Vicarious Trauma: When Patient Pain Hurts the Provider, Too

AONN+ 2020 Conference Highlights Special Feature —January 4, 2021

Empathy and caring are prevalent among those in the helping professions, and navigators are no exception. Although these characteristics are central to helping others, they can also become a detriment by causing the healthcare provider to internalize patients’ suffering—a phenomenon known as “vicarious trauma,” according to Bina Parekh, PhD, the keynote speaker at the AONN+ Virtual Annual Conference.

“Vicarious trauma is a cumulative experience,” she said. “A lot of times, people don’t even recognize that they’re experiencing vicarious trauma.”

With an emphasis on the COVID-19 pandemic and the trauma it has wrought for so many, along with the civil unrest that has been taking place throughout the country in recent months, Dr Parekh pointed out a common thread. Patients with COVID-19 have had diminished breathing capacity, and the haunting refrain of George Floyd as he lay dying under the knee of a police officer was, “I can’t breathe.”

“We have to take a moment to breathe,” she told attendees.

Resulting from engaging with people and their traumas in an empathic way, vicarious trauma can lead to compassion fatigue and burnout. Not unique to healthcare providers, it also affects therapists and counselors, clergy, first responders, and others who provide care to distressed individuals.

“I think this is very much heightened with COVID-19,” Dr Parekh said.

As evidence, she shared a video of a nurse who worked on a COVID-19 unit at a hospital. The nurse tearfully recounted her experiences and expressed feelings of despair and powerlessness. Those caring for individuals with COVID-19 are often hit hard by vicarious trauma in addition to the traumas endured directly amid the pandemic, in the healthcare setting or elsewhere, Dr Parekh explained.

The ongoing pandemic has created a unique situation of collective trauma, which is a traumatic psychological effect shared by a group of people.

“All of this is impacting the entire fabric of society concurrently,” Dr Parekh explained, adding that half of 9/11 first responders reported symptoms of posttraumatic stress disorder 11 to 13 years later.

Often as impactful as firsthand trauma, vicarious trauma can cause symptoms including:

  • Feelings of self-loathing
  • Hopelessness
  • Negative outlook
  • Emotional numbness
  • Feeling overwhelmed
  • Withdrawal from friends and family
  • Intense rage or crying bouts
  • Despair
  • Exhaustion
  • Anxiety
  • Nightmares
  • Resentment
  • Feeling unsafe.

More than simply a constellation of symptoms, vicarious trauma affects one’s whole being, having a marked impact on a person’s sense of self, according to Dr Parekh. Its effects often extend to the provider’s identity, world view, spirit, cognition, and ability to provide self-care.

“Their worldview shifts from a place of trust to a place of fear, mistrust, and cynicism,” she said. “It erodes the faith and meaning in our work.”

Although anyone can experience vicarious trauma, certain factors place an individual at higher risk. Personal factors include having a history of trauma or a preexisting psychological disorder, young age, inadequate support system, having suffered a loss within the previous year, or possessing particular personality traits. Professional risk factors for vicarious trauma are a lack of job orientation, training, quality supervision, or experience. Other professional risk factors include a patient caseload that includes a high percentage of trauma survivors and a mismatch between a worker and an organization, she said.

When one considers that more than 60% of men and more than 50% of women have experienced 1 or more traumatic events and that 90% of clients in public healthcare settings have undergone trauma, it becomes no wonder that between 40% and 80% of helping professionals develop vicarious trauma, compassion fatigue, or traumatic symptoms, Dr Parekh said.

Acknowledging the potential harm caused by vicarious trauma, assessments seek to measure its impact on healthcare providers and others. These include the Professional Quality of Life Scale, Secondary Trauma Stress Scale, and Maslach Burnout Inventory.

Fortunately, in the same way patient trauma can have a vicarious effect, their resilience can also have an impact on those caring for them. As patients move toward adapting to and even overcoming adversity, navigators and other providers often do the same. Indeed, being involved in a patient’s positive transformation can result in vicarious transformation for the provider, who can derive a sense of meaning, growth, and purpose from patients’ empowerment.

Dr Parekh outlined for attendees the ABCs of vicarious resilience:

  • A – Acceptance that vicarious trauma is an occupational hazard and a normal response, as well as that overcoming it, is a process
  • B – Balance of work and leisure activities, as well as one’s caseload with various types of patients
  • C – Connection with oneself and others, as well as with a sense of spirituality.

“It’s a process; it doesn’t happen overnight,” Dr Parekh said. “When we’re able to see our patients become more empowered, we become more empowered.”

Related Articles
2020 AONN+ Award Winners
January 2021 Vol 12, No 1
Each year, at the AONN+ annual conference, we pause to take note of the navigators and organizations among us who have made a significant impact in the field of oncology navigation. Although virtual, 2020 was no different, and it was with pride that we announced the 2020 class of AONN+ Award recipients. It is the distinct honor of the JONS Editorial Board and the AONN+ Leadership Council to recognize the navigators and organizations in our community who have made considerable contributions to our chosen specialty. This class of awardees includes a stellar group of navigators and organizations, each with their own unique and inspiring stories. Below, we tell their stories in the hope it provides inspiration to you in your professional life as an oncology nurse navigator or a patient navigator.
Preconference Workshops Allow for Additional Learning Opportunities
AONN+ 2020 Conference Highlights Special Feature
Attendees seeking to maximize the educational benefits of the conference took part in 4 preconference workshops, addressing topics including genetics and genomics, financial navigation amid the COVID-19 pandemic, professional development, and motivational interview skills for navigators.
AONN+ Awards Recognize Excellence in Navigation
AONN+ 2020 Conference Highlights Special Feature
Honoring the best in the navigation field, the AONN+ awards are presented each year in various professional categories, also recognizing a patient for outstanding contributions to the cancer community with the CONQUER: the patient voice Hero of Hope Award.
Last modified: August 10, 2023

Subscribe Today!

To sign up for our print publication or e-newsletter, please enter your contact information below.

I'd like to receive:

  • First Name *
    Last Name *
    Profession or Role
    Primary Specialty or Disease State