Factors influencing vicarious trauma among Generation Z nursing interns in ICU practice: a cross-sectional study

BMC Nursing https://doi.org/10.1186/s12912-026-04804-8 Article in Press Factors influencing vicarious trauma among Generation Z nursing interns in ICU practice: a cross-sectional study Chengxu Duan, Hui Li, Xinqi Zhuang, Guangjin Min, Hui Ma, Haoyan Tian, Wenke Han, Xiaohan Hua, Wei Zhao, Yenong Zhou, Manhua Zhao & Yin-Ping Zhang Received: 21 January 2026 Accepted: 19 May 2026 Cite this article as: Duan C., Li H., Zhuang X. et al. Factors influencing vicarious trauma among Generation Z nursing interns in ICU practice: a cross-sectional study. BMC Nurs (2026). https://doi.org/10.1186/ s12912-026-04804-8 A S S We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply. 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To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. ACCEPTED ARTICLEMANUSCRIPT IN PRESS Factors influencing vicarious trauma among Generation Z nursing interns in ICU practice: a cross-sectional study Chengxu Duan1+, Hui Li1+, Xinqi Zhuang1, Guangjin Min2, Hui Ma1, Haoyan Tian3, Wenke Han1, Xiaohan Hua4, Wei Zhao1, Yenong Zhou1, Manhua Zhao1, Yin-Ping Zhang1* 1 School of Nursing, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi 710061, China 2 450052, China 3 IN The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China 4 S S E R P The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan E L C I T R A Henan Provincial People’s Hospital, Zhengzhou, Henan 450003, China +Chengxu Duan and Hui Li contributed equally to this work. * Correspondence: Yin-Ping Zhang, PhD, FAAN School of Nursing, Xi’an Jiaotong University Health Science Center No.76, West Yanta Road, Xi’an, Shaanxi, 710061, P. R. China Email: Tel: +86(29) 8265 7015 Fax: +86(29) 8265 7015 Abstract ACCEPTED ARTICLEMANUSCRIPT IN PRESS Background The ICU is a high-stress environment characterized by frequent exposure to patient suffering and traumatic events, making vicarious trauma a significant occupational hazard for nurses. Generation Z nursing interns face unique challenges during ICU rotations due to insufficient skills and limited resilience. However, their current status regarding vicarious trauma and the factors influencing it still remain underexplored. This study aims to investigate the levels of vicarious trauma and its key influencing factors within this cohort. Methods A cross-sectional study was conducted in Zhengzhou, China, from S S E R P July to September 2025, recruiting 240 Generation Z nursing interns through convenience demographic sampling. characteristics The IN instruments questionnaire, E L C I T R A the used included Vicarious a Trauma Questionnaire for Disaster Rescuer (VTQ), the Simplified Coping Style Questionnaire (SCSQ), the Professional Identity Scale for Nursing Students (PISNS), and the Perceived Social Support Scale (PSSS). Data were analyzed using independent t-tests, one-way analysis of variance, Pearson correlation, and multiple stepwise linear regression. Results The mean VTQ score for Generation Z nursing interns was 80.50 ± 26.49, with one-fifth exhibiting vicarious trauma reactions. Significant associations were observed between VTQ and negative coping styles, PISNS, and PSSS (r = -0.195 to -0.216, p < 0.01), as well as between VTQ and positive coping styles (r = 0.250, p < 0.01). The coefficient of determination (R2 = 0.443) indicated that the ICU rotation sequence, daily working hours, ACCEPTED ARTICLEMANUSCRIPT IN PRESS night shift frequency, patient death exposure, perceived workload, sleep quality, coping styles, and perceived social support together explained 44.3% of the variance in vicarious trauma. Conclusion This study offers a comprehensive understanding of vicarious trauma among Generation Z nursing interns by identifying multiple influencing factors, including the clinical environment, work arrangements, individual psychology, and social support. To address these issues, the nursing education system should implement measures such as optimizing the clinical environment, adjusting internship arrangements, and enhancing S S E R P educational guidance to support the mental health of Generation Z nursing interns and reduce the risk of vicarious trauma. Keywords: Vicarious trauma, E L C I T R A occupational health Background IN Generation Z, nursing interns, ICU, The intensive care unit (ICU) is one of the most demanding environments within the healthcare system. Due to the high-intensity and high-stress nature of their work, ICU nurses are constantly exposed to life-and-death situations, severe patient suffering, and profound family grief [1–3]. Such repeated traumatic exposure can cause significant psychological distress, leading to vicarious trauma among nurses [4]. Vicarious trauma, defined as a negative psychological response resulting from indirect exposure to traumatic stimuli through empathetic engagement with patients or witnessing distressing events, has become a critical occupational hazard for ACCEPTED ARTICLEMANUSCRIPT IN PRESS nursing professionals [5–7]. Unlike compassion fatigue, which arises from prolonged empathic engagement with suffering and manifests as emotional exhaustion, vicarious trauma stems from repeated exposure to others’ traumatic experiences and involves profound disruptions to an individual’s cognitive schemas, worldviews, and sense of self. This traumatic reaction manifests as a range of physical and psychological symptoms, including anxiety, depression, emotional numbing, and reduced empathy [6, 8]. Furthermore, vicarious trauma impairs care quality and efficiency, increases the risk of medical errors, and (...truncated)