Have you ever had a patient that really affected you? I still have memories of caring for a severely burned toddler girl in the early 90’s when I was in a clinical rotation for my graduate nursing program in Burns, Emergency, and Trauma. It was an urban teaching hospital and regional burn center and this little girl was pulled from a burning Philadelphia row house. I was swept in to her intense physical pain (burn pain is the worst) and her abusive family history. It affected my personal life, robbed me of sleep, and almost made me physically ill for a time. This experience taught me I wasn’t cut out to be a burn nurse but was also my first experience with secondary trauma.
Secondary Trauma: Patient Trauma Spill-Over
Secondary trauma (also called vicarious trauma) is the experiencing of the trauma of another through their account or indirect exposure to their trauma. A nurse’s mental or emotional ‘reliving’ of the patient’s traumatic experience can then lead to symptoms or reactions similar to post traumatic stress disorder (PTSD).
Our patient population has high levels of trauma in their lives, past and present. For example, many of our patients, especially women, have history of child abuse, domestic violence, or sexual abuse. Military veterans may enter the system with PTSD from combat duty. Inmates have a heavy burden of current trauma while in the criminal justice system. There can be high levels of assault, coercion, and victimization in inmate cultures.
Depending on the type of nursing care you are delivering, this traumatic stress can spill over onto you and be absorbed into your own system; many times without even realizing it. This is why it is important to guard against secondary trauma and take action when you see signs in your own feelings and behaviors.
Monitor for Warning Signs
Here are some common signs of secondary trauma. Watch for them in yourself and those you work with:
- Anger and cynicism
- Avoidance of patients
- Chronic exhaustion
- Dropping out of normal social activities
- Increased family arguments and agitation
What to Do About Secondary Trauma – Put on Your Protective Gear
In the first post in this series on correctional nurse self-care, I talked about putting on your oxygen mask first before helping others. We also need to put on our protective gear, just like other professionals. Construction workers have hard hats and football players have extra padding and mouth guards. What protective gear do correctional nurses need to work with traumatized patients day after day? Here are some ideas from the National Center on Family Homelessness:
- Regularly take your stress temperature – do you see signs of stress in your emotional and interactional responses to daily activities? If so, accelerate your protective activities.
- Make time for regular decompression. This can include reflection, meditation, or physical activities like yoga.
- Consider the possibility of a change in work assignment, work shift, or work group for a period of time.
- Seek out employer-offered programs such as employee assistance or an outside support group for those in helper roles like nursing, social work, counselors, or child assistance workers.
- Take regular meal breaks.
- Focus on increasing sleep and nutrition.
- Find things that make you laugh.
- Spend time with supportive friends.
Just understanding the possibility of secondary trauma and monitoring for signs of increased stress can make a world of difference in your correctional practice. I didn’t understand secondary trauma back in that burn unit rotation years ago. I might have been able to manage it better if I had. Awareness is a powerful thing!
Have you had to deal with secondary trauma in your correctional nursing practice? Share your experience with our readers using the comments section of this post.
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