Identification and Coping with Trauma in Child Adolescent Nursing - - PDF document

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Identification and Coping with Trauma in Child Adolescent Nursing - - PDF document

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APNA 30th Annual Conference Session 2055: October 20, 2016 Identification and Coping with Trauma in Child Adolescent Nursing Practice chair: Julie Carbray, PhD, RN co-chair: Diane Wieland, PhD, RN Child and Adolescent Interactive Panel

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APNA 30th Annual Conference Session 2055: October 20, 2016 Wieland 1

Identification and Coping with Trauma in Child –Adolescent Nursing Practice

chair: Julie Carbray, PhD, RN co-chair: Diane Wieland, PhD, RN

Child and Adolescent Interactive Panel APNA conference, 2016

Disclosures

  • The presenters have no conflict of interest

to disclose

Objectives

  • Describe the neurobiology of trauma in children

and teens

  • Summarize the results of the Child-Adolescent

Survey to address secondary traumatic stress (compassion fatigue) in nurses.

  • Describe the impact of trauma related to the

Council work groups: inpatient care, self-care, special populations, and evidence-based practice.

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APNA 30th Annual Conference Session 2055: October 20, 2016 Wieland 2

Trauma

Kathleen Gaffney

Definition

  • Trauma
  • Complex trauma

Theories

  • Neurosequential model – Dr. Bruce Perry
  • Polyvagal Theory – Dr. Stephen Porges
  • Interpersonal Neurobiological Perspective-

Daniel J. Siegel

Areas of the Brain Affected by Trauma/ Stress

  • Activation of sympathetic nervous system

(flight, fight, freeze response)

  • Suppression of parasympathetic system
  • Increase in cortisol levels affects brain cell

differentiation

  • HPA Axis (Hypothalamic-Pituitary-Adrenal

Axis)

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APNA 30th Annual Conference Session 2055: October 20, 2016 Wieland 3

Effects of Trauma/ Stress

  • n the Brain
  • Smaller intracranial and cerebral volume
  • Smaller corpus callosum – less integration

between hemispheres, language centers and emotional memories not connected (PTSD)

  • Changes in the cerebellar vermis
  • Dysregulation of multiple neurotransmitters

Areas of Impairment in Children Exposed to Trauma

  • Attachment
  • Affect Regulation
  • Behavioral Control
  • Language / Cognition
  • Dissociation
  • Self Concept

Summary Trauma in Childhood

1. Affects brain development 2. Causes social, emotional and cognitive impairments 3. Affects behavior due to changes in brain and impairments 4. Leads to multiple medical and psychological problems (ACEs study) 5. Early death- 20 years off life expectancy

(American Journal of Preventative Medicine,Nov,2009)

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APNA 30th Annual Conference Session 2055: October 20, 2016 Wieland 4

Inpatient Models/Groups Addressing Trauma - Kathy Delaney

  • Implementation of Trauma Informed Care: state of

the literature

  • Other models addressing trauma and

implementation

  • Groups to address trauma- transitioning to

inpatient format - ARC groups

  • Where do we go from here to build our

clinical science?

Psychopharmacology of Pediatric PTSD

  • Jason Earle and Erin Ellington

Recent clinical trials indicate limited benefit for using SSRI’s to treat pediatric PTSD Recent clinical trials and case series of antiadrenergic medications (guanfacine, clonidine, and prazosin) indicate some benefit for treating pediatric PTSD Recent clinical trials and case series of atypical antipsychotics (quetiapine and risperidone) indicate some benefit for treating pediatric PTSD

Child - Adolescent Survey to Address Secondary Traumatic Stress (Compassion Fatigue) in Nurses - Diane Wieland

  • Pilot Survey –Feb. 2016
  • Questions
  • Results from 7 Participants
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APNA 30th Annual Conference Session 2055: October 20, 2016 Wieland 5

Question 1: How do you feel when you read in the chart about the family history and other data of children and adolescents?

  • Neutral
  • Informed
  • Sad
  • Optimistic

Question 2: How do you feel when you need to restrain a child or teenager?

  • Concerned
  • Scared
  • Realize many teens are adult size and could

really hurt someone if violent

Question 3: How do you feel when you know a child has been emotionally, physically, or sexually abused or neglected?

  • Sad and angry
  • Angry at parents
  • Angry at the system that these kids have been

exposed to the abuse

  • Angry about poverty and families where no

adult is rescuing the child

  • Angry that the trauma affects the child for the

rest of their lives

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APNA 30th Annual Conference Session 2055: October 20, 2016 Wieland 6

Question 4: What types of situations in the care of children and adolescents push your buttons?

  • Really punitive ways kids are disciplined.
  • Some of the nurses don’t interact with any kind
  • f connection
  • Abuse, neglect, parents who appear to want to

medicate problems away.

  • Verbal disrespect
  • An adolescent who sits in stone silence and

defies all attempts to converse with a closed body posture

Question 5: What type of education at your place of employment meets your needs to reduce secondary trauma? Any suggestions?

  • None at current place of employment
  • Suggest mutual peer support.
  • Listening
  • Required staff debriefings when incidents occur
  • Grand Rounds on challenging cases
  • A culture to discuss issues in bi-weekly team

meetings.

Question 6: What measures do you use to decrease secondary trauma?

  • Nature/ Outdoors
  • Religious Meetings
  • Grandchildren
  • APNA activities
  • Reading
  • Exercise
  • Playing the piano
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APNA 30th Annual Conference Session 2055: October 20, 2016 Wieland 7

Question 7: What symptoms/ feelings/ thoughts do you have when experiencing secondary trauma?

  • Frustration
  • Tired
  • Ruminating about situations

Question 8: Any other comments? About nurses’ secondary trauma you would like to discuss?

  • I usually have enough insight to ask for support
  • I try to be the “eternal optimist.”

Please Share Your Thoughts on the Survey

  • Good questions related to secondary trauma in

nurses

  • Ask a question related to observations of peers

as to their responses to secondary trauma.

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APNA 30th Annual Conference Session 2055: October 20, 2016 Wieland 8

References on Trauma

  • Child and Adolescent Psychiatric Clinics of North America, 2014-04-01,

Vol.23,Issue2,p.339-361

  • Cohen, J, Mannarina A.P.,Deblinger,E.,(2006) Treating Trauma and

Traumatic Grief in Children and Adolescents, New York, The Guilford Press

  • Gold, C., (2016)The Silenced Child, Boston, Da Capo Press
  • Levine, P. and Kline, M., (2007) Trauma Through a Child’s Eyes, Berkley,

Ca., North Atlantic Books

  • Perry, B.D., (The Child Trauma Academy). (2013) 1: The Human Brain

[Video webcast].In Seven Slide Series. Retrieved from https://www.youtube.com/watch?v=uOsgDkeH52o.

  • Siegel, D., ( 2012) 2nd Ed., The Developing Mind, New York, The Guilford

Press

  • Van der Kolk, B. (2014) The Body Keeps the Score, New York, Viking

And More Resources

  • www.childtrauma.org

http://resiliencetrumpsaces.org/providers.cfm?i d=8

  • http://www.trauma-pages.com/trauma.php
  • http://www.trauma-pages.com/articles.php
  • http://nctsn.org/
  • http://www.nctsn.org/trauma-types/complex-

trauma/effects-of-complex-trauma

  • Kathleen Delaney
  • Kathleen Gaffney
  • Deborah Johnson
  • Sarah Jones
  • Joseph Dull
  • Diane Esposito
  • Jason Earle
  • Erin Ellington
  • Kathleen Roblyer
  • Becca Fuhrken

Thank You to our Steering Committee Members

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APNA 30th Annual Conference Session 2055: October 20, 2016 Wieland 9

Work Groups - Thank You

  • Inpatient
  • Evidenced Based Practice
  • Special Populations
  • Self-Care