Motivation and emotion/Book/2026/Secondary trauma in healthcare workers

Secondary trauma in healthcare workers:
What are the emotional consequences of secondary trauma in healthcare settings?

Overview

Figure 1. Healthcare worker at the end of a shift during the COVID-19 pandemic. Scenario Imagine finishing a demanding shift in an emergency department after caring for several patients who have experienced severe injuries, loss and distress. Although the events did not happen directly to you, you continue thinking about the patients after leaving work. Their experiences replay in your mind, you become increasingly anxious and emotionally exhausted, and you begin distancing yourself from reminders of particularly distressing cases. For healthcare workers who are repeatedly exposed to the trauma and suffering of others, experiences such as these may reflect secondary traumatic stress (STS).

• Healthcare workers may encounter emotionally demanding circumstances when caring for patients experiencing severe illness, trauma , suffering and death, as illustrated by the experience of the healthcare worker during the COVID-19 pandemic (see Figure 1). Repeated exposure to patients' traumatic experiences can leave healthcare professionals vulnerable to secondary traumatic stress (STS) (Zacharias & Upendra, 2024).
• STS refers to trauma-related psychological responses that can emerge through indirect exposure to another person's traumatic experiences. Characteristic responses include intrusion, avoidance and arousal, which resemble aspects of post-traumatic stress responses (Bride et al., 2004; Zacharias & Upendra, 2024).
• STS represents an important occupational concern across healthcare settings. Earlier research identified STS among nurses (Beck, 2011), while more recent research continues to demonstrate a substantial burden of STS among healthcare professionals (You et al., 2026; Zacharias & Upendra, 2024).
• Understanding the emotional consequences of STS is important because healthcare workers' repeated exposure to suffering can affect their psychological and emotional wellbeing. Research has identified factors including emotional exhaustion, repeated exposure to trauma and patient death, workplace demands, coping, social support and resilience as relevant to STS (Tracy & Zadinsky, 2026; Zacharias & Upendra, 2024).

Focus questions What is secondary traumatic stress, and how does it differ from related occupational stress concepts? What emotional and trauma-related consequences can healthcare workers experience as a result of secondary trauma? What factors increase or reduce healthcare workers' vulnerability to secondary traumatic stress? How can secondary traumatic stress in healthcare workers be prevented or managed?

Understanding secondary trauma in healthcare workers

Defining secondary traumatic stress

• STS involves psychological responses arising through exposure to the traumatic experiences of other people rather than experiencing the traumatic event directly (Bride et al., 2004; Zacharias & Upendra, 2024).
• Bride et al. (2004) developed the Secondary Traumatic Stress Scale (STSS) to assess STS symptoms among professionals working with traumatised populations.
• The STSS conceptualises STS symptoms across intrusion, avoidance and arousal, providing a useful psychological framework for understanding how indirect trauma exposure can affect healthcare workers (Bride et al., 2004).
• The nature of healthcare work may create repeated opportunities for secondary exposure, particularly in settings involving frequent contact with trauma, suffering, or death (Beck, 2011; Zacharias & Upendra, 2024).

Secondary traumatic stress and related concepts

• STS should be distinguished from related concepts including compassion fatigue and burnout, despite overlap between these constructs in healthcare research (Cavanagh et al., 2020; Meadors et al., 2010).
• Meadors et al. (2010) examined secondary traumatisation among paediatric healthcare providers in relation to compassion fatigue, burnout and STS, demonstrating the importance of considering related but conceptually distinct forms of occupational distress.
• Compassion fatigue has been widely investigated among healthcare professionals and is associated with the emotional demands of caring for people who are suffering (Cavanagh et al., 2020).
• Distinguishing these concepts is important because not all emotional exhaustion or occupational distress experienced by healthcare workers necessarily represents STS.

Emotional consequences of secondary trauma

Intrusion and heightened emotional arousal

• Intrusion represents one of the core dimensions of STS and may involve unwanted thoughts or recollections associated with traumatic material encountered through professional work (Bride et al., 2004).
• Arousal represents another core STS dimension and reflects heightened psychological and emotional activation associated with secondary trauma exposure (Bride et al., 2004).
• Research involving emergency department nurses has further linked STS with psychological and emotional difficulties and demonstrates that coping and social support are important to understanding workers' experiences of STS (Chen et al., 2026).
• These findings indicate that healthcare workers may continue to experience emotional effects of patients' trauma beyond the immediate clinical encounter.

Avoidance and emotional disengagement

• Avoidance is the third major symptom dimension represented within the STSS and can involve efforts to avoid thoughts, feelings, or reminders associated with indirect traumatic exposure (Bride et al., 2004).
• Avoidance may provide temporary distance from emotionally distressing material but can form part of the broader pattern of secondary traumatic stress.
• Because healthcare professionals often continue working in environments where exposure to suffering is unavoidable, trauma-related avoidance has particular implications for understanding the emotional consequences of STS in caring professions (Bride et al., 2004; Zacharias & Upendra, 2024).

Emotional exhaustion and psychological distress

• Emotional exhaustion has been identified as an important factor associated with STS among healthcare professionals (Zacharias & Upendra, 2024).
• Research among healthcare workers suggests that STS exists alongside broader forms of psychological and occupational distress, highlighting the importance of recognising both trauma-specific symptoms and emotional exhaustion (Chen et al., 2026; van Mol et al., 2015).
• However, emotional exhaustion should not automatically be interpreted as STS because it also overlaps with burnout and compassion fatigue. Identifying trauma-related intrusion, avoidance and arousal helps maintain conceptual distinction (Bride et al., 2004; Cavanagh et al., 2020).

Risk and protective factors

Occupational exposure and workplace demands

• Tracy and Zadinsky (2026) identified three broad areas of STS risk among healthcare workers: personal history and support mechanisms, workplace influences and high-stress healthcare environments.
• Workplace factors appear particularly important. Increased workload and workplace demands, low job satisfaction and burnout were identified as relevant STS risk factors (Tracy & Zadinsky, 2026).
• These findings indicate that STS should not be conceptualised solely as an individual's inability to cope, as characteristics of healthcare environments may also contribute to vulnerability.

Trauma exposure and personal vulnerability

• Greater exposure to trauma-related work may increase vulnerability to STS. A meta-analysis found associations between STS and characteristics of trauma caseload exposure, including the amount and frequency of trauma-related work (Hensel et al., 2015).
• Personal trauma history has also been investigated as a potential vulnerability factor for STS (Hensel et al., 2015).
• Risk is therefore unlikely to be explained by a single characteristic; STS may emerge from the interaction between exposure and personal, interpersonal and workplace factors (Hensel et al., 2015; Tracy & Zadinsky, 2026).

Psychological resilience

• Psychological resilience may help explain why healthcare workers experiencing similar occupational demands do not necessarily experience the same degree of STS.
• A systematic review examining emergency nurses identified an inverse relationship between psychological resilience and STS, suggesting that greater resilience may function as an important protective factor (Şimşek et al., 2025).
• Resilience should nevertheless be considered alongside environmental conditions rather than used to place responsibility solely on individual healthcare workers (Şimşek et al., 2025; Tracy & Zadinsky, 2026).

Coping and social support

• Social and workplace support have been identified as potentially protective against STS (Hensel et al., 2015; Zacharias & Upendra, 2024).
• Among emergency department nurses, Chen et al. (2026) examined the relationship between coping, STS, and social support, highlighting the importance of support resources in workers' responses to occupational trauma exposure.
• Zacharias and Upendra (2024) similarly identified factors including self-care, social support, and debriefing as protective factors across healthcare STS research.
• These findings demonstrate that protective processes can occur at both individual and interpersonal/organisational levels.

Empathy

• Empathy is fundamental to compassionate healthcare but may also be relevant to healthcare workers' emotional responses to patient suffering.
• Dong et al. (2025) examined occupational stress, empathy, and psychological resilience as predictors of STS among emergency nurses.
• Their findings suggest that understanding STS requires considering the interaction between the emotional demands of caring, occupational stress and psychological resources rather than viewing empathy itself as inherently harmful (Dong et al., 2025).

Preventing and managing secondary trauma

Psychological and behavioural interventions

• Interventions designed to address compassion fatigue, burnout and STS among nurses have included psychological, behavioural and comprehensive approaches (Zhang et al., 2025).
• A systematic review and network meta-analysis found that psychological interventions alleviated secondary trauma, while behavioural and comprehensive interventions demonstrated benefits for related outcomes including compassion fatigue, compassion satisfaction and burnout (Zhang et al., 2025).
• Intervention selection should therefore reflect the particular outcome being targeted rather than assuming that one strategy will address all forms of occupational distress.

What does the broader intervention evidence show?

• Although interventions for healthcare-provider distress are promising, the evidence should be interpreted cautiously.
• Patole et al. (2024) reviewed randomised controlled trials of interventions for compassion fatigue among healthcare providers and concluded that the available evidence remained insufficient to establish definitive intervention recommendations.
• This limitation is particularly important when applying compassion-fatigue intervention research to STS because the constructs overlap but are not identical.
• Consequently, future research should continue testing interventions using clearly defined STS outcomes and rigorous study designs (Patole et al., 2024; Zhang et al., 2025).

Organisational and social support

• Prevention should not focus solely on healthcare workers' individual coping strategies because workplace characteristics contribute to STS risk (Tracy & Zadinsky, 2026).
• Social and workplace support may provide protection against STS (Chen et al., 2026; Hensel et al., 2015).
• Organisational responses could therefore consider workload and workplace demands alongside opportunities for support and debriefing (Tracy & Zadinsky, 2026; Zacharias & Upendra, 2024).
• A combined approach recognising both individual psychological resources and organisational responsibility may provide a more comprehensive response to secondary trauma in healthcare settings.

Test yourself!

1

Which three symptom dimensions are commonly used to conceptualise secondary traumatic stress?

	Burnout, fatigue and depression
	Intrusion, avoidance and arousal
	Empathy, resilience and compassion
	Stress, workload and dissatisfaction

2

Which statement best reflects current research on STS in healthcare workers?

	STS is caused entirely by low individual resilience
	Any emotional exhaustion experienced by a healthcare worker indicates STS
	Both individual and workplace factors can influence vulnerability to STS
	Compassion fatigue, burnout, and STS are similar terms

Conclusion

• Secondary trauma can cause intrusion, avoidance, arousal, emotional exhaustion, and psychological distress in healthcare workers, but should be distinguished from burnout and compassion fatigue (Bride et al., 2004; Cavanagh et al., 2020; Meadors et al., 2010; Zacharias & Upendra, 2024).
• Repeated exposure to patients' trauma can contribute to STS, with vulnerability influenced by workplace demands, personal factors, coping, resilience, and social support. Psychological interventions may help, although stronger evidence is needed (Hensel et al., 2015; Patole et al., 2024; Şimşek et al., 2025; Tracy & Zadinsky, 2026; Zhang et al., 2025).
• Practical take-home message: Caring for traumatised patients can carry an emotional cost. Protecting healthcare workers requires recognising STS and strengthening both individual and organisational supports (Tracy & Zadinsky, 2026; Zacharias & Upendra, 2024).

See also

• COVID-19 pandemic impacts on motivation and emotion (Book chapter, 2020)
• Emotional exhaustion (Wikipedia)
• Emotional well-being (Wikipedia)
• Health professional (Wikipedia)
• Social support and emotion (Book chapter, 2019)

References

This section lists the cited references in APA style (7th ed.) or wiki style.

APA style example:

Beck, C. T. (2011). Secondary traumatic stress in nurses: A systematic review. Archives of Psychiatric Nursing, 25(1), 1–10. https://doi-org.ezproxy.canberra.edu.au/10.1016/j.apnu.2010.05.005

Bride, B. E., Robinson, M. M., Yegidis, B. L., & Figley, C. R. (2004). Development and validation of the Secondary Traumatic Stress Scale. Research on Social Work Practice, 14(1), 27–35. https://doi-org.ezproxy.canberra.edu.au/10.1177/1049731503254106

Cavanagh, N., Cockett, G., Heinrich, C., Doig, L., Fiest, K., Guichon, J. R., Page, S., Mitchell, I., & Doig, C. J. (2020). Compassion fatigue in healthcare providers: A systematic review and meta-analysis. Nursing Ethics, 27(3). https://doi-org.ezproxy.canberra.edu.au/10.1177/0969733019889400

Chen, Y.-H., Chang, Y.-Y., Wang, I.-T., & Chang, S.-H. (2026). When caring hurts: The buffering role of social support in emergency department nurses’ coping with secondary traumatic stress. Journal of Nursing Management, 2026(1). https://doi-org.ezproxy.canberra.edu.au/10.1155/jonm/8247254

Dong, A., Pan, Y., & He, F. (2025). A model for predicting secondary traumatic stress in emergency nurses: The roles of occupational stress, empathy, and psychological resilience. Frontiers in Medicine, 12. https://doi.org/10.3389/fmed.2025.1712821

Hensel, J. M., Ruiz, C., Finney, C., & Dewa, C. S. (2015). Meta-analysis of risk factors for secondary traumatic stress in therapeutic work with trauma victims. Journal of Traumatic Stress, 28(2), 83–91. https://doi-org.ezproxy.canberra.edu.au/10.1002/jts.21998

Meadors, P., Lamson, A., Swanson, M., White, M., & Sira, N. (2010). Secondary traumatization in pediatric healthcare providers: Compassion fatigue, burnout, and secondary traumatic stress. OMEGA—Journal of Death and Dying", 60"(2), 103–128. https://doi-org.ezproxy.canberra.edu.au/10.2190/OM.60.2.a

Patole, S., Pawale, D., & Rath, C. (2024). Interventions for compassion fatigue in healthcare providers—A systematic review of randomised controlled trials. "Healthcare", "12"(2), 171. https://doi.org/10.3390/healthcare12020171

Şimşek, B., Özer, Z., & Buldukoğlu, K. (2025). Investigation of the effect of secondary traumatic stress on psychological resilience in emergency nurses: A systematic review. "Journal of Clinical Nursing", "34"(7), 2564–2572. https://doi-org.ezproxy.canberra.edu.au/10.1111/jocn.17688

Tracy, N., & Zadinsky, J. K. (2026). Risk factors of secondary traumatic stress: A scoping review. "Journal of Advanced Nursing", "82"(4), 2570–2590. https://doi-org.ezproxy.canberra.edu.au/10.1111/jan.70076

van Mol, M. M. C., Kompanje, E. J. O., Benoit, D. D., Bakker, J., & Nijkamp, M. D. (2015). The prevalence of compassion fatigue and burnout among healthcare professionals in intensive care units: A systematic review. "PLOS ONE", "10"(8). https://doi.org/10.1371/journal.pone.0136955

You, Q., Li, J., Yang, L., Zhang, Y., & Chen, L. (2026). Prevalence of secondary traumatic stress in nurses: A meta-analysis of observational studies. "Frontiers in Public Health", "14". https://doi.org/10.3389/fpubh.2026.1877091

Zacharias, B. S., & Upendra, S. (2024). Healing the healers: A systematic review on the burden of secondary traumatic stress among healthcare providers. "Journal of Education and Health Promotion", "13"(1). https://doi.org/10.4103/jehp.jehp_218_24

Zhang, H., Xia, Z., Yu, S., Shi, H., Meng, Y., & Dator, W. L. (2025). Interventions for compassion fatigue, burnout, and secondary traumatic stress in nurses: A systematic review and network meta-analysis. "Nursing & Health Sciences", "27"(1). https://doi-org.ezproxy.canberra.edu.au/10.1111/nhs.70042

External links

• Nearly half of all Queensland doctors at risk of burnout, survey finds (Brisbane Times)
• Post Traumatic Stress Disorder (PTSD) Explained (YouTube)
• What is Trauma? (YouTube)