Trauma-informed care is an approach in mental health care and nursing practice that recognises the existence of trauma in the life of patients receiving mental health care, irrespective of whether or not the trauma is known to exist (Isobel & Edwards 2017). Clinicians who employ this approach acknowledge the complexity of trauma, and integrate the principles of safety, trustworthiness, choice, collaboration, and empowerment in care delivery (Qadara, 2013). Using this approach can result in better patient outcomes as well as more effective and fulfilling clinical practice. This essay discusses how trauma-informed care informs the provision of mental health care in Australia at a policy level and for consumers. Also, the essay highlights how this approach will influence the author’s mental health nursing practice.
Before progressive further, it is important to have a comprehensive understanding of what trauma-informed care entails. Trauma-informed care involves recognising the existence of traumatic experiences in mental health patients, the significant effect of trauma on those patients, as well as their care experiences (Isobel & Edwards 2017). Indeed, trauma is prevalent, with diverse and multifaceted impacts on mental health patients. Trauma may originate from various sources such as neglect, abuse, and violence, ultimately resulting in maturational difficulties, impaired social function, emotional problems, as well as physical health complications (e.g. unplanned pregnancies, sexually transmitted illnesses, and cardiovascular disease) (Qadara, 2013; Muskett, 2013; Mental Health Coordinating Council [MHCC], 2013). As per the philosophical tenets of trauma-informed care, mental health practitioners have a responsibility to ensure an emotionally and physically safe environment (Isobel & Edwards 2017). They must strive to minimise iatrogenic harm and to prevent re-traumatisation during the course of care delivery. Indeed, re-traumatisation is a common outcome in mental healthcare delivery (Wilson, Hutchinson & Hurley 2017).
Trauma-informed care focuses on not only patients, but also clinicians (Isobel & Edwards 2017). Similar to patients, clinicians may be victims of traumatic experiences, hence the need for addressing their needs. In fact, nurses may not effectively address the needs of patients if they are not properly empowered. Empowering nurses creates an environment where nurses also feel emotionally safe to address the psychological needs of patients.
It is worth noting that trauma-informed care does not necessarily mean that nurses should identity and treat trauma. Instead, trauma-informed care means having awareness of the possible presence of trauma and its impact, and providing care in a manner that guarantees physical and psychological safety (Isobel & Edwards 2017). Also, employing the trauma-informed care model does not mean abandoning recovery-oriented models (Isobel & Edwards 2017). Trauma-informed care offers an alternative way of conceptualising therapy and recovery. Nurses begin to understand the physical and psychological effects of trauma on individuals and the influence of past events on the present interactions needed to promote recovery. In essence, trauma-informed care seeks to value and empower the patient in every step of the care process.
For nurses to employ the trauma-informed care model, they ought to have a proper theoretical understanding of the model. According to Muskett (2013), lack of understanding of the model on the part of nurses is a major obstacle to effective implementation. This problem can be attributed to, among other factors, limited research on trauma-informed care within the Australian context (Wilson, Hutchinson & Hurley 2017). Poor understanding of the model can lead to resistance or non-commitment to the model, thus hindering the achievement of the desired outcomes. Training nurses on the principles of the trauma-informed model, how it works, and its implications on their responsibilities within the care setting is crucial for building their understanding of the model. From internal memos and meetings to notice boards, newsletters, formal documents, workshops, and informal discussions, the organisation should make use of numerous channels to empower nurses with knowledge on trauma-informed care (Isobel & Edwards, 2017).
Literature has demonstrated the effectiveness of trauma-informed care in improving the delivery of mental health care. Trauma-informed care makes patients feel valued, respected, empowered, informed, connected, and hopeful of recovery (Muskett, 2013; MHCC, 2013). This can result in increased patient satisfaction. Trauma-informed care can also change patients’ perceptions of care and recovery as well as clinician-patient relationships, further improving patient satisfaction. Furthermore, trauma-informed care can enhance patient outcomes by improving patients’ compliance with care and knowledge of self-help techniques. For Wilson, Hutchinson & Hurley (2017), trauma-informed care enhances the patient’s experience of mental health services, and fosters a positive organisational culture.
Trauma-informed care is not widely known in Australia (Isobel & Edwards, 2017). Additionally, many mental health nurses in the country do not have a clear understanding of how they can individually integrate the model into everyday practice (Muskett, 2013). At the policy level, trauma-informed care in Australia largely encompasses eliminating or reducing seclusion, restraint, physical aggression, involuntary detention, forced medication adherence, and other coercive practices (MHCC, 2013; Wilson, Hutchinson & Hurley 2017). Nonetheless, trauma-informed care is much more than just eliminating coercive practices. It also involves staff training, patient involvement in care planning, environmental changes, policy and language change, patient empowerment building rapport and relationships with patients, as well as creating a safe and respectful care environment (Muskett, 2013).
It is imperative for trauma-informed care in Australia to be implemented at the policy level. Organisations involved in mental health care should design and implement a policy that incorporates trauma-informed principles in every organisational aspect – from administration and management to service delivery. Organisations should recognise psychological and physical safety as priorities in the delivery of mental health care. Also, organisations should adopt procedures to avoid or minimise the re-traumatisation of both patients and staff members.
Implementing trauma-informed care at the policy level involves not only mental healthcare organisations, but also a host of other key stakeholders. These include the commonwealth government, state and territorial governments, policymakers, health commissions, as well as communities (MHCC, 2013). A multi-stakeholder approach is important for ensuring trauma-informed care principles become nationally applicable standards as far as mental health care delivery is concerned. Involving all the relevant stakeholders is also vital for mobilising and availing the resources required for initiatives such as staff training and environmental changes. Policy reform in the area of mental healthcare would not only improve clinical practice and patient outcomes, but also stimulate research in this largely under-researched area. Greater research in this area is especially important given the limited research focusing on trauma-informed care within Australian mental healthcare settings (Wilson, Hutchinson & Hurley 2017).
Trauma-informed care has important implications for clinical practice. It provides a guiding philosophy for the delivery of mental health services. Personally, learning about trauma-informed care will significantly influence my nursing practice going forward. I now recognise that patients seeking mental health services have trauma histories that may significantly affect their physical, mental, and emotional wellbeing. These impacts remain long after the end of the trauma (MHCC, 2013). As a nurse in the mental healthcare setting, I must therefore recognise these histories, and connect trauma to patients’ social background. This is particularly because of the link between social factors and health. I must endeavour to deliver care that is meaningful to the patient.
Putting into consideration patients’ trauma histories means that the delivery of mental health care should respond to the specific needs of the patient. Instead of a one-size-fits-all approach, mental health nurses should strive to personalise care. Indeed, the trauma-informed care model puts the patient at the centre of care (Wilson, Hutchinson & Hurley 2017). This means that every element of the care process should be designed with unique needs of each patient in mind. Regrettably, this aspect of responsiveness and individualisation lacks in most mental healthcare settings in Australia. Personalising care means, among other things, seeking to understand the patient’s trauma history, being culturally competent, collaborating with the patient in care planning and delivery, as well as giving the patient choice and autonomy. These are aspects I must incorporate into my practice to improve patient outcomes. Personalising care will not only enhance patient satisfaction, but also give me a sense of fulfilment and gratification. As mentioned earlier, the trauma-informed care approach acknowledges that trauma is prevalent in not only patients, but also healthcare providers. Employing trauma-informed care can help mental health nurses gain a sense of empowerment.
Overall, trauma is a prevalent phenomenon among mental health patients. Most patients seeking treatment for personality disorders, depression, eating disorders, substance abuse, and other mental health complications have experienced trauma at one point or another in their life. Unfortunately, most clinicians in Australia’s mental healthcare setting portray little or no acknowledgement of these trauma histories. They fail to recognise the profound impact these traumas may have on patients’ physical and emotional wellbeing. This can be changed by adopting the trauma-informed care model. Under this model, care is personalised to the specific psychosocial needs of the patient. This approach has immense potential to improve patient and staff outcomes. For trauma informed care to be broadly adopted in Australia, there is need for policy reform, greater research on trauma-informed clinical practice, and staff training.
References
Isobel, S. & Edwards, C. 2017, ‘Using trauma informed care as a nursing model of care in an acute inpatient mental health unit: a practice development process’, International Journal of Mental Health Nursing, vol. 26, p. 88-94.
Mental Health Coordinating Council (MHCC) 2013, Trauma-Informed Care and Practice: Towards a cultural shift in policy reform across mental health and human services in Australia, A National Strategic Direction, Position Paper and Recommendations of the National Trauma-Informed Care and Practice Advisory Working Group, Authors: Bateman, J & Henderson, C (MHCC) Kezelman, C (Adults Surviving Child Abuse, ASCA).
Muskett, C. 2013, ‘Trauma-informed care in inpatient mental health settings: a review of the literature’, International Journal of Mental Health Nursing, pp. 1-9.
Qadara, A. 2013, Implementing trauma-informed systems of care in health settings: the WITH study, State of knowledge paper, Australia’s National Research Organisation for Women’s Safety (ANROWS), Alexandria NSW.
Wilson, A., Hutchinson, M. & Hurley, J. 2017, ‘Literature review of trauma-informed care implications for mental health nurses working in acute inpatient settings in Australia’, International Journal of Mental Health Nursing, vol. 26, pp. 326-343.
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