McLean Hospital 115 Mill Street Belmont, MA 02478
The impact of trauma on patients, nursing professionals, the health care system, and society was examined at the 2018 Fall Nursing Conference. Held on Friday, December 14, at McLean, the day-long event, titled “Resilience in the Aftermath of Trauma: De-Briefing, Co-Creating and Empowering,” featured three speakers who offered insights and perspectives on a range of trauma-related topics.
In her talk, “Got Trauma? Debriefing in the Workplace,” Francine Pingitore, PhD, CNS-BC, a child and adolescent psychiatric clinical nurse specialist in the department of pediatrics at Hasbro Children’s Hospital, and an assistant professor of pediatrics and psychiatry at Brown University’s Alpert Medical School, aimed “to create a conversation around trauma,” enabling conference participants to identify trauma in the workplace and deal with trauma in their day-to-day lives.
Defining trauma as “a disruption from a previously normal state of functioning,” Pingitore explained how events such as a school shooting or the 2013 Boston Marathon bombing could lead to short- and long-term trauma for large groups of people.
For psychiatric nurses, the day-to-day experience of working in a high-stress environment can produce short- and long-term effects. The secondary or vicarious trauma that results from facing “suicides, violence, and aggression in the workplace,” she said, is troubling. “Nurses, of all professions, are most affected by secondary trauma—psychiatric nurses in particular,” Pingitore said. “You are absorbing the struggles of your patients every single day.”
To cope, Pingitore recommended de-briefing sessions for nurses following traumatic work experiences. She gave advice for conducting these sessions, suggesting that nurses should feel free to speak about their experiences and their feelings. Although the format of these sessions can vary, she recommended that all de-briefing meetings be confidential and respectful.
In her talk, “Trauma-Informed Medication Education,” Kathryn Kieran, MSN, PMHCNS-BC, CGP, director of Nursing Operations at McLean’s Hill Center for Women, examined the mind-body connection with trauma. She also offered instruction on how nursing professionals should talk to patients about their medications.
Kieran explained how an individual’s trauma history can relate to their feelings about their prescriptions. For example, a patient who endured physical assault in their sleep may be fearful of using a sleep medication. Similarly, individuals struggling with anxiety or appetite disorders may reject or turn away from medications based on the drug’s physical appearance or how those drugs have made them feel in the past. Moreover, some trauma survivors face cognitive challenges, self-care deficits, coexisting conditions, or problems with the nurse-patient power dynamic that may impact the way they view medications.
To address these issues, Kieran called for “trauma-informed care.” To produce better results, she recommended collaborating with patients on “treatment and recovery in a way that is safe, incorporates respect and acceptance, and minimizes the chance of retraumatization.”
The day’s final speaker was Annie Lewis-O’Connor, PhD, MPH, NP-BC, FAAN, director and founder of the Women’s CARE (Coordinated Approach, Recovery & Empowerment) Clinic at Brigham and Women’s Hospital. In her talk, “Building a Culture of Safety—Trauma and Resilience,” Lewis-O’Connor called on health professionals to consider social determinants of health, such as income, social pressures, and systematic racism. These factors, she said, produce trauma for large groups of individuals and lead to no-shows at appointments, mistrust of the health care system, and poor health outcomes.
Lewis-O’Connor stated that health care professionals must “shift our thinking as it relates to trauma” and move from a traditional model to a “trauma-informed” model.
This model, she explained, is based on collaborative patient interactions. “We need to enter into a partnership with our patients,” said Lewis-O’Connor, describing her success with patients at the CARE clinic. “Our job is to engage them, to raise them up.”