When patients are victimized, the associated trauma affects every area of functioning, including physical, mental and behavioral health. For forensic nurses, understanding the root causes of a patient’s trauma is a beginning step to implementing care that will support whole-body healing. Practitioners who deliver trauma-informed care recognize the impact that past and present trauma and stress have on the patient’s current medical condition.
As an evidence-based approach, trauma-informed care also seeks to introduce compassion and caring into practice, as well as an understanding that anyone can have a traumatic history that affects their encounter with the healthcare system. Trauma-informed care recognizes that untreated trauma can impact patients for a lifetime.
In “Trauma-Informed Care: Helping Patients with a Painful Past,” Cathy Koetting said understanding trauma-based care allows providers to improve practice and patient outcomes.
“In (trauma-informed care), healthcare providers and staff need to be cognizant that trauma is extensive and permeates the lives of many patients,” said Koetting, DNP, APRN. “Trauma-informed care seeks to change the illness paradigm from one that asks, ‘What’s wrong with you?’ to, ‘What has happened to you?’ ”
For registered nurses (RNs) who work with trauma victims, including those seeking online master’s in nursing degrees, understanding and implementing trauma-informed care is crucial to patient outcomes. Working as a forensic nurse means being able to apply nurse terminology, such as trauma-informed care, in everyday practice. How do you do that?
Framework for Trauma-Informed Care in Nursing
Trauma-informed care has roots in counseling, social work and psychology, with the earliest efforts focusing on Civil War soldiers suffering traumatic reactions to the stress. Over the years, the trauma went by many names: shell shock, soldier’s heart and battle fatigue, among others. In 1980, the American Psychiatric Association’s (APA’s) Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III), introduced the present moniker – post-traumatic stress disorder (PTSD).
In 1998, a three-year study called the CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) study found a connection between childhood trauma and an increased risk for adult substance abuse, chronic illnesses, financial challenges and mental health problems.
Since the introduction of the PTSD diagnosis and with information from the ACE study, healthcare practitioners have been working to improve trauma-care treatment approaches and deliver trauma-focused services with the idea that unaddressed trauma can affect every stage of life.
The most effective trauma-informed care integrates a philosophical and organizational approach to patient care, the Illinois Criminal Justice Information Authority (ICJIA) said.
“At its core, ‘trauma-informed’ is an overarching framework that guides the decision-making, behavior and structure of an entire organization with implications for both clients and staff,” the ICJIA said.
For forensic nurses, who primarily work with crime victims, the approach is vital to forming a link between nursing practice and the criminal justice system.
Forensic Nurses Applying Trauma-Informed Care to Practice
Trauma-informed care allows forensic nurses to provide care in a manner that does not revictimize the injured person, which is vital to treatment, Angela F. Amar said in “Forensic Nursing: Response to Victimization.”
Forensic nurses who understand how individuals respond to violence can direct patients to the best resources, Amar, RN-Ph.D., said.
“Nurses routinely interact with individuals whose lives have been touched by violence. Each encounter represents an opportunity to provide teaching, referrals, and access to resources that can help individuals to manage and alleviate the consequences of violence,” Amar said.
To put trauma-informed care into practice, care providers must make changes to both organizational and clinical practices that will alter the narrative regarding victimization, according to the Center for Health Care Strategies, a nonprofit healthcare policy resource organization. The center said there are some key adjustments to make on both the macro and micro levels that will help develop a trauma-informed approach to care:
Changes in overall practices to align with trauma-informed principles can ultimately transform the culture of a healthcare organization. Senior leaders can implement these changes through actions such as:
- Communicating the need for trauma-informed care to the staff and following through with policies and actions.
- Including trauma patients in the organizational-change process for first-hand perspectives and insights.
- Training both clinical and non-clinical staff to create a non-threatening environment.
- Developing an atmosphere that feels physically and emotionally safe.
- Preventing secondary traumatic stress in staff members by providing training, counseling and support.
- Screening potential employees for skills that include empathy and collaboration to build a staff that is suited for trauma-informed work.
Clinical practice changes
While making organizational changes, evidence-based changes to clinical practice can also be made, including:
- Giving patients a voice in their care rather than having clinicians dictate the treatments.
- Developing universal screening to determine the patient’s trauma history.
- Training staff in various evidenced-based treatment approaches for trauma.
- Expanding a network of referral sources and partner organizations for patient services.
In addition, forensic nurses are encouraged to study examples of trauma informed care for a better understanding of how to help patients. RNs who are considering a career in forensic nursing are also encouraged to earn a master’s in nursing (MSN) to provide quality care. Online master’s in nursing degree programs, including Duquesne University’s Online MSN in Forensic Nursing, offer an opportunity for RNs to continue their careers while learning the specialized skills that come with forensic nursing.
About Duquesne University’s Online MSN in Forensic Nursing
Duquesne University’s forensic nursing program has garnered national attention for its dedication to melding nursing and criminal justice. The program operates in partnership with the university’s Cyril H. Wecht Institute of Forensic Science and Law.
RNs who graduate from Duquesne University’s MSN in Forensic Nursing Online program work as sexual assault nurse examiners (SANEs), forensic nurse investigators, nurse death investigators and expert witnesses. The program also provides opportunities for students to add a concentration in nursing education or transcultural nursing.
Duquesne University also offers an online Post-Master’s Certificate in forensic nursing for RNs who already have an MSN and want to advance their nursing skills and expertise in law and forensic science. Gaining a Post Master’s Certificate connects them to expert forensic nurses and provides formalized training to sit for the SANE certification exam.
For more information about the programs, contact Duquesne University today.
Trauma-Informed Care: Helping Patients with a Painful Past: Wolters Kluwer
Historical Account of Trauma: NCBI
Forensic nursing: Response to victimization: Reflections on Nursing Leadership
Using a Trauma-Informed Approach: Office of Justice Programs
Trauma Types and Promising Approaches to Assist Survivors: ICJIA
Key Ingredients for Successful Trauma-Informed Care Implementation: Center for Health Care Strategies