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

Advancing Equity and Justice in Academic Nursing Through Trauma-Informed Education Practice

BACKGROUND

As educators and schools redouble their efforts to support and graduate a diverse and highly competent student body, there is an urgent need to adopt an academic framework to understand the effects of trauma on student learning, ground equity and justice in nursing education, and underpin policy development.

METHOD

This article explicates the use of equity-centered trauma-informed education practice (TIEP) as a framework for examining, scrutinizing, and eliminating the influences and effects of racism, including explicit, implicit, systematic, and microaggressions, as well as inequitable approaches in practices, pedagogy, and policy.

RESULTS

Five key strategies were identified: (1) bias and antiracist work; (2) safety and trust; (3) culturally responsive pedagogy; (4) wellness and balance and (5) community-building.

CONCLUSION

Transforming nursing education requires a paradigm shift, with changes occurring from an individual to a system level. TIEP ensures changes are equity-centered and justice-focused. [J Nurs Educ. 2024;63(8):507-514.].

Theories, Models, Frameworks, Guidelines, and Recommendations for Trauma-Informed Oral Healthcare Services: A Scoping Review

BACKGROUND

Traumatic life experiences (TLE) are common and can affect a person's physical being and health-related behaviors, including those related to oral health. This scoping review aimed to identify evidence exploring the implementation and provision of trauma-informed care (TIC) in oral health services delivery.

METHODS

Arksey and O'Malley's framework with enhancements proposed by Levac et al. and Peters et al. was used. Studies were selected based on a preset inclusion and exclusion criteria and the population/concept/context framework. Primary charting of descriptive data was conducted, followed by thematic analysis to identify ideas common within the included literature. Searches were conducted in Medline (via Ovid), APA PsycINFO (via Ovid), Embase (Elsevier), Scopus, CINAHL (via EBSCO), and Cochrane databases. Google Scholar and ProQuest were used to identify grey literature.

RESULTS

The search identified 251 records, with fifteen records meeting the inclusion criteria. Limited models, frameworks, and recommendations for trauma-informed practices in oral health services were identified. Recommendations for TIC practices were identified, and clinical practice adjustments for dental practitioners were described to improve service delivery for patients who may have experienced trauma. Avenues for future research were identified.

CONCLUSIONS

Limited evidence exists to guide trauma-informed practice in oral health service delivery. This scoping review highlights the need for further research into approaches and practices of TIC for oral health services delivery to assess their efficacy and the need to develop evidence-based TIC frameworks to meet the unique needs of oral health service providers and populations.

Experiencing Trauma During or Before Pregnancy: Qualitative Secondary Analysis After Two Disasters

BACKGROUND

Despite the existing knowledge about stress, trauma and pregnancy and maternal stress during natural disasters, little is known about what types of trauma pregnant or preconception women experience during these disasters. In May 2016, the worst natural disaster in modern Canadian history required the evacuation of nearly 90,000 residents of the Fort McMurray Wood Buffalo (FMWB) area of northern Alberta. Among the thousands of evacuees were an estimated 1850 women who were pregnant or soon to conceive. In August 2017, Hurricane Harvey devastated areas of the United States including Texas, with 30,000 people forced to flee their homes due to the intense flooding.

OBJECTIVE

To explore immediate and past traumatic experiences of pregnant or preconception women who experienced one of two natural disasters (a wildfire and a hurricane) as captured in their expressive writing. Research questions were: (1) What trauma did pregnant or preconception women experience during the fire and the hurricane? (2) What past traumatic experiences, apart from the disasters, did the women discuss in their expressive writing?

METHODS

A qualitative secondary analysis of expressive writing using thematic content analysis was conducted on the expressive writing of 50 pregnant or preconception women who experienced the 2016 Fort McMurray Wood Buffalo Wildfire (n = 25) and the 2017 Houston Hurricane Harvey (n = 25) Narrative data in the form of expressive writing entries from participants of two primary studies were thematically analyzed. One of the expressive writing questions was used in this analysis: "What is the most traumatic, upsetting experience of your entire life, especially that you have never discussed in great detail with others?" NVivo 12 supported thematic content analysis.

RESULTS

For some women, the disasters elicited immense fear and anxiety that surpassed previous traumatic life events. Others, however, disclosed significant past traumas that continue to impact them, including betrayal by a loved one, abuse, maternal health complications, and illness.

CONCLUSION

We recommend a strengths-based and trauma-informed care approach in both maternal health and post-disaster relief care.

Critical Theory, Culture Change, and Achieving Health Equity in Health Care Settings

Achieving optimal health for all requires confronting the complex legacies of colonialism and white supremacy embedded in all institutions, including health care institutions. As a result, health care organizations committed to health equity must build the capacity of their staff to recognize the contemporary manifestations of these legacies within the organization and to act to eliminate them. In a culture of equity, all employees-individually and collectively-identify and reflect on the organizational dynamics that reproduce health inequities and engage in activities to transform them. The authors describe 5 interconnected change strategies that their medical center uses to build a culture of equity. First, the medical center deliberately grounds diversity, equity, and inclusion efforts (DEI) in critical theory, aiming to illuminate social structures through critical analysis of power relations. Second, its training goes beyond cultural competency and humility to include critical consciousness, which includes the ability to critically analyze conditions in the organizational and broader societal contexts that produce health inequities and act to transform them. Third, it works to strengthen relationships so they can be change vehicles. Fourth, it empowers an implementation team that models a culture of equity. Finally, it aligns equity-focused culture transformation with equity-focused operations transformation to support transformative praxis. These 5 strategies are not a panacea. However, emerging processes and outcomes at the medical center indicate that they may reduce the likelihood of ahistorical and power-blind approaches to equity initiatives and provide employees with some of the critical missing knowledge and skills they need to address the root causes of health inequity.

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.

Toward trauma-informed applications of behavior analysis

Despite a growing acknowledgement of the importance of understanding the impacts of trauma on therapeutic approaches across human service disciplines, discussions of trauma have been relatively infrequent in the behavior analytic literature. In this paper, we delineate some of the barriers to discussing and investigating trauma in applied behavior analysis (ABA) and describe how the core commitments of trauma-informed care could be applied to behavior analysis. We then provide some examples of how trauma-informed care might be incorporated into ABA practice. We conclude by suggesting opportunities to approach trauma as a viable avenue for behavior analytic research and argue that omitting trauma-informed care from ABA could be detrimental not only to the public perception of ABA, but to the effectiveness of our assessment and treatment procedures.

A Qualitative Exploration of Perspectives of Strength among Trauma-Exposed Women Living within Homelessness

The purpose of this study was to facilitate self-discovery of strengths of women who were homeless and trauma-exposed. Using an emancipatory feminist and existential phenomenological qualitative research design, seventeen women participated in facilitative dialogs exploring perceptions of strength. The dialogue focused on three aspects of strength: characteristics, strategies, and barriers. The participants' words were represented within global themes of strength: balance, protection, and dangerous environments. Results suggest women who are houseless and abused find ways to remain strong as evidenced in their stories. Findings support strength-based discovery, patient engagement, and partnering as a health intervention with vulnerable women.