Trauma has a devastating impact on people’s lives and health and, crucially, on how they respond to healthcare. Concerningly, 75% of adults in Australia have experienced trauma at some point in their life — be that physical, emotional or psychological, according to the Australian Institute of Health and Welfare.
Nurses play a key role in advancing trauma-informed care (TIC) given their frequent and close interactions with patients.
It is critical that all nurses, not only mental health nurses, are knowledgeable and practicing trauma-informed to provide holistic, compassionate care. Nurse leaders are well-positioned to provide guidance and must first recognise the impact trauma has on the lives of patients and nurses. Nurse leaders can support their teams to understand trauma, how people respond to trauma, and identify ways to help nurses and patients move forward.
What is the role of nurses in trauma-informed care?
Trauma-informed care seeks to support healing by understanding an individual’s behaviour in light of their past experiences. TIC is a systems-led, strengths-based program underpinned by four principles: realise the widespread impact trauma can have, recognise the signs; respond by embedding TIC into procedures and practices, and prevent retraumatising patients by leading with patient-centred care.
TIC prioritises physical, emotional, and psychological safety to support healing and prevent further harm. It has become a priority for mental healthcare across Australia, but to translate the goal into practice requires strong commitment from leadership at all levels, a coordinated approach, proper evaluation of TIC methodologies and ways to measure best practices, and ongoing support for nurses and other trauma care providers.
Core trauma-informed principles include:
- Safety – ensuring the person’s physical environment is safe and that they are emotionally safe
- Trust – being sensitive to the person’s needs and fears, paying attention to non-verbal communication
- Choice – providing the person experiencing trauma with choices, including where, when, and how to have a conversation
- Collaboration – communicating “with” not “to”, allowing patient autonomy with their decisions, and cooperating as much as possible
- Empowerment – identifying ways to interact in a respectful and inclusive way, recognising that trauma often stems from disempowerment.
Keeping patients experiencing trauma informed can help to reduce confusion, help patients feel in control, and build trust to make patients feel safer.
Embedding trauma-informed nursing into healthcare
There are growing efforts to integrate TIC into the broader healthcare framework. For example, NSW Health has adopted a system-wide approach to TIC with the goal of lessening the impacts of trauma, ensuring it is not exacerbated, and promoting healing.
Studies have found that embedding TIC into general health services and training nurses across the healthcare system in trauma care can help to prevent retraumatising patients and improve patient outcomes. In one program, patients who had experienced sexual assault or domestic abuse received TIC services delivered by community health nurses. Interviews found TIC helped them to feel empowered, safe, supported, and informed.
Prioritising cultural safety with TIC
Key to any TIC program in Australia is a deep recognition of the need for cultural context, particularly in relation to the intergenerational and historical trauma experienced by patients from Aboriginal and Torres Strait Islander communities.
This is particularly important for nurses in remote and rural areas, where a commitment to culturally safe care is imperative. In keeping with the principles of TIC, nurses engaging with Aboriginal and Torres Strait Islander peoples should adapt their modes of communication, avoid medical jargon, ensure information is understood, and build rapport and trust when interacting with patients and the community at large.
Ways nurse leaders can manage staff trauma and burnout
Nurses and other healthcare providers also experience trauma and traumatic stress, which can lead to fatigue and burnout. By adopting TIC approaches, nurse leaders can play an important role in workplace satisfaction among nurses. The key ways nurse leaders can lead through TIC include:
- Encourage and support nursing staff to focus on self-care, such as mindfulness, meditation, as well as listening to their experiences.
- Vary or reduce nurses’ workload, particularly for those nurses dealing with patients experiencing a traumatic event.
- Encourage debriefing for nurses dealing with traumatic patient experiences.
- Cultivate and empower peer support and collaboration.
Training is also essential to helping nurses address their own trauma and to support patients with TIC. However, such training should be implemented in a systematic way and embedded in daily care delivery when caring for patients experiencing trauma. Mental health nurses in particular are at the heart of these interactions, supporting and empowering patients to manage distress and trauma.
By providing consistent support for their staff and leading with compassion, trustworthiness and reliability, nurse leaders can help prepare their staff to better deal with trauma and guide them as they engage with patients who need physical, emotional, and psychological support through their own healthcare journeys.
Find out more about how Lippincott® Solutions Australia can support nurses across healthcare settings.
