Missouri Nurse Winter 2022/2023

unwillingness to subject oneself to the type of environment that prevails in nursing. The trauma of COVID, caring for patients who had to suffer and often die alone, and working without enough help highlighted the need for us to better prepare our students for the profession (Goddard et al., 2021). Research on brain science over the past 25 years has improved our understanding of how our brains process trauma. It is important [and possible] to learn ways of letting our brains know that our body is ok. To do so requires a deeper understanding of the effects of trauma (Van der Kolk, 2014). Did you know that people who choose nursing as a profession are more likely than the general population to have past trauma? Personal trauma, combined with the trauma of others, can cause a negative shift in the way we make decisions and solve problems (Felitti et al., 1998). Being trauma-informed means that we understand how to take care of ourselves to avoid compassion fatigue, burnout, or worse--leaving the profession altogether (Missouri Department of Mental Health, 2019). When we are stressed out, either from a traumatic event or from chronic activation of our adrenals, the brain prepares our body for fight or flight. The work of nursing can activate this… day after day, week after week, year after year. Eventually, the prefrontal cortex, the part of our brain that makes good decisions, grows weaker. Simultaneously, the amygdala, the brain center responsible for warning us of danger, strengthens. It becomes the control center, rather than our ‘wise leader’, the prefrontal cortex; therefore, we stay in a chronic stress state, and we lose the ability to effectively self-regulate our emotions. This repeated trauma can cause our response to seemingly small triggers to be out of context with reality (Arnsten et al., 2014). Rear Admiral Aisha Mix, Assistant Surgeon General and CNO of the

USPHS encourages nurses to “become your own priority.” (Turner, 2022). We may seem like the lowest priority when others are counting on us. We channel everything we have into our work and manage to keep our careers afloat, allowing our personal lives to suffer. We, and our loved ones deserve better. The following are some simple, easy tools you can use to feel more grounded and let your brain know you are ok. Practice these techniques when you feel happy, calm, and content. Then, when you feel anxious, overwhelmed, or fearful, you can pull from your stress toolbox, regulate your body temperature, and slow your heart rate. Your brain will sense peace and you will be more likely to feel safe in the moment: 1. Breathe. That’s it. Just breathe. In through the nose and out through the mouth, elongating each breath as you count to four. Do this four times as you visualize building each side of a box. 2. Imagine your emotions when you feel something coming that you don’t want to feel. Start by naming it. Say to yourself, I am feeling anxious, or I am feeling frightened. Imagine those feelings like waves in the ocean. You can’t stop a wave from coming toward you. Don’t try to get rid of the emotion or push it away. Don’t block or suppress it. Alternatively, don’t hold onto it or amplify it. Recognize it for what it is and ride the wave. It will soon be gone. 3. Relax the muscles in your face, from your forehead down to your jaw and chin. Allow the corners of your mouth to turn up ever so slightly. Adopt a peaceful facial expression. 4. Drink ice water or rub an ice cube on your face, along your arm, or on your chest. 5. Take a short walk. Find any way to move your body intentionally.

6. Savor a scent you love and that gives you comfort. 7. Think in categories. Choose something like “football teams”, “musical instruments” or “colors”. Set a timer and mentally list as many things from each category as you can. 8. Count backward from 100. 9. Recite a poem, song, or book passage quietly to yourself or in your head. 10. Practice self-kindness by repeating compassionate phrases to yourself: “You’re having a rough time, but you’ll make it through.” “You’re trying hard and you’re doing your best (ANA, 2022).” Take the time to take care of yourself and “become your own priority”! You may find that you have more reserve to give to those you care about and for. American Nurses Association [ANA]. (2022). Health and Safety. Combatting stress: Health reduction techniques every nurse should try . https://www.nursingworld.org/practice-policy/work environment/health-safety/combating-stress/ Arnsten, A. F., Raskind, M. A., Taylor, F. B., & Connor, D. F. (2015). The Effects of Stress Exposure on Prefrontal Cortex: Translating Basic Research into Successful Treatments for Post-Traumatic Stress Disorder. Neurobiology of stress , 1, 89–99. https://doi. org/10.1016/j.ynstr.2014.10.002 Felitti, V.J., Anda, R.F., Nordenberg, R., Williamson, D.F., Spitz, A.M., Edwards, V., Koss, M.P., & Marks, J.S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine, 14 (4), 245-258. https://doi.org/10.1016/ S0749-3797(98)00017-8 Goddard, A., Jones, R. W., Esposito, D., & Janicek, E. (2021). Trauma informed education in nursing: A call for action. Nurse Education Today, 101 , Article 104880. https://doi.org/10.1016/j. nedt.2021.104880 Missouri Department of Mental Health. (2019). Missouri model: A Developmental Framework for Trauma Informed Approaches . Missouri Department of Mental Health and Partners. https:// dmh.mo.gov/media/pdf/missouri-model-developmental framework-trauma-informed-approaches Peterson, B. (January 15, 2019). The ‘Miracle on the Hudson’ Flight: 8 Things You Might Not Know, a Decade Later. Condé Nast Traveler. https://www.cntraveler.com/story/the-miracle-on the-hudson-flight-things-you-might-not-know Turner, B. (2022, August 1). Healthcare worker burnout: ‘Become your own priority’. Modern Healthcare . http://bi.gale. com/essentials/article/GALE|A712522932 /b0071fa3342078c5d71c37902a64b048?u=morenetswmstu References

Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma . Viking.

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