Healthcare providers, trauma, and the science of resilience
Monday, August 24, 2020
It is widely agreed that all healthcare providers can be exposed to all manner of work-related trauma. Whether it’s a pandemic, a serious disaster, witnessing a child’s suffering, or a grieving family’s pain, it can all add up to trauma.
The terms secondary trauma, compassion fatigue, and vicarious traumatization can often be used interchangeably, and one thing can be deduced from much of the literature: developing resilience is one bulwark against the ravages of such intensely impactful stress.
The Seas of Trauma
In a 2008 article published in the Juvenile and Family Court Journal, authors Osofsky, et al. identified vicarious traumatization, compassion fatigue, or secondary traumatization as “the cumulative effect of working with survivors of traumatic life events as part of everyday work.”
In Beirut, Lebanon, following the August 2020 explosion that caused widespread destruction, death, and injury, we saw under-resourced medical workers responding to utter devastation. Many staff and patients had themselves been killed or injured by the shockwave, and a great deal of vital equipment and medications were also destroyed.
On the other side of the world, Dr. Lorna Breen, a New York City-based E.R. physician on the front lines of the COVID-19 pandemic, took her own life in April due to the trauma of the fight. Having contracted the virus herself, Dr. Breen was recuperating with family when she chose to end her own suffering.
These scenarios are not rare. In fact, wherever there are providers of medical, nursing, mental health, or other forms of care, we find those who have reached the limits of their capacity to cope.
Burnout figures largely in the conversation about secondary trauma. In a study on burnout among healthcare workers originally published in the journal Cureus and republished on the U.S. National Library of Medicine website, burnout is defined as “a combination of exhaustion, cynicism, and perceived inefficacy resulting from long-term job stress.”
If we are to impede the epidemic of burnout among our highly valued healthcare workers, they need the tools and support of both prevention and recovery.
The Science Behind Resilience
In the American Journal of Critical Care, Rushton, et al. stated, “Resilience involves the internal stability, awareness, and flexibility that enable a person to navigate high-stress situations in ways that reduce burnout and moral distress.” And when it comes to burnout and moral distress, those employed in the realms of healthcare are certainly high-risk.
Studies have shown that the hormone oxytocin can mitigate the effects of adverse childhood events on social bonding and attachment. And a fascinating study published in World Psychiatry hypothesizes that there are several central aspects of the “the neurobiology of affiliation” that create the environment for human resilience, and those include the oxytocin system and the power of affiliation.
It appears that oxytocin has a positive impact on neural plasticity, bonding and attachment, and the joining of social groups. And if we agree with the assertion from the above-mentioned study that “greater social support and a sense of belonging to the social group have been repeatedly associated with greater resilience,” we can deduce that social supports and bonding are essential for healthcare workers developing mental, emotional, and spiritual resilience.
Scientific evidence offers concrete examples of tools and strategies for the building of resilience. These include:
- Expressive writing in order to “rewrite the narrative” of a traumatic experience
- Certain types of exposure therapy
- Practices related to the expression of self-compassion and forgiveness
- Evidence-based meditation practices such as Mindfulness-Based Stress Reduction (MBSR)
In terms of fostering resilience, The American Psychological Foundation recommends the prioritization of relationship-building, a focus on physical and mental wellness, and avoiding maladaptive coping such as alcohol and drugs. The APA also urges volunteerism; setting realistic goals; a proactive stance towards keeping perspective and problem-solving; the practice of accepting change; and learning from past experiences.
Where Can Help Come From?
There is no doubt that healthcare workers have a responsibility to self-monitor for signs of burnout, compassion fatigue, and moral distress. Colleagues can also intervene with one another when necessary. However, healthcare workplaces must take action in order to see decreased symptoms of burnout and secondary trauma, as well as increased resilience among staff. Interventions may include:
- More flexibility in scheduling
- Decreased staff-to-patient ratios
- Increased vacation time and mental health days
- Fully funded Employee Assistance Programs (EAPs)
- Evidence-based resilience training (e.g.: MBSR, meditation, etc)
- Engaged, compassionate leadership
- Nurturing a more positive workplace culture (e.g.: eradicating bullying and incivility)
While the situation in Beirut may be out of the ordinary for most, stressors like the coronavirus pandemic, climate change, political uncertainty, injustice, social unrest, and other existential issues are common in the 21st century.
In a complex and troubled world, healthcare workers are essential to our societies, yet too many suffer from their work. If we are to stem the tide, everyone — institutions, governments, individuals, and other organizations — must be involved in the building of resilience in the interest of both individuals and the collective. The health of our societies and citizens depends on it.
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