Nurses and vicarious traumatization

Published in the The Nurse Alliance Roundup on Sept. 27, 2011.

As a psychiatric nurse consultant working in San Francisco General Hospital’s Trauma Unit, Laurie Barkin, RN, MS, routinely evaluated and treated patients with stab wounds, gun shot wounds, and injuries from motor vehicle accidents, fires, and falls. Today, she is a published author whose writing explores what happens to professional caregivers when exposure to tragedy occurs.

In the piece below, Laurie shares some of those experiences with us:

Laurie BarkinIn the early 70s, when I was a teenager, my girlfriend and I drove from our home in Phoenix to Los Angeles. When we entered the city limits, our back tire blew. We spun three times on the freeway before we came to a stop, perpendicular to traffic. With cars detouring around us, we limped off the freeway and onto a nearby patch of grass. As we sat shaking in the car, a highway patrol officer appeared.

“You girls know how to change a tire?” he drawled, lighting a cigarette.

We shook our heads.

“Well, now you’re gonna learn.”

Over the next half hour, he talked us through the process all the while leaning against the car, smoking.

I know now that as a first responder, this man must have witnessed many situations where two teenagers in a car going 75 miles an hour weren’t so lucky. While he smoked his cigarette and talked us through the steps of changing a tire, I bet that some of these scenes replayed in his mind.

Similarly, lodged in the mind of every nurse is an unforgettable patient story. Or two. Or three.

Trauma becomes trapped in our minds and bodies. We absorb the sounds, smells, visions, feel, and taste of trauma. When it happens directly to us, we are traumatized. When it happens to others and we witness the damage, we are vicariously traumatized.

I was working as a psychiatric liaison nurse at San Francisco General Hospital, in 1993 when Gian Luigi Ferri, a disgruntled client of Pettit and Martin, a law office in downtown San Francisco, carried 2 semiautomatic weapons and 250 rounds of ammunition into their offices and started firing indiscriminately, killing or maiming 14 people before killing himself. After they were medically stabilized, I evaluated three of the survivors. Each responded to the trauma in a different way.

One of the survivors was anxious, fearful, tearful, and hypervigilant–jumping each time someone opened the door to her room. Another experienced a sense of unreality. “I thought to myself, ‘These can’t be real bullets!’” she said cheerfully as if unaware she had just survived a life-threatening situation. The third survivor—one whose husband covered her body with his, dying soon after the gunman shot him–told me she thought she was experiencing “emotional shock” because even though she remembered what happened in detail, she could not access the feelings.

Hypervigilance and numbing are common psychological reactions to traumatic events. Another is re-experiencing as in nightmares, flashbacks, and intrusive memories.

Over time, those of us who witness others’ traumas can experience similar reactions. In most people’s lives, traumatic events occur infrequently. Because of our work, however, we may overdose on trauma. We may lose perspective. Our hearts pound when we smell smoke, we avoid listening to the news, we are awakened by nightmares, we panic when our teenagers aren’t home on time. Trauma has seeped into our psyches.

What can we do to ameliorate this effect?

I have spent the last ten years attending many conferences on psychological trauma. Professionals in the field tell us that trauma ”dysregulates” our nervous systems. Practicing “mindfulness meditation” is first on everyone’s list as an antidote to trauma. Other practices and activities that help to “re-regulate” us include exercise, prayer, hiking in natural settings, gardening, writing, listening to music, laughing, dancing, talking with friends, and yoga.

Hospital administrators can help by creating safer work environments by scheduling weekly meetings for caregivers to discuss how they are coping with what they witness on the job. Individual supervision, educational leave, regular vacations, and varied work assignments are additional supportive measures that administrators can offer their staff.

Another problem is that many of us nurses are great at taking care of everyone but ourselves. We dismiss self-care suggestions by rolling our eyes at the mention of the concept. But what is at the heart of our resistance? That we are not deserving? That we’re doing just fine, thank you very much? Or, is it that we are so used to absorbing other people’s woes that we forget to take inventory of our own feelings?

Before I left my job I had reasoned that if my patients must cope with what life had dumped on them, then I could cope with hearing about it secondhand. When I realized that the nightmares, palpitations, tearfulness, shortness of breath, fear for my children’s safety, and anxiety I had developed over time were negatively impacting me and my family, I left my job in order to take care of myself.

Now I know that balance is key. Even making small changes in our lives can replenish our souls, giving us strength to shepherd our patients through their crises.

Since leaving the trauma unit, I have gotten better at listening to my body, breathing deeply, and exercising regularly. Lately, I’ve been thinking about incorporating mindfulness meditation into my life. Maybe this will be the year I give it a try.

Laurie Barkin, RN, MS, is the author of The Comfort Garden: Tales from the Trauma Unit. You can purchase her book from Amazon.com.

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