4 Things Nurses Should Know When Working with Trauma
Nurses are constantly challenged, especially through these difficult times of a pandemic with what they experience and the significant ongoing exposure to human suffering. I have the utmost respect for nurses and share these tips in the hopes that they will help both them and their patients.
There is a high prevalence of trauma within mental health and addictions, even as high as 90+ percent. What we often do not discuss is the high prevalence of trauma-exposed patients within the medical aspects of health care.
For this very reason, when patients arrive at the emergency specifically for medical reasons, the focus of care is often on the injury, wound, or illness and less on the individual's history.
What I want to bring awareness to is the underlying historical exposures to trauma that many of our patients have experienced who enter the medical health care system for help. Coming into the healthcare system can mobilize many patients’ prior trauma symptoms and behavioural responses to coping.
Here are a few trauma-informed points to remember:
Remember the Impact of Abusive Relationships
It is extremely helpful to understand the impact of abusive relationships on the individual. Abuse impacts the survivors' sense of safety within themselves, with others, and the world around them.
Trauma survivors have experienced past relationships of betrayal, danger, oppression, and disempowerment, and felt a loss of control. Many trauma survivors have been in relationships where they have been threatened, dangerous, violent and explosive, exploitative, unpredictable, manipulative, or neglectful.
Those that have been exposed to chronic childhood trauma have a significant disruption in attachment, which is fundamental in the establishing and building of a relationship.
For these several reasons it can be difficult for nursing professionals to form collaborative relationships with clients who have these types of exposures. From the aspects of a transference reaction and re-enactment, a nurse can be viewed by the patient as a potential abuser, or even someone to be feared, avoided, or manipulated.
Be Aware of Trauma Re-enactments
Trauma reenactments are the unconscious reliving of traumatic past events, without conscious awareness in present-day relationships. Patients with a trauma history experience their present-day relationships in ways that are similar to past abusive relationships. Nursing professionals need to be aware that survivors are always on guard for fear of being abused. So relationships with nursing and other professionals are approached by patients suffering trauma with mistrust, state of fear, or anger. This can easily cause countertransference reactions unintentionally reinforcing the trauma reenactment. Trauma reenactment can cause nursing professionals to experience strong emotions, such as being overwhelmed, anger, helpless, or hopeless, which is all projected onto the nursing professionals. Nursing professionals need to understand these reenactments as reenactments, rather than the nursing professional having a lack of understanding of these dynamics and reacting to them. For this reason, creating a safe and empowering relationship with the trauma survivor.
Everything starts with SAFETY
We must create a space, experience, and connection where the patient has a felt sense of safety. When clients with a historical past from trauma come into our system, and they present as guarded or distant, or they might present as charged or reactive, it is because of their history. Be aware, notice this is their history, and want to protect themselves right now. Many patients, in their history, were not protected by those in positions of authority. Also remembering many in authority have directly or indirectly harmed our patients. Building safety is critical to quality health care. Safety can be created by our tone, pacing the interview, being fully present, noticing the patient when they struggle or even slightly dissociating, telling the client what the treatment or interview process will look like before you start, building predictability.
Building Collaboration with the Patient who is a Survivor is essential to EMPOWERMENT and Effective Health Care
Hear the patient survivors viewpoint to foster collaboration
Include the survivor's perspective in the treatment plan, goals, direction of care
Ensure Safety
Explore with your survivor patient at the onset as to what steps can be taken to enhance their felt sense of safety.
Remember, when a survivor patient meets you for the first time, not feeling safe is not only understandable, it's normal for them to have this feeling.
Safety might be sitting in a certain chair, sitting by a window, leaving the door open, offering a glass of water, or holding a comfort item.
Invite your patient to answer questions. Remember this is a collaborative interview and not a fact-finding mission. Inviting builds safety and mutual respect for the patient.
Survivor patients may not be able to respond to your question quickly as they may feel overwhelmed easily. Let the patient know you can return to any questions later on.
Remember to pace the interview, notice the survivor patient responses, and if their effect shifts, so must your pacing.
Be aware of your tone as the nervous system for many of our patients with this type of history is not listening for your words. Their survival system may be more focused on the tone of safety or tone of threat. We need to be very aware of our tone, as their nervous system and ear are close relationships to protect them.
Be well!
Ian