Trauma Informed Care for Nurse Practitioners
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Show notes:
Trauma-informed care sounds like a hard-to-learn, difficult and stressful topic (also reclaimed as “healing-centered care” to de-center trauma in some places, which feels a lot friendlier).
But it’s really accessible. It’s a paradigm of practice you’re likely already doing a lot of in your day-to-day practice, but possibly being more aware of it can help you be more intentional about it.
It centers around the ways that trauma impacts patient care, and the specific ways we can interact with our patients to avoid re-triggering trauma.
I’m sharing about this topic because 1) it’s important, but 2) because even caring, well-intentioned providers can cause harm if they’re uninformed.
It makes a HUGE difference to patients to practice this way!
How to Provide Trauma-Informed Care and Avoid Unintentional Harm
In this video I cover:
The types of responses patients get in response to a stressful situation and what to watch out for
What Trauma Informed Care is and the specific ways you can help patients feel safe and avoid re-traumatization
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well hey there it's liz rohr from real
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world np and you're watching np
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practice made simple the weekly videos
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to help save you time frustration
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and help you learn faster so you can
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take the best care of your patients
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so this week i want to talk about um
Trauma Informed Care
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it's uh it's something called
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trauma-informed care and the reason i'm
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talking about it is because
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i i i just have seen
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some things and i feel like i feel
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compelled to speak up about it because
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i think what hi what what was
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highlighted to me is that this is not
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common knowledge
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so basically i'm not an expert in this
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but basically trauma informed care
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is a paradigm of practice and it
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acknowledges
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that people have traumatic experiences
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right and the thing with trauma and
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i'm gonna keep this a very like safe
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video um but if you feel like you don't
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wanna listen to it uh
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having experienced trauma yourself
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that's totally fine i'm will give
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content warnings and trigger warnings
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and all of that stuff if i'm going to be
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talking about it but basically i'm just
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talking about like the general
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perspective of trauma
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and how it relates to being a provider
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and again just like my
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just real talk my experience and
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knowledge with
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practicing as a safe provider i'm giving
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safe care in the context of
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um trauma-informed care there's a couple
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of different like again again i'm not an
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expert but i'm just going to share my
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truth
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and what i observe to be problematic and
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hopefully something that will kind of be
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a tipping point for you to kind of think
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about if this is something that you're
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already familiar with or that you can
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delve further into
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so um so yeah so basically with trauma
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there are things that are traumatic that
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happen and everyone defines trauma
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differently and everyone has different
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experiences and different reactions
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typically there are four responses to a
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traumatic experience and those are
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um where you're kind of like triggered
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into this state and it's either um
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like an anger it's like a
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fight-or-flight phenomenon right but
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there's kind of four expressions that
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you can see
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so one is kind of like a lashing out um
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of like anger like a fight response
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another one is flight so someone just
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kind of like pieces out and they leave
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another one is freezing which is uh
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unfortunately i mean all of them are
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really common but
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i have some commentary about that and
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then another one is like appease again
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i'm not an expert in this but this is my
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general understanding is it a p
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appease is the last one where it's kind
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of just like
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appeasing the situation to kind of amend
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it such that it will
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be ameliorated right that will be made
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better um and so those are the general
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kind of like trauma responses that
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people have to situations
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so i think just fundamentally having an
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understanding that
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there's a physiologic phenomenon that's
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happening for people
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when they're experiencing initial
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traumas or even like rehashing
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things can trigger trauma responses
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there's anything anything in your
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practice can
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trigger a trauma response right i think
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the responsibility we have as providers
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is to acknowledge that it's real and
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that it's happening
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and be watching out for it right because
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for example
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in the context of somebody who is
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lashing out you can
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respond with kind i mean you can respond
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with kindness in all the situations but
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i think especially with freezing
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responses
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i think it's it's important to
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acknowledge that people who are either
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freezing or appeasing don't necessarily
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have
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like i think that sometimes people who
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are not aware of trauma or
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trauma-informed care is that they will
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approach a situation and expect somebody
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to be able to to tell them what's going
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on right
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tell them what they need verbalize in
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the moment and that's just not the case
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so i feel like for me what trauma
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informed care means is like recognizing
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that there are responses
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that basically it's basically a
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framework also of like
General Principles
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assuming that people have trauma right
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and just like
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like going in with the assumption that
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people have trauma there are many things
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that can trigger them
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many things that can be upsetting and
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trigger those responses where they
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cannot communicate what their needs are
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right and creating the safe spaces so
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that we are providing them the care they
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actually
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like need and this is this is uh not
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really talked about very much and i
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think
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i i think it just has come up a number
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of times recently actually but just
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yeah just i i think it's just a lack of
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awareness so i think that at the very
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least if you're watching this video
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you're listening and you're getting
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curious if you aren't familiar with this
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already to kind of further investigate
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and learn more about it that's that's a
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really great start um
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one other thing i mean again i'm not an
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expert but basically like
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a trauma-informed approach with your
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care is like
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is is at least according to um uh
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some resources that i've utilized to
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kind of inform myself further
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is that it's really based on some
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general principles and it's basically
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like
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the assumption that people have trauma
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the assumption that the things that we
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can do
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can re-trigger them and that they can
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have these responses in these moments
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where they either
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lash out like just disappear or they are
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appeasing or they're just
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not able to respond i'm not putting that
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pressure on that person
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uh in those moments to kind of continue
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forward i think about sensitive types of
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exams right that we're doing that are
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that are potentially challenging for
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people and i think about gynecologic
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exams i think about you know other types
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of sensitive exams
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keeping all of those things in mind but
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in terms of like the other
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the other kind of environment that we're
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trying to create for patients
Safety
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it would be a safe place i mean it's
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based all about safety um
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there's a couple of different pillars
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right so one is about ensuring physical
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and emotional safety and i can link to
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some resources down below to read a
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little bit further
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but basically you're going in and you're
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always asking about what is a safe
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environment
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what kind of consent can i ask can i can
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i explain
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things can i ask permission can i check
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in with people to see how they're
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feeling
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and stopping you know when they say to
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right and not
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continuing on forward um choices that's
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like another thing again talking about
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consent like i every single time
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i mean regardless of my patient care
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regardless of the visit i'm asking there
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from them for their choice right like
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what would you like me to tell you about
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what i'm doing
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would you like me to do this um what do
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you think about this
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versus this right like giving them
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options right um collaboration this like
Collaboration
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ties into the next pillar is like
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you're you're creating safety you're
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giving choices you're collaborating with
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them
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um you're creating trust with them
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right um and you're also like empowering
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them to make decisions i mean i think
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this is really threaded through all of
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my primary care practice and those
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pillars are really
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important regardless of trauma but i
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feel like if you're if you're following
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those things and you're aware of the
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potential responses people can have
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that's a really amazing start to have
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and i think one of the things that
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happened
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there was like a group kind of program
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recently
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facilitated by somebody and they were
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not aware of trauma-informed
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care and they had asked some kind of
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probing questions that were
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uncomfortable
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for some of the participants and i spoke
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up saying that
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uh it was inappropriate because it was
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not it was
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it was not it was kind of not
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recognizing that there were
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traumatic responses happening and it
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wasn't recognizing that
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you know it was just it was just
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completely misinformed
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and like a well-intentioned person right
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um they are there to be caring but they
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what they did was kind of just like
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bring up a lot of
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um you know stressful things um that
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were just not appropriate
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and i hesitate to talk more details
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because again i don't want to be
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triggering if you're watching this video
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um but just being really careful
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whenever we talk because like what we do
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is so intimate whether it's just
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questions whether it's listening to
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somebody's heart and lungs whether it's
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like a you know pelvic or rectal exam
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you know like any of that stuff just
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like being really sensitive to the fact
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that we hold so much power
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and just like again so many people
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experience
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trauma and like just just keeping that
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in the back of your mind and like
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like i said if this is the first time
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you're hearing about it hopefully just
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like believing me that it's a real thing
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because i've expressed this with some
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people and they're just
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they just aren't aware you know and
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they're just not willing to hear it also
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because usually comes up in the context
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of like
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this is problematic and here's why
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so if you're even open to hearing about
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it you you take these into consideration
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with your practice
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and you take the further steps to
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further inform yourself again i am not
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qualified to talk about this
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um to formally educate on this
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but i just wanted to make this video as
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a
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kind of reminder that a reminder if if
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you were sort of aware of it or like a
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brand new introduction if you weren't
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that like this paradigm is really really
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really important and i really feel like
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we should do more of this
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in medicine in general because there are
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just so many things that
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you just never know what people's
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experiences are and
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you never know what's going to be like
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really traumatizing for people
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um i guess a couple of other things um
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um and again i'll share these resources
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down below that kind of gives like a
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general overview
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but um like there's like individual
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relationships and then there's also
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system based
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things that can be re-traumatizing for
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people so individual relationships not
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being
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seen or heard violating trust failure to
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ensure
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emotional safety you know in terms of
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like setting the guidelines the
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parameters the consent
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all of that stuff like checking in with
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people um if it's not collaborative
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that's really traumatizing
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um if you do things uh for somebody or
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to somebody instead of with somebody
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um and then yeah just just
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um you know punitive treatment coercive
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practices just like any sort of coercion
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and this really reminds me of like
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reproductive health
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conversations as well so those are
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that's the way that you can kind of do
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those things in your role again in
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addition to being like more informed if
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you are
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if you're this is brand new for you and
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then the system like thing
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just recognizing just a recognizing to
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start is really helpful for people who
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have experienced trauma
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right that they're having to continually
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retell a story that is traumatic
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like how many times does that happen
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right in print in
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healthcare being treated as a number um
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[Music]
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any procedures that um require
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uh getting undressed um being seen as
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their label so
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somebody um you know being labeled as an
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addict or
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uh schizophrenic or diabetic you know
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anything like that
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not having any choices in their
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treatment and then not uh
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opportunity no opportunity to give
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feedback either directly in the visit
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or and on a systemic level like all of
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those things are potentially like trauma
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inducing and
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if you're i'm just recognizing like as
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i'm talking about this this is if this
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is brand new to you
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this might seem like like what is all of
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that um but i do
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again just trust me that this is a real
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thing
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and that it is really vitally important
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and it has like if we're not mindful of
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people's trauma
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then we are part of the issue we are
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part of the problem we are causing harm
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we are not helping them get better and
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uh yeah
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i mean it's really really important
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we have so much privilege and power in
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this role um
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that just just that alone creating a
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power dynamic is
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is enough right and it's our
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responsibility to be uh responsible
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with that so anyway this is maybe a
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little bit of a heavier video but
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um i will link to some more resources
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down below this video and definitely
10:55
like reach out
10:56
um you know seeking further assistance
10:58
if you need to to learn more about it
11:00
and let me know what any questions that
11:02
you have
11:03
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you
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