#InTheField Special Edition: The Case for Trauma-Informed Training, from a Pediatric Trauma/Psychiatric RN
I remember my clinical rotations from nursing school vividly…well, most of them at least. I remember hesitantly (and eventually confidently) rocking the babies in the nursery during my postpartum care clinical. Throughout my labor and delivery (L&D) clinical, I remember assisting in the delivery room. Even though I was not actively guiding the baby into the world, I was content just steadily holding the birthing parent’s hand, feeling like I was an important part of all the wonderful chaos. I remember my medical-surgical clinicals as the busiest of all the clinical rotations, but somehow as a student I always made time to listen to patients excitedly tell me about their lives waiting for them outside of the hospital.
I remember my psychiatric nursing clinical most distinctly. My rotation was on an inpatient adult psychiatric unit and I had no idea what to expect day-to-day, let alone that this rotation would impact me more than any other. Psychiatric nursing kept me on my toes and I especially enjoyed studying specific diagnoses, treatment plans, and medications. I did not know right away that I would go into trauma/psychiatric nursing as my first RN position, but I like to believe that sometimes the universe will lead you to where you are meant to be, and in this case, where I am meant to thrive and flourish as a nurse.
My first position after passing the NCLEX was as a pediatric trauma/psychiatric RN in an outpatient/residential facility. Caring for children and adolescents that were severely affected by trauma at a very young age was new territory for me. It was heart wrenching to see these patients suffering and not being able to completely process what they were feeling. They would depend on the nurses and other members of the interdisciplinary team to help them understand and process their emotions and reactions. They would ultimately need guidance on how to successfully acclimate back into society with their peers. It took me some time to develop a thick skin to the things that I would see and hear on a daily basis at work. It was at this point I started to accept that I could not immediately take away all the pain felt by these patients. All I could do in these critical moments was provide support through therapeutic communication, de-escalation techniques, and crisis management. At first, it felt like I was not helping or making a difference.
After some time, I became comfortable with the mantra of “two steps forward, one step back” in regard to the progress of my patients, as well as my own professional and personal growth. I felt the sadness and pain of the patients I worked with, but also built resilience and strength as a nurse. After collaborating with social workers, psychiatrists, and child developmental specialists, I was stunned at how little I really knew about trauma during childhood and the adverse effects it can have throughout life.
“I did not know right away that I would go into trauma/psychiatric nursing as my first RN position, but I like to believe that sometimes the universe will lead you to where you are meant to be, and in this case, where I am meant to thrive and flourish as a nurse.”
During my RN program, we touched upon trauma briefly in a few of my classes. However, after working as a trauma/psychiatric nurse, I truly believe that we should dedicate more of the nursing curriculum to this topic. Considering current events in the world today, the need for increased trauma education throughout nursing programs is imperative. Politics, racial tensions, rapid effects of climate change, and the COVID-19 pandemic are just a few causes of direct and indirect trauma to multiple groups of people, most if not all of which we will care for at some point in time. A couple more specific causes of trauma include the Flint Water crisis and U.S.-Mexico border refugee crisis.
As nurses, we need to be prepared for the ramifications that these events may subsequently have on our patients’ mental health and wellbeing, in addition to how patients who have experienced racism or other trauma in medical contexts may feel or struggle when seeking medical attention. There is a great need for more Psychiatric-Mental Health Nurse Practitioners (PMHNP), and it is likely that this demand will persist for years to come. I contend that nurses need an extensive amount of training on trauma. I think this training would be useful for all nurses, not just those working in trauma or psychiatry, since therapeutic communication and empathy are such fundamental building blocks of nursing.
As I try to keep updated with current events and the news, I never fail to hear about another travesty or misfortune. My mind immediately considers the potential for trauma…Which groups of people will become traumatized from this particular situation? How will the trauma present? What will be done to address it? When have I seen this impact my patients? What can I do as a nurse? Seeing as how nursing means to not only care for patients from a medical standpoint but also from a social standpoint, increased trauma education is critical. I have come to learn that to be a nurse is to not only advocate for health and wellness-related solutions, but also for solutions to the economic, legal, and social obstacles of life. As both individual nurses and as a unified profession, we must address and learn how trauma functions and its potential for harm to health and wellness. We can do so by fostering discussions with other healthcare professionals, social workers, and child developmental specialists.
Nurse Columnist Rima Parikh is a psychiatric RN and an MSN-FNP graduate of Simmons University. She is passionate about public health and community outreach, and hopes to be a mentor to other young nurses and nursing students.