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Trauma informed care in an acute setting

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Prior to the start of her fifth mental health nursing placement, Maisie Hare had little experience of observing or facilitating trauma work

While working as a healthcare assistant in a medium secure hospital, I witnessed many patients returning from psychology sessions where the focus of the work had been on trauma.

I would observe some patients, who would return from their sessions appearing as though progress had been made, whereas others would return to the ward appearing low in mood – with some individuals self-harming to cope with their experiences.

I found it challenging that, as a healthcare assistant, I did not feel skilled enough to support them effectively. I felt able to empathise with them to an extent but had a desire to be able to offer clinical, approved interventions.

In addition, it also made me query if work that was being done in the psychology sessions was truly helpful as an inpatient or whether it would be more beneficial to wait until they were further along in their recovery journey before commencing trauma work.

Given my previous experiences as a healthcare assistant, and how I had felt as an external observer of psychology sessions, I jumped at the opportunity to observe trauma work sessions with the hospital psychologist while on placement.

It was finally an opportunity to witness what had led my previous patients to have such varied experiences. I quickly realised that my assumptions of what I believed ‘trauma work’ entailed was far from the truth.

I had imagined both patient and psychologist diving straight into tackling all the traumatic events the patient had experienced in their life, figuring out how to prevent those historical events from causing further distress and harm.

The first session began with understanding the different forms of trauma, which I anticipated. However, following this, the psychologist made it clear that there was work to be done before focusing on the trauma the patient had experienced.

He explained that it is important to stabilise the mind before introducing such intense work, and that this would take precedence in each subsequent session.

After the session, the psychologist described to me the three stages of trauma recovery: stabilising, processing and re-integrating. He explained that we were beginning to work through the first stage.

My involvement in these sessions has enhanced my perspective on the use of trauma work. I can now recognise the importance of offering individuals this intervention during their recovery as it offers them coping mechanisms and methods to manage their experiences of trauma.

Additionally, it has given me insight into how, as a qualified nurse, I could care for someone who is struggling due to historical trauma. I am now aware of some of the skills that individuals are taught and feel confident in supporting individuals to use these.

I am also aware of the work that these individuals do in their psychology sessions, which will enable me to facilitate reflective work or, at the very least, be able to empathise with them more effectively.

In conclusion, I have begun to understand more why some patients may return from trauma sessions feeling positive, while others return feeling quite the opposite. I respect the lengthy process in tackling a topic as complex and delicate as trauma.

Not only was it a joy to observe such carefully planned interventions being put into action, but to it was also a joy to witness a practitioner whose empathy and understanding of emotionally unstable personality disorder was at a standard I strive to achieve myself.

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