Secondary Traumatic Stress and Post‐Traumatic Stress Symptoms in Nurses: Mediating Role of Psychological Distress and Moderating Role of Emotional Support

ABSTRACT

Aim

This study aimed to investigate whether psychological distress mediates the relationship between secondary traumatic stress (STS) and post‐traumatic stress symptoms (PTSS) among clinical nurses, and whether perceived emotional support moderates this mediating effect.

Design

A cross‐sectional study.

Methods

A total of 205 clinical nurses who had direct patient contact and trauma‐related experience were included. Data were collected using validated instruments: the Secondary Traumatic Stress Scale (STSS), Depression Anxiety Stress Scale‐12 (DASS‐12), Impact of Event Scale‐Revised (IES‐R), and the Multidimensional Scale of Perceived Social Support (MSPSS). All scales demonstrated high internal consistency (Cronbach's α = 0.88–0.97).

Results

Psychological distress significantly mediated the relationship between STS and PTSS. Perceived emotional support moderated the path from STS to psychological distress, such that higher emotional support amplified the association. However, emotional support did not significantly moderate the relationship between psychological distress and PTSS.

Conclusion

Psychological distress plays a central role in translating STS into PTSS among clinical nurses. Although emotional support may buffer early psychological distress, it does not attenuate PTSS development once distress is established.

Implications for the Profession and/or Patient Care

Early detection and management of psychological distress can prevent STS from progressing to PTSS. Nurses frequently exposed to trauma require timely psychological support. We recommend implementing routine screening and early interventions focused on distress, along with peer‐support programmes and supervisory encouragement to enhance resilience. Trauma‐informed care training and organisational awareness should also be strengthened to foster a supportive environment.

Impact

This study shows that managing early emotional symptoms is critical in preventing PTSS among nurses exposed to secondary trauma. Findings can inform global policies, peer‐support initiatives, and early screening systems to enhance resilience and safeguard patient care.

Reporting Method

The study adhered to the STROBE checklist for cross‐sectional studies.

Patient or Public Contribution

No patient or public contribution.

Summary.

• What does this paper contribute to the wider global clinical community?

  • ○
    This paper highlights the importance of early emotional support in preventing distress escalation among nurses exposed to secondary trauma.
  • ○
    The paper suggests that targeted interventions addressing emotional symptoms prevent the development of PTSS.
  • ○
    This paper can inform trauma‐informed policies and staff support programs in healthcare settings.

1. Introduction

Secondary traumatic stress (STS) is being increasingly recognised as a significant occupational hazard among helping professionals regularly exposed to others' trauma (Molnar et al. 2017). These professionals, including social workers, psychologists, physicians, and nurses, often develop psychological symptoms from empathic engagement with individuals who have endured traumatic experiences rather than direct personal trauma (Mottaghi et al. 2020; Rauvola et al. 2019; Wagaman et al. 2015). Evidence from various countries highlights its widespread nature. In Australia, 30% of social workers and psychologists reported high levels of STS or post‐traumatic stress disorder (PTSD) symptoms (Rayner et al. 2020). Furthermore, 43% of healthcare workers demonstrated similar distress in Poland (Ogińska‐Bulik et al. 2021). Nearly half of all nurses reported clinically significant symptoms of STS in Jordan (Ratrout and Hamdan‐Mansour 2020). These findings underscore the high emotional burden borne by helping professionals and the need for increased attention to their mental health and resilience.

2. Background

Secondary traumatic stress (STS), as defined by Figley (1995), refers to the typical emotional and behavioral responses that arise from being aware of a traumatic event experienced by someone close. It is the stress that comes from providing, or desiring to provide, care and support to a traumatized or suffering individual (Salston and Figley 2003). Clinical nurses are particularly vulnerable to secondary traumatic stress (STS) due to the nature of their role, which involves continuous exposure to patients' suffering, critical incidents, and end‐of‐life care (Melinte et al. 2023). Repetitive emotional demands of caring for acutely ill or traumatized patients may accumulate and lead to symptoms that mirror those of primary trauma exposure, such as intrusive thoughts, hypervigilance, avoidance behaviors, and emotional exhaustion (Missouridou 2017; Alshammari et al. 2024). STS in nurses has been associated with burnout, reduced quality of care, absenteeism, and professional attrition (Stemmer et al. 2022).

Psychological distress is a multidimensional state of emotional suffering characterised by depression, anxiety, and stress, which can impair functioning and increase vulnerability to mental health problems. While prior studies have shown that STS is strongly linked to psychological distress (Bock et al. 2020; Neria and Sullivan 2011), limited evidence is available on the mechanisms through which distress contributes to post‐traumatic stress symptoms (PTSS) in nurses.

Emotional support has been identified as a protective factor that may alleviate the negative impact of trauma exposure on healthcare professionals (Whittenbury et al. 2025). However, findings regarding its moderating role in the pathway from STS to PTSS remain inconsistent. To date, few studies have examined both the mediating role of psychological distress and the moderating role of emotional support in this relationship among clinical nurses. Clarifying these mechanisms is essential to inform interventions that strengthen resilience, prevent adverse psychological outcomes, and improve the well‐being of the nursing workforce.

Therefore, in this study, we aimed to examine the mediating role of psychological distress, which comprised depression, anxiety, and stress, and the moderating role of emotional support in the relationship between STS and PTSS among clinical nurses. We sought to elucidate these mechanisms and contribute to the development of nuanced, evidence‐based interventions that foster resilience, mitigate psychological risk, and enhance the well‐being of nursing professionals who are trauma‐exposed.

3. Methods

3.1. Design

This study employed a cross‐sectional survey design to examine the mediating role of psychological distress (depression, anxiety, and stress) and the moderating role of emotional support in the relationship between STS and PTSS among clinical nurses.

3.2. Study Setting and Sampling

This study was a secondary data analysis based on the dataset originally collected by Nam and Lee (2025), which validated the Korean version of the Secondary Traumatic Stress Scale for healthcare professionals. The original survey was conducted between November and December 2024 in South Korea across multiple healthcare institutions, including tertiary and general hospitals. Data were collected through a self‐administered, web‐based questionnaire commissioned via Macromill Embrain, a professional online survey research company. Eligible participants were healthcare professionals with trauma‐related clinical experience.

For the present analysis, a subsample of 205 clinical nurses was extracted. This sample size was considered appropriate because mediation and moderated mediation models typically require at least 200 participants to ensure stable parameter estimation and adequate statistical power (Kline 2015). Furthermore, a priori power analysis using G*Power indicated that a minimum of approximately 180 participants would be required to detect a medium effect size (f ² = 0.15) at 80% power and α = 0.05, confirming that the sample of 205 nurses was sufficient.

3.3. Inclusion and Exclusion Criteria

The original dataset by Nam and Lee (2025) included healthcare professionals (physicians, nurses, and paramedics) with prior exposure to trauma‐related clinical situations. For the purpose of this study, inclusion was restricted to clinical nurses with direct patient contact and trauma‐related experience (e.g., managing patients with severe injuries, critical illness, violence, or end‐of‐life care). Nurses working in departments without direct patient interaction (e.g., infection control, appointment scheduling, medical records, administrative services, biomedical engineering) were excluded. The final sample comprised 205 clinical nurses.

4. Data Collection and Analysis

4.1. Demographic Characteristics

Demographic information was collected through structured self‐report questions, including age, gender, marital status, education level, clinical department, years of nursing experience, and work shift pattern. These variables were used to describe the sample and examine potential group differences in study variables.

4.2. Secondary Traumatic Stress Scale (STS)

The STSS, developed by Bride et al. (2004), is a 20‐item instrument measuring intrusion, avoidance, and arousal related to indirect trauma exposure. Items are rated on a 5‐point Likert scale (1 = never to 5 = very often), with higher scores reflecting greater STS. The scale has been widely validated in nursing and healthcare populations, demonstrating strong internal consistency (Cronbach's α typically > 0.90 in prior studies; Bride et al. 2004; Robinson et al. 2022). In the present study, the Cronbach's α for the STSS was 0.94, indicating excellent reliability.

4.3. Depression, Anxiety, and Stress Scale‐12 (DASS‐12)

The DASS‐12, adapted from the original 21‐item DASS, measures negative emotional states across three subscales: depression, anxiety, and stress. Items are rated on a 4‐point Likert scale, and subscale scores are obtained by summing relevant items. The DASS has been validated in nursing populations and has shown good psychometric properties, with Cronbach's α values for subscales ranging from 0.84 to 0.91 (Moussa et al. 2017; Lee et al. 2019). In this study, Cronbach's α values were 0.88 for depression, 0.87 for anxiety, and 0.90 for stress, supporting strong internal consistency.

4.4. Multidimensional Scale of Perceived Social Support (MSPSS)

The MSPSS (Zimet et al. 1988) is a 12‐item scale assessing perceived support from family, friends, and significant others. Each item is rated on a 5‐point Likert scale, with higher scores indicating greater perceived emotional support. The MSPSS has been applied extensively in healthcare research, including among nurses, and consistently demonstrates strong reliability (Cronbach's α = 0.88–0.93; Wongpakaran et al. 2011). In the present study, Cronbach's α for the MSPSS was 0.91, confirming excellent reliability.

4.5. Impact of Event Scale‐Revised (IES‐R)

PTSS were measured with the IES‐R (Weiss and Marmar 1997), a 22‐item instrument capturing intrusion, avoidance, and hyperarousal symptoms. Items are rated on a 5‐point scale (0 = not at all to 4 = extremely). The IES‐R is one of the most widely used tools for assessing trauma‐related symptoms, and its relevance for evaluating PTSS (rather than clinical PTSD diagnosis) has been established in nursing and healthcare worker studies (Creamer et al. 2003; Ratrout and Hamdan‐Mansour 2020). In this study, Cronbach's α for the IES‐R was 0.95, indicating strong reliability.

4.6. Data Analysis

IBM SPSS Statistics version 29.0 (IBM Corp., Armonk, NY, USA) was used for data analysis. First, descriptive statistical analyses were performed to describe participants' characteristics of the sample. Pearson's correlation analysis was conducted to examine the relationships between STS, perceived stress, depression, anxiety, and PTSS. In addition, Model 58 of the PROCESS macro, developed by Hayes, was used to evaluate whether perceived stress, depression, and anxiety mediated the relationship between STS and PTSS among nurses, and whether social support moderated this relationship. Mediation effects were assessed via 95% bootstrap confidence intervals generated from 5000 bootstrap samples. If the confidence intervals did not include zero, the indirect effect was considered statistically significant.

5. Ethical Considerations

This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. The original data were collected after obtaining approval from the Institutional Review Board of Hallym University (1st Approval no. HIRB‐2024‐093). The present study is a secondary analysis of that dataset and received additional approval from the same board (2nd Approval no. HIRB‐2025‐028). All participants in the original study were provided with detailed information regarding the study's purpose, procedures, potential risks, and benefits prior to participation, and written informed consent was obtained.

6. Results

This study included 205 nurses with prior trauma‐related experience (Table 1). Most participants were female (n = 184, 89.8%), while 21 (10.2%) were male. Participants' mean age was 37.54 years (SD = 8.537), and the largest age group was those in their 40s or older (n = 68, 33.2%), followed by those in their 20s (n = 34, 16.6%).

TABLE 1.

General characteristics (n = 205).

Characteristics	Category	n (%)	M ± SD
Gender	Male	21 (10.2)
	Female	184 (89.8)
Age	20–29	34 (16.6)	37.54 ± 8.537
	30–39	105 (51.2)
	≥ 40	66 (32.3)
Marital status	Married	103 (50.2)
	Single	95 (46.3)
	Other	7 (3.4)
Education level	University graduate under	182 (88.8)
	Higher than Masters	23 (11.2)
Work year	< 3	14 (6.9)
	3–5	16 (7.8)
	5–10	66 (32.2)
	> 10	109 (53.1)
Shift work	Yes	101 (49.3)
	No	104 (50.7)
Trauma experience	Yes	30 (14.6)
	No	175 (85.4)
Taking psychiatric medication	Yes	14 (6.8)
	No	191 (93.2)
How likely do you think your job is to involve, directly or indirectly, traumatic situations (disasters, accidents, violence, abuse, etc.)?	Low	57 (27.8)
	Average	52 (25.4)
	High	80 (39.0)
	Extremely high	16 (7.8)
Does your job involve providing assistance or problem‐solving to people involved in traumatic situations?	Rarely	71 (34.7)
	Sometimes	72 (35.1)
	Often	41 (20.0)
	Always	21 (10.2)

Most participants were married (n = 108, 52.7%). Furthermore, 182 individuals (88.8%) reported they had a college or lower level of education, while 23 (11.2%) held a graduate degree or higher. With regard to work experience, more than half of the participants (53.1%) had over 10 years of clinical experience.

Regarding prior exposure to trauma education, 101 participants (49.3%) had received trauma‐related education. Additionally, 130 (63.4%) reported prior experience with trauma in clinical practice, and 30 (14.6%) had worked in psychiatric or mental health‐related departments.

When asked how likely they believed their job was to involve direct or indirect exposure to traumatic situations (e.g., disasters, accidents, violence, abuse), 80 (39.0%) and 16 (7.8%) responded “high” and “extremely high,” respectively. In terms of job function, about one‐third of participants (30.2%) reported that they were often or always engaged in tasks assisting people exposed to trauma.

Group differences in PTSS by participants' general characteristics are presented in Table 2. No statistically significant differences in PTSS were observed according to gender, age, marital status, education level, years of work experience, or shift work (all p > 0.05).

TABLE 2.

Group differences in PTSS by participants' characteristics (N = 205).

Characteristics	Category	t/F (p)	Post hoc test
Gender	Male	−0.438 (0.662)
	Female
Age	20–29	0.673 (0.512)
	30–39
	≥ 40
Marital status	Married	1.805 (0.167)
	Single
	Other
Education level	University graduate under	−0.468 (0.641)
	Higher than Masters
Work year	< 3	0.793 (0.499)
	3–5
	5–10
	> 10
Shift work	Yes	−0.010 (0.992)
	No
Trauma experience	Yes	3.422 (< 0.001)***
	No
Taking psychiatric medication	Yes	4.139 (< 0.001)***
	No
How likely do you think your job is to involve, directly or indirectly, traumatic situations (disasters, accidents, violence, abuse, etc.)?	Low	2.931 (0.035)*	a<d
	Average
	High
	Extremely high
Does your job involve providing assistance or problem‐solving to people involved in traumatic situations?	Rarely	1.470 (0.224)
	Sometimes
	Often
	Always

Note: *p < 0.05; ***p < 0.001.

However, participants who reported prior trauma‐related clinical experience demonstrated significantly higher PTSS scores compared with those without such experience (t = 3.422, p < 0.001). Similarly, nurses who were taking psychiatric medication showed significantly greater PTSS than those who were not (t = 4.139, p < 0.001).

Significant group differences in PTSS were also found according to participants' perceived likelihood of encountering traumatic situations in their work (F = 2.931, p = 0.035). Post hoc analyses revealed that nurses in the “extremely high” group reported significantly higher PTSS than those in the “low” group. Conversely, no significant differences were found in PTSS based on the frequency of providing assistance to trauma‐exposed individuals (F = 1.470, p = 0.224).

A moderated mediation analysis was conducted via PROCESS Macro Model 58 (Table 3, Figure 1) to examine the mediating effect of psychological distress in the relationship between STS and PTSS and the moderating role of perceived emotional support.

TABLE 3.

Conditional indirect effects of STS on PTSS via depression, anxiety, and stress at values of emotional support.

Emotional support (W)	Indirect effect (STS→depression, anxiety, and stress →PTSS)	Boot SE	95% CI
Low (2.75)	0.4137	0.0659	[0.2807, 0.5391]
Moderate (3.83)	0.4745	0.0642	[0.3500, 0.5993]
High (4.58)	0.5163	0.0806	[0.3643, 0.6767]

Note: Emotional support was mean‐centered prior to analysis.

Abbreviations: B, unstandardized regression coefficient; CI, confidence interval; SE, standard error; STS, secondary traumatic stress.

FIGURE 1.

Moderated mediation model on the effects of STSS on trauma through depression, anxiety, and stress, with emotional support as a moderator.

Results indicated that STS and emotional support were positively and negatively associated with psychological distress (B = 0.5108, SE = 0.2155, p = 0.0187; B = −0.3222, SE = 0.1324, p = 0.0159, respectively). Importantly, the interaction between STS and emotional support was statistically significant (B = 0.1178, SE = 0.0589, p = 0.0469), which suggested that emotional support moderated the effect of STS on psychological distress. Simple slope analyses revealed that the association between STS and psychological distress was stronger at higher levels of emotional support. Specifically, the conditional effect of STS on psychological distress was significant at low (B = 0.8348, p < 0.001), moderate (B = 0.9625, p < 0.001), and high (B = 1.0508, p < 0.001) levels of emotional support, and the effect size increased across levels.

Both STS (B = 0.5203, SE = 0.0595, p < 0.001) and psychological distress (B = 0.5020, SE = 0.1380, p < 0.001) were significant predictors in the subsequent regression model that predicted PTSS. However, neither the interaction between psychological distress and emotional support (B = −0.0023, p = 0.9480) nor the main effect of emotional support on PTSS (B = 0.0298, p = 0.7023) achieved statistical significance. This indicated that emotional support did not moderate the association between psychological distress and PTSS.

Conditional indirect effects of STS on PTSS through psychological distress were significant at all levels of emotional support. The indirect effects were B = 0.4137 (95% CI [0.2807, 0.5391]), B = 0.4745 (95% CI [0.3500, 0.5993]), and B = 0.5163 (95% CI [0.3643, 0.6767]) at low, moderate, and high levels of emotional support, respectively. Despite their significance, the effect size did not differ substantially across levels of support, and the moderated mediation index was not significant. This suggested that while emotional support influenced the strength of the relationship between STS and psychological distress, it did not significantly change the magnitude of the overall indirect effect of STS on PTSS through psychological distress.

Pearson's correlation coefficients were conducted to examine the relationships among psychological distress, STS, and PTSS. Table 4 presents the results.

TABLE 4.

Correlations and Cronbach's alpha.

	Depression, anxiety, stress (1)	STS (2)	PTSS (3)
1	0.96
2	0.839 (< 0.001)	0.95
3	0.881 (< 0.001)	0.882 (< 0.001)	0.97

Psychological distress was positively correlated with STS (r = 0.839, p < 0.001) and PTSS (r = 0.881, p < 0.001). Furthermore, STS was positively correlated with PTSS (r = 0.882, p < 0.001). All correlations were statistically significant.

7. Discussion

This study aimed to examine the pathways through which STS influenced PTSS among clinical nurses. Specifically, we assessed the mediating roles of depression, anxiety, and stress and the moderating effect of perceived emotional support. This study utilised Model 58 of Hayes' PROCESS macro, and the analysis yielded statistically significant results that highlighted the complex interplay between these psychological variables and the development of PTSS among clinical nurses.

STS significantly and directly impacted depression, anxiety, and stress (B = 0.511, p = 0.018), which significantly influenced PTSS (B = 0.712, p = 0.0003). These findings were consistent with theoretical models of trauma response, which suggested that the persistence of negative emotional states, such as depression, anxiety, and stress, and difficulty in their regulating may serve as antecedents to PTSS (McLean and Foa 2017). These emotional responses were also reflected in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5) diagnostic criteria for PTSD. Specifically, criterion D includes the presence of a “persistent negative emotional state” following a traumatic event. Such negative emotions must persist beyond the initial trauma for a PTSD diagnosis. Our findings indicated that even in indirect trauma exposure, such as STS, failure to adequately address the resulting depressive and anxious states may lead to the development of PTSD. This study further confirmed that depression and anxiety frequently co‐occurred with secondary trauma and functioned as proximal mediators that exacerbated PTSD symptoms following STS exposure. Clinical nurses are a high‐risk group for STS (Ratrout and Hamdan‐Mansour 2020), as they are frequently exposed to patients' adverse events or medical errors that can lead to secondary trauma and subsequent psychological distress (Robinson et al. 2022). Unresolved psychological distress and STS symptoms that persist for more than 1 month can lead to a risk of progression to PTSD (ElKayal and Metwaly 2022). Therefore, implementing appropriate interventions to manage depression, anxiety, and stress is essential to prevent the development of PTSD among clinical nurses.

In this study, emotional support moderated the relationship between STS and psychological distress (B = 0.118, p = 0.046), which indicated that higher levels of emotional support tended to buffer the impact of STS on depression, anxiety, and stress. This suggests that emotional support serves as a protective factor that alleviates the emotional burden that results from secondary trauma exposure. However, emotional support did not significantly moderate the pathway between psychological distress and PTSD symptoms (B = −0.066, p = 0.229). This implied that while emotional support may be effective in reducing general psychological distress, it may have a limited capacity to alter the course of PTSD development once psychological distress has become severe.

Previous studies identified the lack of social support systems (Von Rueden et al. 2010), insufficient peer emotional support, and lack of organisational awareness of secondary trauma as risk factors for STS among nurses (Newell and MacNeil 2010). Emotional support from colleagues and supervisors, as well as provision of spaces for open communication regarding the emotional impact of trauma‐related work, acted as protective mechanisms that assisted nurses in coping with STS (Whittenbury et al. 2025). Although secondary trauma is common and relatively widespread, less than 10% of those exposed eventually develop PTSD, which highlights the importance of preventive strategies (Owen 2024; Robinson et al. 2022). Therefore, providing preventive interventions before nurses exposed to STS progress to a clinical diagnosis of PTSD is crucial.

A prior study in the United States implemented the Accelerated Recovery Program (ARP) to reduce STS among trauma center nurses (Robinson et al. 2022). This program significantly alleviated secondary trauma and somatic symptoms. ARP, a peer‐support‐based intervention, was designed to reduce STS via the facilitation of emotional sharing and reconstruction of trauma experiences through supportive interactions among team members.

Emotional support strategies for nurses experiencing STS may play a crucial role in mitigating negative emotional outcomes, such as depression, anxiety, and stress. Consequently, it can prevent PTSD progression. Our findings underscore the importance of implementing emotional support interventions at the early stage of emotional response, before STS leads to PTSS, as a proactive and preventive approach.

Our results supported a partially moderated mediation model regarding the relationship between STS and PTSS, which highlighted the roles of negative emotional states and emotional support. The impact of STS on PTSD symptoms was primarily mediated by psychological distress, while emotional support was a protective factor at the early stage of emotional response. These findings underscore the importance of managing emotional symptoms through trauma‐informed interventions for professionals exposed to secondary trauma. A trauma‐informed approach does not view the environment in which nurses are placed and their emotional responses as mere stress, but rather enables a systemic approach centered on recovery and safety (Fleishman et al. 2019). A previous study utilized a trauma‐informed approach as an organisational‐level strategy to mitigate burnout among intensive care unit nurses (Dawson‐Rose et al. 2023). Moreover, interventions aimed at enhancing emotional support may contribute to the prevention of PTSD symptoms, particularly among individuals vulnerable to STS.

8. Strengths and Limitations of the Work and Recommendations for Further Research

A key strength of this study is its focus on an understudied mechanism—the mediating role of psychological distress and the moderating role of emotional support—in the relationship between secondary traumatic stress and post‐traumatic stress symptoms among clinical nurses. The use of validated, psychometrically robust instruments for all major variables enhances the reliability and comparability of findings. Additionally, the study sample consisted exclusively of clinical nurses with direct patient contact and trauma‐related experience, which increases the relevance of results to high‐risk nursing populations.

This study has several limitations. First, the cross‐sectional design restricts the ability to draw definitive causal inferences regarding the relationships among STS, psychological distress, emotional support, and PTSD symptoms. Second, self‐reported measures may introduce potential biases, such as social desirability bias or recall bias. Additionally, this study primarily focused on emotional support as a moderating variable; however, the conditions under which emotional support effectively mitigates the impact of STS on psychological distress remain unclear. Future research should further explore the conditions under which emotional support operates as a buffer in the pathway from STS to emotional distress. Moreover, examining other potential mediators and moderators in the relationship between STS and PTSD symptoms, such as organizational support and individual coping strategies, is essential. Longitudinal studies should clarify the causal pathways and temporal dynamics among these variables, which can provide a stronger empirical foundation for trauma‐informed interventions targeting clinical nurses.

9. Conclusion

This study provides important evidence for understanding the association between secondary traumatic stress and post‐traumatic stress symptoms among clinical nurses. We examined the mediating effects of depression, stress, and anxiety, and the moderating effect of social support. Secondary traumatic stress experienced by nurses is a critical factor in ensuring high‐quality and safe patient care (Robinson et al. 2022). Left unaddressed, such exposure can potentially develop into PTSD. Therefore, developing practical intervention strategies that include efforts to alleviate negative emotional states, such as stress, depression, and anxiety, experienced by nurses and enhance their perceived social support is essential. This approach could serve as an effective foundation for multifaceted intervention strategies aimed at preventing the onset of PTSD among healthcare professionals exposed to secondary traumatic experiences.

Ethics Statement

The original study that obtained the data was approved by the Institutional Review Board (IRB) of Hallym University (HIRB no. 2024‐093).

Consent

Prior to data collection, participants were fully informed of the study's purpose and content and were notified that they could decline to participate at any time if they wished. Voluntary informed consent was obtained from all the participants. Furthermore, participants were informed that the collected responses would be used solely for the purpose of this study. The data used in this study were re‐analysed within the scope of the research purpose, and all personal information was de‐identified, resulting in no direct participant involvement. Therefore, this study obtained an exemption from further ethical review (HIRB no. 2025‐028).

Conflicts of Interest

The authors declare no conflicts of interest.

Nam, S.‐H. , and Lee J.. 2026. “Secondary Traumatic Stress and Post‐Traumatic Stress Symptoms in Nurses: Mediating Role of Psychological Distress and Moderating Role of Emotional Support.” Journal of Advanced Nursing 82, no. 8: 7827–7835. 10.1111/jan.70390.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.