Trauma-informed care (TIC) is a hot topic these days, and the coronavirus pandemic has accelerated the need for implementation of a care standard that considers traumatic events in a patient’s history.
Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as harmful or life threatening. The situation that produces trauma can last for a short or long period of time and has lasting adverse effects on the individual’s mental, physical, emotional and spiritual well-being. Trauma may be an injury (such as a wound) to living tissue caused by an extrinsic agent, or it may be a disordered psychiatric or behavioral state resulting from severe mental, emotional or physical injury.
Healthcare professionals can use the concepts of trauma-informed care to realize the widespread impact of trauma and identify potential paths for recovery. Questions and techniques help recognize the signs and symptoms of trauma in patients, so that the healthcare professional can seek to actively prevent additional trauma or re-traumatization.
Trauma can be produced by many different events, including natural disasters, personal incidents, accidents, health scares or problems, abuse, death, and more. Trauma can fall into two buckets:
Primary Trauma
When an intense experience is unfolding and being experienced, all of the body’s senses are involved. Disparate pieces of the experience are being registered both consciously and unconsciously. The body is responding to what is being heard, seen, felt and understood. This can occur mentally, physically, emotionally, psychologically, or spiritually.
Secondary Trauma
When an individual is experiencing secondary trauma, the body is being affected by another’s trauma. This may result in, when the other is present, the body taking in the other person’s non-verbal language, listening and mirroring the emotional tone.
Either primary or secondary trauma may be identified by the following signs:
In order to understand why a re-traumatization may be occurring, it’s important to understand that triggers can be either external or internal. An external trigger might be trauma brought on by a situation, place, person, sound, or smell. If you’ve identified that a patient is displaying distressed behavior or seems upset at dusk every night, it may be that darkness is triggering to them and you may want to explore options for ensuring the patient is in a brightly-lit space during the transition from daylight to dark. An internal trigger might be trauma brought on by pain, tension, anxiety, sadness, feeling lonely, or memories.
Trauma-informed care aims to understand the impact and history of trauma experienced by an individual, creating a safe environment and context for healing. It also seeks to recognize and honor the individual and restore power and individual autonomy.
The goals of this type of care include:
Asking these questions can help to ensure that we are not contributing to the re-traumatization of our patients. Re-traumatization can be conscious or unconscious, and results in the patient re-experiencing the initial traumatic event. It can be triggered by:
By starting to identify the triggers of trauma for our patients, we’re able to see around corners to ensure their comfort and security. When we’re able to create an environment that feels comfortable and safe (both consciously and unconsciously), patients are able to experience true holistic care.
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