Abstract
The media is filled with an onslaught of violent events and images from across the world. Mass shootings in schools and other public places, and wars in Ukraine and the Middle East have dominated medias with distressing immediacy. As of October 2023, there were 5.3 billion internet users worldwide (65.7% of the global population); of this total, 4.95 billion (61.4% of the global population) were social media users (Statista, 2023). Thus, the majority of the world is witnessing these violent events. While social media is generally used for entertainment or pleasure, what happens when it becomes a source of violent, graphic, and immediate acts of national and international violence occurring through mass shootings or armed conflict, for example? This editorial is being written in response to recent national and international events involving violence directed at world populations and looking at the broader result of secondary trauma. Acknowledging that exposure to media violence is not likely to immediately change, this editorial focuses on identifying the effects of media violence and how nurses can manage their own reactions to this while caring for patients, students, supervisees, and family members.
During times of stress, people tend to increase their use of social media sites such as Facebook, Instagram, or X, and others (Naranjo-Zolotov et al., 2021). The COVID-19 pandemic marked a time when world populations became even more dependent on media for information during social isolation (Liu & Liu, 2020). These authors identified vicarious trauma that generally occurred as populations dealt with the anxiety from information ambiguity and illness risk (Liu & Liu, 2020). They identified that social media could be a source of secondary trauma during a time of crisis (Liu & Liu, 2020). This has implications around the importance of social media given the immediacy of exposure to violence or distressing information.
Researchers agree that social media exposure to violence can have an adverse effect on psychological well-being of all age groups (Redmond et al., 2019). Nurses are no strangers to the adverse health effects of traumatic exposures. This is detailed extensively in the literature and described in many nursing specialties, including inpatient, outpatient, community, acute, and chronic care environments. Nurses and other health care providers are vulnerable to violence directed at them and to the expression of traumatic stress expressed by patients exposed to violent acts (McKay et al., 2020).
Exactly what is exposure to media violence and how is it measured? Felix et al. (2020) defined acute mass violence as incidents of violence that tend to target unsuspecting people, usually unaffiliated with the perpetrator, often in public settings generally considered safe. Acute mass violence events historically have resulted in post-traumatic stress, anxiety, and distress in viewers not directly involved with the violence (Ahern et al., 2004; Busso et al., 2014; Holman et al., 2014). Felix et al. (2020) suggest that the stories people hear shape what they know and think about the world. Media exposure cultivates a sense of social reality across numerous domains. This reality is thought to disproportionately shape the perception of risk, given that most individuals witnessing violence in the media are not likely to directly experience the same violence (Comer et al., 2008).
Houston (2009) suggests that media coverage of terrorism is related to post-traumatic stress. While all exposures to media trauma are unlikely to result in a formal post-traumatic stress disorder diagnosis, witnessing a traumatic event while watching media constitutes exposure and, therefore, risk of further deleterious effects on mental health and well-being. In his meta-analysis, he found that exposure to multiple media sources versus a single medium was more powerful in shaping responses (Houston, 2009). He also found that the younger the individual exposed to the trauma, the more likely the presence of trauma responses (Houston, 2009).
Acknowledging that secondary trauma may emerge as an outcome to this exposure to violence, what are nurses expected to know and do to mitigate the adverse consequences of this exposure on those around them? Kitano et al. (2023) addressed this through research looking at Japanese public health nurses and classifying their response to traumatized patients based on their empathy and secondary traumatic stress. They advocated approaching nurses’ response to trauma in their patients by understanding the nurse’s personal experience, stage of career, lifetime trauma experiences, and work-related distress. Understanding this could help nurses better manage trauma in their patients. They advocated using a person-centered approach to help manage patient reactions (Kitano et al., 2023).
This same strategy applies to patients and their traumatic reactions to violent media events. Kitano et al. (2023) raise the question of how much empathy a nurse is able to provide a patient if they are also experiencing traumatic stress from an adverse event. Nurses are equally as at risk as their patients for exposure to media violence. It is imperative that they understand their own reactions as they provide supportive care to patients experiencing a health challenge along with the potential stress generated by media violence.
Choi et al. (2021) acknowledged the mental health problems that can occur after exposure to media trauma. They emphasized the importance of understanding the characteristics of the traumatic events, the individual’s subjective response to what they are watching, and the ways it is influencing current health. They emphasized prioritizing intervention for those individuals most adversely influenced by watching media violence. This begins with a thorough assessment of activities that expose them to mass shootings, and war images (Choi et al., 2021).
In the current international, emotional climate, all nurses need to understand the potential impact exposure to media violence might have on all the people they encounter, including patients, students, supervisees, and family members. They must begin with identifying and understanding their own reactions to the violent images they witness on a regular basis before they can provide intervention and support to anyone else. It is nearly impossible to “unsee” the distressing images that cross our media feeds, but we can manage how we react, process, and intervene to decrease the stress of secondary trauma while mediating the sense that the world is increasingly an unsafe place.