Psychosocial and Pain Aspects of Trauma

1. Psychosocial and Pain Aspects of Trauma Beth Evenstad, RN, BSN, MICN, PHN LAC+USC Medical Center Los Angeles, California, USA

2. Objectives • Define purpose of psychosocial nursing care in trauma patients • State 3 crisis interventions each for patients, families, and trauma team members • Describe physical manifestations of pain • State 3 interventions for pain management • State 3 reasons for improving end of life care • State 3 main components of the psychosocial aspects in trauma

3. Psychosocial Aspects of Trauma • Trauma is a significant health problem across the lifespan • Variety of mechanisms with the same end result of cell, organ, and tissue damage • Holistic approach to care • Goal is to return patient to pre-injury level of function or maximize quality of life

4. Crisis • Emotionally significant event • Occurs suddenly • Actual or perceived threat to resources/goals • Typical coping skills ineffective

5. Crisis Characteristics • Severity and duration vary by person • Subjective experience • Influenced by outside factors • Can occur at time of trauma or later

6. Stress • Stress is the physical and emotional response of the body in the presence of an actual or perceived threat • Adaptive response • Caused by physical, emotional, or chemical stressors

7. Response to Stress • Stress can be helpful or harmful • Harmful stress causes the body to release glucocorticoids and catecholamines • Physical changes: • Increased heart rate, blood pressure, respiratory rate • Skins cool, clammy

8. Response to Stress

9. Psychosocial Assessment • Patients perception of event • Preceding stressors? • Are there any coexisting life changes/crises? • What was the baseline level of functioning? • Are there continuous outside stressors?

10. Physical Assessment • Mental status exam • Rule out psychiatric/organic causes • Crisis reaction: • Physical • Cognitive • Behavioral • Physical

11. Care of Patients and Families • 3 main psychosocial needs of patients and families: • Information • Compassionate care • Maintenance of hope

12. Intervention and Implementation • Solve immediate problems • Return to pre trauma state of functioning • Crisis intervention strategies • For patients • For families

13. Grief • Grief is the response to loss • Reaction to death of a loved one, loss of function, or change in body image • Experienced by patients, families, and trauma team members

14. Grief • People who are grieving may display a variety of emotions or actions: • Shock/disbelief • Physical complaints • Denial • Anger • Hostility • Guilt • Panic

15. Grief Interventions • Support reactions • Maintain a safe environment • Private room • Reinforce reality • Never deliver bad news alone • Identify potential coping skills • Prepare family for the condition of patient • Allow family to see patient • Avoid statements that minimize feelings

16. Pain • Common to all trauma patients • The FIFTH vital sign • Can be hard to assess • Subjective • It is what the patient says it is • Objective • Physiological findings • Causes systemic problems

17. Pain Assessment Tools Wong-Baker FACES scale Numeric pain scale

18. Pain Assessment Tools Pain scale for infants or nonverbal patients

19. Pain Management • Non-pharmacological • Massage • Cold packs • Heat packs • Positioning • Pharmacological • Opioid medications common • Non-steroidal anti-inflammatory drugs

20. Family Presence during Resuscitation • Traumatic injuries affect the entire family unit • Vulnerable situation • Foreign environment • Lack of knowledge • Studies show improved coping outcomes when resuscitation is witnessed

21. End of Life Care • Traumatic injuries can lead to death • Presents challenges for health care providers • Improve end of life care by: • Supporting peaceful dying • Easing pain/suffering • Giving care to the patient AND family

22. Care of Team Members • Traumatic events impact health care providers • Coping skills • Post event debriefing

23. References • Jacobs, L.M., Bennett Jacobs, B., Burns, K.J. (2005). A plan to improve end-of-life care for trauma victims and their families. Journal of Trauma Nursing, 12(3), 73-76. • Leske, J.S., Brasel, K. (2010). Effects of family-witnessed resuscitation after trauma prior to hospitalization. Journal of Trauma Nursing, 17, 11-18. • Lome, B. (2005). Acute pain and the critically ill trauma patient. Critical Care Nursing Quarterly, 28(2), 200-207. • Richmond, T.S., Aitken, L.M. (2011) A model to advance nursing science in trauma practice and injury outcomes research. Journal of Advanced Nursing, 67(12), 2741–2753. • TNCC: Trauma nursing core course(6th ed.). (2007). Des Plaines, IL: Emergency Nurses Association.