The Forgotten Survivor: A Forensic Nursing Perspective on Secondary and Tertiary Trauma

Partners, parents, siblings, children, and other close supports of sexual assault survivors often experience significant emotional, psychological, relational, and physiological consequences following an assault. Although forensic nurses frequently recognize distress among these affected survivor groups, they are rarely incorporated into formal assessment, education, referral, and intervention processes.

To examine the secondary and tertiary effects of sexual assault within family systems and explore implications for forensic nursing practice.

This conceptual article draws upon trauma-informed care, neurobiology, family systems concepts, and clinical observations from forensic nursing practice to examine the broader relational consequences of sexual assault. Existing literature related to secondary traumatic stress, relational trauma, and family systems disruption was reviewed to inform development of the Parallel Survival Framework.

The Parallel Survival Framework is proposed as a practice-oriented conceptual framework for recognizing affected survivor groups whose needs frequently remain unaddressed within traditional models of care. The framework highlights primary survivors, secondary survivors, tertiary survivors, and trauma-exposed professionals within the broader survivor ecosystem and provides a lens through which forensic nurses may consider the relational consequences of sexual assault.

The Parallel Survival Framework is not intended to replace existing theories of trauma, secondary traumatic stress, or relational trauma. Rather, it offers a practical lens for recognizing affected survivor groups and exploring opportunities to strengthen assessment, education, referral, and support practices. Recognizing and responding to these often-forgotten survivors may strengthen recovery, support family systems, and advance the evolution of trauma-informed forensic nursing practice.