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

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 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. Wieland 1

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

APNA 30th Annual Conference Session 2055: October 20, 2016 Effects of Trauma/ Stress on 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) Wieland 3

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

APNA 30th Annual Conference Session 2055: October 20, 2016 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 Wieland 5

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

APNA 30th Annual Conference Session 2055: October 20, 2016 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. Wieland 7

APNA 30th Annual Conference Session 2055: October 20, 2016 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) 2 nd 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 Thank You to our Steering Committee Members • Kathleen Delaney • Erin Ellington • Kathleen Gaffney • Kathleen Roblyer • Deborah Johnson • Becca Fuhrken • Sarah Jones • Joseph Dull • Diane Esposito • Jason Earle Wieland 8

APNA 30th Annual Conference Session 2055: October 20, 2016 Work Groups - Thank You • Inpatient • Evidenced Based Practice • Special Populations • Self-Care Wieland 9