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Guest H, Miller CL. Trauma-Informed Care in Nursing Curricula: Development of a Simulation-Based Educational Framework to Guide Health Professions. Nurs Educ Perspect 2024; 45:271-275. [PMID: 39159250 DOI: 10.1097/01.nep.0000000000001313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024]
Abstract
AIM This research aimed to uncover elements of a comprehensive, trauma-informed (TI) multidisciplinary health professions simulation framework to improve the delivery of care to traumatized patients. BACKGROUND Trauma is a pervasive public health problem requiring a TI approach. Simulation is an evidence-based teaching strategy that advances knowledge and clinical reasoning. There is a lack of scientifically based simulation education models addressing the delivery of TI care for the health professions. METHOD A Delphi study utilizing a panel of experts was conducted to identify the most critical elements of a simulation framework. RESULTS Phase one identified 10 content areas and 111 subcontent areas. Phase two analysis revealed 99 percent of the 111 subcontent areas achieved expert consensus. CONCLUSION This Delphi study provides the first scientifically based framework to guide the development of a comprehensive, TI, multidisciplinary simulation framework to recognize trauma survivors and subsequently display concern and respect.
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Affiliation(s)
- Heather Guest
- About the Authors Heather Guest, PhD, RN, CNE, CHSE, is an assistant professor, Texas Tech University Health Sciences Center, Lubbock, Texas. Cathy L. Miller, PhD, RN, is a professor, College of Nursing and Health Science, University of Texas at Tyler, Tyler, Texas. This research was supported by a 2022 NLN Research in Nursing Education Mary Anne Rizzolo Doctoral Research Award. For more information, contact Dr. Guest at
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Brown T, Fialkowski A, Elisseou S, Grossman S, Sager Z, Potter J, Trinh NH. Trauma-informed precepting: A novel curriculum for faculty development. MEDICAL TEACHER 2024:1-6. [PMID: 39066897 DOI: 10.1080/0142159x.2024.2382858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 07/17/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE Traumatic experiences are ubiquitous and associated with negative impacts on health and wellbeing in patients, students, and clinicians. Trauma-informed care (TIC) is a harm reduction framework that aims to minimize re-traumatization and the negative health impacts of trauma. TIC is increasingly being incorporated into undergraduate medical education (UME) curricula; however, to date, there is no standardized curriculum to support faculty in precepting TIC clinical skills. METHODS We created a series of five educational modules in an asynchronous online format to support faculty in the instruction and precepting of TIC clinical skills in UME. The modules instruct on trauma epidemiology, trauma-informed clinical skills, trauma-informed precepting, and trauma-informed self-care (TISC). The modules are interactive and utilize multimedia content. RESULTS Fifty-three faculty members of the primary care clerkship participated in the modules. After the modules, faculty demonstrated increased knowledge of TIC, though their comfort in applying principles with patients and students was unchanged. DISCUSSION We present a novel, standardized curriculum to support faculty in the practice and precepting of TIC clinical skills. The intervention is shown to promote knowledge surrounding TIC. In the future, pairing these asynchronous modules with in-person training may be necessary to improve comfort with the application of these skills.
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Affiliation(s)
- Taylor Brown
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Sadie Elisseou
- Harvard Medical School, Physician, Department of Internal Medicine, Veteran Affairs Boston Healthcare System, Boston, MA, USA
| | - Samara Grossman
- Department of Psychiatry, Brigham and Women's Hospital, Social Worker, Boston, MA, USA
| | - Zachary Sager
- Harvard Medical School, Physician, Department of Psychiatry, Veteran Affairs Boston Healthcare System, Boston, MA, USA
| | - Jennifer Potter
- Department of Medicine, Harvard Medical School, Veteran Affairs Boston Healthcare System, Boston, MA, USA
- Department of General Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Nhi-Ha Trinh
- Office of Student Affairs, Harvard Medical School, Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
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Hobbs JA, Cowley DS, Crapanzano KA, Soman A, Camp ME, Houston LJ, New AS, Young JQ, Idicula SA, Brown GP, De Golia SG. Charting the Course for the Future of Psychiatric Residency Education: Guiding Considerations. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2024:10.1007/s40596-024-01977-9. [PMID: 38710981 DOI: 10.1007/s40596-024-01977-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 04/24/2024] [Indexed: 05/08/2024]
Affiliation(s)
| | | | | | | | - Mary E Camp
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - L Joy Houston
- Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Antonia S New
- The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John Q Young
- Northwell Health and the Zucker School of Medicine, Hempstead, NY, USA
| | | | - Gregory P Brown
- Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, NV, USA
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Gladden J, Weller BE, Hernandez A, Hopkins A. Teaching Trauma Content in Higher Education: A Systematic Literature Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:3384-3397. [PMID: 36331141 DOI: 10.1177/15248380221129575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Higher education must prepare future mental health providers to work with individuals who have been exposed to trauma. This is vital to the success of students' practice, many of whom would benefit from trauma reduction strategies in their own lives. The purpose of this systematic review is to summarize the knowledge base on teaching methods that may reduce the potential that trauma content in the classroom could cause: (a) re-traumatization; (b) vicarious traumatization; or (c) secondary traumatic stress (collectively "adverse consequences") in higher education students. This systematic review was conducted following PRISMA-P guidelines. A total of 27 peer-reviewed articles met the inclusion criteria, which included studies that focused on teaching methods that were used to teach trauma content for students in higher education, peer-reviewed articles, and articles published in English before February 12, 2020. Studies were identified based on key words and the full-text articles were reviewed by two authors who discussed discrepancies until consensus was obtained. Researchers recommend using a variety of teaching approaches, from teaching about self-care to journaling. However, the major findings showed that few studies analyzed the effectiveness of these methods, and that therefore, the effectiveness of various methods to address the adverse consequences of teaching trauma content is unknown. Further research is needed, including cross-sectional and longitudinal studies in this area.
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Stern EM. Art is Patient: A Museum-Based Experience to Teach Trauma-Sensitive Engagement in Health Care. THE JOURNAL OF MEDICAL HUMANITIES 2023; 44:481-501. [PMID: 37505360 DOI: 10.1007/s10912-023-09810-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/29/2023]
Abstract
Psychological trauma is ubiquitous, an often hidden yet influential factor in care across clinical specialties. Interdisciplinary health professions education is mobilizing to address the importance of trauma-sensitive care. Given their attention to complex human realities, the health humanities are well-poised to shape healthcare learners' responses to trauma. Indeed, many such arts and humanities curricula propose narrative exercises to strengthen empathy, self-reflection, and sensitive communication. Trauma, however, is often unwordable, fragmentary, and physically encoded, incompatible with storying methods. This article presents a recent innovation, the Art is Patient seminar series, which focuses on aesthetic exercises to help learners access and share non-verbal, embodied, and relational responses to art. Based in an art museum context, it provides successive experiences of approaching, witnessing, and engaging with visual art as an analogue to developing trauma-sensitive relationships. Reflections on the process locate the seminar vis-à-vis health humanities practices, aesthetics, and trauma-informed approaches.
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Affiliation(s)
- Eva-Marie Stern
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Marchese S, Huckins LM. Trauma Matters: Integrating Genetic and Environmental Components of PTSD. ADVANCED GENETICS (HOBOKEN, N.J.) 2023; 4:2200017. [PMID: 37766803 PMCID: PMC10520418 DOI: 10.1002/ggn2.202200017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/28/2022] [Indexed: 09/29/2023]
Abstract
Trauma is ubiquitous, but only a subset of those who experience trauma will develop posttraumatic stress disorder (PTSD). In this review, it is argued that to determine who is at risk of developing PTSD, it is critical to examine the genetic etiology of the disorder and individual trauma profiles of those who are susceptible. First, the state of current PTSD genetic research is described, with a particular focus on studies that present evidence for trauma type specificity, or for differential genetic etiology according to gender or race. Next, approaches that leverage non-traditional phenotyping approaches are reviewed to identify PTSD-associated variants and biology, and the relative advantages and limitations inherent in these studies are reflected on. Finally, it is discussed how trauma might influence the heritability of PTSD, through type, risk factors, genetics, and associations with PTSD symptomology.
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Affiliation(s)
- Shelby Marchese
- Pamela Sklar Division of Psychiatric GenomicsIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
| | - Laura M. Huckins
- Pamela Sklar Division of Psychiatric GenomicsIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Seaver Autism Center for Research and TreatmentIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Present address:
Department of PsychiatryYale University School of MedicineNew HavenCT06511USA
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Essay topic - What is the role of psychiatry in recovery from severe trauma? Australas Psychiatry 2023; 31:564-566. [PMID: 37583107 DOI: 10.1177/10398562231190829e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
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Çınar Özbay S, Boztepe H, Kanbay Y. Nursing students' views on trauma-informed pediatric nursing care and family-centered care. Arch Psychiatr Nurs 2023; 44:107-113. [PMID: 37197854 DOI: 10.1016/j.apnu.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/30/2022] [Accepted: 04/24/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE We studied the views of nursing students on family-centered care (FCC) and their knowledge, opinions, self-rated competence, current practice, and perceived implementation barriers with regard to trauma-informed pediatric nursing care. METHODS This survey was a descriptive correlational study. The sample consisted of 261 nursing students, 3rd and 4th years, who had completed the Child Health and Diseases Nursing Course. The data were obtained using the "Student Information Form," "Family-Centered Care Attitude Scale," and "trauma-informed care (TIC) Provider Survey." RESULTS Nursing students were knowledgeable and held favorable opinions about TIC. The survey showed that students with higher levels and those with a hospitalization experience during childhood had higher scores regarding TIC. A positive relationship was found between the students' TIC to mean score and FCC attitude mean score. CONCLUSIONS Nursing students are not competent to practice TIC, especially with pediatric patients. Therefore, they need to develop relevant skills for helping pediatric patients. PRACTICE IMPLICATIONS Efforts to improve nursing students' trauma-informed pediatric care should highlight specific skills related to helping pediatric patients manage emotional responses to difficult medical experiences. By integrating TIC into the baccalaureate curricula, nursing educators can provide the students with appropriate skills and facilities so that they can provide holistic and highly effective care to highly vulnerable patients.
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Affiliation(s)
- Sevil Çınar Özbay
- Faculty of Health Sciences, Artvin Coruh University, Artvin, Turkey.
| | - Handan Boztepe
- Department of Nursing, Faculty of Health Sciences, Atilim University, Ankara, Turkey.
| | - Yalçın Kanbay
- Department of Nursing, Faculty of Health Sciences, Artvin Coruh University, Artvin, Turkey.
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Burns CJ, Borah L, Terrell SM, James LN, Erkkinen E, Owens L. Trauma-Informed Care Curricula for the Health Professions: A Scoping Review of Best Practices for Design, Implementation, and Evaluation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:401-409. [PMID: 36538661 DOI: 10.1097/acm.0000000000005046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Trauma-exposed persons often experience difficulties accessing medical care, remaining engaged in treatment plans, and feeling psychologically safe when receiving care. Trauma-informed care (TIC) is an established framework for health care professionals, but best practices for TIC education remain unclear. To remedy this, the authors conducted a multidisciplinary scoping literature review to discern best practices for the design, implementation, and evaluation of TIC curricula for health care professionals. METHOD The research team searched Ovid MEDLINE, Cochrane Library, Elsevier's Scopus, Elsevier's Embase, Web of Science, and the PTSDpubs database from the database inception date until May 14, 2021. Worldwide English language studies on previously implemented TIC curricula for trainees or professionals in health care were included in this review. RESULTS Fifty-five studies met the inclusion criteria, with medicine being the most common discipline represented. The most prevalent learning objectives were cultivating skills in screening for trauma and responding to subsequent disclosures (41 studies [74.5%]), defining trauma (34 studies [61.8%]), and understanding trauma's impact on health (33 studies [60.0%]). Fifty-one of the studies included curricular evaluations, with the most common survey items being confidence in TIC skills (38 studies [74.5%]), training content knowledge assessment (25 studies [49.0%]), participant demographic characteristics (21 studies [41.2%]), and attitudes regarding the importance of TIC (19 studies [37.3%]). CONCLUSIONS Future curricula should be rooted in cultural humility and an understanding of the impacts of marginalization and oppression on individual and collective experiences of trauma. Moreover, curricula are needed for clinicians in more diverse specialties and across different cadres of care teams. Additional considerations include mandated reporting, medical record documentation, and vicarious trauma experienced by health care professionals.
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Affiliation(s)
- Courtney Julia Burns
- C.J. Burns is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-3216-5921
| | - Luca Borah
- L. Borah is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-8975-1051
| | - Stephanie M Terrell
- S.M. Terrell is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-7776-4621
| | - LaTeesa N James
- L.N. James is a health sciences informationist, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-5955-2876
| | - Elizabeth Erkkinen
- E. Erkkinen is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-3522-7286
| | - Lauren Owens
- L. Owens is assistant professor, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington; ORCID https://orcid.org/0000-0002-8277-2826
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Lanehurst A, Gordon M, Coverdale J, White CN, Nguyen P. Integrating trauma-informed care into clinical practice with trafficked persons. Bull Menninger Clin 2022; 86:44-55. [PMID: 35238611 DOI: 10.1521/bumc.2022.86.suppa.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Trauma-informed care (TIC) as practiced within anti-human trafficking work is still in its early stages, and there is a significant need for specific guidelines concerning how to apply TIC principles along various phases of behavioral health care. Thus, the goals of this article are to (1) provide an overview of the framework of TIC; (2) identify and summarize the literature that specifically highlights the clinical application of TIC principles; and (3) contribute to the existing literature by providing some examples of integrating TIC principles into patient-clinician interactions with trafficked patients. The authors' hope is that mental health providers will reference the provided script examples to help improve patient-provider interactions and to develop better rapport and trust between providers and trafficked persons.
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Affiliation(s)
- Ashley Lanehurst
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Mollie Gordon
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - John Coverdale
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - C Nicole White
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Phuong Nguyen
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
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Cannon LM, Coolidge EM, LeGierse J, Moskowitz Y, Buckley C, Chapin E, Warren M, Kuzma EK. Trauma-informed education: Creating and pilot testing a nursing curriculum on trauma-informed care. NURSE EDUCATION TODAY 2020; 85:104256. [PMID: 31759240 DOI: 10.1016/j.nedt.2019.104256] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/01/2019] [Accepted: 10/28/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Trauma is a significant contributor to morbidity and mortality. Trauma-informed care (TIC) provides a safe and supportive healthcare environment for patients who have experienced trauma. Educating healthcare providers improves knowledge, attitudes, and skills related to TIC. However, nursing programs do not systematically integrate TIC education. PURPOSE To create, implement, and evaluate nursing content on TIC at the graduate and undergraduate levels at one university. METHOD A pretest-posttest survey was utilized to assess changes in TIC knowledge, attitudes, and skills related to the delivery of content on trauma and TIC to students in three courses at one large Midwestern university in January 2019. Safety, acceptability, and transferability were also measured. FINDINGS The content improved nursing students' knowledge and skills related to providing TIC. Further, content on TIC is acceptable to both undergraduate and graduate students and is transferrable to non-nursing students. DISCUSSION The current study provides a trauma-informed nursing education model that is safe, appropriate, acceptable, and efficacious.
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Affiliation(s)
- Lindsay M Cannon
- University of Wisconsin - Madison, Department of Sociology, Center for Demography and Ecology, 1180 Observatory Drive, Madison, WI 53706, United States of America.
| | - Elizabeth M Coolidge
- University of Michigan School of Nursing, 400 North Ingalls Street, Ann Arbor, MI 48109, United States of America
| | - Julianne LeGierse
- University of Michigan School of Nursing, 400 North Ingalls Street, Ann Arbor, MI 48109, United States of America
| | - Yael Moskowitz
- University of Michigan School of Nursing, 400 North Ingalls Street, Ann Arbor, MI 48109, United States of America
| | - Courtney Buckley
- University of Michigan School of Nursing, 400 North Ingalls Street, Ann Arbor, MI 48109, United States of America
| | - Emily Chapin
- University of Michigan School of Nursing, 400 North Ingalls Street, Ann Arbor, MI 48109, United States of America
| | - Megan Warren
- University of Michigan School of Nursing, 400 North Ingalls Street, Ann Arbor, MI 48109, United States of America
| | - Elizabeth K Kuzma
- University of Michigan School of Nursing, 400 North Ingalls Street, Ann Arbor, MI 48109, United States of America
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Isobel S, Gladstone B, Goodyear M, Furness T, Foster K. A qualitative inquiry into psychiatrists' perspectives on the relationship of psychological trauma to mental illness and treatment: implications for trauma-informed care. J Ment Health 2020; 30:667-673. [PMID: 31997673 DOI: 10.1080/09638237.2020.1714012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Trauma is a factor impacting the lives of many people experiencing psychiatric disorders. Trauma affects people's responses to illness as well as their interactions with services.Aim: This study aimed to explore the understandings and experiences of psychiatrists of working with trauma and emerging models of Trauma-Informed Care.Methods: An interpretive qualitative inquiry was undertaken using semi-structured in-depth interviews with psychiatrists.Results: Four themes were identified: Making sense of trauma; A contentious relationship between trauma and mental illness; Treatment made more challenging by trauma; Trauma-Informed Care highlights tensions. Psychiatrists are familiar with the concept of trauma but there are differences in beliefs about its relationship to mental illness that are consequential for practice. Trauma-Informed Care is seen as an effort to humanise mental health services, but with perceived limited impact on psychiatrists' roles.Conclusion: Findings indicate need for further consultation and collaboration with psychiatrists around trauma-informed care implementation; as well as consideration of what is required to develop professional consensus on trauma and its relationship to illness.
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Affiliation(s)
- Sophie Isobel
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia.,Sydney Local Health District, Concord, Australia
| | - Brenda Gladstone
- Centre for Critical Qualitative Health Research, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Melinda Goodyear
- School of Rural Health, Monash University, Moe, Australia.,The Parenting Research Centre, La Trobe University, Melbourne, Australia
| | - Trentham Furness
- Australian Catholic University, Melbourne, Australia.,NorthWestern Mental Health, Melbourne Health, Melbourne, Australia
| | - Kim Foster
- Australian Catholic University, Melbourne, Australia.,NorthWestern Mental Health, Melbourne Health, Melbourne, Australia
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