N235: Guest Lecture 9/25/17

1) Nadine Burke Harris trauma/toxic stress TedTalk

2) Poverty/early stress/violence changes developing brain in fundamental ways that lead to
higher likelihood of certain outcomes
3) The brains of traumatized/poor children are different and allows them to respond in
different ways a lot of the time
4) 4 or more ACEs correlate with X10 risk of suicide, X5 risk of depression, X4 risk of COPD
5) Foster care population  74% had 4+ ACEs and 10% had 10 ACEs
6) ACE studies are as revolutionary as germ theory was for the 19th century
7) Trauma-informed care is
a) Realizing the widespread impact of trauma
b) Recognizing how trauma may affect children, family, staff, and others
i) The first two steps may be accomplished by situating your current knowledge and
experience within the framework of research and narratives
c) Responding by applying TIC knowledge into practice
d) Preventing re-traumatization
i) The 2nd two steps combine maximizing autonomy and respect through individual and
institutional compassionate, person-centered, resilience-promoting responses to
traumatized people in distress
8) Iatrogenesis in pediatrics
a) Restraining children in hospital setting has lasting effects (physician-generated)
i) SEs from Rx, surgical complications, traumatic stress from specific healthcare
experiences, or failure to provide necessary care
ii) Fraught in pediatrics due to children’s inherent vulnerability as patients who lack
decision-making authority
iii) Grappling with neglected clinical and ethical questions about pediatric iatrogenesis,
how clinicians communicate iatrogenic risks to patients’ parents, how clinicians
manage therapies with inevitable iatrogenic harms and how clinicians might
consider, respond to, and mitigate iatrogenic consequences of their practices
9) Current state of TIC research
a) 2015 literature synthesis identifies:
i) most lit pre-2000 is theoretical in nature
ii) lots of case study, narrative, non-empirical literature
iii) no intervention research: tremendous opportunities to improve evidence base of TIC
iv) providers’ own trauma histories influence provision of care
10) MeSH: formal indexing framework for research literature (algorithms behind PubMed, etc.)
a) Keywords only recently entered for: adult survivors of child adverse events (wasn’t
enough published research before)
11) Traditional “three C’s” of mental health nursing:
a) Custodial (nurses in this field acted more as wardens of asylums than as those providing
treatment), clerical, clinical
b) Trauma-informed frameworks foster a fourth C: compassion
12) Open-ended vs closed-ended questions (video)
 a) SAMHSA
i) Safety
ii) Trustworthiness/transparency
iii) Peer support and mutual self-help
iv) Collaboration and mutuality
v) Empowerment, voice, and choice
vi) Cultural, historical, and gender issues
b) Issues with not posing questions correctly: close client down prevent basic listening
sequence and patients feel like they aren’t heard
c) Improper questions = power shift, lack of connection
d) Open questions: How? Could? For instance? Tell me a little bit more? How are you
feeling today? Can you explain that to me?
e) Close-ended questions have their purpose  help to direct/guide interview, and close
down client talk
f) Why? Questioning in counseling  elicits answer of “I don’t know”
g) Follow-up to make patient feel sure you’re listening, allowing space to let client explain
themselves
13) Social history, reason for presentation, baseline labs + TFTs, mental status exam list