Perceived lack of training moderates relationship between healthcare providers' personality and sense of efficacy in trauma-informed care

Resilience in rural health system

INTRODUCTION

Current literature emphasises the importance of resilience in health care. Studies have shown that lack of resilience not only leads to adverse clinical outcomes but is also associated with burnout and long-term stress in clinicians. Resource-limited rural settings in the United States often impose unique stressors, and thus, it is critical to examine resilience of health care providers practicing rural medicine.

METHODS

An anonymous REDCap survey was completed by medical students, residents and attending physicians between 7 April 2021 and 18 May 2022. The primary outcome of resilience was measured by the Connor-Davidson Resilience Scale 10 (CD-RISC-10©).

RESULTS

Survey takers scored moderately on the resilience scale (30.64 on a 40-point scale). The first quartile of respondents scored between 0 and 28; the second quartile scored between 29 and 30; the third quartile scored between 31 and 35; the fourth quartile scored between 36 and 40. Age and years of service were not correlated with resilience. However, survey takers who had been exposed to trauma informed care scored significantly higher on the resilience scale (32.37 vs. 28.85, p = 0.021). The level of resilience when compared by profession was found to be comparable among medical students, residents and attending physicians.

CONCLUSION

Individuals scoring in the first two quartiles of the CD-RISC-10© perhaps indicate need for support as they are having difficulty coping with stress. Health care organisations should provide resilience training to support the wellness and mental health of their staff. Moreover, dedicated efforts should be made toward creating trauma-informed health care organisations as exposure to the topic of trauma informed care had a significant positive impact on resilience.

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: Insights from a Q-methodology study of advanced practice registered nursing students

BACKGROUND

Trauma-informed care (TIC) aims to create a safe and supportive healthcare environment that empowers patients and cultivates understanding of the role trauma plays in short-term and long-term health. TIC also has the potential to improve health outcomes and foster clinician wellness. Nurse educators must design evidence-based instruction to develop advanced practice registered nurses (APRNs) who deliver high-quality TIC while also protecting their own wellbeing.

OBJECTIVES

To identify patterns in subjective viewpoints about TIC among APRN students and describe how those patterns influence their learning experience in an advanced health assessment course.

DESIGN

Q methodology was used to explore student perceptions of TIC.

SETTING

A virtual advanced health assessment course at a large, midwestern university in the United States.

PARTICIPANTS

Ninety-five APRN students from six specialty APRN programs.

METHODS

Students completed an online Q-sort activity by ranking 32 TIC statements according to how well the statements aligned with their own perspectives. Q-sorts were analyzed using factor analysis and narrative responses to open-ended questions.

RESULTS

Four factors were extracted that revealed different student viewpoints on TIC and their learning experiences: Comfortable/Confident Learners, Uncomfortable/Apprehensive Learners, Empathetic/Hesitant Learners, and Inexperienced/Uncertain Learners.

CONCLUSIONS

All students acknowledged the need to learn about TIC to implement it effectively in practice. It is important for faculty to understand the potential range of divergent student viewpoints about TIC and acknowledge, accept, and support students who have anxiety related to learning about TIC.

How Healthcare Providers Reconcile Bad Things Happening to Good Patients: The Role of Just World Beliefs in Attitudes toward Trauma-Informed Care

Despite prevalent trauma exposure among patients seeking health care, as well as widespread frameworks for enacting trauma-informed care, the uptake of trauma-informed practices such as trauma screening and referral among health-care providers remains relatively low. The current study sought to assess the roles of health-care providers' personal histories of adverse childhood experiences (ACEs) and personal beliefs in the just-world hypothesis in understanding their attitudes toward trauma-informed care. Advanced practice graduate nursing students (N = 180; M age = 34.6 years) completed a self-reported survey assessing their personal history of ACEs, global belief in a just world, and attitudes related to trauma-informed care. Results indicated the relation between providers' ACEs and attitudes toward trauma-informed care was fully mediated by their beliefs in a just world, such that providers reporting higher ACEs scores also report greater endorsement of attitudes consistent with trauma-informed care due to less belief in a just world. Implications for both health-care providers' themselves and cultural shifts necessary for provision of trauma-informed health care are discussed.

The landscape of trauma informed care in community-based HIV service organizations in the United States south

Among people living with HIV, trauma is associated with increased viral loads and obstructed access to HIV care. Trauma-Informed Care (TIC), a SAMHSA Evidence Based Practice, responds to the impact of trauma for service users by focusing on all aspects of service delivery systems and structures. TIC could be potentially lifesaving in regions where HIV rates continue to rise, like the U.S. South. Thus, the purpose of this study is to (1) understand the extent to which HIV service organizations in the U.S. South provide mental health and substance use services and referrals; (2) the extent to which they employ trauma informed care and (3) the barriers of employing trauma informed care. Analyzing quantitative data of 207 organizations, we found that less than a third of organizations provided a trauma informed intervention. Only 44% of organizations had participated in TIC training but 84% expressed interest in TIC training. Organizations who completed TIC training were 10 times more likely than those who did not to report that they implemented at least one trauma informed care strategies. Barriers to TIC implementation included lack of training, capacity, and resources. Building the capacity of organizations to implement TIC will be a key to ending the HIV epidemic.

Prevalence of adverse childhood experiences and post traumatic stress disorder symptoms in a primary care safety-net population: Implications for healthcare service needs

OBJECTIVE

We characterized the prevalence and associated characteristics of Adverse Childhood Experiences (ACEs) and Post-traumatic stress disorder (PTSD) in a safety net system and assessed patient preferences for trauma informed care.

METHODS

We performed a cross-sectional survey among adult patients attending primary care at three urban federally qualified healthcare centers. We used a method of recruitment that included both convenience and systemic sampling. The survey included the ACEs Questionnaire, the PTSD for DSM 5 (PC-PTSD5), and trauma-informed care preferences. We accessed Electronic Health Records for demographic and clinical data. We used descriptive and multivariable statistical analyses.

RESULTS

303 of 481 (63%) patients that were approached participated. Most participants (81%) had one or more ACEs and 38% had four or more. 88 (29%) patients screened positive for current PTSD. ACEs was associated with a diagnosis of mental illness (p = 0.0125) and substance use disorders (p = 0.01). Patients with ACEs >/=4 or positive PC-PTSD reported stress in attending medical visits and that trauma-informed provider behaviors would make their visits less stressful.

CONCLUSIONS

Rates of ACES and current PTSD symptoms were high in this population and support the need for research to evaluate universal trauma-informed care strategies for safety-net healthcare systems.

Experiential Avoidance and Post-traumatic Stress Symptoms Among Child Abuse Counselors and Service Workers: A Brief Report

Professionals who counsel and serve survivors of childhood abuse may be at risk of experiencing symptoms of post-traumatic stress disorder (PTSD), which can be exacerbated by cognitive and emotional processes. It is hypothesized that (1) a significant proportion of professionals who primarily serve child abuse survivors experience elevated levels of PTSD symptoms and (2) elevated PTSD symptoms are associated with psychological inflexibility processes, specifically increased experiential avoidance, cognitive fusion, and emotion regulation difficulties. Child abuse counselors and service workers (N = 31) in a major metropolitan area were recruited for a small pilot study. Participants completed self-report measures of PTSD symptoms and levels of psychological flexibility processes. A significant proportion of counselors endorsed clinically significant PTSD symptoms (n = 13, 41.9%). PTSD symptoms were significantly associated with experiential avoidance (r = .54, p < .01) and emotion regulation difficulties (r = .51, p < .01). These associations remained significant after controlling for the personality trait of emotional stability/neuroticism. These findings suggest that PTSD symptoms may be common among child abuse counselors and service workers, and these symptoms tend to be of greater intensity when responded to in avoidant and inflexible ways.

An approach to trauma-informed education in prelicensure nursing curricula introduction

BACKGROUND

Trauma-informed care (TIC) is an evolving concept that acknowledges the prevalence and impacts of trauma on health; however, knowledge related to implementation for nursing students remains limited.

PURPOSE

The purpose of this study is to understand the learning perspectives of nursing students and develop an innovative conceptual model to guide educators in implementing teaching and learning strategies related to TIC, consistent with the trauma and resiliency competencies for nurses.

METHODS

Qualitative analysis of student responses after an online module to educate students on adverse childhood experiences (ACEs), trauma, and their impact on health through the lifespan.

RESULTS

Three persistent themes emerged from the data: Growing in Self-Awareness, Filling Learning Needs, and Envisioning Future Roles. From these themes, we developed a framework for TIC content for nursing and other healthcare curricula.

CONCLUSIONS

Our findings demonstrate a model to embed ACE education, TIC competencies, secondary traumatic stress awareness, and methods of self-care, including resiliency skills, into undergraduate nursing education.

Assessing healthcare provider knowledge of human trafficking

BACKGROUND AND OBJECTIVES

Human trafficking is a significant problem in which healthcare workers are in a unique position to intervene. This study sought to determine the self-reported knowledge levels of healthcare providers most likely to come in direct contact with victims of human trafficking.

METHODS

An anonymous survey assessing self-reported knowledge of human trafficking was developed and distributed online. Demographic information and questions pertaining to training and knowledge of trafficking in a healthcare setting were asked. The primary outcomes were descriptive statistics and secondary outcomes were comparisons among demographic groups. Qualitative methodology via content analysis was implemented on an open-ended question.

RESULTS

The 6,603 respondents represented all regions of the country. Medical, nursing, and physician assistant students comprised 23% of the sample, while 40% were either physicians, fellows, or residents. Less than half the respondents (42%) have received formal training in human trafficking, while an overwhelming majority (93%) believe they would benefit by such training. Overall, respondents thought their level of knowledge of trafficking was average to below average (mean = 2.64 on a 5-point scale). There were significant differences in knowledge of trafficking by age group (p < .001), region (p < .001), and educational training level (p < .001). 949 respondents (14.4%) provided free-text comments that further described their opinions.

CONCLUSION

Most respondents stated they have not received training but felt they would benefit from it. There were significant differences between demographic groups. Further innovation is needed to design a universally appropriate curriculum on human trafficking that is accessible to all healthcare providers as well as mandatory training programs for healthcare institutions.

Trauma-informed care: recognizing and resisting re-traumatization in health care

Trauma is often viewed as an individual or interpersonal issue. This paper expands the definition of trauma to include the impact collective and structural elements on health and well-being. The need for a trauma-informed response is demonstrated, with instruction as to how to implement this type of care in order to resist re-traumatization. Three examples from healthcare settings across the nation are provided, to demonstrate the ways in which organizations are bringing forward this patient-centered, trauma-informed approach to care.

A patient-oriented research approach to assessing patients' and primary care physicians' opinions on trauma-informed care

OBJECTIVE

To gather patients' and primary care physicians' (PCP) opinions on trauma-informed Care (TIC) and to investigate the acceptability of recommendations developed by patient, family, and physician advisors.

DESIGN

Cross-sectional research survey design and patient engagement.

SETTING

Canada, 2017 to 2019.

PARTICIPANTS

English-speaking adults and licensed PCPs residing in Canada.

MAIN OUTCOME MEASURES

Participants were given a series of questionnaires including a list of physician actions and a list of recommendations consistent with TIC.

RESULTS

Patients and PCPs viewed TIC as important. Both patients and PCPs rated the following recommendations as helpful and likely to positively impact patient care: physician training, online trauma resource centres, information pamphlets, the ability to extend appointment times, and clinical pathways for responding to trauma. PCPs' responses were significantly more positive than patients' responses.

CONCLUSION

TIC is important to patients and PCPs. Patients and PCPs believe changes to physician training, patient engagement, and systemic factors would be helpful and likely to positively impact patient care. Future research needs to be conducted to investigate whether these recommendations improve patient care.

Assessing Trauma History in Pregnant Patients: A Didactic Module and Role-Play for Obstetrics and Gynecology Residents

INTRODUCTION

Assessing and addressing patient histories of trauma constitute a critical component of care for vulnerable populations such as pregnant patients, yet they often go unrecognized in obstetric care. Obstetric providers may feel poorly equipped to address this issue comfortably and effectively.

METHODS

We designed this didactic module for obstetric residents with previous experience taking patient histories and delivering clinical care. The module was delivered with a faculty member and three additional facilitators with expertise in communication skills training. The session included 60 minutes of background information followed by a 15-minute presentation of a communication template for assessing trauma history. Using a practice case, residents had 45 minutes to practice in small groups, with the facilitators serving as the patient in the role-play.

RESULTS

In the 2015-2016 academic year, 21 obstetric residents participated in this module. All residents (100%) endorsed favorable beliefs regarding the importance of assessing trauma history and using trauma-informed care. On average, three-fourths (77%) demonstrated basic awareness of issues related to trauma in medical populations. Most residents (>85%) reported a high sense of efficacy in delivering trauma-informed care in some areas, while fewer (64%) reported efficacy specifically in educating patients about signs and symptoms of traumatic stress.

DISCUSSION

The module was well received overall, with participants indicating that clinical training in trauma-informed communication was needed to enhance their sense of efficacy in this area. This learning exercise provided training in a critical communication skill while highlighting areas for further development.

Healthcare students' personality traits and competence-based learning methodologies

The European Higher Education Area was implemented more than a decade ago with the aim of improving internationally the competitiveness of European university education putting the spotlight on skills and competence development (and not only on knowledge acquisition). This work intends to analyze the impact of competence-based teaching methodologies on university students, as well as to contribute to the study of the individual personality traits differences regarding this impact. For this, a descriptive, quantitative, cross-sectional study was conducted with a non-randomised sample of university students. The sample was composed of a total of 499 students of the University of Huelva (350 from the Health Sciences degree, and 149 form other degrees), who completed a questionnaire on professional skills and teaching methods developed ad hoc for this research, as well as the brief version of the Spanish adaptation of the NEO Five-Factor Inventory. The results show that Health Sciences students feel more satisfied with the most participative and active methodologies, and they consider these better contribute to their future professional competence development. On the other hand, in relation to the big 5 personality traits studied, links have been found between competence development perception and personal preferences and the dimensions of extraversion, agreeableness, conscientiousness and openness to experience. This last factor, openness to experience, appears when analyzing the main differences among both groups, being Health Sciences students more intellectually curious, showing more openness and diversity of interests, in addition to being more creative, innovative, and flexible.