Introduction
Secondary Traumatic Stress (STS) refers to the emotional and psychological consequences for healthcare professionals, especially nurses, due to witnessing or indirectly being exposed to traumatic events occurring among their patients. While STS may resemble post-traumatic stress disorder (PTSD), it impacts explicitly those who empathically engage with trauma survivors, leading them to experience symptoms similar to those directly exposed to traumatizing events. Instead of being precipitated by personal trauma, STS arises through nurses’ close interactions with their patients and an empathic relationship established. Nurses face emotionally charged situations like witnessing patients’ deaths and experiencing extreme discomfort. As nurses often provide caregiving services and are exposed to the suffering and emotional distress of others, prolonged exposure may result in symptoms like emotional numbing, intrusive thoughts, anxiety, and feelings of guilt or helplessness to which nurses can become susceptible. Because nurses are so exposed to traumatized events as caregivers, they must recognize and address STS for their mental and emotional well-being.
Understanding Secondary Traumatic Stress (STS) in Nursing
Secondary Traumatic Stress (STS), also referred to as vicarious trauma or compassion fatigue, is a psychological reaction healthcare professionals, like nurses, can experience when regularly exposed to trauma through their work. STS differs from Post-Traumatic Stress Disorder (PTSD) by being caused by empathy with patients’ experiences of trauma (Aydin & Songül Aktaş, 2021). Nurses providing care at critical moments for patients can feel the emotional toll of their suffering first-hand, leading them to experience symptoms like intrusive thoughts, emotional numbing, and increased stress levels. Witnessing patient deaths or traumatic incidents may exacerbate STS for nurses as they navigate demanding roles within healthcare settings.
Compassion Fatigue: The Emotional Toll on Nurses
Compassion fatigue, often confused with Secondary Traumatic Stress (STS), refers to a condition in which caring for others exhausts emotional resources in nurses and results in emotional fatigue. This can manifest in several forms: emotional exhaustion – where nurses feel drained by their work – depersonalization (resulting in distancing themselves from patients) and reduced sense of personal accomplishment, undermining confidence in themselves and their abilities (Bock et al., 2020). Repeated exposure to patients’ deaths under distressful circumstances affects nurses’ emotional well-being. Experiences such as witnessing violent crime scenes may lead nurses to experience higher stress, burnout, and an overwhelming sense of helplessness, thus, underlining the necessity of interventions and self-care strategies to mitigate adverse outcomes.
Case Study: Nurses Witnessing Traumatic Births
Aydin and Songul Aktas’ (2021) research explores midwives’ experiences of traumatic births. This systematic review and meta-synthesis identified seven significant themes: post-traumatic feelings, post-traumatic stress symptoms, impact on professional values, social support, learning from experience, legal process, and the reflection of patients’ traumatic birth experiences on midwives. These themes highlight the profound connection between midwives’ experiences and secondary traumatic stress (STS). Witnessing traumatic births had profound emotional repercussions, prompting midwives to experience post-traumatic reactions and stress symptoms (Aydin & Songül Aktaş, 2021). This emotional strain led to self-confidence erosion and even intentions of leaving their profession. These findings reveal the urgency of creating comprehensive support systems, including psychological education and peer support, that can protect midwives against the effects of STS both institutionally and individually and enhance their overall well-being in this demanding field.
Case Study: Nurses Working with COVID-19 Patients
Yeliz Akkus and colleagues (2021) conducted a qualitative investigation that sheds light on nurses’ interactions while caring for COVID-19 patients. Research findings uncovered five main themes that capture nurses’ complex challenges during this pandemic: psychosocial adaptation, protection, difficulty in providing care and treatment, accessing information, and working conditions. These themes collectively reveal the profound psychological, social, and physiological ramifications nurses experience due to STS, including its interdependencies. The study provided evidence of its dire toll, leading nurses to experience psychological exhaustion, burnout, and stigmatization (Yeliz Akkuş et al., 2021). Practical challenges extended further – for example, difficulties providing care due to using personal protective equipment (PPE). As nurses navigate these complex stressors, recognizing the significance of psychological and physiological resilience becomes imperative – stressing the importance of tailored interventions, increased support, and self-care strategies to maintain well-being and effectiveness during challenging times.
Coping Strategies and Self-Care
Recognizing the essential role that self-care plays in mitigating Secondary Traumatic Stress (STS) for nurses is of utmost importance, and studies showcased in this paper show how important it is to implement coping strategies to combat STS. These strategies range from psychosocial adaptation and accessing accurate information to finding ways to protect oneself while providing care. Furthermore, research emphasizes the critical role peer support can play in providing a platform for sharing experiences and emotions. Integration of tailored psychological education for healthcare professionals is also crucial for equipping nurses with the ability to deal with STS-related challenges (Bock et al., 2020). Additionally, this study stresses the significance of institutional policies that foster an inclusive work environment to alleviate the emotional strain associated with nursing. These coping strategies, supported by peer networks, psychological education, and institutional policies, can act as a formidable defense against STS, increasing resilience and well-being while fostering compassionate patient care in emotionally demanding conditions.
Implementing Self-Care in Nursing Practice
Implementing effective self-care practices within nursing is crucial to avoiding and mitigating Secondary Traumatic Stress (STS). Prioritizing self-care enables nurses to nurture their mental, emotional, and physical well-being and build resilience against the strain of their demanding roles (Aydin & Songül Aktaş, 2021). Practical strategies include setting healthy boundaries, practicing mindfulness, engaging in regular physical exercise, exploring hobbies, and taking regular breaks. Recognizing that STS may require professional intervention, nurses must remain open to seeking external support when self-care efforts alone are inadequate. By taking an integrated approach to health and well-being care, they can protect themselves from suffering emotionally from STS while continuing to provide compassionate and effective patient care.
Recommendations for Nursing Institutions
Nursing institutions are essential in combatting secondary traumatic stress and supporting their nursing staff’s well-being. Institutions should focus on offering comprehensive psychological support for nurses, such as accessing counseling services or conducting debriefing sessions after traumatic events. To provide practical assistance for nurses, institutions should prioritize providing complete psychological services (Bock et al., 2020). Employing ongoing education on ST recognition and coping strategies gives nurses the skills to deal with their emotional challenges. At the same time, institutions can ensure resources such as stress management workshops or self-care resources are readily available. Establishing a supportive work environment involves encouraging open communication, encouraging peer support networks, and creating policies that recognize the emotional demands of nursing. An institutional commitment to staff well-being enhances quality patient care and strengthens nurses’ ability to negotiate the rigors of their profession while remaining passionate about healthcare provision.
Conclusion
Secondary Traumatic Stress (STS) burdens nurses immensely, impacting their emotional well-being and jeopardizing professional longevity. STS’ close association with compassion fatigue and burnout highlights its significance for healthcare workers. Recognizing and responding appropriately is vital to safeguarding their well-being in the healthcare profession. Nurses must proactively promote their emotional well-being by prioritizing self-care, adopting effective coping strategies, and seeking support. This requires collaboration from nursing institutions, colleagues, and the nurse themselves. When confronting the challenges of patient care, let us acknowledge ST’s impacts while encouraging open dialogues to enhance nurses’ mental well-being and the quality of care provided.
References
Yeliz Akkuş, Yasemin Karacan, Rabiye Güney, & Kurt, B. (2021). Experiences of nurses working with COVID‐19 patients: A qualitative study. Journal of Clinical Nursing, 31(9-10), 1243–1257. https://doi.org/10.1111/jocn.15979
Aydin, R., & Songül Aktaş. (2021). Midwives’ experiences of traumatic births: A systematic review and meta-synthesis. European Journal of Midwifery, 5(July), 1–10. https://doi.org/10.18332/ejm/138197
Bock, C., Heitland, I., Zimmermann, T., Winter, L., & Kahl, K. G. (2020). Secondary Traumatic Stress, Mental State, and Work Ability in Nurses—Results of a Psychological Risk Assessment at a University Hospital. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.00298
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