Healthcare Stories

Healthcare Improvement I Example Stories

Vicarious Trauma

A group of nurses is responsible for meeting regularly with a high-risk population of patients. These patients experience certain risk factors more commonly than the general population, such as housing insecurity, poverty, unemployment, and domestic violence. In their training, nurses were told to not share about their personal experiences, to care for their patients, but not too much, and to try not to internalize their own feelings of grief and disappointment. Previous strategies of trying to block out their own emotional responses led to low morale and feelings of overwhelm. A manager noticed that, even though she had asked nurses to indicate the risk factor most influencing the experience of each patient, nurses had begun to note fewer risk factors and miss critical details about what patients might need.

We organized an educational workshop to present the very subtle and unseen ways that vicarious trauma can have an impact on caregivers. We worked with them, through fictionalized case studies, to demonstrate how consistent threat, even intergenerational, can create norms and assumptions that dictate behavior, even when that threat is gone. Without intentional practices of awareness and self-regulation, caregivers might unintentionally normalize or ignore these behaviors, leading to a repetition of negative outcomes. We offered nurses the chance to identify their own feelings and work strategically to clearly delineate between what belonged to them and what did not. Through practice, they started to realize when their own experiences caused them to ignore or push away challenging information. We invited them to consider the impact of trauma beyond the category of mental health, seeing that everyone’s understanding of what is normal and possible is often influenced by what we have seen before. Through guided practice, nurses began to identify more clearly what their best point of intervention could be. They reported feeling less overwhelmed by the hardships of their patients.

Summary: This was a challenging situation because the risk factors of the patient population were real and troubling. We agreed that it felt overwhelming to even consider how hard life must be without money, a job, or a safe home environment. We work, however, by noticing what can be changed in an organization and how we can build the capacity of a network of leaders within it. These nurses were unknowingly relying on self-denial and overcompensation to respond to seriously difficult problems. It had led them to reject or push away the seriousness of an issue. This reaction is totally understandable. It is a normal human reaction to pain, either our own or that of others. Our job was to teach nurses that a more comfortable and sustainable practice, for them, was possible. We offered them permission to separate their own suffering from that of others. They felt lighter and more adept at seeing the bigger picture. Once they felt less overwhelmed, they began to notice more influences on belief and behavior and feel more comfortable directing patients to a variety of options. Their own self-focus became a model for their patients, even on a non-linguistic level.