workforce
The nurse can feel lower job satisfaction, reduced commitment
to the job, chronic absenteeism, workplace conflicts, reduced
capacity for physical and mental work, and personally they
can become emotionally overwhelmed. It can lead to a lack of
accomplishment, a sense of ineffectiveness, loss of empathy,
poor judgement and eventually emotional breakdown.
You undertook a literature review to better understand and
determine the cause of vicarious trauma and its effects on
nurses working with drug and alcohol clients. What struck
you about the research that’s out there on the topic?
A few things actually. The first was the lack of literature available
on vicarious trauma – I found a total of 13 articles. And even within
these articles, vicarious trauma was used interchangeably with
burnout and traumatic stress, and it is quite clear from my study of
the literature that vicarious trauma is very different from burnout
or secondary traumatic stress and compassion fatigue. The term
needs to be delineated on its own so it can be explored.
Another thing I found in this research was the lack of research
done with trauma in nursing, and drug and alcohol specifically.
There was only one article but it pertained to alcohol and other
drug workers, so not nursing specifically. There was a lot more
literature available for social workers, oncology workers and
other healthcare community service workers, but very little
literature for nurses, and apparently no research whatsoever in
terms of drug and alcohol nursing.
The other thing I found was that all the studies used different
measuring instruments, so there was no specific measurement
tool to identify vicarious trauma. I think the different measurement
tools [are the reason for] the different specific results.
The research also talked about vicarious trauma – or burnout,
or occupation fatigue or secondary traumatic stress – in terms
of what it causes and what it does, but it didn’t really have a
specific recommendation on how it could be dealt with or how
to put strategies in place. There were recommendations but not
anything specific.
What can be done to ensure nurses are supported or
equipped to deal with vicarious trauma, or to minimise its
impacts, or is there just not enough information out there?
To some extent there isn’t a lot of information, but the other
thing I noticed was there was recommendation for clinical
supervision. Now, I am a clinical supervisor. I supervise a group of
nurses and I attend supervision myself as well. Since I have been
engaged in clinical supervision, it has really helped me venture
into reflective practice. I think reflective practice is an immense
tool in trying to deal with vicarious trauma because it helps you
to reflect on your practice in a very objective way – on what you
did well and what you could change for the next time.
I think there is no research t o say that clinical supervision would
benefit nurses in a situation where they are having symptoms or
having signs of vicarious trauma, but I think clinical supervision
would definitely be something that nurses should look into.
Peer mentoring and peer support were also mentioned.
The interesting thing that came out of the literature review
was that there are predisposing factors to vicarious trauma:
client rescuing behaviour, professional boundary issues, poor
work environment, lack of experience and even the individual
psychological make-up.
For nurses to be aware of their limitations is absolutely
imperative, and one of the ways you can learn about your
limitations is through clinical supervision, because it brings you
back into reflective practice.
If you are aware that you have professional boundary issues in
terms of client rescuing behaviour – we are all different and we
all nurse differently, and some nurses tend to be a little bit more
emotionally engaged with their clients – you realise it could be
a danger in drawing you towards having a rescuing behaviour,
then you can put contingency plans in place to deal with an
event or an interaction that you may be aware may initiate that
rescuing behaviour.
You mentioned earlier that vicarious trauma is different
to burnout, compassion fatigue and traumatic stress.
How does vicarious trauma differ and how can a clinical
supervisor potentially identify it?
I don’t think a clinical supervisor may be able to identify vicarious
trauma, burnout or secondary traumatic stress. I think it would be
hard to identify in a group setting or a clinical supervision setting.
I think it would be more along the lines of a person being able to
identify that they are now struggling to come to work, or having
physical symptoms that prevent them from coming to work like
nausea or tummy ache. People do get that, so that’s obviously
something that’s quite concerning.
In terms of the differences, compassion fatigue is classified as
over-involvement in client care. I think that’s just a standalone.
I think it could be over-involvement in client care across any
industry. You could be a teacher or a personal banker, and you
could be a little bit over-involved in the care that you provide to
the patient or the client.
Burnout is different in a sense that it’s just basic indifference and
withdrawal from work environment and clients, and again this is
applicable to any work setting.
Now, secondary traumatic stress is normally characterised
by post-traumatic-like symptoms, and this can actually be
triggered after a single encounter with a client. Let’s say you’ve
spoken with a client with horrific details about domestic
violence or rape and somehow this can cause the clinician to
develop secondary traumatic stress symptoms, again due to the
various predisposing factors or just the effect that the clinician
has been dealing with this for a very long time, dealing with
these type of stories or this type of client disclosure for a very
long time.
Now, vicarious trauma is different because it’s the use of
controlled empathy, it’s the ongoing exposure to client trauma,
continuous ongoing trauma, and the gradual transformation
within the self that makes it different. It actually transforms the
person from inside, where they are in their core as who they are
as a being.
Is there anything else you would like nurses or perhaps clinical
supervisors to know about vicarious trauma?
Just be aware that this is inevitable and is going to happen if you are
dealing with trauma nursing.
If you’re a clinical supervisor and you’re supervising nurses
or clinicians who deal with trauma nursing, the underlying
understanding should be that there is an element of vicarious
trauma probably at different stages within each individual. The
reinforcement of self-care, of trying to practise reflective nursing,
of trying to get counselling, accessing the EAP counselling, and
being mindful of how the interactions are with your own family
members, and just being aware and mindful, is really important. ■
nursingreview.com.au | 27