The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) defines trauma in the following way: “Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life-threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional or spiritual well-being.”
In the United States, a sobering number of people have experienced these types of events. SAMHSA’s data suggest that 61 percent of men and 51 percent of women report exposure to at least one lifetime traumatic event, and 90 to 99 percent of clients in public behavioral health care settings have experienced trauma. If this trauma goes unaddressed, providers may not understand the best ways to manage problems such as mental illnesses and addictions that spring partly from past events. Ignoring trauma can therefore lead to poor physical health outcomes and hinder recovery.
Although trauma has long-term effects that resonate across all medical areas, it is particularly impactful in the mental health arena. SAMHSA states that psychiatric patients have a nearly universal experience of trauma.
Psychiatric mental health nurse practitioners (PMHNPs) and others in the psychiatric field should therefore assume that trauma exists and behave accordingly. In fact, when asking the question “What does a psychiatric nurse practitioner do?”, this function ranks high in importance. By taking a trauma-informed perspective, PMHNPs can ensure the best possible health outcomes for their patients.
Preparing to take this approach is an important part of the nurse practitioner education process. The right knowledge can be obtained through Ohio University’s online MSN program, which prepares registered nurses (RNs) and other Bachelor of Science in Nursing (BSN) graduates for advanced careers as nurse practitioners Those who will specialize as PMHNPs need to understand trauma and other issues common in psychiatric practice.
The Importance of Trauma-Informed Care
Medical care that takes potential trauma into account is known as trauma-informed care. A trauma-informed approach is defined by SAMHSA as “a program, organization, or system that realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; and responds by fully integrating knowledge about trauma into policies, procedures, and practices, and seeks to actively resist re-traumatization.”
Physician Monique Tello recalls an incident where trauma-informed care was neglected, to the detriment of two patients. Two young siblings, a brother and a sister, were brought in for physicals and were due for immunizations. Both children became very upset and resisted the procedure. The mother and the nurse tried to physically restrain the children to administer the shots, but not surprisingly, their efforts just made things worse. The children became increasingly agitated and resistant. The staff eventually gave up in frustration, and the children left in tears.
Months later, word trickled back that these children had been removed from their home due to parental abuse. The children’s panicked responses had probably been fueled by this trauma. By failing to consider this possibility, medical staff not only upset the children, they were unable to deliver necessary medical care.
Medical or psychiatric intervention that builds upon trauma in this manner is called re-traumatization. The Institute on Trauma and Trauma-Informed Care (ITTIC) explains that while some practices—such as physical restraint, which was used with the siblings—are obvious triggers, others are not. Patients who have experienced trauma can be triggered by many things, including being forced to tell their story over and over again, being treated as a number, being asked to disrobe, or having no input into their service or treatment. Even a smell can take someone back to a difficult experience.
Because re-traumatization is so specific to the individual and can be seemingly minor, medical personnel have no way to avoid it altogether. Rather, PMHNPs and other medical professionals must be alert to signs of distress. They do not need to understand the trauma to see that it has been triggered.
To reduce the likelihood of re-traumatization, the ITTIC recommends following five key principles that should be adopted by everyone in a practice, from the receptionist on up. Nurse practitioners, who have more substantive interactions with psychiatric patients, have a correspondingly bigger responsibility to keep these things in mind. The five principles are:
- The first principle of trauma-informed care is ensuring the patient’s physical and emotional safety. In practice, this approach may mean that common areas are welcoming and patient privacy is respected.
- Patients must feel that they have choice and control in any medical interaction. Providing a clear and appropriate message about patient rights and responsibilities can contribute to this aspect of treatment.
- Trauma victims need to feel that decisions are made with their input and that power is shared with the medical provider. In trauma-informed care, patients therefore have a significant role in planning and evaluating services.
- The provider must earn the patient’s trust in areas including task, clarity, consistency, and interpersonal boundaries. Ensuring that respectful and professional boundaries are maintained is essential.
- The provider must prioritize empowerment and skill-building as an end goal of any treatment plan. Patients should feel validated and confirmed with every contact during their interaction with healthcare professionals.
By keeping these principles at the forefront of their work, PMHNPs can provide trauma-informed care that maximizes outcomes for their patients. They must never forget that their patient population is uniquely likely to have experienced trauma that contributes to their mental and physical health issues.
Ohio University’s Online Master of Science in Nursing (MSN) Program
The online MSN program at Ohio University is designed for practicing RNs who want to advance their expertise in the nursing field. Students in the Psychiatric Mental Health Nurse Practitioner concentration take courses in the assessment and management of mental health disorders, psychotherapeutic treatment modalities, and other topics.
For more information about the online MSN program, MSN degree benefits, and additional concentrations for MSN nursing careers, visit Ohio University’s website.
Trauma definition and prevalence – U.S. Substance Abuse and Mental Health Services Administration
Defiition of trauma-informed care – U.S. Substance Abuse and Mental Health Services Administration
Immunization incident – Harvard Health Publishing
Re-traumatization – Institute on Trauma and Trauma-Informed Care
Five principles – Institute on Trauma and Trauma-Informed Care