Trauma-informed care

I stood within the doorway of room 630 and watched her, deep in thought, staring out the window. She was a 20-year-old young woman admitted to the ward resulting from gastrointestinal bleeding. I walked into the room, introduced myself, and told her I needed an initial health assessment. I placed on the stethoscope and moved closer, and he or she raised her hands and said, “Please don’t.” I stepped back in confusion and informed her that I needed to envision the bleeding and be sure that all the things was OK. She shook her head as tears filled her eyes. I asked her why she was crying and he or she replied, “Because I don’t feel comfortable when strangers touch me.” I assured her I would not hurt her, and after a number of minutes of silence she said, “I experienced sexual violence as a teenager.” I thanked her for sharing this very personal and painful information and asked how I could make her more comfortable. She was grateful and just asked for more time. This was the start of my nursing profession and I had no special training or experience in coping with trauma victims.

Traumatic events corresponding to sexual abuse, domestic violence, elder abuse, and combat injuries can have serious, long-lasting, and harmful effects on a person’s physical, emotional, and mental well-being. These life events can result in depression, insecurity, smoking, substance abuse, shame and low self-esteem. Traumatic events also can shape a person’s comfort level and approach to health care.¹ Routine preventive care visits, which include invasive physical examinations and shut contact with a health care provider, could make a patient feel scared and anxious.

Trauma-informed care (TIC) is a term that has been used lately in a wide range of areas, including social services, education, mental health, and corrections, to fulfill the needs of people that have experienced traumatic life events. The Substance Abuse and Mental Health Services Administration (SAMHSA) defines trauma-informed care as a strategy for responding to individuals who’re in danger for or have experienced trauma.² There are 4 basic approaches and 6 principles of trauma-informed care.

The 4 basic approaches to trauma-informed care will be present in a program, organization, or system that:²: :

1. Recognizes the widespread effects of trauma and understands potential paths to recovery.
2. Recognizes signs and symptoms of trauma in clients, families, staff, and others.
3. Responds by fully integrating trauma-informed knowledge into policies, procedures and practices.
4. He tries to actively resist re-traumatization.

The six key principles of trauma-informed care include:²: :

1. Safety – be sure that that your patient and his relations feel protected, each physically and mentally.
2. Trustworthiness and transparency – trust between patients, staff and management is crucial in constructing strong relationships.
3. Peer Support – Identifying individuals with similar experiences of trauma helps ensure safety, builds trust, improves collaboration, and promotes recovery and healing.
4. Collaboration and reciprocity – emphasize that every one team members, including patients, are equal.
5. Empowerment, Voice and Choice – Identify individual strengths and differences and use them as a foundation for recovery and healing. Provide the patient with selection and the chance to take part in the decision-making process, leading to a way of control.
6. Acknowledging cultural, historical and gender issues – put aside stereotypes and cultural prejudices.

How can we apply these principles in on a regular basis practice? For patients who openly share their trauma history, clinicians must be cautious when delving into their psychological history unless they’ve specific training in trauma.¹ However, many patients feel ashamed and don’t feel comfortable disclosing their past. Every member of the health care team must be trained in universal trauma precautions, recognizing that one and all has potentially experienced trauma up to now.² There are several strategies that clinicians can use to implement the TIC approach in overall patient care. ¹

1. Ask each patient what you’ll be able to do to make them more comfortable during their visit.
2. Before the physical examination, explain what parts of the body can be examined and permit the patient to ask questions.
3. Give the patient the chance to take off his clothes as an alternative of putting on a gown.
4. Provide a pillow to support the back for patients who feel anxious when lying down.
5. Offer a mirror to view procedures or tests that the patient cannot see.
6. If the patient appears to be moderately to very anxious, offer the patient the chance to point distress verbally or by raising his or her hand in the course of the procedure.

1. Understand that poor coping mechanisms corresponding to smoking, substance abuse, overeating, and dangerous sexual behavior could also be linked to a history of trauma.
2. Engage with patients in a collaborative and nonjudgmental way when discussing health behavior changes.

1. Maintain an inventory of referral sources across disciplines for patients who’ve disclosed a history of trauma.
2. Referrals and trauma education materials must be kept in waiting rooms.
3. Engage in interprofessional collaboration to make sure continuity of care.

1. Consider your personal history of trauma (if applicable) and its impact in your interactions with patients.
2. Learn the signs of burnout and prioritize self-care.

1. Decide whether your organization will investigate current trauma or history of traumatic events.
2. Consideration must be given as to if screening can be face-to-face or self-reported by the patient.
3. Provide all staff with communication skills training on discussing a positive trauma screen with a patient.
4. Make sure your organization has resources available to supply appropriate patient care or has procedures in place to refer patients to other resources.

Unfortunately, traumatic events occur more often in our society than we predict. Caring for patients who’ve experienced traumatic life events requires a high level of sensitivity and compassion. Healthcare organizations may also help their employees navigate sensitive and difficult situations by providing educational training, tools, and resources on a trauma-informed approach to care.

Child welfare information portal
National Council on Behavioral Health
Substance Abuse and Mental Health Services Administration
Trauma-informed care project

1. Raja, S., Hasnain, M., Hoersch, M., Gove-Yin, S., and Rajagopalan, C. (2015). Trauma-informed care in medicine: Current knowledge and future research directions. 38 section 3, 216-226.

2. Koetting, C. (2016). Trauma-informed care: helping patients with painful pasts. , 33(4), 206-213.