Trauma-informed Care

by Angela Richard-Eaglin, DNP, MSN, FNP-BC, CNE, FAANP, CDE

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    00:05 What is trauma informed care? And why is it necessary for us to even talk about it? Well, trauma informed care is care that gives us a complete picture and considers a person's entire life situation.

    00:19 And it's healing focus.

    00:21 So the whole beginning of care is around that healing orientation and health outcomes.

    00:28 And also considering the whole person.

    00:30 When we don't consider someone's entire life picture where we can do is cause harm up to an including death and also trigger people through retraumatization unintentionally, when we haphazardly approach care of a person.

    00:45 And oftentimes we do that because we think about what is the person here for today.

    00:51 We're not thinking about all the things that created the situations that we deal with, with a person each time they show up.

    00:58 And also considering when we talk about trauma informed care, that you may not get that whole picture the first day you meet the person, but we want to consider it with each subsequent visit.

    01:09 So with trauma informed interactions, we definitely want to approach it always from a focus on respect.

    01:16 Respect for human life and dignity, which is one of those humanitarian principles.

    01:22 With the core principles of trauma-informed care, it begins with safety.

    01:26 And when we think about safety, we're thinking about physical safety, as well as psychological safety.

    01:32 How do we create psychological safety? Where we're obviously we can't control what someone thinks and feels, but the way we act can promote that psychological safety.

    01:42 And we do that with empowering patients embodying everything about them being a human.

    01:49 A human life, the dignity, the respect, respect for whatever that trauma is to that patient and their response.

    01:56 Trust worthiness and transparency is another one of those principles.

    02:00 We definitely want to make sure we include people in everything being transparent about everything we're going to do, making decisions with the goal of building and maintaining trust.

    02:11 And how do we do that? Number one, embracing people.

    02:15 and every part of those people without judgment.

    02:18 Peer support is a big one.

    02:20 When we think about trauma informed care in the workplace environment.

    02:23 What does it look like in terms of that? So if someone is burned out on something, maybe taking care of a particular type of patient at one point in time, and they get burned out a patient that may require a little more effort and care.

    02:36 So how do we look at that and support our colleagues in that? And then what does peer support look like in terms of a patient situation? So if a person has been through some type of trauma, we want to make sure that the patient is aware of some resources.

    02:51 And I use the word patient loosely, because in some situations, if a person's not sick, they may still need us to provide some type of resources for them in terms of peer support groups with people who have experienced some of the same types of trauma.

    03:06 And I do also want to point out that trauma occurs at different levels.

    03:11 Oftentimes, we think about really, really severe and serious traumatic situations.

    03:17 But when we think back to micro aggressions are different things people experience in terms of bias, and in terms of stigma, exposure to those situations can also create trauma over time.

    03:28 So we want to think of trauma broadly.

    03:31 Then thinking about the next principle of collaboration.

    03:35 We as healthcare providers have to be aware of the power differentials, even if we think we're being very humble with people.

    03:42 There is a power differential by way of your title and by way of your role and position in terms of the healthcare sphere.

    03:49 So making sure that we acknowledge that with ourselves and include patients in decision making, because shared decision making also helps what will lead to another one of those principles.

    04:01 But with empowering patients, to feel some type of control over their bodies, and also over their health care.

    04:09 Empowerment. So there is some controversy around that word, because who are we to empower somebody.

    04:14 But we do inadvertently empower people by just respecting number one, which is like at minimum what we should do.

    04:21 And also including people in those decisions, because even though something says we have to approach care in a certain way.

    04:29 We have to individualize it to each patient.

    04:31 So whether a textbook tells us things have to be done a certain way to cure a certain disease or to improve health of an individual, we have to respect what the person wants in terms of how they want their treatment plans to look at.

    04:47 It may not include all the things that we think should be a part of that and there may be reasons for that.

    04:53 So that's why it's very important to build those trusting relationships.

    04:57 And we have to recognize a patient's strengths, and also say something to it.

    05:02 Affirmation is one of those big things when we talk about micro aggressions and micro affirmations.

    05:08 We want to do the same things in terms of a patient's health.

    05:11 We want to meet them where they are.

    05:13 Believe in resilience and their ability to heal.

    05:16 And people don't have to heal at our pace.

    05:18 They can heal at their own pace.

    05:20 And they can also approach their care at their own pace.

    05:23 So just because they don't want to do something we prescribe or recommend today, we want to give them time while educating and explaining because that trauma may be informing.

    05:33 How they approach and accept what we offer.

    05:36 And then the next principle is humility and responsiveness.

    05:40 And just acknowledging and recognizing the historical trauma that may be associated with biases and stereotypes that a person may have experienced.

    05:50 So just if we keep it in mind, and it may be something that is superficial to you, but not to the person who has experienced it.

    05:58 So it's unique to everyone.

    06:01 And again, just keeping in mind that we may think about sexual trauma.

    06:05 We may think about intimate partner violence, we may think about people who have served in the military and all the big things or people who have experienced any type of trauma.

    06:14 One of the most recent ones was COVID.

    06:17 And the burnout of health care providers working during that period when the pandemic was at its height.

    06:24 So, in addition to those things, there may be some other lower level trauma experiences that are heightened by some of the bigger traumatic experiences.

    06:35 All of the more significant and emotionally intense.

    06:39 And again, it's what it is to that person.

    06:41 Just creating this base of psychological and physical safety will help people be more apt to have conversations with you about some of their experiences.

    06:52 And also making it a non-judgmental space and more of a helping space. And you do have to say that.

    06:59 One of the examples I can give, and it is not necessarily related to trauma, but when I worked in the STD environment, just given a preface to before we start asking those questions of why you want to ask? That you're asking questions to help people not to harm people.

    07:17 So they will be more likely to share those things with you if you tell them why you're asking those questions.

    07:25 So especially sensitive things, when you're going to do a physical exam.

    07:30 If you're going to touch a person in a certain way, or whatever it is, and you don't know that they may have been exposed to some type of sexual trauma.

    07:37 The example I gave about asking questions about sexual history, those things are very personal. They are can be very sensitive.

    07:46 We don't know things like even just religious background or cultural background that will influence how people interact with you about those questions.

    07:55 So, building rapport, showing respect, given those explanations is extremely important before you just start asking people those types of questions.

    08:05 Allow patients to bring a trusted friend or family member into the room with you if they seem nervous.

    08:11 And this goes back to that cultural intelligence.

    08:13 You do have to be so aware and not sometimes rules can be bent or broken, especially if our goal is to provide comprehensive, and holistic, and sensitive care, patient sensitive care, and culturally sensitive care.

    08:32 So some of the benefits of using trauma informed care principles is that is just good for everyone.

    08:39 It encourages people to have full engagement in their care.

    08:43 It promotes that trust and improves the long term care relationships as well as outcomes.

    08:49 And relationships with you as an individual health care provider, regardless of your role, and also relationships with the healthcare system, regardless of the organization.

    08:59 But we know there's often mistrust in the system.

    09:03 But if we show people that we really care and are committed to every aspect of who they are as human beings, then we're more likely to decrease some of the disparities.

    09:12 And then in terms of workplace.

    09:14 It reduces burnout when we show that we really care and that we do want to support our colleagues as well as patients in terms of any type of trauma.

    09:25 And we don't want to trivialize or minimize anything that anybody has been through just because it may seem trivial to us or we can't relate.

    09:33 We still need to be there and provide the resources that people need.

    About the Lecture

    The lecture Trauma-informed Care by Angela Richard-Eaglin, DNP, MSN, FNP-BC, CNE, FAANP, CDE is from the course Mindful Communication.

    Author of lecture Trauma-informed Care

     Angela Richard-Eaglin, DNP, MSN, FNP-BC, CNE, FAANP, CDE

    Angela Richard-Eaglin, DNP, MSN, FNP-BC, CNE, FAANP, CDE

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