Health Care Providers’ Responses to Medical Traumatic Stress in Their Patients

Lopez-Castillo and colleagues (1999) surveyed 196 health care professionals at 4 hospitals: 38% reported diagnostic levels of psychological distress, including depression, anxiety, and impaired functioning at a rate comparable to their patients.

3 Surgeons

What is Secondary Traumatic Stress?

Working with ill and injured children and families can be professionally meaningful and satisfying. But providers treating patients with challenging medical conditions can sometimes feel drained, upset, or frustrated. This may be especially true during times of increased workloads or heightened personal stress.

Sometimes these very human responses get in the way of being optimally effective at work – contributing to tension or conflicts with patients’ families, or to stresses within the health care team.

A study by the Association of Professors of Medicine (2004) estimated the prevalence of burnout among physicians in the US at 22%. As part of a larger study on burnout in physicians, Deckard and colleagues (1994) found that 58% of the 59 pediatricians studied scored high on emotional exhaustion measures.

In responding to the pain and distress of children and families, the research suggests that the ability to identify, understand and manage one’s emotional reactions is paramount to preventing and/or managing secondary traumatic stress.

When working with children and families with complex and challenging illnesses or injuries, it is recommended that health care providers routinely use the following self care tips to prevent secondary stress:

  • Be aware of their own emotional reactions and distress when confronting others’ traumatic experiences, and know what traumatic material may trigger them.
  • Connect with others by talking about their reactions with trusted colleagues or others who will listen.
  • Maintain a balance between their professional and personal lives, with a focus on self-care (e.g., relaxation, exercise, stress management, etc.) to prevent, and lessen the effects of, workplace stress.

Self Care Tips to Prevent Secondary Stress

The key is for individual nurses to be able to identify their unique triggers and build a wide range of coping strategies that they can apply to particular situations... Compassion, often the ultimate gift of nurse to patient, must be nourished to
be sustained.
-Maytum, 2004

Each provider may have a different way of coping with work-related stresses. Here are practical strategies for preventing and reducing the effects of stress reactions:

Preventing Secondary Traumatic Stress: In your daily routine:

  • Eat sensibly and regularly every day
  • Get adequate sleep each night
  • Exercise regularly
  • Be aware of your stress level; take precautions against exceeding your own limits
  • Acknowledge your reactions to stressful circumstances; allow yourself time to cope with these emotions

Preventing Secondary Traumatic Stress: At work:

  • Try to diversify tasks at work, or vary your caseload, to the extent that you can
  • Take breaks during your workday
  • Take vacation days
  • Use relaxation techniques (e.g., deep breathing) as needed
  • Talk with colleagues about how your work affects you
  • Seek out, or establish, a professional support group
  • Recognize your personal limitations; set limits with patients and colleagues

Preventing Secondary Traumatic Stress: Outside of work:

  • Spend time with family and friends
  • Stay connected with others through community events, religious groups, etc.
  • Engage in pleasurable activities unrelated to work, especially those that allow for creative expression (writing, art, music, sports, etc.)
  • Be mindful of your own thoughts (especially cynicism) and feelings; seek out the positives in difficult situations
  • Engage in rejuvenating activities such as meditation, prayer, or relaxation to renew your energy
  • Seek therapy if your work is negatively impacting your self-esteem, quality of life or relationships

Preventing Secondary Traumatic Stress: RED FLAGS
Be on the alert for these immediate stress responses and/or long-term effects:

Physical Reactions

  • Fatigue
  • Sleep disturbances
  • Changes in appetite
  • Headaches
  • Upset stomach
  • Chronic muscle tension
  • Sexual dysfunction

Emotional Reactions

  • Feeling overwhelmed/ emotionally spent
  • Feeling helpless
  • Feeling inadequate
  • Sense of vulnerability
  • Increased mood swings
  • Irritability
  • Crying more easily or frequently
  • Suicidal or violent thoughts or urges

Behavioral Reactions

  • Isolation, withdrawal
  • Restlessness
  • Changes in alcohol or drug consumption
  • Changes in relationships with others, personally & professionally

Cognitive Reactions

  • Disbelief, sense of numbing
  • Replaying events in one’s mind over & over
  • Decreased concentration
  • Confusion or Impaired memory
  • Difficulty making decisions or problem-solving
  • Distressing dreams or fantasies

Self-Care Resources for Preventing Secondary Traumatic Stress

The American Academy of Pediatrics offers online resources for physician health and wellness

The International Society for Traumatic Stress Studies has a webpage addressing indirect trauma

The Texas Medical Association's Committee on Physician Health and Rehabilitation offers online and home study courses relevant to self-care

Click here to download a resource list of reading materials on provider stress (PDF)