Nursing is a profession rooted in care, compassion and the promotion of health. We act as the safety net of the health care system, and our influence touches almost everything. As nurses, we are taught to care for all walks of life.
Trauma survivors can come to us as patients at any age, and they require a specialized lens and level of care.
What does trauma mean, exactly?
Trauma, as defined by the American Psychological Association®, is "an emotional response to a terrible event like an accident, crime, natural disaster, physical or emotional abuse, neglect, experiencing or witnessing violence, death of a loved one, war, and more."
Nearly 70% of people globally will experience a traumatic event during their lifetime, according to a World Health Organization study in 2024. This can have many enduring, long-term consequences. Traumatic experiences have the potential to profoundly impact how individuals respond to nursing care or healthcare in general.
What is trauma-informed care (TIC)?
Trauma-informed care (TIC) has emerged as an essential framework in nursing to address these needs effectively. This framework is a holistic approach that recognizes the widespread impact of trauma and seeks to create environments that promote safety and empowerment.
By integrating an understanding of trauma into clinical practice, nurses can foster safer, more supportive environments that promote healing and resilience for those who've experienced significant trauma.
Nursing and traditional medical care service systems are not only the places where experts have noted the benefits of trauma-informed care either.
The Substance Abuse and Mental Health Services Administration recognizes that a trauma-informed approach to systems and processes makes a significant difference in healing.
Since trauma effects the majority of our global population, focusing on trauma-informed care will benefit most patient and care-provider settings.
From behavioral health services in therapy to primary care services with nurses and doctors in clinical settings, TIC is a highly-effective way to maximize our care.
How trauma impacts physical and mental health
So, trauma is everywhere. But what difference does it ultimately make for the human body? Why is this a nursing concern?
Trauma impacts the individual in many ways. Physically, it activates the body’s stress response system, which significantly increases someone’s allostatic load. An article I was a part of in The DO defines “allostatic load” as the cumulative burden of chronic stress on an individual.
A high allostatic load is associated with high epinephrine and norepinephrine and increased cortisol levels. These elevated levels predispose patients to...
- Heart disease
- Hypertension
- Suppression of the immune system
- and many other physiological impacts at varying levels of intensity
In addition to the physiological effects of trauma, there is also a psychological component.
Both recent trauma and childhood trauma are closely linked to mental health challenges like anxiety, depression, post-traumatic stress disorder (PTSD) and substance abuse. These behavioral health problems inevitably bring unique challenges to nurses attempting to deliver health care.
For example, a survivor of trauma with PTSD might experience intense adverse reactions to certain environments, smells or sounds while under a nurse’s care for something routine.
Handling trauma in healthcare settings
As nurses, physicians, providers and other allied health professionals engage in treatment planning for patients, we can inadvertently trigger or exacerbate past trauma histories.
A hospital environment, invasive procedures, or perceived loss of control can retraumatize patients.
For example, survivors of sexual assault may find routine physical examinations distressing. In the mental health realm, as a physician, when I inquire about a traumatic event, I try to avoid asking patients to repeat their traumatic, potentially triggering, stories multiple times.
Recognizing these triggers is crucial for nurses to provide empathetic and non-harmful care. The ultimate goal is to provide the highest level of care while also minimizing the possibility of re-traumatization.
Trauma-informed care in this case would be structuring the healthcare teams and processes to ensure a patient only needs to tell their story once.
Trauma-informed care in nursing
In nursing, trauma-informed care involves integrating trauma-awareness into every aspect of patient care, from communication to clinical interventions.
Nurses play a critical role in implementing trauma-informed care. We are a select group of healthcare professionals who are in close/daily contact with patients. This gives us the unique opportunity to provide empathetic care that acknowledges trauma while promoting healing.
Nurses who understand TIC follow some core principles as a guide to their practice.
The 6 core principles of trauma-informed care
- Safety
- Trustworthiness and Transparency
- Peer Support
- Collaboration and Mutuality
- Empowerment, Voice and Choice
- Cultural, Historical and Gender Sensitivity
The below will go into more detail on what these core principles mean and how to easily implement them into your evidence-based care.
1. Establish safety
Creating a sense of safety starts with small actions.
A nurse might ensure that a patient’s bed area is clean and quiet or offer reassurance during a painful procedure. Emotional safety is part of this as well. For instance, a nurse might take the time to explain every step of a dressing change to help a patient feel prepared and in control.
In an emergency room, a nurse can help patients feel physically safe by explaining procedures beforehand and maintaining a calm demeanor.
Ex: “I’m going to take your blood pressure now. It won’t hurt, and I’ll tell you when I’m done.”
To establish emotional safety, a nurse can respect the personal space of a patient who appears anxious by asking permission before touching them.
Ex: “May I check your bandage dressing? I’ll let you know what I’m doing step-by-step.”
2. Build trust
Trust develops when patients feel that their nurses respect their boundaries and communicate openly.
If a nurse needs to perform a procedure that might be distressing, such as starting an IV or inserting a foley catheter, explaining what to expect and asking for consent can make a significant difference. Patients tend to be more at ease when they trust their caregivers and understand what’s happening to them.
Ex: “We’ll be taking you to the operating room in about 10 minutes. Before that, I’ll start an IV. Do you have any questions?”
Building trust could also come from something as simple as not promising a certain discharge date or time. Patients will hold you to that "noon discharge tomorrow." It is far better not to make a promise you can’t keep. If, for some reason out of your control, the discharge is delayed or withdrawn, you can instantly lose all the credibility and trust you were building over several days.
Instead, be honest and acknowledge the fluid situation that has many variables with the goal to discharge them when they are ready.
3. Support peer connections
Peer support recognizes the value of shared experiences. It involves connecting patients with others who have similar experiences to foster understanding and validation.
As the nurse, you can refer your patient to peer support programs. Many support groups are not run by healthcare professionals, but by patients. This can give a different approach to trauma care.
For example, nurses can do so much just by telling their patient, "There's a victim of domestic violence group meeting in two days. It could be a safe and helpful place."
Support groups are important to the recovery process for the patient. Trauma survivors often feel isolated. Meeting and interacting with others who have navigated similar experienced trauma can instill hope and reduce the feelings of loneliness.
But of course, you need to know about these meetings to be able to offer them as a resource. Staying aware and abreast of the current support options within your care facility could be a big help to your patients.
4. Collaboration and mutuality
This principle emphasizes working with patients rather than doing things to them. It elevates equal partnerships and values the expertise of both the nurse and the patient.
Trauma often robs individuals of a sense of control. Collaborative care helps restore their autonomy and empowers them to take an active role in their healing journey.
From my personal experience, patients are more likely to buy into their care when they have a hand in it. Involving the patients in decision-making will give them a voice in their care plan.
With this in mind, you should try your best to provide options when possible. For example, when discussing pain management with someone you're caring for, nurses might ask, "Would you prefer medication or would you like ice therapy."
There may be signs and symptoms that indicate a patient has experienced trauma before. By asking them what has worked in the past, you can not only improve the physical care given but also add the collaboration component that is necessary for quality trauma-informed care.
5. Empowerment, voice and choice
This principle focuses on helping patients regain control of their lives by recognizing their strengths and encouraging their active participation in their recovery.
Trauma survivors can often feel powerless, especially in healthcare settings where they are exposed to invasive procedures or directed goals. Empowering patients helps rebuild their confidence and self-efficacy.
This is another instance where it’s important to have the patient make choices regarding their care whenever possible. Sometimes even a small decision, like scheduling what time of the day to have their speech therapy, can make a patient feel empowered and more in control.
Ex: "Would you like Speech therapy to come by around breakfast or lunch time?"
6. Cultural, historical and gender sensitivity
It's essential to recognize the importance of cultural competence, historical context and gender dynamics in trauma care. We should always respect the diverse backgrounds, identities and experiences of patients.
Trauma can originate from (or be exacerbated by) discrimination, cultural misunderstanding, sexual orientation, age or gender-based violence. As globalization advances, we need to make sure we apply a culturally-sensitive approach to ensure care is inclusive, respectful and equitable.
An easy example of this is by addressing your patient in the way they prefer to be addressed or asking open questions.
I tell my nursing students that they will not know every culture or religion of the patients they care for, but they must always incorporate a culturally-sensitive approach to nursing. They can do this by taking the time to understand how a patient's cultural or spiritual belief can influence their care preferences.
For example, when working with Jewish patients, we can take steps to make their care more inclusive by offering Kosher food options and access to a Rabbi chaplain.
How to build a trauma-informed organization
Health care organizations play a pivotal role in helping nurses deliver trauma-informed care by fostering a supportive environment, providing education and prioritizing staff well-being.
Nurses and healthcare workers experience trauma just like our patients do. Learning more about trauma’s impact benefits us on many levels.
Create training opportunities
Continuing nursing education and training is fundamental to TIC. Organizations can offer workshops, e-learning modules and simulations to help nurses understand trauma’s impact and how to apply trauma-informed care principles, such as ensuring safety and empowering patients.
As a nursing simulation professor at Rasmussen, I recently oversaw a patient simulation where a native American woman was anxious due to adverse childhood experiences. The lesson plan involved teaching my nursing students how to properly navigate these situations that they will encounter in their professional work.
Include trauma-informed care in guides and protocol documents
Policies and protocols should explicitly integrate trauma-informed care, providing nurses with clear guidelines for trauma-sensitive practices, such as obtaining informed consent or de-escalating crises.
Set aside some physical space
Organizations can further create patient-centered spaces and areas that promote physical and emotional safety, like private rooms and soothing environments, which align with TIC’s core principles.
Support collaboration between healthcare teams
Supporting collaboration is also key, and your organization can build interdisciplinary teams of nurses, social workers and mental health professionals, to ensure comprehensive care for trauma-affected patients.
Protect your healthcare professionals’ wellbeing
To reduce burnout, organizations must also prioritize their staff's wellness by offering mental health resources, flexible schedules and forums for peer support.
In my healthcare system we have resources for staff and physicians that provide access to free mental health services.
Make sure leadership is involved
Leadership plays a vital role by fostering open communication and advocating for resources that nurses need to succeed in implementing TIC.
Additionally, organizations can monitor outcomes through patient feedback and staff surveys, refining TIC strategies as needed. By embedding TIC into their culture and operations, organizations empower nurses to provide compassionate, patient-centered care that promotes healing and trust.
When an organization practices what it preaches, this will instill a culture that provides great trauma-informed practices.
Is trauma-informed care worth investing in?
As you can see trauma-informed care doesn’t necessarily require lots of resources. But it definitely requires intentionality. Trauma impacts so many people, and we’ve only scratched the surface on what TIC can offer healthcare in terms of increased patient trust, and even in terms of connecting with patients who distrust the healthcare environment.
It is essential in nursing and health care organizations to create safe, compassionate and effective environments for patients and staff.
But nurses can’t implement trauma-informed care alone. Organizations play a crucial role by providing education, clear policies and resources that will enable the nursing staff to deliver high-quality care.
Without organizational support, trying to provide trauma informed care could easily feel like one more thing nurses have to handle in a busy day full of challenges. Supporting staff through training and mental health resources can reduce nursing burnout.
Embedding trauma-informed care into nursing practice and organizational frameworks ultimately leads to better patient outcomes, improved staff well-being and a healthcare system that prioritizes dignity and resilience for all.
Some nurses incorporate trauma-informed care into their entire practice. If this interests you, you might like a role in holistic nursing. Check out What is a Holistic Nurse? to see what it’s like.
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