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Mental Health Nursing · Chapter 6

Redesign the Shift

Trauma-informed care starts from an assumption rather than a screening result: anyone you care for may have a trauma history, and the way care is delivered either supports recovery or reproduces the original dynamics of powerlessness. Re-traumatisation is almost always accidental. Take six completely ordinary moments from one shift and redesign each of them — then sort what you do when a flashback happens.

Six moments on one shift

0 of 6 redesigned

The moment

A flashback in the dayroom

She is staring past you, unresponsive to her own name, breathing fast. She is not remembering the event — she is experiencing it in the present tense. Sort each action.

What that redesign does

Choose a moment to beginEach option is explained after you commit. Notice that in several of these, the wrong answers are not cruel — they are efficient, or kind, or protective. That is exactly why re-traumatisation is usually accidental.

The six principles

Translated to a shift, they sound like this: explain before you touch, tell people what will happen and when, keep every small promise, ask permission, offer real choices even when the options are narrow, and never use force when persuasion has not yet been tried.
Ask the better question. Replace “what is wrong with you?” with “what happened to you?” — and then with “what has helped you get through it?” The third question is the one that finds strengths, and strengths are what the care plan is built from.

How long has it been?

A timeline showing which trauma- and stressor-related diagnosis applies at each interval after an event: psychological first aid in the first days, acute stress disorder from three days to one month, post-traumatic stress disorder beyond one month, adjustment disorder within three months of a stressor, and prolonged grief disorder from twelve months after a death first days acute stress d/o post-traumatic stress disorder adjustment disorder prolonged grief PTSD, delayed expression event3 d1 mo6 mo12 moyears
Pick a person from the row above and the timeline will show which frame applies — and what the nursing response is at that point.