The Nurse's Role in Supporting Patients and Family in Sharing Personal Accounts of Traumatic Events: A Personal Experience

Donaldson-Andersen, Jill MSN, RN, CNS, CMSRN

Journal of Trauma Nursing:
doi: 10.1097/JTN.0000000000000276
Personal Viewpoint
Abstract

Life-changing events unfold quickly as trauma nurses provide care for patients during the most vulnerable time of their lives. Nurses also bear the weight of simultaneously caring and providing emotional support for the families of trauma victims. Trauma nurses have a profound responsibility to assist patients and families through this process, as well as having a unique opportunity to encourage families to share their personal stories and experiences. On occasion, some high-profile traumas make their way to the local news and inquiries from the media soon follow. The public has an interest in stories related to trauma and a fascination in the reactions of individuals immediately impacted. These stories have value to the public, as they create opportunities for others to learn, examine personal values and social norms, develop new perspectives, and reflect on the fragility and meaning of life. Personal accounts of traumatic life events can be shared privately or publicly, and nurses should be prepared to provide effective interventions and, on occasion, support families faced with weighing the potential risks and benefits of sharing their story with the media.

Author Information

Mission Hospital, Mission Viejo, California.

Correspondence: Jill Donaldson-Andersen, MSN, RN, CNS, CMSRN, Mission Hospital, Mission Viejo, CA 92691 (Jill.donaldson@stjoe.org).

The author declares no conflicts of interest.

Article Outline
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PROLOGUE

Trauma and critical care nurses are naturally drawn to care for others during the most pivotal moments of the human experience. Just before a critical trauma patient arrives, there are times when a nurse will first stop to pause and reflect ... while experiencing a momentary sensation of tingling in the chest, or in pit of the stomach, a feeling that is quickly forgotten and seldom discussed. When a radio call describes an incoming patient as “a child,” “an adult on a bicycle,” or an “MVA on a local highway,” we instinctively begin a mental process of elimination, pulled between the need to know, and a fear of finding out. How often do we linger close to a radio room or telephone or ask for additional clarification in an effort to ensure, to confirm, that our own child, spouse, or friend is safe at home?

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SHARING THE STORY

Humans are naturally driven to engage in sharing their personal stories. Storytelling allows us to preserve and pass on the most epic as well as most trivial life events. Telling stories is also essential to the art of nursing. Stories are influential in how nurses learn, how we teach, and they provide us the anecdotal pearls of evidence to support the care we provide every day. Nurses are also instrumental in engaging patients and families in sharing their experiences. Although nurses routinely encourage patients and their families in storytelling, this highly therapeutic process may not be fully appreciated for its true healing potential. Personal accounts of traumatic life can be shared privately or publicly; yet, however, the story is told, nurses need to know to what degree this process should be facilitated and encouraged. Whether it is a quiet whispered recollection honoring a loved one, a life story written as a narrative, or even as extreme as sharing the worst experience of one's life with the public, the nurse may be the most influential person to listen, help the family cope, and offer support when these opportunities become available. There is much to consider as a nurse and patient advocate. During a process of crisis and coping, nurses have limitless opportunity to engage patients and families in identifying opportunities to tell their stories and manage these situations well. Storytelling is a healing art and may even have a therapeutic effect when the audience is in the magnitude of millions of TV viewers, and I can base this opinion on my own personal experience.

My shift began on a quiet, warm summer weekend afternoon as I was working in the trauma department office as a trauma nurse and a case manager. The telephone rang, and I picked up the receiver and held it to my ear. My husband's voice was on the line, but he could not speak and had difficulty forming words that I could understand. Our conversation was brief, but the impact was life changing. I don't recall what was said, or even the frantic run to the emergency department where a small group of staff had already huddled in the radio room. They looked up toward me as I approached, and we stood together listening to the rapid, static-infused verbal exchanges over the radio. The air was thick with dread and silence as the paramedic reported: “Father found male infant floating in backyard Jacuzzi,” “approximately 5 min,” “pupils fixed and dilated,” “upper extremity posturing,” “assisting respirations with bag-valve-mask.” When the call came to an end, the radio nurse turned in her chair to provide me with a condition report, just as she always did, but all that she could muster when her eyes finally met mine was “they'll be here in 3 min.” I called a pediatric intensive care unit nurse to assist me in the trauma room because I wanted more help with this patient. After all, this patient was my responsibility. He was my 14-month-old son ... and I was about to be his trauma nurse.

When my son arrived in the trauma room, the resuscitation went smoothly, his airway was secured, and I assisted with the intravenous insertion. Once stabilized, he was admitted to the pediatric intensive care unit in stable but critical condition. My husband soon arrived at the hospital, and we were both incredibly overwhelmed, vulnerable, scared, and completely unsure of our son's ultimate prognosis. We sat by his bedside through the long night, never taking our eyes off him while he lay motionless in his sterile hospital crib. When the morning arrived, we were approached by some of my coworkers who had received several messages left by newspaper reporters. Speaking to anyone about what had just happened to our little boy, let alone a reporter, was definitely not a consideration. We silently hoped that the calls would cease, but they did not. As the day progressed, our son's condition began to improve, and by noon he sat up and began to play with all the wires and engage with his two very relieved parents. At that time, I recall the pure relief and began toying with potential positive outcomes of sharing our story. Maybe we could make a difference in someone else's life. Our son was alive and from all appearances doing better, but speaking to the media was uncharted territory and another scary proposition to say the least. Our son's nurse happened to overhear our conversations and neutrally suggested that our sharing our tragedy might serve to help others. We considered her input, entertained the thought, but simultaneously shook our heads in quiet discomfort and immediately put the idea to rest.

The day we arrived home from the hospital with our son, a newspaper reporter was waiting for us in our driveway. He was leaning up against his car with a notepad in hand. Not able to avoid him, I was surprised to find that my husband was eager to engage in conversation with him. I was not. As a nurse, I was accustomed to dealing with the media by dodging sneaky reporters and referring all calls to a marketing department representative. I wanted to run inside my house and hide and was mortified of any publicity regarding the accident. Instead, I had to deal with a husband who eager to talk and share his story. As minutes passed, I found the reporter to be kind and realized quickly that if our story were to be told it should come from us. My husband invited the reporter into our home, and I think he knew that sharing our personal experience would somehow make a difference. Our story appeared on the front page of the several local newspapers just a few days later (Figure 1).

Shortly thereafter, we received another phone call from a representative from the television show “Rescue 911.” Again, my husband was enthusiastic to engage in conversation and I was not. The idea of reliving and reenacting a very personal crisis on television at the same hospital where I worked in front of all of our friends, coworkers, and family to see was terrifying. However, because of my husband's eagerness to participate, I reluctantly agreed. My husband was willing to reenact the scene himself, but I initially declined, so the director casted an actress to play my role. I loaned the actress my scrubs and laboratory coat, and her hair was cut by the staff in a style that closely resembled mine. The “Rescue 911” show is intended to be a reenactment, utilizing the actual members involved, but it was too close to home for me. It was my work, my associates, my husband, my child, my experience, and there was an actress just about to portray a very dramatic interpretation of what I had experienced. As I sat there watching the initial scene unfold, I quickly realized that only I could correctly portray a level-headed trauma nurse in crisis, so I decided to step in to play my part just the way it happened. The long-term outcome? I can't imagine that I was so close to turning down such an important opportunity to share my story, as well as personally advocate drowning prevention by simply participating in a televised reenactment (Figures 2 and 3). The 911 episode is still routinely played for my hospital's infant cardiopulmonary resuscitation course—driving home the fact that tragedies can happen to anyone, even the institution's own trauma nurse.

In the years that have passed, I have recognized how crucial it is for critical care and trauma nurses to provide appropriate intervention and support during similar high-profile traumatic events. Heath care providers are traditionally in the position of educating, providing information and quiet assurances as patients and families struggle to make major life decisions on their own. Nurses may feel unprepared to encourage and stimulate conversation at this time, not understanding that this is exactly what families need. To best support a family's response following a traumatic event, it is important to first understand the concept of crisis and coping on which to base nursing interventions. In addition, suggestions for encouraging storytelling, as well as a framework for helping patients and families appropriately respond to the media, are of great value to any nurse working in critical care and trauma.

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Understanding Crisis and Coping

A situational crisis is unimaginably overwhelming. We see it often in the eyes and expressions of our patients and their loved ones. It appears to be a universal experience; yet, it is very unique to every individual. Crisis has been defined as “the perception or experience of an event or situation as an intolerable difficulty that exceeds the person's current resources and coping mechanisms” (James & Gilliland, 2013). There are many factors that influence how someone perceives a traumatic event, including past experiences, personality, socioeconomic, religious, and cultural elements. Nurses must constantly evaluate and adapt to the needs of patients and families when they are in the midst of a crisis, and providing effective emotional support is key to facilitating a positive outcome.

The origins of crisis theory are often attributed to Lindemann (1944), who identified crisis as a three-phase experience: (1) a period of disequilibrium; (2) a process of working through the problems; and (3) an eventual restoration of equilibrium. If the desired outcome of restoration of equilibrium is achieved, there is a gradual decrease of anxiety and an increase in satisfying experiences. A smooth transition can be facilitated by “finding meaning” through sharing the experience with others. There is compelling evidence that following a crisis, individuals may come to realize their own strengths, have a new appreciation for relationships, and “find meaning” in the face of adversity (Calhoun, Tedeschi, Cann, & Hanks, 2010). Many survivors of traumatic events experience strengthened relationships with others, increased creativity, and a new-found purpose and deeper meaning in their lives (Rendon, 2016). When sharing the experience with others, it is important for family members to tell their stories with as much detail as possible because understanding various versions creates opportunities to appreciate the feelings and experiences of others by building a “healing theory” (Figley & Kiser, 2013). This reframes various views and perspectives, making them manageable and aiding the recovery process. Nurses can assist by increasing interpersonal contact, fostering a sense of optimism, and offering “positive reappraisal” by encouraging family members to identify ways in which the patient's injury helped them grow (Auerbach et al., 2005). The process of healing takes time and may be a long-term goal. However, following a traumatic event, important decisions must be made by family members. Nurses often bear the weight of supporting families to identify opportunities to cope.

Recently, the concept of “posttraumatic growth” has been of interest for researchers. Posttraumatic growth is defined as a “positive psychological change experienced as a result of the struggle with highly challenging life circumstances” (Tedeschi & Calhoun, 2004). It is a complex topic, and although individuals respond and adjust to traumatic events differently, adjustment by means of personal growth can be a potential part of the healing process. Posttraumatic growth is affected by the nature of the event and the way a person views the event (Lancaster, Kloep, Rodriguez, & Weston, 2013). Research indicates that positive change after a trauma is associated with problem-focused acceptance, optimism, religion, cognitive processing, and positive affect (Linley & Joseph, 2004). Tedeschi and Calhoun (1996) studied survivors of many different kinds of trauma and discovered that the majority reported that their lives had changed for the better or they were directed toward life-fulfilling goals. Suffering actually pushed them to adjust, and in the process, they experienced “positive life changes.” Five domains of posttraumatic growth include a greater appreciation for life, closer relationships with others, greater sense of personal strength, recognition of new possibilities, and spiritual change (Tedeschi & Calhoun, 2004). These concepts are important to understand because they add perspective to the “meaning-making need” experienced following a traumatic event. When an individual is struggling to find meaning, the idea of posttraumatic growth shifts the focus from “why did it happen” and instead answers the question “what for?” (Zoellner & Maercker, 2006). For example, individuals who experience growth after trauma may seek out opportunities that add meaning and purpose to their life such as becoming an “expert” and resource to others by offering support, encouragement, and education. Identifying the positive effects of a traumatic event is a coping strategy for trauma victims, and the possibilities are limitless.

Calhoun and Tedeschi (2010) describe a model of “expert companionship” for working with people who have experienced a life crisis. Instead of merely providing comfort or reassurances, an expert companion has “the courage to hear” and is willing to explore beliefs and doubts by listening to unpleasant stories of death, illness, accident, personal violence, and traumatic images that a person carries with him/herself. An expert companion is able to appreciate the many perspectives of the stories told by patients and families while being sensitive to their readiness to consider opportunities for personal growth. Nurses are naturally expert companions and can facilitate the process of “finding meaning” by listening and encouraging the storytelling process.

Storytelling has been used for centuries as a universal and useful coping mechanism. It requires the storyteller to recognize and reflect upon his/her life position that creates opportunities for both the storyteller and the listener to reflect and consider new perspectives. Patients and families find comfort in sharing their feelings and experiences with others, and nurses are in a unique and powerful position to encourage them to tell their story.

In her last days, I needed her caregivers to recognize her value. I told stories about Mom, just briefly, to anyone who had a significant part in her care and wanted to listen. I used the process of story-telling to celebrate the dignity and value of a special human being and to help people look past the aging and illness. (Kunzman, 2000)

Nurses knowingly and unknowingly are fundamental to this very powerful process.

When patients and families are faced with sharing their stories publicly, the risks and benefits must be carefully evaluated. If there is potential benefit of revealing personal accounts of a tragedy with an opportunity to help others, this is a key factor. The notion of promoting awareness and education in an effort to prevent another's misfortune may be very therapeutic. Learning from a traumatic event can be empowering for both patients and families, as this helps place the event in the context of a greater good. However, there may be instances when victims regret their contact with reporters in the days immediately after a disaster. Today's television news is highly focused on our culture's fascination with trauma, victims, and raw human emotion. This leaves the storyteller at risk because it is not a journalist's duty to heal, only an ethical responsibility of a journalist to report accurately with only the obligation to “do no harm” (Simpson & Cote, 2006). Although there are published interviewing techniques for victims of trauma (Brayne, 2007), it is still possible for the most ethical journalism to hurt innocent people. As a rule, most news organizations do not allow interviewees to review a news story prior to publication; however, many reporters allow victims to review the content of a publication and make minor changes that were felt to help the victim (Bonnie & Seymour, 2009). The Dart Center for Journalism & Trauma (Brayne, 2007) recommends including victims and families in the interviewing process by reading back quotes, playing back recorded interviews, and encouraging them to ask questions in order to ensure accuracy of the story. It is extremely important for patients and families to be knowledgeable regarding the risks and benefits associated with sharing their stories with the media.

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Risks and Benefits of Sharing Stories With the Media

Families are sometimes approached within a few hours of a high-profile tragedy. Hospitals can be inundated with calls from the press inquiring about a patient's status and requesting family contact or even press conferences. Both the potentially positive and negative consequences of media coverage should first be explored, clear reasons for choosing to be involved should be established, and according to West (1996), participants “should be encouraged to think about whether or not their expectations can be realistically met” (p. 197).

There are several risks associated with sharing a personal account of a traumatic event with the media. Following exposure in the community, the storyteller's version of the event is no longer viewed as a private personal crisis. This can result in criticism as to how the event was handled and the victim may be blamed, and if culpability is an issue, there may be an unfavorable response from peers or the public (West, 1996). Extended family members can be impacted as well and may experience discomfort with the emotional impact of unwanted media attention. Finally, if the event is inaccurately portrayed or dramatized by a journalist, it cannot be taken back.

The benefits associated with sharing the story with the media include an opportunity to help others by promoting awareness, education, and potentially preventing others from suffering the same misfortune. When the storyteller becomes an expert in a particular life experience or tragedy, this places the trauma in the context of a “greater good” and an opportunity for personal growth. Public storytelling can also offer a chance to celebrate an act of heroism or simply acknowledge a kind act from a bystander who was brave enough to stop and help. Telling the story may help with resolution of the event by putting the story to rest by creating a final and meaningful version that cannot change over time. Victims who have participated in media coverage were found to be motivated by the opportunity to acknowledge and say “thank you” to all involved (West, 1996).

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CONCLUSION

It has been 22 years and our son is now 24 years old. I am certain that sharing our story with the media has made all the difference for our family. We will never know how many near-drowning accidents were prevented or lives saved as a result of speaking with the reporter and reenacting the event on “Rescue 911”; yet, I can honestly say that our family was significantly and positively affected by the experience. It was absolutely the right thing to do. If it were not for my brave husband, I would not have this opportunity to write about the benefits of public storytelling. My husband is truly my pillar of strength and had an amazing, instinctive ability to know that sharing our own story was right thing to do even in the face of crisis. Without him, I would not have this opportunity to say “thank you” to all involved and put my story to rest once again. Retelling it continues to heal me. Next time your patient or family member tells you about a personal account of a traumatic event, be an expert companion with the courage to listen. Be sensitive to their readiness to consider opportunities for personal growth. Help them explore and find a deeper meaning from the experience. There may be a time when you find someone struggling with how to respond to seemingly invasive calls from the media. Remember that storytelling heals, and as outrageous as it sounds, in the right circumstance, sharing one's personal trauma with the world just might be a life-affirming experience.

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KEY POINTS

* A situational crisis is precipitated by a sudden unexpected event in a person's life, which may be experienced as (1) a period of disequilibrium; (2) a process of working through problems; and (3) an eventual restoration of equilibrium. (Lindemann, 1944)

* Nurses can be an “expert companion” by having the “courage to hear,” simply by listening to and helping patients and families explore their beliefs, doubts, and personal accounts. (Calhoun & Tedeschi, 2010)

* By encouraging storytelling among family members, various perspectives are reframed, making the trauma more manageable and aiding in the recovery process. (Figley & Kiser, 2013)

* Storytelling is a useful way to inspire and build rapport with patients and families and provide opportunities to “find meaning” in the face of adversity and opportunities for personal growth. (Calhoun, 2010)

* Many survivors of trauma experience a transformative and meaningful life change by developing a deeper understanding who they are and how they want to live. (Rendon, 2015)

* By fostering a sense of optimism, increasing interpersonal contact, and encouraging family members to identify ways the crisis helped them grow may aid in posttraumatic growth. (Auerbach, et al., 2005; Tedeschi & Calhoun, 2004)

* Nurses are well positioned to help patients and families explore potential risks and benefits of sharing their stories publicly and with the media.

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REFERENCES

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Coping; Crisis; Families; Media; Posttraumatic growth; Storytelling; Trauma

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