NU 349 Transition to Professional Practice: Trauma Informed Care

Trauma

a normal reaction from an event that causes intense physical/psychological stress and is the persons perception of the event, not the event itself

Trauma can affect ___________ , and is connected with?

work, sleep, emotional, physical, social, spiritual health; substance use/mental health

Trauma is made up of..

Events

Experiences

Effects

Types of Trauma

Natural or human-caused

Individual/group/mass/community

Political terror/war

Interpersonal

Developmental

System-oriented

Triggers for trauma

may be subconscious and can cause a person to relive the trauma/view healthcare setting as distressing

Impacts of Trauma

Emotional dysregulation

Numbing

Somatization

Sleep issues

Physical/cognitive issues

Triggers/flashbacks

Dissociation, depersonalization, derealization

Behaviors

Reenactments

Self-harm

Substance use

Avoidance

Social/developmental impacts

Flight Trauma Response

remove self from the situation

Fight Trauma Response

when flight is not an option, verbally/physically attack

Freeze Trauma Response

when fight/flight are not options, body shuts down and their is an inability to think, speak, fight, or flight

Fawn Trauma Response

when there is no other option, do whatever it takes to avoid/diffuse danger

Vulnerable Populations

Groups at higher risk for trauma and health disparities

Examples of vulnerable populations

Veterans

Pregnancy women

Hx of sexual assault

Chronically ill

Kids

Mentally ill

Substance users

Disabled

Elderly

Refugees

Prisoners

Marginalized groups

Trauma-Informed Care

provides evidence-based and best practice information for providers to work more effectively with people who have been exposed to chronic traumas and/or are at risk of developing traumatic stress reactions

Trauma-Informed Approach

Realizes impact of trauma

Recognizes signs/symptoms of trauma

Responds by integrating knowledge about trauma

Seeks to resist re-traumatization

Guiding Principles of Trauma-Informed Care

Safety

Trust

Peer support

Collaboration

Empowerment

Cultural, historical, gender issues

Systemic Bias in Healthcare

unfair, embedded discrimination that leads to unequal medical treatment and worse health outcomes for marginalized groups.

Potential Challenges to TIC

Cultural shifts

Commitment to client over self

Inconvenience

Staff turnover

Cost

Accountability

Importance of TIC

Avoidance of medical/dental services

Non-adherence to treatment

Postponing services

Misuse of medical services (pain meds)

Patient Presentation: TIC

"High maintenance"

Oppositional clients

People pleasers

Highly emotional

Physical/somatic/cognitive reactions

Tips for TIC

Non-judgemental

Consent for everything

Clear introduction

Confirm identity

Watch body language

Encourage questions

Allow breaks

Ask about special needs

Ask questions

Listen to preferences

Respectful language

Validation

Reducing Triggers

Sights (white lab coats, equipment)

Sounds (drills, ambulance sirens)

Smells (rubbing alcohol)

Invasive procedures

Removal of clothing

Physical touch

Distressing questions

Power dynamics

Gender

Vulnerable positioning

Micro-Level: Treatment

Trauma informed referrals

"Doing with"

Transparency around process

Confidentiality

Consistent assessment and evaluation

Language Matters

Avoid use of terms like drug seeking, frequent flyer, pet names, uncooperative, suffers from/victim of, commited suicide, etc. and be mindful of non-verbal body languages which makes up (40% ) of communication

Adverse Childhood Experiences (ACE)

measures household dysfunction, including abuse, on a score of 0-10 (higher score, higher likelihood of negative impact) such as mental health, physical health, substance abuse, etc; early intervention for childhood trauma is key!

Pediatric Trauma

MAY look different and we may need to tailor questions; go at a slower pace, use developmentally appropriate language, use a child life specialist, allow parental involvement, and provide choices when possible

Secondary Trauma/Burn-Out

relates to the behaviors and emotions that result from knowledge about traumatizing events experienced by clients and the stress resulting from helping or wanting to help them

Symptoms of Burnout

Difficulty eating/sleeping/appetite

Dreading work/anxiety

Physical symptoms

Irritability

Maladaptive coping mechanisms

Self-Care

work/life balance and do what brings you joy; mindfulness, sleep, exercise, diet, etc.

Advocacy in the Workplace

lead by example and do not participate in unethical practices; educate and advocate for changes in policies for patients/employees

How to Advocate

Validate

"I statements"

Benefit of the doubt

Concrete suggestions

Do not take no as an end-all-be-all

Offer collaboration