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Identify Stress and Vicarious, Secondary, Indirect Trauma in Nurses


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. Nurse 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.

The empathy and the desire to alleviate the pain and suffering of patients can dramatically enhance the connection between patient and nurse. Unfortunately, this connection can have a serious psychological impact on the nurse with long-term consequences if left untreated.

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 nurse.

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, post-traumatic stress disorder, compassion fatigue and secondary traumatic stress disorder are often used interchangeably.

Although there is some discrepancy in the definitions, most researchers agree that having a clear and distinct understanding of each term will help how we identify, respond and prevent the emotional impact of stress and trauma at work.

Stress and Trauma

  • Vicarious Trauma and Compassion Fatigue

    • Vicarious trauma, or compassion fatigue, is often described as an occupational hazard for nurses during engagement with trauma victims. Over time, nurses begin to mirror the bio-psychosocial effects shown by the victims of trauma.
    • Vicarious trauma can impact the physical and mental health of a nurse, permeating all aspects of work and home life. Over time, even the character and personal belief systems can be altered, resulting in drastic changes in spirituality and  major psychological needs.
  • Secondary Trauma and Indirect Trauma

    • Secondary or indirect trauma describes how a nurse begins to experience similar symptoms as the patient, whereby the traumatising event of the patient becomes a traumatising event for the nurse.
    • The symptoms of secondary trauma and vicarious trauma are essentially the same. The only notable difference is that secondary trauma can occur unexpectedly and suddenly after just one case, whereas vicarious trauma occurs over time.
  • Traumatic Countertransference

    • Traumatic countertransference is when a nurse relates to a patient in such a way that they unconsciously connect the patient with an existing relationship in their own life. This can occur in many situations (not just in a medical setting) where there is a connection between people based on empathy.
    • This can be harmful in more ways than one because as a nurse, the relationship should be professional and not because the patient reminds you of your mother, for example.

Identify Stress and Vicarious trauma, Secondary trauma, Indirect Trauma, compassion fatigue in Nurses

Behaviour and Symptoms

The human response to stress and trauma is autonomic, but the chemical and biological process that causes a person to experience vicarious or secondary trauma are the same. This stress response is not subject to cognitive or rational processing, and therefore two individuals will likely perceive and react in a different manner to the same event.

Nurses who are experiencing vicarious or secondary trauma will likely have several symptoms present. Common physical signs of vicarious and secondary trauma include: headaches, increased allergies, eating problems, bowel disorders, sleep disorders, burnout, and high blood pressure.

There are also a range of emotional behaviours and symptoms that are associated with vicarious and secondary trauma. Some common behaviours include: irritability, emotional volatility, social withdrawal, disrupted personal relationships, and addictive behaviours.

If left untreated, these symptoms can develop into feelings of helplessness, confusion, alienation, and paranoia. Together, these can be a prelude to the development of other mental health issues such as anxiety disorder, depression and dissociative episodes.

Prevention and Protection

Exposure to stressful working conditions can have a direct influence on a nurse’s health and safety. Coping with these stresses requires protective measures that not only stem from the individual, but also from the professional organisation that they work for.

  • Individual Strategies
    • Individual strategies to avoid stress and trauma can include: improved self-awareness, better management of work/life balance, better personal and social connections, the motivation to learn and grow professionally and emotionally, and use of reflective practices such as mindfulness and yoga.
    • Many nurses will experience compassion satisfaction, which is when a nurse has positive feelings associated with the belief that they have contributed or helped in some way. Individual and organisational processes that enhance compassion satisfaction can significantly help protect an individual from work-related stress and trauma.
  • 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.

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