (scored as 5), yielding a cumulative score range of 0 to 120. Elevated scores reflected a higher perceived level of stress by the nurses on specific items. The overall Cronbach's alpha coefficient for the Chinese version was reported as 0.96, with a split-half reliability of 0.84 [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. In the present study, the Cronbach's alpha coefficient for this scale was found to be 0.979.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCoping Style\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe Trait Coping Style Questionnaire (TCSQ) was employed to evaluate the coping styles of trauma nurses [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The TCSQ comprises two subscales: Negative Coping (NC) and Positive Coping (PC), each containing 10 items, resulting in a total of 20 items. Responses were recorded using a 5-point Likert scale, ranging from 5 (\"definitely yes\") to 1 (\"definitely no\"). The NC subscale includes the cumulative scores of items 2, 4, 6, 7, 10, 12, 13, 16, 17, and 19, with scores exceeding 30.26 ± 8.74 indicating negative coping. Conversely, the PC subscale comprises the cumulative scores of items 1, 3, 5, 8, 9, 11, 14, 15, 18, and 20, with scores exceeding 21.25 ± 7.13 indicating positive coping. In the present study, the overall Cronbach's α of the scale was 0.894, with the NC subscale achieving a Cronbach's α of 0.904 and the PC subscale achieving a Cronbach's α of 0.915.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData Collection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study's objectives, informed consent details, and questionnaire content were incorporated into an electronic questionnaire using a free online survey platform (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.wjx.cn\u003c/span\u003e\u003cspan address=\"https://www.wjx.cn\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). The survey's purpose, intended demographic, and completion methodology were communicated to the head nurses of trauma centers across the nation. Upon obtaining their consent, the questionnaire link was distributed to these head nurses via WeChat (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://weixin.qq.com/\u003c/span\u003e\u003cspan address=\"https://weixin.qq.com/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). The head nurses then coordinated the completion of the questionnaire by trauma nurses who met the inclusion criteria. To prevent duplicate responses, restrictions were set to allow each account and IP address to submit only once. To ensure the questionnaire's completeness, all questions were mandatory for submission. After data collection, two postgraduate nursing students reviewed the submissions, excluding those completed in less than three minutes or with evidently illogical responses.\u003c/p\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eThe potential profile model was established utilizing Mplus 8.3 software. The average scores of the items across the five dimensions of the TVQ were used as explicit indicators. Profiles were incrementally added, and the parameters of each model were analyzed. The optimal model was then selected based on fit indices. The fit indices for the potential profile model are categorized into three groups: (1) Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), and sample Corrected Bayesian Information Criterion (aBIC), where lower values indicate a better model fit [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]; (2) information entropy, with values closer to 1 indicating more accurate classification, and an entropy value of 0.8 suggesting classification accuracy exceeding 90% [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]; and (3) the Lo-Mendell-Rubin adjusted likelihood ratio test (LMRT) and the Bootstrap-based likelihood ratio test (BLRT), where a p-value of less than 0.05 suggests that a model with k categories provides a superior fit compared to a model with k-1 categories [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eUpon selecting the optimal profile model, we employed SPSS version 26.0 to conduct descriptive statistical analyses. Data that did not conform to a normal distribution were represented by medians and quartiles, and intergroup comparisons were performed using the Kruskal-Wallis H test. Categorical data were presented as frequencies and percentages, with comparisons between groups conducted using the chi-square (χ²) test and Fisher's exact test. To investigate the factors influencing the potential profiles of varying vicarious traumatization, multiple logistic regression analysis was utilized. The significance level was set at α = 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eParticipant Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 965 questionnaires were administered, of which 930 were deemed valid, resulting in a valid response rate of 96.37%. The survey participants were drawn from 22 provincial-level administrative regions, including Guizhou, Zhejiang, Xinjiang, Jiangsu, Fujian, Anhui, Guangxi, Guangdong, Yunnan, Heilongjiang, Inner Mongolia, Sichuan, Hunan, Hubei, Hebei, Shanghai, Tianjin, Ningxia, Shanxi, Jiangxi, Jilin, and Shandong. The cohort comprised 598 trauma nurses from Level 3A hospitals, 145 from Level 3B hospitals, and 187 from Level 2 and below hospitals. Among the 930 valid respondents, 785 (84.41%) were female, 698 (75.05%) were married, 805 (86.56%) held a bachelor\u0026apos;s degree, 475 (51.08%) possessed an intermediate professional title, 466 (50.11%) had 6\u0026ndash;10 years of experience in trauma care, and 308 (33.12%) had received psychological trauma training. Further details are provided in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDemographics of trauma nurses based on different vicarious traumatization profiles (N\u0026thinsp;=\u0026thinsp;930).\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOverall (n\u0026thinsp;=\u0026thinsp;930\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eC1(n\u0026thinsp;=\u0026thinsp;329)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eC2(n\u0026thinsp;=\u0026thinsp;487)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eC3(n\u0026thinsp;=\u0026thinsp;114)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eZ/\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHospital level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLevel 3A hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e598\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e310\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e4.291\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.368\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLevel 3B hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLevel 2 and below hospitals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003eWhether or not it is a trauma care center construction unit of the China Trauma Care Alliance\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e664\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e341\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e4.542\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.103\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e266\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e6.543\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.038\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e785\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e275\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e422\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u0026thinsp;~\u0026thinsp;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e334\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e6.971\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.137\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31\u0026thinsp;~\u0026thinsp;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e501\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e269\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e2.716\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.599\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e698\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e253\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e355\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducational background\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJunior college degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e6.532\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e805\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e287\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e417\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaster degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProfessional title\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJunior nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e363\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.487\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.344\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSenior nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e475\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e255\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAssociate senior and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003eYears of experience in trauma care\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u0026thinsp;~\u0026thinsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e466\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e5.430\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.246\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u0026thinsp;~\u0026thinsp;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhether or not you had received psychological trauma training\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e21.618\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e622\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eStressor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29.00(13.50, 51.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53.00(32.00, 70.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70.50(48.00, 80.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e164.381\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eWork Engagement\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.00(41.50, 77.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45.00(28.00, 63.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45.00(30.00, 60.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85.700\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNegative Coping (NC)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.00(14.00, 21.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.00(20.00, 28.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.00(27.75, 33.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e253.213\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePositive Coping (PC)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35.00(28.50, 41.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.00(25.00, 35.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.00(28.00, 34.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58.148\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eNote: a: \u0026chi;\u003csup\u003e2\u003c/sup\u003e, b: z. C1, Low vicarious traumatization group; C2, Medium vicarious traumatization group; C3, High vicarious traumatization group.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eLatent Profile Analysis of Vicarious Traumatization\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe item scores for the VTQ among trauma nurses were as follows: the overall score was 1.86 (1.50, 2.11). Specifically, the item score for the emotional response dimension was 1.89 (1.44, 2.22), the behavioral response dimension was 2.00 (1.57, 2.29), the cognitive response dimension was 1.60 (1.00, 2.00), the beliefs about life dimension was 2.00 (1.67, 2.33), and the physical dimension was 1.73 (1.27, 2.09).\u003c/p\u003e\n\u003cp\u003eFive potential profile models were fitted using the mean scores of the five dimensions of the VTQ as exogenous indicators, with the fitting indicators for each model presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. As the number of models increased, the values of AIC, BIC, and aBIC exhibited a decreasing trend. When the number of categories reached five, the AIC, BIC, and aBIC values were minimized; however, the LMRT test was not statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.640). With four categories, the entropy value was maximized, but the probability percentage for one category was only 1.4%. The entropy value for model 3 was 0.897, exceeding the threshold of 0.800, and both the LMRT and BLRT tests were statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). After a comprehensive comparison of the fitting indices for each model, model 3 was identified as the best-fitting model for this study. The potential profiles were plotted based on the categorization results, as depicted in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. The three potential profiles of vicarious traumatization among trauma nurses displayed no intersections and exhibited relatively consistent morphological trends across the entries.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eIndexes for fitting the model of LPA in vicarious traumatization.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eModel\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAIC\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eBIC\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eaBIC\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eEntropy\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eProbabilities of classes\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLMRT\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBLRT\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8769.684\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8818.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8786.277\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6769.081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6846.444\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6795.630\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.940\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.811/0.189\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" class=\"fr-cell-fixed \"\u003e\n \u003cp\u003e\u003cspan style=\"color: rgb(226, 80, 65);\"\u003e3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cspan style=\"color: rgb(226, 80, 65);\"\u003e5563.405\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cspan style=\"color: rgb(226, 80, 65);\"\u003e5669.779\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cspan style=\"color: rgb(226, 80, 65);\"\u003e5599.909\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan style=\"color: rgb(226, 80, 65);\"\u003e0.037\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan style=\"color: rgb(226, 80, 65);\"\u003e0.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan style=\"color: rgb(226, 80, 65);\"\u003e0.897\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" class=\"fr-cell-handler \"\u003e\n \u003cp\u003e\u003cspan style=\"color: rgb(226, 80, 65);\"\u003e0.354/0.524/0.122\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5088.770\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5224.155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5135.230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.927\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.309/0.014/0.527/0.150\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4804.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4968.413\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4860.433\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.640\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.915\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.294/0.478/0.129/0.088/0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\"\u003eAbbreviations: aBIC, sample-size adjusted Bayesian Information Criterion; AIC, Akaike Information Criterion; BIC, Bayesian Information Criterion; BLRT, Bootstrapped Likelihood Ratio Test; LMRT, Lo\u0026ndash;Mendell\u0026ndash;Rubin Adjusted Likelihood Ratio Test.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe initial profile comprised 35.38% of trauma nurses who exhibited the lowest scores on the cognitive response dimension, and was designated as the low vicarious traumatization group. The subsequent profile encompassed 52.37% of trauma nurses, also scoring lowest on the cognitive response dimension, and was identified as the medium vicarious traumatization group. The final profile consisted of 12.25% of trauma nurses who recorded the lowest scores on both the emotional and behavioral response dimensions, and was termed the high vicarious traumatization group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis of Factors Influencing the Potential Profile of Vicarious Traumatization for Trauma Nurses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates statistically significant differences among trauma nurses across the three profile categories concerning gender (\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;6.543, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.038), psychological trauma training (\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;21.618, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.038), stressor (z\u0026thinsp;=\u0026thinsp;164.381, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), work engagement (z\u0026thinsp;=\u0026thinsp;85.700, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), negative coping (z\u0026thinsp;=\u0026thinsp;253.213, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and positive coping (z\u0026thinsp;=\u0026thinsp;58.148, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003cp\u003eSubsequently, variables that demonstrated statistical significance were incorporated into an unordered multinomial logistic regression model. The independent variables included stressor (original input), work engagement (original input), negative coping (original input), positive coping (original input), gender (coded as male\u0026thinsp;=\u0026thinsp;1, female\u0026thinsp;=\u0026thinsp;2, with \u0026quot;female\u0026quot; serving as the reference group), and psychological trauma training (coded as yes\u0026thinsp;=\u0026thinsp;1, no\u0026thinsp;=\u0026thinsp;2, with \u0026quot;no\u0026quot; serving as the reference group). The findings suggest that, when comparing the mid-vicarious traumatization group to the low-vicarious traumatization group, higher scores in psychological trauma training (OR\u0026thinsp;=\u0026thinsp;0.601, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005), work engagement (OR\u0026thinsp;=\u0026thinsp;0.977, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and positive coping (OR\u0026thinsp;=\u0026thinsp;0.952, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were associated with an increased likelihood of being classified in the low-vicarious traumatization group. Conversely, elevated scores in stressors (OR\u0026thinsp;=\u0026thinsp;1.029, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and negative coping (OR\u0026thinsp;=\u0026thinsp;1.128, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were linked to a greater probability of belonging to the mid-vicarious traumatization group. Furthermore, when comparing the high-vicarious traumatization group to the low-vicarious traumatization group, being male (OR\u0026thinsp;=\u0026thinsp;2.211, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.025), along with higher scores in psychological trauma training (OR\u0026thinsp;=\u0026thinsp;0.428, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005), work engagement (OR\u0026thinsp;=\u0026thinsp;0.968, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and positive coping (OR\u0026thinsp;=\u0026thinsp;0.896, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), were associated with an increased likelihood of classification in the low-vicarious traumatization group. In contrast, higher scores in stressors (OR\u0026thinsp;=\u0026thinsp;1.050, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and negative coping (OR\u0026thinsp;=\u0026thinsp;1.300, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were associated with a greater probability of being categorized in the high-vicarious traumatization group. Then, when comparing the mid-vicarious traumatization group to the high-vicarious traumatization group, it was found that higher scores in positive coping (OR\u0026thinsp;=\u0026thinsp;1.062, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were more likely to be associated with the mid-vicarious traumatization group. Conversely, higher scores in female gender (OR\u0026thinsp;=\u0026thinsp;0.462, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008), stressors (OR\u0026thinsp;=\u0026thinsp;0.979, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and negative coping (OR\u0026thinsp;=\u0026thinsp;0.867, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were more likely to be associated with the high-vicarious traumatization group. For further details, refer to Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eLogistic regression of different vicarious traumatization profiles.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWald X\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eC2 (ref. C1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConstant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.578\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.419\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.903\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eStressor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e57.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.021\u0026thinsp;~\u0026thinsp;1.036\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eWork Engagement\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23.981\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.977\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.969\u0026thinsp;~\u0026thinsp;.986\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNegative Coping (NC)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e73.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.097\u0026thinsp;~\u0026thinsp;1.159\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePositive Coping (PC)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.952\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.928\u0026thinsp;~\u0026thinsp;0.977\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.247\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.935\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.628\u0026thinsp;~\u0026thinsp;1.657\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePsychological trauma training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.510\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.817\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.601\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.420\u0026thinsp;~\u0026thinsp;0.859\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eC3 (ref. C1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConstant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-4.959\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.706\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e49.371\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eStressor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e70.246\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.050\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.038\u0026thinsp;~\u0026thinsp;1.063\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eWork Engagement\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.469\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.968\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.954\u0026thinsp;~\u0026thinsp;0.984\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNegative Coping (NC)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e111.627\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.239\u0026thinsp;~\u0026thinsp;1.365\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePositive Coping (PC)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.295\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.896\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.848\u0026thinsp;~\u0026thinsp;0.947\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.793\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.354\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.025\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.104\u0026thinsp;~\u0026thinsp;4.427\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsychological trauma training\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.850\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.304\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.817\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.428\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.236\u0026thinsp;~\u0026thinsp;0.776\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eC2 (ref. C3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConstant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.382\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.616\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e50.559\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eStressor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.761\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.979\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.970\u0026thinsp;~\u0026thinsp;0.989\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWork Engagement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.784\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.996\u0026thinsp;~\u0026thinsp;1.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNegative Coping (NC)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42.998\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.867\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.831\u0026thinsp;~\u0026thinsp;0.905\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePositive Coping (PC)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.339\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.021\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.009\u0026thinsp;~\u0026thinsp;1.118\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.773\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.943\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.462\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.260\u0026thinsp;~\u0026thinsp;0.820\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePsychological trauma training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.340\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.266\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.632\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.405\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.834\u0026thinsp;~\u0026thinsp;2.367\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003e\u003cem\u003eNote\u003c/em\u003e: C1, Low vicarious traumatization group; C2, Medium vicarious traumatization group; C3, High vicarious traumatization group; ref., reference group; \u003cem\u003eB\u003c/em\u003e, unstandardized coefficient; bold numbers: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eAbbreviations: CI, confidence interval; OR, odds ratio.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study identified significant differences in the profiles of vicarious traumatization among trauma nurses, which can be classified into three distinct categories: low vicarious traumatization group (35.38%), medium vicarious traumatization group (52.37%), and high vicarious traumatization group (12.25%). The findings offer novel empirical insights into how variables such as gender, psychological trauma training, stressors, work engagement, positive coping, and negative coping influence the various levels of vicarious traumatization. These insights provide valuable evidence for the development of targeted interventions aimed at reducing the incidence of vicarious traumatization among nurses.\u003c/p\u003e\u003cp\u003e\u003cb\u003eImpact of gender\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn this study, gender emerged as a significant factor influencing the prevalence of high vicarious traumatization among trauma nurses, aligning with findings from previous research [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. This phenomenon may be attributed to the greater sensitivity of female nurses to emotional experiences, which often results in heightened empathy and sympathy. Consequently, female nurses may find it more challenging or time-consuming to detach from negative emotions [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. When caring for trauma patients, female nurses tend to exhibit greater empathy than their male counterparts, thereby absorbing more emotional stress from patients and increasing their susceptibility to vicarious traumatization. Therefore, it is imperative to acknowledge and address the gender-based differences in vicarious traumatization within clinical practice to safeguard the mental health of nursing professionals. To more effectively mitigate the incidence of vicarious traumatization among female nurses, it is recommended that management establish robust communication channels tailored specifically for this demographic, conduct regular mental health assessments, and offer essential psychological support services. Furthermore, the implementation of targeted psychological training programs could be beneficial in equipping female nurses with strategies to better manage the psychological challenges encountered in their professional roles.\u003c/p\u003e\u003cp\u003e\u003cb\u003eImpact of psychological trauma training\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn this study, the absence of psychological trauma training emerged as a significant factor influencing both the low and high vicarious traumatization groups among trauma nurses. This may be attributed to the tendency of nurses without such training to harbor unrealistic perceptions regarding clinical and social dimensions, thereby experiencing heightened negative impacts from traumatic events [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. According to Social Cognitive Theory [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], structured training programs can substantially facilitate the deconstruction and reconstruction of individual cognitive schemas through self-regulatory mechanisms and observational learning processes. Implementing psychological trauma training can assist nurses in the early identification of somatization symptoms associated with vicarious traumatization. This understanding allows them to recognize vicarious traumatization as a normal adaptive process and to employ appropriate protective intervention strategies to mitigate the impact of trauma exposure. A scoping review by Kim et al. [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] highlighted that psychological education, including interventions such as cognitive behavioral therapy, professional skills training, and peer support networks, is effective in addressing vicarious traumatization. Furthermore, research by P\u0026eacute;rez et al. [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] demonstrated that online mindfulness training significantly reduces compassion fatigue and burnout among nurses. Consequently, nursing managers must implement psychological education programs focused on vicarious traumatization to effectively prevent and manage its occurrence among nursing staff.\u003c/p\u003e\u003cp\u003e\u003cb\u003eImpact of Work Engagement\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn this study, a low level of work engagement emerged as a significant factor influencing trauma nurses in both the low and high vicarious traumatization groups. Work engagement, characterized by energy, dedication, and focus, enabled nurses with high engagement levels to deliver superior quality care and achieve improved patient outcomes [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. According to the Conservation of Resources Theory (COR) [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e], individuals facing work-related stress evaluate whether to invest additional resources through a process termed \"resource trade-off.\" A decline in work engagement may lead employees to conserve their resources by reducing their organizational resource expenditure, thereby increasing the risk of experiencing vicarious traumatization [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Research has demonstrated a significant negative correlation between work engagement and job burnout, indicating that high job engagement can mitigate the adverse effects of occupational stress on burnout by enhancing psychological capital [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. At the organizational level, work engagement has been shown to enhance efficiency and improve performance [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. On an individual level, work engagement contributes to increased job satisfaction and a reduction in job burnout [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. A cross-sectional survey conducted by Zhong et al. [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e] revealed that nurses in China exhibit a moderate level of work engagement, which is notably lower than that of their international counterparts. Consequently, nursing managers must prioritize the cultivation of trauma nurses' enthusiasm for trauma care, emphasizing its significant impact on patient health and social well-being. By doing so, they can enhance nurses' work engagement and help mitigate the effects of vicarious traumatization.\u003c/p\u003e\u003cp\u003e\u003cb\u003eImpact of stressor\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn this study, stressors emerged as significant influencing factors for vicarious traumatization among trauma nurses. This finding aligns with the research conducted by Li [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], which identified stress load as a risk factor impacting vicarious traumatization in emergency nurses. Stressors are defined as situations, stimuli, activities, and events that elicit a stress response in individuals [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Trauma nurses are frequently required to deliver prompt care to patients who have undergone traumatic incidents. These patients, confronted with life-threatening conditions, necessitate urgent medical intervention. The high-pressure and rapid nature of this work environment has emerged as a significant stressor for trauma nurses. Additional stressors arise from the patients' family members, who frequently experience anxiety and a sense of helplessness in response to the sudden traumatic events affecting their loved ones. Consequently, trauma nurses are often required to engage in more empathetic interactions with these family members. However, due to the demanding nature of their work, characterized by extended hours and high workloads, trauma nurses typically have limited opportunities for physical and mental relaxation, as well as emotional management. This lack of respite can impede their ability to effectively address the cascade of negative emotions that may arise during the rescue process. The aforementioned factors represent specific stressors encountered by trauma nurses. Prolonged exposure to elevated stress levels can result in job burnout and compassion fatigue [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], which may subsequently lead to the development of vicarious traumatization. Consequently, it is imperative for management to promptly identify these stressors, offer timely psychological counseling, and implement preventive measures to mitigate the risk of vicarious trauma among trauma nurses.\u003c/p\u003e\u003cp\u003e\u003cb\u003eImpact of Coping Style\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn this study, coping style was identified as a significant factor influencing vicarious traumatization among trauma nurses. This finding aligns with the research conducted by Li et al. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], which demonstrated that positive coping was associated with lower levels of vicarious traumatization, whereas negative coping correlated with higher levels. According to the Transactional Model of Stress, individuals facing stressors, such as exposure to others' traumatic events, engage in cognitive appraisal to assess the nature of the stressors and their coping capabilities, subsequently selecting appropriate coping strategies [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Coping styles are categorized into positive and negative types, with each having distinct impacts on the physical and mental well-being of healthcare professionals. Positive coping styles serve as protective mechanisms, facilitating the maintenance of favorable emotional experiences. In contrast, negative coping styles exacerbate negative emotions and can lead to anxiety, depression, and psychological trauma [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. A study conducted by Rabie et al. [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e] demonstrated that the coping styles of nurses serve as a fundamental intervention mechanism for alleviating post-traumatic psychological stress and emotional disorders. Positive coping styles are particularly significant for the mental health of nurses as they navigate the adverse effects of traumatic events during epidemics [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. The findings of this research further underscore the importance of employing positive coping strategies as essential resources for mitigating psychological distress [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e], thereby aiding healthcare professionals in alleviating the detrimental consequences of vicarious traumatization. Nurses frequently operate in high-pressure environments, such as emergency departments, intensive care units (ICUs), and operating rooms. In the context of dynamically monitoring patients with severe trauma, they are required to make critical clinical decisions while simultaneously addressing the psychological needs of those patients. The ongoing emotional labor involved in this work renders nurses susceptible to vicarious traumatization, highlighting the necessity for positive coping styles to buffer against occupational psychological trauma. Consequently, management must develop and implement strategies aimed at enhancing nurses' coping styles and overall well-being.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStrengths and Limitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis research presents several notable advantages. First, it employs a novel research methodology\u0026mdash;potential profile analysis. Second, the study was conducted on a national scale, utilizing a large sample size that enhances the reliability and representativeness of the findings. Lastly, the results offer valuable insights for nursing managers, enabling them to develop personalized intervention strategies and implement more effective training and support measures. However, the study is not without its limitations. First, the use of an online survey platform allowed participants to self-evaluate, which may have introduced subjective biases that could compromise the authenticity and accuracy of the data. Second, due to financial constraints, the research employed a convenience sampling method, which may limit the generalizability of the findings. Finally, the study focused solely on a cross-sectional analysis of the vicarious traumatization experienced by trauma nurses, neglecting to account for the temporal dynamics that may influence the trajectory of their vicarious traumatization over time.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThrough a potential profile analysis conducted in this study, three distinct categories of trauma nurses were identified: the low-vicarious traumatization group, the medium-vicarious traumatization group, and the high-vicarious traumatization group. The findings showed a significant prevalence of vicarious traumatization among trauma nurses, with most developing substantial occupational trauma risks during their work in trauma care. These results emphasized the emotional labor involved in trauma care and highlighted the urgent need for implementing appropriate intervention strategies to address the mental health challenges faced by trauma nurses. Additionally, the study identified several factors influencing vicarious traumatization among trauma nurses, including gender, psychological trauma training, stressor, work engagement, and coping style. These insights offered a foundation for developing targeted intervention strategies. Moving forward, it was crucial for management to closely monitor the emotional stress levels of female nurses and provide timely stress-relief resources. Moreover, regular psychological trauma training should be conducted to help nurses understand that vicarious traumatization is a normal adaptive response and to facilitate early detection of related physical symptoms.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eWHO World Health Organization\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePTSD Posttraumatic Stress Disorder\u003c/p\u003e\n\u003cp\u003eLPA Latent Profile Analysis\u003c/p\u003e\n\u003cp\u003eSTROBE Strengthening the Reporting of Observational Studies in Epidemiology\u003c/p\u003e\n\u003cp\u003eVTQ Vicarious Traumatization Questionnaire\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUWES Utrecht Work Engagement Scale\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSSEN Stressor Scale for Emergency Nurses\u003c/p\u003e\n\u003cp\u003eTCSQ Trait Coping Style Questionnaire\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eICU intensive care unit\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eICUs intensive care units\u003c/p\u003e\n\u003cp\u003eAIC Akaike Information Criterion\u003c/p\u003e\n\u003cp\u003eBIC Bayesian Information Criterion\u003c/p\u003e\n\u003cp\u003eaBIC sample Corrected Bayesian Information Criterion \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLMRT Lo-Mendell-Rubin adjusted likelihood ratio test\u003c/p\u003e\n\u003cp\u003eBLRT Bootstrap-based likelihood ratio test\u003c/p\u003e\n\u003cp\u003eCOR Conservation of Resources Theory\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003e This study received approval from the Ethics Committee of Tongji Hospital, Tongji Medical College, University of Science and Technology of China (TJ-IRB202405026). Informed consent was deemed to have been obtained from all participants upon their completion and successful submission of the questionnaire, indicating their comprehensive understanding of the study. The questionnaire was administered anonymously, ensuring that participants' data remained confidential and were not disclosed. Furthermore, participants retained the right to withdraw from the study at any point.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThe study was not funded.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eM.F. was the first author. X.L. and X.P.L. contributed equally and shared the corresponding authorship. M.F., X.L., and X.P.L. conceived and designed the study. M.F. and X.L. collected the data. M.F., Z.J.H., and Y.F.Z. analyzed and interpreted the data. M.F. wrote the original draft of the manuscript. All authors contributed to reviewing and editing the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to express their gratitude to the clinical nurses who participated in this study.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\u003cp\u003eThe datasets used during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. 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The mediating role of coping styles in the relationship between fear of COVID-19 and mental health problems: a cross-sectional study among nurses. BMC Public Health. 2024;24(1):545.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePiras I, Usai V, Contu P, Galletta M. Vicarious trauma, coping strategies and nurses' health outcomes: An exploratory study. AIMS public health. 2024;11(4):1071\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Vicarious traumatization, Nurse༛Latent profile analysis, Stressor, Work engagement, Coping style","lastPublishedDoi":"10.21203/rs.3.rs-7253913/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7253913/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eAim\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTrauma nurses are susceptible to vicarious traumatization, which may substantially undermine their physical and mental well-being, as well as their capacity to provide high-quality care. This study employed latent profile analysis to examine the latent profiles of vicarious traumatization among trauma nurses and to identify the factors influencing these profiles.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study employed a cross-sectional design. A convenience sampling method was used to select 930 trauma nurses from 22 provincial administrative regions in China, with data collection occurring from August 2024 to February 2025. Data were gathered using a general information questionnaire, the Vicarious Traumatization Questionnaire, the Utrecht Work Engagement Scale, the Stressor Scale for Emergency Nurses, and the Trait Coping Style Questionnaire. Latent profile analysis was applied to assess the characteristics of vicarious traumatization among trauma nurses, and the factors influencing these latent profiles were determined through univariate analysis and multinomial logistic regression. Data analysis was conducted using Mplus version 8.3 and SPSS version 26.0.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study included a total of 930 trauma nurses, achieving an effective questionnaire response rate of 96.37%. The vicarious traumatization score among these nurses was 70.50 (interquartile range: 57.00, 80.25). Vicarious traumatization was categorized into three latent groups: low vicarious traumatization group (35.38%), medium vicarious traumatization group (52.37%), and high vicarious traumatization group (12.25%). Disordered multi-class logistic regression analysis identified several influencing factors for the latent profiles of vicarious traumatization, including female gender, stressors, work engagement, positive coping style, and negative coping style (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study identified substantial heterogeneity in the vicarious traumatization experienced by trauma nurses. Nursing managers are encouraged to use the identified profiles and influencing factors of vicarious traumatization to prioritize support for trauma nurses who are female, experience high levels of stressors, demonstrate low work engagement, utilize negative coping strategies, and lack psychological trauma training. It is recommended that hospital administrators implement targeted intervention strategies to mitigate the levels of vicarious traumatization among nursing staff. This study's findings illuminated the potential characteristics and influencing factors of vicarious traumatization among trauma nurses, providing a new perspective for the formulation of customized intervention strategies.\u003c/p\u003e","manuscriptTitle":"The current situation and influencing factors of vicarious traumatization among trauma nurses: A latent profile analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-11 12:51:59","doi":"10.21203/rs.3.rs-7253913/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e0f4fd1e-b191-4422-b6ee-3710a77529ea","owner":[],"postedDate":"September 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-06T10:53:56+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-11 12:51:59","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7253913","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7253913","identity":"rs-7253913","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}