Culture as both a risk and protective factor for vicarious traumatisation in nurses working with refugees: a literature review

BACKGROUND: There are an estimated 25.9 million refugees worldwide, who require health services while living in host countries. To effectively treat refugee patients, nurses must document their history which requires hearing about their traumatic journeys. Listening to trauma has been shown to cause vicarious traumatisation. AIMS: To identify the risk and protective factors involved in the development of vicarious traumatisation. METHODS: After searching four databases, nine studies were selected for review. Key words ‘vicarious trauma’, ‘refugee’ and ‘nurse’ formed the search. Articles were appraised using the Critical Appraisal Skills Program and Mixed Methods Appraisal Tool. RESULTS: Vicarious traumatisation is common amongst nurses working with refugees. Aspects of culture formed the principal risk and protective factors. Differences between cultures made for strained communication while similarities created better understanding. Some cultures provided more resilience than others. Vicarious resilience, a feeling of personal growth resulting from hearing about and helping patients overcome trauma, was also highlighted. The development of vicarious resilience was a protective factor. CONCLUSIONS: Further investigation into how to minimise risk and establish protective factors is required. Some coping recommendations include personal reflection, comprehensive training and better access to counselling.