“Falling in and climbing out”: a qualitative study on vicarious trauma among hospice nurses

Hospice nurses may encounter vicarious trauma during the empathy process with patients. However, vicarious trauma is a neglected issue in most hospice clinical nursing settings. The study aims to explore vicarious trauma experience and perspectives among hospice nurses. We conducted participatory observations in three hospitals and held semi-structured in-depth interviews with 16 hospice nurses from 9 cities between May and October 2023. Field notes and interview transcripts were analyzed as one coherent text by using reflexive thematic analysis. Three main themes were identified: (1) “Falling in,” with subthemes of suffering from vicarious trauma and self-perceiving vicarious trauma; (2) “Struggling,” with subthemes of dealing with ambivalence; (3) “Climbing out,” with subthemes of “digesting” vicarious trauma and calling for organizational support. The findings indicated that hospice nurses are deeply affected by vicarious trauma. Nursing managers should pay more attention to the potential impacts of vicarious trauma on hospice nurses, and explore scientifically informed training courses and empowerment strategies to prevent and intervene in the vicarious trauma experiences of hospice nurses. Hospice nurses are deeply affected by vicarious trauma and lack a clear understandings of it. In the absence of organizational support, they rely primarily on personal coping strategies and inner resilience to manage with the negative impacts of vicarious trauma. Nursing managers should be attentive to the risk of vicarious trauma among hospice nurses and actively foster an open and supportive working environment that enables the timely identification of, and intervention for, nurses experiencing such trauma.