A certified pediatric forensic nurse who works with victims of violence and trauma, Villanova University Fitzpatrick College of Nursing Professor Elizabeth B. Dowdell, PhD, RN, AFN-C, FAAN, has co-authored Trauma-Informed Care in Nursing Practice, a compelling Continuing Education Feature article in the April 2022 issue of AJN, American Journal of Nursing. Dr. Dowdell, a nurse scientist in child internet safety, cyber aggression and sleep texting, and Patricia M. Speck, DNSc, CRNP, FNP-BC, AFN-C, DF-IAFN, DF-AFN, FAAFS, FAAN, urge the use of trauma informed care (TIC) to create a welcoming, respectful and inclusive environment for those with experiences of trauma who may be seeking care at any time in their life.
Why? The authors note that trauma is universal with decades of research pointing to cumulative deleterious health effects on individuals who have suffered trauma and related stress. Many times when seeking care, these patients may feel judged or marginalized and thus retraumatized by the health care system interaction if the care and communication provided is not sensitive to their summative experience.
In their article, the authors say that given the stress of complex trauma, patients who reach out for help and feel victimized again will slip away from the system, protecting themselves by avoiding interaction with health care providers and causing a worsening of their health status. They refer to this population as “never-served” persons who only seek care when there is a crisis. “That’s a problem,” Dr. Dowdell affirms.
Nurses, other care providers, and healthcare systems can do better.
A trauma informed approach, the authors share, “recognizes that effective care requires an understanding of patients' lived experiences and may improve patient participation, treatment adherence, and health, as well as provider well-being, through the use of strategies that increase hope by pointing patients toward their goals.”
TICs six principles include safety, trustworthiness and transparency, peer support, collaboration and mutual support, empowerment (voice and choice) and cultural and historical sensitivity, the article outlines. Drs. Dowdell and Speck illustrate through a case study how TIC can improve provider practice and the larger health care organization to support trauma victims. It includes examples of how to pose sensitive but essential questions in nonjudgmental way- a method which gives patients a choice in what they share, says Dr. Dowdell in a podcast interview with AJN. Additionally, in the COVID-19 era, she explains, health systems are looking for ways to create trusting, supportive and transparent environments for their workforce, and “TIC becomes a financially responsible mechanism of intervention and communication” – a tool that can be used with nursing staff and other health care providers.
Dr. Dowdell hopes to inspire a sea change with this publication, leading to more widespread use of TIC and thus appropriate, collaborative care for those previously victimized to promote and restore their health. “I’d like to see a change in thinking - a change in thinking changes behavior - where nurses bring it into their units, work settings and patient interactions and it can climb the vine up to administration.”
Dowdell, E.B. and Speck, P. M. CE: Trauma-Informed Care in Nursing Practice, AJN, American Journal of Nursing: April 2022 122 (4) 30-38. doi: 10.1097/01.NAJ.0000827328.25341.1f
Listen to the podcast interview with AJN.