Does vicarious traumatisation affect oncology nurses? A literature review

SummaryIt is widely documented that nurses experience work-related stress [Quine, L., 1998. Effects of stress in an NHS trust: a study. Nursing Standard 13 (3), 36–41; Charnley, E., 1999.Occupational stress in the newly qualified staff nurse. Nursing Standard 13 (29), 32–37; McGrath, A., Reid, N., Boore, J., 2003. Occupational stress in nursing. International Journal of Nursing Studies 40, 555–565; McVicar, A., 2003. Workplace stress in nursing: a literature review. Journal of Advanced Nursing 44 (6), 633–642; Bruneau, B., Ellison, G., 2004. Palliative care stress in a UK community hospital: evaluation of a stress-reduction programme. International Journal of Palliative Nursing 10 (6), 296–304; Jenkins, R., Elliott, P., 2004. Stressors, burnout and social support: nurses in acute mental health settings. Journal of Advanced Nursing 48 (6), 622–631], with cancer nursing being identified as a particularly stressful occupation [Hinds, P.S., Sanders, C.B., Srivastava, D.K., Hickey, S., Jayawardene, D., Milligan, M., Olsen, M.S., Puckett, P., Quargnenti, A., Randall, E.A., Tyc, V., 1998. Testing the stress–response sequence model in paediatric oncology nursing. Journal of Advanced Nursing 28 (5), 1146–1157; Barnard, D., Street, A., Love, A.W., 2006. Relationships between stressors, work supports and burnout among cancer nurses. Cancer Nursing 29 (4), 338–345]. Terminologies used to capture this stress are burnout [Pines, A.M., and Aronson, E., 1988. Career Burnout: Causes and Cures. Free Press, New York], compassion stress [Figley, C.R., 1995. Compassion Fatigue. Brunner/Mazel, New York], emotional contagion [Miller, K.I., Stiff, J.B., Ellis, B.H., 1988. Communication and empathy as precursors to burnout among human service workers. Communication Monographs 55 (9), 336–341] or simply the cost of caring (Figley, 1995). However, in the mental health field such as psychology and counselling, there is terminology used to captivate this impact, vicarious traumatisation. Vicarious traumatisation is a process through which the therapist's inner experience is negatively transformed through empathic engagement with client's traumatic material [Pearlman, L.A., Saakvitne, K.W., 1995a. Treating therapists with vicarious traumatization and secondary traumatic stress disorders. In: Figley, C.R. (Ed.), Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. Brunner/Mazel, New York, pp. 150–177]. Trauma not only affects individuals who are primarily present, but also those with whom they discuss their experience. If an individual has been traumatised as a result of a cancer diagnosis and shares this impact with oncology nurses, there could be a risk of vicarious traumatisation in this population. However, although Thompson [2003. Vicarious traumatisation: do we adequately support traumatised staff? The Journal of Cognitive Rehabilitation 24–25] suggests that vicarious traumatisation is a broad term used for workers from any profession, it has not yet been empirically determined if oncology nurses experience vicarious traumatisation. This purpose of this paper is to introduce the concept of vicarious traumatisation and argue that it should be explored in oncology nursing. The review will highlight that empirical research in vicarious traumatisation is largely limited to the mental health professions, with a strong recommendation for the need to empirically determine whether this concept exists in oncology nursing.

ZusammenfassungIn zahlreichen Untersuchungen wurde nachgewiesen, dass Krankenpflegepersonal einem erheblichen berufsbedingten Stress unterliegt [Quine, L., 1998. Effects of stress in an NHS trust: a study. Nursing Standard 13(3), 36-41; Charnley, E., 1999. Occupational stress in the newly qualified staff nurse. Nursing Standard 13(29), 32-37; McGrath, A., Reid, N., Boore, J., 2003. Occupational stress in nursing. International Journal of Nursing Studies 40,555-565; McVicar, A., 2003. Workplace stress in nursing: a literature review; Journal of Advanced Nursing 44(6), 633-642; Bruneau, B., Ellison, G., 2004. Palliative care stress in a UK community hospital: evaluation of a stress-reduction programme. International Journal of Palliative Nursing 10(6), 296-304; Jenkins, R., Elliott, P., 2004. Stressors, burnout, and social support: nurses in acute mental health settings. Journal of Advanced Nursing 48(6), 622-631], wobei die Pflege von Krebspatienten mit besonders intensivem Stress verbunden ist [Hinds., P.S., Sanders, C.B., Srivastava, D.K., Hickey. S., Jayawardene, D., Milligan, M., Olsen, M.S., Puckett, P., Quargnenti, A., Randall, E.A., Tyc, V., 1998. Testing the stress-response sequence model in paediatric oncology nursing. Journal of Advanced Nursing 28(5), 1146-1157; Barnard, D., Street, A., Love, A.W., 2006.Relationships between stressors, work supports and burnout among cancer nurses. Cancer Nursing 29(4), 338-345]. Für diese Art von Stress werden die Begriffe “Burnout” [Pines, A.M., Aronson, E., 1988. Career Burnout: Causes and Cures. Free Press, New York], “Companion Stress” (“Mitleidsmüdigkeit”, “Mitgefühlserschöpfung”) [Figley, C.R., 1995. Compassion Fatigue. Brunner/Mazel, New York], “emotional contagion” (“emotionale Ansteckung”) [Miller, K.I., Stiff, J.B., Ellis, B.H., 1988. Communication and empathy as precursors to burnout among human service workers. Communication Monographs 55(9), 336-341] oder schlicht “cost of caring” („Preis des Helfens“) [Figley, C.R., 1995. Compassion Fatigue. Brunner/Mazel, New York] verwendet. Psychologen und Seelsorger verwenden jedoch auch einen weiteren Begriff, um dieses Phänomen zu beschreiben: „vicarious traumatisation“(„stellvertretende/ indirekte Traumatisierung“). Dabei handelt es sich um einen Prozess, bei dem die inneren Wahrnehmungen des Therapeuten durch empathisches Einfühlen in die Traumata des Klienten negativ beeinflusst werden [Pearlman, L.A., Saakvitne, K.W., 1995a. Treating therapists with vicarious traumatization and secondary traumatic stress disorders. In: Figley, C.R. (Ed.), 1995 Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. Brunner/Mazel, New York, pp. 150-177]. Traumata wirken sich nicht nur auf Personen aus, die zum Zeitpunkt eines Traumas physisch anwesend sind, sondern auch auf Personen, mit denen traumatisierte Personen über ihre traumatischen Erfahrungen sprechen. Wenn eine Person infolge einer Krebsdiagnose ein Trauma erleidet und dieses traumatische Erlebnis mit einer onkologischen Pflegekraft bespricht, so kann es bei dieser Pflegekraft zu einer „vicarious traumatisation“kommen. Auch wenn Thompson [2003. Vicarious traumatisation: do we adequately support traumatised staff? The Journal of Cognitive Rehabilitation 24-25] die Ansicht vertritt, dass es sich bei „vicarious traumatisation“um einen allgemeinen Begriff handelt, der auf jeden Beruf anwendbar ist, wurde bislang noch nicht empirisch untersucht, ob auch bei onkologischen Pflegekräften eine „vicarious traumatisation“entstehen kann. Das Ziel dieses Artikels besteht darin, das Konzept der „vicarious traumatisation“vorzustellen. Die Autoren plädieren dafür, dieses Phänomen bei onkologischen Pflegekräften zu untersuchen. Es wird betont, dass die empirische Erforschung des Phänomens „vicarious traumatisation“weitgehend auf Personen beschränkt ist, die auf dem Gebiet psychischer Erkrankungen beruflich tätig sind, und es wird dringend empfohlen, empirisch zu untersuchen, ob das Phänomen „vicarious traumatisation“auch bei onkologischen Pflegekräften auftritt.