Exploring Nurses' Knowledge and Experiences Related to Trauma-Informed Care

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.].

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.].

Trauma-Informed Care in Acute Adult Public Mental Health Settings: A Scoping Study Examining Implementation

Trauma-informed care (TIC) is not a new concept. Despite TIC being at the forefront of international acute public mental health services policy, and researched since 2006, implementation has been hampered. This paper reports findings from a scoping study examining clinical and lived experience workers experience of TIC in Acute Adult Public Mental Health Services. In this scoping study five databases and grey literature were scanned in 2021 and updated in 2023, to address the question: What is known about TIC concerning the clinical and mental health lived experience workforce in the acute adult public mental health service? Forty-six papers met the inclusion criteria. Analysis revealed commitment in conceptualisation of TIC in mental health policy, requirements for incorporating TIC in acute adult mental health care, and barriers to implementation, including dissonance towards role expectations. The literature calls for investment in implementing TIC, which includes an increased workforce consisting of mental health lived experience workers, clinical staff with TIC knowledge and skills, and specialist TIC experts. Further research is needed to understand more fully the opportunities and barriers to implementing TIC in acute public mental health settings.

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.

Preparedness of Australian and British nurses and midwives about domestic violence and abuse

BACKGROUND

Domestic violence and abuse (DVA) is a major health problem that affects individuals across the world. Nurses, midwives and healthcare providers need to be confident and competent in identifying and responding to DVA.

AIMS

To measure current levels of knowledge, opinions and preparedness towards DVA and how it is managed by registered nurses and midwives residing in Australia and the UK.

METHODS

A cross-sectional study design was used. Data were collected using the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) measuring the perceived preparation and knowledge, actual knowledge, opinions and practice issues. Australian data were collected in 2018 and UK data were collected in 2017-2018. Descriptive and inferential statistics were used to analyse the data and differences in knowledge and attitudes of British and Australian nurses.

FINDINGS

Nurses and midwives (n = 368; 130 from Australia; 238 from the UK) responded to the survey. Minimal previous DVA training was reported by the participants. Participants had minimal knowledge about DVA, though had a positive attitude towards engaging with women experiencing DVA.

DISCUSSION

Most participants felt unprepared to ask relevant questions about DVA and had inadequate knowledge about available resources. Australian participants scored better than British participants; however, the mean difference in all aspects remained statistically insignificant.

CONCLUSION

Australian and British nurses and midwives have a positive attitude towards women experiencing DVA; however, the knowledge and skills to support women experiencing DVA are limited.

IMPLICATIONS FOR NURSING POLICY

Nursing institutions should develop strategic policies regarding mandatory preparation and training of nurses for domestic violence assessment and management.

Impact of Trauma-Informed Care Training on Attitudes Among Emergency Department Personnel, Staff Advocates, and Nursing Students

BACKGROUND

Health care providers may risk retraumatizing patients and intensifying patient distress unless they practice trauma-informed care. As the first line of defense in assisting trauma survivors' physical and emotional recovery, health care providers must use a strengths-based framework that promotes resilience and expands on the trauma survivor's existing resources.

OBJECTIVE

This study aimed to compare the effect of trauma-informed care training on the attitudes of emergency department personnel, staff advocates, and nursing students toward trauma-informed care.

METHODS

This study used a pretest-posttest design. Assessment of attitudes toward trauma-informed care was done before and after trauma-informed care training. Data collection occurred from February 2021 through August 2021. Participants included three cohorts of emergency department staff, advocates for trauma survivors, and nursing students. Attitudes toward trauma-informed care were measured using the Attitudes Related to Trauma-Informed Care (ARTIC) Scale.

RESULTS

A total of 433 participants were studied, including 88 emergency department staff, 123 staff advocates, and 222 nursing students. All three cohorts significantly increased ARTIC Scale scores posttraining (p < .001). At preintervention, all three cohorts significantly differed from each other on ARTIC Scale scores (p < .01). In contrast, postintervention, ARTIC Scale scores did not significantly differ between nursing students and advocates (p = .99). Nursing students showed a significant increase in scores from pre- to postintervention compared with either advocates or emergency department staff.

CONCLUSION

The results strongly suggest that health care providers can improve attitudes toward trauma-informed care after completing training on the principles and application of trauma-informed care.

Correlations between childhood trauma and depression, anxiety, and stress levels in nurses

AIMS

This study aims to determine correlations between childhood trauma and depression, anxiety, and stress levels in nurses.

METHODS

This cross-sectional study was conducted among nurses in Turkey from August to September 2022. A total of 395 nurses were included in the study. Data were collected through an online survey using a personal information form, the Childhood Trauma Questionnaire (CTQ-28), and the Depression, Anxiety, and Stress Scale (DASS 21).

RESULTS

The mean score of the CTQ-28 total scale was 51.6, and emotional neglect was the most common type of abuse. The prevalence of moderate-to-extremely severe depression, anxiety, and stress was 34.7 %, 42.2 %, and 18.3 %, respectively. Emotional abuse and emotional neglect subscales of the CTQ were independently related to all three DASS subscale scores.

CONCLUSION

This study revealed that the emotional abuse and neglect experienced in childhood are related to the nurses' current stress, anxiety, and depression levels.

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.

Outcomes from an interprofessional curriculum on trauma-informed care among pediatric service providers

The effects of trauma on the health of individuals have been well established as a major public health concern. However, the integration of trauma-informed practices within the multidisciplinary pediatric health care system still faces significant challenges and barriers. This study sought to understand the changes in knowledge, behaviors, and attitudes related to trauma-informed care following administration of a trauma-informed educational intervention. Eighteen pediatric professionals participated in this interprofessional study design. The intervention included several components of self-study, face-to-face active learning experiences, presentations, and case discussions. Six weeks following the intervention, participants engaged in a follow-up focus group dialogue. To crystallize the transformative impact of education in practice, the study used both quantitative and qualitative data. Quantitative data was measured using the Attitudes Related to Trauma Informed Care (ARTIC) scale, while a focus group was used to understand the subjective experiences of participants and the effects of participation on practice. Results showed statistically significant pre- to post-programming improvements across all ARTIC domains. Qualitative themes aligned with the quantitative findings, indicating a sense of empowerment through knowledge, as well as an enhanced awareness of systematic challenges to implementation of trauma-informed care approaches.

Creating safe relational space: Public health nurses work with mothering refugee women

OBJECTIVE

Exploring how public health nurses (PHNs) provide community-based support to women who are refugees and mothering.

DESIGN

A constructivist grounded theory (CGT) design was used where intersectionality as an analytical tool was applied. Varying data collection approaches including focus groups were used.

SAMPLE

Twelve PHNs from four public health units in Western Canada participated in this study.

RESULTS

Participants in this study described an overall process of creating safe relational space to address a basic social problem of establishing trust while managing structural forces. This overarching process was expressed through burning with passion, connecting while looking beyond, protecting from re-traumatization, and fostering independence. Findings reveal strategies PHNs used to enhance health equity. This study extends critical caring theory to include sociopolitical and economic influences on public health nursing practice. Consequences of these influences on the mothering refugee women population are also revealed. Implications include structural integration of trauma-and-violence-informed principles to support public health nursing practice.

CONCLUSIONS

This study adds to an emerging body of knowledge on PHNs work with complex populations. Innovative application of intersectionality is demonstrated as an effective approach to analyzing impacts of broad sociopolitical priorities on communities that are systemically marginalized.

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.

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 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.

The Development of Trauma and Resilience Competencies for Nursing Education

BACKGROUND: Trauma and its consequences have been identified as a high-priority public health risk. A growing body of research reveals the devastating long-term consequences from common and widespread adverse events across the life span. In addition, recent research links medical procedures and medical illnesses with posttraumatic stress disorder. Nurses too are at risk and suffer vicarious trauma. Nurses must be able to recognize and assess for early trauma symptoms and assist in enhancing resilience in order to prevent and care for those with trauma. However, there is a lack of trauma-informed and trauma-specific training in nursing education. Given the ubiquity of traumatic events, the pervasive physical and emotional sequelae of trauma, and the existence of evidence-based treatment for trauma; there is a critical need to develop core competencies for nursing education and practice. AIM: The purpose of this study was to develop and validate Trauma and Resilience Competencies for Nursing Education. METHOD: An expert panel of 16 nurses met in 2018 to develop Trauma and Resilience Competencies for undergraduate and graduate nursing programs, and for psychiatric mental health nurse practitioner education. Following the Expert Panel's work and approval from the institutional review board, a modified e-Delphi survey was sent to experts in trauma and resilience to validate this work. RESULTS: The competencies were validated and edited to 88 competencies through two rounds of a Delphi survey. CONCLUSIONS: Implications for education, practice, and research are discussed. The Trauma and Resilience Competencies for Nursing Education will be disseminated widely through publications and are available online.

Impacts of trauma- and violence-informed care education: A mixed method follow-up evaluation with health & social service professionals

OBJECTIVES

Trauma- and violence-informed care (TVIC) creates safety by understanding the impacts of trauma on health and behavior, and the intersecting impacts of structural and interpersonal violence. This study examined the impact, 1-2 years later, of TVIC professional education.

DESIGN, SAMPLE AND MEASUREMENTS

We conducted a mixed method descriptive follow-up evaluation (online survey, n = 67, and semi-structured interviews, n = 7) with health and social service providers, leaders and researchers who attended TVIC workshops. Participants were asked how the workshop impacted their thinking, actions and perceptions of organizational changes.

RESULTS

Participants reported greater impact on attitudes than on behaviors. The most common change in awareness and thinking related to better understanding of the links among trauma, pain and substance use. Practice changes included more active listening and empathy, less use of jargon and less judgement in care encounters. Participants linked these practices to better care interactions, and more trust, openness and satisfaction among service users.

CONCLUSION

Educating health professionals and others (e.g. educators) about trauma, violence, and discrimination is not easy. TVIC education can help shift potentially stigmatizing attitudes which can then precipitate practice change. These approaches are emerging as an important way to improve health and quality of life.

What is needed for Trauma Informed Mental Health Services in Australia? Perspectives of clinicians and managers

Trauma Informed Care is an approach to the delivery of mental health care that requires sensitivity to the prevalence and effects of trauma in the lives of people accessing services. While TIC is increasingly emphasized in mental health policy and frameworks in Australia, people working in mental health settings have reportedly struggled to translate the values and principles into their everyday practice. This qualitative study used an experience-based co-design methodology to explore the potential for implementation of Trauma Informed Care into mental health services in Australia. The experiences of consumers, carers, clinicians, and managers were gathered. This paper presents the perspectives of clinicians (n = 64) and senior managers (n = 9) from across three Local Health Districts in New South Wales in Australia. All data were analysed thematically to address the research question: What is needed for Trauma Informed Mental Health Services in Australia? To be trauma-informed, managers required: leadership at all levels, access to resource, relevant and accessible training, support for staff, resolution of wider systems issues, and clarification of the concept and actions of TIC. Clinicians identified that to be trauma-informed they required services to: be aware of staff well-being, support different ways of working, address workplace cultures and provide increased resources. The findings have implications for any service, team or individual seeking to implement TIC within mental health settings.

Parent and Clinician Communication During Paediatric Burn Wound Care: A Qualitative Study

PURPOSE

To thematically describe parent-clinician communication during a child's first burn dressing change following emergency department presentation.

DESIGN AND METHODS

An observational study of parent-clinician communication during the first burn dressing change at a tertiary children's hospital. Verbal communication between those present at the dressing change for 87 families, was audio recorded. The recordings were transcribed verbatim and transcripts were analysed within NVivo11 qualitative data analysis software using qualitative content analysis.

FINDINGS

Three themes, underpinned by parent-clinician rapport-building, were identified. Firstly, knowledge sharing was demonstrated: Clinicians frequently informed the parent about the state of the child's wound, what the procedure will involve, and need for future treatment. Comparatively, parents informed the clinician about their child's temperament and coping since the accident. Secondly, child procedural distress management was discussed: Clinicians and parents had expectations about the likelihood of procedural distress, which was also related to communication about how to prevent and interpret procedural distress (i.e., pain/fear). Finally, parents communicated to clinicians about their own distress, worry and uncertainty, from the accident and wound care. Parents also communicated guilt and blame in relation to injury responsibility.

CONCLUSIONS

This study provides a description of parent-clinician communication during paediatric burn wound care.

PRACTICAL IMPLICATIONS

The results can assist healthcare professionals to be prepared for a range of conversations with parents during potentially distressing paediatric medical procedures.

Interactive Case-Based Childhood Adversity and Trauma-Informed Care Electronic Modules for Pediatric Primary Care

INTRODUCTION

Training health professionals for the skills and capacity to respond adequately to children and adults who have been exposed to adverse childhood experiences is recognized as an essential need in health care. Accessible opportunities to educate physicians and physician-trainees are limited.

METHODS

Four computer-based e-modules were created focusing on addressing childhood adversity and implementing trauma-informed care in the pediatric primary care setting. These childhood adversity and trauma-informed care (CA-TIC) e-modules were designed as an individualized, self-directed experience to allow for distance learning with flexibility to be embedded into existing coursework. To foster an engaging learning environment, we narrated the modules, prioritized images, and included the opportunity for participant interaction via multiple-choice and short-answer questions. Twenty-eight pediatric residents, two medical students, four attending physicians, and one fellow at Children's National Hospital completed the e-modules.

RESULTS

Overall, participants rated the CA-TIC e-modules 4.6 (SD = 0.5) out of 5 for design and quality. Using paired t tests and Wilcoxon signed rank tests, we found statistically significant score increases from presession to postsession for participants' knowledge, attitudes, practice, and confidence related to CA-TIC. The most commonly cited learning points and practice changes included asking about trauma in practice and the seven C's of resilience.

DISCUSSION

A trauma-informed, strengths-based approach to care can assist health care providers in mitigating the link between adversity and related poor health outcomes. The CA-TIC e-modules provide an opportunity to train health professionals using an innovative, self-directed, and low-resource mechanism.

Exploring the health and service utilisation of general practice patients with a history of adverse childhood experiences (ACEs): an observational study using electronic health records

OBJECTIVES

To examine the relationships between adverse childhood experiences (ACEs), chronic health and health service utilisation among a sample of general practice patients.

DESIGN

Cross-sectional observational study using anonymised data from electronic health records for 763 patients.

SETTING

Four general practices in northwest England and North Wales.

OUTCOME MEASURES

Patient demographic data (age, gender); body mass index; self-reported smoking status; self-reported ACEs; diagnosis of chronic health conditions; current mental health problems; total number of service contacts and repeat medication use in the previous 6 months.

RESULTS

A history of ACEs (experiencing abuse or neglect as a child, and/or growing up in a household characterised by violence, substance use, mental health problems or criminal behaviour) was strongly independently associated with current mental health problems, smoking and chronic obstructive pulmonary disease, showing a dose-response relationship with level of ACE exposure. Medication use and contact were significantly greater among patients with high ACE exposure (≥4 ACEs), compared with those with no ACEs. However, contrary to findings from population studies, health service utilisation was not significantly different for patients with increased ACE exposure (1-3 ACEs) and their ACE-free counterparts.

CONCLUSIONS

Findings highlight the contribution ACEs make to unequal distributions of risk to health and well-being and patterns of health service use in the UK.

Prevalence of Traumatic Experiences in South Korean Adults

Although a variety of traumatic experiences can impact health over the lifetime, little is known about the prevalence of such experiences in South Korea. The purpose of this study was to examine the frequencies of traumatic experiences and their differences by gender and age. South Korean adults (N = 3000) aged 19-65 years completed a self-report survey assessing childhood and adulthood trauma and sociodemographic characteristics. Overall, 79.5% of the participants reported at least one traumatic experience in adulthood. Unemployment or job loss and academic or work difficulties were commonly reported. The most distressing adulthood trauma was the unexpected death of a loved one, followed by diseases in loved ones. Childhood trauma was higher in males than in females. In males, childhood trauma was higher at a younger age, but in females, it was higher at an older age. Adulthood trauma was higher in females than in males and at older ages for both males and females. The current findings demonstrate the differences in traumatic experiences by gender and age in the South Korean general population. These results could help improve assessment of and targeted intervention for psychological trauma through trauma-informed strategies in public health practice.

Becoming Trauma Informed: Validating a Tool to Assess Health Professional's Knowledge, Attitude, and Practice

To effectively address the negative health effects of early childhood trauma and adversity, healthcare professionals and healthcare institutions must understand the impact of adverse childhood experiences and trauma on health. This study aimed to validate a tool to assess knowledge, attitude, and practice of trauma-informed care among interdisciplinary pediatric healthcare staff.

Methods

A 36-item survey tool, "Knowledge, Attitudes, and Practices of Trauma-Informed Practice," was adopted and modified with permission from the author. We administered the survey electronically to 2,659 staff at a pediatric healthcare institution. To assess the tool's reliability and validity, internal consistency reliability testing, content validity, and construct validity assessments were conducted.

Results

A total of 592 surveys were collected, representing a 22.3% response rate. Confirmatory factor analysis revealed that 21 items provided the strongest internal consistency reliability for the overall tool and each factor. The overall Cronbach's alpha for the 21-item tool was 0.86, with 0.84 for the knowledge factor, 0.74 for the attitude factor, and 0.78 for the practice factor. The goodness of fit based on this analysis was good to adequate, with a 0.077 root mean square error of approximation.

Conclusions

Healthcare professionals and organizations are in a unique position to improve the health and well-being of their patients by implementing a trauma-informed approach to minimize the impact of adverse childhood experiences and trauma. This validated tool will allow organizations to identify gaps in knowledge, attitude, and practice among staff to subsequently begin developing pointed strategies to achieve a culture of trauma-informed practice.

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.

Primary Care Providers' Perspectives on Providing Care to Women Veterans with Histories of Sexual Trauma

BACKGROUND

One in four women Veterans who use the Veterans Health Administration (VA) screen positive for military sexual trauma and may need trauma-sensitive care and coordination. VA primary care providers (PCPs), women veterans' main source of care, need to be well-versed in trauma-sensitive approaches to care. Women veterans' numerical minority in the VA can make provider exposure to female patients inconsistent, which may impede PCP experience in providing appropriate care. To inform strategies for improving trauma-sensitive primary care, we sought to better understand PCPs' current approaches to providing care to women veterans with sexual trauma histories.

METHODS

We conducted semistructured telephone interviews with PCPs (n = 28) practicing in VA primary care clinics. Participants were asked about their experiences delivering trauma-sensitive care as well as best practices. Interviews were recorded, transcribed, and analyzed for major themes regarding barriers to and facilitators of trauma-sensitive care.

RESULTS

Participants expressed challenges delivering care to women with sexual trauma histories, including 1) insufficient time, 2) lack of perceived proficiency and/or personal comfort (with general physical examinations as well as gender-specific care such as Pap, breast, and pelvic examinations), and 3) difficulties with fostering positive patient-provider relationships. Access to mental health resources was noted as a key facilitator of providing trauma-sensitive care. Participants also shared existing (and potential) best practices and recommendations, such as paying special attention to patient behavioral cues related to comfort.

CONCLUSIONS

PCPs delivering care to women in VA facilities may benefit from an increased awareness of best practices to facilitate the delivery of trauma-sensitive care.