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Varghese L, Emerson A. Trauma-informed care in the primary care setting: An evolutionary analysis. J Am Assoc Nurse Pract 2022; 34:465-473. [PMID: 34618717 DOI: 10.1097/jxx.0000000000000663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The high prevalence of trauma in the United States and its adverse effects on patient wellbeing has led to the adoption of trauma-informed care (TIC) in some specialized health care services. However, the implementation of TIC in primary care, where many nurse practitioners (NPs) provide services, is relatively uncommon and the concept not well-defined. Trauma includes physically and emotionally devastating experiences that have a lasting impact on individuals. OBJECTIVES To synthesize a definition of TIC in the primary care setting for NPs to guide future practice and research. DATA SOURCES We searched CINAHL, PsycINFO, Social Work Abstracts, Scopus, and PubMed for articles published 2010-2020 that described the use of TIC in primary care. Rodgers' evolutionary method and the framework method of analysis were used to identify attributes and contexts of TIC in primary care and synthesize a definition. Thirty-one articles from nursing, medical, and social work sources were selected, including data-based studies ( n = 15) and thought pieces ( n = 16). Attributes, antecedents, and consequences were combined to provide a definition grounded in the literature. CONCLUSION Trauma-informed care in primary care is a strengths-based approach in which trained, trauma-aware health care professionals provide services that prioritize safety, empowerment, and support, resulting in improved patient satisfaction and health care engagement in individuals who have experienced trauma. IMPLICATIONS FOR PRACTICE A clearly defined concept provides a starting point for developing strategies to help NPs recognize and respond more effectively to the needs of patients who have experienced trauma.
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Affiliation(s)
- Latha Varghese
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri
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Goldhammer H, Marc LG, Chavis NS, Psihopaidas D, Massaquoi M, Cahill S, Nortrup E, Dawson Rose C, Meyers J, Mayer KH, Cohen SM, Keuroghlian AS. Interventions for addressing trauma among people with HIV: a narrative review. AIDS Care 2021; 34:505-514. [PMID: 34612097 DOI: 10.1080/09540121.2021.1984382] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Traumatic experiences are disproportionately prevalent among people with HIV and adversely affect HIV-related health outcomes. As part of a national cooperative agreement funded by the Health Resources and Services Administration's HIV/AIDS Bureau, we searched the literature for interventions designed to address trauma among people with HIV in the U.S. Our search yielded 22 articles on 14 studies that fell into five intervention categories: expressive writing, prolonged exposure therapy, coping skills, cognitive-behavioral approaches integrated with other methods, and trauma-informed care. Thematic elements among the interventions included adaptating existing interventions for subpopulations with a high burden of trauma and HIV, such as transgender women and racial/ethnic minorities; addressing comorbid substance use disorders; and implementing organization-wide trauma-informed care approaches. Few studies measured the effect of the interventions on HIV-related health outcomes. To address the intersecting epidemics of HIV and trauma, it is critical to continue developing, piloting, and evaluating trauma interventions for people with HIV, with the goal of wide-scale replication of effective interventions in HIV settings.
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Affiliation(s)
| | - Linda G Marc
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Nicole S Chavis
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | | | | | - Sean Cahill
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Boston University School of Public Health, Boston, MA, USA.,Bouve College of Health Sciences, Northeastern University, Boston, MA, USA
| | | | - Carol Dawson Rose
- Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Janet Meyers
- Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stacy M Cohen
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | - Alex S Keuroghlian
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Cuca YP, Shumway M, Machtinger EL, Davis K, Khanna N, Cocohoba J, Dawson-Rose C. The Association of Trauma with the Physical, Behavioral, and Social Health of Women Living with HIV: Pathways to Guide Trauma-informed Health Care Interventions. Womens Health Issues 2019; 29:376-384. [PMID: 31303419 DOI: 10.1016/j.whi.2019.06.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/25/2019] [Accepted: 06/07/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Trauma is increasingly recognized as a near-universal experience among women living with HIV (WLHIV) and a key contributor to HIV acquisition, morbidity, and mortality. METHODS We present data from the baseline analysis of a planned intervention trial of the impact of trauma-informed health care on physical, behavioral, and social health outcomes of WLHIV in one clinic, with a particular focus on quality of life and viral suppression. Data were collected through interviewer-administered surveys and electronic health record data abstraction. RESULTS Among 104 WLHIV, 97.1% of participants reported having experienced lifetime trauma, and participants had experienced on average 4.2 out of 10 Adverse Childhood Experiences. WLHIV with more lifetime trauma were significantly more likely to report post-traumatic stress disorder, depression, and anxiety symptoms; significantly more likely to report potentially harmful alcohol and drug use; and had a significantly poorer quality of life. In addition, women who had experienced more lifetime trauma were significantly less likely to report being on and adhering to HIV medications, although trauma was not significantly associated with having an undetectable HIV viral load. CONCLUSIONS These data suggest that trauma is associated with much of the morbidity and mortality experienced by WLHIV. The results of this study support the implementation and study of trauma-informed approaches to health care for WLHIV.
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Affiliation(s)
- Yvette P Cuca
- Department of Community Health Systems, UCSF School of Nursing, San Francisco, California.
| | - Martha Shumway
- UCSF School of Medicine, Department of Psychiatry, San Francisco, California
| | - Edward L Machtinger
- UCSF Women's HIV Program, San Francisco, California; UCSF Center to Advance Trauma-informed Health Care, UCSF Department of Medicine, San Francisco, California
| | - Katy Davis
- UCSF Women's HIV Program, San Francisco, California
| | - Naina Khanna
- Positive Women's Network-USA, Oakland, California
| | - Jennifer Cocohoba
- UCSF Women's HIV Program, San Francisco, California; UCSF School of Pharmacy, San Francisco, California
| | - Carol Dawson-Rose
- Department of Community Health Systems, UCSF School of Nursing, San Francisco, California
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