trauma nursing case study

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Johnny Tsunami, a 21 year-old male, was suffering off the coast of Leo Carrillo State Park when he was viciously attacked by a Great White Shark. The shark traumatically amputated his left arm before biting his chest and thrashing him against a coral reef. johnny was able to punch the shark in the nose, causing it to release him. He then floundered back to shore, before collapsing in a pool of his own blood. Lifeguards took action immediately. They activated the emergency response system, applied an emergency tourniquet, initiated c-spine precautions, packed his wounds, and administered oxygen via bag valve mask. EMS arrived promptly and loaded Johnny onto a medevac helicopter. Johnny’s vitals were BP: 78/65, HR: 167, RR: 43, SPO2: 81, T: 36.4 C, GCS: 11. His breathing was fast and labored with asymmetric chest expansion and use of accessory muscles, but no paradoxical movement. Breath sounds were absent on the left, diminished on the right, and his trachea was slightly  deviated to the right. A sucking chest wound was discovered on the left side of his chest wound. They continued to ventilate him via bag valve mask, placed a right AC 18 gauge, and began a 1 L bolus of Lactated Ringers.

Upon arrival to the VCMC emergency department, Johnny’s vital signs were: BP: 84/68, HR: 158, RR: 36, SPO2: 88, T: 36.5 C, GCS: 11. Assessment findings revealed shallow and rapid respirations, cool and clammy skin, deep lacerations on his chest and back, a left arm amputated at the elbow, and a compound fracture of his right tibia and fibula. Johnny was confused and lethargic.

Johnny was admitted to the ED, stabilized in OR, and transferred to the ICU. Case management helped coordinate Johnny’s care with the rehab team, physical therapy, psychological services, and connect him with additional support services.

Case Study Questions

• Explain the mechanisms of injury affecting Johnny?
• What diagnostic tests should the nurse anticipate?
• What life saving interventions can the nurse anticipate?

Case Study Answers

1.Explain the mechanisms of injury affecting Johnny?

• Blunt force trauma to his right lower extremity from being thrashed against the coral reef by the shark
• Blunt force trauma to his chest from jaws of shark
• Penetrating trauma from the shark teeth
• Hypovolemia/hemorrhage
• Traumatic amputation of left arm
• Risk for introduction of infectious agents
• Punctured lung/Pneumothorax
• Tib/Fib Fracture
• Sea-water aspiration/risk for aspiration pneumonia

2.What diagnostic tests should the nurse anticipate?

• Labs (Trauma Panel, including: CBC, ABGs, PT/PTT, BMP, U/A)
• X-ray (arm, chest,leg)
• CT scan (chest, abdomen, head, spine)
• Ultrasound FAST
• EKG (heart monitor for changes in rhythm)

3.What life saving interventions can the nurse anticipate?

• Tube thoracostomy for tension pneumothorax/Chest tube
• Oxygen therapy 15 L non-rebreather at 100% FiO2
• Large bore IV access followed by fluid resuscitation with crystalloids, colloids, and blood products
• Surgical debridement/closure of amputated limb

Harrois, A., Duranteau, J., & Intensive Care Department. (2019, February 05). Fluid Choices in Trauma. Retrieved from https://healthmanagement.org/c/icu/issuearticle/fluid-choices-in-trauma

MedlinePlus. (2019). Medical tests. Retrieved from https://medlineplus.gov/lab-tests/Morton & Fontaine. (2013). Essentials of critical care nursing: A holistic approach. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Nursing Case Studies by and for Student Nurses Copyright © by jaimehannans is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

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Nursing Case Study for (PTSD) Post Traumatic Stress Disorder

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Mr. Bryant is a 32-year-old male who presents to the emergency room brought by law enforcement for what they describe as possible public drug or alcohol intoxication along with erratic and aggressive behavior. He was outside a local bar and patrons called 911. Law enforcement officers (LEOs) seek medical clearance before proceeding any further and present a Veteran Health Care ID card identifying Mr. Bryant. The patient is resisting officers and saying he has to, “…save my buddies. They are down range and there’s explosions and gunfire. Can’t you hear it? Let me go so I can help them!” He also points at the LEOs and whispers to the nurse, “These guys captured me. They’re not on our side.”

What assessments and initial check-in activities should the nurse perform to best assist the patient and law enforcement?

• The priority for this patient and staff is SAFETY. First, place the patient in a gown, removing all potential dangers; this step is vital for security and safety, and it also helps the nurse to begin a full head-to-toe assessment which is the first step of the nursing process. He should be screened for suicide and asked specifically if he has a plan. Signs of injury or hints to the patient’s history can guide the plan of care and next interventions. Determining his veteran status may help with obtaining medical history as well as to guide nursing interactions to help alleviate the paranoia he seems to be exhibiting. Next, asking LEOs to leave the room will afford the patient his right to privacy and protection of his personal health information to which he is entitled. LEOs may remain nearby (i.e. outside of the room)

What orders does the nurse expect the provider to give?

• Psychiatric precautions like placing in a gown, removing personal items, searching for weapons, suicide/harm screening should be expected. Diagnostics to rule out medical issues like vital signs, urine drug screen/blood alcohol level, blood work, and IV start are all orders to anticipate. The IV may be needed for urgent/STAT med orders. Further diagnostics (i.e. radiology, etc.) might be anticipated only after initial screening gives data. For example, high HR and BP may warrant an EKG. Signs of trauma may warrant an XRay or CT scan. Similarly, referrals may be necessary, but not initially.

After screening and assessing the patient, the nurse has the following data:

Patient is able to follow instructions after LEOs step out of the room. He removes his clothing with assistance to be placed in a gown and on a monitor. He voids unassisted, but supervised, for a urine sample. Offers no resistance to IV placement and blood draw.

He frequently looks around and seems hyperalert. He is unable to articulate his exact location, only saying, “I’m at a hospital.” PERRLA, moves all extremities. Multiple military-themed tattoos are visible on his arms, chest, back, and legs.

No potential weapons noted. No signs or symptoms of physical assault, skin is intact with no bruising. The patient is wearing military-issued dog tags on a long chain beneath his clothing. Personal items placed in a belongings bag and secured per protocol. He indicates he has not slept for several days due to being out of his medication and says, “I can’t do it anymore. I can’t take the nightmares, so I don’t want to sleep. I just can’t make it.” He denies a medical or psychiatric history only saying, “I go to the VA hospital. They give me meds and therapy, though.”

PRN medications ordered: Lopressor 5 mg IV bolus given over 2 minutes, PRN Normal Saline 0.9% 1000 mL rapid IV bolus, PRN Naloxone 0.4-2 mg IV/IM/SC; may repeat q2-3min PRN; not to exceed 10 mg Lorazepam 1 mg IV, may repeat PRN; not to exceed 4 mg

BP 180/90 SpO2 98% on Room Air HR 112 bpm and regular Ht 182 cm RR 28 bpm Wt 99.8 kg Temp 37.9°C

Prioritize the top nursing interventions. What are some vital interventions and why are they performed in this order?

• Making sure the patient and staff stay SAFE is the priority right now. Placing him in a gown and checking for dangerous items take precedence PRIOR to obtaining labs or monitoring. Reassuring the patient and remaining calm throughout is needed at this time as well. Putting him on a monitor for continuous monitoring is important in case there are sudden changes so that happens 2nd since his initial triage vital signs are outside of parameters but not emergent. Obtaining samples to rule out medical/metabolic concerns vs intoxication is 3rd. Further examining the patient’s statements with therapeutic communication can happen concurrently with medical interventions and help foster a healthy nurse-patient relationship. Based on assessment findings, the nurse could also use a reliable and valid PTSD screening tool like the five-item Primary Care PTSD Screen for the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. Please note: restraints are not mentioned and should be avoided if the patient is SAFE. If orders for restraints are placed, the provider MUST document as either medical or behavioral. This is not within a nurse’s scope of practice.

Should the nurse administer the PRN medications written by the provider now or question other medication orders? Why or why not?

• No. Firstly, ALL PRN orders need parameters to proceed. I.e. Answer Lopressor IV 5 mg bolus over 2 minutes FOR stated HR and/or BP. These orders do not have any parameters provided. It is beyond a nurse’s scope of practice to administer without the prescriber’s guidance. None of these PRN orders have parameters provided. Also, for each med: For the Lopressor, there is no indication this is a cardiac issue and no frequency/max provided either. For the IVF there is no indication that he is dehydrated, and cardiac status is not known so the nurse should be concerned for possible fluid overload. Also, there is no scientific evidence that NS can impact the alcohol intoxication this patient appears to have. For the naloxone, UDS shows the patient did not ingest an overdosage of opioids and his V/S do not indicate respiratory depression or opioid intoxication (even without labs to prove it). For the Lorazepam, there is no seizure activity and giving this medication may impair the psychiatric screening needed to further assess the situation.

Are there other orders the nurse might anticipate and/or suggest?

• Placing him on suicide precautions would be a good start as it is not harmful and can always be discontinued after further observation/assessments. Obtaining medical records to determine PTSD treatment and/or other conditions would be helpful. Also, seeking expert consultation in the form of a psychiatric consult is in the patient’s best interest.

Are there past medical history concerns specific to this patient and his background that may aid in the plan of care?

• Research indicates that many who suffer from PTSD also have a history of traumatic brain injury and/or other combat trauma. Determining his TBI status may help in obtaining consults (i.e. neurology, occupational therapy, etc.) as well as guiding further diagnostics (does he need a head CT? For example). TBI-related issues may be the root cause of his current behavior but if they are not then psychiatric concerns would be more likely. Finding out all you can about his current treatment plan will help in the present.

After determining the patient is not a harm to himself or others, LEOs release him to the medical treatment facility. A records request produces a brief patient history and treatments he is receiving from the local VA hospital. Records do not indicate any history of physical combat trauma, no traumatic brain injury (TBI). The medication list is available to review and, since some time has passed and the patient has been cooperative and calm, he is conversing appropriately. He concurs with his medications verbally.

Regarding patient medications, what process is necessary for the nurse to perform and why?

• A medication reconciliation should be completed on ALL patients per Joint Commission. From the National Patient Safety Goal literature: “NPSG.03.06.01 Maintain and communicate accurate patient medication information. –Rationale for NPSG.03.06.01– There is evidence that medication discrepancies can affect patient outcomes. Medication reconciliation is intended to identify and resolve discrepancies—it is a process of comparing the medications a patient is taking (or should be taking) with newly ordered medications. The comparison addresses duplications, omissions, and interactions, and the need to continue current medications. The types of information that clinicians use to reconcile medications include (among others) medication name, dose, frequency, route, and purpose. Organizations should identify the information that needs to be collected in order to reconcile current and newly ordered medications and to safely prescribe medications in the future.”

What patient education topics would need to be covered? When? Is this only the nurse’s responsibility?

• Once the patient is determined to be no harm to himself and AA&O enough to participate in self-care (by assessment and provider determination) then staff can provide education with a focus on medication regimen adherence with rationales (i.e. sudden discontinuation of antidepressants may cause sleep disturbances and they should not be taken with alcohol either). Resources for him to seek out if he has suicidal ideation (this should be simple and clearly explained – avoid medical jargon) or thoughts of self-harm. Ensuring he has a support system and the resources to follow up with appropriate parties should be part of the interactive education process. Case management may need to assist in discharge/follow-up recommendations. His family/support system should be included in discharge planning as well. There may be literature or web sources to give to the patient as well so he can participate in self-care.

After sleeping for a few more hours, the patient remains appropriate, cooperative, and calm. HR, BP, RR all decreased. His spouse arrives to take him home. They both verbally acknowledge discharge plans for him to return home with particular emphasis on follow-up with the VA psychiatric team. Mr. Bryant states very clearly that he has no plans to harm himself or others. The nurse documents he is fully alert and oriented x 4 after assessing one more time.

What does oriented x 4 mean? Why is this important?

• Oriented x 4 means oriented to person (who are you? name?), place (where are you? specific), time (time/day/date), and situation (what is going on?) This is vital for this patient because initially, he presented as disoriented. In order for him to be discharged to self-care and able to follow up as directed he must be fully awake and oriented so as not to pose a threat to himself, others, or his future care. This also allows staff to accurately document the level of consciousness at discharge.

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This nursing case study course is designed to help nursing students build critical thinking.  Each case study was written by experienced nurses with first hand knowledge of the “real-world” disease process.  To help you increase your nursing clinical judgement (critical thinking), each unfolding nursing case study includes answers laid out by Blooms Taxonomy  to help you see that you are progressing to clinical analysis.We encourage you to read the case study and really through the “critical thinking checks” as this is where the real learning occurs.  If you get tripped up by a specific question, no worries, just dig into an associated lesson on the topic and reinforce your understanding.  In the end, that is what nursing case studies are all about – growing in your clinical judgement.

Nursing Case Studies Introduction

Cardiac nursing case studies.

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Trauma, Compassion Fatigue, and Burnout in Nurses

Within health care, trauma-informed care has become an embedded approach in caring for patients; however, nurse leaders are not always prepared to lead nurses with a background of trauma. Nurses’ past trauma, coupled with workplace stressors, may result in compassion fatigue, burnout, and secondary traumatic stress. Nurse leader engagement and trauma-informed leadership approaches are imperative to mitigate and mediate the effects of trauma in nurses as the COVID-19 pandemic recedes.

Key Points:

• 1. Nurses and healthcare professionals may be impacted by Adverse Childhood Events and trauma, both personally and professionally.
• 2. Adverse Childhood Events and trauma play a role in compassion fatigue, burnout, secondary traumatic stress, and resilience in nurses.
• 3. Trauma-informed approaches and self-care in nurse leaders are imperative for effective leadership.

When I attended nursing school in the early 1990s, trauma-informed care was not a defined concept. I learned about trauma-informed care in 2017 as a nursing faculty member while participating in a colleague’s undergraduate course lecture. Although my own undergraduate education included instruction on empathy, compassion, and patient advocacy, I realized trauma-informed care was the link I had been missing in my approach to patients as both a faculty member and a practicing emergency department nurse. In recent discussions with other nurse leaders and colleagues, I have found that there are gaps in knowledge on trauma-informed care for those who attended nursing school more than 10-15 years ago. This article will give a synopsis of what I have learned about trauma-informed care, the impacts of trauma and trauma-informed care on nurses, and the development of resilience in nurses. As a new hospital-based nurse manager, I will also discuss how I am learning to translate trauma-informed care practices into the leadership role.

What is Trauma-Informed Care?

Trauma-informed care has emerged and evolved over the past 20 years as a response to the landmark Adverse Childhood Events (ACEs) study. 1 Felitti et al. 2 defined ACEs as “childhood emotional, physical, or sexual abuse, and household dysfunction during childhood.” Household dysfunction was further delineated as witnessing violent acts against one’s mother, living with a family member who used illicit substances or alcohol, having a household family member who was imprisoned, or living with a family member who had a mental illness or who was suicidal. 2 ACEs are pervasive, and it is estimated that 55%-90% of the current U.S. population has experienced at least one form of childhood trauma. 3 Of the 55%-90% who have experience childhood trauma, many have experienced as many as five traumatic events in their lifetime. 3 Long-term outcomes of ACEs are an increased risk of developing chronic illnesses such as cancer, ischemic heart disease, and chronic lung disease, as well as higher rates of depression, alcoholism, drug abuse, and suicide in trauma survivors. 2

The Substance Abuse and Mental Health Services Administration established the National Center for Trauma-Informed Care in 2005 after recognizing a need for care delivery which includes a trauma-informed framework at its core. 1 This framework assists health care professionals in viewing patients and clients through the lens of past trauma, using the mindset and verbiage of “what has happened to you,” rather than “what is wrong with you.” 4 A trauma-informed approach also allows the trauma survivor to define his/her own traumatic experience and resultant stress. 1 This shift in patient approach and health care provider mindset serves to decrease retraumatization of the patient and provide psychological safety in patient care. 1

How are Nurses Affected by Trauma and Trauma-Informed Care?

Nurses and health care providers are not immune to ACEs, trauma, and traumatic stress. Current literature postulates that ACE scores among nurses mimic those of the population, with some studies suggesting that nurses may have higher rates of ACEs than the general population. 5 , 6 Nurses who have a history of childhood trauma and who work in high-acuity settings are at risk of being retraumatized through exposure to stressful situations, leading to anxiety, depression, post-traumatic stress disorder, compassion fatigue, and burnout. 7 The implementation of trauma-informed care by nurses, particularly in patient populations with high levels of trauma, can also lead to compassion fatigue and burnout. 8 These feelings of compassion fatigue and burnout are associated with negative work performance, nurse turnover, increased financial burden for employers, decreased patient satisfaction, and worsened quality of care delivery. 7 , 9 , 10

Compassion Fatigue

Compassion fatigue is the “phenomenon of stress resulting from exposure to a traumatized individual rather than from exposure to the trauma itself.” 11 (p1) Signs of compassion fatigue include physical and emotional exhaustion, increased anxiety, anger, irritability, intimacy issues, and irrational fears. 11 , 12 Nurses may display decreased sympathy and/or empathy toward patients and coworkers and may express dread in working with certain clients or patients. 11 , 12 Negative coping behaviors, including drug and alcohol abuse, may emerge along with decreased job satisfaction. Nurse leaders may notice that staff members demonstrate increased use of sick days and/or paid time off and higher rates of absenteeism. 11 , 12 In contrast to absenteeism, presenteeism is the physical presence of a nurse or health care provider on the job when they should not report for duty due to illness or job-related stressors. 13 Nurses have the highest rates of presenteeism in the workforce, which is linked to poor patient outcomes and decreased patient safety. 13

Health care providers at the highest risk of experiencing compassion fatigue are younger nurses and nurses with 2-5 years of experience. 14 Compassion fatigue in younger or inexperienced nurses may lead to decreased retention, increased turnover, and the intent to leave the nursing profession entirely. 14 Nurses who are exposed to chronic stressors and traumatic patient experiences are also at an increased risk for experiencing compassion fatigue, as are nurses who work in medical-surgical and pediatric inpatient departments, outpatient home health, and those who practice in rural settings. 15 , 16 , 17 Workplace incivility and higher patient-to-nurse staffing ratios are also associated with higher rates of compassion fatigue and burnout in nurses. 15

Dr. Beth Hudnall Stamm’s original research on Professional Quality of Life proposed that burnout is a byproduct of compassion fatigue, yet the two are not synonymous. 18 Burnout tends to have a gradual onset, whereas compassion fatigue may present more rapidly or suddenly. 19 Burnout, or burnout syndrome, is often characterized by feelings of hopelessness, emotional exhaustion, lack of self-efficacy, depersonalization, and decreased productivity in the workplace and is thought to be caused by prolonged exposure to workplace stressors and events. 20 , 21 Studies have demonstrated that burnout is present in as many as 40%-75% of health care professionals and is not isolated to nurses. 12 The literature estimates that as many as 12% of physicians suffering from burnout syndrome struggle with suicidal thoughts, and the rate of completed suicide among medical students is twice that of the general population. 12

Nurses at an increased risk for burnout are often those working in high-acuity, high-intensity environments such as critical care, oncology, and emergency nursing. 14 , 22 , 23 , 24 , 25 Prior to the COVID-19 pandemic, The Joint Commission 9 surveyed over 2000 nurses and found that 15.6 of those surveyed had feelings of burnout, with even higher rates among emergency room nurses. Charge nurses working in oncology and critical care also reported higher rates of burnout and secondary traumatic stress than staff nurses. 22

Secondary Traumatic Stress

Secondary traumatic stress or secondary trauma, like burnout, is another outcome of untreated or unresolved compassion fatigue. 18 Secondary traumatic stress develops from exposure to patients with a significant history of trauma, similar to vicarious trauma. 14 Secondary traumatic stress in nurses is associated with sleep disturbances, anxiety, intrusive thoughts, and avoidance behaviors around reminders of trauma suffered by patients. 14

Resilience is thought to be a positive and protective mechanism for survivors of trauma, 26 described as one’s ability to overcome, bounce back, or rebound from adversity. 7 , 13 In nurses, resilience provides a buffer from the stressors and challenges of the workplace, increasing adaptability and ability to cope within the work environment. 7 , 9 The first step for nurses in developing resilience is recognition of their own ACEs along with past trauma and stressors. 6 This may be facilitated by nurse leaders mindfully educating nurses on ACEs and trauma-informed care. Nurses must then provide consideration to the impact their own past trauma has on their knowledge, skills, and attitudes in patient interactions and care delivery.

Resilience in nurses has become so crucial that the Future of Nursing 2020-2030 committee has included resilience in their work, recognizing that nurse well-being and resilience are vital parts of quality health care delivery. 27 Prior to the COVID-19 pandemic, The Joint Commission 9 authored their safety brief, Developing Resilience to Combat Nurse Burnout, discussing that nurses often provide care to others at a high personal cost. Additionally, many nurses report feeling a lack of support by administration and health care systems in addressing effective methods to reduce burnout. 9 The Joint Commission 9 recommended the focus of organizational leadership move to that of developing and improving resilience in nurses to combat burnout.

How Do We Translate Trauma-Informed Care Into Leadership?

In a recent editorial, Dr. Rose Sherman recently challenged nurse leaders to consider the effects of primary and secondary trauma on nurses, instituting the same trauma-informed approach that nurses use when engaging patients and clients. 28 This approach is demonstrated by viewing nurses’ attitudes and behaviors through the lens of “what has happened to you” instead of “what is wrong with you.” 4 , 28 By implementing a trauma-informed leadership approach, the nurse leader has the opportunity to have a significant influence on nurse compassion fatigue and burnout. 19 Research has demonstrated that low levels of nurse manager support are significant predictors of burnout and compassion fatigues. 14 , 19 In contrast, authentic leadership, as exhibited through qualities of trustworthiness, compassion, reliability, and genuineness in nurse leaders and health care administrators, is associated with workplace satisfaction in nurses. 14 , 19

Dr. Dawn Emerick recommends that nurse leaders view the COVID-19 pandemic as a form of trauma for frontline nurses and staff members. 29 I have observed that acute care nurses, now over two years into pandemic care, are exhibiting signs of compassion fatigue, burnout, and moral exhaustion, particularly after caring for COVID-19–positive patients who have had increased lengths of stay. Nurses are discussing moving out of high-acuity hospital settings, leaving their current place of employment for lucrative travel assignments, or even leaving the nursing profession entirely. A nurse who worked in the food service industry prior to graduating from nursing school told me that she missed her previous job and was picking up restaurant shifts during the pandemic, stating “At least when I work there, no one tries to die on me.”

Nurse leaders must provide nurses and frontline staff encouragement and resources to help them process workplace stress and trauma and to engage in self-care. Recommended trauma-informed leadership approaches include the following:

• • Encourage staff participation self-care activities while at work (e.g., journaling, walking, mindfulness, meditation, and gratitude activities)
• • Invite a staff member to go on a walk at work and listen to his/her stories
• • If staff members volunteer information about their own past trauma and its subsequent effects, consider their story in interactions with them, particularly in those showing signs of compassion fatigue and burnout
• • Have crucial conversations with staff members who are exhibiting signs of compassion fatigue and burnout, offering a change of job duties or work assignment if possible
• • Diversify or decrease staff workload, particularly in dealing with patients experiencing traumatic events or those admitted with COVID-19
• • Support staff in having time off work, particularly on evenings, nights, and weekends, and have minimal work-related contact with staff on their days off
• • Allow staff to take vacations and use paid time off when possible
• • Encourage participation in debriefings after difficult or traumatic patient care experiences
• • Educate and encourage staff to have professional boundaries with patients and their families
• • Provide positive recognition of staff in ways that are personally meaningful to the individual staff members
• • Acknowledge and reward staff members who are loyal to the organization (e.g., retention bonuses, extra shift bonuses)
• • Encourage peer support, teamwork, and collaboration
• • Empower and encourage staff in pursuing education, training, and professional development
• • Support employee autonomy, shared decision-making, and sense of control in the workplace. 15 , 16 , 30 , 31

Work-Related Injuries

Compassion fatigue and burnout, if left untreated, may lead to long-term emotional trauma, depression, and suicide in health care providers. 32 Therefore, compassion fatigue, burnout, and secondary traumatic stress should be treated as on-the-job injuries or work-related injuries. 16 , 30 Nurse leaders should first attempt to mitigate the effects of compassion fatigue and burnout in employees by using approaches and strategies such as those listed earlier in the study. 30 If unable to mitigate, workplace mental health resources such as employee assistance programs should be instituted as soon as possible. 30

How Do I Deal With Trauma as a Leader?

Nurse leaders must first acknowledge their own past trauma and its impact on their mental health and leadership style. Additionally, nurse leaders must take time for self-care and find a healthy work-life balance. 33 I have found that walking 30 minutes each day, either on a treadmill or during breaks at work, has significantly improved my mindset and allows time for mental processing. Recognition of my own self-care deficit and work-life imbalance has served as a barometer in managing my compassion fatigue. Similarly, this same self-awareness in nurse leaders will help in recognizing signs and symptoms of compassion fatigue and burnout in staff members and other leaders, allowing for early intervention, offering of resources, and increased support. 12

Many nurses have experienced trauma in their lives, including working through the COVID-19 pandemic. When previous trauma is combined with current workplace stressors, nurses are at risk of experiencing compassion fatigue and burnout, and the quality of patient care suffers. Hospital and health care leaders can positively affect nurse well-being through a trauma-informed leadership approach and by promoting practices to decrease compassion fatigue and improve employee resilience. Leadership behaviors that foster self-care and nursing resilience are imperative to maintain and strengthen the nursing workforce. 9

Elizabeth A. Wolotira, MSN, RN, CEN, CPEN, CFRN is a Nurse Leader for CommonSpirit Health, CHI St. Anthony Hospital in Pendleton, Oregon, and a doctoral student at Bryan College of Health Sciences in Lincoln, Nebraska. She can be reached at [email protected] .

Note: The author did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The author would like to thank her colleague and classmate, Katrina Dielman, MSN, RN, CNE, for introducing her to trauma-informed care. She would also like to thank Katrina and Dr. Kelsi Anderson for assisting with proofreading and editing her manuscript.

#349: Assessing Skin Signs Case Study

Case study for GIB, liver disease, and skin assessment

Neurology Case Study: Episode 135

Neuro Case Study

Trauma Nursing Core Course (TNCC)

Find a course near you.

• Reshaped and revised pre-course learning activities to include modules on communication and shock. 
• The addition of “The LGBTQ+ Trauma Patient” chapter.
• Interactive activities are interwoven throughout the classroom time.  

Every second counts when stabilizing life-threatening trauma cases. This course, taught by qualified nurses, prepares you with the knowledge, critical thinking skills and training needed to provide high-quality trauma nursing care. After completing this course, you will be able to properly assess patients and implement evidence-based interventions to improve outcomes for them.

Here’s a glimpse into what you’ll learn:

• The latest trauma nursing practice recommendations
• Systematic assessment and standardized approach to trauma nursing care 
• Rapid identification of life-threatening injuries

TNCC Course Format A variety of learning methodologies are included to cater to every learning style, including:

• Provider manual
• Online modules
• Instructor-led classroom discussions and skill stations
• Virtual courses available

Manual: The provider manual includes evidence-based content developed by experts in trauma care. A valuable resource for future reference.

Pre-course learning: Includes access to required online modules prior to the course date to let you learn at your own pace, apply what you learn, and receive immediate feedback. Modules include a step-by-step breakdown of the Trauma Nursing Process and a comprehensive study guide.

Why is ENA's TNCC the right course for you?

• Evidence-based content developed by trauma nursing experts
• Curriculum designed specifically for nurses
• Course content is updated regularly as trauma care evolves
• Four-year, internationally recognized verification as a TNCC provider is earned upon successful completion
• Increases your confidence in trauma patient care
• Courses are available year-round at locations conveniently located near you
• Earn 19.5 CNE hours

Prerequisites

• Only registered nurses are eligible for provider status.
• Licensed practical nurses and paramedics are eligible to attend all portions of the course and obtain CNE hours, but are not eligible for provider status verification.

The Emergency Nurses Association is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation. Provider Unit No. P0232

The Emergency Nurses Association is approved by the California Board of Registered Nursing, Provider #2322.

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Mental health associated with the cluster of childhood trauma and resilience among nursing students: A cross-sectional study

Affiliation.

• 1 School of Nursing, Wenzhou Medical University.
• PMID: 37227834
• DOI: 10.1037/tra0001527

Objective: This study aimed to propose clusters of the association between childhood trauma and resilience in nursing students and to examine their mental health according to these clusters.

Method: A cross-sectional study was carried out between September 2018 and May 2019. A total of 1,245 undergraduate nursing students (104 male, 1,141 female) were enrolled in a medical university in East China to complete the Childhood Trauma Questionnaire, Connor-Davidson Resilience Scale, Self-Rating Anxiety Scale, and Self-Rating Depression Scale.

Results: The cluster analysis identified three clusters as follows: the self-healing group (40.7%), the mildly traumatized with low resiliency group (22.2%), and the healthy group (37.1%). The logistic regression analysis revealed that the levels of anxiety and depression significantly differed between the three clusters, with the mildly traumatized with low resiliency group having the highest odds to have anxiety and depression.

Conclusion: This study identified three clusters of the association between childhood trauma and resilience in undergraduate nursing students and indicated that each cluster was associated with a different level of anxiety and depression. The unique characteristics of the three clusters may help identify and develop appropriate interventions to promote the mental health of undergraduate nursing students. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

• Adverse Childhood Experiences*
• Cross-Sectional Studies
• Education, Nursing, Baccalaureate*
• Mental Health
• Psychological Tests*
• Resilience, Psychological*
• Self Report*
• Students, Nursing* / psychology

Supplementary concepts

• Connor-Davidson Resilience Scale
• Childhood Trauma Questionnaire

Grants and funding

• Ministry of Education