Safe and Collaborative Communication Skills: A Step towards Mental Health Nurses Implementing Trauma Informed Care

Implementing Trauma-Informed Care-Settings, Definitions, Interventions, Measures, and Implementation across Settings: A Scoping Review

Traumatic experiences can have long-lasting negative effects on individuals, organizations, and societies. If trauma is not addressed, it can create unsafe cultures with constant arousal, untrusting relationships, and the use of coercive measures. Trauma-informed care (TIC) can play a central role in mitigating these negative consequences, but it is unknown how and in which way(s) TIC should be implemented. Our objective was to conduct a scoping review that systematically explored and mapped research conducted in this area and to identify existing knowledge about the implementation of TIC. The search was conducted on the CINAHL, Cochrane, Embase, ERIC, Medline, PsycINFO, and Web of Science databases, and more than 3000 empirical papers, published between 2000 and 2022, were identified. Following further screening, we included 157 papers in our review, which were mainly from the USA, Australia, New Zealand, and Canada, focusing on study settings, methodologies, and definitions of TIC, as well as the types of interventions and measures used. This review shows that TIC is a complex and multifaceted framework, with no overarching structure or clear theoretical underpinnings that can guide practical implementations. TIC has been defined and adapted in varied ways across different settings and populations, making it difficult to synthesize knowledge. A higher level of agreement on how to operationalize and implement TIC in international research could be important in order to better examine its impact and broaden the approach.

Working effectively with consumers: Perspectives from students, teachers, nurses, and consumers

Preparing enrolled nurses (ENs) to effectively work with mental health consumers is crucial to meeting Australia's healthcare demands. This qualitative study aimed to explore various stakeholders' perceptions regarding the mental health knowledge, skills, and attributes (KSAs) required by ENs to engage with individuals experiencing mental health issues, thus guiding future training priorities. The sample comprised 44 participants including 18 students, 3 graduate ENs, 5 experienced ENs, 5 registered nurses (RNs), 4 nurse unit managers (NUMs), 5 teachers, and 5 consumers of mental health services. Focus groups were used to collect data from the students, whilst individual interviews were conducted with all other participants. A thematic analysis revealed communication was the most vital skill for effectively working with mental health consumers. Skills such as critical thinking and clinical reasoning were also deemed crucial, given the volatile nature of the mental health inpatient environment, necessitating effective responses to acute escalations to prevent adverse outcomes for both staff and consumers. Essential knowledge components included understanding mental health disorders, symptoms, and treatments, particularly medications used for mental health issues. Participants also emphasised the importance of attributes like confidence and empathy in supporting and caring for consumers, who often experienced trauma and vulnerability. These findings provide valuable insights into the content that should be incorporated into the diploma of nursing (DN) training to produce competent graduate ENs.

Evaluating the Effectiveness of Trauma-Informed Care Frameworks in Provider Education and the Care of Traumatized Patients

INTRODUCTION

Trauma-informed care (TIC) spans many different health care fields and is essential in promoting the well-being and recovery of traumatized individuals. This review aims to assess the efficacy of TIC frameworks in both educating providers and enhancing care for adult and pediatric patients.

METHODS

A literature search was conducted using PubMed, EMBASE, Proquest, Cochrane, and Google Scholar to identify relevant articles up to September 28, 2023. Studies implementing TIC frameworks in health care settings as a provider education tool or in patient care were included. Studies were further categorized based on adult or pediatric patient populations and relevant outcomes were extracted.

RESULTS

A total of 36 articles were included in this review, evaluating over 7843 providers and patients. When implemented as a provider education tool, TIC frameworks significantly improved provider knowledge, confidence, awareness, and attitudes toward TIC (P < 0.05 to P < 0.001). Trauma screenings and assessments also increased (P < 0.001). When these frameworks were applied in adult patient care, there were positive effects across a multitude of settings, including women's health, intimate partner violence, post-traumatic stress disorder, and inpatient mental health. Findings included reduced depression and anxiety (P < 0.05), increased trauma disclosures (5%-30%), and enhanced mental and physical health (P < 0.001).

CONCLUSIONS

This review underscores the multifaceted effectiveness of TIC frameworks, serving both as a valuable educational resource for providers and as a fundamental approach to patient care. Providers reported increased knowledge and comfort with core trauma principles. Patients were also found to derive benefits from these approaches in a variety of settings. These findings demonstrate the extensive applicability of TIC frameworks and highlight the need for a more comprehensive understanding of their applications and long-term effects.

"They just looked at me like I was human": The experiences of parenting women and providers with substance use disorder treatment

BACKGROUND

The current US addiction treatment system does not effectively meet the needs of pregnant and parenting women with substance use disorder (SUD). The aim of this research was to identify barriers and facilitators to engagement and retention in SUD residential treatment for pregnant and parenting women. This research was part of a co-design process to collaboratively create a more patient-centered long-term residential program.

DESIGN AND METHODS

The study conducted semi-structured individual interviews with both parenting women with lived experience (WWLE) in residential SUD treatment and SUD treatment providers. Interviews aimed to elicit participants' experiences either receiving or providing care. The study team analyzed data in NVivo-12 using a deductive codebook based on the six principles of trauma informed care (TIC).

RESULTS

We conducted a total of 32 interviews (WWLE =13, SUD providers =19). The study identified four major themes: 1) peer relationships provide inspiration and diminish shame; 2) providing individuals safe space to stumble in recovery creates opportunities for growth and builds self-efficacy; 3) reasonable, clear boundaries create a structured, protective environment for early recovery; 4) nonjudgmental connections facilitate engagement and build trust. We identified small pivotal moments along the continuum of care that showed how the elements in the four themes enhanced engagement and retention in treatment. These interactions, along the care continuum, are either structural (workflow process) or relational (interpersonal).

CONCLUSION

This research increases understanding of the interplay of the structural and relational barriers and facilitators to engagement and retention in treatment. These seemingly minor positive or negative interactions along the care continuum are pivotal to fully operationalizing TIC and optimizing women's engagement in treatment. Improvement strategies that integrate the voices of WWLE and collaboratively co-design a more patient-centered system are critical steps to improving engagement in SUD treatment and more equitable SUD treatment services.

Trauma and the perinatal period: A review of the theory and practice of trauma-sensitive interactions for nurses and midwives

AIM

With high rates of trauma in the population, known links between trauma and perinatal distress, and the intimate and close nature of the nursing and midwifery roles, ensuring awareness and understandings of trauma is crucial for guiding practice. This paper aims to explore the relationship of trauma to the perinatal period, based on theory and practice, to consider on how nurses and midwives can deliver trauma-sensitive interactions.

DESIGN AND METHODS

This discursive discussion draws on relevant research from the fields of trauma therapy, attachment theory and nursing and midwifery practice to consider elements of trauma-sensitive practice in the perinatal period.

RESULTS

Nurses and midwives can foster safety for people who have experienced trauma through noticing and responding to triggers, supporting awareness of attachment and its relationships to trauma, undertaking psychosocial screening with care, supporting linearity and cohesion in narratives and developing collaborative care plans that maximise safety and agency. For nurses and midwives, understandings of the relationship between trauma, pregnancy, birth, early parenting and distress is crucial for effective care delivery. Delivering perinatal nursing or midwifery care of any kind, without universal trauma precautions risks reinforcing, misinterpreting or re-enacting dynamics of trauma. To be trauma-sensitive in this period requires nurses and midwives to have awareness of the dynamics of trauma in relation to pregnancy, birth and attachment.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This paper fills a gap in the translation of theory to practice for trauma-sensitive care in the perinatal period, with a focus on the therapeutic relationship formed by nurses and midwives. The findings highlight that nurses and midwives can foster safety for people who have experienced trauma within their practice, when they hold a robust understanding of the relationship between trauma, pregnancy, birth, early parenting and distress.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Communicating Through and Around Trauma: Understanding the Limitations to Narrative and Resilience

In this autoethnographic account of my experiences as a parent who discovers and attempts to respond to the abuse of her child, I highlight the ways trauma can remove access to storytelling as a sensemaking and healing tool in a crisis. I narrate how I experienced secondary trauma as a meaning-making black hole that blocked language's healing capacities, blinded me to important sensemaking turning points, and hampered my and my child's ability to ask for help. These experiences caused me to question many foundational assumptions I made as a health communication scholar and to see an interdisciplinary bias toward narrative resiliency. Narrating the inhibiting effects trauma has on emplotment, help-seeking, and meaning-making points to the uniquely communicative nature of trauma which enables narrative theory and health communication research to make strong theoretical contributions to better understand trauma and support appropriate trauma-informed practices.

Trauma-Informed Care Curricula for the Health Professions: A Scoping Review of Best Practices for Design, Implementation, and Evaluation

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.

Effecting change and improving practice in a regional Emergency Department: A Mental Health Nurse Practitioner's perspective

Providing appropriate, timely intervention and care to people who present with mental health issues to an Emergency Department presents unique ongoing challenges, often affecting patient experiences and outcomes. To address such concerns, a Mental Health Liaison Nurse role, led by a Mental Health Nurse Practitioner, was introduced to a regional Emergency Department. This role provided integrated emergency-based mental health clinical practice, with positive findings reported in a recently published multi-site translational research project. With sound quantitative and qualitative evidence detailing the benefits of this role, the experiential perspective from a clinician working in this frontline space further confirms the importance of having access to such a position in leading cultural and systemic change. This discussion article identifies key processes that align current research with the clinical perspective. Such processes recognize the challenges of implementing a new role and moving forward from these to embed consistent clinical practices. The need to build sound internal and external stakeholder partnerships, effect change implementation, and assign recommendations to ensure sustainability of improved practice and processes are highlighted in this paper. This article is, therefore, designed to assist other advanced practice nurses, who may be embarking on a similar journey and want to influence organizational policy and practice.

Development, implementation, and evaluation of a trauma-informed simulation-based training program for graduate nurses: A single arm feasibility and pilot study

BACKGROUND

The chance of hospital staff encountering a patient with a trauma history is high. The way health services are offered and carried out are important when engaging with people who have experienced trauma. Implementing training in trauma-informed care (TIC) is part of a cultural change of benefit to both patients and staff. Simulation-based training is a well-accepted method to reduce staff fear and anxiety when working with individuals in distress and to address issues relating to bias and stigma.

OBJECTIVES

To provide simulation-based TIC training to graduate nurses.

DESIGN

A three-phase process was undertaken to i) create the intervention, ii) determine feasibility, and iii) evaluate the developed training.

SETTING

A 600-bed inner-city tertiary hospital in Melbourne, Victoria.

PARTICIPANTS

Graduate nurses undertaking their first year of employment (n = 23).

METHODS

The content of the training was created using evidence derived from a literature review, a scoping study of available resources, and expert consensus. A pre/post-test within-groups design to assess the safety, acceptability, and effectiveness of the training was undertaken.

RESULTS

The Trauma Informed-Simulation Based Training (TI-SBT) aims to increase TIC knowledge and promote TIC behaviours. It is delivered face-to-face over one day and encompasses an education component followed by three immersive patient simulations using professional actors. Analysis found significant improvement in TIC knowledge (p ≤ 0.001, 95% CI = -3.53, -0.47) and behaviours (p = 0.013, 95% CI = -8.88, -5.03). No significant differences were found in measures of anxiety and confidence. Satisfaction with all aspects of the training was high. Qualitatively, participants provided concrete examples of changes to their practice to facilitate TIC.

CONCLUSIONS

The developed and novel TI-SBT is a feasible (safe, acceptable, and effective) way of introducing TIC to graduate nurses. These findings provide strong evidence to support a more rigorous evaluation of the training by randomised controlled trial. The TI-SBT has the capacity to not only improve patient care but the experience of hospital staff.

Defensive practices in mental health nursing: Professionalism and poignant tensions

Mental health nursing is a skilled profession, well positioned to support patients towards recovery with evidence-based therapeutic interventions. However, the profession continues to be challenged by tensions surrounding the delivery of restrictive interventions and concerns over tendencies towards defensive practices. This paper examines the ambiguity this creates within the mental health nursing role. Organizational cultures that overvalue metrics and administrative tasks create barriers for therapeutic engagement while contributing to role confusion and stress within nursing. We need to address such structural constraints on nurses as mental health nurses' well-being is crucial to service delivery and the realization of therapeutic goals. From the UK perspective, authors argue that there is a need to examine service structures that foster compassionate and transformational leadership to enable mental health nurses to exercise the agency to practice therapeutically. Education and quality nursing research have a pivotal role to play in enabling this shift.

Exploring the knowledge base of trauma and trauma informed care of staff working in community residential accommodation for adults with an intellectual disability

Background

Taking a trauma informed care approach has demonstrated positive outcomes for services for people in the general population. Given the increased vulnerability to psychological trauma for adults with an intellectual disability, this study explores what residential staff know about trauma and trauma informed care.

Methods

Thirty‐two staffs representing three staff groups: direct care staff; managers; and specialist practitioners, were interviewed using semi‐structured interviews, which were analysed following a structured framework.

Findings

Each staff group held different perspectives in their knowledge of trauma and trauma informed care. Limitations were noted in staffs' knowledge of trauma, implementation of evidence‐based supports, and access to specialist services for adults with an intellectual disability. All participants highlighted their training needs regarding trauma.

Conclusion

Increased training on recognising and responding to trauma is needed among community staff supporting those with a trauma history if organisations are to move towards trauma informed care.

Child Adversity and Trauma-Informed Care Teaching Interventions: A Systematic Review

OBJECTIVES

Health professionals need training to provide trauma-informed care (TIC) for children with adverse childhood experiences (ACEs), which can affect short- and long-term health. We summarize and evaluate published curricula for health professionals on ACEs and TIC.

METHODS

We searched PubMed, Embase, Web of Science, CINAHL, Cochrane Central Register of Controlled Trials, PsychInfo, and MedEdPORTAL through January 2021. Studies meeting the following criteria were included: Described teaching interventions on ACEs, TIC, and child abuse and maltreatment; included health care providers or trainees as learners; were written in English; included an abstract; and described a curriculum and evaluation. We reviewed 2264 abstracts, abstracted data from 79 studies, and selected 51 studies for qualitative synthesis.

RESULTS

Studies focused on ACEs/TIC (27), child abuse (14), domestic/intimate partner violence (6), and child maltreatment/parental physical punishment (4). Among these 51 studies, 43 were published since 2010. Learners included a mix of health professionals (34) and students (17). Duration, content, and quality of the 51 curricula were highly variable. An analysis of 10 exemplar curricula on ACEs and/or TIC revealed high and very high quality for methods and moderate to very high quality for curriculum evaluation, suggesting that they may be good models for other educational programs. Four of the 10 exemplars used randomized controlled trials to evaluate efficacy. Studies were limited to English language and subject to publication bias.

CONCLUSIONS

ACEs and TIC are increasingly relevant to teaching health professionals, especially pediatricians, and related teaching curricula offer good examples for other programs.

Psychiatric hospital nurses' attitudes towards trauma-informed care

WHAT IS KNOWN ON THE SUBJECT?: Research indicates many clients using mental health services have trauma histories. Consequently, mental health professionals must be aware of the impact of trauma and of how they can avoid retraumatizing service-users. Care delivered with this awareness is known as trauma-informed care (TIC). There is little research on attitudes towards TIC. To date, only one study explored these attitudes among MHNs exclusively. Additionally, a richer understanding of TIC attitudes using methods like in-depth interviews is needed. It is unclear whether knowledge of TIC results in more favourable attitudes. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: MHNs in this study had little knowledge of TIC but expressed overall favourable TIC attitudes. Traumatic histories were not appreciated as causes of challenging behaviour. On rehabilitation wards, clients come to be perceived as family members and this makes it harder for MHNs to not take challenging behaviour of clients personally. MHNs face work-related traumas which interfere with their ability to provide TIC. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Findings of this study can be used to guide plans to implement TIC in psychiatric hospitals. Policymakers are called to appreciate that ensuring MHN well-being on the workplace will facilitate their delivery of TIC. TIC training initiatives for MHNs must stress the importance of acknowledging traumatic histories as causes of challenging behaviour and of maintaining professional boundaries with long-term clients. This would benefit service-users by ensuring MHNs are more trauma-informed. More research on attitudes towards TIC among MHNs is needed. ABSTRACT: Introduction Quantitative studies exploring trauma-informed care (TIC) attitudes have not used samples made up exclusively of mental health nurses (MHNs). Qualitative methods were sparingly used. Aim To examine nurses' TIC attitudes at a psychiatric hospital. Method A mixed-method design was used. One hundred and thirty-six MHNs completed the Attitudes Related to Trauma-Informed Care scale. Data were analysed using inferential statistics. A focus group interview among ten MHNs ensued. Thematic analysis was used. Results MHNs demonstrated favourable TIC attitudes. Ambivalent attitudes for the subscale "Causes" were identified. MHNs employed for less than 5 years at the hospital and those in acute settings displayed more favourable attitudes on some subscales. Three themes "Awareness," "Unhealthy boundaries" and "Inhibition" emerged from qualitative analysis. Discussion Challenges uncovered in the provision of TIC include the unacknowledged impact of trauma on challenging behaviour among MHNS, the influence of blurred professional boundaries with long-term clients on the cycle of perpetuated trauma identified by previous research and MHNs work-related traumas. Implications for practice Identified challenges to TIC integration among MHNs can facilitate the implementation of TIC in hospitals. TIC educational packages for MHNs should acknowledge traumatic histories in the aetiology of challenging behaviour and stress the importance of maintaining professional boundaries with clients.

The 'trauma' of trauma-informed care

OBJECTIVES

As mental health services increasingly position themselves as providing 'trauma-informed care', there is a need for ongoing critical reflection on the challenges that this movement highlights for mental health services, including those related to the concept of trauma itself.

CONCLUSIONS

To become trauma-informed requires opportunities to reflect on what trauma means and consideration of the challenges the concept poses to diagnostically driven systems. Alongside uptake, further debate is required.

Exploring How Sexual Assault Nurse Examiners Practise Trauma-Informed Care

BACKGROUND

Sexual violence is a term describing sexual acts where consent is not freely given. Registered nurses employed as sexual assault nurse examiners (SANEs) provide care to address the medical and legal needs of victims/survivors of sexual violence. Trauma-informed care (TIC) is an approach recommended when caring for individuals who have experienced trauma.

PURPOSE

The study purpose was to understand how SANEs incorporate trauma-informed approaches in the care of adult and postpubescent adolescent victims/survivors of sexual violence.

METHODS

Eight SANEs were purposively recruited to participate in online semistructured interviews. Interview data were analyzed using qualitative interpretive description.

RESULTS

Six themes emerged from the analysis: (a) the importance of understanding the patient's experience; (b) personalized connection: developing a safe nurse-patient relationship; (c) choice: the framework of how we do things; (d) rebuilding strengths and skills to support healing and posttraumatic growth; (e) a wonderful way to practise: facilitators and benefits of trauma-informed practice; and (f) challenges to trauma-informed practice.

CONCLUSIONS

These findings indicate the perceived value of TIC and the need for enhanced support of providers who deliver TIC. More research is warranted to strengthen the evidence about trauma-informed practice in SANE programs and across healthcare settings.

"Can mental health nurses working in acute mental health units really be trauma-informed?" An integrative review of the literature

WHAT IS KNOWN ON THE SUBJECT?: The lifetime prevalence of trauma for consumers of mental health services is high. Both nurses and consumers of mental health services experience trauma and re-traumatization in mental health units. TIC is a model of care or approach increasingly used in mental health units to guide nursing actions to minimize trauma and re-traumatization for those working and accessing mental health services. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Overall, there is poor quality of studies exploring TIC in acute mental health units from the perspective of the MHN. Acute mental health units have competing organizational demands that can often be a source of conflict for nurses providing TIC. To be trauma-informed, a critical examination of the dynamic and unique system-related processes in mental health units is required. TIC literature reveals that nurses are seeking to develop the basic skills expected to be gained in earlier preparatory education to respond therapeutically to consumers. Not all MHNs agree that TIC is necessarily a new or useful model to inform their practice. Trauma and re-traumatization experienced by MHNs can be a source of conflict for TIC in the mental health unit environment. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The broader environmental and organizational demands placed on nurses can create professional and moral conflict for providing TIC. TIC should acknowledge trauma and re-traumatization experienced by MHNs in the acute mental health units.

ABSTRACT

INTRODUCTION: Trauma-informed care (TIC) is an approach that mental health inpatient units are increasingly adopting, with mental health nurses (MHNs) being the largest occupational group working this area.

AIM

To critically examine the literature on TIC in mental health inpatient units from a MHN perspective.

METHODS

Primary studies examining TIC in mental health inpatient units from a MHN perspective were examined in CINAHL, Medline and PsycINFO database including the reference lists of primary sources. A total of n = 10 studies met the inclusion criteria with four themes identified.

DISCUSSION

There is a paucity of quality research available on TIC to guide MHNs employed in mental health inpatient units. The review has highlighted that MHN practice is influenced by the medical model ideology and competing organizational demands that can at least partially negate the effective provision of TIC.

IMPLICATIONS FOR PRACTICE

For purposeful application of TIC, the parallel and often unconscious organizational processes that exist for MHNs working in mental health units must too be examined.

RELEVANCE STATEMENT

The review invites an opportunity for important reflections by MHNs employed in mental health units. TIC may help restore MHN practice to the interpersonal tenants the profession is best distinguished by.

Exploring recovery-focused educational programmes for advancing mental health nursing: An integrative systematic literature review

Recovery-focused educational programmes have been implemented in mental health services in an attempt to transform care from a purely biomedical orientation to a more recovery-oriented approach. Mental health nurses have identified the need for enhancing their abilities and confidence in translating recovery knowledge into mental health nursing practice. However, recovery-focused educational programmes have not fully address nurses' learning needs. Therefore, this review synthesized the evidence of the effectiveness of recovery-focused educational programmes for mental health nurses. A systematic search of electronic databases and hand-searched references was conducted. It identified 35 programmes and 55 educational materials within 39 studies. Synthesizing the literature revealed three themes and nine subthemes. The first theme, a framework for understanding and supporting consumers' recovery, had four subthemes: consumers' involvement, multidisciplinary approach, profession-specific training, and performance indicators. The second theme, contents of educational materials, included the subthemes: knowledge development and recovery-focused care planning. The final theme, nurses' learning experiences, included the subthemes: understanding recovery, the positive effects of recovery-focused educational programmes, and implementation of recovery-oriented practices. Based on these findings, a mental health nursing recovery-focused educational programme framework is proposed. Further research should investigate the effectiveness of the framework, especially in relation to recovery-focused care planning and consumer and carer involvement in the development, delivery, participation, and evaluation of these educational programmes.

A concept analysis of trauma-informed care

AIM

This concept analysis aims to provide an in-depth analysis of the concept of trauma-informed care and explore the use of this concept in nursing, using Walker and Avant's method.

BACKGROUND

Trauma-informed care is a priority for nurses caring for patients with previous trauma. Many forms of trauma exist. Various types of trauma may not be apparent without appropriate assessment. Therefore, nurses must approach all patients with the components of trauma-informed care.

DESIGN

Concept analysis.

DATA SOURCE

PubMed, Cumulative Index of Nursing and Allied Health Literature, and PsycINFO databases were searched for articles in English. The final sample consisted of 23 documents published from 2015 to 2020.

REVIEW METHODS

Concept analyzed using Walker and Avant's eight-step method.

RESULTS

Four defining attributes of trauma-informed care were identified as recognition, knowledge, concern, and respect. Definitions, the use of the concept of trauma-informed care, antecedents, consequences, and empirical referents are described. Model, borderline, and contrary cases are discussed.

CONCLUSION

Many forms of trauma exist. Various types of trauma may not be apparent without appropriate assessment. Therefore, establishing an operational definition of trauma-informed care has implications and significance in victim identification and the provision of trauma-informed care, advocacy, and nursing and interdisciplinary research.

'What would a trauma-informed mental health service look like?' Perspectives of people who access services

Trauma-informed care is an approach to the delivery of mental health care based on an awareness of the high prevalence of trauma in the lives of people accessing mental health services, the effects of trauma experiences and the potential for trauma or re-traumatization to occur in the context of care. Across Australia, inquiries and reports have increasingly indicated an urgent need for mental health services to become trauma-informed. However, how Australian mental health services should deliver trauma-informed care is not well documented. Efforts towards trauma-informed care in any setting require engagement with those who receive care. This qualitative study used an experience-based co-design methodology to explore the perspectives of consumers of mental health services in Australia and their family members, in relation to the question 'what would a trauma-informed mental health service look like?' Focus groups were held with consumers (n = 10) and carers (n = 10). Thematic analysis of transcripts identified that consumers and carers consider that trauma-informed care requires increased awareness of trauma amongst mental health staff, opportunities to collaborate in care, active efforts by services to build trust and create safety, the provision of a diversity of models and consistency and continuation of care. The findings provide important new information about the experiences of Australian service users and have implications for the implementation of trauma-informed care across settings.

Care planning and nonpharmacological interventions in a metropolitan inpatient dual diagnosis service: A retrospective exploratory study

In Australia, the terms dual diagnosis and comorbidity are commonly used, often interchangeably, to describe the experience of consumers with both mental health difficulties and difficulties with alcohol and other drug use. Consumers with comorbidity often have complex needs that require comprehensive assessment, multidisciplinary team support, and trauma-focused management. More information about the demographics of consumers admitted with comorbidity, and the documented assessed needs, care, and interventions provided, would provide the foundations for working towards improved quality and continuity of care. Therefore, the aim of this study was to explore the documentation of inpatient assessment, care, and interventions provided to people with comorbidity. The research design was a retrospective exploratory study, and data collection involved a 12-month healthcare record audit. Forty-one records were screened, and 36 consumer healthcare records were identified as eligible for inclusion in the study. Most consumers (n = 34, 94%) were admitted on an involuntary basis, and 8 (22.2%) were female. Consumers had a median length of stay of almost six months. In most healthcare records, there was no documented evidence of care planning involvement by consumers or the multidisciplinary team. There was great variance in the delivery of nonpharmacological interventions. Most consumers did not receive trauma-focused assessment or intervention, and assessment tools were often incomplete with outcome measures poorly documented. This study has demonstrated significant gaps in consumer and multidisciplinary engagement with care planning and goal setting. There was poor documentation of comprehensive assessment and nonpharmacological interventions.

Nurses' psychological trauma: "They leave me lying awake at night"

OBJECTIVE

To describe nurses' personal and professional psychological trauma.

METHODS

A content analysis of 372 responses surrounding personal and professional trauma was performed.

RESULTS

Five themes emerged. A new type of trauma was uncovered, heretofore undescribed in the literature: insufficient resource trauma caused by a lack of resources and staff needed to render quality, safe care.

CONCLUSION

Nurses' reports were vivid, frequently indicating they were still recovering from traumatic experiences. Professional sources of trauma were categorized as inherent in the role of the nurse and those that could be mitigated through organizational policy, adequate resources, and oversight.

Effectiveness of 1-day trauma-informed care training programme on attitudes in psychiatric hospitals: A pre-post study

Many patients in mental health settings are likely to have histories of interpersonal traumatic experiences. Mental health providers are recommended to adopt trauma-informed care (TIC) to ensure sensitivity and responsiveness to the impact of trauma on patients. However, few studies have examined the effectiveness of a TIC training programme using standardized measures with follow-up assessments. The aim of the study was to evaluate the effects of a TIC training programme on attitudes towards TIC in mental health professionals. The study involved a pre-post design with 3-month follow-up assessments conducted between March and June 2018. In total, 65 mental health professionals from 29 psychiatric hospitals in Tokyo and its suburban prefectures participated in the study. Mental health professionals participated in a 1-day programme consisting of a 3.5-hour lecture and 1-hour group discussion. Development of favourable attitudes towards TIC was the primary outcome, as assessed by using the Attitude Related Trauma-Informed Care scale. The majority of participants were women (86%), and the mean age was 42.2 years. The mean score of the Attitude Related Trauma-Informed Care scale scores increased significantly from 5.1 during pre-training to 5.5 immediately after training (mean difference: 0.4; 95% confidence interval: 0.3-0.5) and 5.4 after 3 months (mean difference: 0.3; 95% confidence interval: 0.2-0.4). Furthermore, half of the participants claimed to have implemented TIC practice in daily clinical settings at the 3-month follow-up. These results suggested that this brief TIC training programme improved attitudes towards TIC practice significantly.

Confronting the Social Determinants of Health: Has the Language of Trauma Informed Care Become a Defense Mechanism?

Many writers have been calling for the incorporation of trauma-informed care (TIC) in nursing education and practice, with some recently advocating the adoption of formal TIC competencies in psychiatric nursing. In light of this heightened interest, it is worth engaging seriously with criticisms of TIC. This paper reviews some of the published criticisms of TIC, starting with those emerging from within the TIC scholarly community. These focus mostly on matters of methodological rigor and conceptual clarity. It then presents critiques that emerge through the lenses of feminism, cultural sociology, and psychoanalysis. These focus on the shift away from political and historical consciousness in some TIC language and call attention to discursive mechanisms that split off our concern for patients from concern about ongoing social determinants of trauma in the world. The paper then addresses the implications for TIC in nursing, advocating a social justice orientation to the teaching of trauma.

'In some ways it all helps but in some ways it doesn't': The complexities of service users' experiences of inpatient mental health care in Australia

Recovery-oriented mental health care requires active involvement of service users in the evaluation of care. While experience of care surveys is routinely given out upon discharge, capturing the depth and detail of service users' experiences in such a way to meaningfully improve services may require more in-depth and targeted approaches. This study aimed to gather voluntary and involuntary service users' experiences of care during hospitalization in two acute adult mental health inpatient units, through the collaborative completion of a purpose designed tool. The purpose of the study was to examine broad experiences of care and to identify the utility of proactive approaches to ongoing service evaluation. Overall, 67 participants were interviewed. Findings highlight the complexity of experiences of care including how an admission can seemingly facilitate clinical recovery while not being recovery-oriented. The findings also detail areas for improvement in the way that care is delivered and evaluated. The implications are particularly pertinent for mental health nurses to consider how, within the existing constraints of their roles, they can provide therapeutic care to all service users.

A Systematic Review on Implementing Education and Training on Trauma-Informed Care to Nurses in Forensic Mental Health Settings

BACKGROUND

Engaging in trauma-informed approaches in nonforensic mental health settings improves therapeutic relationships, promotes healing, promotes posttraumatic growth, improves staff well-being, and fosters hope and empowerment, yet little is known of its influences in forensic settings. This literature review explores trauma-informed education and its training implications for nurses working in forensic mental health.

METHOD

Using a range of electronic databases, a systematic search of literature was carried out focusing on trauma-informed practice in adult forensic mental health settings. Before searching, predefined inclusion and exclusion criteria were agreed.

FINDINGS

After duplication removal, abstract review, and full screening, nine articles met review criteria for inclusion. A thematic analysis of the literature identified two key themes: "education for trauma-informed practice" and "applying theory into practice." Each had several subordinate themes.

IMPLICATIONS FOR FORENSIC PRACTICE

Organizations and their staff must recognize that operational change and ongoing training will be required. By adopting a trauma-informed approach, forensic mental health nurses can better understand their patients' traumatic experiences, improve their therapeutic relationships, and engage patients in collaborative care. Training in trauma-informed care should start with nurses who will change their personal practice and can support and train their colleagues.

Prescribing With a Trauma-Informed Perspective

As a survival strategy, trauma arouses intensive neurobiological mechanisms that, if unchecked, contribute to severe chronic stress responses and disability. Although posttraumatic stress disorder can be considered a distinctive psychiatric disorder, it likely underlies many psychiatric disorders, including depression and mood, anxiety, substance use, and personality disorders. Psychiatric-mental health nurses need to carefully assess for trauma symptomatology in all patients and diverse populations, such as children; adolescents; immigrants; active and inactive military personnel; women; and lesbian, gay, bisexual, transgender, queer individuals. Pharmacotherapy should focus on priority of target symptoms with first-line medications including serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, and adrenergic blocking agents. Serotonin antagonists (i.e., second-generation antipsychotic agents) and benzodiazepine drugs are contraindicated and should be used sparingly and with caution. Psychotherapy is an effective adjunct to pharmacotherapy in treating trauma-related conditions. [Journal of Psychosocial Nursing and Mental Health Services, 56(8), 7-10.].