What does trauma-informed care look like?
The first step is to identify how common trauma is and to comprehend that every patient may have experienced serious trauma. We don’t automatically need to interrogate people about their experiences; relatively, we should just accept that they may have this history, and act accordingly.
This can mean many things: We should clarify why we’re asking delicate questions. I might say, “I need to ask you about your sexual history, so I know what tests you may need.” We should describe why we need to complete a physical exam, specifically if it comprises the breasts or genitals. If someone is nervous, we can let them bring a reliable friend or family member into the room with them. I’ve had many female patients hold someone’s hand during a pelvic exam. We can tell them that if they need us to stop at any time, they can say the word. If someone refuses outright to have a certain exam or test, or if they’re upset about something (like having vaccinations), we can answer with compassion and work with them, rather than attempting to force them or become annoyed.
For someone who has experienced trauma, the hospital or doctor’s office can be a frightening place. Often time “Patients often do not volunteer such information about prior experiences, because of guilt or shame. Medical professionals often ask about safety in a patient’s present relationships, but few ask about past experiences. A simple question such as, “Is there anything in your history that makes seeing a practitioner or having a physical examination difficult?” or, for those with a known history of sexual abuse, “Is there anything I can do to make your visit and exam easier?” can lead to more sensitive practices geared to developing a trusting relationship. Patients can support themselves by describing to their healthcare providers their anxiety about medical visits, why this is so, and what they have found helpful or harmful in prior healthcare meetings.”
Read the scenario below and answer the following: Could the case I described have been handled differently? What actions would you recommend? What components of trauma approach care would you implement?
DJ is a 34-year-old woman who arrived with police at the ED following an argument with her male partner. She described her relationship with her partner as financially supportive but with episodes of violence. She said he had choked and beaten her that day and on previous occasions, her children had witnessed the couple’s fights, and police had previously been called to the scene of the brawls. DJ told the ED nurse she didn’t want her partner to know she was currently in the hospital. When asked about her medical history, she told the nurse she had been diagnosed at age 16 with type 1 diabetes mellitus with neuropathy and chronic pain and a history of posttraumatic stress disorder. DJ resides alone with her two children (ages 10 and two) and works part-time in computer science. She is 5 ft. 10 in. tall, weighs 142 lbs. and has an athletic build. Physical assessment revealed patterned injuries (specifically, bruise patterns in various stages of healing all over her body), and three (3 cm × 1 cm) linear abrasions over the trapezius muscle on the right side of her neck. Given her admission history of nonfatal strangulation, the priority nursing action focused on monitoring her airway and her type 1 diabetes. (On admission, her glycated hemoglobin level was 13%.) A contrast computed tomography scan revealed swelling of the right carotid artery and soft tissue in the neck. Laboratory tests indicated that she had diabetic ketoacidosis (DKA). The health care team initiated a medication regimen to safely control her DKA and to prevent stroke while she healed. When an ICU bed became available, she was transferred there for medical management.
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