Application of Trauma Informed Practice - U10 Flashcards
What are the 3 tiers of the Individual to Organizational implementation?
TOP = Individual Practice
MIDDLE = Inter-professional Collaboration
BOTTOM = Organizational Policies, Procedures & Leadership Support
*Findings from Muskett, 2014; TIP & the role of nurses (individual practice):
- Recognize the value of emotionally supportive care by nurses for pt’s with significant trauma histories
- Maintain clear and appropriate boundaries, honouring confidentiality policies, consistency, and predictability are keys to creating a trauma informed system of care
- Nurse should question coercive activities; focus on rules, locked doors, and the use of seclusion and restraint that are potentially retraumatizing
Inter-professional collaboration (middle):
Collaborative practice occurs when multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, caregivers and communities to deliver the highest quality of care across settings
What does effective inter-professional collaboration involve?
- Role clarity
- Trust and confidence
- The ability to overcome adversity
- Ability to overcome personal differences
- Collective leadership
What is the concept of a trauma-informed approach?
According to SAMHSA, it is a program, organization or system that is trauma informed:
- They REALIZE the widespread impact of trauma and understands potential paths for recovery;
- They RECOGNIZE the signs and symptoms of trauma in pt’s, families, staff and others involved with the system;
- They RESPOND by fully integrating knowledge about trauma into policies, procedures, and practices
- They seek to actively RESIST RE-TRAUMATIZATION
How can TIP principles be integrated into action?
- Strengths-based assessment
- Staff education, training, and clinical supervision
- Patient education
- Policies to reduce traumatization
What are the 6 principles of TIP integrated into HC?
- Active leadership support, role modelling, and engagement in trauma-informed principles
- Data collection
- Debriefing and prevention-focused analysis of events (usually restraint/seclusion)
- Trauma-informed education and skill development among staff
- Use of a range of assessment tools (including strengths based assessments)
- Involvement of individuals with lived experience at all levels of care
What is being done in BC to implement TIC at an organizational level?
- Staff education at all levels
- TIP being included in hiring practices (in descriptions and requirements)
- Environmental restructuring when possible*
- Reduced use of restraint and seclusion
Universal precautions VS Trauma assessment: The intent to do no further harm
If chosen, trauma assessment should be considered carefully and done in the least invasive way possible, with the focus on symptoms and behaviours rather than on facts (do not delve into specific details; story telling is often re-traumatizing)
How do you conduct screening and assessment?
Know why you’re asking, and how it can be useful to the care of the patient to prevent re-traumatization**
- understand that pt’s may be uncomfortable answering questions because of distrust of others in general
- clearly communicating the pt’s right to not answer a question
*Findings from TIP Guide, Appendix 4; Asking about trauma:
- Use normalization and explain why you’re asking:
EX. “Often the people I see here tell me that troublesome events from their past are affecting them now. Is there anything about your past that you feel is important I know so I can better help you?” - Ask questions in a non-threatening way
EX. “What is your sense of what your sleep troubles might be related to?” - Ensure the pt doesn’t feel forced to disclose; provide choice
EX. “If anything I ask makes you uncomfortable or you don’t want to talk about it, please let me know and we can move on”
AVOID: - Assumptions
- Asking for details
- Dwelling in the negative, expressing shock/horror
- Making promises
What are risks for mental health professionals?
- Secondary traumatization
- Compassion fatigue
- Countertransference
- Burnout
- PTSD
- *Vicarious trauma = a cumulative process of negative transformation that occurs in individuals as a result of working with trauma survivors
S&S: - Disruptions of professional self-identity; questioning if you’re helping, leading to thoughts of if you’re helping anyone
- Disruptions of the world view
- Disruptions in our cognitive beliefs; with safety, trust, and self-esteem
What is vicarious post-traumatic growth?
It is positive psychological change on the part of the provider of care to traumatized individuals
- Gives improved relationship skills
- An appreciation for the resilience in people
- Satisfaction from witnessing growth in pt’s and being apart of the healing process*
- Gives an increased personal strength*
