key: cord-0835232-ipm36go5 authors: Fowler, Karen; Wholeben, Melissa title: COVID-19: Outcomes for trauma-impacted nurses and nursing students date: 2020-07-07 journal: Nurse Educ Today DOI: 10.1016/j.nedt.2020.104525 sha: dae6e0f555e45596161acbc04b37cbb8246f4363 doc_id: 835232 cord_uid: ipm36go5 nan Suppose you wake up one day, and all your plans are hindered, postponed, and potentially suspended. Your future, the future of your family, and life as you know it is changed. Although the COVID-19 pandemic did not occur overnight, the impact on nursing and nursing education appeared to have happened abruptly. During the pandemic, nurses and nursing students voiced concern for themselves, families, patients, communities, and the future (McClunie-Trust, 2020) . The actions taken to flatten the curve can have an unprecedented impact on a specific sect of nurses and nursing students who have been survivors of trauma or acute childhood experiences (ACE). Nurses and nursing students as individuals are not immune to traumatic experiences in their formative years. Nursing school is a high stake, stressful environment, and the opportunity to be re-traumatized is high. In addition, cognitive processes impact students who have experienced ACE events. Conversely, practicing professional nurses will be exposed to highstress events, such as death, patient trauma, and COVID-19, which has the potential to retraumatize the nurse and influence the care provided. Nursing is a people-oriented career. Whether nurses are providing care to patients or nursing faculty, educating the next generation of nurses, people are involved. The certainty of nurses connecting with people assures that some will display behaviors and actions based on J o u r n a l P r e -p r o o f linked to unfavorable physical and social outcomes as an adult. ACEs have dose-related effects on adult well-being, indicating more events, the greater the effect (Keesler, 2018) . The more adverse events, the higher the risk to adult well-being. There are significant neurological, physiological, psychological, and cognitive effects of chronic exposure to trauma (McConnico et al., 2016) . The neuroscientific underpinnings related to individuals subjected to traumatic experiences as a child has cumulative effects on the person as an adult. Nurses and nursing students who have experienced ACE events have overcome some of the impacts by achieving a level of success required for nursing. However, exposure to the circumstances present during the COVID-19 pandemic may predispose this sect of nurses and nursing students to retraumatization. High-stress events are often triggers for re-traumatization (Franic et al., 2014) . COVID-19 pandemic responses included sheltering at home, closing business, social distancing, selfquarantine, and disruption in schools. The uncertainty and fear produced anxiety for most. For nurses and nursing students who are survivors of ACE events, the ability to cope may be compromised. A case study conducted by Franic et al. (2014) found that fifteen years after a traumatic event was experienced, intense emotions and feelings triggered psychological disruption in the person. The provision of Trauma-informed care has been reported to yield many benefits for nurses. In one study, a Trauma-informed approach taken by nurses within their practice enhanced job satisfaction, reduced risk for burnout, and improved patient experiences and outcomes (Schulman & Menschner, 2018) . Hospitals and other health care organizations that employ nurses would be ideal locations for setting up nursing task forces that would facilitate Trauma-informed care practices. Representatives from each facility unit would be trained to J o u r n a l P r e -p r o o f serve on the task force and they would monitor their respective units for factors that affect job satisfaction, staff stress levels, and burnout. In addition, they would also assess patient satisfaction scores to determine what kind of interventions are needed to improve nursing care. Taskforce members would be considered "super users" and would provide anticipatory guidance if there were any noted personal concerns among nurses, and would provide the resources needed to support them, such as debriefing sessions. The implementation of a Trauma-informed care task force may potentially prompt discussions about ACEs and other trauma components that would help to destigmatize the conversations about stressors that have a significant impact on mental health and well-being. With higher education, it is crucial to not only provide guidance and training to students regarding their nursing practice but also to support them in times of crisis. With the emergence of the COVID 19 pandemic, students may have been placed in a position to choose between the safety of family and pursuing careers. Nursing schools should have policies and procedures in place to protect the students and the faculty as they navigate through the myriad of challenges resulting from major life events. Policies outlining alternative plans to facilitate completion of academic requirements by students during stressful life events would minimize hardships inherent to difficult circumstances. These protocols would have tools in place to assess both the students' and faculty members' stress levels and coping abilities. Within specific parameters, J o u r n a l P r e -p r o o f  Train nurses/students in traumainformed care  Educate on stress reducing strategies for both personal and professional stress  Set up hospital and nursing faculty task forces to facilitate trauma-informed practices  Implementation of "super-users" both in nursing and among nursing students  Support nurses and students during crises  Alternative plans for course completion What Strategies Do the Nurses Apply to Cope With Job Stress? A Qualitative Study. Global journal of health science REPRINT OF: Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study Mixed dissociative states in a combat PTSD patient triggered by re-traumatisation 15 years after the traumatic war experiencecase report Neuroimaging of child abuse: A critical review Adverse childhood experience among direct support professionals Recalling stress and trauma in the workplace: A qualitative study of pediatric nurses Effects of a Brief Mindfulness Intervention on Potential impacts of COVID-19 pandemic: What will happen to nursing after the pandemic? Kai Tiaki A framework for traumasensitive schools Laying the Groundwork for Trauma-Informed Care SAMHSA's concept of trauma and guidance for a trauma-informed approach