SLOs for PTSD, Self-Harm

characteristics/risk factors of individual responses to trauma and stressors

Adverse Childhood Experiences

• exposure to actual/potentially traumatic events

  • death of family member by suicide

  • experiencing violence/abuse/neglect

  • witnessing violence

• enviornmental influences

  • alcohol/drug misuse

  • mental health problems of caregivers (exhibit poor coping)

  • instability at home (parental separation, incarcerated household member)

• early adversity → lasting impacts

  • injuries (physical abuse)

  • mental health disorders (depression, anxiety, suicide, PTSD)

  • maternal health (unintended pregnancy, complications, detal death)

  • infectious diseases (HIV, STDs with lack of parental guidance)

  • chronic diseases like diabetes/cancer (socioeconomic resources limited, lack of education on prevention/management, prone to barriers in seeking medical care)

  • risky behaviors (alcohol/drug abuse, unsafe sex) as find ways to cope, no safety precautions at home

  • opportunities (education, occupation, income)

responses of patients with PTSD to trauma and stressors

set of behaviors in response to feelings of fear/helplessness/terror from an event threatens/results in actual injury

• intrusion symptom → reexperiencing trauma via dreams, intrusive thoughts that break in inappropriate ways, flashbacks

• avoidance symptom → staying away from places/events/objects/thoughts/feelings

• two arousal and reactivity symptoms → feeling “tense” or “on edge”, easily startled, difficulty sleeping, angry outbursts

• two cognition and mood symptoms → trouble remembering key features of traumatic event, negative thoughts about oneself/world, distorted feelings like guilt/blame (feel responsibility), loss of interest in activities (limits people’s activites/choices)

• children with PTSD

  • wetting the bed even though learned to use the toilet (mindful it could be other causes)

  • forgetting how/unable to talk (could be neurological or abuse)

  • acting out scary event during playtime → allows adults to figure out what happened

  • being unusually clingy either parent/adult

apply nursing process to care of patients/families affected by PTSD

• trauma informed care/approach

  • mindful, reduces risk of retraumatizing someone, screening for ACEs, referrals, being aware of one’s own history (trauma we have affects perception of patient’s situation)

• TIC/TIA basics

  • safety → feel relaxed, pay attention to body language/words

  • trustworthiness and transparency → follow through on commitments, explainations to patient wellness/no assumptions

  • empowerment/voice/choice → giving patient choice, option to treat conditions/small things, no ultimatiums given

  • use of peer support → include them in conversations, can be of any age

  • cultural/historical/gender responsiveness → thoughtful of beliefs/barrier

• safety, respect, trust

• nursing care promotes recovery after trauma

  • seeking support from other people, like friends/family

  • finding support group after traumatic event

  • learning to feel good about their own actions in face of danger

  • having positive coping strategy or ability to get through an event and learning through it

  • can act/respond effectively despite fear

risk factors for self-harm

• depressed individuals who are newly taking anti-depressant medications → brain is getting used to external source, takes weeks to get optimal results

• perform non-suicidal self-directed violence (maladaptive way to cope)

apply nursing process to care of a suicidal process

• assess for suicide risks

  • asking questions does not trigger thoughts of killing oneself

  • ask everyone, stay calm/fact-oriented, do not leave them alone

• build trust with patient

  • listening proactively, non-judgemental framework, space to share feelings without inappropriate comments

  • encourage limit setting of non-violent self-directed violence, telling patient they are ultimately in control of the behavior

  • empathetic/supportive without reinforcing self-harming behavior

  • informed about common causes of self-injury, current methods of self-harm, and treatments

explain non-suicidal self-injury and implications for nursing care

non-suicidal self-injury: risk-taking behaviors

• cutting, scratching, burning, ingestion of chemicals/medications → disconnect from reality

implications

• any self-harm is a concerning sign

• ask → are you thinking about killing yourself

• keep them safe → reduce access to lethal items/places

• be there → listen and acknowledge feelings

• help them connect → call/text the crisis lifeline number

• stay connected → follow up and stay in touch after a crisis