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Rhian Wood discusses trauma care

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VOL: 98, ISSUE: 37, PAGE NO: 33

Rhian Wood, RN, is clinical practice lead, accident and emergency department, St Thomas' Hospital, London

I was unable to move, trapped upside down in the darkness in an overturned car. I could feel the vibration of the fire crew's tools slicing through metal inches from my head. Then I felt someone take my wrist to check my pulse and heard a voice asking if I was all right.

I was unable to move, trapped upside down in the darkness in an overturned car. I could feel the vibration of the fire crew's tools slicing through metal inches from my head. Then I felt someone take my wrist to check my pulse and heard a voice asking if I was all right.

This one-to-one communication made me feel safe for the next hour while I was being rescued. As I slid onto the spinal board and was loaded into an ambulance, I opened my eyes and spoke to Adrian, the trainee ambulance driver who was attending to me. The experience was only a training exercise but my isolation and fear were real, as was the comfort I derived from Adrian's care.

But are such one-to-one relationships maintained when patients arrive at hospital and are transferred to the care of the trauma team? I would argue that they lapse as soon as a patient enters the resuscitation room and that patients suffer as a result.

Patients may have their field of vision reduced by being strapped down. Their hearing may be compromised by spinal immobilisation and they may be subjected to painful procedures which are explained to them in medical terms that they do not understand. Imagine how frightening that must be, particularly if no one is taking the time to comfort and reassure you.

In an emergency situation with a patient whose senses are compromised, there may not be time to explain what is happening. Yet what we say is only a small percentage of good communication: how it is said and the body language we use is far more significant. Equally, a caring touch can do much to comfort and reassure patients. Unfortunately, trauma care is increasingly high-tech and the use of touch can suffer as a result.

By putting patients at the centre of care we can do much to reduce the pain and anxiety they experience. Listening to what they say and giving them time to think also ensures that they can give informed consent.

But patients do not want information only. They also want access to their families, if they are available, and need to feel in control to maintain their self-esteem. Unfortunately, this rarely happens in resuscitation rooms, where many patients are subjected to dehumanising, undignified experiences. It is little wonder that psychological problems are a common result of trauma.

Nurses need to communicate with trauma patients to improve morbidity as well as mortality. Advanced Trauma Life Support patients need another form of ATLS - Access to family; Touch for reassurance and comfort; Listening to ensure informed consent; and Self-esteem to be maintained throughout - to kick-start their recovery.

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