"This Is Not My Loss": Lived Experiences of Vicarious Trauma and Post-Traumatic Growth Among Pediatric Emergency Room Social Workers

Background and Purpose: Pediatric emergency room social workers (PERSWs) are exposed to high levels of stress and trauma through their work with patients and families in crisis situations. Vicarious trauma (VT) is a phenomenon where individuals experience the emotional and psychological effects of trauma indirectly by being exposed to others’ traumatic experiences. VT can have profound emotional and cognitive impacts on PERSWs, affecting their well-being and professional functioning. Alternatively, Tedeschi and Calhoun (1996) proposed the concept of post-traumatic growth to capture the potential positive changes a person may experience in the process of overcoming a traumatic event. This study aims to explore the challenges and impacts of VT among PERSWs, as well as dynamics of post-traumatic growth following exposure to VT. Methods: The study employed a qualitative phenomenological research design involving semi-structured interviews with 23 PERSWs working in Level 1 trauma centers. Participant recruitment involved purposive sampling based on PERSW’s experience and work setting to ensure participants had sufficient experience and thus a higher likelihood of exposure to VT. The data analysis process used thematic analysis to identify major themes and subthemes related to lived experiences of VT and post-traumatic growth among PERSWs. Results: The qualitative analysis identified major themes related to the causes and impacts of VT as well as post-traumatic growth experienced by PERSWs. Within the major theme of contributing factors to VT, the analysis identified subthemes involving the role of acuity (intense cases, high workload), triggers (cases that reminded PERSWs of their own family/situation) and isolation (lack of support at work, reluctance to discuss VT outside of work). Within the major theme of impacts of VT, participants expressed subthemes of the physical, emotional, and cognitive impacts of VT, as well as subsequent practice impacts on their work with parents and families. Finally, the major theme of post-traumatic growth included participants’ lived experiences with overcoming VT and reaffirming their commitment to the profession, with important subthemes of motivation, reward, and validation from being a stable presence for families experiencing “the worst day of their lives.” Conclusions and Implications: The findings of the study illustrate both the negative and positive impacts experienced by PERSWs exposed to the trauma and suffering of children and families in the ER. Considering the significant impact of VT on PERSWs’ physical, emotional, and mental well-being as expressed by the participants, the study findings emphasize the need for effective interventions and support programs for PERSWs to address these impacts. Conversely, the findings suggest some PERSWs exhibit post-traumatic growth and affirmation through the process of overcoming VT, which can inform the application of strengths-based approaches to promote the overall health, well-being, and productivity of PERSWs. Thus, organizations and hospital systems should prioritize implementing policies and procedures that promote PERSWs’ well-being, such as promoting self-care and providing debriefing and formal and informal support systems, and ameliorate the impacts of high acuity and isolation. Overall, this study underscores the critical need to prioritize the mental health and well-being of PERSWs and other professionals working in high-stress, trauma-exposed environments.