Learning that healing the body isn’t always enough.

For much of my career as a trauma ICU nurse and orthopedic trauma nurse practitioner, I focused on building my knowledge of pathophysiology and mastering the assessment and procedural skills required to care for trauma survivors. After a decade of practice, I felt like I had entered the “expert” phase of clinical competence described by Dr. Patricia Benner in AJN in 1982.

But I was completely ignorant of a giant hole in my practice. A trauma survivor pointed out this gap during a routine clinic visit. Ms. H was six months removed from an ankle fracture she’d suffered in a motor vehicle collision on her way to work one morning. On exam, she had regained full strength and range of motion, the fracture was healed on radiographs, and her pain was limited to a minor ache after extended activity. She’d healed remarkably.

I told her that she had done an excellent job with her recovery and could resume her life, including going to work. I’ve come to believe that Ms. H’s response to this assertion changed my entire perspective on patient care. “I can’t go back to work,” she said. “Since the accident, I can’t get in a car without having panic attacks.”

I was shocked at the realization that I had been unaware of what she was going through, and immediately responded, “I’m so sorry. We haven’t made you better after all.”

Treating the whole person.

Let my experience be a reminder of the need to treat the whole person, including their emotional and psychological needs. I focused solely on her ankle and neglected the rest of her. She spent six months experiencing a distressing psychological effect of her car accident before it was addressed. From that point forward, I incorporated emotional assessments into my clinical interactions. I believe this made me a more complete clinician. My interaction with Ms. H also led me to pursue a program of research examining the symptoms experiences of trauma survivors. I owe her deeply.

Information for nurses on identifying and addressing emotional injuries.

Jeremy Bishop/Unsplash

In the case of trauma survivors, it’s important to remember that while their bodies experienced physical injury, their psyches also experienced the trauma and may have injuries that can’t be seen on physical exam. Anxiety, depression, pain, sleep disturbance, and stressor-related disorders are common among trauma survivors and negatively influence their long-term outcomes. Nurses across the care continuum, from the emergency department to the outpatient clinic, are in the perfect position to identify and address these unseen injuries in trauma survivors.

In this CE article, “Pain and Mental Health Symptoms After Traumatic Orthopedic Injury,” we discuss the presentation and consequences of post-injury symptoms, common screening tools used to identify such symptoms, and pharmacologic and nonpharmacologic treatments.

We hope that our article prepares and empowers you to assess and address these symptoms in your respective patient populations so that nursing care can continue to lead the way in treating the whole person.

Stephen Breazeale is a postdoctoral scholar at the University of Pittsburgh, Pittsburgh, PA.