Vicarious trauma: spotting the signs and taking action

What is vicarious trauma?

Vicarious trauma is a process of change resulting from engaging with those who’ve suffered trauma – essentially secondary traumatic stress.

As nursing staff, you spend your days taking care of other people and are routinely exposed to your patients' experiences. The culmination of these experiences can have a negative effect on your mental health.

If not mitigated against, it can get worse, and even lead to post-traumatic stress disorder.

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There are some factors that make people more vulnerable to vicarious trauma, such as previous traumatic experience, long-term exposure to trauma, and limited opportunities to share and communicate your feelings with others.

What are the signs?

Nursing staff often treat patients who are going through difficult periods in their lives. As such, it’s normal to feel anxious, stressed, and sad for your patient. However, if those feelings are particularly intense or last for a long time, it could be a sign of vicarious trauma.

The following symptoms can be self-identified, but you can also look out for them in your colleagues.

• Feelings of guilt, hopeless about the future, or emotional numbness.
• Losing meaning in what you do.
• Bystander guilt – when a person feels bad about what happened to someone else or wishes they'd done more.
• Thinking about patients outside of work.
• Having problems managing personal boundaries.
• Worrying excessively.
• Intrusive thoughts or imagery.
• Fatigue, exhaustion and problems with sleep.
• General symptoms of trauma: flashbacks, panic attacks, and dissociation.

What is dissociation?

When an experience is overwhelming, the mind can dissociate as a coping mechanism.

Symptoms may include feeling numb or detached from your body and the world around you, feeling like you are floating or spaced out.

Even if the experience is out of sight, it's not always out of mind. People can go on to experience symptoms at any time in their lives.

Is it preventable?

Due to the nature of the roles of nursing staff, you cannot predict when you might encounter trauma in patients, or when that experience goes from being manageable to being detrimental to your mental health.

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However, there are steps you can take to make sure you keep on top of your wellbeing, to help reduce the likelihood of being traumatised.

What coping strategies might help?

There are several wellbeing practices to help in your day-to-day life, and help you identify when you need to seek professional services.

• Acknowledge the symptoms. The first step to recovery or preventing adverse effects of vicarious trauma is to acknowledge the presenting symptoms.
• Be prepared (if you can). Depending on your area of practice, you can mentally prepare yourself if you think you might encounter an upsetting or graphic experience.
• Communicate. To feel less alone, it helps to talk to people you trust. This doesn’t have to be a serious, planned discussion, but have someone to talk to about your day, and what’s on your mind.
• Implement a mentor or buddy system. This can be especially helpful for new starters and students, but all staff can benefit from having a point of contact where they feel safe to express themselves and keep an eye out for each other.
• Prioritise physical health. Take breaks, stay hydrated, and eat well-balanced meals to keep energised.
• Give yourself downtime. Allow yourself to disconnect and rest, whatever this means to you. From turning on your favourite reality TV programme to having a bath, discover activities that allow you to switch off and recharge.
• Create a sleep routine. Perhaps your shift patterns often change, but try to go to bed consistently at the same time if possible and stay away from screens an hour before sleeping.
• Practice self-care. Listen to music, cook something new, or go for a walk to make sure there’s a divide between your professional and home life.
• Seek further help. If you experience symptoms of vicarious trauma that don’t go away, speak to your GP or seek out support in your workplace. If you feel comfortable, speak to your line manager or occupational health.