THE 8TH PAN-AFRICAN PCAF PSYCHOTRAUMA CONFERENCE

“Trauma and Mental Health across the Lifespan”

By: Prof. Anna K. Karani PhD (UoN)Professor of Nursing Sciences E:mail:

Kagure@uonbi.ac.ke or karanikagure@yahoo.com

DATES: 13TH – 17TH JULY, 2015 VENUE: THE CATHOLIC UNIVERSITY OF EASTERN AFRICA ULTRA-MODERN CONFERENCE CENTRE

NAIROBI, KENYA

ROLES OF THE NURSE IN PSYCHO TRAUMA

Abstract :The role of the nurse includes multitasking in different situations which is challenging. The objective of this presentation is to describe the nurse’s role using discussion as the methodology. One of the areas that poses challenges include the role in psycho trauma conditions.

ROLES OF THE NURSE IN PSYCHO TRAUMA

• Trauma is a situation specific, severe and stressful violation or disruption that has serious psychiatric consequences for the individual, either soon or long after the event. ( Klein & Schermer, 2000 as cited by Ulman, 2004).

ROLES OF THE NURSE IN PSYCHO TRAUMA

• The nurse plays a leading role in the care and management of those that suffer conditions such as psycho trauma (Karani et al 2006).

• This is commonly seen in any “event that can be perceived as life threatening or pose the potential of serious bodily injury to self or others” (Wade, 2013).

ROLES OF THE NURSE IN PSYCHO TRAUMA

• Results indicate that major roles of the nurse is leadership in the management, control and prevention of Psycho trauma.

• Nurse identifies the causes or factors contributing to Psycho trauma in order to manage ,control and prevent psycho trauma conditions where possible (Karani et al 2006).

ROLES OF THE NURSE IN PSYCHO TRAUMA

• For the vast majority of the population, the psychological trauma brought about by the experience of profound threat is limited to an acute, transient disturbance.

• In conclusion the nurse coordinates the health team in collaborative management for treatment plan

ROLES OF THE NURSE IN PSYCHO TRAUMA

• . Nurse counsellor and advocate coordinates care linking patient, family, health team, resources and health education to community.

• Then patients develop the emotional, social and intellectual skills adjusting to normal lives.

ROLES OF THE NURSE IN PSYCHO TRAUMA

THE ROLES OF THE NURSE IN PSYCHO TRAUMA

• This presentation is a desk review discussion plus life experiences.

• The aim was to review the role of the nurse in Psycho trauma in different situations.

ROLES OF THE NURSE IN PSYCHO TRAUMA

• The discussion includes causes /predisposing factors and management Psycho trauma clients.

• Generally the nurse leads and coordinates the health care team in the management of Psycho trauma patients and clients.

ROLES OF THE NURSE IN PSYCHO TRAUMA

Definition of psychotrauma• Trauma is a situation which is specific, severe and

stressful violation or disruption that has serious psychiatric consequences for the individual observed either immediately or long after the event. ( Klein & Schermer, 2000 as cited by Ulman, 2004)

• Psychological trauma can occur after observing a life threatening event which may be real or perceived to cause potential danger of body injury to self or others {sic} Wade, 2013.

ROLES OF THE NURSE IN PSYCHO TRAUMA

Definition of psychotrauma cont.

Psychological trauma occurs as a result of profound threat of acute, transient disturbance ( Kendall-tackett, K., 2009) which manifests following:

• Something that reminds them of previous exposure, flashbacks, thoughts and nightmares, sleeplessness, irritability, emotional outburst and anger, It can be depression, avoidance, withdrawal, dissociation or confusion.

ROLES OF THE NURSE IN PSYCHO TRAUMA

Psycho trauma may occur due to many factors according to Prepared, R. & Agency, V., 2005 which includes following:-• Disasters, e.g. Kenya Bomb Blasts • Accidents, Medical procedures, • Terrorism noted in some parts of the world• Crime, Abuse, • Rape, Witnessing Violence, • Loss, Vicarious trauma as noted all over the

world.

ROLES OF THE NURSE IN PSYCHO TRAUMA

Physical Psychosocial Spiritual

ROLES OF THE NURSE IN PSYCHO TRAUMA

Some of the Effects of Psycho trauma include:- Physical, Somatic complaints, Fatigue, Startle reactions, Gastro intestinal disturbances, Psychological, Feeling helpless, powerless and hopeless, Feeling overwhelmed• That is why after these incidents, those involved

require a lot of psychological support among other needs (Karani et al 2006)..

Some of the Effects of Psycho trauma Cont.:-

• and vulnerable, Fear, terror, Depression, sadness, Shame, embarrassment, Anger, feelings of revenge, Loss of pride, dignity, security, Disbelief, denial, Relational, Withdrawing or clinging to others, Breakdown in trust, (Karani et al 2006).

• Distortions in reactions to others and Wade,

2013 observed Alienation from family, friends and co-workers.

ROLES OF THE NURSE IN PSYCHO TRAUMA

Cognitive Effects are:

• Confusion, Difficulty remembering things, Difficulty concentrating, Assumption that the world is not safe, Intrusive imagery (Flashbacks).

• Others include Disorientation on space, Euphoria or guilt about being alive (Karani et al 2006)..

ROLES OF THE NURSE IN PSYCHO TRAUMA

Cognitive Effects are:

• Confusion, Difficulty remembering things, Difficulty concentrating, Assumption that the world is not safe, Intrusive imagery (Flashbacks).

• Disorientation on space, Euphoria or guilt about being alive (Karani et al 2006)..

ROLES OF THE NURSE IN PSYCHO TRAUMA

Spiritual Effects include:

• Loss of clinging to faith, Spiritual doubts, Despair, hopelessness, Questioning the meaning of life (Karani et al 2006).

ROLES OF THE NURSE IN PSYCHO TRAUMA

Teacher• Advocate• Counsellor• Communicator

Leader• Manager• Case Management

Researcher• Innovator• Change agent• Care Giver

ROLES OF THE NURSE IN PSYCHO TRAUMAGENERAL NURSES ROLE IN PSYCHO TRAUMA (Karani et al 2006).

• Caregiver – which involves Physical, Social, Psychological and Spiritual aspects of a person

• Communicator – That is an integral part of the nurses role where communication is with the client, family,

members of the health team and other people the community. The purpose is to identify clients problem and explain or discuss with the client and other members of the health team on how to sort out any issues. This is a process of nursing care which can be done verbally or and in writing.

ROLES OF THE NURSE IN PSYCHO TRAUMA

• Teacher – The nurse assesses clients needs, plans with client sets goals then guides and teaches the client the things they need to learn about their health and care including procedures that would help them get well and maintain their health.

• Advocate – As an Advocate, the nurse role is to protect the client by representing his needs to the physician and other members of the health team presenting their rights.

ROLES OF THE NURSE IN PSYCHO TRAUMA

• Counselor – Helps the client recognize and manage their stress, whether psychological or social problems. Aim is to improve interpersonal relationships and promote emotional, Psychological and intellectual growth.

• Change agent – Helps client improve in clinical care and their behavior where the client makes changes that help him or her better as body system changes to promote their health back to normal.

ROLES OF THE NURSE IN PSYCHO TRAUMA

• Leader – Influences the individual client, family, members of the community, members of the health team and other professionals. Nurse uses her leadership and interpersonal skills to identify the needs and goals that motivate people.

• Manager - As a manager the nurse ensures provision of individualized nursing care including care to

families and communities. The nurse manager delegate, supervises and evaluates the care given to ensure quality care is maintained.

ROLES OF THE NURSE IN PSYCHO TRAUMA

• Case management – This is another role of the nurse to ensure nurses work with all members of the

health team to ensure good planning and monitor their outcomes

• Researcher – nurses often do and use research to improve the client care. In every clinical setting nurses

should be:- Be involved in the process and language of research; protect human subjects; help in identifying researchable problems and use research findings in promoting client care.

NURSES’ SPECIFIC ROLES

PlanNurse

Assess

Nursing DiagnosisOutcome

Implement

Evaluate

ROLES OF THE NURSE IN PSYCHO TRAUMA

SPECIFIC ROLE OF THE NURSE IN THE MANAGEMENT OF PSYCHO TRAUMATIC CLIENTS / PATIENTS (Karani et al 2006).

• To assess the patient, both mentally and physically and makes appropriate diagnoses. Then speaks with family members and those close to the client to assess the client’s mental needs.

• The nurse has a vital role in the administration of psychotherapy to the client.

ROLES OF THE NURSE IN PSYCHO TRAUMA

• The nurse ensures there is collaborative management as a member of the health team with psychiatrists, clinical psychologists and psychological counsellor and social worker where necessary.

• The nurse participates in development of the treatment plan and using her/his therapeutic skills to offer a range of options to psycho traumatic patients and their families.

ROLES OF THE NURSE IN PSYCHO TRAUMA

• The nurse explains to the family of the psycho traumatic client and families about the client’s condition, as well as the treatment plan.

• As an advocate for psycho traumatic clients and their families the nurse co-ordinates care and links the client with the psychiatrist and other members of the health care team plus resources.

ROLES OF THE NURSE IN PSYCHO TRAUMA

• The nurse provides health education to the client, family and community on psycho trauma, and addresses their questions and concerns.

• The nurse participates in rehabilitation of the pyscho traumatic client including Group Therapy (Ulman, K.H., 2004) in order to enable facilitate their healing process by encouraging them to develop the emotional, social and intellectual skills needed to live, learn and work.

ROLES OF THE NURSE IN PSYCHO TRAUMA

NURSING CARE PLAN FOR A PSYCHO TRAUMATIC PATIENTS / CLIENTS (Karani et al 2006).

Assessment : • This is when the nurse conducts a complete

physical and mental status assessment in order to plan the interventions.

• That means evaluating the clients’ progress in terms of coping skills, other adjustments including assessment of clients’ adjustment and how he is dealing with the trauma including social and environmental trauma.

OTHER CLINICAL ASSESSMENT BY THE NURSE OF PSYCHO TRAUMA

sudden disability and changes in self-care should be noted.

Any disfigurement,

coping mechanisms and available support system

including the risk for self harm or suicide tendencies.

feelings related to the stress, mood,

intelligence,

Perception of stress,

feelings related to the stress, mood,

ROLES OF THE NURSE IN PSYCHO TRAUMA

Other assessments include:• Perception of stress,• feelings related to the stress, mood, • intelligence, • defense, • coping mechanisms and available support system • including the risk for self harm or suicide

tendencies. • Any disfigurement,• sudden disability and changes in self-care should

be noted.

ROLES OF THE NURSE IN PSYCHO TRAUMA

Nursing DiagnosisThe nurse makes nursing diagnosis after collecting data which she compares with all the available information to analyze in order to come up with a nursing diagnosis of psycho traumatic clients . Some examples of nursing diagnosis could be:

• Self harm potential related to severe trauma which the client may talk about on loosing hope in living.

• Client may be unable to cope which could manifest as depressed mood with client withdrawal, isolating himself, experiencing insomnia and lack of appetite.

ROLES OF THE NURSE IN PSYCHO TRAUMA

Outcome • The expected outcomes include –

Individualized client goal to improving the client’s health status

• The nurse and the client both identifies the outcomes and the nurse understands clients’ coping mechanisms and what influences them.

ROLES OF THE NURSE IN PSYCHO TRAUMA

Outcome Cont.• It is important to clarify goals as a healing

process. That is why nurse client relationship is based upon mutually agreed.

• Goals that are realist and time bound and they should be written down in behavioral terms.

ROLES OF THE NURSE IN PSYCHO TRAUMA

Planning • The nurse involves the client, family and

members of the health team in planning the care. Once the goals are selected then, outline the plan on how achieve them (Boyd, M. A.,2008).

• The basis of an analysis is that the nurse organizes the problems in order of priority. That will help enable the nurse to meet the goals or desired objectives.

ROLES OF THE NURSE IN PSYCHO TRAUMA

Implementation• The nurse performs interventions during this time in order to

achieve client’s goals. The nursing interventions will promote healing by preventing mental and physical illness (Boyd, M.A.,2008).

• It will also promote, maintain, and restore mental and physical health. Nurses need to have intellectual, interpersonal and technical skills in order to implement therapeutic healing.

ROLES OF THE NURSE IN PSYCHO TRAUMA

Nursing Interventions (Karani et al 2006).

Early response : Advice and Support This is suitable for patients who display acute stress in the days and weeks following trauma. Most people exposed to trauma will only require this level of intervention Simple Psychological strategies This is suitable for patients in the weeks and months following trauma with persistent mild to moderate distress. It promotes recovery, secondary prevention and early identification of mental health problems.

ROLES OF THE NURSE IN PSYCHO TRAUMA

Mental Health Interventions• Suitable for patients in the weeks and months following trauma

with persistent more severe distress.• A small but significant number of patients require this

intervention. Nursing actions are of two types-• Dependent nursing action: Action derived from the advice from the psychiatrist. For example, giving medicines.• Independent nursing actions: This is based on nursing diagnosis and plan of care.

ROLES OF THE NURSE IN PSYCHO TRAUMA

Bio psycho social Nursing Interventions for the psycho traumatic Patient (Karani et al 2006).Provide a sense of safety• Calm the patient e.g. through use of deep

breathing technique ( Wade, 2013) • Administer psychotropic medications if

indicated

ROLES OF THE NURSE IN PSYCHO TRAUMA

Roberts’ Seven-Stage Crisis Intervention Model can be utilized:• Plan and conduct a thorough biopsychosocial

and lethality/imminent danger assessment • Make psychological contact and rapidly

establish the collaborative relationship • Identify the major problems, including crisis

precipitants

ROLES OF THE NURSE IN PSYCHO TRAUMA

Roberts’ Seven-Stage Crisis Intervention Model cont.:• Encourage an exploration of feelings and

emotions• Generate and explore alternatives and new

coping strategies• Restore functioning through implementation

of an action plan• Plan follow-up and booster sessions

ROLES OF THE NURSE IN PSYCHO TRAUMA

Cognitive behavioural therapy: • This involves cognitive restructuring, which is

the process of learning to refute cognitive distortions, aiming to replace one's irrational, counter-factual beliefs with more accurate and beneficial ones.

• This is established by helping the individual gain awareness of detrimental thought habits, learn to challenge them and substitute life-enhancing thoughts and beliefs.

Nurse Group Therapy

Nurse

Client

Client

Client

Client

Client

Nurse Interventions in Group Therapy

ClientWithdrawal

Client Denial

ClientGroup

Therapy

Client and Family

strategies

Client Fears

ROLES OF THE NURSE IN PSYCHO TRAUMA

Some Nursing interventions (Karani et al 2006). which are specifically related to the patient / client symptoms are as follows:• Withdrawal - Avoid forcing the patient to deal

with the situation by providing a supportive environment with ongoing information on the situation and care.

• Denial - Support patient/client showing him or her on how to deal with fears and answer questions honestly and give information in small pieces.

ROLES OF THE NURSE IN PSYCHO TRAUMA

Group Therapy: • Offers a special advantage for preventing

isolation and withdrawal. That is useful in reintegration of the patient into the society.

Family Intervention strategies are used by the nurse to enhance or improve relationships.

ROLES OF THE NURSE IN PSYCHO TRAUMA

Some Nursing interventions• Regression – Encourage and reward positive

behaviour and independence, but avoid responding negatively to the behavior but acknowledge coping difficulties.

• Anger and hostility - Encourage the client/ patient to talk about his problems while helping him/her to search for the meaning to injury and provide choices and control.

ROLES OF THE NURSE IN PSYCHO TRAUMA

Some Nursing interventions Cont.

• Depression - Acknowledge the loss but focus patient on realistic expectations.

• Anxiety - Support the client/patient by acknowledging fears and give information in small frequent piece’s.

ROLES OF THE NURSE IN PSYCHO TRAUMA

Evaluation : • The process involve changing the patient’s

health for improvement over time by providing nursing care which is a dynamic process.

• That means giving new data, different diagnosis, and modifications on the plan of care (Ulman, K.H., 2004).

• The nurse reviews the previous nursing process and determines if the expected outcomes for the patient/client have been met.

ROLES OF THE NURSE IN PSYCHO TRAUMA

Evaluation Cont.: • This is done by checking – whether

everything has been done for the patient? Is patient/client better after the planned care?

• Evaluation of the client or patient’s progress will reveal if the problems of the client/patient has been solved.

• This can be assessed again, re-planned, implemented and re-evaluated.

ROLES OF THE NURSE IN PSYCHO TRAUMA

References• Beck. J., 2013. Nursing Process In Psychiatric Nursing.

Psychiatric Nursing Open Access Articles on Mental Health.• Boyd, M. A., 2008. Psychiatric Nursing, Contemporary

Practice. Wolters Kluwer Health/ Lippincott Williams and Wilkins.

• Kendall-tackett, K., 2009. Psychological Trauma and Physical Health : A Psychoneuroimmunology Approach to Etiology of Negative Health Effects and Possible Interventions. American Psychological Association, 1(1), pp.35–48.

• Karani Anna, Wagoro Miriam, Onen Tom in the book - Psychiatry and Mental Health for Africa

• AMREF, Nairobi, Kenya. 2006. Nursing in Mental Health - Chapter 70 (pp 535 – 545) .

ROLES OF THE NURSE IN PSYCHO TRAUMA

References Cont.• Phipps, W. J. et al, 2003. Medical Surgical Nursing. Health and

Illness Perspectives. Mosby, Inc.• Prepared, R. & Agency, V., 2005. The Effects of Psychological

Trauma on Children and Adolescents. Vermont Agency for Human Services. Department of Health, Divison of Mental Health.

• Sherin, J.E. & Nemeroff, C.B., 2011. Post traumatic stress disorder: the neurobiological impact of psychological trauma. Dialogues for Clinical Neuroscience (13), pp.263–278.

• Ulman, K.H., 2004. Group Interventions for Treatment of Psychological Trauma module 1 : Group Interventions for Treatment. American Group Psychotherapy Association, pp.13–59.

ROLES OF THE NURSE IN PSYCHO TRAUMA

References Cont.• Wade, D., 2013. Early response to psychological

trauma What GPs can do. Australian Family Physician, 42(9), pp.610–614.

• The Peter C. Alderman Foundation and Africa Mental Health Foundation invite you to submit an abstract for the upcoming 8th Pan-African PCAF Psychotrauma Conference. Submissions can be made in the form of: Oral Presentations

• pcafnairobi2015@amhf.or.ke• www.pcafnairobi2015.or.ke• pcafnairobi2015@amhf.or.ke or call +254 20 2651360.

Thank You