NURS 2547 Week 4: Land, Assignments, Mental Health

Week 4 Overview

• The course is HH/NURS 2547 6.0, Mental Health Across the Lifespan.
• Course Director is Mary Smith, NP, PhD, [email protected]

Land Acknowledgement

• York University acknowledges its presence on the traditional territory of many Indigenous Nations.
• The area known as Tkaronto has been care taken by these groups:
  • Anishinabek Nation
  • Haudenosaunee Confederacy
  • Huron-Wendat
• Tkaronto is now home to many First Nation, Inuit, and Métis communities.
• The current treaty holders are the Mississaugas of the Credit First Nation.
• The territory is subject to the Dish with One Spoon Wampum Belt Covenant.
• The Dish with One Spoon Wampum Belt Covenant is an agreement to peaceably share and care for the Great Lakes region.

Check In

• virtualwellbeinghub.ca is a resource for checking in.

Course Agenda

• Updates on assignments and activities are being provided:
  • Glossary Assignment
  • MSEs (Mental Status Exam)
  • Learning Plans
  • Med Calc Testing
  • Reflective Assignment
• Preparing for the Midterm is on the agenda.
• Overview from the previous week will be reviewed.
• Topics for the current lesson include:
  • Trauma – TIC (Trauma-Informed Care)
  • ACEs (Adverse Childhood Experiences)
  • Intergenerational Trauma
  • Compassion & Research
  • Disaster/Crisis
  • PTSD
  • IPV (Intimate Partner Violence)
  • TVIC (Trauma- and Violence-Informed Care).

Trauma-Informed Care (TIC)

• TIC involves shifting the focus from what's wrong to the impact from past experiences now.
• TIC incorporates an understanding of trauma, specifically experiences of powerlessness and loss of control.
• TIC prioritizes the individual's safety, choice, and control to ensure that care does not cause further traumatization in all aspects of service delivery

The Four Rs of Trauma-Informed Care

• Realize: Understand the widespread impact of trauma and potential paths for recovery.
• Recognize: Be aware of the signs and symptoms of trauma in clients, families, staff, and others involved within the system.
• Respond: Integrate knowledge about trauma fully into policies, procedures, and practices.
• Resist Re-traumatization: Prevent re-traumatization of children and the adults who care for them.

Principles of Trauma-Informed Practice

• Safety: Providing physical and psychological safety to staff and those served.
• Trustworthiness & Transparency: Making decisions transparently to cultivate trust.
• Peer Support: Sharing stories and experiences to aid recovery.
• Collaboration & Mutuality: Leveling power differences and sharing decisions among all involved.
• Empowerment, Voice & Choice: Building on positive attributes, offering choices, and promoting self-advocacy.
• Respect for Diversity: Overcoming stereotypes to recognize individual needs.

Active Listening in Trauma-Informed Care

• Active listening is an important component of trauma-informed care.
• Helpful practices for active listsening:
  • Listening more than talking.
  • Allowing the speaker to finish before responding.
  • Asking open-ended questions.
  • Remaining attentive to what's being said.
  • Being aware of one's own biases.
  • Managing one's own emotions.
  • Being attentive to ideas and problem-solving opportunities.
  • Giving verbal and nonverbal cues that one is listening.
  • Listening for both feelings and content.
• Practices that should be avoided:
  • Dominating the conversation.
  • Interrupting.
  • Finishing the speaker's sentences.
  • Jumping to conclusions
  • Responding with blaming or accusatory language
  • Becoming argumentative
  • Demonstrating impatience or multitasking
  • Formulating what to say next in one's mind.
  • Listening with biases or shutting out new ideas.

Adverse Childhood Experiences (ACEs) Study

• The ACE Study conceptual framework is used which uncovers how ACEs strongly relate to the creation of risk factors for disease and well-being over a lifetime

Mechanism by which Adverse Childhood Experiences Influence Health and Wellbeing Throughout the Lifespan

• Adverse Childhood Experiences, can lead to:
  • Disrupted Neurodevelopment
  • Social, Emotional, and Cognitive Impairment
  • Adoption of Health-Risk Behaviors
  • Disease, Disability, and Social Problems
  • Early Death

Types of Child Abuse

• Violence: a broad category that includes harming others and the self by force or coercion
• Intimidation: instilling fear through actions, gestures, or destruction of property.
• Using Adult Privilege: treating children as servants, punishing them, and denying them input.
• Threats: threatening abandonment, suicide, or harm to loved ones.
• Economic Abuse: Withholding basic needs or misusing family money.
• Sexualizing Children's Behaviour sexually: actions which exploit and harm children via the use of sex
• Emotional Abuse: put-downs, name-calling, using children as confidants, and being inconsistent.
• Isolation: Controlling access to peers/ adults, siblings, other parent, grandparents
• Using Institutions: Threatening punishment or using authoritative establishments against victim
• Committing Incest: Sexual abuse between family members

Signs of Abuse

• Physical Abuse: Unexplained injuries like bruises, burns, or fractures
• Sexual Abuse: Fearful behavior, nightmares, changes in bowel/bladder function
• Emotional Abuse: Sudden changes in confidence, headaches, fears, or attempts to run away
• Neglect: Failure to gain weight, affection-seeking behavior, or stealing food

Impact of Abuse on a Growing Child

• Physical System: Stress during childhood may activate the hypothalamic-pituitary-axis, affecting sexualization and puberty.
• There's also potential irreversible brain damage and decreased volume in the prefrontal cortex, impacting behavior, emotions, and perception.
• Belief System: Children may learn to prioritize others, experience lowered self-esteem, and internalize the problem as their fault.

Long Term Health Effects:

• Physical: Seizures have been linked to sexual abuse

• Early intercourse can also indicate cervical cancer prevalence

• Premature menarche also occurs

• Mental: PTSD, Anxiety Disorders, Personality Disorders, Phobias, Dissociation, depersonalization

• Eating Disorders Substance Abuse Suicide, self harm Homelessness

• Social; Difficulties with parenting

• Problems in interpersonal relationships

Duty to Report

• Nurses have a legal responsibility to report suspected child abuse to the Children's Aid Society, even if unsure.
• Look for signs of abuse:
  • Physical injuries
  • Emotional issues or withdrawal
  • Sexualized behavior
  • Stealing food
  • Inappropriate dress

Nursing Interventions for Abuse Cases

• Foster a non-threatening and non-judgmental relationship with parents.
• Recognize children may resist betraying their parents.
• Conduct a complete physical, mental & social assessment of the child.
• Inquiring thoroughly and completely is important.
• Report child abuse to CAS or contact a supervisor for proper reporting.
• Follow the proper procedures and collect all the evidence.
• Maintain accurate records: Who did the injury, verbatim statements of who caused it, and a map of physical injuries.
• Reassure the child of their safety and support a therapeutic attachment.

Intergenerational Trauma

• Roots in residential schools and the "sixties scoop."
• Truth and Reconciliation Commision of Canada:Calls for Justice
• Murdered and Missing Indigenous women and Girls:.
  • Support healing via community revitalization and strength-based cultural approaches

Compassion-Informed Care

• Acknowledgement that trauma exists
• Focus on resilience and innate strength
• Fosters trust through open communication/ respectful relationships

Disaster Preparedness and Response

• Crisis can be classified in 3 categories: -Development of maturation -Situational -Disaster of Adventitious

PTSD

• An acute emotional response to a traumatic event or situation involving servers environmental stress
  • Recurrent intrusive recollections of the event -Persistent avoidance of stimuli associated with the trauma -Persistent numbing of central responsiveness
  • Persistent symptoms of increased arousal

Understanding the cycle of violence

• Acute Explosion: Abuser uses abuse, victim's safety is compromised
• Tension Building: Tension grows via tactics of manipulation
• Honeymoon Phase: Apologies and forgiveness are offered, which serves to enable the cycle

Trauma- & Violence-Informed Care (TVIC)

• TVIC brings to light broader themes such as: broader social conditions impacting people’s health ongoing violence discrimination and harmful approaches embedded in the ways systems & people know and do things the need to shift services to enhance safety & trust

• TVIC expands on the intersecting impacts of systemic and interpersonal violence specifically on:

  • structural inequities on a person’s life - historical & ongoing violence
  • person’s experiences of past and current violence

The Four Principles of TVIC

• Understand trauma, violence and its impacts on people’s lives and behaviors

• Create emotionally and physically safe Environments

• Foster opportunities for choice, collaboration, and connection

• Use a strengths-based and capacity-building approach to support clients

Recommendations to use when approaching individuals

Be empathetic and nonjudgmental, use active listening, respect personal space/remain calm Address the issue at hand

Clues to Post-Traumatic Stress

• Re-experiencing the trauma through intrusive distressing recollections of the event
• Flashbacks and/or nightmares
• Avoidance: of places, people, and activities that are reminders of the trauma.
• Increased Arousal: difficulty sleeping and concentrating, feeling jumpy, irritable, anxious
• Negative Changes mood/thinking: memory problems, negative beliefs or emotions
• Flat affect

Case study 1:

A staff nurse, Chandra, is assisting a 30-year-old victim of domestic abuse in the emergency department where her goal should be to secure her safety

d. Guide and assist the patient to develop a safety plan for rapid escape should abuse recur.

Case Study 2:

Trauma and violence-informed care (TVIC) is the approach taken by nursing in an emergency department which means one should acknowledge that others have experienced abuse a. The approach that anyone may have had experiences of abuse

The theme for next week is: Mood Disorder

• Topics covered: -Depression
  • Bipolar disorder -Suicide and Self Harm -Psychotropic Drugs