From the presentation we had learned, “Over 90% of patients who are
seen in public behavioral health clinics have experienced trauma” as well
as physical complaints can be a manifestation of trauma. When coping with
trauma individuals may develop maladaptive coping mechanisms also referred to
as “health risk behaviors”. This may include, tobacco or substance
use, risky sexual behavior, or overindulgence of food. Trauma in childhood may
lead to anxiety, social isolation, and chronic diseases such as diabetes, or
substance use disorders. A history of trauma could result in “non-compliance”
such as, missing appointments with a provider.
Adverse childhood experiences (ACES) is a tool utilized by healthcare
providers to aid in the assistance of treating trauma as well as health
conditions which may be a result of said trauma. This tool identifies various
types of trauma including physical, sexual, and emotional abuse; neglect,
losing a parent (including divorce), exposure to domestic violence, a parent
with mental illness, a member of the household abusing substances or alcohol,
and a parent imprisoned. This tool does not account for stressors outside of
their household, protective factors, or differences on an individual basis.
This tool is utilized as an indicator of risk for development of health
consequences due to toxic stress over months or years. Some of these health
consequences include increased risk for chronic pulmonary lung disease,
hepatitis, depression, and suicide.
One aspect from this presentation which stood out was the importance in how
a provider ask a question regarding trauma question. For instance, one question
which was phrased well was “Would you like more support in taking care of
your body, emotions and spirit?” The phrasing of this question
specifically, “more support”, addresses that the patient has support
and the tools within themselves however, the provider may be of assistance in
aiding more support to this patient. There is high importance in building
rapport between patient and provider as this is the process of building trust
within the patient provider relationship. Without trust, communication and
cooperation between patient and provider may be halted. Thus, it is essential
that a provider builds trust, expresses empathy, and provides an environment in
which the patient feels safe to provide quality care. To provide a safe
environment respecting boundary is of high importance. For instance, asking for
permission prior to a procedure, asking sensitive questions, or touching a
patient. Explanations and rationales for questions, assessments, etc will also
aid in this process as this could decrease anxiety in a patient. Finally,
encouraging and facilitating a patient to be an active participant in their own
healthcare aids in the administration of control for patients who have felt as
though they have lost control due to trauma.
ii.What are some long-term impacts of adverse childhood experiences (ACES)?iii.How will you apply the Trauma-Informed Care (TIC) principles to your future nursing practice?
