You’ve known about child development all along, but now you can learn about the additive and graded physiological effects of trauma and the differential effects according to the developmental stage of life at which the trauma occurs. You’ve known about the hypothalamic-pituitary-adrenal (HPA) and chronic fight-or-flight reactions, but now you can trace in detail the HPA aspects of your psychologically bruised patients’ experiences and be definitively reminded how the hippocampus shrinks.
Transgenerational aspects of psychiatry are ready for your consideration. Catch up with the role of genes in trauma response, but don’t forget about family environmental events when taking a history. You’ll learn how even before birth, your patients were often influenced by the psychological stressors their parents experienced. Be warned: the memes of trauma can also be transmitted to you, leading to vicarious traumatization and job burnout. All is not lost, however. There’s a well-studied scale to measure how you are influenced by your patients’ traumas.
Naturally, nurses prioritize the health, care, and safety of patients, followed by care toward family, friends and pets. Nurses tend to place self-care last, which means there is an increased risk of becoming emotionally disconnected from oneself due to compassion fatigue. What risk does this have on nurses working with patients suffering from trauma?
Trauma is an umbrella term that may be considered perplexing. For the purpose of this paper, trauma will be explored using a psychiatric lens and will be conceptualized as direct or indirect physical, sexual and/or psychological abuse. Direct trauma (DT) is when the victim is abused by the perpetrator directly. Indirect trauma (IT) is when a person witnesses another person who is experiencing DT or helping another person (such as a patient) who has experienced DT or IT.
Re-traumatization is when an individual encounters DT or IT similar to a previous experience of trauma.
Nurses working with traumatized patients are encouraged to optimize care by reducing symptomology produced by the patient’s trauma. However, it is important to note that symptoms vary among each person as they permeate through the five senses; though the experience of trauma and re-traumatization may manifest similar in nature. For example, an individual who has a heightened sensitivity to tactile sensations compared to scent, this sensory button will be vulnerable and act as a trigger during a traumatic experience.
For this reason, there is an array of symptoms that result from trauma. Symptoms can be categorized into physiological and psychological. Physiological symptoms can include but are not limited to: diaphoresis, night terrors, body memory, tachycardia and tachypnea. Psychological symptoms can include but are not limited to: denial, guilt, anger, rejection, hopelessness and dismay.
Learning about trauma helps nurses ascertain if patients or they themselves are becoming triggered and how one can navigate through these difficult situations.
The following coping strategies act as a self-care guide for nurses who are experiencing trauma/re-traumatization. Similar strategies can be used with patients too:
Become acquainted with yourself and your patient. A psychiatric nursing requisite includes the application of a trauma-informed paradigm to optimize patient health outcomes. However, to successfully do this, the nurse must be aware and accept if they have been traumatized or are at risk of re-traumatization. If the answer is yes, the nurse must decide if he or she has appropriate resources and self-care tools to deliver safe and competent care. This self-analysis is considered difficult for nurses, as it go against the grain of nursing care, causing emotional distress.
Participating in behavioural therapy (BT). BT such as CBT and DBT assist in treating triggers that can amend unsafe behaviours and cope with challenging events. Evidently, this treatment can be used to provide relief in personal and professional lifestyles.
Engage in hobbies and activities outside of work. This will keep the mind active, providing an alternative perspective on life, which can sharpen the nurse’s professional lens when working with traumatized patients.
Build a social support network. This will decrease the probability of experiencing chronic symptoms of trauma.
Find the courage to speak to your family doctor or a therapist. This is recommended especially if triggers or symptoms are affecting one’s ability to function on a day-to-day basis.
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