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Document Type

Dissertation - University Access Only

Award Date


Degree Name

Doctor of Philosophy (PhD)


Graduate Nursing

First Advisor

Barbara Hobbs


Lack of anonymity, secondary traumatic stress, rural nursing theory


Objective: The purpose of the study was to determine the relationship, differences, and association between lack of anonymity and secondary traumatic stress in nurses from different population densities (metropolitan, micropolitan, and rural). Background: Lack of anonymity was identified as a concept in rural nursing theory that affects nurses. Secondary traumatic stress exists in nursing practice, causing psychological distress. In literature, demographic characteristics are linked to the risk of developing secondary traumatic stress. Methods: The study used a descriptive, correlational study design, using random sampling of nurses from metropolitan, micropolitan, and rural counties in Minnesota. Participants completed the Lack of Anonymity Instrument (LOAN-10©), Compassion Fatigue Short Scale-Adapted (CF-SS-A), and demographic data instruments. Social cognitive theory and rural nursing theory provided a framework for the study.
Results: The data revealed that there was a significant difference in lack of anonymity among nurses from different population densities, with rural nurses having higher levels of lack of anonymity than metropolitan nurses. This finding supports theoretical statement three of rural nursing theory. While less prevalent, lack of anonymity was present among nurses in metropolitan areas, supporting literature that smaller communities develop within large metropolitan areas. Nurses reported a mixture of lack of anonymity, and anonymity, revealing the paradoxical nature of lack of anonymity and supporting literature suggesting that environmental context acts as a determinate of lack of anonymity. Secondary traumatic stress was present in 39% of the total sample. Lack of anonymity and secondary traumatic stress are unrelated in nurses from different population densities. Thus, rural nurses experience secondary traumatic stress similar to metropolitan nurses. The amount of variance of secondary traumatic stress explained by lack of anonymity was small (1.6%). Population density did not appear to predict lack of anonymity and secondary traumatic stress. Conclusions: The findings from the study advance the understanding of the relationship of lack of anonymity and secondary traumatic stress on nurses in different population densities. New knowledge of lack of anonymity as a concept of theoretical statement three in rural nursing theory was found.

Library of Congress Subject Headings

Nurses -- Psychology Nurses -- Job stress Rural nurses -- Psychology Rural nurses -- Job stress


Includes bibliographical references (pages 91-108)



Number of Pages



South Dakota State University


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