Trauma-informed education: Creating and pilot testing a nursing curriculum on trauma-informed care

Trauma-Informed Care in Nursing Curricula: Development of a Simulation-Based Educational Framework to Guide Health Professions

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.

Help-Seeking Behaviors in a Community Experiencing Multiple, Concurrent Natural Disasters. Lessons from a Greater Houston Community

Previous disaster research exploring mental health consequences has been conducted after a single disaster. Community mental health nurses offer critical support in the aftermath of a disaster through complex assessments, psychosocial education and treatment. This research examines help-seeking behaviors in a Greater Houston community struggling with two simultaneous disasters, a historic winter freeze amidst the COVID-19 pandemic. Three Mental Health Crisis clinics, staffed by an interdisciplinary team, offered walk-in crisis services. The study characterizes adults who accessed services and describes those who accepted follow-up, subsidized behavioral health therapy or case management, including populations experiencing health disparities. Statistical analysis included descriptive and inferential statistics. Those who recognized the need for behavioral health care and accessed episodic care differed from those who accepted follow-up care. The population that was more likely to accept follow up care largely consisted of females, individuals without a previously existing mental health condition, those who reported trauma exposure, and young adults of Hispanic/Latino origin. Nurses can leverage female support to inspire male adults to seek care and advocate for increased resources and training to support culturally relevant care. Nurses and the interdisciplinary team need to assess for trauma exposure, as it influences care decisions.

Stoicism and Cognitive Strategies for Nursing Professional Development

BACKGROUND

Nurse educators are experiencing a vocational crisis, and the unsustainable rate at which nurses are leaving the profession impacts the health of the nation. Nurse educators, including academic and professional development faculty and preceptors, need skills to manage the complex academic and clinical environments. This article describes the development of a course for nurse educators and preceptors around Stoicism and cognitive strategies, describes the perceived takeaways of one group of learners who experienced the course, and offers recommendations for the use of this content.

METHOD

This course was evaluated with survey data from 23 nurse educators for demographic information and use of strategies after an educational course.

RESULTS

Participants identified several specific takeaways from the training that could be incorporated into their personal, teaching, and clinical practices. Themes included emotional regulation, using the cognitive triangle, and managing stress in emotionally charged situations with patients and colleagues through creating a healthy emotional distance to better evaluate situations.

CONCLUSION

Stoicism and cognitive strategies are important additions to nurse educator personal and professional development. [J Contin Educ Nurs. 2024;55(8):378-386.].

Education for Health Care Providers on Implementation of Trauma-Informed Care in Practice

BACKGROUND

Traumatic experiences can adversely affect a child's health. These effects often continue into adulthood, especially when trauma is not addressed. Although the evidence shows benefits with addressing trauma earlier in life, trauma-informed care of children is underused in primary care. Health care providers (nurses, nurse practitioners, physicians) report gaps in knowledge of trauma-informed care and in their comfort level addressing trauma in primary care.

METHOD

This project investigated the use of continuing education sessions to increase health care providers' knowledge and readiness to implement trauma-informed care into their practice.

RESULTS

The education sessions improved health care providers' knowledge and comfort with trauma-informed care.

CONCLUSION

This intervention improved providers' readiness to implement trauma-informed care into their primary care practice. [J Contin Educ Nurs. 2024;55(5):246-252.].

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.

Trauma-informed care education for midwives: Does education improve attitudes towards trauma-informed care?

INTRODUCTION

Continuing education is important to improve midwives' attitudes to trauma-informed care in addressing the needs of women during the perinatal period. This study aimed to evaluate if there was a significant difference in attitudes towards trauma-informed care between midwives who participated in a 2-day trauma-informed care education program and those who did not.

METHOD

A static group comparison design was adopted with a convenience sample of midwives to analyse differences in attitudes towards trauma-informed care between midwives who received a 2-day TIC education (n = 19, intervention group) and their peers who did not receive the education (n = 18, comparison group).

RESULTS

The results suggest that midwives who participated in a 2-day trauma-informed care education program had significantly higher scores for positive attitudes towards trauma-informed care compared to those who did not take part in the program and that this effect was sustained at 6 months.

CONCLUSION

To minimise perinatal trauma for mothers and babies, midwives require specific trauma-informed care education. This study proposes that trauma-informed care education is a foundational pathway for implementing a trauma-informed care framework across a maternity service.

Trauma Informed Care for Nursing Action Bachelor of Science in Nursing Course

BACKGROUND

Nurses commonly experience psychological trauma with high risk for a host of mental health concerns such as suicide, depression, anxiety, and substance use disorders, as well as high rates of burnout and moral injury. Despite rigorous academic preparation, baccalaureate nursing education curricula lack content on the widespread effects of trauma.

METHOD

Using a trauma informed care (TIC) model, an innovative course called Trauma Informed Care for Nursing Action (TIC4NA) was created.

RESULTS

This course allows students to safely explore the profession of nursing to transform their learning about trauma related to patient care, the nursing community, and society.

CONCLUSION

TIC curriculum delivery offers supportive strategies to mitigate negative outcomes during nursing school. This content could have positive effects on nurse and nursing student retention as well as mitigating a barrage of negative outcomes for individual nurses and the nursing profession. [J Nurs Educ. 2024;63(4):233-240.].

A pilot resiliency course for Doctor of Nursing Practice (DNP) students: Lessons learned

Graduate nursing students can face varied and significant stressors during their programs of study. The need for interventions to promote nursing student resiliency has been reported in the literature, by accrediting bodies, and in previous research conducted with students at the same university. Thus, the purpose of this project was to pilot a resilience course for Doctor of Nursing Practice (DNP) students. The theoretical frameworks guiding the design and implementation of the resiliency pilot program were andragogy (the science of adult learning) and rapid cycle quality improvement. The course included eleven monthly modules addressing resiliency content with written material, original videos, and online discussions and meetings. The first module overviewed the resiliency skills (Belief, Persistence, Trust, Strength, and Adaptability), five modules were dedicated to a specific resiliency skill, two modules addressed recent and anticipated challenges, two modules concentrated on the application (clinical and academic) of the resiliency skills, and the last module focused on reflection. Results of this pilot program indicate that DNP students can benefit from receiving resiliency content during their studies, especially from faculty involvement and increased peer support; however, future resiliency content may be more accepted and effective if embedded into nursing program curriculum and activities.

Primary Care Providers' Knowledge, Perceptions, and Practice of Trauma-Informed Care in a Public Health Care Setting

Despite serving patients with especially high rates of trauma exposure and related sequelae, many primary care providers do not receive specialized training in the provision of trauma-informed care (TIC). This study sought to document primary care providers' baseline rates of TIC training and their knowledge, perceptions, and practice of TIC at a large, urban public hospital in the Southeastern United States. Participants (n = 67; 68.7% women; 44.8% white; Mage = 36.7 years, standard deviation [SD]age = 9.8 years) completed an online self-report survey on their TIC training status, trauma-related knowledge, perceptions, and practices, as well as burnout and secondary traumatic stress. Less than half of participants (43.3%) endorsed TIC training exposure. Participants generally had adequate levels of trauma-related knowledge (76.5% of items correct) and favorable perceptions of TIC (endorsed 89.7% of TIC-supportive statements). Most participants (86.6%) endorsed recently using trauma-informed practices, but only 47.8% reported routinely screening for trauma-related disorders. Participants who reported receiving prior TIC training scored better on knowledge items and endorsed recently using more trauma-informed practices than those who did not have training exposure. TIC training status' associations with current screening practices and perceptions of TIC were trending toward significance. TIC training status was not related to burnout, and trained participants reported greater secondary traumatic stress than those without training exposure. Results point to system-wide TIC training as a well-received, translational strategy that can enhance the trauma-informed nature of primary care provision.

Integration of Trauma-informed Care Into the Doctor of Pharmacy Curriculum

Trauma-informed care (TIC) is a framework based on understanding and responding to individuals' experiences of psychological trauma (defined as harmful circumstances that have a lasting impact on emotional well-being), as well as fostering their sense of safety and empowerment. Health profession degree programs are increasingly integrating TIC training into their curricula. Although literature is scarce regarding TIC education in academic pharmacy, student pharmacists will likely encounter patients, co-workers, and peers who have experienced psychological trauma. Students may also have experienced psychological trauma themselves. Therefore, student pharmacists would benefit from TIC learning, and pharmacy educators should consider implementing trauma-informed education. This commentary defines the TIC framework, explores its benefits, and considers an approach to implementing the TIC framework in pharmacy education with little disruption to existing curricula.

Associations between violence, self-harm and acute psychiatric service use: Implications for inpatient care

WHAT IS KNOWN ON THE SUBJECT?: Service users who behave violently may suffer. This is because violence can lead to unnecessary medication, seclusion on the ward and strained relationships with other people. It can also affect a service user's self-esteem and lead to feelings of shame. Service users who behave violently can also make life frightening and unpredictable for members of staff, and other service users on the ward. It is important to gain a sound understanding of violence in order to help reduce it. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Previous research has shown that having a past history of violence, being admitted to PICU and being admitted to hospital under section is associated with violent behaviour on the ward. We identified several new factors associated with violent behaviour, such as engaging in self-harm, being the target of another person's violence and being referred to a Psychiatric Liaison Team.

IMPLICATIONS FOR PRACTICE

For some service users, behaving violently may be a response to previous trauma and an expression of distress. It is therefore important that mental health nurses are supported by their employers to work with service users in a trauma-informed manner. Nurses employed across a range of psychiatric settings could benefit from direct interventions such as comprehensive trauma-informed care training and psychological debrief spaces, or systemic interventions to address staff shortages and improve ward conditions.

ABSTRACT

INTRODUCTION: Instances of violence in acute psychiatric settings are frequent, can be devastating for service users and staff, and are costly. Such settings would benefit from a greater understanding of violence.

AIM

We analysed the association between current and historical variables and rates of inpatient violence. To address gaps in current research, we included instances of self-harm and being the target of violence. We also included seldom used service metrics.

METHOD

Data were extracted on admissions to acute adult wards and PICUs 2017-2020 within South London and Maudsley NHS Foundation Trust. A zero-inflated negative binomial regression mixed model was used to analyse the impact of variables on rates of violence.

RESULTS

Variables associated with an increased rate of violence were as follows: an increased number of violent incidents in the year before admission, being admitted on MHA section, being admitted to PICU, instances of self-harm, being the target of violence and referral to a Psychiatric Liaison Team.

DISCUSSION

The novel associations found between enacting violence, self-harm and being the target of violence indicate trauma-informed care is crucial to reduce violent presentations of distress.

IMPLICATIONS FOR PRACTICE

System level interventions are crucial to ensure mental health nurses are supported to provide trauma-informed care.

Nursing students' views on trauma-informed pediatric nursing care and family-centered care

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.

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.

Integrating Adverse Childhood Experiences Into Undergraduate Nursing Curriculum: A Scoping Review

BACKGROUND

Adverse childhood experiences (ACEs) are traumatic events occurring in childhood that can have severe effects on health throughout the life span. Quality nursing care includes the knowledge and skills to recognize patients who were exposed to ACEs and respond appropriately.

METHOD

A scoping review of the literature was conducted as the foundation for implementing ACEs into baccalaureate nursing curricula.

RESULTS

A total of 22 articles were examined and included 15 research studies, two literature reviews, one quality improvement project, and four discussion articles. The literature reflects a prevalence for case-based ACEs content and the importance of student safety measures during content implementation.

CONCLUSION

Knowledge derived from this review can assist nursing educators to integrate ACEs education into baccalaureate nursing curricula and identify research areas for further investigation. [J Nurs Educ. 2022;61(12):673-678.].

Primary early childhood educators' perspectives of trauma-informed knowledge, confidence, and training

There is a growing body of research documenting the impact of traumatic stress on child development, which has resulted in a call to action for trauma-informed practices as a priority, yet implementation within schools and training for educators is lacking (American Academy of Physicians, https://www.aap.org/en-us/Documents/ttb_aces_consequences.pdf, 2014). Understanding teachers' perceptions regarding current levels of knowledge, self-efficacy, and trauma-informed training can help guide future professional development experiences for both pre-service and practising teachers. This study investigated the knowledge, self-efficacy, and training of trauma-informed practices as self-reported by primary educators, serving in grades kindergarten through third-grade, within two regions of Tennessee and Virginia. The Primary Early Childhood Educators Trauma-Informed Care Survey for Knowledge, Confidence, and Relationship Building (PECE-TICKCR) scale was adapted from the TIC-DS scale (Goodwin-Glick in Impact of trauma-informed care professional development of school personnel perceptions of knowledge, disposition, and behaviours towards traumatised students, Graduate College of Bowling Green State University, 2017), validated, and created for the purpose of this study. The sample consisted of 218 primary educators who completed an online survey regarding personal knowledge, self-efficacy, and training experiences of trauma-informed practices. Correlations revealed a statistical significance between the Knowledge of Trauma factor and the Confidence in Providing Trauma-Informed Strategies factor. There was also a statistical significance between the Knowledge of Trauma factor and the Confidence in Creating Supportive relationships factor and between the Confidence in Providing Trauma-Informed Strategies factor and the Confidence in Creating Supportive Relationships factor. The findings indicated that teachers need more knowledge regarding community resources for families and students but feel confident in providing supportive relationships. Teachers also are interested in more training events related to strategies to use when working with students exposed to trauma. Implications for teacher preparation programs and professional development training for practising teachers is discussed.

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.

Faculty, Preceptor, and Students' Perceptions of the Need for Trauma-Informed Education: Recommendations for Implementation

BACKGROUND

The widespread physical, mental, and emotional health impacts of trauma are well established. Trauma-informed care (TIC) is an approach that uses knowledge about trauma and its effects to create safe care environments.

PURPOSE

Using a concurrent mixed-methods design, this study assessed faculty, preceptor, and students' perceptions about the need for TIC content in nursing education.

METHODS

Semistructured interviews were conducted with 15 faculty, and cross-sectional survey data were collected from a nonprobability sample of 99 nursing students at a large Midwestern university to evaluate the need for education on TIC.

RESULTS

Faculty and preceptors stressed the importance of education on TIC and discussed barriers and facilitators to implementation. Nursing students reported that it is important to learn about TIC, yet do not feel prepared to provide TIC.

CONCLUSIONS

The results illustrate the need for nursing content on TIC and provide recommendations for trauma-informed educational practices.

Trauma-Informed Pedagogy to Foster Resilience in Graduate Nursing Education

ABSTRACT

The experiences of graduate nursing students during the COVID-19 pandemic necessitate a trauma-informed approach to education. Three hundred graduate nursing students responded to a discussion assignment in a doctoral-level health care policy course. Thematic analysis identified common themes of fear, anxiety, frustration, and exhaustion (n = 93). Conflict and strain were identified in relation to all major roles (provider, student, and family member), ultimately creating physical and mental barriers to fulfilling each of the roles. Curricular standards must maintain rigor while incorporating flexibility into design standards to assist students when faced with trauma or crisis.

Trauma-Informed Education in Nursing: A Concept Analysis

BACKGROUND

Trauma-informed education provides a framework for a collaborative, relational trauma awareness model when working with nursing students. This concept analysis provides clarification, explicates the conceptual meaning of trauma-informed education, and lays a foundation for nurse educators navigating the challenge of meeting student needs during and after the coronavirus disease 2019 (COVID-19) pandemic.

METHOD

Using Walker and Avant's concept analysis method, exhaustive multi-disciplinary and ancestry searches conducted in PubMed, CINAHL, ERIC, and PsychINFO identified 31 relevant article that were evaluated for relevance to the concept analysis as it relates to the context of nursing education.

RESULTS

This analysis proposes a new definition of trauma-informed education to support future practice and research endeavors, providing a framework for transforming the nurse educator-student dyadic relationship.

CONCLUSION

Trauma-informed education can provide a collaborative relational model with students based on trauma awareness as affecting one's being and self. [J Nurs Educ. 2022;61(6):296-302.].

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.

Impact of COVID-19 on graduating U.S. pharmacy students in the early epicenter of the pandemic in New York City

Objective

To describe the self-reported impact of the COVID-19 pandemic among final year student pharmacists enrolled in a Doctor of Pharmacy program in New York City during the first peak of the outbreak March through May 2020.

Methods

A required senior seminar course for graduating student pharmacists served as a conduit for faculty led monitoring of the wellbeing of the cohort through three data sources: 1) polling data regarding stress factors during a COVID-19 informational session (March 2020), 2) survey data from a 12-item COVID-19 Impact Survey developed and administered electronically in May 2020 and 3) qualitative data from reflection papers mentioning COVID-19. Descriptive statistics, bivariate analysis and thematic analysis were used to summarize data.

Results

In March, almost half of respondents (total = 185) reported high personal (47.6%) and school related stress (42.1%). Most students were participating in advanced pharmacy practice experiences (80%) and working in a pharmacy (80%). Survey data (n = 96) revealed the majority of participants perceived negative impact on their future career (69%) and reported concern for people close to them with suspected and confirmed COVID-19. One-third of participants reported knowing someone who died from COVID-19 and 8% were self-confirmed COVID-19 positive. Themes emerging from the reflection papers included: changed perspective, gained experience as a pharmacist during a pandemic, concern for loved ones, and positive outlook.

Conclusion

The COVID-19 pandemic had a significant impact on the wellbeing of a cohort of graduating student pharmacists in New York during the initial peaks of the spread in the United States. The results reinforce a need for student support during emergency situations, especially during the final year.

•

In March 2020, COVID-19 blazed through New York City resulting in tremendous challenges for health professions training.

•

Pharmacists remained the most accessible health profession but lacked the ability to ensure safety for student pharmacists.

•

This study describes the personal experiences of student pharmacists during the peak of the pandemic.

Trauma informed care education for midwives: An integrative review

BACKGROUND

Nearly half of new mothers describe their childbirth as traumatic. Perinatal trauma impacts both short and long-term biopsychosocial outcomes for mother and child. Midwife trauma-informed care education and practice is essential to mitigate this risk.

OBJECTIVE

This review aimed to identify and describe the nature and extent of trauma informed care education provided for midwives and midwifery students.

DESIGN

An integrative review.

METHODS

Five databases (Medline, Embase, CINAHL, Psycinfo, and Emcare) were searched to identify primary research regarding trauma informed care education for midwives and midwifery students. Quality appraisal was conducted using the Mixed Methods Appraisal Tool.

RESULTS

Three papers were identified. None of the papers were midwifery focused, with midwives representing a small proportion of the participants. Most midwives reported receiving no previous trauma informed care education and lacked confidence to provide quality care to women with lived trauma. Midwives reported trauma informed care education as essential and relevant for providing quality practice. Improvements in knowledge, skills and attitudes was demonstrated following trauma informed care education. More in-depth content and content delivered in multiple ways were recommended.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Midwives are well placed to deliver trauma informed care. Trauma informed care education for midwives is limited. Given the impact of perinatal trauma, further trauma informed care education and research is paramount.

A need for trauma informed care curriculum: Experiences from Pakistan

Trauma is a major global health problem. Currently a trauma curriculum, from a psychological perspective, has not been uniformly incorporated in medical education. Nonetheless, professionals from various medical disciplines have an integral role in providing trauma care to survivors. The current COVID-19 pandemic only underscores the relevance and urgent need of this training, as studies show an uptick in mental health disorders due to this trauma. This article will present a discussion on the need for trauma curriculum for health care professionals, using information gained through trauma informed care workshops for healthcare personnel at Aga Khan University Hospital Pakistan.

Restorative Parenting: Delivering Trauma-Informed Residential Care for Children in Care

Background

There are 78,150 children in care in England and 12% live in group residential settings. Little empirical research informs our understanding of how these vulnerable children heal from multi-type trauma in residential homes. Evidence-based multisystemic trauma-informed models of care are needed for good quality consistent care.

Objective

Using a novel multisystemic trauma-informed model of care with an embedded developmental monitoring index, the Restorative Parenting Recovery Programme, pilot data was collected from young people and care staff from four residential homes over a two-year period. Five key developmental areas of children’s recovery were investigated through monthly monitoring data. Staff were also interviewed to explore their experiences of delivering the intervention to contextualise the findings.

Methods

Data was gathered from 26 children, aged 6–14 years, over a two-year period. Their developmental wellbeing was measured using the Restorative Parenting Recovery Index and analysed through a comparison of means. To add further context to this preliminary analysis, qualitative interviews were undertaken with 12 Therapeutic Parents to explore their perceptions of how the Restorative Parenting Recovery Programme influenced the children’s development.

Results

Young people showed significant improvements on indices relating to relationships (p = 0.002, d=0.844). Significant changes are observed during the first half of the programme in self-perception (p = 0.006, d = 0.871) and self-care (p = 0.018, d = 0.484), although limited progress around self-awareness and management of impulses and emotions.

Conclusions

This novel integrative approach to re-parenting and embedded measurement system to track the children’s progress is the first of its kind and has originated from extensive multisystemic clinical practice.

Maintaining Core Values in Postgraduate Programs During the COVID-19 Pandemic

The novel coronavirus identified in 2019 (COVID-19) pandemic has impacted pharmacy graduate and postgraduate education. This crisis has resulted in a cosmic shift in the administration of these programs to ensure core values are sustained. Adjustments may be needed at a minimum to ensure that postgraduate trainees complete program requirements while maintaining safety. Moving forward, additional issues may arise that will need to be addressed such as admissions and program onboarding, acclimating students to new training environments, and managing inadequate resources for distance education, distance practice, and remote versus in-person research opportunities.

Implementing Patient-Centered Trauma-Informed Care for the Perinatal Nurse

Adverse childhood experiences and trauma significantly impact physical and mental health. Increased maternal perinatal depression/anxiety, preterm labor, and low birth weight, as well as infant morbidity and mortality, are some examples of the impact of trauma on perinatal health. Trauma-informed care begins with knowledge about trauma, the ability to recognize signs of a trauma response, responding to patients effectively, and resisting retraumatization. As holistic providers, perinatal nurses can create safe care environments, establish collaborative patient relationships based on trust, demonstrate compassion, offer patients options when possible to support patient autonomy, and provide resources for trauma survivors. This can prevent or reduce the negative impact of trauma and improve the health and well-being of infants, mothers, and future generations. This clinical article outlines key strategies for implementation of patient-centered trauma-informed perinatal nursing care.