Despite the intentions to create favorable environments for citizens, it is not always possible for people to avoid trauma. In addition to physical damage, emotional problems and mental health risks are increased, provoking new challenges in humanitarian work. Healthcare providers, psychologists, and humanitarian volunteers face various distressing events and cooperate with trauma survivors, demonstrating their empathy and choosing the most appropriate interventions and treatment plans. In their attempts to provide patients with the best care, this staff experience severe working conditions, interpersonal conflicts, and trauma-related stressors (Aldamman et al., 2019). Involvement in the humanitarian sector is associated with serious mental health outcomes because care providers should combine the needs of their patients, as well as their personal demands and expectations. On the one hand, it is necessary for employees to manage self-care and predict risks. On the other hand, support from organizations, supervisors, and team members remains a significant protective factor for people (Rauvola, Vega, & Lavigne, 2019). Contemporary literature in relation to the mental health of humanitarian workers and the risks of stress, burnout, and vicarious traumatization will be analyzed in traumatic contexts to promote self-care, education, and cooperation.
Peculiarities of Working with Trauma
Humanitarian aid work is commonly developed in modern society, and many people want to join this sector and make their contributions to human lives. Annually, millions of volunteers organize support groups and assist affected or vulnerable populations to deal with suffering and make decisions (Ghodsi, Sohrabizadeh, Jazani, & Kavousi, 2019). Sometimes, a traumatized person is in need of improving his or her feeling of worthiness, and humanitarian missions are established in regard to such goals (Albuquerque, Eriksson, & Alvesson, 2018). Some international and national non-profit organizations share their funds and resources to support the humanitarian sector, but, in the majority of cases, people should work distantly, visit new places, and cooperate with unfamiliar clients.
To succeed in understanding their tasks and completing their duties, humanitarian workers are properly trained and motivated. Albuquerque et al. (2018) underline that personal motivation of nurses and other employees continue changing over time, and they are interested in discovering new methods to help and deal with their own problems and concerns. Humanitarian work touches upon social, political, economic, health, and technological factors, and people’s traumas vary, depending on the existing environments.
Trauma is hardly predictable at either individual or social levels. There are situations when a client faces a challenge and experiences unwanted feelings or changes, which causes trauma. When therapists or other humanitarian workers try to help a traumatized person, these relationships may also follow trauma, known as vicarious trauma (Abendroth & Figley, 2013). There are many forms of adverse outcomes in the humanitarian sector, including burnout, compassion fatigue, distress, and even suicidal ideation (Aldamman et al., 2019). Some workers are ready to recognize their problems and find solutions, and some people need more time and effort to improve their conditions. Therefore, the establishment of such professional affairs within the chosen field requires specific education and training.
When trauma has to be discussed within a particular context, it is necessary to identify causes and outcomes from multiple perspectives. Health complications are not the only burdens of nurses and other humanitarian aid workers. Many financial, family-related, cultural, and social questions should be researched and answered. Still, the impact of working with traumatic people on health provokes debates around the globe, and the evaluation of contemporary literature is required.
Health of Humanitarian Workers
Being a humanitarian worker is associated with a number of benefits, including relief to the suffering, maintenance of human dignity, and saving lives. In addition to emotional support, these people must demonstrate a number of professional qualities to stay calm, be focused on tasks, and have compassion for those in need (Albuquerque et al., 2018). The responsibilities of employees are based on altruism and personal preferences that are expressed in terms of justice, respect, and open-mindedness.
Due to high expectations and obligations, many humanitarian aid workers challenge their health in a variety of ways. Some contemporary researchers develop their studies to explain the importance of health, organizational support, and self-care for people who work in traumatic conditions (Aldamman et al., 2018; Ghodsi et al., 2019; Rauvola et al., 2019). Sources of stress change, influencing productivity and functionality of the staff. Volunteers do not have enough experience to respond to outside irritants and continue exposing themselves to unknown or poorly recognized threats. Therefore, recent investigation results and health literature are needed to improve practice and analyze the current state of affairs.
During their missions that are deployed worldwide, humanitarian workers pay much attention to the needs of other people. Despite the existing profits of voluntarism in modern society and the possibility to solve humanitarian emergencies, aid workers face specific risks and unfavorable situations. About 35% of workers report their personal health deterioration because of accidents and violence (Nilles, Gushulak, & Kayden, 2019). The study of the American Red Cross shows that more than 10% of volunteers are injured during their missions, and 16% suffer from violence (as cited in Nilles et al., 2019). Besides, about 40% of humanitarian aid workers find their job more stressful than they expect (as cited in Nilles et al., 2019). For example, in such regions as Afganistan or Yemen, violence surveillance is increased, and such insecure locations result in negative health changes, including motor vehicle accidents, injuries, and emotional distress (Nilles et al., 2019). Employees should be aware of how to predict risks, cooperate, and exchange experiences in effective ways. As soon as their health gets worse, they are not able to perform tasks and help other people, questioning the idea of humanitarian aid in general.
Trauma work aims at improving public health, but healers’ health remains poorly addressed and managed. As a result, such problems as vicarious traumatization, stress, and burnout are discussed in contemporary studies. In reference to burnout and stress, the concept of compassion fatigue was presented, where stress is acute, and burnout is a gradual process (Rauvola et al., 2019). According to Abendroth and Figley (2013), working with the suffering is hard, and vicarious trauma cannot be ignored because humanitarian aid workers, nurses, and therapists do not control the effects of clients’ trauma on themselves. To help traumatized people get well, interventions must be developed, and this task is impossible until each concept of mental health in the humanitarian sector is discussed.
Vicarious Traumatization
When people share their traumatic stories and seek help from different sources, humanitarian aid workers cannot stay detached and try to support clients by any possible means. It turns out to be impossible not to experience those traumatic emotions. The exposure to clients’ problems and empathic engagement make helpers vulnerable, and researchers call this situation vicarious traumatization. Contemporary studies use the definition “a transformation of the helper’s inner experience resulting from empathic engagement with client’s trauma material” coined by Saakvitne and Pearlman in 1996 (as cited in Abendroth & Figley, 2013, p. 113). Counselors, volunteers, and other involved care providers witness fears, pain, and terror that usually accompany trauma. Degrees of damage, either physical or emotional, are never the same, and psychological abnormalities vary within the humanitarian sector (Li et al., 2020). It is not only some tension or preoccupation that exists between a client and a helper but the possibility to interpret information and cope with stress and other upshots.
Vicarious traumatization is frequently discussed by contemporary care providers, psychologists, and sociologists because of the necessity to introduce and analyze its causes and outcomes. Today, medical personnel suffer from this condition due to the COVID-19 pandemic crisis and the failure to gain control over the infection (Li et al., 2020). Several decades ago, people used humanitarian aid to solve natural or human-made disaster-related problems (Ghodsi et al., 2019). Veterans, families, and children address social and healthcare workers regularly (Abendroth & Figley, 2013). Still, even the most experienced workers are not able to predict who may be their next clients and what kind of trauma requires professional help.
Instead of thinking about personal traumas and psychological problems, researchers recommend to study the symptoms of vicarious traumatization and recognize them at early stages. The main signs of this condition are physical decline, sleep problems, despair, fear, fatigue, and loss of appetite (Li et al., 2020; Rauvola et al., 2019). According to Abendroth and Figley (2013), female workers demonstrate anger, irritability, and muscle pain, compared to men who do not have the same symptoms under the same working conditions. Attention to such studies is necessary because it is a good chance to learn how vicarious trauma is developed and what groups of people are at higher risks.
This type of trauma affects people by the inabilities to manage their interpersonal conflicts and give appropriate responses. Being vicariously traumatized and unable to change something, people may commit suicide or compel others to do the same (Li et al., 2020). When a group of people face a problem locally and receive help from a properly train worker, the analysis of causes and intervention choices follow specific schemes. When the scope of a crisis is large (like COVID-19), it is hard to identify all symptoms because this situation provokes traumas globally, and its impact is poorly studied.
Stress and Burnout
In working with trauma, symptoms of burnout and stress are frequently developed in caregivers. Abendroth and Figley (2013) explain these situations as the result of experiencing traumas themselves and failure to cope with challenges. The general symptoms of stress are “irritability, impulsive behavior, inability to concentrate, headaches, muscle pain and psychoses” (Abendroth & Figley, 2013, p. 112). In recent studies, burnout’s definition is taken from the studies of the 1990s-2000s, and this condition is characterized by “emotional exhaustion, depersonalization, and personal accomplishment” (as cited in Rauvola et al., 2019). Lack of resilience provokes burnout and stress that become the triggers for such mental health problems as posttraumatic stress disorder (PTSD) (from 6% to 42%) and depression (from 4% 5o 68%) (Ghodsi et al., 2019). Humanitarian workers may not face traumas directly, but their prolonged physical or emotional exhaustion related to the nature of their work determines their health. As soon as people feel themselves under pressure, cannot take breaks, and become irritable, they are diagnosed with burnout to promote health improvement. Therefore, it is correct to say that burnout is one of the outcomes of trauma exposure.
The reason why stress, burnout, and vicarious traumatization are discussed in many studies is the connection between these concepts. Some researchers believe that burnout is a core component of empathy-based stress, yet other studies prove the distinction of these concepts (as cited in Rauvola et al., 2019). Experienced humanitarian workers are able to identify the first signs of burnout and take precautionary measures and breaks to stabilize their well-being. However, in many cases, people cannot recognize their problems and continue exposing their feelings and emotions to negative outside factors. With time, they demonstrate less effective results and even stop working, with a desire to change a job and avoid irritants. According to Ghodsi et al. (2019), burnout and stress depend on the level of social support people obtain from their employers and managers. Still, humanitarian workers do not always have supporters, and their abilities to find motivation are their personal achievements. Volunteers need to know that their work is valued to increase job satisfaction and decrease work-related stress and burnout, which makes self-care and improved education critical elements within the chosen traumatic context.
Self-Care
One of the core goals of recent research projects is to promote self-care and apply it to working with traumatized patients. Both formal and informal caregivers have to measure strain and associated fatigue, stress, and burnout (Abendroth & Figley, 2013). However, many individuals admit that their intertwined styles of life, overwhelming responsibilities, and personal biases deprive them of time and space for self-care (Rauvola et al., 2019). Indirect trauma’s impact on human health is closely related to self-preservation. If a person understands what kind of work has to be done to avoid unfavorable outcomes, he or she may differentiate between personal and professional realms and continue cooperating with traumatized patients. Abendroth and Figley (2013) develop an effective self-care model that enhances the positive effect, resources, and personal well-being. Nilles et al. (2019) emphasize that any humanitarian aid worker must strive for self-sufficiency. It means that a person knows when it is necessary to stop doing something or change a direction and what resources are required to meet a goal. A balance plays a crucial role in self-care, and modern researchers offer different techniques for its maintenance.
Self-care differs among caregivers because it is built upon the surroundings, people, and resources. Albuquerque et al. (2018) use self-determination theory to explain how self-motivation is organized to strengthen autonomy and competence as the elements of self-care. First, any employee should be competent to maintain a work-life balance and develop a positive environment. Secondly, autonomy means that individuals follow a specific plan to relieve stress, follow relaxation and meditation techniques, and take enough time for themselves. Mindfulness-based interventions have to be introduced during early occupational stages to not only mitigate stress and vicarious trauma but also prevent similar problems (Rauvola et al., 2019). To work with traumatic people means to demonstrate empathy but never give up on objectivity (Abendroth & Figley, 2013). Objective caregivers should investigate alternatives and choose those that do not contradict their (not only clients’) interests and needs. Current studies include the role of cultural and social factors that may influence self-care. Therefore, there is no specific and constant requirement for self-motivation and self-efficacy because the more people are obsessed with progress and development, the more new options for their self-care they obtain.
Interventions to Promote Emotional Well-Being
Vicarious traumatization, burnout, and work-related stress are negative conditions for trauma workers, but all of them may be predicted or, at least, mitigated. For example, Ghodsi et al. (2019) recommend improving caregivers’ resilience through educational programs that include leadership training, organizational planning, and the development of management skills. The initial stage of this intervention is based on understanding the reasons for stress and behavioral changes and gathering the material from different sources. Volunteers need clear descriptions of their jobs and responsibilities, learn their working hours, and have enough time to rest (Aldamman et al., 2019). As soon as a situation has a clearly defined background, it is possible to find out a solution and reach for improvements.
Another coping strategy is the identification of realistic expectations from volunteer practice. Abendroth and Figley (2013) admit that it is normal for caregivers to develop real and definite ideas and goals for their practice. To avoid burnout, stress, and traumas, it is better to get themselves prepared for potential problems, negative emotions, and concerns with which patients would like to address. When a person knows what to expect, he or she accepts trauma easier. Current interventions support the idea of being ready for traumatic experiences and never underestimate the impact of direct or indirect trauma.
Finally, to ensure physical and emotional wellness, caregivers are better to have supervisors who may help to define potential personal risks for trauma. According to Abendroth and Figley (2013), care providers may validate their feelings under professional supervision. Experts share debriefing policies and communication to discuss what challenges humanitarian practice, what recommendations have already been followed, and what needs are identified at the moment. Many supervisors assist in creating positive attitudes, behaviors, and team cultures (Rauvola et al., 2019). Aldamman et al. (2019) prove that supervision is a significant contributor to mental health even if it provokes negative self-efficacy. Professional care providers need a backup to know that they are not alone in the traumatic context, and there is always someone to share similar emotions and discuss available ways out.
Conclusion
In this paper, contemporary literature analysis in relation to vicarious trauma, stress, and burnout within the traumatic context was developed. It shows that many humanitarian aid workers, caregivers, nursing, and other personnel are not able to manage stress when they try to complete their direct duties. The experience of people with traumas has a serious impact on human development and understanding of reality. Therefore, self-care strategies have to be constantly improved in regard to people’s needs, resources, and expectations. Self-care means the promotion of a life-work balance, education, and mindfulness. In addition, care providers should consider the worth of supervision and collaboration to control their irritability, fear, anger, and other signs of stress and work-related depression. Trauma cannot be predicted or avoided sometimes, and there is always a need for professional assistance to identify risky factors and manage human behavior and reactions properly.
References
Abendroth, M., & Figley, C. (2013). Vicarious trauma and the therapeutic relationship. In D. Murphy and S. Joseph (Eds.), Trauma and the traumatic relationship: Approaches to process and practice (pp. 111-125). New York, NY: Palgrave Macmillan.
Albuquerque, S., Eriksson, A., & Alvesson, H. M. (2018). The rite of passage of becoming a humanitarian health worker: Experiences of retention in Sweden. Global Health Action, 11(1).
Aldamman, K., Tamrakar, T., Dinesen, C., Wiedemann, N., Murphy, J., Hansen, M.,… & Vallières, F. (2019). Caring for the mental health of humanitarian volunteers in traumatic contexts: The importance of organisational support. European Journal of Psychotraumatology, 10(1). Web.
Ghodsi, H., Sohrabizadeh, S., Jazani, R. K., & Kavousi, A. (2019). Development and validation of the humanitarian aid workers resilience scale (HAWRS). Medical Journal of the Islamic Republic of Iran, 33. Web.
Li, Z., Ge, J., Yang, M., Feng, J., Qiao, M., Jiang, R.,… & Yang, C. (2020). Vicarious traumatization in the general public, members, and non-members of medical teams aiding in COVID-19 control. Brain, Behavior, and Immunity, 88, 916-919. Web.
Nilles, E. J., Gushulak, B. D., & Kayden, S. (2019). Humanitarian aid workers. In G. W. Brunette & J. B. Nemhauser (Eds.), CDC yellow book 2020: Health information for international travel (pp. 498-503). New York, NY: Oxford University Press.
Rauvola, R. S., Vega, D. M., & Lavigne, K. N. (2019). Compassion fatigue, secondary traumatic stress, and vicarious traumatization: A qualitative review and research agenda. Occupational Health Science, 3, 297-336.