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Vicarious Trauma: Information, Prevention and Resources

November 12, 2019  |  Category: Articles, Nursing

Nurse in the emergency room

Leonie Harvey-Rolfe knew something was wrong, but she couldn’t put her finger on it. The 30-year-old was employed as the service coordinator for a community health center, where she worked closely with women who were the victims of “daily violence, abuse, poverty, homelessness, and addiction” as Refinery29 describes it.

She didn’t exhibit any symptoms of stress, but she noticed her “threshold for what was shocking or risky had all but disappeared.” At first, she responded by taking on even more work despite the toll it was taking on her mental health because she felt that taking a break from her work would be a sign of weakness and failure. Eventually, her doctor prescribed 30 days off from work. Only after that long break did she realize the devastating impact of the vicarious trauma she felt.

The lesson Harvey-Rolfe learned from her experience with vicarious trauma was how important it is for people who care for victims of trauma to take care of themselves as well. Healthcare providers are particularly susceptible to vicarious trauma, which is also called secondary trauma and secondary traumatic stress because those who are affected frequently work with people who are experiencing or have recently gone through a traumatic event. Nurses and other healthcare professionals need to know what vicarious trauma is, how to identify vicarious trauma, and how to support themselves and their coworkers who are affected by the condition.

What Is Vicarious Trauma?

GoodTherapy defines vicarious trauma as “indirect exposure to a traumatic event through firsthand account or narrative of that event.” While emergency responders, healthcare workers, and people in law enforcement are at greatest risk of vicarious trauma, the condition can affect anyone who has a “significant relationship with a survivor of trauma,” according to the site.

In the course of their work, therapists, nurses, and other healthcare professionals must ask patients to recount the traumatic events that caused their injuries. Hearing these accounts often evokes in caregivers a similar but muted response to the trauma that the patient experienced. The vicarious trauma they feel can cause the caregiver’s worldview to shift; it may also lead to “compassion fatigue” and burnout.

Compassion fatigue occurs when caregivers spend so much time assisting victims of trauma that they have no time to care for themselves. It causes physical and emotional exhaustion, but, unlike vicarious trauma, compassion fatigue doesn’t cause symptoms of trauma or a negative change in a person’s worldview.

Examples of Vicarious Trauma

A nurse educator observing interactions between patients and nurses in emergency rooms notices that new nurses are “excited, enthusiastic and engaged with patients,” as the Association of American Medical Colleges notes. By contrast, the nurses who have 20 to 30 years of work experience appear detached from their patients, as if they are “going through the motions” and “have built walls to avoid the hurt” of witnessing their suffering and trauma. The term “compassion fatigue” is ill suited to describe this situation because the veteran nurses haven’t lost their compassion or desire to help people.

Instead, they are experiencing “professional emotional saturation,” which combines symptoms of burnout and secondary traumatic stress. Burnout originates externally: It is caused by working long hours and having too much work to do. Also contributing to burnout is the fact that nurses don’t have enough time to spend with each patient, in part because they are constantly entering data into computers and devices. In contrast, secondary traumatic stress originates within: It results from sharing the grief when a patient dies and from feeling overwhelmed by negative emotions. While all healthcare professionals must feel some detachment in their work, with secondary traumatic stress the detachment becomes extreme and leads to cynicism, jadedness, and depersonalization.

In another example of the impact of vicarious trauma, a nurse with 22 years of experience left the profession with feelings of “turmoil, shame, and confusion,” as she describes in Reflections on Nursing Leadership. Not until much later did she realize that she was experiencing secondary traumatic stress. She found that she had become “hardened and cynical,” and she felt “crippled when confronted again by suffering,” which led to “feelings of hopelessness, withdrawal, and lack of self-esteem.” Her coping mechanisms included “going silent . . . redirecting, shutting down, minimizing, or ignoring the experiences of patients.”

How to Identify Vicarious Trauma

Symptoms of vicarious trauma can be divided into five categories, as GoodTherapy explains:

  • Emotional symptoms: Persistent feelings of grief, anxiety and sadness; irritability and anger; being easily distracted; changes in mood or sense of humor; feeling isolated; and feeling unsafe
  • Behavioral symptoms: Increased drinking and substance abuse; changes in eating and sleeping habits; risky behavior; avoiding people or favorite activities; and failing to separate work life from personal life
  • Physiological symptoms: Increased incidence of headaches, rashes, ulcers, heartburn, and other signs of physical illness
  • Cognitive symptoms: Increased cynicism and negativity; inability to concentrate and make decisions; memory problems; inability to stop thinking about the trauma others have experienced
  • Spiritual symptoms: Loss of hope or sense of purpose; feeling disconnected from others and the world in general; feeling unworthy or undeserving of love

Many healthcare employers have instituted screening programs intended to recognize signs of vicarious trauma and burnout in nurses and other clinicians. These programs are implemented in conjunction with information on self-assessment and increased awareness of the prevalence of vicarious trauma and other stressors in healthcare environments.

How to Address Vicarious Trauma

The veteran nurse in the above example who abandoned a 22-year career was eventually able to return to the profession after working with a trauma therapist. Effective treatments for vicarious trauma include cognitive behavior therapy, eye movement desensitization reprocessing (EMDR), resilience training and mindfulness-based stress reduction.

Preventing and recovering from the negative effects of vicarious trauma depend on having strong personal and professional support networks. Feelings of isolation and ineffectiveness can be alleviated by talking with colleagues. Nurse managers play an important role in promoting self-assessment and self-help for their staff members, but they can have a more direct impact on preventing vicarious trauma by helping nurses with their most challenging cases and with their caseloads.

The U.S. Department of Justice Office for Victims of Crime has created the Vicarious Trauma Toolkit designed to assist healthcare professionals and others who work with the victims of trauma by providing information and techniques they can apply to prevent and treat the condition. In particular, the tool kit’s “What Is Vicarious Trauma?” page lists the common reactions to negative trauma and explains the steps coworkers and managers can take to assist their colleagues who may be suffering from vicarious trauma.

Vicarious Trauma and the AHU Bachelor of Science in Nursing

Nurses and other healthcare professionals must strike a balance between feeling empathy for their patients’ suffering and desensitizing themselves to the impact of spending day after day, year after year helping people who are experiencing trauma now or have recently suffered a traumatic event. How nurses can help themselves and their colleagues to recognize, prevent, and respond to vicarious trauma is a component of AdventHealth University Online’s Bachelor of Science in Nursing (RN-BSN) degree program, which teaches whole-person care for both patients and nurses.

The RN-BSN program prepares nurses to excel as healthcare professionals during times of tremendous technological and social change. The program curriculum includes such classes as Community Health for RNs, Leadership and Management in Nursing, and Health Promotion and Assessment for RNs. Learn more about the benefits of AdventHealth University Online’s RN-BSN program for a long and successful nursing career.

Recommended Readings

Nurse Burnout: Causes, Symptoms and Prevention

Nursing Career Paths: What You Can Do with a BSN or MSN Degree

The Fastest Growing Healthcare Careers

 

Sources

Association of American Medical Colleges, “Compassion Fatigue: The Toll of Being a Care Provider”

British Medical Association, “Vicarious Trauma — Signs and Strategies for Coping”

European Journal of Psychotraumatology, “Secondary Traumatization in First Responders: A Systematic Review”

GoodTherapy, “Vicarious Trauma”

Health Care Toolbox, “Health Care Providers’ Responses to Medical Traumatic Stress in Their Patients”

Psychiatric Times, “Vicarious Trauma in Clinicians: Fostering Resilience and Preventing Burnout”

Refinery29, “If You’re a Compassionate Person, You May Be Experiencing ‘Vicarious Trauma’”

Reflections on Nursing Leadership, “I Left Nursing Because of Secondary Traumatic Stress”

Trauma Center at Justice Resource Institute, The Cost of Helping: Vicarious Trauma and Best Practices for Sustaining Trauma Informed Practices