How the Camel’s Back Breaks: A Scoping Review of Cumulative Occupational Distress and the Conceptual Absence of Micro-Trauma in Nursing

Vollständiger Abstract

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Background/Objectives: Nursing involves repeated exposure to emotionally, morally, and psychologically distressing experiences, yet the mechanisms through which low-intensity occupational stressors accumulate and contribute to psychological harm remain conceptually unclear. This scoping review examined how the nursing literature conceptualises the cumulative effects of repeated occupationally distressing experiences and identified the conceptual gap created by the absence of a unifying term such as micro-trauma. Methods: A scoping review was undertaken to map concepts used to describe cumulative occupational distress in nursing and determine whether any terminology captures the cumulative impact of repeated low-intensity exposures. Searches were conducted across CINAHL, MEDLINE, and Emcare, supplemented by citation searching, Google Scholar, targeted grey literature searching and structured generative artificial intelligence-assisted source identification. Data were extracted using a priori criteria and synthesised narratively. Consistent with Joanna Briggs Institute guidance, quality appraisal was not undertaken. Results: No included publication applied the term ‘micro-trauma’ to nursing or healthcare workers. Seven publications met the inclusion criteria following expanded searching across supplemental pathways. The literature used heterogeneous and overlapping terminology, including burnout, compassion fatigue, cumulative grief, moral distress, workplace trauma, and post-traumatic stress disorder symptomatology, to describe cumulative psychological burden, but none provided a unifying conceptual frame for repeated low-intensity exposures. Conclusions: The current literature does not yet clearly define or consistently apply micro-trauma in nursing, despite evidence that repeated occupational exposures contribute to cumulative psychological burden. This review highlights a conceptual space before end-point conditions such as burnout, compassion fatigue, or post-traumatic stress disorder symptomatology are recognised. Future research should develop and test a clearer conceptual framework for micro-trauma in nursing before it is applied as a distinct unifying concept.