At the recent Oncology Nursing Society (ONS) Congress in Anaheim, California, Bina Parekh, PhD, explained the concept of vicarious trauma and empowered nurses with positive personal growth strategies to deal with challenges, fears, and trauma that stem from dealing with patients with cancer. In this interview with Oncology Data Advisor, Dr. Parekh discusses the concept of vicarious trauma and how nurses, programmed to care for others, are often affected. She shares advice for nurses on how to address and overcome intrapsychic turmoil.
Oncology Data Advisor: Welcome to Oncology Data Advisor. Today, I'm joined by Dr. Bina Parekh.
Dr. Parekh, what is vicarious trauma and why is it important for oncology nurses and other health care professionals to talk about it?
Bina Parekh, PhD: It's funny because vicarious trauma oftentimes gets conflated with a lot of different things, whether it's burnout, whether it's compassion fatigue, or whether it's secondary trauma symptoms. All of those are parts of vicarious trauma, but vicarious trauma, if we think about it, really is defined as the relationship that one as a health care provider has with their patient. When they see their patient in distress or when they see their patient being traumatized, they too experience similar symptoms and similar expressions of the trauma that is in line with what their patient is experiencing.
In other words, even though they're not the firsthand trauma victims, they can become traumatized by just sitting with the narratives and the powerful stories of those patients that they work with. I think it's important for us to talk about because a lot of times, especially in oncology, people assume that that's just what the job entails. Well, it is part of the job, but at the same time the negative long-term effects of working in these high-stress and high-distressing situations with patients can take a long-term toll. Unless we talk about it and actually address it, a lot of people suffer in silence and a lot of nurses suffer in silence.
I think it's really important that we start to have a dialogue about it so we can do some things to actually shape the workplace and our relationships with our patients in a more meaningful way.
Oncology Data Advisor: Do you think the dialogue should start at work?
Dr. Parekh: I do. I think if we can start even having a sense of community with our peers, including other oncology nurses, that would be the first step. Then, I think taking it up and institutionally working with supervisors and other individuals that are in care settings or hospitals will really create an openness to this. What happens a lot of times is that institutions obviously have their own demands in terms of seeing patients and what's put upon them, but a lot of times the nurses bear the brunt of it. When they have to see more and more and more patients that have similar harrowing experiences, of course it's going to take a cumulative effect on their ability to provide appropriate clinical care.
Oncology Data Advisor: What are the risk factors for developing vicarious trauma?
Dr. Parekh: Well, I would say there's individual risk and then there's what I would call work-related risk. Now, individual risk can be things like if you've suffered a long-term loss recently or if you have a certain level of newness to the profession. I think sometimes younger nurses experience vicarious trauma a lot more than maybe seasoned nurses just because of the experience. Certain personality characteristics make us more at risk for vicarious trauma in the sense that individuals that are very hard and self-critical tend to also experience these symptoms more.
I think last is that if someone's had a trauma history, so if someone has experienced trauma in their personal life, that makes them more likely to be susceptible to vicarious trauma. In terms of the work, in the workplace the risk factors are there's no support, there's more demand on nurses' time, and there are not enough resources to actually provide breaks and spaces to talk about these things. When it's coming from individual as well as outside of the individual, internal and external factors together can make someone more at risk for vicarious trauma.
Oncology Data Advisor: What effects can vicarious trauma have on oncology nurses?
Dr. Parekh: Well, I think the difficulty with vicarious trauma is it affects all levels of functioning, so there are areas where they may have identity confusion like, "Am I in the right career? Do I really even want to be doing this? Is this really a calling for me?" Some oncology nurses may even question their goodness or fit for the career. Secondly, I think it produces a lot of what I call intrapsychic turmoil—in other words, anxiety, depression, fearfulness, not wanting to engage with patients, keeping distance between themselves and their patients.
I think cognitive confusion occurs where, because the symptoms of vicarious trauma mimic post-traumatic stress disorder (PTSD), sometimes they can't think through the problems. As a nurse, you have to be a troubleshooter 24/7, and if that impairs your clinical judgment, it could actually affect clinical outcomes for patients if we don't address vicarious trauma on all levels—not just about identity but in terms of all levels of functioning.
Oncology Data Advisor: What can nurses do to address vicarious trauma and try to overcome it?
Dr. Parekh: Well, that is the big question. I think, as I've said before, we have to first see vicarious trauma as an occupational hazard. It is part of what you do as an oncology nurse, that there will be situations where you are traumatized by the firsthand experiences of your patients, number one. Number two, I think we have to value connection and speaking about vicarious trauma. Right now, it's the hidden secret, right? It's something that we know exists, but no one wants to talk about, or I think there's a lot of shame in talking about it.
People talk about it maybe, privately, but I think we need to have a larger, more open dialogue, especially since nurses have been so negatively impacted as of late in terms of the demand. I think the other thing is understanding what real work/life balance is. I think we can all say, "Yes, I want to have work/life balance," but what does that really mean? I think that means that having dialogues with yourself, having dialogues with your family, and as always, also having dialogues with your supervisor—like "What can I take on and what do I need to limit?" I think that that is something that really needs to be shaped as well.
I think the last thing would be that valuing this idea of being compassionate to oneself is really, really important in that a lot of times nurses put their patients way above themselves, which is understandable, but in order for you to give good care, you have to put yourself at the same level as your patient if you're going to provide the best care. A lot of times, nurses have what I call the self-sacrificing identity, and we have to kind of work on balancing that identity a little bit.
Oncology Data Advisor: Well, thank you so much. Those are all really great tips. Do you have anything else you want to add?
Dr. Parekh: I just want to say that I think that once we understand more about vicarious trauma, and I think it's finally in the public square, people are starting to talk about it. It has a lot to do with what happened to the health care system with regards to the pandemic, but we have a lot more work to do. I think it starts with nurses themselves, advocating for themselves that this is something real and it's legitimate and that it shouldn't be pathologized, because a lot of times nurses are worried that "If I admit to this, does that say something deficient about me?" Actually, I would say that the fact that you're aware of it is a strength versus a deficiency.
Oncology Data Advisor: Thank you so much, Dr. Parekh.
Dr. Parekh: Absolutely.
About Dr. Parekh
Bina Parekh, PhD, is the Associate Department Chair and a Full Professor in the Clinical Psychology Program at The Chicago School of Professional Psychology (TCSPP), Anaheim. Dr. Parekh is a licensed psychologist and specializes in health psychology. She has published peer-reviewed papers in the areas of cross-cultural psychology and behavior health, and she teaches courses in the areas of health psychology, diversity, cognitive behavioral therapy, psychometric theory, research methods, and statistics.
For More Information
Parekh B (2022). Enhancing nurse well-being by promoting and fostering vicarious resiliency. Presented at: 47th Annual ONS Congress.
Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.
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