We cannot know an individual’s complete story when we encounter them in our clinical practice. As nurses, we are privileged to witness a small part of patients’ lives, often when they are going through their most difficult times. When patients are obtaining treatment under nursing care, they often are psychologically unwell, too. Not all patients will exhibit symptoms of their psychological disturbances. There might be cultural, gender, age, and other contributing factors that make a patient’s internal environment unknown to their treatment team (De Choudhury et al., 2017). They could also be embarrassed or ashamed to share their personal experiences with the medical team (DeCou et al., 2019).
Trauma, or the emotional reactions to a difficult situation in an individual’s life, can be difficult for patients to share with their health team members. The experience of trauma is different for everyone; it can be a result of an event early in childhood, including molestation or rape, or from witnessing the death of a family member, among many possible tragedies. Trauma can also be an experience collectively realized by a community, such as a hurricane or flood that causes major destruction. Even listening to the news and hearing difficult first-hand stories of a child’s trauma can leave a mark (Li et al., 2017).
Since trauma can cause deleterious effects on health and well-being, the hope is that it is recognized and treated by professionals focused on mental health. However, the reality is that not all patients will be willing to discuss their trauma histories. Unfortunately, healthcare members can be potential triggers for this trauma; perhaps, a nurse reminds them of their mother who was abusive, or maybe the way a medical technician grabs their arms brings them back to memories of physical abuse when they were teenagers.
To help ensure that nurses do not inadvertently become triggers of past-trauma for patients under their care, they should consider the following:
If nurses treat all patients as if they have had trauma in their lives, they can be mindful of an individual’s needs during their course of treatment. Asking how a patient wishes to be addressed, asking and obtaining permission to touch them, knocking on their doors and waiting for them to respond, and allowing for privacy (keeping voices low when talking about intimate issues) are all necessary when treating patients.
Trauma-Informed Care can be imagined as a basic means to patient care, much as hand washing and gloves are used in all care interactions. See the considerations to keep in-mind whenever treating a patient from the framework of trauma-informed care as depicted by this CDC image (2020):
As you consider the concept of trauma-informed care with patients in 5B, how might you have engaged with patients under your care has you work on that ward during the onset of the AIDS epidemic?
Centers for Disease Control and Prevention. (2020, September 17). Infographic: 6 guiding principles to a trauma-informed approach. Centers for Disease Control and Prevention.
Cannon, L. M., Coolidge, E. M., LeGierse, J., Moskowitz, Y., Buckley, C., Chapin, E., Warren, M., & Kuzma, E. K. (2020). Trauma-informed education: Creating and pilot testing a nursing curriculum on trauma-informed care. Nurse Education Today, 85, 104256. https://doi.org/10.1016/j.nedt.2019.104256
DeCou, C. R., Mahoney, C. T., Kaplan, S. P., & Lynch, S. M. (2019). Coping self-efficacy and trauma-related shame mediate the association between negative social reactions to sexual assault and PTSD symptoms. Psychological Trauma: Theory, Research, Practice, and Policy, 11(1), 51–54. https://doi.org/10.1037/tra0000379
De Choudhury, M., Sharma, S. S., Logar, T., Eekhout, W., & Nielsen, R. C. (2017). Gender and cross-cultural differences in social media disclosures of mental illness. Proceedings of the 2017 ACM Conference on Computer Supported Cooperative Work and Social Computing. https://doi.org/10.1145/2998181.2998220
Li, Z., Ge, J., Yang, M., Feng, J., et al. (2020). Vicarious traumatization in the general public, members, and non-members of medical teams aiding in COVID-19 control. Brain, Behavior, and Immunity, 88, 916–919. https://doi.org/10.1016/j.bbi.2020.03.007
Substance Abuse and Mental Health Services Administration. (July 2014). SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach. SAMHSA’s Trauma and Justice Strategic Initiative.