A Quick Guide: Principles of Trauma-Informed Care

As an emergency department (ED) nurse, it’s important to understand how a patient's current or previous experience(s) of trauma may have or had an impact on their health and well-being, which can affect their ability to advocate for their own healthcare. Every year, millions of patients come to EDs who have experienced physical, mental, and/or emotional traumatic experiences. However, for many patients, the experience of being in the ED itself can be a trigger and/or worsen the patient’s level of distress and can lead to fight, flight, or freeze responses, which are all potential barriers to potential care. Recent publications recommend integrating trauma-informed care (TIC) into emergency services to keep you and your patients safe while providing care. 

TIC is a well-established, theoretical, and organizational framework for improving care for patients with a history of trauma. The federal Substance Abuse and Mental Health Service Administration's (SAMHSA) six guiding principles of TIC offer a universal precaution approach to care that can be applied to all patients, regardless of their trauma history.  

Key Principals 

1. Safety: Ensure physical, emotional, and psychological safety for patients and providers. Even perceived threats can also be triggering, such as crowds, body positioning, and isolation, but minimizing such threats can prevent secondary traumatizing events. 

2. Trustworthiness and transparency: Build trust and transparency in all interactions by deferring procedures that may retraumatize patients, describing procedures prior to performing, and guiding them through exams using supportive language.  

3. Peer support: Providing opportunities for patients and providers to connect with others who have had similar experiences through support groups and facilitated peer discussions have their place in TIC. 

4. Collaboration and mutuality: Use shared decision-making practices between patients and providers of the healthcare team to promote patient autonomy and empowerment. Wherever possible, interdisciplinary collaborative care models, including referrals, are imperative to the continuum of care. 

5. Empowerment and advocacy: Encourage patients to voice their concerns, ask questions, and make informed choices about their care to return a sense of control to the patient. 

6. Cultural humility: Recognize the impact of culture, history, and gender on patient care. Assess and reflect upon one’s own biases. Use patient-centered care approaches including person-first, non-judgmental language.