About 70 percent of U.S. adults say they have experienced trauma, according to a study conducted by the Sidran Institute. Of those 70 percent of adults, 20 percent reported developing post-traumatic stress disorder (PTSD).
The effects of childhood trauma can last for a lifetime. In many cases this trauma can lead to anxiety, depression and addiction, as well as to hypertension and diabetes. Untreated trauma also can prevent people from seeking healthcare services. The number of traumatic events adults and adolescents experience makes trauma-informed care essential.
Healthcare professionals need to understand the six principles of trauma-informed care and how they can be implemented to provide patients with optimal treatment. Nurses can take the lead in introducing trauma-informed care to their organizations, due to their crucial role in patient care and their extensive collaboration with colleagues.
What Is Trauma-Informed Care?
Trauma-informed care approaches patients’ healthcare needs in a manner that takes into account any trauma that they may have experienced. A key goal of trauma-informed care is to prevent any re-traumatization that could prevent patients from continuing to seek care. When used effectively, trauma-informed care enables nurses and other medical professionals to ensure that healthcare processes, procedures and settings protect patients and staff from re-traumatization.
Professionals who practice trauma-informed care attempt to fully understand the effect of trauma and devise a treatment plan to aid in recovery. These professionals audit their medical practices and policies to improve upon their implementation of trauma-informed care. Organizations help new hires understand the meaning of trauma-informed care and how it is used within an organization. Throughout the organization that practices trauma-informed care, professionals are able to identify the symptoms of trauma in patients.
The 2018 Stress in America Survey evaluated 3,458 American adults and their relationship to stress. The results of the survey concluded that two-thirds of American adults have felt high levels of stress in their lifetime. One of the major catalysts for these high levels of stress was healthcare. A goal for the healthcare industry should be to identify and curb the stressors that are preventing patients from seeking care.
A Nurse’s Role in Trauma-Informed Care
Nurses are on the front lines interacting with patients and providing care. They collaborate closely with physicians to implement patient treatment plans. They also spend more face-to-face time interacting with patients than physicians do. Nurses on average spend about 33 percent of their time in patients’ rooms, according to the 2018 article “Estimating Time Physicians and Other Health Care Workers Spend with Patients in an Intensive Care Unit Using a Sensor Network” published in the American Journal of Medicine. In contrast, physicians spend about 15 percent of their time interacting with patients in their rooms.
Nurses must understand the past and present conditions of a patient when establishing treatment plans for recovery. The first step in understanding a patient’s past traumatic conditions is identifying whether or not the patient exhibits any adverse childhood experiences (ACEs). Some examples of ACEs are poverty, racial discrimination, sexual assault, physical violence and neglect. In the United States, 60 percent of adults have experienced at least one ACE, 25 percent have experienced three or more, and 16 percent have had four or more, according to the Center for Health Care Strategies.
Nurses can analyze whether a patient exhibits any signs of trauma by screening them for ACEs. This screening process is meant to ensure that nurses are taking the necessary steps in preventing re-traumatization prior to treatment.
6 Principles of Trauma-Informed Care
Healthcare organizations, nurses and other medical staff need to know the six principles of trauma-informed care: safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice and choice; and cultural issues. These principles help organizations build processes and systems that focus on patient and employee care by redefining the organizations’ processes and systems.
1. Safety
Patients need to feel safe while they are in the care of nurses and other medical professionals. Nurses should ensure that patients and families feel physically, emotionally and psychologically safe while in their care. Healthcare organizations should establish safe healthcare settings that provide patients and families with a sense of security. For example, waiting rooms should have ample space for individuals that may be re-traumatized by sitting in close contact with strangers.
The exterior of a healthcare facility must also promote a sense of safety and security. Parking for patients and their families should be ample and nearby. Proper lighting in parking structures and walkways will promote a sense of security for those patients who have appointments in the evening. Security guards can help patients feel less nervous or hesitant about entering the building.
Nurses can help create an environment in which patients feel safe by addressing any concerns that they may have. They can also enable patients to have family members or other individuals stay with them when they are receiving care. In addition, nurses can promote a feeling of safety by acting as liaisons between physicians and patients.
2. Trustworthiness and Transparency
Nurses need to be transparent with patients to build a sense of trustworthiness, especially when patients have suffered traumatic events such as domestic violence, assault or other forms of abuse. In many of these cases, patients are afraid to seek medical care because they lack a sense of trust. These patients might reason that if the people who love them can hurt them, so could a complete stranger. For this reason, it is especially important that nurses develop a sense of trustworthiness with patients.
Healthcare facilities must also embody a sense of trustworthiness and transparency. Employees should be well-informed about policies and procedures that may impact how they are able to care for patients. Moreover, these organizations and employees need to provide transparency when explaining the type of care they are providing to patients and the overall cost of this care.
3. Peer Support
To provide trauma-informed care, nurses, doctors and other medical professionals must thoroughly understand various traumatic conditions and how they affect patient care. Medical professionals need to acknowledge that each patient may have experienced a traumatic event that may prevent them from being open about their healthcare problems. By actively listening to patients, professionals can determine a patient’s needs as opposed to trying to “fix” or “heal” a condition.
Medical professionals who have experience with certain types of trauma may be best suited to provide care for patients with similar trauma. For example, a medical professional who has experienced assault in the past could be best suited to provide care for a patient dealing with this particular trauma. This shared traumatic experience allows nurses or other medical professionals to approach a patient as a “peer.” Some healthcare facilities have resources and groups for patients who are struggling with traumatic events such as domestic violence or battery.
In order to address secondary traumatic stress and burnout, medical professionals must support one another in providing care. Professionals dealing with trauma need to communicate this to their supervisors. Supervisors should institute trauma-informed care best practices to help their employees manage their stress. Employees should also have access to therapists and be encouraged to take paid time off in order to avoid workplace stress. Nurses dealing with a patient who might trigger their own internal trauma should communicate this to a colleague.
4. Collaboration and Mutuality
Nurses and medical organizations should view patients as partners in the effort to develop treatment plans. As collaborators, patients, nurses and medical organizations will work together to achieve the desired result. Through collaboration, patients become active participants in their healthcare decisions.
For example, a patient recently diagnosed with diabetes can collaborate with nurses to devise a treatment plan that meets the demands of their daily life. This collaboration can provide patients with a sense of well-being and security. The mutuality of trauma-informed care can enable patients to take greater responsibility for addressing their healthcare needs.
5. Empowerment, Voice and Choice
Nurses work to empower patients who have experienced trauma to take back control of their health. To do this, nurses should encourage patients to feel comfortable sharing their stories. Nurses and other medical professionals need to effectively communicate with patients about options for treatment and enable patients to actively participate in determining their care.
Trauma-informed care promotes a healthcare system that helps communities, patients and employees heal and grow from trauma. Trauma can serve as a unifier for patients, communities, organizations and medical professionals. When dealing with patients, healthcare organizations and professionals need to recognize that there is a power differential between them and their patients. To prevent re-traumatization, patients’ voices should be heard in healthcare decisions.
6. Cultural Issues
To establish effective trauma-informed care, nurses, doctors and staff members need to recognize and eliminate any potential cultural, racial, gender or other biases. This can be accomplished by offering services that help identify and cater to patient needs. If a patient feels more comfortable receiving care from a female physician, for example, this request should be accommodated. If no female physician is available, a female nurse or other medical professionals should be present when the patient is receiving care.
Cultural differences should also be recognized when a patient is receiving care. Organizations and healthcare professionals should devise processes and protocols to accommodate the cultural needs of patients. The potential for re-traumatization from the lack of sensitivity to cultural, racial, gender or any other biases is a major concern when developing a plan to institute trauma-informed care. An individual’s autonomy needs to be taken into consideration.