Paul T. Clements

Children's responses to family member homicide.

Homicide is a significant behavioral deviation resulting in a sudden and unexpected loss of life and can leave children in the chaotic wake. Interviews conducted with 13 children ages 9 to 11 years during the initial 1 to 3 months after a family homicide provided insight into themes of bereavement. A major finding in the study was that the witnessing or hearing the news of a family member homicide was a powerful associative factor for childhood posttraumatic stress disorder (PTSD) and for complicated bereavement.

Examining Childhood Bullying and Adolescent Suicide: Implications for School Nurses

Adolescent suicide is a preventable tragedy yet is still the third leading cause of death in young people of age 10–24. Contrary to the idea that childhood bullying is a normal part of growing up or a rite of passage, it is now correlated with adolescent suicidality. An integrative review of the contemporary, extant literature was conducted to examine the following question: Are adolescents who have been involved in childhood bullying or cyberbullying as victim, offender, or victim/offender at greater risk for suicidality than those who have not. It is important to empower school nurses with current and evidence-based information regarding childhood bullying and examine empirical science and tools to effectively address the current serious problem of adolescent suicide risk assessment and intervention.

Biology of Memory and Childhood Trauma

Examples have been presented of childrens behaviors that demonstrate the trauma-learning pattern of re-enactment, repetition, and displacement. They become persistent parts of the symptom complex of PTSD. The encapsulation phase occurs when the trauma event occurs and symptoms present themselves, but the events as yet are undisclosed. The trauma-specific behavior patterns, the general hyper-arousal symptoms, and the avoidant, numbing symptoms persist; the emerging disruptive behaviors are not linked to the traumatic event and reactions to the trauma. The response of the childs social and interpersonal context to the internalizing or externalizing behaviors post-trauma, continue shaping the internal cognitive schema of the child. When the child is unable to link ongoing, self-defeating, disruptive behavior to trauma experience, the underlying fear persists. This interferes with the childs ability to modulate emotions either through altering the persistence of refractory, self-limiting cognitive schema or the inability to use new experience to develop and grow. The flexibility of children to discriminate new information may be lost; the children are either numb to new information or hyperalert and perceive danger. Issues for treatment include childrens distress over memories of the trauma and the lack of capacity to learn and develop from new interpersonal experiences. It has been our experience that nurses first must help the child relearn flexibility through self-observation, the element of self-soothing and calming behaviors, processing of new information, and strengthening of social relationships. With new and strengthened personal resources, the child then is able to begin to process the traumatic memories.

GRIEF IN THE SHADOWS: EXPLORING LOSS AND BEREAVEMENT IN PEOPLE WITH DEVELOPMENTAL DISABILITIES

A greater understanding of how developmentally disabled people cope with loss and bereavement is needed to improve assessment and intervention for these individuals. Misconceptions exist about how effectively developmentally disabled persons can articulate their perceptions and feelings about traumatic experiences, death, and the subsequent impact of the events that follow. The lived experience and expression of grief may differ for the developmentally disabled population. As a result, their reactions may not be adequately recognized, interpreted, or managed therapeutically, compounding their distress. Three case reports of developmentally disabled individuals who experienced a loss are presented, along with helpful guidelines regarding assessment and intervention.

When, catastrophe happens. Assessment and intervention after sudden traumatic death.

The goals of grief after sudden traumatic death is to acknowledge the loss, identify the changes the loss will have in the co-victims life, and reinvest in life within the new structure. Although these goals seem simple, there is no definitive timeline for when these tasks will be engaged and completed by each of the family members. The pathway and time frame for each co-victim may differ.

Persons with developmental disabilities exposed to interpersonal violence and crime: strategies and guidance for assessment

PURPOSE Persons with developmental disabilities are frequently exposed to interpersonal violence and crime, directed at themselves and others, and are in need of specific interventions tailored to their unique needs. CONCLUSIONS What may be different in comparison to other survivors are the:ways therapeutic interventions are adapted so that fears and ongoing concerns can be effectively expressed and addressed. PRACTICE IMPLICATIONS Persons with developmental disabilities may benefit from a variety of interventions in the treatment of intrapsychic trauma after exposure to interpersonal violence and crime.

Talking as a primary method of peer defusing for military personnel exposed to combat trauma.

1. Humanitarian relief missions and military operations are unquestionably stressful and clearly have potential to affect the mental health of soldiers. 2. After being exposed to traumatic events, soldiers may develop acute stress reactions, a historically known phenomenon better recognized and understood today. 3. Although organized resources exist, they may not be accessible or appropriate. Soldiers are the most precious asset the military forces have and their peers may be the best and only resource available to them. 4. The need to ventilate and the relief that follows after talking about distressing events are evidence that defusing by talking should be encouraged after exposure to a traumatic event.

Patterns of Knowing as a Foundation for Action-Sensitive Pedagogy

Graduate students in the health sciences often juggle full-time careers, demanding programs of study, and family responsibilities. Frustration, a perception of limited caring on the part of role models, and a sense of disengagement, or even despair, are common features of postbaccalaureate study for many of them. Nursing has long recognized the value of multiple perspectives in knowledge development. Previous work involving patterns of knowing not only has advanced the disciplinary knowledge base but has also encouraged innovative applications of the patterns to philosophy, evidence-based practice, and research aimed at reducing health disparities. In an effort to both extend the dialogue about ways of knowing and humanize the experience of graduate education for nursing students, the authors propose six patterns of knowing as a foundation for effective, action-sensitive pedagogy.

War, terrorism, and children.

Many caregivers are encountering the issue of communicating with children and adolescents about current world events, specifically war and terrorism. As health care providers, it is important to raise awareness of how children may understand, interpret, and respond to related fears and concerns. Although honesty and reassurance are clearly the best approach, it is important to provide information that is developmentally appropriate. Providing education and guidance can reduce stress and enhance understanding of the chaotic events confronting our nation. It also provides a platform for communication and exploration should additional terrorist attacks or acts of war occur. It is important to examine how to approach children and adolescents to communicate with them about these sensitive issues.

Shaken baby syndrome: assessment, intervention, and prevention

Child abuse and neglect continue to be parts of a disturbing reality in both the United States and the world. Despite significant advances in the identification and treatment of child abuse, health care professionals are still attempting to grasp the extent of the physiological and psychological effects of child maltreatment and injury. Child abuse, in all of its forms, is preventable, and more must be done to decrease its incidence. Shaken baby syndrome is one of the most deadly and devastating forms of child abuse and is characterized by a traumatic brain injury caused by the violent shaking of an infant. Recognition of high-risk families, combined with education of parents and other caregivers are key to prevention of shaken baby syndrome.This quality improvement project provided a descriptive analysis of the patient population that received integrated mental and physical health care at Old Town Clinic, and evaluated patient and staff satisfaction with this model of care. Seventy-three patients and seven staff members were surveyed, using two satisfaction surveys distributed in January 2003. Survey data revealed that the majority of Old Town Clinic patients were homeless. Patients indicated high levels of satisfaction with the clinics location, ease of accessing care, and health promotion and illness prevention education. Staff satisfaction with this model of care was reported to be moderate regarding accessibility, response time, communication, support, treatment, completeness of care, and education. Recommendations for further research and implications for practice are offered.