guiding principle of intervention trauma directed care

#GUIDING PRINCIPLE OF INTERVENTION TRAUMA DIRECTED CARE SERIES#

We included any study that involved emergency clinicians (eg, physicians, nurses, nurse practitioners, and physician assistants) and non-clinical staff (eg, administrative staff, security staff, and environmental services staff). Since TIC as a framework was developed in the 1990s, we included studies from 1990 onward to August 12, 2020, when databases were queried. 30 – 33 However, despite the immense burden of trauma seen in the ED and the benefits of TIC for patients and clinicians, TIC remains a nascent field within EM. 29 Trauma-informed care has been shown to be a cost-effective intervention with clinical benefits to patients and job satisfaction benefits to staff. 23 – 28 In 2012, the US Attorney General National Task Force on Children Exposed to Violence called for all EDs to provide TIC, and for all clinicians interacting with patients experiencing trauma to be trained in TIC. 7 Trauma-informed care is increasingly being adopted as an approach to clinical care in both primary and specialty care, including emergency medicine (EM). 23 It is based on six principles: 1) safety 2) trustworthiness and transparency 3) peer support 4) collaboration and mutuality 5) empowerment, voice, and choice and 6) cultural, historical, and gender issues. Trauma-informed care (TIC) is a framework that aims to prevent re-traumatization in the healthcare setting and promote resilience for both patient and clinicians. 19 – 21 There is evidence to suggest that non-clinical staff also experience STS from witnessing acute care. About 11.9–16.8% of emergency physicians screen positive for PTSD and STS symptoms at any one time, 13 – 18 and these rates may be even higher in emergency nurses with 33–64% of nursing staff screening positive for at least one symptom of STS.

5, 6 The combination of direct trauma and secondary trauma likely contributes to the high rates of post-traumatic stress disorder (PTSD) and secondary traumatic stress (STS) experienced by emergency clinicians. 4 Staff practicing in the ED also experience high rates of workplace violence (ie, direct trauma). The COVID-19 pandemic demonstrated the toll secondary trauma exposure can have on frontline healthcare workers and staff. The ED setting, by virtue of its emergency-level care, presents multiple potential sources for both direct and secondary trauma (ie, indirect exposure to traumatic events) to clinicians and non-clinical staff. 12 Similarly, hypervigilance could make the often-hectic environment of the ED, as well as interventional procedures, harder to tolerate. 12 The close interplay between executive functioning and emotional regulation may impact both the patient and the care team’s navigation of the encounter. 11 Survivors of trauma may experience emotional dysregulation (ie, trouble controlling strong emotions) or hypervigilance (ie, increased threat perception and reactivity). 10įor some survivors of trauma, the experience of the ED may be re-traumatizing or trigger past experiences.

9 These previous traumatic experiences are not equally distributed, with those self-identified as female, American Indian/Alaskan Native, and Black being more likely to experience several types of adverse childhood experience than those self-identified as male or White. 3 Patients presenting with acute trauma often are survivors of previous traumatic experiences a survey of survivors of community violence participating in a hospital-based violence intervention program found that 100% of participants reported at least one adverse childhood experience. In the United States, the yearly incidence of these events range from 1.7 million ED visits for assault-related injury 1 to 88,000 due to firearm-related injuries, 2 and over 28,000 ED visits attributed to IPV. Patients frequently present to the ED with the types of trauma defined above: individual (medical traumas/injuries) IPV and societal traumas (gun violence and community violence). Newer publications have expanded this definition to explicitly address structural trauma (eg, racism, sexism).

#GUIDING PRINCIPLE OF INTERVENTION TRAUMA DIRECTED CARE SERIES#

1 – 6 The Substance Abuse and Mental Health Services Administration (SAMHSA) defines trauma as “an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life-threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.” 7 This definition of trauma encompasses experiences that range from individual (eg, car accident, death of a loved one), to interpersonal (eg, interpersonal violence, discrimination, abuse), to societal (eg, natural disasters, pandemics, terrorist attacks). Trauma exposure is a highly prevalent experience in the emergency department (ED) for both patients and clinicians.

Guiding principle of intervention trauma directed care