TRAUMA, CRISIS, DISASTER, AND RELATED DISORDERS

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trauma

an individual’s physical, psychological, or emotional response to adverse events or experiences. an shape an individual’s worldview and impact their daily lives and ability to function. events may occur as a single adverse event or as repeated exposures to adverse events or conditions, which can happen at any age

crisis

a situation or event which causes emotional or cognitive stress to those involved.

disaster

an incident or event that could end human life or cause health-related harm, requiring immediate response in resources and workforce. can be natural or man-made

complex trauma

exposure to chronic trauma that also distorts the individual’s fundamental sense of self (persistent social inequity, racism, discrimination due to sexual orientation or gender identity).

vicarious trauma

also called secondary trauma, it is an indirect trauma that results from engaging with victims of trauma. (Health care personnel during COVID-19, first responders after 9/11 or Hurricane Katrina).

bowlby’s attachment theory

theory that suggests the attachment relationships formed with caregivers, such as parents, during infancy and early childhood are necessary for survival and brain development. relationships formed during this period significantly influence the development of nerve pathways that influence autonomic regulation of body functions, social-emotional learning, emotional and behavioral self-regulation, cognitive function, relationships, and coping mechanisms.

polyvagal theory

trauma response centers on the vagus nerve, which relays sensory and motor info between the brain and the body. responses to trauma are due to vagal responses or a dysregulation of the ANS, as the vagus nerve communicates a survival response to keep the person safe via inflammatory changes. when exposure is continuous, the inflammatory response becomes chronic and has negative impacts on the individual overtime.

toxic stress

results from prolonged activation of the stress response, preventing the body and brain from recovering fully. causes prolonged activation of the HPA which leads to chronic inflammation and increases an individual’s risk for trauma-related disorders and medical commodities.

fear learning

in people who have significant trauma, they often stay in a state of toxic or chronic stress. the fear response continues even after a stressor is removed and a person will lose the ability to reinforce feelings and memories of safety and security. is caused by changes in nerve pathways.

fear conditioning

prevents individuals from distinguishing between their memories (the original experience of trauma/fear) and what they are currently experiencing. describes the strengthening neural circuitry that creates a biological memory of a traumatic event. can result in hyperarousal manifestations, such as elevated blood pressure, or clinical behavior changes, such as restlessness, agitation, worry, or aggression.

fear extinction

the gradual reduction in the autonomic response to a perceived threat or fear-provoking stimulus. occurs when the brain’s neural circuitry acts as a braking system, helping to restore equilibrium and a sense of safety.

memory consolidation

biological memory created and stored in the hippocampus for later retrieval to promote survival.

hypervigilance

a state of abnormal alertness in response to perception of perceived danger or threat.

stress sensitization

result of stress that overwhelms neural circuits and predisposes an individual to develop a mental illness. can occur when an individual’s stress experiences have been internalized, as trauma and stress become expected or normal occurrences.

epigenetics

genetic alterations that determine whether a gene will be activated or deactivated. describes how genes interact with environmental stressors. these changes occur when genetic switches for DNA proteins are turned on or off. influences how DNA is translated and expressed across the lifespan and to future generations.

historical trauma

when trauma has been experienced across multiple generations, or the influences of trauma have permeated a cultural group. effects result from inherited changes to genes. can result in future developmental or physical disorders and vulnerable populations. can occur via things like slavery, genocide, extreme poverty, or mass casualty events. nurse’s awareness of this is essential, as current stressors and adverse experiences can exacerbate unhealed trauma and cause traumatic reexperiences.

PACEs

experiences that reduce an individual’s likelihood of developing mental and physical health issues later in life. ex include parent/caregiver unconditional love, spending time with friends, volunteering, being active in a social group, having a non-familial mentor, living in a clean safe environment, having opportunities to learn, having a hobby, being active and playing sports, and having routines and fair rules at home.

reactive attachment disorder (RAD)

caused by an absence of adequate caregiving during childhood, leading to a child that is withdrawn from adults or other caregivers due to unmet needs. this could be caused by a lack of touch or attention from caregivers. child is unable to relate to others and does not turn to an attachment figure for comfort or social interaction. is usually diagnosed between 9 months and 5 years.

disinhibited social engagement disorder (DSED)

caused by an absence of adequate care giving during childhood and shows a child who displays overly familiar behaviors toward strangers (or those relatively unfamiliar to them) without regard for appropriate social boundaries. usually diagnosed after 9 months of age.

acute stress disorder (ASD)

stress manifestations that last 3 days to 1 month following a traumatic event. is closely connected to an anxiety response.

PTSD

stress manifestations persist fro more than one month and create distress and impair ability to function in social and occupational roles. is closely connected to an anxiety response. manifestations of this in children can include nightmares, reexperiencing, time skews (child recalls details in a different sequence from when they occurred), omen formations (child believes they can prevent future traumas if they are more alert), and post-traumatic play (demonstration of an aspect of the trauma). shows intrusion manifestations, avoidance negative alterations in cognition and mood, alterations in arousal and reactivity, and functional impairments in those older than 6.

adjustment disorder

emotional and behavioral manifestations in response to an identifiable stressor within three months of exposure that do not last more than six months. manifestations do not meet the criteria for other stress-related disorders and are not an exacerbation of a known mental health disorder. stressors may be situational or developmental, such as being fired from a job or the death of a loved one. individual is struggling with the changes that the stressor has caused, and their distress is out of proportion to the severity or intensity of the event or stressor. associated with suicide.

THREADS

A resilient child has the following:

Thinking and developing brain

Hope (to deal with present situation)

Regulation (able to self-regulate)

Efficacy (able to react to situation)

Attachment (healthy relationships)

Development (mastery of tasks and skills)

Social context/support (safe, supportive people and places)

FRAYED

a child can embody the following after traumatic experiences

Fits, frets, fear

Regulation disorder

Attachment problems

Yawning/yelling

Educational delays

Defeat & dissociation

secondary traumatic stress

similar to post-traumatic stress disorder, this refers to an individual such as a nurse witnessing a client suffering from traumatic stress.

marginalized groups

a group not considered a part of the social mainstream due to culture, social, religious, or other differences. these individuals are faced with barriers in achieving their potential, resulting in disparity in every aspect of their life, including health care.

trauma informed care

provides an evidence-based framework that encourages establishing a safe, stable, and supportive environment while navigating a crisis, traumatic event, or trauma-related disorder. creates the opportunity for the client to feel psychologically and emotionally safe and serves as a protective factor for both the client and nurse. involves being calm, containing the amount of trauma informed needed to provide care, practicing self care as a nurse, and emphasizing positive coping skills.

universal trauma precautions

require the nurse to assume that everyone has experienced trauma and focus care on reducing the risk for traumatic reexperiencing. does not require the client to disclose their trauma experience unless they choose to share. rovides the nurse the opportunity to provide trauma-informed care without triggering traumatic reexperiencing or causing more harm by discussing a client’s trauma, as this could impede recovery. 

primordial prevention

focuses on preventing risk factors from developing via SDOH. emphasizes programs that address public health policies and environmental and behavioral risk factors. includes developing positive lifestyle habits during childhood as well as targeting larger populations regarding food safety or nutritional guidelines. improves health through policies, laws, and initiatives such as maternal and infant health.

situational awareness

a practice of being consciously aware of situations occurring in the immediate environment and how one participates in that environment.