Understanding Shame as an Obstacle: Toward a Global Perspective.

In this paper, the authors suggest that shame is a barrier to many patients' willingness to disclose their history of trauma to nurses and other members of the healthcare team and that the clinicians participate in this withholding of information because of their experience of vicarious shame. The authors propose that shame and vicarious shame reduce the accuracy of assessment, limit the nurse-patient relationship, and reduce the ability of the healthcare teams to accurately diagnose and treat patients. Shame as a barrier to trauma assessment is also considered in light of the Roy adaptation model and from a global perspective. Implications for education, research, and nursing practice are discussed.