Secondary Trauma: No Bruises Left Behind
By Elizabeth Fiegel DNP, MSN, RN NEA-BC
I know that when I inventoried nine full oxygen tanks just this morning they were all there in the rack. I have looked everywhere and for the life of me, I cannot determine where three of the nine might have gone. If there is not at least a full rack, we will simply not have enough to last throughout the night. These patients desperately need oxygen to survive. Then I checked everywhere, and our supply of saline has also run critically short; we certainly had at least a full case just this morning, and will not be getting another delivery until after the hurricane has passed, maybe for many days. We have an emergency room full of patients who might need this saline for their critical injuries. What am I going to do? I must report back to the incident command center and I am confident that the supplies were correctly inventoried, and ready for the storm just this morning. Surely, I will be held to blame, I feel my heart racing, my mouth is dry and the sweat droplets are forming on my brow, the room is spinning. Oh no, I must sit down for just a moment; I am not sure… I just can’t hold back the tears and can’t do this anymore. As I hold my face in my hands, in this very dark room, my pillow now stained with my tears, I suddenly realize that my husband is gently rousing me from my deep sleep and this terrible nightmare. Then, I recall that I was just reliving the hurricane preparations at my local hospital, where I had worked for seven twelve hour shifts in a row after volunteering at the emergency shelter. It has been over two months since the hurricane, and I still cannot sleep through an entire night, and have had trouble focusing at work. My husband is worried about me and I just don’t seem to find joy in anything right now.
This story is an example of secondary trauma suffered by a nurse who volunteered during a major hurricane. She had been a nurse for over 35 years during some of the worst hurricanes ever to hit the gulf coast. She was a seasoned nurse with a clinical background in emergency and trauma care. She had seen some of the worst types of injuries and nothing seemed to faze her; she could tolerate blood and traumatic injuries with the best of them. Clinicians, however, are not immune to Secondary Trauma, which is defined as trauma-related stress reactions and symptoms resulting from exposure to another individual’s traumatic experiences, or the event itself (SAMHSA, 2014). Secondary Traumatization is also referred to as compassion fatigue (Figley, 1995) and vicarious traumatization (Pearlman and Saakvitne, 1995).
As Hurricane Florence struck a heavy blow to the east coast this last month resulting in devastation and loss of life, I am reminded that healthcare workers respond to disasters often in a moment’s notice in the dark of night and leave their family and personal needs behind to care for others. They put in long hours without sleep and work under grueling conditions, even neglecting their own health and safety at times. The combination and interaction of systemic and traumatic stresses place nurses and others working in the health care field at an increased risk of suffering from serious negative stress effects in the areas of physical, emotional, cognitive, behavioral and interpersonal well-being (Rosh, 1996). There are no bruises or scars in Secondary Trauma; the signs of Secondary Trauma are often missed in healthcare providers but demonstrate themselves as:
- Sleep disturbances
- Changes in appetite
- Chronic muscle tension
- Sexual dysfunction
- Fear of impending doom
- Replaying events in one’s mind over & over
- Difficulty making decisions or problem-solving
According to The International Society of Traumatic Stress Studies (2018), there are effective strategies for preventing and reducing the effects of stress reactions, and preventing secondary traumatic stress in healthcare providers:
- Eat nutritiously and regularly every day
- Get adequate sleep each night at least 6-8 hours
- Exercise regularly for at least 30-60 minutes each day
- Be aware of your stress level; take precautions against exceeding your own limits, by practicing mindfulness, yoga or meditation
- Acknowledge your reactions to stressful circumstances; allow yourself time to cope with these emotions, seek personal or group therapy
- Take scheduled vacation or days off in between work shifts
Some organizations attempt to reduce the incidence of secondary trauma in healthcare workers by offering formalized post-event debriefings. Structured events allow for a review of readiness to response and evaluation of reactions to the events themselves. Practice guidelines on debriefing formulated by the International Society for Traumatic Stress Studies (2018) conclude there is little evidence that debriefing prevents the effects of secondary trauma. The guidelines do recognize that debriefing is often well received and that it may help (1) facilitate the screening of those at risk, (2) disseminate education and referral information, and (3) improve organizational morale. However, the practice guidelines specify that if debriefing is employed, it should be conducted by experienced, well-trained practitioners, not be mandatory, utilize some clinical assessment of potential participants, and be accompanied by clear and objective evaluation procedures. Currently, many mental-health workers consider some form of stress debriefing the standard of care following both natural (earthquakes) and human-caused (workplace shootings, bombings) stressful events For individuals who demonstrate serious signs and symptoms of Post-Traumatic Stress Disorder, and/or harm to themselves or others, individual therapy and immediate crisis intervention may be needed (Dept. of Veterans Affairs, 2018).
Disaster response is often a well-coordinated event by healthcare workers and first responders, rending lifesaving aid to millions of others, providing hope to the hopeless, and compassion to the heartbroken; truly, this has been evident during and after Hurricane Florence, Katrina, and many other natural disasters. Understanding the etiology of Secondary Trauma, early recognition of signs and symptoms and strategies to avoid the negative impact of Secondary Trauma can result in healing for both the healthcare worker and those they aide. While valuables, personal treasures, and homes can be lost, lives can be restored and healthcare workers and first responders play a unique and important role in recovery; providing for their health and wellness is essential in disaster management.