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Identify Stress and Vicarious, Secondary, Indirect Trauma in Nurses

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The relationship between a healthcare professional and their patient is often very close, and this proximity can expose staff to the distress and trauma experienced by patients. Caseloads can often include patients who have been affected by trauma, violence, abuse, death and fear, combined with a myriad of other physical and mental health issues.

Empathy and the desire to alleviate the pain and suffering of patients can dramatically enhance the connection between patient and worker. Unfortunately, this connection can have a serious psychological impact on the worker, with long-term consequences if left untreated (Upton 2018).

Empathic behaviour is associated with the mirroring of emotions and body movements between people (e.g. how laughing and yawning is considered to be contagious). In cases of trauma, the result is the mirroring of negative psychological issues in the healthcare worker.


Stress and Trauma Terminology

There is a great debate on the correct terminology for this type of trauma, with a range of descriptions that are often confused with each other. Vicarious trauma, secondary traumatic stress, compassion fatigue and burnout are often used interchangeably (albeit incorrectly) (Tabor 2011).

Although there is some discrepancy in the definitions, and these feelings may co-exist, it is important to be able to differentiate between the terms (Blue Knot Foundation 2018). This will help how we identify, respond and prevent the emotional impact of stress and trauma at work.

Vicarious Trauma

Vicarious trauma occurs from repeated exposure to other people’s trauma. Over time, workers begin to mirror the bio-psychosocial effects shown by the victims of trauma (Tabor 2011; The Lookout 2017).

Vicarious trauma can be described as a cumulative ‘negative transformation’ that impacts the physical and mental health of a healthcare worker, permeating all aspects of work and home life. It builds up over time, intruding on everyday life, and has the potential to drastically alter an individual’s character and belief systems (The Lookout 2017; Dragon 2019).

Secondary Traumatic Stress

Secondary trauma is the development of PTSD-like symptoms without directly witnessing or having being involved in a traumatic event. In healthcare, the traumatising event of a patient can become a traumatising event for the healthcare worker (Sudden 2019).

Unlike vicarious trauma, which accumulates over time, secondary trauma can occur unexpectedly and suddenly (Sudden 2019).


Organisational Strategies

From an organisational level, there should be policies and procedures that recognise and prevent risk factors for vicarious and secondary trauma. Notably, this should include the provision of educational material about mental health disorders and the support systems that are available to all staff.

Organisations can also make sure that managers encourage professional development as well as making sure staff maintain a proper work/life balance. Finally, even positive encouragement and the continuing appreciation of work can be beneficial in promoting a supportive and safe workplace for all.

Additional Resources
  • Burnout, Compassion Fatigue, and Secondary Post Traumatic Stress, https://www.ausmed.com/cpd/articles/burnout-fatigue-post-traumatic-stress
  • Mindfulness and Nursing, https://www.ausmed.com/cpd/articles/mindfulness-and-nursing
  • The American Institute of Stress 2017, Compassion Fatigue, The American Institute of Stress, viewed 20 April 2020, https://www.stress.org/military/for-practitionersleaders/compassion-fatigue
  • Blue Knot Foundation 2018, Vicarious Trauma, Blue Knot Foundation, viewed 20 April 2020, https://www.blueknot.org.au/Workers-Practitioners/For-Health-Professionals/Resources-for-Health-Professi onals/Vicarious-Trauma
  • Clark, ML & Giori, S 1998, ‘Nurses, Indirect Trauma, and Prevention’, Image — The Journal of Nursing Scholarship, vol. 30, no. 1, pp. 85-7, viewed 16 January 2017, https://www.ncbi.nlm.nih.gov/pubmed/9549948
  • Dragon, N 2019, ‘Nurses at Higher Risk of Vicarious Trauma’, Australian Nursing & Midwifery Journal, October 31, viewed 20 April 2020, https://anmj.org.au/nurses-at-higher-risk-of-vicarious-trauma/
  • Good Therapy 2019, Countertransference, Good Therapy, viewed 20 April 2020, https://www.goodtherapy.org/blog/psychpedia/countertransference
  • Good Therapy 2016, Vicarious Trauma, Good Therapy, viewed 20 April 2020, https://www.goodtherapy.org/blog/psychpedia/vicarious-trauma
  • The Lookout 2017, Vicarious Trauma & Burnout, The Lookout, viewed 20 April 2020, https://www.thelookout.org.au/family-violence-workers/self-care-family-viole nce-workers/vicarious-trauma-burnout
  • Olga Phoenix 2015, Painful Truths About Vicarious Trauma: Statistics From the Field, Olga Phoenix, viewed 20 April 2020, https://www.olgaphoenix.com/blog/painful-truths-about-vicarious-trauma-statistics-from-the-field/
  • Professional Quality of Life Measure 2018, Compassion Satisfaction, Professional Quality of Life Measure, viewed 20 April 2020, https://proqol.org/Compassion_Satisfaction.html
  • Sudden 2019, Supporting the Supporter: Vicarious Trauma and Support Needs Webinar Report, Sudden, viewed 20 April 2020, http://www.suddendeath.org/uncategorised/222-supporting-the-supporter-vicarious-trauma-and-support- needs-webinar-report
  • Tabor, PD 2011, ‘Vicarious Traumatization: Concept Analysis’, Journal of Forensic Nursing, vol. 7, no. 4, pp. 203-8, viewed 20 April 2020, https://www.ncbi.nlm.nih.gov/pubmed/22123041
  • Upton, K V 2018, ‘An Investigation Into Compassion Fatigue and Self-compassion in Acute Medical Care Hospital Nurses: a Mixed Methods Study’, Journal of Compassionate Health Care, viewed 20 April 2020, https://jcompassionatehc.biomedcentral.com/articles/10.1186/s40639-018-0050-x


James Graham

James Graham is a freelance medical writer with a PhD in neuroscience. After 5 years of being a post-doctoral research scientist, James left the UK in 2014 and set up his own freelance medical writing business, Craftext, on the Gold Coast. James writes for a diverse stable of clients and has quickly accrued experience across a number of different medical and scientific topics as well as writing in a broad range of styles and formats. See Educator Profile

Ausmed Editorial Team

Ausmed’s Editorial team is committed to providing high-quality and thoroughly researched content to our readers, free of any commercial bias or conflict of interest. All articles are developed in consultation with healthcare professionals and peer reviewed where necessary, undergoing a yearly review to ensure all healthcare information is kept up to date. See Educator Profile


Identify Stress and Vicarious, Secondary, Indirect Trauma in Nurses
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