A recent study from The Children's Hospital of Philadelphia (CHOP) and Penn State Hershey Children's Hospital published in the Journal of Pediatric Nursing reveals pediatric trauma nurses are knowledgeable about practicing trauma-informed care, but points to the need for additional nurse training to help families cope after a child's injury. When an injury occurs, both the child and other family members may experience traumatic stress reactions interfering with a full recovery. Pediatric nurses play a key role in preventing injury-related post-traumatic stress by providing trauma-informed care, which includes recognizing pre-existing trauma, addressing acute traumatic stress reactions associated with the traumatic event, minimizing potentially traumatic aspects of treatment, and identifying children who need additional monitoring or referrals for more help.
Researchers surveyed 232 nurses across five level I and level II pediatric trauma centers about their knowledge, opinions, and current practices in addressing psychological recovery in their injured patients. More than 90 percent of the nurses surveyed recognize the importance of attending to psychosocial needs as part of trauma nursing care, and 75 to 80 percent report that they encourage parents to turn to family and friends for support and help parents manage a child's pain and anxiety during procedures. However, far fewer nurses surveyed reported directly assessing a child or parent's distress or providing specific instruction in how to cope with difficult or painful experiences.
"When a child is hospitalized for an injury, nurses play a key role not only in medical care, but also in helping families cope and fully recover emotionally," says Nancy Kassam-Adams, PhD, a psychologist, director of the Center for Pediatric Traumatic Stress at CHOP, and a lead author on the study. "Taken together with other recent studies that found only one in five trauma centers routinely screen child and youth for traumatic stress responses, these results help to identify gaps in current practice and point to possible policy and training needs."
According to one parent's experience after her son suffered severe injuries, the care he received at the hospital from the nursing staff made all the difference in his healthy recovery, both medically and emotionally. "For a long time after my son Stephen's accident, I was committed to remaining strong for him and my family and just powering us all through the crisis," says Kathy Conaboy, a member of the Center's Family Advisory Committee. "What I realized over time with the help of his nurses was that our entire family was traumatized, and we needed help that I didn't even know that I needed to ask for. We gradually learned from his nurses how to talk about what happened and to seek positive coping skills and supports to be able to move forward."
The results of this survey suggest that efforts to improve trauma-informed pediatric nursing care should highlight specific skills related to helping patients and their parents manage emotional responses to difficult medical experiences. As one nurse surveyed for the study noted: "I would like to have information about what to teach parents to say and how to talk about the event without re-traumatizing the patient."
To help nurses build on the skills they already possess and to promote full recovery in the pediatric patients they treat, the Center for Pediatric Traumatic Stress is now offering free continuing education courses in trauma-informed care at HealthCareToolbox. The training is based on the "DEF Protocol" created by the Medical Trauma Working Group of the National Child Traumatic Stress Network, which helps healthcare providers address distress, emotional support, and family needs in a systematic manner.