Marian Vinas
Florida National University
Professor: Dr. Nora Hernandez-Pupo
December 11, 2024
Trauma-informed Care
Trauma-sensitive care is a crucial model for caring for patients’ physical, psychological, and emotional well-being in the context of trauma. DJ’s case exemplifies the need for such an approach as her presentation to the emergency department (ED) demonstrates the interplay between domestic violence, chronic illnesses, and psychological trauma. When thinking about DJ’s case, it is important to evaluate whether her treatment was consistent with the principles of trauma-informed care and to identify how the application of these principles can improve her well-being.
One way this case could have been handled differently is by more explicitly addressing DJ’s emotional safety and empowering her throughout the process (Forkey et al., 2021). For instance, based on the fact that DJ was worried that her partner would know she was in the hospital, the ED team could guarantee that nobody in the partner’s vicinity would be informed of her admission to the hospital. This entails ensuring that visitors are restricted and any contact from outside is well managed. Further, the team could try to reduce her sense of vulnerability while she is in the hospital, for example, by allowing her to make choices in her care plan whenever possible, such as having someone she knows with her during a physical exam.
The nurse’s initial approach to obtaining DJ’s history could also have been more trauma sensitive. Although, it is important to ask about DJ’s medical and psychosocial history, the questions about her experience of violence and whether she has PTSD should have been asked in a sensitive manner (Bennett et al., 2022). Such wording promotes sharing information, and at the same time, it does not force DJ to retell traumatic stories. In order to improve the care of DJ, some more trauma-informed approaches like emotional safety, building trust, and working together could have been integrated more. One action would be to ensure that she was given reasons for each of the procedures done to her, and the reason why her airway was being monitored and treatment for diabetic ketoacidosis (DKA). Explaining these procedures would be beneficial to DJ since she would comprehend how the procedures are in line with her recovery and safety.
The other important step would be to listen to her carefully and acknowledge her emotions, which might help her feel valued. Building trust is one of the core principles of trauma-informed care, and in DJ’s case, it might have been bolstered by more effective communication and check-ins (Kimberg & Wheeler, 2019). For example, after transferring DJ to the ICU, the ED team should coordinate with the ICU staff to share her expressed needs and concerns to guarantee that the care provided remains patient centered. Further conversations with social workers or advocates may also help her by providing safety planning materials, legal advice, or information about local organizations addressing domestic violence or trauma. Finally, it is crucial to acknowledge the structural aspect of trauma within the context of healthcare interactions. The ED team should anticipate how DJ’s PTSD history may impact her reactions to medical procedures and make adjustments to minimize these triggers.
References
Bennett, A., Crosse, K., Ku, M., Edgar, N. E., Hodgson, A., & Hatcher, S. (2022). Interventions to treat post-traumatic stress disorder (PTSD) in vulnerably housed populations and trauma-informed care: a scoping review. BMJ open, 12(3), e051079.
Forkey, H., Szilagyi, M., Kelly, E. T., & Duffee, J. (2021). Trauma-informed care. Pediatrics, 148(2).
Kimberg, L., & Wheeler, M. (2019). Trauma and trauma-informed care. Trauma-informed healthcare approaches: A guide for primary care, 25-56.
