What Are the 6 Principles of Trauma-Informed Care?

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A nurse takes notes while meeting with a patient.About 70 percent of U.S. adults say they have experienced trauma, according to a study conducted by the Sidran Institute. Of those 70 percent of adults, 20 percent reported developing post-traumatic stress disorder (PTSD).

The effects of childhood trauma can last for a lifetime. In many cases this trauma can lead to anxiety, depression and addiction, as well as to hypertension and diabetes. Untreated trauma also can prevent people from seeking healthcare services. The number of traumatic events adults and adolescents experience makes trauma-informed care essential.

Healthcare professionals need to understand the six principles of trauma-informed care and how they can be implemented to provide patients with optimal treatment. Nurses can take the lead in introducing trauma-informed care to their organizations, due to their crucial role in patient care and their extensive collaboration with colleagues.

What Is Trauma-Informed Care?

Trauma-informed care approaches patients’ healthcare needs in a manner that takes into account any trauma that they may have experienced. A key goal of trauma-informed care is to prevent any re-traumatization that could prevent patients from continuing to seek care. When used effectively, trauma-informed care enables nurses and other medical professionals to ensure that healthcare processes, procedures and settings protect patients and staff from re-traumatization.

Professionals who practice trauma-informed care attempt to fully understand the effect of trauma and devise a treatment plan to aid in recovery. These professionals audit their medical practices and policies to improve upon their implementation of trauma-informed care. Organizations help new hires understand the meaning of trauma-informed care and how it is used within an organization. Throughout the organization that practices trauma-informed care, professionals are able to identify the symptoms of trauma in patients.

The 2018 Stress in America Survey evaluated 3,458 American adults and their relationship to stress. The results of the survey concluded that two-thirds of American adults have felt high levels of stress in their lifetime. One of the major catalysts for these high levels of stress was healthcare. A goal for the healthcare industry should be to identify and curb the stressors that are preventing patients from seeking care.

A Nurse’s Role in Trauma-Informed Care

Nurses are on the front lines interacting with patients and providing care. They collaborate closely with physicians to implement patient treatment plans. They also spend more face-to-face time interacting with patients than physicians do. Nurses on average spend about 33 percent of their time in patients’ rooms, according to the 2018 article “Estimating Time Physicians and Other Health Care Workers Spend with Patients in an Intensive Care Unit Using a Sensor Network” published in the American Journal of Medicine. In contrast, physicians spend about 15 percent of their time interacting with patients in their rooms.

Nurses must understand the past and present conditions of a patient when establishing treatment plans for recovery. The first step in understanding a patient’s past traumatic conditions is identifying whether or not the patient exhibits any adverse childhood experiences (ACEs). Some examples of ACEs are poverty, racial discrimination, sexual assault, physical violence and neglect. In the United States, 60 percent of adults have experienced at least one ACE, 25 percent have experienced three or more, and 16 percent have had four or more, according to the Center for Health Care Strategies.

Nurses can analyze whether a patient exhibits any signs of trauma by screening them for ACEs. This screening process is meant to ensure that nurses are taking the necessary steps in preventing re-traumatization prior to treatment.

6 Principles of Trauma-Informed Care

Healthcare organizations, nurses and other medical staff need to know the six principles of trauma-informed care: safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice and choice; and cultural issues. These principles help organizations build processes and systems that focus on patient and employee care by redefining the organizations’ processes and systems.

1. Safety

Patients need to feel safe while they are in the care of nurses and other medical professionals. Nurses should ensure that patients and families feel physically, emotionally and psychologically safe while in their care. Healthcare organizations should establish safe healthcare settings that provide patients and families with a sense of security. For example, waiting rooms should have ample space for individuals that may be re-traumatized by sitting in close contact with strangers.

The exterior of a healthcare facility must also promote a sense of safety and security. Parking for patients and their families should be ample and nearby. Proper lighting in parking structures and walkways will promote a sense of security for those patients who have appointments in the evening. Security guards can help patients feel less nervous or hesitant about entering the building.

Nurses can help create an environment in which patients feel safe by addressing any concerns that they may have. They can also enable patients to have family members or other individuals stay with them when they are receiving care. In addition, nurses can promote a feeling of safety by acting as liaisons between physicians and patients.

2. Trustworthiness and Transparency

Nurses need to be transparent with patients to build a sense of trustworthiness, especially when patients have suffered traumatic events such as domestic violence, assault or other forms of abuse. In many of these cases, patients are afraid to seek medical care because they lack a sense of trust. These patients might reason that if the people who love them can hurt them, so could a complete stranger. For this reason, it is especially important that nurses develop a sense of trustworthiness with patients.

Healthcare facilities must also embody a sense of trustworthiness and transparency. Employees should be well-informed about policies and procedures that may impact how they are able to care for patients. Moreover, these organizations and employees need to provide transparency when explaining the type of care they are providing to patients and the overall cost of this care.

3. Peer Support

To provide trauma-informed care, nurses, doctors and other medical professionals must thoroughly understand various traumatic conditions and how they affect patient care. Medical professionals need to acknowledge that each patient may have experienced a traumatic event that may prevent them from being open about their healthcare problems. By actively listening to patients, professionals can determine a patient’s needs as opposed to trying to “fix” or “heal” a condition.

Medical professionals who have experience with certain types of trauma may be best suited to provide care for patients with similar trauma. For example, a medical professional who has experienced assault in the past could be best suited to provide care for a patient dealing with this particular trauma. This shared traumatic experience allows nurses or other medical professionals to approach a patient as a “peer.” Some healthcare facilities have resources and groups for patients who are struggling with traumatic events such as domestic violence or battery.

In order to address secondary traumatic stress and burnout, medical professionals must support one another in providing care. Professionals dealing with trauma need to communicate this to their supervisors. Supervisors should institute trauma-informed care best practices to help their employees manage their stress. Employees should also have access to therapists and be encouraged to take paid time off in order to avoid workplace stress. Nurses dealing with a patient who might trigger their own internal trauma should communicate this to a colleague.

4. Collaboration and Mutuality

Nurses and medical organizations should view patients as partners in the effort to develop treatment plans. As collaborators, patients, nurses and medical organizations will work together to achieve the desired result. Through collaboration, patients become active participants in their healthcare decisions.

For example, a patient recently diagnosed with diabetes can collaborate with nurses to devise a treatment plan that meets the demands of their daily life. This collaboration can provide patients with a sense of well-being and security. The mutuality of trauma-informed care can enable patients to take greater responsibility for addressing their healthcare needs.

5. Empowerment, Voice and Choice

Nurses work to empower patients who have experienced trauma to take back control of their health. To do this, nurses should encourage patients to feel comfortable sharing their stories. Nurses and other medical professionals need to effectively communicate with patients about options for treatment and enable patients to actively participate in determining their care.

Trauma-informed care promotes a healthcare system that helps communities, patients and employees heal and grow from trauma. Trauma can serve as a unifier for patients, communities, organizations and medical professionals. When dealing with patients, healthcare organizations and professionals need to recognize that there is a power differential between them and their patients. To prevent re-traumatization, patients’ voices should be heard in healthcare decisions.

6. Cultural Issues

To establish effective trauma-informed care, nurses, doctors and staff members need to recognize and eliminate any potential cultural, racial, gender or other biases. This can be accomplished by offering services that help identify and cater to patient needs. If a patient feels more comfortable receiving care from a female physician, for example, this request should be accommodated. If no female physician is available, a female nurse or other medical professionals should be present when the patient is receiving care.

Cultural differences should also be recognized when a patient is receiving care. Organizations and healthcare professionals should devise processes and protocols to accommodate the cultural needs of patients. The potential for re-traumatization from the lack of sensitivity to cultural, racial, gender or any other biases is a major concern when developing a plan to institute trauma-informed care. An individual’s autonomy needs to be taken into consideration.

Why Is Trauma-Informed Care Important?

Healthcare organizations and medical professionals can benefit by developing protocols and processes that encourage trauma-informed care. Prior to implementing trauma-informed systems, healthcare organizations and staff need to ask themselves: Why is trauma informed care important?

The most obvious reason is that it offers nurses and other medical experts the opportunity to develop a sense of empathy, as they begin to identify how trauma has negatively impacted the health and well-being of their patients. Moreover, these medical professionals can begin to identify their own trauma and start to understand how their own struggles are impacting their lives. By understanding their own trauma, they are able to closely identify with patients.

Other staff members at healthcare organizations should also understand trauma-informed care. Security guards and receptionists are usually the first people patients encounter at a healthcare facility. These professionals would benefit from trauma-informed care training because it can help them to make a good first impression with patients and make them feel comfortable from the start of the care process.

The role of a medical professional is to provide patients with the best possible care. Trauma-informed care can help patients to be collaborators in their care and participate in decisions pertaining to their medical treatment. This collaborative environment allows medical professionals to work closely with patients and help them reach their long-term health goals.

Healthcare organizations also have the opportunity to work closely with the community in creating awareness of trauma in society. These organizations can establish resources for patients struggling with trauma, such as psychological services for children dealing with family separation or divorce. Moreover, women or men who have experienced assault or domestic violence can meet in support group environments facilitated by the healthcare organization. Healthcare organizations can have nurses on staff who specialize in addiction, trauma or mental health issues. Trauma-informed care not only benefits patients, it also can have lasting positive effects on the community as a whole.

Considerations for Nurses and Trauma-Informed Care

Nurses need to understand that when working with patients with trauma, they themselves may experience secondary traumatic stress. Secondary traumatic stress is the experience of trauma that stems from caring for patients who have experienced a traumatic event.

Nurses must be aware that their own traumatic history can have a negative impact on patient care. To curb secondary traumatic stress, nurses should take the time to address their own trauma issues, before they experience burnout. While dealing with patients, nurses can explore the option of using universal trauma precaution. This system allows nurses to treat each patient with a level of care that assumes that they have one or more ACEs.

Alongside childhood experiences, community environments can create trauma in a patient’s life. Examples of adverse community environments are poverty and the lack of economic mobility, affordable housing or medical care. Poverty negatively impacts an individual’s ability to access healthcare. Nurses need to be aware that individuals experiencing poverty may not seek out proper medical care until their health conditions worsen.

Pursue an Advanced Career in Nursing

Professionals who have earned a Master of Science in Nursing and are looking to further their education should consider a post-master’s certificate in a nursing specialty. These certificates can help experienced nurses distinguish themselves in their profession.

Duquesne University offers four specialized post-master’s certificates: Executive Nurse Leadership and Health Care Management, Family (Individual Across the Lifespan) Nurse Practitioner, Forensic Nursing, and Nurse Education and Faculty Role. The Forensic Nursing post-master’s certificate curriculum can equip nursing professionals to provide care for patients who have been victims of crimes or have experienced some other type of trauma. The program can also prepare nurses to take the Sexual Assault Nurse Examiner (SANE) certification exam.

Learn more about how Duquesne University’s online post-master’s nursing certificates can prepare professionals to advance in their careers as leaders in an evolving field. 

Recommended Readings

Importance of Nurse Manager Resilience
Nurse Practitioners Turned Entrepreneurs: How NPs Are Changing the World
Role of the Nursing Supervisor in Hospital Settings


American Hospital Association, “What Is Trauma-Informed Care?”
The American Journal of Medicine, “Estimating Time Physicians and Other Health Care Workers Spend with Patients in an Intensive Care Unit Using a Sensor Network.”
Mental Health America, “CPS Blog: Trauma-Informed Peer Support”
Online Journal of Issues in Nursing, “Trauma-Informed Nursing Practice”
Sidran Institute, “Traumatic Stress Disorder Fact Sheet” 
Social Work Today, “Awareness of Trauma-Informed Care”
Substance Abuse and Mental Health Services Administration, Understanding Child Trauma
Trauma-Informed Care Implementation Resource Center, “What Is Trauma-Informed Care?”