Trauma Informed Care: Addressing DISTRESS
Addressing Distress includes optimizing pain management, as well as helping children cope with any fears and worries.
While referral to social work or child life services may be a part of the picture, there is much that frontline health care professionals are uniquely positioned to do.
How do I do this?
- Do what you can to reduce unnecessary exposure to traumatic - possibly distressing - elements within the hospital environment. Some things cannot be changed, but look for ways to minimize children’s exposure to scary sights and sounds, separation from parents, etc.
- Actively assess and treat pain, using your hospital’s protocol. Optimal pain management reduces the risk of traumatic stress reactions and PTSD.
- Provide the child with age-appropriate information about what is happening. To ensure they understand, ask the child to explain what is happening in their own words, and then clarify any misconceptions.
- Provide the child with choices when possible - i.e. about positioning during a procedure
- Ask directly about fears and worries, and listen carefully to understand and address these. Remember that a child’s perspective may be quite different from our own.
- Provide reassurance and realistic hope. Describe to both the child and parent what is being done to help them feel better. Make sure not to promise things which can’t be guaranteed.
Case example: Meet Anthony
After a recent illness, 8-year-old Anthony’s parents noticed an increase in his shortness of breath, coughing, and wheezing. His symptoms did not seem to relieve completely with nebulized albuterol treatments.
A few days ago, when his mother noticed him having trouble breathing, she brought Anthony to the Emergency Department at your hospital. He was admitted for IV steroids and O2 therapy.
Over the first day of his admission, you notice that Anthony is often whiny and fearful when the health care team interacts with him to provide care. Now, while you are in the room, Anthony’s parents remind him that he really needs to cooperate with the nurse so that he can get better. Anthony reacts with anger to this, saying “You can’t tell me what to do!”
What would you do next?
To address Distress, you might:
- Assess Anthony’s current pain level to be sure that this is not a reason for his irritability.
- Strike up a conversation with Anthony and his parents about how it’s been going since he got to the hospital. Ask “Anything especially worrying you?”
This is a great opportunity to assess Anthony’s distress and help both you and his parents learn about anything that's worrying him. There will often be multiple opportunities in the course of your regular patient care interactions when you can be alert to a patient’s concerns and follow up with a simple question or two.
Want to learn more about addressing distress with your patients? Take an interactive online course “D is for Distress” - with free CE credits for nurses.