Assessing and managing the impact of trauma has important implications for the care of patients and populations affected by trauma and violence. The current role and ongoing development of trauma-informed care are the focus of the October/December special issue of the Journal of Forensic Nursing, official journal of the International Association of Forensic Nurses. The journal is published in the Lippincott portfolio by Wolters Kluwer.
“Trauma-informed care offers a framework for promoting equity and improving health outcomes,” write Guest Editors Kathryn Laughon, PhD, RN, FAAN, of University of Virginia, Charlottesville, and Annie Lewis-O'Connor, PhD, NP-BC, MPH, FAAN, of Brigham and Women’s Hospital, Boston. As specialists in providing care to victims and perpetrators of violence, trauma and abuse and leaders in anti-violence efforts, forensic nurses are uniquely positioned to advocate for trauma-informed care (TIC), at both the individual and structural level.
‘Potential to advance equity for all’ through trauma-informed care
Trauma is the result of an event or circumstances perceived to be harmful, with long-term and pervasive effects. “Trauma-informed care provides a theoretical framework to allow us to provide effective care that acknowledges that patients we care for bring a history of collective life-time trauma,” Drs. Laughon and Lewis-O'Connor write. The special issue presents original research and perspectives on incorporating trauma-informed approaches into a wide array of nursing practice settings: for example, in the emergency department, work with sexual assault victims/survivors, addiction or mental health treatment, and other settings where high-risk patients and clients are treated.
A critical issue is the need for TIC content in nursing education. A paper by Candance W. Burton, PhD, RN, AFN-BC, AGN-BC, FNAP, of University of California, Irvine, and colleagues suggests ways of incorporating trauma-informed approaches into baccalaureate nursing programs. Nursing curricula should include an understanding of care for diverse and vulnerable populations, different types of trauma (historical and structural trauma, as well as individual violence and abuse), and their impacts on health.
Dr. Burton and colleagues emphasize that TIC content is compatible with the essentials of baccalaureate nursing education, as defined by the American Association of Colleges of Nursing. The authors conclude: “By integrating TIC into baccalaureate curricula, nursing educators can provide students with the skills and facility necessary to provide holistic and highly effective care to the most vulnerable of patients.”
“Making our practices more trauma-informed is a necessary and laudable first step but will be insufficient without larger structural reforms,” Drs. Laughon and Lewis-O'Connor write. “Racism, misogyny, xenophobia, religious discrimination and other forms of systematic social discrimination are poignant historical realisms that also account for trauma.”
A paper by Deanna R. Befus, PhD, RN, SANE, of Western University, London, Ont., Canada and colleagues highlights the need for a broader approach to the concept of structural violence. This viewpoint “situates violence in the context of social determinants, thereby repositioning violence as a public health issue in which systems and institutions are held accountable.”
The authors advocate a trauma- and violence-informed care approach – “accounting for the fact that trauma can result from various forms of structural violence as well as individual interactions and that some populations are disproportionately affected by multiple forms of violence.” The authors believe that this approach can provide “more equity-oriented holistic care that incorporates principles of social justice.”
“We cannot ignore that racism and other systematic forms of discrimination are trauma that impact the health and well-being of individuals and communities,” Drs. Laughon and Lewis-O'Connor conclude. They believe the special issue papers “provide a blueprint for advancing health delivery using a trauma-informed lens, which has the potential to advance equity for all.”
About Journal of Forensic Nursing
The Journal of Forensic Nursing (JFN), the official journal of the International Association of Forensic Nurses, is a groundbreaking publication that addresses health care issues that transcend health and legal systems by articulating nursing’s response to violence. The journal features empirical studies, review and theoretical articles, methodological and concept papers, and case reports that address the provision of care to victims and perpetrators of violence, trauma, and abuse. Topics include interpersonal violence (sexual assault, abuse, intimate partner violence); death investigation; legal and ethical issues; forensic mental health nursing; correctional nursing; and emergency and trauma nursing.
About the International Association of Forensic Nurses
The International Association of Forensic Nurses (IAFN) is an international education and membership organization comprised of forensic nurses working around the world and is the recognized authority on forensic nursing. The mission of the IAFN is to provide leadership in forensic nursing practice by developing, promoting, and disseminating information internationally about forensic nursing science and universal access to forensic nursing care for patients impacted by violence and trauma. The Association defines and advances the global research agenda to enhance nursing's evidence-based response to the needs of forensic populations, and serves as a global network for forensic nurses to exchange ideas, serve as mentors and enhance their practice. For more information visit www.forensicnurses.org