Do you know the definition of trauma? When I did my undergraduate studies, I don’t remember any formal education on treating patients with trauma. What discussion was had was reserved for those who were veterans or victims of abuse and sexual assault. It seemed flippant to categorize anything else as trauma, as if doing so would somehow lessen the gravity of what had happened to those people.
To be fair, the research on trauma has come a long way in the last 20+ years which is why I ask if you know the definition.
SAMHSA, the Substance Abuse and Mental Health Services Administration, defines trauma as “experiences that cause intense physical and psychological stress reactions. It can refer to a single event, multiple events, or a set of circumstances that is experienced by an individual as physically and emotionally harmful or threatening and that has lasting adverse effects on the individual’s physical, social, emotional or spiritual well-being.”
This definition certainly broadens trauma to encompass more than just veterans and abuse victims.
Now keep in mind that experiencing trauma and developing PTSD are not the same. Many people experience trauma and its detrimental effects without meeting diagnostic criteria for PTSD.
If we know this definition, we can look for the signs and symptoms of trauma in the absence of an obvious catastrophic event. Rather than thinking something is wrong with the patient, we can see it as a stress response to something that has happened TO the patient.
We might even start to find some of these symptoms in ourselves.
Why would this be?
A trauma response can happen as a result of the work that we do. We call it secondary trauma or vicarious trauma.
Yup, it is an inherent risk of being a nurse, of repeatedly being exposed to suffering.
Other factors that contribute to secondary trauma are:
1. Dealing with patients who have a history of trauma
2. Trauma from disasters
3. Rapid triage often with limited resources
4. Concern for personal safety
5. Being culpable for patient harm/ potential harm ie: medication errors or patient safety
6. Futility of care
7. Loss of a patient
Before you panic though, it doesn’t mean that we are doomed or that we need to leave the profession. Trauma is treatable.
Let’s use the nursing process and start with assessment.
What are some of the signs and symptoms of vicarious trauma?
• Recurring thoughts or dreaming about a traumatic experiences of patients
• Change in sleep patterns: difficulty falling or staying asleep
• Change in eating habits: overeating or undereating
• Being overly emotionally involved in a patient’s case
• Feelings of anger or guilt about the patient’s trauma
• Questioning personal beliefs and identity
• Avoiding patients with trauma histories
• Irritability or anger
• Loss of empathy in the long-term
• Agitation (increased startle effect), fear or despair
• Loss of interest in activities once enjoyed
• Feelings of hopelessness related to work
• Feelings of job inadequacy and lack of satisfaction
• Taking on more work than is necessary and increased overtime
• Problems managing personal boundaries: inability to say no when tired
• Poor relationships: blaming, emotional outbursts, isolating, poor collaboration
Why do I tell you this? To reassure you that you aren’t broken, that nothing is wrong with you if you are experiencing some of these things. These are nervous system defense mechanisms, not a moral failing.
1 in 5 people have a history of some type of traumatic childhood event (remember, experiences that cause intense physical and psychological stress reactions.) This means that these responses are imprinted on us early on, when our brains are not fully developed. These responses can be triggered again when we are repetitively surrounded by suffering.
I’m going to say it again.
Nothing is wrong with you. Please sit with that for a minute and soak it in.
You can be ok. We need to reassure your nervous system and allow it to recover.
The first step is awareness, diagnosing the problem.
From there we can start gently, and with compassion; with understanding and care for the person who has undergone this trauma.
Don’t chastise yourself that you are losing your empathy, support yourself and give yourself time to heal.
Of course, there are many professionals that can help you and therapies that target rewiring the traumatized brain, but we can also start this on our own, for free.
Mindfulness is one of the known strategies for calming the brain and the body, gentle awareness of the here and now.
You don’t have to figure it out on your own. You can download an app like Headspace, Calm, PTSD coach, or 10% Happier to name a few.
Try and take some slow breaths. Follow a short meditation. You can’t do it wrong. Just listen and try your best to do what it says. Gently bring your attention back when you get distracted, even if it’s 20 times.
There are lots of resources available, ones that you may have never tried which is totally understandable if you didn’t know what the problem might be.
The problem may be trauma. In the studies completed BEFORE covid, about 20% of nurses met diagnostic criteria for PTSD and up to 88% had some type of psychological symptoms.
You are not alone.
You are not broken.
You can heal and build resilience.
Knowing is half the battle.
P.S. There are multiple strategies for dealing with trauma, this is just a good place to start, something that you can try today. Talk to your colleagues, share your experiences. Give yourself some understanding.
If you think you need some professional help, here are some resources to find a mental health provider.
American Association of Nurse Practitioners
American Psychological Association locator
Insurance, taking new patients, specialty areas
National Register of Health Service Psychologists
Other online databases
https://www.psychologytoday.com/us incl. APN, MD, LCSW, PhD
https://www.betterhelp.com/ no insurance, $65-95 session, licensed therapists
And if you need a coach to brainstorm new ideas and support you while you practice them, reach out. I’m here. Message me or schedule a consultation here.
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