Beyond the Physical Wound: The Effectiveness of Trauma-Informed Care Models in Nursing Across Healthcare Settings—A Scoping Review of Patient and Staff Outcomes
Abstract
Background: Trauma, both physical and psychological, represents a pervasive public health crisis with profound implications for healthcare utilization. Trauma-Informed Care (TIC) has emerged as a systemic, organizational framework that recognizes the pervasive impact of trauma and promotes environments of healing and safety for all.
Aim: This scoping review aims to map the breadth and effectiveness of TIC models as implemented and led by nursing professionals across the care continuum, from high-acuity settings like the Emergency Room to community-based Primary Care.
Methods: A scoping review methodology following the Joanna Briggs Institute (JBI) framework was conducted. Five electronic databases (PubMed, CINAHL, PsycINFO, Scopus, Web of Science) were systematically searched for literature published between 2010 and 2024.
Results: Findings are categorized across four key settings: Emergency/Trauma, Inpatient, Mental Health/Substance Use, and Primary Care. For nursing staff, TIC implementation is associated with decreased burnout, reduced secondary traumatic stress, increased professional self-efficacy, and improved perceived safety. Key implementation success factors include universal education, environmental modifications, and organizational leadership commitment.
Conclusion: TIC is a potent, effective framework that transforms clinical encounters and workplace culture. Widespread adoption requires sustained investment in training, policy reform, and a fundamental shift toward a culture of safety and collaboration in all healthcare settings.
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References
Amateau, G., Gendron, T. L., & Rhodes, A. (2023). Stress, strength, and respect: Viewing direct care staff experiences through a trauma-informed lens. Gerontology & Geriatrics Education, 44(3), 380-395. https://doi.org/10.1080/02701960.2022.2039132
Azeem, M., Aujla, A., Rammerth, M., Binsfeld, G., & Jones, R. B. (2017). Effectiveness of six core strategies based on trauma informed care in reducing seclusions and restraints at a child and adolescent psychiatric hospital. Journal of Child and Adolescent Psychiatric Nursing, 30(4), 170-174. https://doi.org/10.1111/jcap.12190
Beattie, J., Griffiths, D., Innes, K., & Morphet, J. (2019). Workplace violence perpetrated by clients of health care: A need for safety and trauma‐informed care. Journal of clinical nursing, 28(1-2), 116-124. https://doi.org/10.1111/jocn.14683
Beck, C. T. (2011). Secondary traumatic stress in nurses: A systematic review. Archives of psychiatric nursing, 25(1), 1-10. https://doi.org/10.1016/j.apnu.2010.05.005
Bendall, S., Eastwood, O., Cox, G., Farrelly-Rosch, A., Nicoll, H., Peters, W., ... & Scanlan, F. (2021). A systematic review and synthesis of trauma-informed care within outpatient and counseling health settings for young people. Child maltreatment, 26(3), 313-324. https://doi.org/10.1177/1077559520927468
Berger, R., & Quiros, L. (2014). Supervision for trauma-informed practice. Traumatology, 20(4), 296. https://psycnet.apa.org/doi/10.1037/h0099835
Berliner, L., & Kolko, D. J. (2016). Trauma informed care: A commentary and critique. Child maltreatment, 21(2), 168-172. https://doi.org/10.1177/1077559516643785
Bloom, S. L., & Farragher, B. (2013). Restoring sanctuary: A new operating system for trauma-informed systems of care. Oxford University Press.
Borders, L. D., Lowman, M. M., Eicher, P. A., & Phifer, J. K. (2023). Trauma-informed supervision of trainees: Practices of supervisors trained in both trauma and clinical supervision. Traumatology, 29(2), 125. https://psycnet.apa.org/doi/10.1037/trm0000382
Dunkerley, S., Akin, B. A., Brook, J., & Bruns, K. (2021). Child welfare caseworker and trainer perspectives on initial implementation of a trauma-informed practice approach. Journal of Child and Family Studies, 30(4), 1082-1096. https://doi.org/10.1007/s10826-021-01935-1
Forkey, H., Szilagyi, M., Kelly, E. T., & Duffee, J. (2021). Trauma-informed care. Pediatrics, 148(2). https://doi.org/10.1542/peds.2021-052580
Forster, M., Grigsby, T. J., Rogers, C. J., & Benjamin, S. M. (2018). The relationship between family-based adverse childhood experiences and substance use behaviors among a diverse sample of college students. Addictive behaviors, 76, 298-304. https://doi.org/10.1016/j.addbeh.2017.08.037
Galvin, E., O’Donnell, R., Avery, J., Morris, H., Mousa, A., Halfpenny, N., ... & Skouteris, H. (2022). Residential out-of-home care staff perceptions of implementing a trauma-informed approach: The sanctuary model. Journal of Child & Adolescent Trauma, 15(3), 653-667. https://doi.org/10.1007/s40653-021-00427-0
Greenwald, A., Kelly, A., Mathew, T., & Thomas, L. (2023). Trauma-informed care in the emergency department: concepts and recommendations for integrating practices into emergency medicine. Medical Education Online, 28(1), 2178366. https://doi.org/10.1080/10872981.2023.2178366
Hales, T., Kusmaul, N., & Nochajski, T. (2017). Exploring the dimensionality of trauma-informed care: Implications for theory and practice. Human Service Organizations: Management, Leadership & Governance, 41(3), 317-325. https://doi.org/10.1080/23303131.2016.1268988
Han, H. R., Miller, H. N., Nkimbeng, M., Budhathoki, C., Mikhael, T., Rivers, E., ... & Wilson, P. (2021). Trauma informed interventions: A systematic review. PloS one, 16(6), e0252747. https://doi.org/10.1371/journal.pone.0252747
Hartinger-Saunders, R. M., Jones, A. S., & Rittner, B. (2019). Improving access to trauma-informed adoption services: Applying a developmental trauma framework. Journal of Child & Adolescent Trauma, 12(1), 119-130. https://doi.org/10.1007/s40653-016-0104-1
Iverson, K. M., Dichter, M. E., Stolzmann, K., Adjognon, O. L., Lew, R. A., Bruce, L. E., ... & Miller, C. J. (2020). Assessing the Veterans Health Administration’s response to intimate partner violence among women: protocol for a randomized hybrid type 2 implementation-effectiveness trial. Implementation science, 15(1), 29. https://doi.org/10.1186/s13012-020-0969-0
Kendall-Tackett, K., & Beck, C. T. (2022). Secondary traumatic stress and moral injury in maternity care providers: a narrative and exploratory review. Frontiers in Global Women's Health, 3, 835811. https://doi.org/10.3389/fgwh.2022.835811
Maguire, D., & Taylor, J. (2019). A systematic review on implementing education and training on trauma-informed care to nurses in forensic mental health settings. Journal of Forensic Nursing, 15(4), 242-249. DOI: 10.1097/JFN.0000000000000262
Menschner, C., & Maul, A. (2016). Strategies for encouraging staff wellness in trauma-informed organizations. Center for Health Care Strategies.
Miller, A., Trochmann, M. B., & Drury, I. (2022). Trauma-informed public management: A step toward addressing hidden inequalities and improving employee wellbeing. Public Administration Quarterly, 46(3), 238-257. https://doi.org/10.37808/paq.46.3.3
Nizum, N., Yoon, R., Ferreira‐Legere, L., Poole, N., & Lulat, Z. (2020). Nursing interventions for adults following a mental health crisis: A systematic review guided by trauma‐informed principles. International Journal of Mental Health Nursing, 29(3), 348-363. https://doi.org/10.1111/inm.12691
O’Dwyer, C., Tarzia, L., Fernbacher, S., & Hegarty, K. (2021). Health professionals’ experiences of providing trauma-informed care in acute psychiatric inpatient settings: A scoping review. Trauma, Violence, & Abuse, 22(5), 1057-1067. https://doi.org/10.1177/1524838020903064
Phung, B. (2022, November). Potential challenges and future implications for trauma-informed approaches in schools. In Frontiers in Education (Vol. 7, p. 1040980). Frontiers Media SA. https://doi.org/10.3389/feduc.2022.1040980
Reynolds, A. M., Spaeth, A. M., Hale, L., Williamson, A. A., LeBourgeois, M. K., Wong, S. D., ... & Carskadon, M. A. (2023). Pediatric sleep: current knowledge, gaps, and opportunities for the future. Sleep, 46(7), zsad060. https://doi.org/10.1093/sleep/zsad060
Rushforth, A., Durk, M., Rothwell-Blake, G. A., Kirkman, A., Ng, F., & Kotera, Y. (2023). Self-compassion interventions to target secondary traumatic stress in healthcare workers: a systematic review. International Journal of Environmental Research and Public Health, 20(12), 6109. https://doi.org/10.3390/ijerph20126109
Sweeney, A., Filson, B., Kennedy, A., Collinson, L., & Gillard, S. (2018). A paradigm shift: relationships in trauma-informed mental health services. BJPsych advances, 24(5), 319-333. doi:10.1192/bja.2018.29
Tabone, J. K., Rishel, C. W., Hartnett, H. P., & Szafran, K. F. (2022). Trauma-informed intervention with children: Integrating the CANS assessment with the ARC framework in a clinical setting. Journal of Child & Adolescent Trauma, 15(1), 65-74. https://doi.org/10.1007/s40653-021-00357-x
Timmer, S. G., Hawk, B. N., Washington, A. M., & Urquiza, A. J. (2022). Trauma-informed care for maltreated children: evidence-based treatments from a developmental perspective. In Handbook of Child Maltreatment (pp. 493-523). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-030-82479-2_25
Weiss, D., Kassam-Adams, N., Murray, C., Kohser, K. L., Fein, J. A., Winston, F. K., & Marsac, M. L. (2017). Application of a framework to implement trauma-informed care throughout a pediatric health care network. Journal of Continuing Education in the Health Professions, 37(1), 55-60. DOI: 10.1097/CEH.0000000000000140
Yatchmenoff, D. K., Sundborg, S. A., & Davis, M. A. (2017). Implementing trauma-informed care: Recommendations on the process. Advances in Social Work, 18(1), 167-185. https://doi.org/10.18060/21311
Authors
Copyright (c) 2024 Bushra Abdullah Alblwi, Nouf Sulaiman Alharbi, Duaa Mohammad Alreheli, Bader Nafae Alrashidi, Badr Eyadah Alrashidi, Bandar Ali Saleh Alrashidi, Basmah Helal Sayfi AlKhaibari, Bador Shaiem M Remal, Sharifah Braq Jaber Asiri, Hana Otish Al Rowily, Talal Al-Humaidi Al-Harbi, Saeedah Dahel Alhazme
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