Exploring Trauma Recovery in Nurses: A Text Mining and Thematic Analysis Based on Swanson’s Theory of Caring

Exploring Trauma Recovery in Nurses: A Text Mining and Thematic Analysis Based on Swanson’s Theory of Caring | 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 Exploring Trauma Recovery in Nurses: A Text Mining and Thematic Analysis Based on Swanson’s Theory of Caring Jinyoung Park, Go-Un Kim, Sunah Kim This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5315927/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 12 Mar, 2025 Read the published version in BMC Nursing → Version 1 posted 13 You are reading this latest preprint version Abstract Background Nurses are frequently exposed to workplace trauma, placing them at a heightened risk of post-traumatic stress disorder. However, targeted interventions to promote psychological recovery among nurses are limited. This study explored the trauma recovery experiences of nurses who participated in an Internet-based Trauma Recovery Nursing Intervention (IBTRNI), based on Swanson’s Theory of Caring. The objective was to identify the emotional and psychological changes experienced by participants through a combination of text mining and thematic analysis. Methods Secondary analysis was conducted on free-text responses from 102 nurses who completed IBTRNI. Text mining identified high-frequency keywords, while thematic analysis provided deeper emotional and psychological insights. The analysis was structured around Swanson’s three phases: “Knowing,” “Doing For,” and “Enabling.” Results In the “Knowing phase,” the participants demonstrated increased self-awareness, recognizing their emotional responses and the effects of negative thoughts on daily life. The “Doing For” phase revealed enhanced emotional regulation, where participants learned to manage and transform negative emotions into positive ones. Finally, the “Enabling” phase highlighted improvements in interpersonal relationships, and the adoption of effective coping mechanisms such as communication and meditation to manage stress. Conclusions Swanson’s Theory of Caring provides a robust framework for supporting nurses' trauma recovery. The combination of text mining and thematic analysis offers a comprehensive understanding of the emotional and psychological transformations experienced during the intervention. The findings underscore the potential for theory-based digital interventions to support trauma recovery among healthcare professionals. Future research should expand on these methodologies to enhance their broader applicability. Trial registration This study involved secondary data analysis. The primary study was registered at ClinicalTrials.govUS National Library of Medicine (clinical trial registration number NCT04989582) on 20220131 and is available online. psychological trauma psychosocial intervention nurses Swanson’s Theory of Caring Figures Figure 1 Background Post-traumatic stress disorder (PTSD) is a mental health condition stemming from direct or indirect exposure to traumatic events [ 1 ]. Nurses are particularly vulnerable considering their repeated exposure to traumatic situations during work, including caring for patients with both physical and psychological trauma [ 2 ]. High rates of PTSD have been documented among nurses in critical care fields such as intensive care, emergency care, and oncology [ 3 ]. Moreover, in the process of empathetic listening and providing care, nurses face the risk of secondary traumatic stress, further exacerbating their vulnerability [ 4 ]. Nurses also experience first-hand trauma driven by the prevalence of workplace violence in healthcare settings. Nurses experience workplace violence at higher rates than other professionals, negatively affecting both their physical and mental health [ 5 , 6 ]. If left unresolved, the cumulative stress from patient care and workplace abuse could lead to severe mental health issues, including depression, anxiety, and PTSD, significantly impacting job performance and personal well-being [ 7 ]. Despite these challenges, there are limited interventions aimed at promoting post-traumatic recovery, particularly those tailored for healthcare professionals [ 8 ]. Accordingly, it is imperative to implement effective and accessible interventions as well as online recovery programs [ 9 , 10 ]. For example, Kim et al. [ 11 ] implemented an Internet-based trauma recovery nursing intervention (IBTRNI) based on Swanson’s Theory of Caring [ 12 ], which showed significant improvements in nurses' mental health and resilience through quantitative measures. However, while quantitative findings seem valuable, they often fail to capture the complexity of participants' experiences. To understand the nuances of such interventions, a combination of quantitative and qualitative approaches is necessary [ 13 ]. Traditional qualitative analysis methods such as manual coding, discourse analysis, and grounded theory are time-consuming and labor-intensive, thereby making them inefficient for large-scale data analysis [ 14 ]. Automated approaches such as text mining have emerged to address these limitations, efficiently processing large volumes of text data [ 15 ]. Abbe et al. [ 16 ] underscored the benefits of integrating text mining with traditional qualitative methods, emphasizing its ability to enhance insight depth and breadth. Nevertheless, text mining alone may not fully capture the emotional and psychological complexities of participants' experiences. Therefore, thematic analysis was employed to provide a comprehensive interpretation of the data and uncover latent meanings. Braun and Clarke [ 17 ] argue that thematic analysis offers a flexible and systematic approach to qualitative data analysis, making it a valuable method for exploring patterns in psychological research. Therefore, this study aims to comprehensively analyze nurses' experiences in IBTRNI using a combination of text mining and thematic analysis, ensuring both efficient data processing and comprehensive exploration of participants' emotional and psychological processes. Methods Study design This study employed a secondary data analysis approach to systematically analyze the responses of nurses who participated in IBTRNI during each session from a previous study [ 11 ]. Text mining was employed to analyze session-based responses, extracting keywords and using word cloud visualization to effectively identify major patterns within the responses. Additionally, thematic analysis was conducted to explore the deeper meanings and emotional changes embedded in the responses from each session. The qualitative approach adopted a constructivist paradigm [ 18 ], to understand participants' experiences as shaped by personal meaning-making processes. This allowed for a comprehensive exploration of the emotional and psychological recovery process, recognizing subjective experiences as socially constructed. Participants Participants in this study included 102 general nurses. Initially, 112 nurses were recruited for the primary study, but the secondary analysis included only 102 nurses who completed the intervention. The inclusion criteria (applied in the primary study) were: 1) aged 23–40, 2) self-score greater than 80% (64 points) on the Korean version of the PTSD Checklist, 3) ability to access the program through a mobile device, 4) understand the purpose of the study and voluntarily agree to participate, and 5) has not been diagnosed with a mental illness and is not on related drugs. Intervention: Internet-based trauma recovery nursing intervention (IBTRNI) The IBTRNI was developed by the primary research team using Swanson’s theoretical framework [ 12 , 19 ]. The secondary analysis analyzed these sessions through session-specific questions, focusing on three key concepts: “Knowing,” “Doing For,” and “Enabling.” Knowing emphasized self-understanding and self-respect, Doing For focused on self-acceptance and release of negative emotions, and Enabling centered on effective communication and stress management [ 11 , 19 ]. Nurses participating in the study responded to these questions in the online program, which allowed them to explore their thoughts and feelings in relation to the goals of individual sessions. Researchers communicated with the participants throughout the intervention by providing feedback after each session and offering ongoing emotional support. At the end of each theory-based section, the participants were provided with the opportunity to express their experiences and reflections on how they had changed. These reflective questions were designed to encourage nurses to assess their emotional and psychological changes during the recovery process, allowing for personal and subjective insights. For a detailed overview of these theory-based questions, refer to Table 1 . Table 1 Theory-Based Questions in the IBTRNI Program Theory (Session) Question Knowing (1 ~ 2) What new things did you learn about yourself, and what do you expect from yourself? How is that emotional distress affecting your current daily life? Doing (3 ~ 5) What did you learn or what was helpful to you during this session? What can you do to experience more positive emotions in your daily life? Enabling (6 ~ 8) Over the past week, was there a situation where you believe you handled stress well? If so, describe the situation and how you managed it. After completing this program, what would you like to continue applying it to your daily life? Data collection and ethical considerations Secondary analysis was conducted using data from a primary study [ 11 ]. Institutional Review Board (IRB) approval was obtained for the secondary analysis (IRB No. Y-2021-0790) from X-University (blinded for review). Participants in the primary study were informed of the current study and provided consent for the use of their responses in secondary data analysis. Data analysis We employed a combination of text mining and thematic analysis to systematically analyze nurses' responses. For text mining, we used R (version 4.2.2), a widely-recognized tool for processing unstructured data [ 20 ]. The KoNLP (Korean Natural Language Processing) package and NIADic dictionary are well-established tools for processing Korean text; however, they may have limitations in capturing certain contextual nuances specific to this study's dataset. To ensure accurate analysis, the research team conducted additional post-processing and manual validation. Contextually-significant terms that were not included in the dictionary (e.g., "I-message") were incorporated based on the consensus of the research team, ensuring their relevance to the study objectives. Common data pre-processing steps were taken, including elimination of duplicate and meaningless words (e.g., copulas, adjectives, adverbs) by designating them as stop words. Words that did not contribute to the overall context or analysis, such as frequently occurring function words (e.g., "있다," "하다"), were also excluded. In cases where contextually-significant terms did not appear in the dictionary (e.g., "I-message"), the research team reached a consensus to include them as unique terms, based on their relevance to the themes of trauma recovery and emotional processing. The cleaned data was then visualized using ggplot, through bar graphs and word clouds, to identify key patterns and high-frequency keywords. To complement the text mining analysis, thematic analysis was conducted following the six-phase approach outlined by Braun and Clarke (2006) [ 17 ]. Text mining identified high-frequency words from the participants' responses, and corresponding sentences were subsequently extracted for further qualitative analysis. The researchers familiarized themselves with the extracted sentences through repeated reviews. Three team members independently performed initial coding, systematically identifying meaningful text segments. The coding process, facilitated using Excel, involved breaking down each response into meaningful units and assigning descriptive codes to capture recurring patterns. Subsequently, the researchers convened to resolve any discrepancies in coding, ensuring inter-coder reliability. Once a consensus was reached, the codes were grouped into overarching themes that accurately reflected nurses’ emotional and psychological experiences during the intervention. These broader themes were reviewed iteratively to ensure consistency and alignment with the study objectives. The thematic analysis was conducted within the framework of Swanson’s Caring Theory, which served as the basis for both intervention design and analysis of participants' responses. This theoretical approach guided the coding and categorization of themes throughout the analysis. Swanson’s three key concepts—"Knowing,” “Doing For,” and “Enabling”—were employed to categorize participants' responses, facilitating the evaluation of how well the intervention aligned with the intended theoretical goals. Results Demographic characteristics of the participants The characteristics of the participants are presented in Table 2 . The mean age of participants was 31.04 (SD = 4.50), ranging from 22 to 40. Females accounted for a majority of participants (96.1%), and the distribution of religious affiliation was evenly split, with 50% identifying themselves as religious. Most participants were single (60.8%), with 38.2% being married and 1.0% separated, widowed, or divorced. Regarding educational background, 75.5% had attained a college degree or higher, and 24.5% had completed graduate school. The vast majority (90.2%) were currently employed, with 33.3% having 5–10 years of work experience and 27.5% having 10 or more years of experience. Table 2 Demographic Characteristics of the Participants (N = 102) Variables Categories N (%) Mean (SD) Age (years) 31.04 (4.50) (Range: 22–40) Gender Men 4 (3.9) Women 98 (96.1) Religion Yes 51 (50.0) No 51 (50.0) Marital status Single 62 (60.8) Married 39 (38.2) Separated, widowed, or divorced 1 (1.0) Education level College or higher 77 (75.5) Graduate school or higher 25 (24.5) Current employment Current 92 (90.2) None or past 10 (9.8) Working experience < 3 years 19 (18.6) 3–< 5 years 21 (20.6) 5–< 10 years 34 (33.3) ≥ 10 years 28 (27.5) Keyword and thematic analyses of trauma recovery experiences: applying Swanson's Theory of Caring This study explored the trauma recovery experiences of nurses who participated in the IBTRINI program. Participants' free-text responses were analyzed using a combination of text mining and thematic analysis, based on Swanson's three key concepts: “Knowing,” “Doing For,” and “Enabling.” Text mining efficiently processed large volumes of data to identify key patterns and frequently recurring keywords, while thematic analysis explored underlying emotional and psychological meanings behind these patterns. The complementary approach of text mining and thematic analysis provided a comprehensive understanding of the complex nature of participants' recovery experiences. Figure 1 illustrates the top 10 keywords identified at each stage of the program, representing the most frequently mentioned terms by the participants during each phase. In addition to bar charts, word clouds visually depict the relative frequency of these keywords. Insert Fig. 1 about here. The Knowing Phase (Session 1 – 2) The “Knowing” phase focused on enhancing self-awareness and recognizing personal strengths. Text mining identified keywords such as thoughts, strength, trifles, gratitude, and self-control, reflecting participants' focus on their emotional state and personal development. Theme 1: Self-awareness The participants reported an increased awareness of their emotional responses and thought patterns, which facilitated the recognition of the impact of negative thoughts on their daily lives. "I didn’t realize how many negative thoughts I had until this session made me aware of them." "I always believed that I was strong, but through this program, I realized how emotionally vulnerable I was." Additionally, the participants expressed a newfound appreciation of their strengths and the smaller, often overlooked, positive aspects of their lives, which contributed to their emotional resilience. "I now try to appreciate even the small things in my life, and that’s a huge change for me." "Reflecting on my strengths made me appreciate even the trifles that I used to overlook." The Doing For Phase (Session 3 – 5) The “Doing For” phase centered on emotional regulation and behavioral transformation. Text mining revealed keywords such as positive, change of thought, behavior, emotion, and experience, indicating participants' efforts to manage emotional responses and modify their behaviors. Theme: Emotional Regulation The participants learned strategies to manage negative emotions and shift their responses toward more positive outcomes. Emotional regulation was crucial for behavioral changes and stress management. "I started focusing more on positive thoughts and how they influenced my emotions, which helped me manage stress." "One of the biggest changes was learning to shift my emotions from negative to positive and recognizing how that impacted my behavior." By practicing emotional regulation, participants gained better control over their behaviors, allowing them to handle stress effectively and respond proactively in challenging situations. "Now, when I face stressful situations, I change my thoughts and behavior before reacting emotionally." "This experience taught me how to control my emotions and modify my behavior in difficult situations." The Enabling Phase (Session 6 – 8) In the “Enabling” phase, the participants developed improved communication skills and stress management techniques. Text mining identified keywords such as conversation, daily life management, situation, meditation, and communication, reflecting a focus on managing interpersonal relationships and daily stressors. Theme: Interpersonal Relationships The participants reported significant improvements in their interpersonal relationships, facilitated by enhanced communication skills and effective stress management strategies. Meditation was frequently mentioned as a tool that helped participants regulate emotions and engage more positively with others. "Through meditation, I’ve been able to control my emotions, and it’s made conversations with others much easier." "I’ve learned not to always be defensive in conversations, which has improved my relationships." Moreover, the participants reported better management of daily life and stress, which empowered them to navigate challenging situations with ease. "Stress used to overwhelm me, but now I manage it through meditation and self-care." "I’ve started managing my daily life effectively, and when stressful situations arise, I feel more in control." Discussion This study employed a combination of text mining and thematic analysis to explore the trauma recovery experiences of nurses who participated in an Internet-based trauma recovery nursing intervention (IBTRNI), which used Swanson’s Theory of Caring as the guiding framework. This approach provided an in-depth understanding of the emotional and psychological recovery processes, where text mining efficiently processed large volumes of data to identify key patterns, and thematic analysis enabled deeper exploration of participants' experiences and emotional shifts. In the “Knowing” phase, the dominant theme of self-awareness emerged. Text mining revealed keywords such as thoughts, strength, gratitude, and self-control, reflecting participants’ increased awareness of their emotional state and personal development. This self-awareness is critical in trauma recovery, as recognizing the impact of negative thoughts on daily life is a vital step toward emotional resilience. Prior research supports the importance of self-reflection in promoting emotional recovery, where acknowledging personal strengths plays a central role in fostering well-being [ 21 ]. Swanson’s concept of “Knowing” emphasizes the value of self-understanding and self-respect, which aligns closely with these findings [ 12 ]. The “Doing For” phase focused on emotional regulation and behavioral transformation, which were central themes identified through both keywords and thematic analysis. Keywords such as positive thinking, behavioral change, and emotional control were highlighted, illustrating the cognitive and emotional shifts that participants experienced. This aligns with previous studies that emphasized the role of cognitive restructuring in trauma recovery [ 22 , 23 , 24 ]. Through this phase, participants successfully managed their emotions, transitioning from negative to positive emotional responses, which facilitated meaningful behavioral changes. The theme of emotional regulation is consistent with Swanson’s theory, where “Doing For” involves actively supporting emotional and psychological well-being through nurturing actions. The “Enabling” phase revealed the theme of interpersonal relationships and stress management. Text mining identified keywords such as conversation, meditation, and stress management, indicating that participants applied learned coping mechanisms to manage their stress and improve their relationships. The integration of these techniques into daily practice facilitated better emotional regulation and strengthened participants’ social interactions. This finding is supported by existing literature, which highlights the importance of communication and stress management strategies in enhancing emotional stability during trauma recovery [ 25 , 26 ]. In line with Swanson’s “Enabling” concept, participants demonstrated increased ability to manage interpersonal relationships and effectively navigate stressful situations. The combination of text mining and thematic analysis can be considered a robust methodological approach for examining the complex nature of trauma recovery. Text mining efficiently identified key patterns across large datasets, while thematic analysis provided richer insights into the emotional and psychological transformations experienced by participants. The integration of these methods enabled a comprehensive understanding of the recovery process, supporting the relevance of Swanson’s theory in nursing interventions. This approach holds significant potential for future research in healthcare settings, particularly in developing interventions that address the psychological challenges faced by healthcare professionals. Limitations This study has several limitations. First, the relatively small sample size (n = 102) limits the generalizability of the findings to a broader population. Second, the KoNLP and NIADic dictionaries may not fully capture the subtle contextual nuances of Korean language, necessitating additional manual validation. However, the manual process may introduce potential bias in data analysis. Therefore, to mitigate such potential bias, this study also employed thematic analysis to identify context-specific meanings and derive key themes. Additionally, since this study focused exclusively on Korean nurses, there may be limitations in applying the results directly to other populations or cultural contexts. Future research should aim to include more diverse populations to enhance the generalizability of the findings. Conclusions This study demonstrates that the trauma recovery program, based on Swanson’s Theory of Caring, effectively aligned with the recovery experiences of the participants. The use of text mining revealed key patterns, while thematic analysis provided deeper insights into the emotional transformations of nurses. The observed changes in the participants closely corresponded with Swanson’s theoretical framework, particularly within the “Knowing,” “Doing For,” and Enabling phases. These findings suggest that the theoretical model effectively guided and supported the mental health recovery of the participants. Future research should focus on refining these methodologies and expanding the sample to validate the broader applicability of the intervention. Abbreviations Post-traumatic stress disorder (PTSD) Internet-based trauma recovery nursing intervention (IBTRNI) Korean Natural Language Processing (KoNLP) Declarations Ethics approval and consent to participate This study involved secondary data analysis. The primary study was approved by the Institutional Review Board (IRB) of Yonsei University Health System, Severance Hospital (Approval No. Y-2019-0083), and all participants provided informed consent during the primary study in accordance with the Declaration of Helsinki. For this secondary analysis, which involved only data analysis, additional IRB approval was obtained from the Institutional Review Board of Yonsei University Health System, Severance Hospital (Approval No. Y-2021-0790). Consent for publication Consent for publication was obtained from all participants during the primary study. All participants consented to the use of anonymized data for publication in future research. For this secondary analysis, only anonymized data were used. Availability of data and materials The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request. Funding This manuscript was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (No. 2018R1A2B6001504), which was involved in the data collection process and editing of the manuscript. The authors declare no actual or potential conflicts of interest. Authors' contributions All the listed authors meet the authorship criteria according to the latest guidelines of the International Committee of Medical Journal Editors and are in agreement with the manuscript. J.P., S.K. and G.K. were responsible for the concept and design of this study. S.K. and G.K. performed the data collection. J.P., S.K. and G.K. were responsible for the data analysis and interpretation. J.P. wrote the manuscript under the supervision of S.K. All the authors contributed to and approved the final manuscript. Conflict of interest The authors declare no conflicts of interest. Acknowledgements None References American Psychological Association. What is Posttraumatic Stress Disorder. https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd (2024). Accessed on 3 Sept 2024. Schuster M, Dwyer PA. Post‐traumatic stress disorder in nurses: an integrative review. J Clin Nurs. 2020;29(15–16):2769–2787. https://doi.org/10.1111/jocn.15288 Missouridou E. Secondary posttraumatic stress and nurses’ emotional responses to patient’s trauma. J Trauma Nurs. 2017;24(2):110–115. https://doi.org/10.1097/JTN.0000000000000274 Kelly L. Burnout, compassion fatigue, and secondary trauma in nurses: recognizing the occupational phenomenon and personal consequences of caregiving. Crit. Care Nurs. Q . 2020;43(1):73–80. https://doi.org/10.1097/CNQ.0000000000000293 Kafle S, Paudel S, Thapaliya A, Acharya R. Workplace violence against nurses: a narrative review. J Clin Transl Res. 2022;8(5):421–424. https://doi.org/10.18053/jctres.08.202205.010 Honarvar B, Ghazanfari N, Shahraki HR, Rostami S, Lankarani KB. Violence against nurses: a neglected and health-threatening epidemic in the university affiliated public hospitals in Shiraz, Iran. IJOE. 2019;10(3):111–123. https://doi.org/10.15171/ijoem.2019.1556 Zhang S-E, Liu W, Wang J, Shi Y, Xie F, Cang S, Sun T, Fan L. Impact of workplace violence and compassionate behaviour in hospitals on stress, sleep quality and subjective health status among Chinese nurses: a cross-sectional survey. BMJ Open. 2018;8(10):e019373. https://doi.org/10.1136/bmjopen-2017-019373 Hong S, Kim H, Nam S, Wong JYH, Lee K. Nurses’ post‐traumatic stress symptoms and growth by perceived workplace bullying: an online cross‐sectional study. J. Nurs. Manag. 2021;29(5):1338–1347. https://doi.org/10.1111/jonm.13275 Marsac ML, Kassam-Adams N, Hildenbrand AK, Nicholls E, Winston FK, Leff SS, Fein J. Implementing a trauma-informed approach in pediatric health care networks. JAMA Pediatr. 2016;170(1):70–77. https://doi.org/10.1001/jamapediatrics.2015.2206 Weiss D, Kassam-Adams N, Murray C, Kohser KL, Fein JA, Winston FK, Marsac ML. Application of a framework to implement trauma-informed care throughout a pediatric health care network. J Contin Educ Health Prof . 2017;37(1):55–60. https://doi.org/10.1097/CEH.0000000000000140 Kim S, Park J, Lee W, Kim G. Internet-based trauma recovery intervention for nurses: a randomized controlled trial. CXP. 2024;10(1–4):45–58. https://doi.org/10.1159/000540350 Swanson KM. Empirical development of a middle range theory of caring. Nurs Res. 1991;40(3):161–166. https://doi.org/10.1097/00006199-199105000-00008 Richards DA, Bazeley P, Borglin G, Craig P, Emsley R, Frost J, Hill J, Horwood J, Hutchings HA, Jinks C, Montgomery A, Moore G, Plano Clark VL, Tonkin-Crine S, Wade J, Warren FC, Wyke S, Young B, O’Cathain A. Integrating quantitative and qualitative data and findings when undertaking randomized controlled trials. BMJ Open. 2019;9(11):e032081. https://doi.org/10.1136/bmjopen-2019-032081 Duriau VJ, Reger RK, Pfarrer MD. A content analysis of the content analysis literature in organization studies: research themes, data sources, and methodological refinements. Organ. Res. Methods. 2007;10(1):5–34. https://doi.org/10.1177/1094428106289252 Nam ST, Shin SY, Jin CY. Text mining and visualization of unstructured data using big data analytical tool R. JKIICE. 2021;25(9):1199–1205. https://doi.org/10.6109/jkiice.2021.25.9.1199 Abbe A, Grouin C, Zweigenbaum P, Falissard B. Text mining applications in psychiatry: a systematic literature review. Int J Methods Psychiatr Res. 2016;25(2):86–100. https://doi.org/10.1002/mpr.1481 Braun V, Clarke V. Using thematic analysis in psychology. Qual. Res. J. 2006;3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa Creswell JW, Poth CN. Qualitative inquiry and research design: Choosing among five approaches. 4 th ed. Los Angeles, Washington DC, and Toronto: SAGE Publications; 2016. Kim S, Kim G-U, Lee W, Park J. Developing an internet-based trauma recovery nursing intervention based on Swanson’s theory of caring for trauma recovery. Int J Environ Res Public Health. 2021;18(13):6715. https://doi.org/10.3390/ijerph18136715 Nelson LK, Burk D, Knudsen M, McCall L. The future of coding: a comparison of hand-coding and three types of computer-assisted text analysis methods. Sociol. Methods Res. 2021;50(1):202–237. https://doi/10.1177/0049124118769114 Cregg DR, Cheavens JS. Gratitude interventions: effective self-help? a meta-analysis of the impact on symptoms of depression and anxiety. J. Happiness Stud. 2021;22:413–445. https://doi.org/10.1007/s10902-020-00236-6 Cheng S-T, Tsui PK, Lam JHM. Improving mental health in health care practitioners: randomized controlled trial of a gratitude intervention. J. Consult. Clin. Psychol. 2015;83(1):177–186. https://doi.org/10.1037/a0037895 Weiner L, Berna F, Nourry N, Severac F, Vidailhet P, Mengin AC. Efficacy of an online cognitive behavioral therapy program developed for healthcare workers during the COVID-19 pandemic: the REduction of STress (REST) study protocol for a randomized controlled trial. Trials. 2020;21:870. https://doi.org/10.1186/s13063-020-04772-7 Lorenzo-Luaces L, Lemmens LHJM, Keefe JR, Cuijpers P, Bockting CLH. The efficacy of cognitive behavioral therapy for emotional disorders. In: Wenzel A, editor. Handbook of cognitive behavioral therapy: Overview and approaches. Washington: American Psychological Association; 2021. p. 51–89. https://doi.org/10.1037/0000218-003 Polizzi C, Lynn SJ, Perry A. Stress and coping in the time of COVID-19: pathways to resilience and recovery. Clin Neuropsychiatry. 2020;17(2):59–62. https://doi.org/10.36131/CN20200204 Pipe TB, Bortz JJ, Dueck A, Pendergast D, Buchda V, Summers J. Nurse leader mindfulness meditation program for stress management: a randomized controlled trial. JONA. 2009;39(3):130–137. https://doi.org/10.1097/NNA.0b013e31819894a0 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 12 Mar, 2025 Read the published version in BMC Nursing → Version 1 posted Editorial decision: Revision requested 29 Nov, 2024 Reviews received at journal 26 Nov, 2024 Reviews received at journal 23 Nov, 2024 Reviews received at journal 20 Nov, 2024 Reviewers agreed at journal 11 Nov, 2024 Reviewers agreed at journal 05 Nov, 2024 Reviewers agreed at journal 05 Nov, 2024 Reviewers agreed at journal 05 Nov, 2024 Reviewers invited by journal 05 Nov, 2024 Editor invited by journal 04 Nov, 2024 Editor assigned by journal 01 Nov, 2024 Submission checks completed at journal 01 Nov, 2024 First submitted to journal 23 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-5315927","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":376873457,"identity":"23f7a844-b3d6-4cec-acfa-f2c39ec3a7a6","order_by":0,"name":"Jinyoung Park","email":"","orcid":"","institution":"Yonsei University","correspondingAuthor":false,"prefix":"","firstName":"Jinyoung","middleName":"","lastName":"Park","suffix":""},{"id":376873458,"identity":"f2cb197a-154c-4313-8aee-2aed547ba410","order_by":1,"name":"Go-Un Kim","email":"","orcid":"","institution":"Pusan National University","correspondingAuthor":false,"prefix":"","firstName":"Go-Un","middleName":"","lastName":"Kim","suffix":""},{"id":376873459,"identity":"cdd64a4d-c517-4b53-bb32-dcffe436b566","order_by":2,"name":"Sunah Kim","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYJCCAx8qbOQYGHiI18H4cMaZNGOStDAb87YcTmwgWos5/xkzad4G5vQNN3IPf2CosSOsxXJGjpnk3B1suRtu5KVJMBxLJqzF4AaPmcTbMzxALTlmDAxsB4jQcv6MmQRvm0S6wY0c4w8M/4jRciDH2JC3zSABqMVAgrGNCC2WM9IKgYGcYDjzzBszicQ+Ivxizn94AzAq/8vzHQc67MM3IkLMgIHDAMxQADkpgbAGkBb2B2CGfAMxykfBKBgFo2BEAgCgmj7c5BJOvgAAAABJRU5ErkJggg==","orcid":"","institution":"Yonsei University","correspondingAuthor":true,"prefix":"","firstName":"Sunah","middleName":"","lastName":"Kim","suffix":""}],"badges":[],"createdAt":"2024-10-23 05:53:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5315927/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5315927/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12912-025-02757-y","type":"published","date":"2025-03-12T15:56:55+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":70038218,"identity":"d09896c8-4385-461d-b777-5d980e0f6078","added_by":"auto","created_at":"2024-11-27 17:33:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":108576,"visible":true,"origin":"","legend":"\u003cp\u003eRepresentative visualization example: top 10 keywords and word cloud\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5315927/v1/a83bd76f4a49415b016415e4.png"},{"id":78688821,"identity":"ffba6d18-652a-47e9-862a-b491953e3e01","added_by":"auto","created_at":"2025-03-17 16:01:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":835279,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5315927/v1/af4644df-e81d-4f13-9cd6-5ebf0a7e82e2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploring Trauma Recovery in Nurses: A Text Mining and Thematic Analysis Based on Swanson’s Theory of Caring","fulltext":[{"header":"Background","content":"\u003cp\u003ePost-traumatic stress disorder (PTSD) is a mental health condition stemming from direct or indirect exposure to traumatic events [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Nurses are particularly vulnerable considering their repeated exposure to traumatic situations during work, including caring for patients with both physical and psychological trauma [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. High rates of PTSD have been documented among nurses in critical care fields such as intensive care, emergency care, and oncology [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Moreover, in the process of empathetic listening and providing care, nurses face the risk of secondary traumatic stress, further exacerbating their vulnerability [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNurses also experience first-hand trauma driven by the prevalence of workplace violence in healthcare settings. Nurses experience workplace violence at higher rates than other professionals, negatively affecting both their physical and mental health [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. If left unresolved, the cumulative stress from patient care and workplace abuse could lead to severe mental health issues, including depression, anxiety, and PTSD, significantly impacting job performance and personal well-being [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Despite these challenges, there are limited interventions aimed at promoting post-traumatic recovery, particularly those tailored for healthcare professionals [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccordingly, it is imperative to implement effective and accessible interventions as well as online recovery programs [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. For example, Kim et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] implemented an Internet-based trauma recovery nursing intervention (IBTRNI) based on Swanson\u0026rsquo;s Theory of Caring [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], which showed significant improvements in nurses' mental health and resilience through quantitative measures. However, while quantitative findings seem valuable, they often fail to capture the complexity of participants' experiences. To understand the nuances of such interventions, a combination of quantitative and qualitative approaches is necessary [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTraditional qualitative analysis methods such as manual coding, discourse analysis, and grounded theory are time-consuming and labor-intensive, thereby making them inefficient for large-scale data analysis [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Automated approaches such as text mining have emerged to address these limitations, efficiently processing large volumes of text data [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Abbe et al. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] underscored the benefits of integrating text mining with traditional qualitative methods, emphasizing its ability to enhance insight depth and breadth. Nevertheless, text mining alone may not fully capture the emotional and psychological complexities of participants' experiences. Therefore, thematic analysis was employed to provide a comprehensive interpretation of the data and uncover latent meanings. Braun and Clarke [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] argue that thematic analysis offers a flexible and systematic approach to qualitative data analysis, making it a valuable method for exploring patterns in psychological research.\u003c/p\u003e \u003cp\u003eTherefore, this study aims to comprehensively analyze nurses' experiences in IBTRNI using a combination of text mining and thematic analysis, ensuring both efficient data processing and comprehensive exploration of participants' emotional and psychological processes.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis study employed a secondary data analysis approach to systematically analyze the responses of nurses who participated in IBTRNI during each session from a previous study [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Text mining was employed to analyze session-based responses, extracting keywords and using word cloud visualization to effectively identify major patterns within the responses.\u003c/p\u003e \u003cp\u003eAdditionally, thematic analysis was conducted to explore the deeper meanings and emotional changes embedded in the responses from each session. The qualitative approach adopted a constructivist paradigm [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], to understand participants' experiences as shaped by personal meaning-making processes. This allowed for a comprehensive exploration of the emotional and psychological recovery process, recognizing subjective experiences as socially constructed.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eParticipants in this study included 102 general nurses. Initially, 112 nurses were recruited for the primary study, but the secondary analysis included only 102 nurses who completed the intervention. The inclusion criteria (applied in the primary study) were: 1) aged 23\u0026ndash;40, 2) self-score greater than 80% (64 points) on the Korean version of the PTSD Checklist, 3) ability to access the program through a mobile device, 4) understand the purpose of the study and voluntarily agree to participate, and 5) has not been diagnosed with a mental illness and is not on related drugs.\u003c/p\u003e\n\u003ch3\u003eIntervention: Internet-based trauma recovery nursing intervention (IBTRNI)\u003c/h3\u003e\n\u003cp\u003eThe IBTRNI was developed by the primary research team using Swanson\u0026rsquo;s theoretical framework [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The secondary analysis analyzed these sessions through session-specific questions, focusing on three key concepts: \u0026ldquo;Knowing,\u0026rdquo; \u0026ldquo;Doing For,\u0026rdquo; and \u0026ldquo;Enabling.\u0026rdquo; \u003cb\u003eKnowing\u003c/b\u003e emphasized self-understanding and self-respect, \u003cb\u003eDoing For\u003c/b\u003e focused on self-acceptance and release of negative emotions, and \u003cb\u003eEnabling\u003c/b\u003e centered on effective communication and stress management [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Nurses participating in the study responded to these questions in the online program, which allowed them to explore their thoughts and feelings in relation to the goals of individual sessions. Researchers communicated with the participants throughout the intervention by providing feedback after each session and offering ongoing emotional support.\u003c/p\u003e \u003cp\u003eAt the end of each theory-based section, the participants were provided with the opportunity to express their experiences and reflections on how they had changed. These reflective questions were designed to encourage nurses to assess their emotional and psychological changes during the recovery process, allowing for personal and subjective insights. For a detailed overview of these theory-based questions, refer to Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTheory-Based Questions in the IBTRNI Program\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheory (Session)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuestion\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eKnowing (1\u0026thinsp;~\u0026thinsp;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhat new things did you learn about yourself, and what do you expect from yourself?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow is that emotional distress affecting your current daily life?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDoing\u003c/p\u003e \u003cp\u003e(3\u0026thinsp;~\u0026thinsp;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhat did you learn or what was helpful to you during this session?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhat can you do to experience more positive emotions in your daily life?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEnabling (6\u0026thinsp;~\u0026thinsp;8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOver the past week, was there a situation where you believe you handled stress well? If so, describe the situation and how you managed it.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter completing this program, what would you like to continue applying it to your daily life?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eData collection and ethical considerations\u003c/h3\u003e\n\u003cp\u003eSecondary analysis was conducted using data from a primary study [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Institutional Review Board (IRB) approval was obtained for the secondary analysis (IRB No. Y-2021-0790) from X-University (blinded for review). Participants in the primary study were informed of the current study and provided consent for the use of their responses in secondary data analysis.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eWe employed a combination of text mining and thematic analysis to systematically analyze nurses' responses. For text mining, we used R (version 4.2.2), a widely-recognized tool for processing unstructured data [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The KoNLP (Korean Natural Language Processing) package and NIADic dictionary are well-established tools for processing Korean text; however, they may have limitations in capturing certain contextual nuances specific to this study's dataset. To ensure accurate analysis, the research team conducted additional post-processing and manual validation. Contextually-significant terms that were not included in the dictionary (e.g., \"I-message\") were incorporated based on the consensus of the research team, ensuring their relevance to the study objectives. Common data pre-processing steps were taken, including elimination of duplicate and meaningless words (e.g., copulas, adjectives, adverbs) by designating them as stop words. Words that did not contribute to the overall context or analysis, such as frequently occurring function words (e.g., \"있다,\" \"하다\"), were also excluded. In cases where contextually-significant terms did not appear in the dictionary (e.g., \"I-message\"), the research team reached a consensus to include them as unique terms, based on their relevance to the themes of trauma recovery and emotional processing. The cleaned data was then visualized using ggplot, through bar graphs and word clouds, to identify key patterns and high-frequency keywords.\u003c/p\u003e \u003cp\u003eTo complement the text mining analysis, thematic analysis was conducted following the six-phase approach outlined by Braun and Clarke (2006) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Text mining identified high-frequency words from the participants' responses, and corresponding sentences were subsequently extracted for further qualitative analysis. The researchers familiarized themselves with the extracted sentences through repeated reviews. Three team members independently performed initial coding, systematically identifying meaningful text segments. The coding process, facilitated using Excel, involved breaking down each response into meaningful units and assigning descriptive codes to capture recurring patterns. Subsequently, the researchers convened to resolve any discrepancies in coding, ensuring inter-coder reliability. Once a consensus was reached, the codes were grouped into overarching themes that accurately reflected nurses\u0026rsquo; emotional and psychological experiences during the intervention. These broader themes were reviewed iteratively to ensure consistency and alignment with the study objectives. The thematic analysis was conducted within the framework of Swanson\u0026rsquo;s Caring Theory, which served as the basis for both intervention design and analysis of participants' responses. This theoretical approach guided the coding and categorization of themes throughout the analysis. Swanson\u0026rsquo;s three key concepts\u0026mdash;\"Knowing,\u0026rdquo; \u0026ldquo;Doing For,\u0026rdquo; and \u0026ldquo;Enabling\u0026rdquo;\u0026mdash;were employed to categorize participants' responses, facilitating the evaluation of how well the intervention aligned with the intended theoretical goals.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eDemographic characteristics of the participants\u003c/h2\u003e \u003cp\u003eThe characteristics of the participants are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The mean age of participants was 31.04 (SD\u0026thinsp;=\u0026thinsp;4.50), ranging from 22 to 40. Females accounted for a majority of participants (96.1%), and the distribution of religious affiliation was evenly split, with 50% identifying themselves as religious. Most participants were single (60.8%), with 38.2% being married and 1.0% separated, widowed, or divorced. Regarding educational background, 75.5% had attained a college degree or higher, and 24.5% had completed graduate school. The vast majority (90.2%) were currently employed, with 33.3% having 5\u0026ndash;10 years of work experience and 27.5% having 10 or more years of experience.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic Characteristics of the Participants (N\u0026thinsp;=\u0026thinsp;102)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.04 (4.50)\u003c/p\u003e \u003cp\u003e(Range: 22\u0026ndash;40)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e98 (96.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62 (60.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39 (38.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSeparated, widowed, or divorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollege or higher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77 (75.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGraduate school or higher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (24.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent employment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCurrent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92 (90.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone or past\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorking experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (18.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;\u0026lt; 5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21 (20.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;\u0026lt; 10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (27.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eKeyword and thematic analyses of trauma recovery experiences: applying Swanson's Theory of Caring\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis study explored the trauma recovery experiences of nurses who participated in the IBTRINI program. Participants' free-text responses were analyzed using a combination of text mining and thematic analysis, based on Swanson's three key concepts: \u0026ldquo;Knowing,\u0026rdquo; \u0026ldquo;Doing For,\u0026rdquo; and \u0026ldquo;Enabling.\u0026rdquo; Text mining efficiently processed large volumes of data to identify key patterns and frequently recurring keywords, while thematic analysis explored underlying emotional and psychological meanings behind these patterns. The complementary approach of text mining and thematic analysis provided a comprehensive understanding of the complex nature of participants' recovery experiences. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the top 10 keywords identified at each stage of the program, representing the most frequently mentioned terms by the participants during each phase. In addition to bar charts, word clouds visually depict the relative frequency of these keywords.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eInsert Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e about here.\u003c/p\u003e \u003cp\u003e \u003cb\u003eThe Knowing Phase (Session 1\u003c/b\u003e\u0026ndash;\u003cb\u003e2)\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe \u0026ldquo;Knowing\u0026rdquo; phase focused on enhancing self-awareness and recognizing personal strengths. Text mining identified keywords such as thoughts, strength, trifles, gratitude, and self-control, reflecting participants' focus on their emotional state and personal development.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTheme 1: Self-awareness\u003c/h3\u003e\n\u003cp\u003e The participants reported an increased awareness of their emotional responses and thought patterns, which facilitated the recognition of the impact of negative thoughts on their daily lives.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I didn\u0026rsquo;t realize how many negative thoughts I had until this session made me aware of them.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I always believed that I was strong, but through this program, I realized how emotionally vulnerable I was.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003e Additionally, the participants expressed a newfound appreciation of their strengths and the smaller, often overlooked, positive aspects of their lives, which contributed to their emotional resilience.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I now try to appreciate even the small things in my life, and that\u0026rsquo;s a huge change for me.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Reflecting on my strengths made me appreciate even the trifles that I used to overlook.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eThe Doing For Phase (Session 3\u003c/b\u003e\u0026ndash;\u003cb\u003e5)\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe \u0026ldquo;Doing For\u0026rdquo; phase centered on emotional regulation and behavioral transformation. Text mining revealed keywords such as positive, change of thought, behavior, emotion, and experience, indicating participants' efforts to manage emotional responses and modify their behaviors.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eTheme: Emotional Regulation\u003c/h2\u003e \u003cp\u003e The participants learned strategies to manage negative emotions and shift their responses toward more positive outcomes. Emotional regulation was crucial for behavioral changes and stress management.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I started focusing more on positive thoughts and how they influenced my emotions, which helped me manage stress.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"One of the biggest changes was learning to shift my emotions from negative to positive and recognizing how that impacted my behavior.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003eBy practicing emotional regulation, participants gained better control over their behaviors, allowing them to handle stress effectively and respond proactively in challenging situations.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Now, when I face stressful situations, I change my thoughts and behavior before reacting emotionally.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"This experience taught me how to control my emotions and modify my behavior in difficult situations.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eThe Enabling Phase (Session 6\u003c/b\u003e\u0026ndash;\u003cb\u003e8)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e In the \u0026ldquo;Enabling\u0026rdquo; phase, the participants developed improved communication skills and stress management techniques. Text mining identified keywords such as conversation, daily life management, situation, meditation, and communication, reflecting a focus on managing interpersonal relationships and daily stressors.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eTheme: Interpersonal Relationships\u003c/h2\u003e \u003cp\u003e The participants reported significant improvements in their interpersonal relationships, facilitated by enhanced communication skills and effective stress management strategies. Meditation was frequently mentioned as a tool that helped participants regulate emotions and engage more positively with others.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Through meditation, I\u0026rsquo;ve been able to control my emotions, and it\u0026rsquo;s made conversations with others much easier.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I\u0026rsquo;ve learned not to always be defensive in conversations, which has improved my relationships.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003eMoreover, the participants reported better management of daily life and stress, which empowered them to navigate challenging situations with ease.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Stress used to overwhelm me, but now I manage it through meditation and self-care.\"\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I\u0026rsquo;ve started managing my daily life effectively, and when stressful situations arise, I feel more in control.\"\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study employed a combination of text mining and thematic analysis to explore the trauma recovery experiences of nurses who participated in an Internet-based trauma recovery nursing intervention (IBTRNI), which used Swanson\u0026rsquo;s Theory of Caring as the guiding framework. This approach provided an in-depth understanding of the emotional and psychological recovery processes, where text mining efficiently processed large volumes of data to identify key patterns, and thematic analysis enabled deeper exploration of participants' experiences and emotional shifts.\u003c/p\u003e \u003cp\u003eIn the \u0026ldquo;Knowing\u0026rdquo; phase, the dominant theme of self-awareness emerged. Text mining revealed keywords such as thoughts, strength, gratitude, and self-control, reflecting participants\u0026rsquo; increased awareness of their emotional state and personal development. This self-awareness is critical in trauma recovery, as recognizing the impact of negative thoughts on daily life is a vital step toward emotional resilience. Prior research supports the importance of self-reflection in promoting emotional recovery, where acknowledging personal strengths plays a central role in fostering well-being [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Swanson\u0026rsquo;s concept of \u0026ldquo;Knowing\u0026rdquo; emphasizes the value of self-understanding and self-respect, which aligns closely with these findings [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe \u0026ldquo;Doing For\u0026rdquo; phase focused on emotional regulation and behavioral transformation, which were central themes identified through both keywords and thematic analysis. Keywords such as positive thinking, behavioral change, and emotional control were highlighted, illustrating the cognitive and emotional shifts that participants experienced. This aligns with previous studies that emphasized the role of cognitive restructuring in trauma recovery [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Through this phase, participants successfully managed their emotions, transitioning from negative to positive emotional responses, which facilitated meaningful behavioral changes. The theme of emotional regulation is consistent with Swanson\u0026rsquo;s theory, where \u0026ldquo;Doing For\u0026rdquo; involves actively supporting emotional and psychological well-being through nurturing actions.\u003c/p\u003e \u003cp\u003eThe \u0026ldquo;Enabling\u0026rdquo; phase revealed the theme of interpersonal relationships and stress management. Text mining identified keywords such as conversation, meditation, and stress management, indicating that participants applied learned coping mechanisms to manage their stress and improve their relationships. The integration of these techniques into daily practice facilitated better emotional regulation and strengthened participants\u0026rsquo; social interactions. This finding is supported by existing literature, which highlights the importance of communication and stress management strategies in enhancing emotional stability during trauma recovery [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In line with Swanson\u0026rsquo;s \u0026ldquo;Enabling\u0026rdquo; concept, participants demonstrated increased ability to manage interpersonal relationships and effectively navigate stressful situations.\u003c/p\u003e \u003cp\u003eThe combination of text mining and thematic analysis can be considered a robust methodological approach for examining the complex nature of trauma recovery. Text mining efficiently identified key patterns across large datasets, while thematic analysis provided richer insights into the emotional and psychological transformations experienced by participants. The integration of these methods enabled a comprehensive understanding of the recovery process, supporting the relevance of Swanson\u0026rsquo;s theory in nursing interventions. This approach holds significant potential for future research in healthcare settings, particularly in developing interventions that address the psychological challenges faced by healthcare professionals.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study has several limitations. First, the relatively small sample size (n\u0026thinsp;=\u0026thinsp;102) limits the generalizability of the findings to a broader population. Second, the KoNLP and NIADic dictionaries may not fully capture the subtle contextual nuances of Korean language, necessitating additional manual validation. However, the manual process may introduce potential bias in data analysis. Therefore, to mitigate such potential bias, this study also employed thematic analysis to identify context-specific meanings and derive key themes. Additionally, since this study focused exclusively on Korean nurses, there may be limitations in applying the results directly to other populations or cultural contexts. Future research should aim to include more diverse populations to enhance the generalizability of the findings.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study demonstrates that the trauma recovery program, based on Swanson\u0026rsquo;s Theory of Caring, effectively aligned with the recovery experiences of the participants. The use of text mining revealed key patterns, while thematic analysis provided deeper insights into the emotional transformations of nurses. The observed changes in the participants closely corresponded with Swanson\u0026rsquo;s theoretical framework, particularly within the \u0026ldquo;Knowing,\u0026rdquo; \u0026ldquo;Doing For,\u0026rdquo; and Enabling phases. These findings suggest that the theoretical model effectively guided and supported the mental health recovery of the participants. Future research should focus on refining these methodologies and expanding the sample to validate the broader applicability of the intervention.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePost-traumatic stress disorder (PTSD)\u003c/p\u003e\n\u003cp\u003eInternet-based trauma recovery nursing intervention (IBTRNI)\u003c/p\u003e\n\u003cp\u003eKorean Natural Language Processing (KoNLP)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study involved secondary data analysis. The primary study was approved by the Institutional Review Board (IRB) of Yonsei University Health System, Severance Hospital (Approval No. Y-2019-0083), and all participants provided informed consent during the primary study in accordance with the Declaration of Helsinki. For this secondary analysis, which involved only data analysis, additional IRB approval was obtained from the Institutional Review Board of Yonsei University Health System, Severance Hospital (Approval No. Y-2021-0790).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsent for publication was obtained from all participants during the primary study. All participants consented to the use of anonymized data for publication in future research. For this secondary analysis, only anonymized data were used.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis manuscript was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (No. 2018R1A2B6001504), which was involved in the data collection process and editing of the manuscript. The authors declare no actual or potential conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the listed authors meet the authorship criteria according to the latest guidelines of the International Committee of Medical Journal Editors and are in agreement with the manuscript. J.P., S.K. and G.K. were responsible for the concept and design of this study. S.K. and G.K. performed the data collection. J.P., S.K. and G.K. were responsible for the data analysis and interpretation. J.P. wrote the manuscript under the supervision of S.K. All the authors contributed to and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts\u0026nbsp;of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAmerican Psychological Association. What is Posttraumatic Stress Disorder. https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd (2024). Accessed on 3 Sept 2024. \u003c/li\u003e\n\u003cli\u003eSchuster M, Dwyer PA. Post‐traumatic stress disorder in nurses: an integrative review. J Clin Nurs. 2020;29(15\u0026ndash;16):2769\u0026ndash;2787. https://doi.org/10.1111/jocn.15288\u003c/li\u003e\n\u003cli\u003eMissouridou E. Secondary posttraumatic stress and nurses\u0026rsquo; emotional responses to patient\u0026rsquo;s trauma. J Trauma Nurs. 2017;24(2):110\u0026ndash;115. https://doi.org/10.1097/JTN.0000000000000274\u003c/li\u003e\n\u003cli\u003eKelly L. Burnout, compassion fatigue, and secondary trauma in nurses: recognizing the occupational phenomenon and personal consequences of caregiving. Crit. Care Nurs. Q . 2020;43(1):73\u0026ndash;80. https://doi.org/10.1097/CNQ.0000000000000293\u003c/li\u003e\n\u003cli\u003eKafle S, Paudel S, Thapaliya A, Acharya R. Workplace violence against nurses: a narrative review. J Clin Transl Res. 2022;8(5):421\u0026ndash;424. https://doi.org/10.18053/jctres.08.202205.010 \u003c/li\u003e\n\u003cli\u003eHonarvar B, Ghazanfari N, Shahraki HR, Rostami S, Lankarani KB. Violence against nurses: a neglected and health-threatening epidemic in the university affiliated public hospitals in Shiraz, Iran. IJOE. 2019;10(3):111\u0026ndash;123. https://doi.org/10.15171/ijoem.2019.1556\u003c/li\u003e\n\u003cli\u003eZhang S-E, Liu W, Wang J, Shi Y, Xie F, Cang S, Sun T, Fan L. Impact of workplace violence and compassionate behaviour in hospitals on stress, sleep quality and subjective health status among Chinese nurses: a cross-sectional survey. BMJ Open. 2018;8(10):e019373. https://doi.org/10.1136/bmjopen-2017-019373\u003c/li\u003e\n\u003cli\u003eHong S, Kim H, Nam S, Wong JYH, Lee K. Nurses\u0026rsquo; post‐traumatic stress symptoms and growth by perceived workplace bullying: an online cross‐sectional study. J. Nurs. Manag. 2021;29(5):1338\u0026ndash;1347. https://doi.org/10.1111/jonm.13275\u003c/li\u003e\n\u003cli\u003eMarsac ML, Kassam-Adams N, Hildenbrand AK, Nicholls E, Winston FK, Leff SS, Fein J. Implementing a trauma-informed approach in pediatric health care networks. JAMA Pediatr. 2016;170(1):70\u0026ndash;77. https://doi.org/10.1001/jamapediatrics.2015.2206\u003c/li\u003e\n\u003cli\u003eWeiss D, Kassam-Adams N, Murray C, Kohser KL, Fein JA, Winston FK, Marsac ML. Application of a framework to implement trauma-informed care throughout a pediatric health care network. J Contin Educ Health Prof . 2017;37(1):55\u0026ndash;60. https://doi.org/10.1097/CEH.0000000000000140\u003c/li\u003e\n\u003cli\u003eKim S, Park J, Lee W, Kim G. Internet-based trauma recovery intervention for nurses: a randomized controlled trial. CXP. 2024;10(1\u0026ndash;4):45\u0026ndash;58. https://doi.org/10.1159/000540350\u003c/li\u003e\n\u003cli\u003eSwanson KM. Empirical development of a middle range theory of caring. Nurs Res. 1991;40(3):161\u0026ndash;166. https://doi.org/10.1097/00006199-199105000-00008\u003c/li\u003e\n\u003cli\u003eRichards DA, Bazeley P, Borglin G, Craig P, Emsley R, Frost J, Hill J, Horwood J, Hutchings HA, Jinks C, Montgomery A, Moore G, Plano Clark VL, Tonkin-Crine S, Wade J, Warren FC, Wyke S, Young B, O\u0026rsquo;Cathain A. Integrating quantitative and qualitative data and findings when undertaking randomized controlled trials. BMJ Open. 2019;9(11):e032081. https://doi.org/10.1136/bmjopen-2019-032081\u003c/li\u003e\n\u003cli\u003eDuriau VJ, Reger RK, Pfarrer MD. A content analysis of the content analysis literature in organization studies: research themes, data sources, and methodological refinements. Organ. Res. Methods. 2007;10(1):5\u0026ndash;34. https://doi.org/10.1177/1094428106289252\u003c/li\u003e\n\u003cli\u003eNam ST, Shin SY, Jin CY. Text mining and visualization of unstructured data using big data analytical tool R. JKIICE. 2021;25(9):1199\u0026ndash;1205. https://doi.org/10.6109/jkiice.2021.25.9.1199\u003c/li\u003e\n\u003cli\u003eAbbe A, Grouin C, Zweigenbaum P, Falissard B. Text mining applications in psychiatry: a systematic literature review. Int J Methods Psychiatr Res. 2016;25(2):86\u0026ndash;100. https://doi.org/10.1002/mpr.1481\u003c/li\u003e\n\u003cli\u003eBraun V, Clarke V. Using thematic analysis in psychology. Qual. Res. J. 2006;3(2), 77\u0026ndash;101. https://doi.org/10.1191/1478088706qp063oa\u003c/li\u003e\n\u003cli\u003eCreswell JW, Poth CN. Qualitative inquiry and research design: Choosing among five approaches. 4\u003csup\u003eth\u003c/sup\u003e ed. Los Angeles, Washington DC, and Toronto: SAGE Publications; 2016.\u003c/li\u003e\n\u003cli\u003eKim S, Kim G-U, Lee W, Park J. Developing an internet-based trauma recovery nursing intervention based on Swanson\u0026rsquo;s theory of caring for trauma recovery. Int J Environ Res Public Health. 2021;18(13):6715. https://doi.org/10.3390/ijerph18136715\u003c/li\u003e\n\u003cli\u003eNelson LK, Burk D, Knudsen M, McCall L. The future of coding: a comparison of hand-coding and three types of computer-assisted text analysis methods. Sociol. Methods Res. 2021;50(1):202\u0026ndash;237. https://doi/10.1177/0049124118769114\u003c/li\u003e\n\u003cli\u003eCregg DR, Cheavens JS. Gratitude interventions: effective self-help? a meta-analysis of the impact on symptoms of depression and anxiety. J. Happiness Stud. 2021;22:413\u0026ndash;445. https://doi.org/10.1007/s10902-020-00236-6\u003c/li\u003e\n\u003cli\u003eCheng S-T, Tsui PK, Lam JHM. Improving mental health in health care practitioners: randomized controlled trial of a gratitude intervention. J. Consult. Clin. Psychol. 2015;83(1):177\u0026ndash;186. https://doi.org/10.1037/a0037895\u003c/li\u003e\n\u003cli\u003eWeiner L, Berna F, Nourry N, Severac F, Vidailhet P, Mengin AC. Efficacy of an online cognitive behavioral therapy program developed for healthcare workers during the COVID-19 pandemic: the REduction of STress (REST) study protocol for a randomized controlled trial. Trials. 2020;21:870. https://doi.org/10.1186/s13063-020-04772-7\u003c/li\u003e\n\u003cli\u003eLorenzo-Luaces L, Lemmens LHJM, Keefe JR, Cuijpers P, Bockting CLH. The efficacy of cognitive behavioral therapy for emotional disorders. In: Wenzel A, editor. Handbook of cognitive behavioral therapy: Overview and approaches. Washington: American Psychological Association; 2021. p. 51\u0026ndash;89. https://doi.org/10.1037/0000218-003\u003c/li\u003e\n\u003cli\u003ePolizzi C, Lynn SJ, Perry A. Stress and coping in the time of COVID-19: pathways to resilience and recovery. Clin Neuropsychiatry. 2020;17(2):59\u0026ndash;62. https://doi.org/10.36131/CN20200204\u003c/li\u003e\n\u003cli\u003ePipe TB, Bortz JJ, Dueck A, Pendergast D, Buchda V, Summers J. Nurse leader mindfulness meditation program for stress management: a randomized controlled trial. JONA. 2009;39(3):130\u0026ndash;137. https://doi.org/10.1097/NNA.0b013e31819894a0\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"psychological trauma, psychosocial intervention, nurses, Swanson’s Theory of Caring","lastPublishedDoi":"10.21203/rs.3.rs-5315927/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5315927/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eNurses are frequently exposed to workplace trauma, placing them at a heightened risk of post-traumatic stress disorder. However, targeted interventions to promote psychological recovery among nurses are limited. This study explored the trauma recovery experiences of nurses who participated in an Internet-based Trauma Recovery Nursing Intervention (IBTRNI), based on Swanson\u0026rsquo;s Theory of Caring. The objective was to identify the emotional and psychological changes experienced by participants through a combination of text mining and thematic analysis.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eSecondary analysis was conducted on free-text responses from 102 nurses who completed IBTRNI. Text mining identified high-frequency keywords, while thematic analysis provided deeper emotional and psychological insights. The analysis was structured around Swanson\u0026rsquo;s three phases: \u0026ldquo;Knowing,\u0026rdquo; \u0026ldquo;Doing For,\u0026rdquo; and \u0026ldquo;Enabling.\u0026rdquo;\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn the \u0026ldquo;Knowing phase,\u0026rdquo; the participants demonstrated increased self-awareness, recognizing their emotional responses and the effects of negative thoughts on daily life. The \u0026ldquo;Doing For\u0026rdquo; phase revealed enhanced emotional regulation, where participants learned to manage and transform negative emotions into positive ones. Finally, the \u0026ldquo;Enabling\u0026rdquo; phase highlighted improvements in interpersonal relationships, and the adoption of effective coping mechanisms such as communication and meditation to manage stress.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eSwanson\u0026rsquo;s Theory of Caring provides a robust framework for supporting nurses' trauma recovery. The combination of text mining and thematic analysis offers a comprehensive understanding of the emotional and psychological transformations experienced during the intervention. The findings underscore the potential for theory-based digital interventions to support trauma recovery among healthcare professionals. Future research should expand on these methodologies to enhance their broader applicability.\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e \u003cp\u003eThis study involved secondary data analysis. The primary study was registered at ClinicalTrials.govUS National Library of Medicine (clinical trial registration number NCT04989582) on 20220131 and is available online.\u003c/p\u003e","manuscriptTitle":"Exploring Trauma Recovery in Nurses: A Text Mining and Thematic Analysis Based on Swanson’s Theory of Caring","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-27 17:33:42","doi":"10.21203/rs.3.rs-5315927/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-29T05:21:13+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-26T17:23:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-23T09:30:35+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-20T15:44:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"52267032964200545119109747984720820621","date":"2024-11-11T23:05:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"181195720433870454882224222131945508308","date":"2024-11-05T18:23:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"35772809943682502037031649986186658983","date":"2024-11-05T13:19:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"286784973359593122972097538994696299575","date":"2024-11-05T07:03:20+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-05T05:35:42+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-11-04T09:27:07+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-01T05:31:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-01T05:31:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2024-10-23T05:48:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b60d2f49-9e0f-4731-8af5-fef01190d4ac","owner":[],"postedDate":"November 27th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-03-17T15:59:12+00:00","versionOfRecord":{"articleIdentity":"rs-5315927","link":"https://doi.org/10.1186/s12912-025-02757-y","journal":{"identity":"bmc-nursing","isVorOnly":false,"title":"BMC Nursing"},"publishedOn":"2025-03-12 15:56:55","publishedOnDateReadable":"March 12th, 2025"},"versionCreatedAt":"2024-11-27 17:33:42","video":"","vorDoi":"10.1186/s12912-025-02757-y","vorDoiUrl":"https://doi.org/10.1186/s12912-025-02757-y","workflowStages":[]},"version":"v1","identity":"rs-5315927","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5315927","identity":"rs-5315927","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}