Trauma-informed care (TIC) is a patient-centered approach to providing health care which prevents re-traumatization of patients and staff.
The healthcare system can be re-traumatizing for patients with trauma history
such as
Experiencing or observing physical, sexual, and emotional abuse;
Childhood neglect;
Having a family member with a mental health or substance use disorder;
Experiencing or witnessing violence in the community or while serving in the military;
Poverty and systemic discrimination.
Childhood adversity or trauma is associated with increased risk of heart disease, diabetes, autoimmune disorders, and even premature mortality which we can see in the ACE study
This means individuals with trauma are more likely to be our patients!
When individuals feel threatened they rely on the parts of their brain aimed at survival, or the flight, fight, or freeze system. As a result, the rational parts of the brain involved in memory, planning, decision making, and regulation become less important. In healthcare settings, this can impact the patient’s engagement with services and ability to adhere to treatment plans.
The Substance Abuse and Mental Health Administration lists the following principles for a trauma-informed approach:
Safety (physical and emotional)
Trustworthiness and transparency
Empowerment, voice, choice
Use of peer support
Cultural, historical, and gender responsiveness
Studies have shown
A study published in the journal of nurse practitioners found that only 33% of 188 NPs screened for a history of childhood abuse
A study in the journal of psychiatry found only 29% of primary care physicians surveyed usually or always screen for a history of childhood abuse
How do we practice Trauma informed care:
Introduce yourself and you role, this empowers the patient to be engaged in their care
Use open and non threatening body positions | helps prevent the threat detection areas of the brain from taking over, which helps patients stay regulated.
Provide anticipatory guidance | verbal what the patient can expect during the visit or procedure. this reassures patients even when their is discomfort, this reduces the changes of surprises or activation. even with minor procedures like a dressing change
ASK BEFORE TOUCHING | For many trauma survivors, inappropriate or unpleasant touch was part of a traumatic experience. Touch, even when appropriate and necessary for providing care, can easily activate a fight, flight, or freeze response. get consent, this gives them a choice.
Maintain patient privacy | room mates, other staff, always ask
Secondary Trauma
is the development of PTSD-like symptoms without directly witnessing or having being involved in a traumatic event. In healthcare, the traumatizing event of a patient can become a traumatizing event for the healthcare worker one study found that 17% of mental health nurses met the criteria for PTSD. We must also practice trauma informed care for ourselves
Additional links https://onlinelibrary-wiley-com.silk.library.umass.edu/doi/full/10.1002/2327-6924.12378#jaan12378-bib-0037 Lee, J., Daffern, M., Ogloff, J. P., & Martin, T. (2014). Towards a model for understanding the development of post-traumatic stress and general distress in mental health nurses. International Journal of Mental Health Nursing, 24(1), 49–58. https://doi.org/10.1111/inm.12097