Trauma-Informed Nursing Care
Trauma-informed nursing care incorporates a detailed look at the full scope of a patient’s situation, including past traumatic events. Nursing care that is comprehensive and trauma-informed is now considered best practice. Trauma-informed care is an evidence-based change in nursing that is occurring throughout the nation. Trauma-informed nursing will play a vital role in provider/patient relationships and contribute greatly to healing and recovery in all healthcare settings.
What is Trauma?
The Substance Abuse and Mental Health Services Administration (SAMHSA) aims to improve the nation’s behavioral health and defines trauma as:
“An event or circumstance resulting in physical, emotional, and/or life-threatening harm that has lasting adverse effects on the individual’s mental, physical, emotional, social and/or spiritual well-being… It occurs as a result of violence, abuse, neglect, loss, disaster, war and other emotionally harmful experiences… Trauma has no boundaries with regard to age, gender, socioeconomic status, race, ethnicity, geography or sexual orientation.”
All persons have the ability to suffer trauma. It is a very common experience for both adults and children, with particular prevalence in individuals with substance abuse and mental disorders. Until relatively recently, trauma was relatively ignored as a significant, widespread, negative contributor to health in the overall population. The effects of trauma can, in fact, be deep and far-reaching. For instance, trauma experienced by children can later manifest as mental health issues like addiction, anxiety, and depression or physical conditions such as diabetes and high blood pressure. Trauma can also prevent individuals from seeking out the help they require.
What is the Trauma-Informed Approach?
A trauma-informed approach to care focuses on a detailed, understanding look at the full scope of a patient’s situation to provide appropriate and effective treatment and promote healing. By transitioning to a trauma-informed approach, healthcare organizations can guide patients to become more involved in their own care and follow treatment plans more closely. This may improve health outcomes and reduce costs to patients and payers. Moreover, this approach improves the well-being of healthcare staff.
A trauma-informed approach seeks to achieve four main goals:
- Realize that the negative impact of trauma is significant and pervasive in the U.S. population
- Recognize the signs and symptoms of trauma in patients as well as the patients’ families and members of the healthcare staff
- Reintegrate knowledge of, data about, and experience with trauma into shaping policy, revising clinical procedures, and checking best practices with the thoughtful intention of creating a more welcoming environment for both patients and healthcare workers
- Resist the re-traumatization of all people in the healthcare setting
The Six Principles of Trauma-Informed Care
Healthcare organizations, physicians, nurses, and other members of staff can adopt the trauma-informed care model by incorporating six key principles into the culture of their workplace.
1. Safety
Patients and healthcare staff feel both physically and psychologically safe throughout all levels of the organization. The best outcomes are achieved when patients feel secure and safe in the healthcare setting, including both the interior and exterior environments of the facility:
- Paint colors that promote a sense of calm and well-being
- Ample, brightly-lit parking
- Appropriately-spaced seating in waiting rooms
- Generous visiting hours
- Patient liaisons
2. Trustworthiness & Transparency
Healthcare staff should be well-trained, competent, and subsequently empowered to provide trauma-informed care. Patients should be able to sense trustworthiness and transparency in their relationship with healthcare staff, making them more likely to reach out and seek care.
- Nurses and doctors establish a warm rapport with patients, especially those who have suffered acute trauma
- Patient care decisions are made clear, with the intent of full disclosure of information (including financial cost of services)
3. Peer Support
Medical professionals who have experienced similar trauma as a patient can approach their care as a “peer” and may be best suited to guide the relationship. Many facilities offer services and resources for patients who have suffered particular forms of trauma. Additionally, healthcare staff can join groups for shared support in dealing with traumatic events. Examples of peer support include:
- Counseling services for patients who have suffered domestic abuse
- Workplace-based stress-management groups for healthcare workers
- Therapists for both patients and hospital staff
- Organizational policy for provider mental health days
4. Collaboration & Mutuality
Healthcare organizations and staff should perceive the patient-provider relationship more as a partnership, with both parties making an active, collaborative effort in the treatment and healing process. Patients are encouraged to be more active in their care and to participate in shared decision-making, which tends to lead to better outcomes and greater patient satisfaction. Among healthcare workers, managers should communicate respectfully to promote shared decision-making regarding policies and best practices.
5. Empowerment, Voice, & Choice
Throughout the organization, the strengths of healthcare staff and patients are identified and utilized to shape better outcomes.
- Nurses empower patients to share feelings and stories
- Patients come to believe they can heal from a traumatic experience
- Patients feel that they are being heard and understood by providers and have the power to make informed decisions about their care
6. Cultural, Historical, & Gender Issues
Physicians, nurses, and other healthcare staff identify and address potential biases involving race, gender, sexual orientation, and culture in an effort to minimize re-traumatization. This could include specialized services for patients with specific needs, and internal policy shifts to promote and respect employees from different cultures or religious practices.
- Accommodation for patients preferring a female provider
- Prayer rooms for patients and staff
Implementing Trauma-Informed Nursing Care
Because of the vital roles that nurses play in the patient experience and as part of a collaborative team of healthcare providers, they should feel empowered to spearhead and adopt trauma-informed care initiatives for their staff and within their organizations.
Nurses work very closely with patients, so integrating a trauma-informed approach to care is essential to maintain and promote a mutually beneficial relationship. Nurses should know and be aware that their own internal trauma issues may adversely affect their work, and may suffer secondary stress when caring for patients affected by trauma. Therefore, nurses should remember to practice self-care to help prevent re-traumatization or burnout.
A well-established, trauma-informed nursing practice involves staff who can identify trauma history and care requirements, and then incorporate best practices to manage them in a thoughtful, intentional manner.
The Benefits of Becoming a Trauma-Informed Nursing Unit or Organization
Adopting a trauma-informed approach at all levels can significantly improve patient and staff experiences by resulting in:
- Higher care quality and outcomes of patient services
- Fewer unnecessary interventions and repeat admissions
- Reduced financial costs
- Higher staff morale
- Fewer negative patient interactions (including uncooperativeness, aggression, and violence)
- Higher patient and family satisfaction levels and ratings
- Reduced staff burnout and turnover
- Less patient use of crisis/acute services
- More collaboration and cooperation among patients and staff
Further Resources for Trauma-Informed Nursing Practice
Additional Resources for RNs
