Understanding Complex Trauma: Three Case Studies

Marianne: A Survivor of the Stolen Generation

Complex trauma is a condition that many people experience due to challenges and threats in their life such as physical abuse, violence, and sexual abuse (Wimalawansa 2014). Complex trauma can lead the victim to being anti-social, untrusting, drug abuse, and sometimes develop coping strategies to prevent them from experiencing any more harm (Schultz, & Schultz, 2015). Post-Traumatic Stress Disorder (PTSD) was distinguished as a disorder with a particular arrangement of indications and was formally added to the Statistical Manual of Mental Disorders (DSM) in 1980.

The most basic causes are: extraordinary auto collisions, strike (sexual or on the other hand physical, including burglary), long haul sexual manhandle, long haul disregard, long haul savagery (typically household), encountering war (either in battle or on the other hand as a non military personnel), fear based oppressor assaults, seeing somebody pass on, catastrophic events, a sudden dangerous therapeutic finding, and demise of a friend or family member.

Maryanne, a 64 years old woman has post traumatic disorder due to her being sexually abused in her childhood and her mother not being able to raise her. Maryanne got married at a very young age of 19 years to a man who was an alcoholic. Maryanne has two children but due to her alcoholism, Maryanne is deemed as not fit to raise her children. Maryanne is lonely, homeless, and has anxiety.

This study  of Amira who is  a refugee whose family was killed in front of her. Amira moved to a camp where her children died of hunger and where Amira was sexually abused. Amira moved to stay with her cousin in a town where she doesn’t know their language and feels alienated

Phillip, a 25 year old male has experienced sexual disorder when he was a child. His grandparents did not believe him which led him to running away from home. Phillip uses drugs and is a sexual worker but was beaten by his client and stolen from. Phillip seeks financial assistance.

Conclusion

In conclusion, traumatic disorders are mainly caused from below the standard parental care which is the main cause as to why Marryanne, Amira and Phillip are mentally depressed.

Answers for the case studies

Question 1:  How would you respond to the client’s current distress?

Answer:

For Maryanne’s case, as a nurse who the patient came to. A safe place for the patient to stay in can be provided. Rothschild, 2003, explained that, building a confiding in connection among advisor and patient is an essential factor to tending to horrible recollections or utilization of any system, regardless of whether that takes a long time. This includes helping the customer reduce the resistances they have used to adapt to their injury. On the off chance that the treatment circumstance does not feel safe, a slackening of safeguards can prompt an increment in defenselessness to additional hurt (Rothschild, 2003).

For Amira’s case,  Amira can be talked to and sustain hope and respect for her. Amira can be taught  the adaptive coping strategies and teach her interpersonal and assertiveness skills and encourage her to learn the English language in order for her to be able to communicate with the people around her. (Courtois, 2008) stresses the importance of ‘trust’ and the significance of distinguishing and expanding on the customer’s interior and outside assets. She clarifies that it is imperative to enable the customer to recognize the assets he/she as of now has such as, a comical inclination and guard instruments, relational assets, conviction framework, and so forth.

Amira: A Refugee from Civil War

Phillip will be taught how to monitor his thoughts and responsive actions, provide him with a safe place at the facility for him to stay and make sure that he is comfortable and free and out of danger from his predators. Phillip ca also be taught on how to trust the people around him and how to respond to various situations.

Question 2: How would you collaboratively identify the client’s specific trauma needs and develop strategies to address them?

Answer:

 Psychological evaluation of the three patients can be performed. Also, a detailed study of the patient’s history and physical health would be important to ensure that the signs of trauma is correctly identified. DSM-V criteria to survey the indications of post traumatic complex trauma  can be used (Moffit et al, 2015). By inquiring pointed inquiries regarding their history and physical wellbeing, it very well may be simpler to decide if their indications are misrepresented or if a patient is underplaying their seriousness (Rhoades et al. 2015).  After this, the level of trauma the patients are in can be estimated hence coming up with a plan to help the patients deal with their trauma and help them understand the importance of self-care and how to go about it  (Sier, 2015).

Question 3: Considering your service, existing partnerships and referral pathways, what specialist services could be appropriate for the client?

Answer:

After assessment of Marianne, it is clear that the patient has post traumatic stress disorder and has developed a drinking problem. This is preventing her from seeing her children and grandchildren. She is also homeless and has no financial stability. Marianne would be referred to a rehabilitation centre that is known well and also a therapist who would help her to cope with her childhood problems and help her newly adapt and have a stable life

After the assessment of Amira’s situation, it is clear that the she had bad times and bad memories starting from the death of husband and sons in her war tone country and the demise of her children in the refugee camp. The sexual harassment  has a big impact on her. Amira can be taught skills to help her cope up with the situation and dealing with sexual trauma by telling her to focus on her present moment and try to imagine beautiful life that may await her. Amira can also be referred to a psychological  behavior Therapy which can be a powerful healing solution for her past trauma. Amira can be advised to learn English and advise her to cope up with the new environment positively.

Phillip can be referred to a Cognitive Behavior Therapy. Psychological Behavioral Therapy can be a powerful device with injury survivors. This therapy works with comprehensions to vary feelings, contemplations and practices. The objective is to see how certain contemplations cause pressure and aggravate indications. Psychological Behavioral.

Theory for injury incorporates figuring out how to adapt to tension and adverse contemplations; overseeing outrage; getting ready for pressure responses; taking care of future injury indications; tending to inclinations to `self-alleviate’ with liquor or medications and conveying and relating successfully with individuals. The CBT display, when utilized with survivors of tyke manhandle, more often than not centers around the ‘without further ado’ as opposed to on returning to the injury itself.

Phillip: A Survivor of Childhood Abuse

Question 4: Using your service’s referral procedures, how would you refer the client to these services? How would you support them during the referral process?

Answer: For all three cases, a warm handoff would be done by reaching the specialist verbally with the patients and their evaluation data. Specialists to be explained about the patient’s referral purpose and the impact of their problems on their lives and the need for them to recover from their complex trauma (Verma, 2017).

Question 5:  What self-care practices would you need to implement for yourself?

Answer: For the three cases studies, time can be taken for social life and leisure activities without thinking about work avoid crossing professional boundaries with the patients and avoid being too emotionally involved to the extent that might not take healthcare guidelines and protocols of Post Traumatic Stress Disorder care (Parry, Lloyd & Simpson, 2018). 

Issues in the field of study

The two major issues faced in the department of nursing and specifically the nurses dealing with patients who have experienced complex traumas are lack of enough information for nurses to use when caring for these patients and also, the teaching of ethical practices to nurses when dealing with complex trauma patients. These  issues can be researched because if they are solved, better post traumatic stress disorder care will be provided to patients and thus increase their recovery rate and prevent likely relapse (Chandler, Mogyoros, Rubio & Racine, 2013). The information from (Chandler, Mogyoros, Rubio & Racine (2013) only states the problem but does not give the recommendations for coping with the issue.

It also does not explain completely how lack of information affects service delivery. The article however offers a platform for referencing and gaining information and based on its year of publication, it means that the issue is up to date. Research can be applied in place of work by encouraging training and education programs for nurses dealing with patients of PSTD. This way, the nurses are able to exchange information on effective methods of treating different stress traumas and also are able to learn the ethical considerations and decision making in a dilemma and learn an evidence based method of dealing with the ethical issues.

Task 3

Supervisor Feedback	Goal	Strategy	Timeframe	Progress Measure
Is good at referrals but improvement is needed	To learn how to accurately do referrals and the pathways to use	Use past information available to learn more about referrals Ask for help from supervisors and fellow workmates who are more experience Do some practical work on referrals	2 weeks	At the end of the two weeks, I should be able to do referrals accurately and giving all the information that is required for the referral and the referrals I do are perfect.
Still has a lot of work to do to assess and diagnose patients	To assess and accurately diagnose complex trauma patients	Use case studies available Be present at the time when the supervisor is assessing patients	Throughout the training session	At the end of the training, I can correctly diagnose a patient and grade their level of traumatic stress.

Emerging strategies

            Some emerging trends in the industry such as use of antidepressants and technology would be helpful in making the work of the nurse easier. Antidepressants help the patients heal faster and better than just relying on therapists (Bockting, et al. 2018). Technology can be used to make interactive programs that help individuals identify the symptoms of depression early enough and seek help before the depression gets into the more hard to treat level. These can be implemented through teaching the nurses on the importance of the above tools and helping them understand how to use them appropriately

             I reflected on the importance of ethical responsibility in a workplace and how it affects service delivery and outcome, (Kukkonen & Sharifullin 2017). Using evidence-based procedures to treat patients can be sometimes exhausting and people may choose to take shortcuts. However, this can affect both the nurse and the patient later on and as a result affect the health centre too. Therefore, it is important to always follow ethical considerations and behavior whenever administering treatment and recommendations regardless of whom the patient is.

Cluster Six
Key lessons learnt: ethics, communication, work-leisure stability and endurance
Skills	Attributes	Strategies to develop further
communication	Logical thinking Listening skills Awareness of others Positive attitude	Learning to observe non-verbal aspects of communication Listen to what others have to say before replying to them Learn to manage time by paying attention to important facts and not relying much on the unimportant aspects
Ethics	Quality guided decision making Honesty Leadership skills Commitment	Ensure to learn the company’s ethics, vision, mission and core values and work towards them always Learn the art of honesty and commitment and loyalty to place of work. Be a leader and an example
Endurance	Mindset Logical Willpower	Set goals and a specific timeline and work towards achieving them despite the challenges
Work-leisure stability	Time management Balancing between work and social life Planning Personal attributes	Come up with a schedule and strictly follow it Learn when to socialize and also when to work
Analytical skills	Problem solving skills Attention to detail Analysis Organizational skills	Practice by assessing my knowledge and analysing existing patient cases and learn trends and variations between them

Supervisor’s Statement
CHCMHS013:  Implement trauma informed care	Evidence/Comments
Student has demonstrated the following skills: ·       Understanding of principles and practices of trauma informed care ·       Developed strategies to address people’s specific trauma needs ·       Promoted trauma informed practices ·       Maintained safety in practice (Ask: How do you work with people affected by trauma? How do you take care of yourself whilst doing this work?)	The student is able to understand the professional boundaries when coming up with strategies and has good leadership skills. Student is also very observant and keen to details which make the student assess the patients and provide accurate results. The students also understand the policies of a work place when administering care
CHCPOL003: Research and apply evidence to practice	Evidence/Comments
Review the two issues the student researched in Task 2 of this workplace assignment. ·      Are the issues relevant to their work or the organisation? ·      Is the research and strategy they have identified useful?	The student has comprehensive research skills and is able to identify the different issues that affect a nurse in their workplace thus hindering service delivery or poor quality services. The research and strategy provided by student was very helpful.
CHCPRP003: Reflect on and improve own professional practice	Evidence/Comments
Student has demonstrated the following skills: ·       Reflected on and enhanced own practice ·       Engaged in ongoing professional development	The student used networking skills to create a network to develop their skills and career
Supervisor’s name:
I give consent to be contacted by an OTEN teacher about this evidence process. Supervisor’s signature:
Supervisor’s phone number:
Supervisor’s email:
Date:

References

Bockting, C. L., Klein, N. S., Elgersma, H. J., van Rijsbergen, G. D., Slofstra, C., Ormel, J., … & Schene, A. H. (2018). Effectiveness of preventive cognitive therapy while tapering antidepressants versus maintenance antidepressant treatment versus their combination in prevention of depressive relapse or recurrence (DRD study): a three-group, multicentre, randomised controlled trial. The Lancet Psychiatry, 5(5), 401-410.

Chandler, J. A., Mogyoros, A., Rubio, T. M., & Racine, E. (2013). Another look at the legal and ethical consequences of pharmacological memory dampening: the case of sexual assault. The Journal of Law, Medicine & Ethics, 41(4), 859-871.

Kukkonen, N., & Sharifullin, R. (2017). Nursing Interventions for Post-Traumatic Stress Disorder: A Narrative Literature Review.

Parry, S., Lloyd, M., & Simpson, J. (2018). “It’s not like you have PSTD with a touch of dissociation”: Understanding dissociative identity disorder through first person accounts. European Journal of Trauma & Dissociation, 2(1), 31-38.

Rothschild, A. J. (2003). Challenges in the treatment of depression with psychotic features. Biological psychiatry, 53(8), 680-690.

Sier, G. J. (2015). U.S. Patent Application No. 14/550,986.

Schultz, D. P., & Schultz, S. E. (2015). A history of modern psychology. Cengage Learning.

Verma, P. (2017). Golden Circle (Doctoral dissertation, California State University, Long Beach).

Wimalawansa, S. (2014). Mechanisms of developing post-traumatic stress disorder: new targets for drug development and other potential interventions. CNS & Neurological Disorders-Drug Targets (Formerly Current Drug Targets-CNS & Neurological Disorders), 13(5), 807-816.

Rhoades, D., Beiter, R., Nash, R., McCrady, M., Linscomb, M., Clarahan, M., & Sammut, S. (2015). The prevalence and correlates of depression, anxiety, and stress in a sample of college students. Journal of affective disorders, 173, 90-96.

Moffitt, T. E., Houts, R., Asherson, P., Belsky, D. W., Corcoran, D. L., Hammerle, M., … & Poulton, R. (2015). Is adult ADHD a childhood-onset neurodevelopmental disorder? Evidence from a four-decade longitudinal cohort study. American Journal of Psychiatry, 172(10), 967-977.