CCS NOTES

• Trauma Informed Practice (TIP)


  Apply in practice by learning the definition, purpose and principles
• Trauma Informed Practice (TIP)

  • Improves communication by awareness and reflecting on conversations
• Gender equity


  Equal treatment of all, regardless of gender. No gender discrimination
• Cultural safety


  Recognizing power and resource distribution. Awareness of institutional discrimination
• Cultural humility


  Lifelong learning. Interpersonal respect and reflection
• Health equity


  Elimination of systematic health disparities associated with social advantage & disadvantage
• In Canada, Western medicine is at the forefront and benefits don't cover alternative medicine, leading to discrimination and lack of trust in the healthcare system; the families suffer from consequences
• Types of bias


  • Ethnocentrism - do it my way, because you are wrong
  • Stereotypes - oversimplified image of others / conventional image
  • Discrimination - unjust or prejudice treatment
  • Racism - race discrimination
• To make a change, education allows us to be aware, think about equity guidelines and policy, changes on research, be accountable, and advocate
• Cultural Humility


  • Ensure culturally congruent and equitable care
  • Personal AND professional self-awareness
  • Organizational awareness
  • Community awareness
• Trauma Informed Practice (TIP)

  Closely tied to substance use, mental health, stigma, healthcare access barriers and other challenges
• Purpose of Trauma Informed Practice (TIP)

  • Prevention - prevent more harm & trigger
  • Safety - take down barriers / reduce stigma
• 4 Rs of Trauma Informed Practice (TIP)

  • Realize
  • Recognize
  • Respond
  • Resist
• Principles of Trauma Informed Practice (TIP)

  • Safety
  • Trust & Transparency
  • Peer Support
  • Empowerment, voice & choice
  • Collaboration & mutuality
  • Cultural, Historical & gender issues
• Communication


  Therapeutic relationships, basis for the nursing process, client autonomy, better client outcomes, increases professional credibility
• Levels of Communication


  • Intrapersonal
  • Transpersonal
  • Interpersonal
  • Small group
  • Public
• Communication process


  Sender > message > channel > receiver
• Feedback loop & consider contextual factors
• Metacognition


  Other pieces which affect communication (e.g. actual spoken word (7%), tone (38%), and body language (55%))
• Verbal communication


  • Written
  • Oral
  • Sign language
• Verbal communication


  Definition / denotative & Assigned meaning / connotative, Vocabulary, pacing, tone, brevity, timing, relevance
• Nonverbal communication


  Reinforce, undermine, supplement the verbal communication
• Nonverbal communication


  • Personal appearance
  • Facial expression
  • Posture & gait
  • Eye contact
  • Touch
  • Gestures & sound
  • Personal space
• Personal space and touch


  Intimate (0-1.5 ft), personal (1.5-4 ft), social (4-12 ft), public (12+ ft)
• Elements of Professional Communication

  • Courtesy
  • Use of names
  • Trustworthiness
  • Autonomy and responsibility
  • Assertiveness (use of I)
• Therapeutic Communication Techniques


  • Validating
  • Paraphrase
  • Clarify
  • Summarizing
  • Provide information
• Nontherapeutic Communication Techniques


  • Non validating
  • Automatic
  • False reassurance
  • Passive aggressive
• Barriers or roadblocks to communication


  • Asking personal questions
  • Asking for explanations: why?
  • Giving personal opinions
  • Approval or disapproval
  • Changing the subject
  • Defensive responses
  • Automatic response
  • Passive or aggressive
  • False reassurances
  • Arguing
  • Sympathy
• Strategies for Active Listening

  • Sit facing patient
  • Open posture
  • Lean forward
  • Eye contact
  • Relax
• Open ended questions


  How may I help? Provide more depth in communication
• Close ended questions


  Can I help you? Yes or no questions
• Specific client needs


  • Aphasia - inability to produce/ understand language
  • Cannot speak clearly
  • Cognitively impaired
  • Hearing impaired
  • Visually impaired
  • Touch
  • Unresponsive
  • Speak different language
• Age-specific approach (older adult client needs)

  • Physical and psychosocial
  • Function impacted by disease and disability
  • Decreased homeostasis
  • Lack of standard norms
  • Altered manifestations and response
• 3 Ds


  • Dementia
  • Delirium
  • Depression
• Delirium


  Acute, reversible state of disorientation, inattention, and confusion, rapid onset (hrs - days), increased prevalence with age & likely to occur in acute care settings
• Signs and symptoms of delirium


  • Confused/disoriented
  • Visual hallucinations (auditory sometimes)
  • Difficulty thinking/ focusing attention
  • Behavior or personality different than usual
  • No sense of time (whether it's day/night)
  • Drift between sleep and awake
  • More alert or more tired
• Causes of delirium (PRISME)

  • Pain / psychosocial
  • Restraint / retention
  • Infection/ impaction/ impaired cognition / intake oral
  • Sleep disturbance/ sensory change/ social isolation
  • Medication / metabolic / mobility
  • Environment
• Delirium can lead to poor outcomes like falls, injury, low sodium, impaction, increased length of stay, and death
• Management of delirium


  • Find treatment and underlying cause
  • Include family and friends
  • Keep client routine as simple as possible
  • Keep environment good
  • Encourage health eating and promote drinking fluids
  • Keep sentences basic
  • Make sure have their aids
  • Do not argue
• Dementia


  Broad term for a set of symptoms that affect the brain, generalized impairment of intellectual functioning or gradual deterioration