Tools Use Can Use: Learning to talk about the trauma

Reconnecting with friends  and family after a hospital stay provides many kids with an easy way to return to normal life. However, for some, telling their peers about their injury or illness can be difficult. Potentially distressing memories, anxiety over looking different, and worry about others’ perceptions of them causes some kids to socially withdraw after returning home from the hospital. The Center for Pediatric Traumatic Stress developed worksheets (available in English and Spanish) to help kids share their story, lessening their distress and anxiety, smoothing the transition back to life before their hospital stay.

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Nursing History to Guide Future Practice

A pioneer for nurses, Florence Nightingale pushed through boundaries to provide the best care for her patients. She showed good patient care is at the forefront of nursing, driving the future of nursing towards where we are today. Even though Nightingale stressed the importance of sanitation and hygiene in nursing care, she once said, “apprehension, uncertainty, waiting, expectation, fear of surprise, do a patient more harm than any exertion”, clearly recognizing the distress patients experience in a medical setting and the need for what we call trauma-informed care today.

This year, use Nurses Week to celebrate the nurses of the past and move into the future. What are some ways you can be a pioneer for trauma informed care in your setting? Are there things that can change?

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Research: Far Reaching Effects of a Traumatic Event

Doctors, nurses, children and parents may experience traumatic stress reactions and PTSD after an injury, but they’re not the only ones experiencing these reactions. Recent research suggests even 911 operators show symptoms of emotional distress, despite only secondary involvement with the traumatic incident. In fact, over 30% of 911 operators express emotional distress after a traumatic call and almost 4% experience PTSD symptoms. Not knowing the outcome of the call proves especially distressing to operators. This research highlights the far reaching effects of a traumatic event as well as the need to provide training on coping with emotional distress to professionals peripherally involved in potentially traumatic events.

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Living with Cystic Fibrosis

A cystic fibrosis diagnosis forces a family into a completely new way of life, filled with many difficulties and challenges. Countless pills, time consuming inhaled medications, and the ever present possiblity of a lung infection alter every aspect of a child’s life. For parents with a newly diagnosed child, learning to cope with knowledge their child will not experience the typical “normal” childhood can be especially taxing. Listen to several young adults and parents share their stories of living with cystic fibrosis in the New York Times feature, “Patient Voices”.

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Tools You Can Use: Cultural Considerations in Pediatric Care

Healthcare providers routinely treat children and families from many different backgrounds. While a universal biological response to trauma exists, enthocultural factors affect children’s and families’:

  • Vulnerability to trauma and traumatic stress
  • Expression of distress and trauma symptoms
  • Response to trauma treatment
  • Help-seeking behaviors
  • Communication with and between family members
  • Willingness to disclose psychosocial information to providers

Considering the cultural background of patients helps providers implement trauma-informed care in a manner that considers a child and family’s unique cultural beliefs, values, and practices. The Center for Pediatric Traumatic Stress developed a cultural considerations component to the D-E-F protocol to give nurses and doctors tips in providing trauma-informed care in a culturally sensitive manner.

As a healthcare provider, do you alter the care you provide based on your patient’s cultural background?

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Research: Lasting Impact of a PICU Stay

Can a PICU stay leave a lasting impact on the emotional well-being of a child? Decades of research says it can. Researchers estimate approximately 25%  of PICU patients will experience lasting psychological consequences, such as anxiety, reoccurring memories, and other symptoms of PTSD. A meta-analysis of 28 studies conducted by Janet E. Rennick, Ph.D. revealed  32% of children experience disturbing memories from their PICU admission up to 3 months post discharge and 25% experienced hallucinations 3 months afterwards.  A year after discharge, 21% of children continued to experience symptoms of PSTD.  Unfortunately  Dr. Rennick’s research stalled due to the lack of appropriate PTSD screening tool for PICU patients. This lead to the creation of the Children’s Critical Illness Impact Scale (CCIIS), a developmentally appropriate PSTD screener. Through the use of the CCIIS, Dr. Rennick hopes to better characterize the emotional impact of a PICU stay as well as better identify those children who may need additional psychological support.

Do you think a PICU stay can have lasting impacts on your patients?

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Building Staff Resilience Through Creativity

Caring for injured and ill kids and their families day after day takes a toll on healthcare providers. The Schwartz Center Rounds® program provides doctors and nurses at Children’s Hospital of Philadelphia a place to talk with other co-workers about the trials and tribulations of caring for these children. Taking the program one step further, a clinical nurse at CHOP developed a program called  “Arts and Humanities: Building Staff Resilience” where staff utilize their creative outlets as a way to cope with the challenges of their jobs. Since 2008, this annual program draws over a 100 physicians and nurses who share their feelings and emotions through art, photography, music, and poetry.

As a healthcare provider, how do you cope with the daily strains of your work?

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Handling Adults with Kid Gloves

Few medical procedures performed in a hospital come without apprehension for our patients. Hospitals, in and of themselves, can cause anxiety.  As a healthcare provider, the sights, sounds, and smells of a hospital are routine for us.  However, it seems the only time we acknowledge the foreign and scary environment of a hospital, is when we work on a pediatric unit or floor.  We’ll prepare a young child for a procedure, such as blood draw, knowing the anxiety caused. We’ll comfort a child coming out of surgery by making sure their parents are at the bedside when they wake up.

Why not treat an adult patient in the same way?

Many times, we expect adults to cope with the hospital environment, but if it’s their first visit to hospital, in some respects, they’re just like a child.  The unfamiliar hospital environment, painful procedures, isolation from family and friends can all overwhelm an adult patient. Many of the practices we typically use in pediatric realm can help to ease the pain and anxiety experienced by the adult population. Applying these principles to trauma, we need to remember what a parent sees can cause just as much trauma and emotional distress for them as it can for a child.

Do you think doctors and nurses should treat adult patients with “kid gloves”?

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Tools You Can Use: Online Education for Nurses and Doctors

Looking for ways to increase your trauma-informed skills when caring for the emotional needs of patients and families? The Center for Pediatric Traumatic Stress developed an online educational module, Trauma Informed Pediatric Care “Tommy’s Story”, designed specifically for health care providers.  Shown through the eyes of a young boy, Tommy, this 30-minute video follows his journey from the time of injury all the way to recovery. Healthcare providers will learn about the typical traumatic stress reactions injured children may express as well as ways to assess and treat this emotional side of trauma often experienced by hospitalized children and families.

Log on today to take advantage of this free educational opportunity!

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Research: 1 in 8 injured kids experience traumatic stress symptoms

Have you ever had a pediatric patient and/or their parent(s) express overwhelming feelings of fear, helplessness, and horror after a car accident, dog bite, or another type of injury? Research conducted by Flaura K. Winston, MD, PhD shows that while nearly all children and parents will experience feelings of traumatic stress in the aftermath of an injury, up to 1 in 8 will continue to experience these reactions for months.  As Dr. Winston explains, the symptoms of a traumatic stress reaction include re-experiencing, avoidance, and/or hyperarousal.

As healthcare providers, it’s vital to recognize these symptoms and suggest appropriate treatment for your patient and family. It’s also important to remember the severity of the accident or injury does not necessarily have an impact on the traumatic stress reactions in children and their parents. Even kids who witness an accident may experience traumatic stress reactions.

What have you done for a patient who seems to show signs of traumatic stress?

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