The American Psychological Association offers the following description of trauma: “Trauma is an emotional response to a terrible event like an accident, rape or natural disaster. Immediately after the event, shock and denial are typical. Longer-term reactions include unpredictable emotions, flashbacks, strained relationships, and even physical symptoms like headaches or nausea. While these feelings are normal, some people have difficulty moving on with their lives.”
Treating patients who have experienced trauma requires a unique approach from nurses and health care professionals. Trauma-informed care takes into account that trauma may affect a person on an emotional, social, neurological, or psychological level.
The right knowledge can be obtained through a Master of Science in Nursing (MSN) program, which prepares registered nurses (RNs) and other Bachelor of Science in Nursing (BSN) graduates for advanced careers as nurse practitioners. Those who specialize as PMHNPs need to understand trauma and other issues common in psychiatric practice to provide effective trauma-informed care.
Trauma and Mental Health
According to the U.S. Department of Veterans Affairs, approximately 60% of men and 50% of women experience at least one trauma in their lives. Additionally, about 15 million adults develop PTSD each year. Regarding children specifically, more than two-thirds report at least one traumatic event by the time they turn 16, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Furthermore, trauma is a risk factor for virtually all behavioral health and substance use disorders.
Although trauma has long-term effects that resonate across all medical areas, it is particularly impactful in the mental health arena. There’s a clear link between trauma and mental health, especially for those who experience trauma at a young age or experience it multiple times throughout their lives. Individuals who experience trauma run the risk of developing the following conditions:
- Depression
- Anxiety
- Post-traumatic stress disorder
- Borderline personality disorder
- Substance misuse issues
According to the Erie Coalition for a Trauma-Informed Community, trauma is a nearly universal experience. PMHNPs and others in the psychiatric field should therefore assume that trauma exists and behave accordingly. By taking a trauma-informed perspective, PMHNPs can ensure the best possible outcomes for their patients.
The Importance of Trauma-Informed Care
Medical care that takes potential trauma into account is known as trauma-informed care. A trauma-informed approach is defined by SAMHSA as “a program, organization, or system that realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; and responds by fully integrating knowledge about trauma into policies, procedures, and practices, and seeks to actively resist re-traumatization.”
Physician Monique Tello recalls an incident where trauma-informed care was neglected, to the detriment of two patients. Two young siblings, a brother, and a sister were brought in for physicals and were due for immunizations. Both children became very upset and resisted the procedure. The mother and the nurse tried to physically restrain the children to administer the shots, but not surprisingly, their efforts just made things worse. The children became increasingly agitated and resistant. The staff eventually gave up in frustration, and the children left in tears.
Months later, word trickled back that these children had been removed from their homes due to parental abuse. The children’s panicked responses had probably been fueled by this trauma. By failing to consider this possibility, medical staff not only upset the children but also were unable to deliver necessary medical care.
Medical or psychiatric intervention that builds upon trauma in this manner is called re-traumatization. The Institute on Trauma and Trauma-Informed Care (ITTIC) explains that while some practices — such as physical restraint, which was used with the siblings — are obvious triggers, others are not. Patients who have experienced trauma can be triggered by many things, including being forced to tell their story over and over again, being treated as a number, being asked to disrobe, or having no input into their service or treatment. Even a smell can take someone back to a difficult experience.
Because re-traumatization is so specific to the individual and can be seemingly minor, medical personnel have no way to avoid it altogether. Rather, PMHNPs and other medical professionals must be alert to signs of distress. They do not need to understand the trauma to see that it has been triggered.
The Five Principles of Trauma-Informed Care
To reduce the likelihood of re-traumatization, the ITTIC recommends everyone in a practice, from the receptionist on up, adopt the following five key principles of trauma-informed care. Nurse practitioners, who have more substantive interactions with psychiatric patients, have a correspondingly bigger responsibility to keep these things in mind.
- Safety: The first principle of trauma-informed care is ensuring the patient’s physical and emotional safety. In practice, this approach may mean that common areas are welcoming and patient privacy is respected.
- Choice: Patients must feel that they have choice and control in any medical interaction. Providing a clear and appropriate message about patient rights and responsibilities can contribute to this aspect of treatment.
- Collaboration: Trauma survivors need to feel that decisions are made with their input and that power is shared with the medical provider. In trauma-informed care, patients, therefore, have a significant role in planning and evaluating services.
- Trustworthiness: The provider must earn the patient’s trust in areas including task, clarity, consistency, and interpersonal boundaries. Ensuring that respectful and professional boundaries are maintained is essential.
- Empowerment: The provider must prioritize empowerment and skill-building as an end goal of any treatment plan. Patients should feel validated and confirmed with every contact during their interaction with healthcare professionals.
By keeping these principles at the forefront of their work, PMHNPs can provide trauma-informed care that maximizes outcomes for their patients. They must never forget that their patient population is uniquely likely to have experienced trauma that contributes to their mental and physical health issues.
Develop the Nursing Skills to Provide Trauma-Informed Care
The process of delivering trauma-informed care is important for the millions of individuals who have survived traumatic events. The work that PMHNPs do helps restore their patients’ quality of life and empowers them to retake control.
The online MSN program at Ohio University is designed for practicing RNs who want to advance their expertise in the nursing field. The Psychiatric Mental Health Nurse Practitioner concentration features courses in the assessment and management of mental health disorders, psychotherapeutic treatment modalities, and other topics, providing students with the training and skills to deliver trauma-informed care to those who need it.
Learn more about how earning an online MSN from Ohio University can help you serve others while pursuing your professional goals.
Recommended Readings
4 Tips for Delivering Evidence-Based Treatment at Point of Care
Choosing Your Path: Why Be a Nurse Practitioner?
Difference Between Family Nurse Practitioners and Psychiatric Mental Health Nurse Practitioners
Sources:
The American Psychological Association, Trauma
Erie Coalition for a Trauma Informed Community, What Os Trauma?
Harvard Health Cara, “Trauma-Informed Care: What It Is, and Why It’s Important”
The Institute on Trauma and Trauma-Informed Care, “What Is Trauma-Informed Care?”
Integrative Life Center, “The 5 Principles of Trauma-Informed Care”
Office on Women’s Health, Abuse, Trauma, and Mental Health
SAMHSA, Understanding Child Trauma
Trauma-Informed Care Implementation Resource Center, What Is Trauma-Informed Care?
U.S. Department of Veterans Affairs, How Common Is PTSD in Adults?