Which is the correct order of steps the nurse will implement when providing care to a client who has experienced trauma?

Trauma-informed care shifts the focus from “What’s wrong with you?” to “What happened to you?” A trauma-informed approach to care acknowledges that health care organizations and care teams need to have a complete picture of a patient’s life situation — past and present — in order to provide effective health care services with a healing orientation. Adopting trauma-informed practices can potentially improve patient engagement, treatment adherence, and health outcomes, as well as provider and staff wellness. It can also help reduce avoidable care and excess costs for both the health care and social service sectors.

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Trauma-informed care seeks to:

• Realize the widespread impact of trauma and understand paths for recovery;
• Recognize the signs and symptoms of trauma in patients, families, and staff;
• Integrate knowledge about trauma into policies, procedures, and practices; and
• Actively avoid re-traumatization.

A comprehensive approach to trauma-informed care must be adopted at both the clinical and organizational levels. Too frequently, providers and health systems attempt to implement trauma-informed care at the clinical level without the proper supports necessary for broad organizational culture change. This can lead to uneven, and often unsustainable, shifts in day-to-day operations. This narrow clinical focus also fails to recognize how non-clinical staff, such as front desk workers and security personnel, often have significant interactions with patients and can be critical to ensuring that patients feel safe.

Following are recognized core principles of a trauma-informed approach to care that are necessary to transform a health care setting:

Throughout the organization, patients and staff feel physically and psychologically safe

Decisions are made with transparency, and with the goal of building and maintaining trust

Individuals with shared experiences are integrated into the organization and viewed as integral to service delivery

Power differences — between staff and clients and among organizational staff — are leveled to support shared decision-making

Patient and staff strengths are recognized, built on, and validated — this includes a belief in resilience and the ability to heal from trauma

Biases and stereotypes (e.g., based on race, ethnicity, sexual orientation, age, geography) and historical trauma are recognized and addressed

There are a number of benefits to using a trauma-informed approach, not only for patients but also for providers and staff. Many patients with trauma have difficulty maintaining healthy, open relationships with a health care provider. For patients, trauma-informed care offers the opportunity to engage more fully in their health care, develop a trusting relationship with their provider, and improve long-term health outcomes. Trauma-informed care can also help reduce burnout among health care providers, potentially reducing staff turnover.

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Individuals can build trauma-informed health care organizations that create safe, caring, inclusive environments for all patients. There are a number of trauma-informed strategies that organizations can adopt to help people overcome the effects of trauma, ranging from organizational changes in the culture and atmosphere of a health care setting to full adoption of practices to address trauma at the clinical level.

For more details, see Get Started with Trauma-Informed Care.

There are many ways to become a trauma-informed organization and the process does not have to be a burden to adopt. Foundational steps organizations can take to move toward fully adopting a trauma-informed approach to care include:

1. Building awareness and generating buy-in for a trauma-informed approach;
2. Supporting a culture of staff wellness;
3. Hiring a workforce that embodies the values of trauma-informed care; and
4. Creating a safe physical, social, and emotional environment.

For more details, see a brief on Laying the Groundwork for Trauma-Informed Care.

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