In the year and a half I worked in that department, I learned more about medicine, human rights, patients’ responses to loss, and the ambivalent relationships of medical personnel than throughout my entire medical work history and career as a nurse.

Although I later moved on to direct care positions in multiple departments (OB and surgery, Mother/Baby/PP, Med-Surg, Trauma), the emergency room experience was my formal introduction to many foundational aspects of the medical environment, especially regarding the unaddressed conflict in the relationships between the differing roles of providers in medicine.

The main concerning dynamic I observed was that nurses were generally dismissed and disregarded by many physicians, as both professionals and as necessary components in the practise of medicine.

In my experience as a professional, this aspect has still not changed over time and spans throughout all specialties in medicine.

When I became a nurse in the year 2000, I was no longer just the observer of adverse or lack of communication toward nurses from physicians or the frequent poor treatment of physicians toward nurses. I became the receiver of both.

Nursing Expertise Is Still Mostly Misunderstood

Many physicians do not see the nursing staff as an imperative extension of their own care and knowledge. Many are unaware of what most nurses do and how much they know. They do, in fact, just expect their orders to be carried out and quite often neglect to understand the gap that nurses must close from orders of care to implementation of care and then to continued follow-up of care. The latter two skills are what create and sustain patient health and wellness.

Nursing responsibilities, experience and skills remain a neglected and misunderstood facet of healthcare. Most lay people see nurses as the medical personnel carrying out their doctor’s orders, making the necessary calls to patients and hopefully, effectively understanding the medical reasoning and intricacies behind the care and information they are delivering.

However, true nursing goes beyond this.

Learning to regurgitate orders and instructions is not what gets a good nurse through school or what keeps his/her patients alive. Critical thinking, research, and observation while responding appropriately in and to emergent, acute, and chronic situations, listening when no one thinks we are listening, and knowing when the wrong medicine or treatment has been ordered or recommended are.

The doctor will not go to jail if the nurse gives an inaccurately ordered medication, resulting in an adverse event or fatality; it is the nurse.

We are, first and foremost, the buffer between a physician and his patient.

And both patients and physicians need this.

What Effective Nursing Offers To Physicians’ Care of Their Patients

Good nurses listen to their patients and have a knack, not just the training for, for excellent triage. Body language tells more than a patient’s report. Patients’ verbal reports must be delicately and discreetly screened for hidden information that is critical in many cases, to appropriate safe care and orders. Nurses hone in on things not said, or that are mis/underrepresented, which often results in a totally different approach to treatment than at first written.

Nurses’ bedside experience yields a wealth of information and patient history that frequently change the initially documented needs and treatment of the patient’s condition. The following are some common examples: (Note that global and national MyChart EMR records now give access to patient medical information and have greatly improved providers’ knowledge of documented patient information.)

1. A patient comes into the emergency room or the clinic reporting a “terrible headache” and is nauseated and dizzy but denies a history of hypertension. Vital signs reveal a dangerously high pressure, but the patient defines themselves as non-hypertensive because they are normally prescribed hypertensive medications, so they consider themselves “cured.” This is a much more common thought process than is understood, especially for elders.

Further nursing triage reveals that the patient is “between” PCPs (very often this is code for the patient’s dislike for their previous one and so they just quit going to visits) and the patient has been out of their medication for two months (due to an inability to cover changing Medicare/other insurance costs). This knowledge prevents the ordering of further hypertensive medications (for perceived acute/undiagnosed episodes) by the ER physician or urgent care clinic doctor which could cause a dangerous drug interaction and/or overdose because the patient is very likely to refill the original medication as well at a later date. This is another common problem among elderly patients, especially. Gaining a full picture of the patient’s circumstances in this situation will also predicate running lab tests which may have not been ordered otherwise or ordered differently. This would offer additional insight to the patient’s current cardiac and renal status/risk in association with current signs and symptoms.

Nursing also contacts the inhouse social worker to assist the patient in funding available to cover the cost of medications and to elicit a list of PCP’s in the immediate area that take patient’s insurance (this is providing SW is as thorough as expected.) Nursing also provides a follow up call a few days after the visit to ensure that patient has had their needs addressed.

2. Patient presents with guarded abdominal pain. Their eyes are dark, their pupils pinpoint, and they are jittery and talking fast. The nurse notices skin irritations and sores and a “slack jaw” appearance in the patient. Many physicians immediately write this patient off as an addict, document “drug-seeking behaviour” as cause for visit and stop there. This has been both my personal and professional experience. Given the patient’s appearance which concurs with heroin/meth addiction, this may be a correct standing diagnosis. However, there is always more to know and investigate. This patient is a human being in need of care and thorough assessment. The pain the patient complains they have often has another root source besides withdrawal. The nurse notices after the doctor leaves the exam room that the patient winces when standing and limps on the right side. An astute nurse will pull the physician back in and subsequent due diligence medically reveals appendicitis. A life is saved.

*A more frequent finding with patients in addiction is bodily injury due to violence perpetrated against them from the population they associate with. Since shame is a huge factor in this group, the patient will often not divulge a criminal act against them and associated injury is easily missed in assessment.

3. Patient complains of generalized dizziness and imbalance. She mentions that she notices one side of her body seems to be “lagging.’ The neurological “tug” test is performed along with the routine balance test. No present abnormalities are observed, yet the patient insists she is experiencing increasing episodes. Although labs are ordered to check for abnormalities in hydration, glucose, and possible tell-tale results of a recent stroke or myocardial infarction (cardiac enzymes and CRP), they come back normal. As the physician is writing discharge orders for PCP follow-up recommendations, the nurse checks in with the patient.

The patient is sitting with her head down. Her off-handed mumbled comment catches the nurse’s attention. “I feel like I’m literally living in darkness and am scared most of the time.” This comment strongly hints at mental health issues. Adverse mental health conditions that are left untreated will absolutely affect the body (altered stature, weight balance, gait, eye movement, posture, cognitive word halt/jumble.) Upon further assessment, the patient also reveals long-term anxiety-related insomnia, one hallmark (though not entirely definitive) of compromised mental health.

A discussion with the doctor now adds a psych evaluation, a mental health consult to her PCP follow up and community referrals. The patient’s time is not wasted reaching out to the medical community because a nurse made the decision to follow the cornerstone of his/her medical training to observe/listen to the patient. Nurses are taught to observe both the presence and absence of information and body language and many other factors. The picture presented when first meeting a patient is most often just the tip of the iceberg.

The Benefits Of Honoring and Respecting One Another as Providers

When physician and nursing roles support and complement each other’s expertise and knowledge, and each respects the other’s insight and practice, great results occur for patients:

• a much more in-depth picture of the patient’s overall physical and mental health is revealed.
• potential risks and needs that often go unidentified are exposed.
• the patient receives a much more comprehensive, relative treatment plan.
• patient trust in the medical community increases

Better patient health is achieved, and a much-needed deeper level of patient trust in their care team begins to be restored.

Unified medical forces create reliability and safety for all involved.

Patient compliance is directly related to patient trust for their provider.

When physicians respect the nurses they work with and understand that good nursing staff are an immeasurable source of support and diverse medical knowledge, the target of healthcare, patients, benefit the most.

They are why there are doctors and nurses in the first place.

The post How Physicians Benefit From The Experience and Knowledge of Nurses appeared first on Medika Life.

The perpetual fear of being re-harmed or fear of harming others in any way, stemming from child abuse and violence, or any other trauma or issue, can exist either consciously or unconsciously. These particular type of symptoms occur from the compromise or loss of the sense of the goodness/stability of our self and loss of personal and human identity. 

Christina Vaughn

Harm OCD is a common subtype of OCD that causes intrusive, unwanted thoughts, images or urges to harm oneself or others.

My Experience of The Results Of Early Trauma

A Breeding Ground For OCD

After experiencing sexual abuse in 1983 at age 14, I began having symptoms of panic in my everyday life, fight or flight responses that worked to keep me in a constant state of terror and an urgency to try to control my environment.

A few weeks after being sexually abused by a fellow (adult, age 19) student in my high school, I became acutely aware that I had begun aggressively shaking my knee as I sat in each class, distracting myself from the chaos I felt inside. I began to recognize that I felt on edge all the time. I then began making decisions that put me further in harm’s way, such as hanging out with the girls I had met who had also been abused by the same person. Other boys I met in this crowd began to prey on me as well, as the unaddressed vulnerability from trauma often attracted the attention of other abusers.

The most detrimental, long-lasting effect of the abuse that I still struggle with today was the overwhelming feelings of “foreboding” and heaviness (guilt). I had no words or definition for the blanket of dark and suffocating terror that would creep over me.

Upon revealing to my parents what had happened to me, I was guided to my high school counselor for “talking” about the incident and subsequent harmful occurrences in my life.

Tragically, this man had the habit of taking advantage of vulnerable students and further traumatized me and my situation by asking overtly inappropriate sexual questions and making lewd suggestions to me regarding the abuse. This was all said after he got up and locked his office door in that first and only appointment before executing these violations against me.

I received no other help for the abuse nor sought help until recently, 40 years after the original incident of abuse. Manifestations of abuse will erupt sometime, somewhere in life and more so erratic and abstract without therapy.

Symptoms Begin To Manifest

I first experienced a year-long bout with OCD symptoms in 1989 at age 20 during my first pregnancy and for the first year of my newborn son’s life. I can say with confidence that the symptoms evolved with a definition of Postpartum Syndrome. Still, I believe the issue was more related to an initial acute presentation of Harm OCD.

Because of the urgent nature of harmful thoughts, sensations, and impulses toward my newborn, I believed I was a murderer and only told my father what was happening a year after the experience began because I thought I was going to lose control, commit a violent act, and be sent to prison. To me, the threat was very real. The impact remains with me. The overwhelming vulnerability and incredible sense of loss of self-control were tormentous and paralyzing.

Today, I still have strong memories of several other random thought processes related to my children’s safety that occurred in the past 33 years and provoked life-long terror, guilt, and shame.

The ever-present foreboding feelings caused me to almost completely shy away from intimate playtime with my children as they were growing up. I did not know that these feelings I was having were defined as anything except scary. I was terrified of committing a criminal act involuntarily so I just distanced myself in that way.

I saw and felt that it confused and hurt them. I did not know what to do and deeply grieved the loss we were all experiencing and felt such deep sorrow and shame that subsequently drove most of my life decisions forward.

I experienced a second extended bout of intrusive thought processes and symptomatic Harm OCD several years later:

One Thanksgiving holiday, I made plans to travel from our home in Austin, Texas to Dallas to be with family. After many setbacks in the plans, including having the brakes on our car suddenly go out and finagling repairs near a Holiday, we set out. Just before we reached the highway, a commercial truck hit us head-on. My 8-year-old daughter smashed her face into the back of my seat. Everyone was crying and upset, especially me.

All the frustrations of single-parenting and years of being alone in our needs as humans and family void of any support just seemed to capitalize that day emotionally.

Our car was towed, and we went home. I pressed the insurance company for a rental and we went on to Dallas the next day, but not without experiencing a terrifying incident the night of the crash at the kids’ bedtime.

While putting my two youngest children to bed, I turned my head to speak to them and distinctly heard the words with overpowering impulse “Kill them, kill them, now!”

I was startled and terrified. My body had a neuro-receptive response and I felt “shaky” inside and felt the urgent need for immediate cover or safety, but there was none. Again, because I had no reference point or explanation for any of these feelings, I just condemned myself as crazy and innately murderous.

From that point on, I continued to suffer from harmful thoughts, sensations, and impulses for almost 3 years. One particular day, I had enough and as I was driving somewhere I finally verbally “evicted” what I perceived as demons (and there is truth to this) from my life and thoughts. What changed was that I actually shifted my thought processes and decided to “stop believing the problem was character-related” and to “pay them no attention.”

These two belief mindsets are the bedrock of OCD therapy, as I have learned in my extensive research during the last couple of years.

This thought process is challenged constantly in my life with the symptoms and various nuances of OCD and I do not always have victory over it in the moment, but I am aware of its incongruencies, now, at least.

In employing these changes in my attitude toward the thoughts at the time, the intensity of the symptoms was relieved. Although I experienced relapses of them, they were very brief in comparison.

I endured a few more intense encounters over the following years. Notably, it has only been the last year that I have gained any understanding of and even the definition for OCD and how it is intricately connected to the root origins of C-PTSD I see my therapist.

How Can Sexual Abuse show up as (Harm) OCD Symptoms?

The correlation between childhood abuse (and other traumas) and OCD are noted as often congruent occurrences. Although psychotherapy does not directly source the two at this time, it is well-documented that the sudden and invasive loss of one’s personal boundaries works immediately to compromise an individual’s trust of themselves, others, their surroundings, the perception of their safety, and that of others in their world.

These and many other dysregulated responses create an environment of uncertainty in the mind that seeks from conception to reassure itself. Fear becomes a leading emotion, one from which most of life’s subsequent choices are made, including reactions, responses, and emotional states of being. Autonomic body responses (sensations, impulses, unexplained physical symptoms — the feeling that your response to the symptoms is involuntary.) occur and can cause a great deal of confusion concerning one’s personal “desires” vs. OCD symptoms.

The perpetual fear of being re-harmed or fear of harming others in any way, stemming from child abuse and violence, or any other trauma or issue, can exist either consciously or unconsciously. These particular type of symptoms occur from the compromise or loss of the sense of the goodness/stability of our self and loss of personal and human identity.

Unconsciously, there is the question sometimes asked of oneself “If someone could do those things to me, what stops me from doing the same to others?”

This begins a tormentous, scrupulous investigation into one’s innate morals and decency, true intentions in interactions with others, and a condemning defamation of our person.

Convoluted thought processes that occur as the mind tries to make sense of both the trauma experienced and what to do and how to be afterward can produce thoughts focusing on potential similar threats to those we love and others we value, as OCD capitulates many times on the themes and values we hold dearest to us: such as children, family, certain populations (children, parents) reputation, body functions and perception and others.

Feeling like you could harm someone you love or others physically, sexually, or otherwise (this includes children, which is deeply distressing to experience) detaches a person from healthy physical and emotional interactions with those around us.

As we focus on the horror of those type of thoughts we seclude ourselves further emotionally and physically second to the tormenting shame and guilt associated with those thoughts. One can begin to question every physical or emotional encounter, ruminating relentlessly on one’s “true intentions” for touch, especially any response to normal human interactions.

This is crippling and debilitating.

What To Do:

The primary route to wellness in and from Harm OCD is obtaining help. Therapy for Harm OCD and any other OCD theme includes many methods, with ERP showing the most positive and effective treatment.

Obtaining proper intervention prevents and treats the resultant state of mind that can evolve from initial concerning symptoms to the absolute terror, panic, and dark, chaotic existence that can happen from isolation. Trying to “figure it out” on your own will not bring success, the same way a heart attack or a broken leg will not fix itself without proper intervention.

Many people suffer in silence as guilt, shame, and humiliation prevent them from speaking about their OCD experiences. Being human with a creative mind means we are going to encounter bizarre and sometimes problematic mind processes.

You are not crazy, murderous, pedophilic, or losing your sanity. You have OCD and you need help right now.

Disclaimer: This article focuses on the relationship between Harm OCD and (child) sexual abuse. This type of OCD is not specific to an abuse victim of any particular violence and can occur in anyone for many reasons other than abuse. There is always a core fear(s) that needs to be addressed in any subtype of OCD to treat it effectively.

The post How Past Sexual Abuse Can Show Up As (Harm) OCD appeared first on Medika Life.

We want to teach them they do not need to “fit in”, but rather learn to accept who they are, understand their needs and progress into verbalizing and protecting those needs.

What Is Masking?

Masking is defined as “wearing a mask.” This is a coping mechanism that children, and many times, adults on the Autism Spectrum employ to withstand over stimulating and confusing environments.

The results are extremely unhealthy and manifest in various ways.

Especially in young children, it can look like physical, verbal or emotional detachment, a glazed affect, overly compliant behaviour, extreme fatigue, depressive ideology or actions, combative, angry, or exaggerated responses to minor issues, or adult-like backtalk (retortive).

Many parents find these symptoms difficult to verbalize.

In children with ASD, masking is an involuntary response to extreme stress and confusion that occurs when they attempt to meet the demands of their environment, but either do not have the tools to do so or cannot function safely in that environment to begin with (thus degrees on the Spectrum). It can be explained as tangibly putting one’s “presence” on hold, and placing that presence on a parallel dimension to exist next to their peers and/or school staff in a desperate attempt to “get by” without the emotional, mental and physical investment needed. They cannot safely (nor at all, usually) produce these things when their unique needs are not met.

They begin to simply, emotionally “stand by” to observe their present experiences, instead of feeling them, not (properly or at all) processing any reaction, communication or event, because their unique learning and social needs are not being met. They are literally “out of pocket” in their own daily life experience.

Compare their social experiences to watching a movie that is very difficult to follow. At times, you think you understand what is happening on the screen, but repeatedly a scene occurs which appears to you to be out of context to your momentary understanding of the storyline. You then lose your place in the sequence of things all over again. You spend the majority of time during this movie trying to “catch up” and understand what you are looking at. Movements and sounds feel 3D and can be shocking or feel invasive.

“Masking” emerges to support and protect a child’s self and psyche in controlling the multi-faceted internal dysregulation that occurs when he/she attempts to comprehend and respond to their perceived disorderly and demanding surroundings (creating a lack of safe haven).

The need for masking is compounded by environments (like classrooms) which are truly chaotic and disorderly to begin with.

This type of detachment is very painful, confusing and mentally exhausting for them to maintain.

What Causes Masking?

Incidental or chronic exposure to an overstimulating and confusing environment (such as a daily chaotic home environment or the extended hours of a daily school environment) cause negative coping mechanisms and distraught feelings in many children, but for children with Autism Spectrum Disorder there are additional neurological and social alterations that occur with such experiences.

Several necessary learning abilities and functions become compromised and often damaged in these children due to the physical, emotional and social stress occurring in an environment that is not specifically tailored to promote the wellbeing, integration and neurological safety of ASD children. Individual integrative care plans in school are an absolute necessity for their success and safety in their school lives.

Their ability to retain information, understand and respond appropriately to communication (instructions, conversations etc.) and a substantial decreased ability to tolerate any variations in noise level (even when previously acclimating and adjusting to these things through therapies) are further gravely affected.

This creates a fundamental discombobulation of previously compromised processing abilities, a breakdown in accessing cues to self composure and for the processing of events such as social interactions, verbal direction and stimulations, and confidence in “feeling safe.”

A mental and emotional shutdown occurs, necessitating the need to detach to “glide” through the day without engaging any or appropriate feelings about the day’s occurrences/human interactions or appropriating successful responses to such.

My Personal Experience With Masking

Journal excerpt:

It’s quiet today in the car on the way home from school. Watching Charlie in the rearview mirror, I see him sigh deeply as he looks out the window.

“How was school?” I ask. “It’s fine.” he says, without looking at me.

Attempting to briefly engage him again, I ask “What did you do that was fun to you? Did you play with anyone particular in recess?” He responds, frustrated. “I don’t remember, Mom, I told you that.” Most days, he recounts that he “does not remember” his occurrences in school.

This is a coping mechanism that allows him to separate his school environment and his safe home environment. For him, the first must not invade the latter.

Yesterday, Charlie’s response to his day at school was comparatively non-passive. By the time we had walked the 10 feet from the school office at dismissal time to the car, he already had a serious, public meltdown over the day’s swim plan cancellation, which continued intermittently until after 8 pm. Combative behaviour, resisting direction, aggression and backtalk are all common responses to over-stimulation causing the need to mask in school.

I am raising my 6 1/2 year old grandson whose diagnoses include Autism Spectrum Disorder.

Since 18 months old, we have attempted both regular and private daycare, Montessori (worked the best and the longest) and now finally a charter (public) school for his education and introduction to social development.

We have had many negative experiences that left Charlie detached and alienated in the classroom and even physically unsafe as the staff/teachers in the schools refused to follow through on safety and inclusion plans for him. I was not aware until very recently that the responses he had been having in subsequence to the poor care and exclusions he was experiencing was masking.

As a smaller child, he would pull his pants down at home, poke himself with items and generally run around like a madman, unable to properly re-acclimate to the home environment after school. I knew his sensory issues were the source, but I did not connect his (ASD) detached school environment to his behaviour at the time.

Understanding how autistic children respond to society’s idea of “normal” social situations is imperative. ASD children placed in public schools whose environment does not properly recognize nor support neurodivergence (or any sort of divergence from the norm, for that matter) causes these children to develop strenuous coping mechanisms that are exhausting and unhealthy.

Our family’s experience exemplifies this problem.

Practical Ways To Reduce The Effects of Masking At Home To See Your Child Happier and More Content

Reiterating the concept of home as their safe space fosters their belief that they are free to be themselves at home. This builds a reliable, daily source to de-acclimation from both hypo and hyper stimulations and the associated confusion and exhaustion of circumstances outside the home.

The following are effective ways to do this:

• Quiet time with books or drawing (see environment suggestions below)
• (Yes) TV time with time limits. Using an alarm for activities helps them know what to expect and for how long
• Manipulatives to center their nervous system: legos, blocks, both small and large motor skill sensory activities (bead threading, sand play, water play, finger-painting )
• Yoga poses
• Breathing exercises
• Pressure massage to arms, legs, back, chest, shoulders and head (for those who can tolerate touch)
• Tell short stories or read to them as they play
• One on one parent-child time…just sitting or lying on the floor on your backs with them, allowing feelings to flow in the room with quiet, non-judgemental atmosphere, using gentle words and supportive observation.
• ABA therapy (research and monitor this method), PT, OT and ST therapy (separate from the ABA facility.) See this link.
• Counselling: helps them understand their unique diagnosis and responses to stimulation. The goal is to increase their self confidence in their individuality and unique self. This enables them to see themselves as part of the diverse group of children in their environments and not as an “outlier.”

Summary:

Children with sensory challenges and disorders have bodies and nervous systems that do not respond, under-respond or desperately over-respond to “normal” contextual language, body language, and voice tone. They perceive things as concrete literal and cannot decipher a “play on words” or receive teasing or joking in a “normal” healthy way. They cannot process the events occurring around them in linear time.

We can often forget that our ASD children are usually desperately trying to “keep up” with and integrate into their surrounding environment. We want to teach them they do not need to “fit in”, but rather learn to accept who they are, understand their needs and progress into verbalizing and protecting those needs.

Because their self image and confidence build upon the way they see others respond to them, as we all do, they often internalize all responses and begin to feel ostracized and isolated even as they appear to be socializing.

The difference for them is that they cannot control the thought processes of their often dismembered inner dialogue and need help understanding that things are not always as they appear to be. To them, what they see…just is… and they do not know how to process, respond or function in a way that is “accepted by their peers” and the adults around them.

Masking shows up to provide an emotional and neurological “cushion” from the noises, movements, other human responses to their ASD behaviours and thought processes.

We can recognize this phenom and implement loving methods to decrease its stress sources occurring in their daily lives.

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