Hospital in-patient
Soraya is an occupational therapist in an acute care hospital. Along with her other clinical responsibilities, she provides splinting services to in-patient units in the hospital. Today, she has received a referral to make a forearm splint for a 32-year-old male who has had surgical repair for compartment syndrome on his left forearm. While reviewing the chart, Soraya discovers that the patient developed compartment syndrome because he passed out after a bout of heavy drinking and was lying on his left arm all night. His medical history includes substance use (alcohol and marijuana), depression, and anxiety. Nursing notes indicate that the patient is reported as being “aggressive during dressing changes” and “non-compliant with nursing and wound care post-op.”
The following table list strategies, informed by TIC practice tips, that Soraya can use to help her build a trauma-informed interaction with this patient.
| TIC tip | Strategy |
|---|---|
| Be aware of the prevalence of trauma and its impacts | Soraya has read about the prevalence of trauma and is aware of the long-term health impacts of trauma |
| Recognize that some health practices can be traumatizing | Soraya reflects on the bias that healthcare providers may have towards people who use substances and how this can impact interactions between providers and patients, including use of labelling language |
| Provide a safe environment | Soraya resolves to interact with the patient in a respectful and compassionate manner |
| Routine query about trauma history | “Many people have had traumatic experiences in their life — situations in which they felt their safety and lives were threatened. I ask all my patients about their trauma histories because we know trauma has a big impact of their health. You don’t have to answer the question if you don’t want to, but is there anything I should know about your history that will help us to work together in a way that makes you feel safe?” |
| Recognize when someone is being triggered | “I noticed that dressing changes have been difficult for you. Can you tell me more about this? It will help me to make the splinting process more comfortable for you” |
| Respond to disclosures | “Thank you for telling me that you are having a lot of pain and are worried about taking care of your incision and splint after discharge. I know there are a lot of instructions to follow and it can feel confusing” |
| Risk assessment and referral | “I want to make sure that you have the help you need to heal well from your surgery after you are discharged from the hospital. The surgeon will be making a referral to our outpatient wound clinic. Would it be okay if I make a referral for a home care social worker for you? They can help you to access transportation and other services while you are recovering from your surgery.” |
Hospital out-patient
Jess works in the breast screening program in their local hospital. They would like to incorporate trauma-informed care principles and provide a safe environment for patients who come in for mammograms.
Jess can build a trauma-informed care practice by using the bold-faced strategies with their patients. The non-bolded options should be avoided, as they will not be helpful.
- Ask if the client has ever had the procedure or had difficulties with the procedure before
- Explain the procedure: provide an overall description and also explain why this is being done
- Show the patient what you are going to do before doing it
- Ask for permission before touching the patient
- Do the mammogram quickly before the patient has a chance to get scared
- Ask what will make the patient more comfortable
- Tell the patient that you are the expert so they should listen to you and do what you say
- Check-in regularly throughout the procedure to see how the patient is doing
- Tell the patient, “Of course, it is going to hurt, but you are a grown-up, right?”
Long-term care
Roman is a PSW who works in a long-term care home. He has just been assigned to work with a new resident, Mary, who is an 82-year-old woman with advanced dementia. In a conversation with Roman, Mary’s daughter mentions, “Mom had a hard time with dad.” Roman has no other information on Mary’s social history. He has received trauma-informed care training at his nursing home and decides he should use this approach when providing care to Mary.
| TIC tip | Strategy |
|---|---|
| Be aware of the prevalence of trauma and its impacts | Roman recognizes that based on the daughter’s report, Mary may have a trauma history |
| Recognize that some health practices can be traumatizing | Roman reflects that Mary may find it traumatic to receive personal care from a male care provider |
| Provide a safe environment | Roman asks a female colleague to assist him with Mary’s personal care to ensure that Mary feels safe |
| Routine query about trauma history | Roman realizes that Mary may not be able to provide history due to her advanced dementia. He decides to talk to Mary’s daughter on her next visit to get more information |
| Recognize when someone is being triggered | Roman observes carefully when providing care to Mary to ensure that she is not becoming triggered. He uses orienting cues throughout the care activity, such as telling her what he is doing, involving her in the activity, and checking in frequently to make sure she is tolerating the activity |
| Respond to disclosures | Roman thanks the daughter for sharing more information and tells her, “I know it can be difficult to share these things with other people and I really appreciate you telling me about your mother’s history. It will help us to provide her better care and make sure she feels safe and comfortable” |
| Risk assessment and referral | Roman reports Mary’s history in team rounds. The team decides to make a referral to the behaviour support consultation service so that a comprehensive assessment can be completed and an individualized care plan developed for Mary |
Primary care: family health team
Mina works as a nurse in a family health team. She is assigned to administer the HPV vaccine to a 17-year-old female patient. When administering the vaccine, Mina notices several cuts on the patient’s hands, some of which are deep and appear to be fresh injuries. When asked, the patient states that she “fell into a rose bush.” There is no mention in the patient’s chart about a trauma history or any report of prior cutting behaviour. Mina is meeting this patient for the first time and is not likely to be part of her regular care. What should Mina do next?
Mina can build a trauma-informed care practice by using the bold-faced strategies on this list. The non-bolded options should be avoided, as they will not be helpful.
- Accept what the patient told her and leave it at that
- Document her observations in the patient’s chart, making note of the nature and number of injuries and the patient’s response
- Pretend she didn’t see anything, someone else will find out anyway
- Meet with the nurse practitioner associated with the patient’s team and verbally report her observations: i.e., report her concern that the injuries may indicate cutting behaviour, and document the conversation in the patient’s chart
- Challenge the patient and tell her she has to “tell the truth”