Tag Archives: trauma

Trauma and Tramps in Nursing Education

She wouldn’t leave the hotel room without her stone. The lucky one that her best friend found in New Zealand, a small piece of the other side of the earth. There were ten legs standing in the doorway, two walkie-talkies, one stretcher, one AED, five watches ticking, two security guards waiting to disable the keycard to the room, three EMTs ready to make a phone call. There was one story on repeat told to each person who entered, and whispers as I left to look on the mahogany desk under a pile of drink glasses, reading glasses, faded jeans, and concert programs. I handed her the stone. She got on the stretcher.

She won’t remember.

hand over mouth

There were two nurses and one aide, a gaggle of doctors and screaming from the other side of the ER. Pupils dilated, round, equal, and reactive to light, eyes puffy, skin clammy and cold and red around the eyes, pulse tachy at 110, respirations brady at 9, blood pressure 110/89.

Patient’s friend reports she vomited three times but patient cannot remember.

Patient’s friend reports patient got lost halfway through the show, but patient cannot remember.

Nurse asks about the bruises on patient’s arms, but patient cannot remember. Patient’s friend wasn’t there.

Patient looks like she has been crying, wears a hospital gown over jeans and her sweatshirt pulled on only over her arms. Patient does not remove shoes.

old school nurse“Don’t look like a tramp,” said our nursing professor last week. That was the conclusion of the 20-minute lecture on how to dress professionally as a home-health nurse. Which came after the explicit instructions to not wear mini skirts and let your “nasty bits” show, nor to wear high heels in case you had to run. It was confusing, as no one tells women not to wear high heels, but they expect you to learn how to run in them.

Nursing faculty believe in words like “professional.” They use them loosely.

They talk about how to maintain a sterile field and appropriate use of silence and how to talk to people who don’t speak your language. They tell you that babies cannot vocalize, but we still know to hold them and feed them and speak in a soothing voice. They say to apply the same logic to all patients.

They teach you about critical thinking and therapeutic communication and how to educate a patient with asthma about smoking cessation without sounding judgmental.

They do not talk much about trauma.

charcoal-pillsThey do not teach you how to use nonjudgmental language when asking how many drinks she has had. In a field dominated by women, they do not emphasize how one in every six American women will be the victim of attempted or completed rape in her lifetime. That if we count our female friends on all our fingers and toes, count our female patients on all our fingers and toes, three are survivors of sexual violence.

They do not teach you how to avoid trigger words or how to speak with a victim. How to avoid telling her that you don’t believe her, that she is just drunk or crazy or irresponsible. That she dresses like a tramp.

They do not teach you how to tell someone that there is no commercial test to detect GHB or how language can be incriminating.

They teach you about disease processes, about non-pharmacological interventions for pain, about screening and prevention, and eating right. They teach you how to care for the whole person, how to advocate, how to make decisions to the best of your ability, at the bedside, in the home, on the street. How to assess.

How to recognize in that instant, amidst five Adam’s apples and two batons, two notepads, and ten utility boots, that finding one stone may be the most powerful care you can provide.