Understanding Trauma-Informed Care in Nursing Practice

When I first started my nursing career, I worked on the pediatric inpatient unit. I remember feeling sad and upset when getting report on my patients who had experienced terrible trauma in their young lives. I wondered how they would make it to and through adulthood after having survived abuse, neglect, witnessing violence, or serious illness or injury.

That was over 20 years ago, and now many of these patients are showing up in the health care system carrying their pain and bad memories with them. They may be the adult we meet with a substance or alcohol use issue, chronic pain, or help-rejecting behaviors. They might be the patient whom colleagues have labeled “difficult.” Or they might be chronically late for appointments or fail to show up at all. Frequently, people with a history of trauma can be further traumatized by an interaction with an uncaring health care system and choose to avoid getting the care they need. They may be experiencing symptoms of PTSD along with their other reasons for seeking health care.

Practicing trauma-informed-care (TIC) can help address this problem. June is PTSD awareness month, and we’d like to highlight our April CE feature, “Trauma-Informed Care in Nursing Practice.” Authors Elizabeth Dowdell and Patricia Speck point […]

2022-06-15T14:09:56-04:00June 9th, 2022|Nursing, patient engagement, Patients|0 Comments
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Column Spotlight: Professional Development and Leadership  

What you didn’t know you needed to know.

AJN’s interim editor-in-chief Christine Moffa likes to say that when you read articles online rather than subscribing to and thumbing through a print issue of a journal like AJN, you risk missing out on all the rich content “you didn’t know that you needed to know.” For this reason, we’ve taken to highlighting some of our columns here—and we thought our Professional Development column was particularly appropriate this week as we celebrate Nurses Month and the American Nurses Association four weekly themes: self-care, recognition, professional development, and community engagement.

Lifelong education to advance careers, improve patient care.

The Future of Nursing: Leading Change, Advancing Health report highlights the importance of lifelong education, not only so nurses can advance their own careers but also as a way to improve patient care. AJN’s Professional Development column focuses on professional and leadership development. It includes a series on leadership coordinated by the American Organization of Nurse Executives, highlighting topics of interest to nurse managers and emerging nurse leaders, and a series on conflict engagement.

Other varied topics include finding joy in the workplace and supporting staff during the COVID-19 pandemic. Upcoming installments include an article on narrative writing as an outlet for stress and burnout and an article on peer reviewing. […]

2022-05-19T09:43:35-04:00May 19th, 2022|Nursing|0 Comments
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May Issue: Addressing Nurse Burnout, New Chest Pain Assessment Guidelines, More

“This is the third Nurses Day celebrated since the start of the pandemic and nurses’ work has gotten more recognition than ever. But is that recognition enough?”—AJN senior clinical editor Christine Moffa in her editorial, “Honoring Nurses Where They Need It”

The May issue of AJN is now live. Here’s what’s new. Some articles may be free only to subscribers.

Original Research: Combating the Opioid Epidemic Through Nurse Use of Multimodal Analgesia: An Integrative Literature Review

This review presents strong evidence on the benefits of multimodal analgesia in reducing opioid use for pain management in the acute care setting.

CE: Chemicals in the Home That Can Exacerbate Asthma

The authors describe how the use of cleaning and disinfectant products may affect asthma and asthma-related symptoms and report the findings of a recent study they conducted that identified how these products could reduce asthma control in older adults.

Effective Holistic Approaches to Reducing Nurse Stress and Burnout During COVID-19

This quality improvement project evaluated the use of serenity lounges—dedicated rooms where nurses can take workday breaks to relax and rejuvenate—and massage chairs on nurses’ anxiety, stress, and burnout.

[…]

2022-04-25T09:32:36-04:00April 25th, 2022|Nursing|0 Comments
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Use of an App for Improved Documentation During a Code

A code or rapid response announced over the hospital PA system typically leads to a flurry of activity and a swarm of people responding to the patient’s needs. Many steps of the ACLS algorithm happen rapidly and concurrently, and can be difficult to track with accurate timestamps by the person assigned the role of scribe.

Clear and accurate documentation is critical for post-event analysis to demonstrate the team did everything according to standards and determine if things could have gone better. Many facilities use a code sheet kept on or near the crash cart and others use real-time charting in the EHR. Often the details are written on scrap paper and added to a document later. All of these methods are cumbersome and can lead to inaccurate data collection.

Using an app for documentation during code events.

This month’s Cultivating Quality article, “Improving Accuracy in Documenting Cardiopulmonary Arrest Events,” describes the use at one hospital (Beth Israel Deaconess Medical Center in Boston) of a handheld electronic device for code documentation that makes it simpler and more organized to capture this information.

The project took place on four medical–surgical pilot units, where nurses were trained in the use of a documentation app for live cardiopulmonary arrest events. The American Heart Association’s […]

2022-06-15T14:10:43-04:00April 21st, 2022|Nursing|0 Comments
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A Small Gesture of Kindness

Illustration by Janet Hamlin for AJN.

In our January Reflections column (free until March 1), “Just One More,” a nurse shares her memory of a family facing one of the most painful experiences imaginable—the death of a child.

In a situation like this, there is so little that can be done, and the usual gestures of expressing condolences or giving a pat on the hand feel inadequate and hollow.   

She writes:

“I knew that no words could lessen the unexpected heartbreak . . . But still, I wished there was something I could say, or do, that might make a small difference.”

Small gestures, lasting effects.

Most nurses can relate to such a situation. You may not be able to do anything to change a patient’s circumstances, and all you have left in your arsenal of care is a small gesture of kindness. […]

2022-02-11T09:39:23-05:00February 11th, 2022|Nursing, pediatrics, writing|0 Comments
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Column Spotlight: Learning to Be Strip Savvy When Reading ECGs

“In my experience, many nurses working outside of critical care haven’t had a lot of training in reading and understanding basic ECGs.”

Have you ever learned something new and thought to yourself, how did I miss this? Why didn’t I know about this sooner?

Now more than ever people are finding information by searching for it on their own. The days of reading a print journal cover to cover are, for the most part, behind us. Many readers find articles by searching for a specific topic of interest. While this approach can be useful, you risk missing out on all that rich content in a journal issue you didn’t know that you needed to know.

One of AJN’s great features is our broad coverage of nursing topics.

We intentionally put together each issue to bring nurses the information they need to stay on the top of their professional game. For this reason, I like to highlight our columns here every now and then. (See, for example, my spotlight on our Nursing Research, Step by Step column).

Another great column nurses might be missing out on is Strip Savvy, written by Nicole Kupchik and Joel Green. This month’s installment, “A Case of an Asymptomatic […]

2022-02-02T10:18:08-05:00February 2nd, 2022|Nursing|0 Comments
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Nursing Resources: A Helpful Guide on Marijuana and Marijuana Products

As a psychiatric NP, I’m required to ask patients about the drugs they are currently taking, whether legally or illegally. This is important information to know regarding patients’ overall health, as well as for deciding which medication is safe to prescribe for them. With the recent changes in cannabis legalization, more and more patients who report using medical or recreational marijuana are being seen in health care environments.

More patients using cannabis products.

Staying knowledgeable of the effects, adverse effects, and potential interactions of marijuana is therefore critical for those of us caring for patients. Yet there isn’t much focus on marijuana education in the general training of health care professionals and cannabis is often not included in drug guidebooks. […]

2022-01-07T14:11:20-05:00January 7th, 2022|Nursing|0 Comments
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The Essentials for Nurses About Recognition and Treatment of MIS-C

‘A massive systemic inflammatory response.’

While on the whole the United States is seeing a decline in COVID cases, this most recent wave of the Delta variant has seen an unprecedented number of children infected and hospitalized for COVID-19.

While children generally fare better than adults from the virus, infection may make them susceptible to a rare condition known as multisystem inflammatory syndrome in children (MIS-C).

This rare but serious condition was described by Shields and colleagues in our May issue as “a massive systemic inflammatory response that has physiologic correlations to Kawasaki disease, Kawasaki disease shock syndrome, toxic shock syndrome, macrophage activation syndrome, and cytokine release syndrome.”

The CDC reports that, as of October 4, the number of patients meeting the case definition for MIS-C was 5,217 (up from 4,000 reported in June) and the total number of deaths meeting the case definition was 46.

The CDC case definition includes the following:

2021-10-28T10:36:09-04:00October 20th, 2021|COVID-19, infectious diseases, Nursing|0 Comments
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Alleviating Some Pressure for Acute Care Nurses

Holding huddles during a shift helped to keep nurses informed of hospital-wide and unit-based updates and allowed staff to express their concerns and ask questions. Photo by James Derek Dwyer / Beth Israel Deaconess Medical Center.

It’s well-known that nurses are facing relentless pressure and challenges due to the COVID-19 pandemic, and it doesn’t seem to be resolving anytime soon. While we know that short-staffing is a huge problem and needs to be addressed, hospitals also need to adopt strategies in the here and now to alleviate some of these stressors. AJN recently published several articles detailing the creation and employment of such strategies.

One such article, “Supporting Frontline Staff During the COVID-19 Pandemic,” can be found in our September issue. In the article, nurse leaders from Beth Israel Deaconess Medical Center in Boston describe the challenges nursing staff faced during the COVID-19 surge in the spring of 2020 and the actions taken to support them. […]

2021-10-07T09:50:09-04:00October 7th, 2021|Nursing, safe staffing|0 Comments
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Asleep at the Wheel: Night Shift and Drowsy Driving

‘The most exhausting year of my life.’

Photo by Jan Baborák/ Unsplash

In my 25-year-plus nursing career, I’ve had the opportunity to work every shift—days, nights, evenings, 8-hour and 12-hour shifts. Without a doubt, my least favorite was 12-hour night shifts, as I am more of a morning person than night person.

When I was a new graduate, it was hard finding a job on the day shift, since it’s typically more popular and there are fewer openings for inexperienced nurses. Because of this, I accepted a position working from 7 pm to 7 am.

It was the most exhausting year of my life. No matter what I tried, I couldn’t sleep well during the day, and by the end of the 12 hours I was wiped out. Although I was lucky enough to live only a few miles from the hospital, I found it difficult to stay awake for the whole ride home. I would catch myself trying to keep my eyelids from closing, and a few times I briefly fell asleep at red lights.

Close calls on the roads.

I am grateful that nothing bad ever happened during my sleep-deprived journeys. I have a friend who wasn’t as lucky and totaled her car one morning on the […]

2021-10-04T11:15:27-04:00October 4th, 2021|Nursing|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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