Trauma-Informed Practice (TIP) resources can easily be found in an Internet search of the term. But putting TIP into practice can be much easier said than done in many care areas. In a healthcare system that in many ways was built on paternalistic policies and practices that involve care control and risk management, it can be a task to genuinely empower a patient. Similarly, principles like person-centred care can be a daunting task in care areas like mental health where clinicians are trained to be the expert and to use coercive practices with the intention of enhancing patient safety.
Conscious Reflection
We each bring our values and beliefs to our nursing practice obligating us to interrogate them to ensure that they align with the mission, vision, and values of the organizations that we work in. Areas like labour and delivery can be a touchy area especially with women who use substances. Nurses may feel a moral inclination to dictate care based on perceptions and attitudes about substance use. Similarly, care of adolescents can be influenced by the vulnerability that we feel for youth and the need to protect them above all costs. However, a critical lens must be taken to interrogate policies and practices that are outdated. When we say that we are “trauma-informed” we must reflect on how we do this each day in the care that we give to our patients. But, we also need to take a critical lens to explore the organizations that we work in to make sure that the policies, practice guidelines, and standard operating procedures are trauma-informed.
Principles of TIP include:
Trauma Awareness
Emphasis on Safety and Trustworthiness
Opportunity for Choice, Collaboration, and connection
Strengths-based and skill-building
It can be easy to fall into a trap of thinking that we are trauma-informed simply because we work within a caring profession. There are many of examples throughout the history of healthcare in which practices that were developed for the sake of care, in retrospect, caused harm. Mental health services, particularly inpatient areas, are under increased scrutiny of coercive practices that have been a well-accepted part of policies and practices but no longer align with standards of human rights, in turn impeding nurses’ ability to enact a trauma-informed approach. Organizations like the WHO recognize that conscious and deliberate efforts must be made to both recognize and change the reliance on coercive practice. Practices that were once accepted, like medical students practicing exam skills on unconscious patients who did not provide consent must be seen for what they are, and their potential to cause trauma.
Focusing on Actions for Change
TIP involves developing and implementing practices, policies and procedures that first require careful examination of the current healthcare practices, values and beliefs of all those who involved in healthcare, meaning clinicians, but also administrator, and most importantly, patients and health services users.
In this month’s episode of The Shift Change we welcome guest Karen Castro, an RN with experience in maternity health, labour and delivery, adult mental health, and youth mental health. We delve into the intersections between TIP, patient empowerment, and patient autonomy. We also explore barriers to enacting TIP in a healthcare system that is led by practices and policies created in the paternalistic and sometimes outdated conceptualization of the patient-clinician relationship. We ask some challenging questions that all nurses must think about like what do we mean when we say “trauma-informed practice,” how do we engage in TIP, what helps us carry out this approach, and what gets in the way?
Teaching Resources
The Registered Nurse Association of Ontario has a guide for Trauma-Informed Care Teaching activities and resources on their website. It is located within their Mental Health and Addictions Resource but we know that TIP must be integrated into all parts of the healthcare system.
References
Poole N, Greaves L. Becoming Trauma-Informed . Toronto, Canada: Centre for Addiction and Mental Health; 2012.
Poole N , Talbot C , Nathoo T . Healing families, helping systems: a trauma-in- formed practice guide for working with children, youth and families. Victoria, BC: Ministry of Children and Family Development; 2017 .
Sugiura, K., Mahomed, F., Saxena, S., & Patel, V. (2020). An end to coercion: rights and decision-making in mental health care. Bulletin of the World Health Organization, 98(1), 52.
Goldberg, Emma. (2020, February 17). She Didn’t Want a Pelvic Exam. She Received One Anyway. The New York Times. https://www.nytimes.com/2020/02/17/health/pelvic-medical-exam-unconscious.html