Trauma Informed Care-The Newest Standard Precaution
Many people experience a traumatic event sometime during their lives. Trauma is usually sudden, unexpected, and shocking. The effects of trauma may leave people overwhelmed and alter their ability to cope. In the short term, trauma leads to feelings of helplessness, fear, and vulnerability. Long-term unresolved trauma may lead to physical, cognitive, and emotional impairments up to and even including a shortened lifespan.
The Substance Abuse and Mental Health Services Administration (SAMHSA) defines trauma in terms of “The 3 E’s.” Trauma is the result of an Event (or Series of Events) that is Experienced by an individual. That event is usually physically or emotionally harmful or life-threatening and it has lasting Effects on the individual’s functioning and well-being- Including mental, physical, social, emotional, or spiritual well-being. A traumatic event can be an experience that affects the person directly or indirectly. Indirect trauma could be witnessing trauma to a loved one or vicarious trauma experienced by first responders or hospital personnel caring for a patient who has undergone a traumatic event.
Impersonal Trauma- May be due to impersonal events such as natural disasters including:
Hurricanes
Tornadoes
Forest Fires
Interpersonal Trauma- Traumatic Events that occur between individuals. This type of trauma has worse long-term outcomes for survivors. The closer the relation to the inflictor of the trauma, the worse the impact of the event. This is especially true for trauma that occurs over time. Examples of Interpersonal Trauma are:
Child abuse or neglect
Intimate partner abuse
Sexual assault
Human trafficking
Community Violence- Exposure to intentional acts of interpersonal violence committed in a public area by people who are not immediately related to the victim such as:
Gang Violence
School Shootings
Public Shootings
Terrorism
Acts of War
Historical Trauma- This type of Trauma is a complex and collective trauma that is experienced over time and across generations by a group of people who share an identity, affiliation, or circumstance. Examples would be:
Holocaust Victims
Japanese Internment camps
Racism and racist policies
Medical Trauma- This is usually related to the nature of the illness, the shock and loss of control associated with the diagnosis, possibly the hospital environment, hallucinations, and perceived or actual mistreatment by medical providers. Trauma affects a victim’s world view (school is not safe, hospitals are not safe), their Identity (I am broken, damaged, weak, no good), and their spirituality (Why me? Why did God allow me to go through this?) Trauma experiences overwhelm a person’s coping resources. Trauma victims often find ways of coping with that trauma in the short term that may not be effective in the long term. Trauma victims may turn to drinking or drug use, aggression, isolation, or even cutting as a means of escape from the overwhelming emotions elicited by the trauma. In 1998 the Adverse Childhood Experiences study found that 1 in 4 people experienced some form of trauma as a child and 1 in 16 were exposed to at least 4 adverse experiences. The CDC reports that half of all women and a third of all men experience some form of sexual abuse during their lifetime. It is known that the more adverse experiences or traumas a person is exposed to, the more health-related problems (Physical and Mental) the person has and the shorter the person’s expected lifespan. With all of these traumas in the world, the odds are that most patients have experienced some form of trauma in their lives. Therefore, it is just as important to use Trauma Informed Care techniques when caring for all people as it is to wear gloves and to wash hands.
Trauma-informed care is a concept of treating everyone as if they have a history of trauma. This includes patients, their families, and our co-workers. Trauma-informed care should be a culture of care that is delivered to all people who walk in the door of the facility. Trauma-informed care must be a facility-wide practice to be effective- from the reception desk to the financial office and ANYONE the patient may encounter during or after their care.
Safety- The patient must feel safe both physically and psychologically and be free from moral judgment. This may be the most important aspect of trauma-informed care as the patient will not advance unless they feel safe. Patients should not be expected to ask others to leave the room before medical issues are discussed. This is the healthcare professional’s responsibility
Trust and Transparency – No surprises in their care (if at all possible) Promises should be kept and follow-through is key. This includes explaining all that will be done, how long it should last, what the patient will experience, and why it is being done. Even down to the smallest action such as shutting the door for privacy.
Collaboration and Mutuality- Leveling the power differential. Not looking down on the patient- who is sitting down but looking eye to eye with the patient and allowing the patient to have shared decision-making. Asking ‘How can we make you feel more comfortable?’
Empowerment- Recognizing the patient’s strengths and validating feelings. For instance, ”These tests can be stressful, thank you for being so cooperative, you are doing a great job! “ Allow the patient choices when possible- “Would you like to have your shower now or after lunch?”
Voice and Choice- After explaining to or educating the patient on the situation, allow them to use their voice and make choices. Patients have the right to refuse any and or all care. It is important to be non-coercive, supportive, and non-judgmental about the choices patients make. Be aware of YOUR negative reactions
Build a relationship
Talk less- Listen More- Make Eye contact and don’t be looking at the computer when you talk
Remember- You are taking care of a person, not completing a task
Remember the Patient’s trauma response may not be what you think it should be
Responses are REACTIONS, not Illnesses
Use appropriate pronouns
Avoid triggers (any external event that causes internal discomfort or distress)
Be attentive to Language
No jargon
Be empowering
Be aware of agitation and allow time to calm down or decompress if needed.
Avoid language that stigmatizes such as “frequent flyer” or “entitled” or “Drug-seeking”
All of these techniques and practices take practice and time to implement. It takes dedication from healthcare workers to become fluent in practicing trauma-informed care. However, when looking at the statistics of how many of our patients and coworkers are likely to have been affected by traumatic events, it is safe to say this Universal precaution should be used in all interactions. Health.edu has several trauma-informed care programs that will assist you in implementing appropriate care throughout your organization. If you would like to request more programs on this subject, contact us at Health.eduCSRequests@ttuhsc.edu or call 1-800-424-4888.