Sustained maladaptive response to a traumatic, overwhelming event

• Diminished ego strength
• Environment not conducive to needs
• Exaggerated sense of responsibility
• Inadequate social support network

• Depressive disorder
• Dissociative amnesia
• Phobic disorders

• Age
• Gender
• Education level
• History and circumstances of accident or trauma
• Patient's perception of event
• Physical injuries sustained, including cardiopulmonary, musculoskeletal, genitourinary, and integumentary
• Neurologic status
• Emotional reactions, including grief reaction, self-concept, and sleep pattern
• Cognitive reactions, including concentration, memory, and orientation
• Behavioral reactions, including available support systems, clergy, coping patterns, family members, problem-solving ability, and social interactions
• Available support systems

• Disrupted thought processes (00493)
• Excessive anxiety (00400)
• Excessive fear (00390)
• Impaired decision-making (00429)
• Impaired mood regulation (00241)
• Impaired resilience (00210)
• Impaired sexual function (00386)
• Inadequate self-compassion (00325)
• Ineffective sleep pattern (00337)
• Maladaptive coping (00405)

• Patient will recover or be rehabilitated from physical injuries to the extent possible.
• Patient will state feelings and fears related to traumatic accident or event.
• Patient will express feelings of anger, blame, fear, and guilt.
• Patient will express feelings of safety.
• Patient will use available support systems.
• Patient will use effective coping mechanisms to reduce fear.
• Patient will mobilize support systems and professional resources, as needed.
• Patient will maintain or reestablish adaptive social interactions with family members.

Suggested NOC Outcomes

• Follow the medical regimen to manage physical injuries. Attention to physical needs supports healing of the body.
• Monitor mental status, reorienting patient to surroundings and interpreting reality as often as necessary, to alleviate psychic numbing, a characteristic symptom of assault.
• Instruct patient in at least one fear-reducing behavior, such as seeking support from others when frightened, to help the patient gain a sense of mastery over the current situation.
• Provide emotional support:
  • Visit patient frequently to reduce patient's fear of being alone.
  • Be available to listen to respond empathetically to patient's feelings.
  • Accept and encourage the statement of patient's feelings to reassure patient that feelings are appropriate and valid.
  • Assure patient of personal safety, and take the measures needed to ensure it. Frequent nightmares or flashbacks may cause patient to question the safety of his or her environment.
  • Avoid care-related activities or environmental stimuli that may intensify symptoms associated with trauma (loud noises, bright lights, abrupt entrances into patient's room, or painful procedures or treatment). Environmental stimuli can easily intensify flashbacks to a traumatic event.
  • Reorient patient to surroundings and reality as frequently as necessary. Post-trauma psychic numbing impairs orientation, memory, and reality perception.
  • Instruct patient in at least one fear-reducing behavior such as seeking support from others when frightened. As patient learns to reduce fears, coping skills will increase.
• Support patient's family members:
  • Provide time for them to express feelings.
  • Help family understand patient's reactions. This reduces their anxiety and gives them a chance to help patient.
• Offer referrals to other support persons or groups, including clergy, mental health professionals, and trauma support groups. Referrals help patient to regain a sense of universality, reduce isolation, share fears, and deal constructively with feelings.
• Recognize that patient's culture may affect patient's response to trauma; remain supportive and nonjudgmental to show your support for and acceptance of patient's response to trauma.
• Help patient identify support persons who can be trusted, such as a therapist, clergy person, or school nurse, to help prevent further episodes of violence.
• Make appropriate referrals to mental health professionals and social service agencies to ensure the patient's safety in the community.

Suggested NIC Interventions

• Patient resumes usual activities of daily living to extent possible.
• Patient expresses feelings associated with traumatic event.
• Patient expresses feelings of anger, blame, fear, and guilt.
• Patient expresses feeling of safety.
• Patient interacts with supportive people to alleviate distress.
• Patient demonstrates use of at least one fear-reducing behavior (specify).
• Patient interacts with family members in beneficial manner.

• Patient's perception of traumatic event
• Observations of patient's behavior
• Observations of patient's social interaction with others
• Interventions
• Patient's responses to nursing interventions
• Referrals to other support persons or groups
• Evaluations for expected outcomes

• Bonnan-White, J., Hetzel-Riggin, M. D., Diamond-Welch, B. K., & Tollini, C. (2018). “You blame me, therefore I blame me”: The importance of first disclosure partner responses on trauma-related cognitions and distress. Journal of Interpersonal Violence, 33(8), 1260-1286. doi:10.1177/0886260515615141
• Cascio, K. A. (2019). Providing trauma-informed care to women exiting prostitution: assessing programmatic responses to severe trauma. Journal of Trauma & Dissociation, 20(1), 100-113. doi:10.1080/15299732.2018.1502713
• Frost, R., Hyland, P., McCarthy, A., Halpin, R., Shevlin, M., & Murphy, J. (2019). The complexity of trauma exposure and response: Profiling PTSD and CPTSD among a refugee sample. Psychological Trauma: Theory, Research, Practice & Policy, 11(2), 165-175. doi:10.1037/tra0000408