What is trauma? 

Trauma can arise when someone has experienced very stressful, frightening or distressing events that are difficult to cope with or out of their control. It could be one incident, or an ongoing event that happens over a long period of time. 

Most of us will experience an event in our lives that could be considered traumatic. But we won't all be affected the same way. Trauma can happen at any age. And it can affect people at any time, including a long time after the event has happened. 

What about when patients do choose to disclose trauma?  

Choosing to show you the card and disclose that they have experienced trauma may be a difficult thing for a patient to do. Unless the situation is one where there are currently at risk you do not need to know or ask for details of the trauma. What matters is how it affects them now and what you can do to make their appointment / health care less difficult for them. It is really helpful if you can respond in a calm and supportive manner, recognising the trust that they are placing in you.  

If you are in a public area such as a reception area please be sensitive and discrete – they have chosen to disclose to you but may not want other patients to know. You can thank them and ask them to let you know if there is anything you can do to help. You can bear in mind the suggestions in the Trauma Informed care part of this guide such as ….. LINK and give examples. 

If you are in a confidential space you might feel able to ask more specific questions about what might help them. These might depend on the nature of their appointment. For sexual trauma you can read what people have told us helped them here. 

The larger of the trauma cards include space for people to write down what might help them. If they have written information on their card please treat this as valuable information to help you provide the best care you can. Their suggestions can help you know what might help. It can be very different for different people.  

What is Trauma Informed Care?  

Trauma informed care is an approach that addresses the pervasive impacts of trauma in society by promoting healing and resilience. By addressing physical and psychological safety in the context of a health care professional-patient relationship, we resist re-traumatisation and create pathways for resilience. Trauma informed care enhances patients’ health outcomes and engagement. 

How do I practice Trauma Informed Care in a health care setting?  

Recognising that there is a high prevalence of trauma and that many patients are affected by it without disclosing it, trauma informed care is practiced with all patients all the time. Trauma informed care shifts the provider’s perspective from ‘What is wrong with you?’ to ‘What happened to you?’ It means inquiring how past experiences may impact accessing, participating in, and following through with care now. It does not mean asking for details of trauma experiences which can be triggering. Asking, “Is there anything I can do to make this visit more comfortable for you?’ will go a long way towards making patients feel safe and seen. 

Trauma Informed Care Principles and Tips in a health care setting:  

Safety (Physical, Psychological, Emotional) 

  • Provide respectful and accessible welcome by using welcoming and accessible on all signage.
  • Throughout the visit, ensure immediate basic needs are addressed.
  • Orient patients to staff and their roles in the health care setting.
  • Keep noise levels low in waiting rooms or common shared spaces.
  • Support patients understanding of the physical space. Provide information on where critical services are located: bathrooms, receptionists, etc.
  • Keep car parks, common areas, bathrooms, entrances, and exits well lit. Offer guidance on exiting at the completion of a visit.
  • Provide consistent, predictable, respectful care, and maintain healthy boundaries. If changes or delays occur, provide sufficient information, notice, and preparation.
  • Speak to patients at eye level whenever possible. Crouch down or sit in a chair when appropriate.
  • Be aware of your body language with a patient – don’t tower over patients or visitors, allow a patient an option of where to sit in the room so that they may see and access the door.
  • Ask patients if they would like the door open or closed. Consider privacy when discussing care.
  • Be aware that patients may not always be able to verbalize distress. Consider talking with a patient about different ways to let staff know if they are uncomfortable, scared, anxious, etc.
  • Provide flexibility so that staff members are able to interact with people in distress without telling them what to do or immediately giving consequences.
  • Ask, and wait for, permission to touch the patient or move patient’s belongs.
  • Invite consent/autonomy.  

Trustworthiness and Transparency  

  • Inform patients about what to expect before, during, and after exams or procedures. This will build and maintain trust
  • Let patients know which parts of the body may be impacted before beginning or proceeding with an exam.
  • When possible, allow patients more control of care steps, i.e. apply gel, holding stethoscope.
  • Narrate tasks or procedures for patients - even for small tasks.
  • Focus on patient interaction and make eye contact. Balance computer time with patient engagement.  

Empowerment, Voice, Choice  

  • Keep patients well informed about all aspects of their care.
  • Maintain awareness and respect for basic human rights and freedoms, including the option to decline treatment as appropriate.
  • Offer alternative explanations to patients who may be having a hard time with treatment options or expectations.
  • Allow patients the option to include others in their plan of care when appropriate.
  • Provide options wherever possible: - Doors, curtains, shades – can the patient decide if they want those open or closed? - If a patient has to be woken up for meds or vitals, ask how they would prefer to be woken up.
  • Conduct as much of the visit with a patient’s own clothes on rather than dis-robing.  

Collaboration

  • Establish a nurturing and supportive relationship that minimizes power imbalances by being respectful, empathic, non-shaming, and non-blaming.
  • Provide opportunities for patients to make decisions about their goals and care where they are active participants in their care. Allow flexibility for those goals to shift depending on circumstance.
  • Invite patient questions in a genuine and authentic way.
  • Learn about patient strengths and resources to manage past challenges. Ask “what has worked for you in the past?”  

Recognition of Cultural, Historical and Gender Issues  

  • Understand that cultural and social factors impact one’s response to trauma. Patients will have differences in what they perceive as safe.
  • Use interventions that respect diverse cultural backgrounds and create opportunities for patients to engage in culturally sensitive interventions and practices that promote trauma healing and recovery.
  • Listen to and validate a wide range of emotions (i.e. grief, sadness, anger, and fear) from patients.
  • Ask patients upon arrival what their preferred language is in which to communicate, use medical interpreters. When possible, provide written material in native language.
  • Ask patients how they identify and/or which pronouns they prefer to use. Communicate this to other team members. If a patient is mis-gendered, or the wrong pronouns are used, apologize and move on.  

Peer Support  

  • Promote healing and recovery by valuing lived experience of patients and individuals with shared experiences. For example, create mutual support groups for patients and offer peer supporters/navigators as part of health care delivery. 

Trauma Informed Care Tips for Medical Exam or Intervention:  

  • Meet with patient fully clothed first to review the care procedure step by step and explain why exam is needed.
  • Leave the room to allow patient to change in private.
  • During the exam, when possible, stay within a patient’s eyesight
  • Use simple language throughout the exam.
  • Wait for approval from the patient before touching and proceeding with each step.
  • If exam or intervention cannot be completed due to a patient’s distress, normalize this experience and offer to reschedule the appointment.
  • Give the patient the option of getting dressed before discussing next steps
  • Provide written follow up information to patients or how to access their care information online.  

Inpatient Trauma Informed Care Tips:  

  • With patients, come up with a plan of care for the shift when possible – what are the windows for medication or vitals or other procedures.
  • Involve the patient when possible in setting expectations and a plan.
  • If patient has an upcoming procedure, even routine ones, be transparent with what it will involve from start to finish (sometimes patients are told only what the procedure looks like but not the after-care. For example, “you may feel groggy and you won’t be able to eat right away”).
  • Ask a patient what would make them more comfortable before a procedure whenever possible – some patients want to be awake and alert and others would prefer sedation. Some patients may want a warm blanket.
  • Let patients know who is on their care team and why they are involved. It may be obvious to providers why a consult was called but not to a patient. Utilize white board with care team and care goals.
  • Consider a huddle or more formal care coordination with team members for patients experiencing distress at being hospitalized.
  • Be proactive in managing escalating behaviour. Understand that it may be due to a trauma reaction and reframe behaviour to understand it in response to a stimuli or experiences.