From left to right: Michael Lewis, case manager, BRAVE; Illana Perlman, social worker, Tory Trauma Program; and Dr. Avery Nathens, surgeon-in-chief at Sunnybrook.

The repeat experience of injuries resulting from gun- or stabbing-related incidents is often the result of unmet social needs.

“We see it time and again where a patient is treated for a minor gunshot wound and then returns with a more severe injury from another shooting incident,” says Dr. Avery Nathens, medical director of Sunnybrook’s Tory Trauma Program. “We have an opportunity to intervene and prevent the second injury that may end – or significantly change – the patient’s life forever.”

Patients who experience the physical and psychological impact of violence can benefit from a hospital-based violence intervention program and approach that incorporates trauma-informed care with traditional medical care. Such programs are proven effective in reducing risk factors and optimizing the outcomes of young people negatively affected by community violence.

The Tory Trauma Program, under Trauma Services Manager Corey Freedman, launched Breaking the Cycle of Violence with Empathy (BRAVE) in October 2020. BRAVE supports people aged 17 to 30 who have been treated for a gun or stabbing injury by connecting them to a case manager to support them through their recovery for approximately six months.

“BRAVE uses the ‘teachable moment’ approach to intervene early and support the patient’s overall physical, social and psychological needs,” says Brandy Tanenbaum, injury prevention coordinator at Sunnybrook, who designed BRAVE based on models out of San Francisco and other U.S. cities.

With shooting incidents in Toronto doubling since 2014 and Sunnybrook seeing a rise in the number of violent injury patients, Dr. Nathens and Tanenbaum recognized an urgent need for this kind of program. A $100,000 grant from the City of Toronto to run BRAVE as a one-year pilot made it possible.

The BRAVE journey begins with patients still in recovery. They are visited by Michael Lewis, the program’s case manager, who brings extensive experience in community youth violence prevention. He is able to develop a rapport with patients and their families who are often looking for additional support, but do not know how to find it. Lewis continues his work after discharge by visiting patients as they continue their recovery in rehab or at home. In these visits, he learns about the patients’ circumstances.

“I get to know the patients as people and understand what their needs and goals are and begin to develop a case plan to implement over time as they are ready,” Lewis says.

Through conversations, Lewis is able to assess patients’ needs and start connecting them and their family with services. Connections can include victim services, peer support, education counselling, mental health and addiction services and more. Most important is the mentorship Lewis provides to the young patients, without the judgment or bias so often experienced by this patient population.

Support can look different for different patients, says Lewis. He recalls one young man with numerous gunshot wounds who was recovering very slowly and kept losing weight. With BRAVE, the patient was supported throughout his physical and psychological recovery. “Now back home and getting stronger, that young man has plans to study engineering,” Lewis adds.

Lewis says his job is to provide an empathetic ear, help people connect to services and nudge them to move ahead with their lives.

“When you meet people in trauma, you often run into patients who’ve been looking to make a change for a long time.”

The post Breaking a dangerous cycle of violent injury through the new BRAVE program appeared first on Your Health Matters.

“People are scared, and they don’t know what to expect,” says Janna Di Pinto, a social worker who sees patients and families in the Tory Trauma Program at Sunnybrook.

Here are five tips for supporting a loved one through an unexpected stay in the critical care unit:

1. Education is key

Patients in the critical care unit often end up there suddenly, leaving families little time to make sense of what’s happening.

“As social workers, part of our role is to provide education on what to expect during a critical care stay. Patients can be doing well one day, and not so well the next, and it’s important for family members to know that such changes in their loved one’s condition are common,” says Di Pinto.

Staff members talk to family members about some of the expected responses and feelings they may have in this crisis event, such as:

• Feeling scattered and unable to think straight
• Processing information poorly
• Decreased short-term memory
• Decreased sense of hunger or thirst

Other helpful educational resources are available online on Sunnybrook’s Navigating the ICU website, which was developed after extensive collaboration between staff and family members.

2. Establish defined roles

In the critical care unit, families can spend a lot of time sitting at the patient’s bedside, but they aren’t sure how they can help.

Family members can contribute to their loved one’s recovery by making a playlist of the patient’s favourite songs to play at the bedside, holding the patient’s hand, bringing in photos and ensuring staff are aware of what is important to the patient.

At Sunnybrook, family members are also encouraged to participate in the care team’s daily rounds at the bedside.

“Staff can teach family members how to participate in their loved one’s care, such as encouraging range of motion exercises or redirecting a patient from pulling tubes and lines,” says Di Pinto.

3. Give yourself permission to take care of yourself

 Di Pinto says it’s important for family members to give themselves permission to take care of their own wellbeing, too.

“We don’t expect them to be at a patient’s bedside 24/7. It’s okay for them to go home, rest and then call the unit as often as they like to check in,” says Di Pinto.

Coordinating a rotating visiting schedule with others can be helpful, because it allows everyone a chance to be at the hospital while also building in time to look after themselves.

“People have many demands to juggle – maybe they live far away from the hospital, or have to return to work, or need to sort out child care. This is a time to establish a new balance and figure out new roles for themselves,” she says.

 4. Find coping strategies that work for you

Some people have a lot of anger after their loved one ends up in critical care, says Di Pinto, particularly if the admission was the result of a trauma (like a car crash) caused by someone else.

“We help family talk about which coping strategies may work best for them. For example, we let people know where the quiet spaces are around the hospital, such as the chapel or going for a walk outside. We let them know it’s okay to go to the gym, spend time with friends or pets, or even just go outside and scream if they need to,” she says.

5. It’s okay to have hope 

Di Pinto says they often talk with family members about the road to recovery, and how it is a process that takes time.

“When your loved one is in critical care, there may be a fine line between being hopeful and being realistic, but it’s okay to have hope that your family member will recover.”

The post 5 tips for getting through a loved one’s stay in the critical care unit appeared first on Your Health Matters.