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- Trauma Providers’ Knowledge, Views and Practice of Trauma-Informed Care
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DMER Staff Nurse Previous Year Question Papers Pdf | Download MHN CWT SN Solved Papers
Trauma-informed interventions have been implemented in various settings, but trauma-informed care TIC has not been widely incorporated into the treatment of adult patients with traumatic injuries. The purpose of this study was to examine health care provider knowledge, attitudes, practices, competence, and perceived barriers to implementation of TIC.
This cross-sectional study used an anonymous web-based survey to assess attitudes, knowledge, perceived competence, and practice of TIC among trauma providers from an urban academic medical center with a regional resource trauma center. Providers nurses, physicians, therapists [physical, occupational, respiratory] working in trauma resuscitation, trauma critical care and trauma care units were recruited.
Descriptive statistics summarized knowledge, attitudes, practice, competence, and perceived barriers to TIC and logistic regression analyses examined factors predicting use of TIC in practice. All participants rated the following as significant barriers to providing basic TIC: time constraints, need of training, confusing information about TIC, and worry about re-traumatizing patients.
Despite some variability, providers were generally knowledgeable and held favorable views toward incorporating TIC into their practice. Psychological consequences may develop and persist long after physical wounds of traumatic injury have healed.
While the majority of injured adults experience full recovery Zatzick, et al. Several risk factors appear to increase risk for persistent PTSD after an index event such as a traumatic injury, including prior exposure to traumatic experiences, overall life stress, more severe acute traumatic stress symptoms, maladaptive coping responses, and poorer social support Richmond, et al. Emotional and psychological responses to physical injury, including PTSD symptoms, are the dominant contributors to poor functional recovery and lower health-related quality of life HRQOL Richmond, et al.
The impact of PTSD symptoms on health and functional outcomes underlines the importance of understanding and addressing factors that contribute to these symptoms, as part of comprehensive medical and nursing care of the injured adult. Trauma-informed care TIC offers a framework for health care providers and institutions in helping to avert persistent traumatic stress responses in injured patients.
The primary elements of a trauma-informed approach in any service system have been defined by the Substance Abuse and Mental Health Services Administration as 1 realizing the widespread impact of trauma exposure, 2 identifying how trauma may impact patients, families, and staff in this system, 3 responding by applying this knowledge into practice and institutional policies, and 4 preventing re-traumatization Substance Abuse and Mental Health Services Administration, At a minimum, trauma-informed approaches endeavor to do no harm, i.
Providers specializing in care of injured patients may perceive that they lack the time, knowledge, and resources to focus care on the psychological aspects of traumatic injury Kassam-Adams, et al. Trauma-informed pediatric health care, including the care of traumatically injured children, has begun to be better defined and described Kassam-Adams, et al.
However, infusion of TIC for the treatment of adult patients admitted to hospital trauma centers has not been explored. Trauma providers were recruited from an urban tertiary academic medical center with a regional resource trauma center to complete an anonymous web-based survey. All trauma providers nurses, physicians, therapists [physical, occupational, respiratory] working in trauma resuscitation, trauma critical care, and trauma nursing care units were eligible to participate and received information about the survey via flyers, emails, and announcements at staff meetings.
To reduce barriers to honest self-reporting of knowledge and performance, no personal identifiers were included in the survey; thus, data were reported anonymously.
Respondents were informed that their consent to participate was implied by voluntarily choosing to complete the survey. Data collection took place during a four-week period between August and September Four raffles with gift cards were held as incentives for providers to complete the survey. It was originally developed for pediatric providers Kassam-Adams, et al. The survey assessed five domains: knowledge regarding injury-related posttraumatic stress and TIC 11 items ; opinions regarding TIC 6 items ; self-rated competence in TIC 10 items ; recent past 6 months use of specific TIC practices 6 items ; and perceived barriers to implementation of TIC 4 items.
Respondents rated each item for knowledge, opinions, self-rated competence, and perceived barriers on a three- or four-point Likert scale with anchors appropriate for each category, e.
We also collected provider demographics including gender, age, race, ethnicity, role, number of years in role, and highest degree obtained. We first examined respondent demographics and survey item responses with descriptive analyses. We created summed scores for 3 survey domains knowledge, opinions, self-rated competence. Potential associations among demographic variables and survey items or summary scores were examined using chi square analyses or logistic regression.
Demographic variables were entered into multivariate logistic regression models for each question. Finally, participants above and below the sample median for years of experience, provider role, educational level, and other demographics were compared. One hundred forty-seven trauma providers completed the survey Table 1. The years of experience providing care to trauma patients varied to some extent among the three professional groups; nurses with a median time of 2 years IQR 1—7 years , therapists with a median time of 3 years IQR 1—10 years , and physicians with a median time of 4 years IQR 2—11 years.
The majority of the participants answered the knowledge items correctly Table 2. Most participants However, less than half of the participants nurses Overall, the vast majority of the participants held favorable opinions about TIC Table 3. The most frequently endorsed trauma-informed practices in the past 6 months were teaching patients specific ways to manage pain and anxiety during a procedure Greater than half of the participants reported asking questions to family members to assess symptoms of distress.
However, fewer than half reported teaching families what to say to their family member after a difficult experience and informing families about reactions that indicate that their family member may need help. Participants rated four factors that were barriers in providing basic trauma-informed assessments and interventions: time constraints, need of training, confusing information and evidence on trauma-informed practices, and worry about further upsetting or re-traumatizing patients.
The majority of the participants listed all factors as barriers. Provider age, gender, race, or ethnicity was not associated with summed scores for self-rated competence, knowledge, or favorable opinions of TIC. No differences between nurses and physicians were found regarding knowledge of traumatic stress or TIC.
In multiple logistic regression analysis, knowledge and opinions of TIC were not associated with any reported TIC practices. However, self-rated competence was modestly associated with all TIC practices, with odds ratios ranging from 1.
The findings of this study indicate that despite some variability with regard to teaching patients how to cope with difficult experiences, providers were generally knowledgeable and held favorable views to integrating TIC into their practice. Providers reported competence in providing care that incorporates psychosocial considerations, and endorsed implementation of a range of these skills into their current practice. These results are positive in that they indicate an openness toward providing TIC, and some prior awareness about how traumatic experiences may affect patients emotionally and behaviorally.
This study reinforces findings from previous research in a sample of pediatric nurses providing trauma care, which found that experience in pediatric nursing and self-rated competence were independently associated with reported practice of TIC Kassam-Adams, Summed scores on knowledge, opinions, and competency are strikingly similar to those in the prior study of a sample of pediatric trauma nurses.
While trauma providers in this study did not rate their competence as highly as nurses in the pediatric study in understanding how traumatic stress may present itself differently in patients of different ages, genders, or cultures The history of trauma that many patients may have been exposed to prior to and in addition to their injury experience place them at high risk for acute stress responses, reinforcing the need to increase provider competence in talking with patients about traumatic experiences without re-traumatizing them Kazak, et al.
A strength of this study is the inclusion of staff in diverse roles in a level I trauma center nurses, nurse practitioners, physicians, surgeons, physical, occupational, and respiratory therapists that represent multiple practice areas trauma resuscitation, trauma ICU, and trauma nursing unit.
This study also included staff with varying levels of trauma provider experience. Not all trauma providers working with patients elected to take the survey, which introduces a potential for selection bias. Also, this study does not seek to evaluate efficacy of implementation of TIC in terms of implementation or patient outcomes, but rather seeks to provide an initial needs and barriers assessment regarding future implementation of a validated TIC protocol in an urban trauma center.
Because this study surveyed providers working in one trauma center in an urban area in one US state, these results may not be generalizable to providers in other types of settings or regions. Future work should examine knowledge, opinions, and barriers to TIC in larger national samples in a variety of regions.
While systematic training of all providers is needed, it may be particularly important for trauma nurses at the bedside, who are the closest point of contact for patients, and who are uniquely positioned to observe, identify, and support patients experiencing distress.
Integration of TIC training into nursing curricula and hospital employee orientations can support trauma nurses in developing awareness of thoughtful interventions to minimize re-traumatizing patients. Other tools and information, and materials for patient education, available in several languages, can be found at www. Providers generally held favorable views to integrating TIC into their practice and had some prior awareness about how traumatic experiences may affect patients emotionally and behaviorally.
There is a need for provider training in supporting patients during potentially traumatic experiences and in educating patients and families in recovery responses and coping strategies. A strength of this study is the inclusion of staff in diverse roles in a level I trauma center that represent multiple practice areas with varying levels of trauma provider experience.
Conflicts of Interest: Authors report no conflicts of interest. National Center for Biotechnology Information , U. J Trauma Nurs. Author manuscript; available in PMC Mar 1. Marta M. Karen M. Therese S.
Author information Copyright and License information Disclaimer. Corresponding author Information: Therese S. Copyright notice. The publisher's final edited version of this article is available at J Trauma Nurs.
See other articles in PMC that cite the published article. Methods This cross-sectional study used an anonymous web-based survey to assess attitudes, knowledge, perceived competence, and practice of TIC among trauma providers from an urban academic medical center with a regional resource trauma center. Conclusions Despite some variability, providers were generally knowledgeable and held favorable views toward incorporating TIC into their practice. METHODS Trauma providers were recruited from an urban tertiary academic medical center with a regional resource trauma center to complete an anonymous web-based survey.
Open in a separate window. Knowledge of injury-related posttraumatic stress The majority of the participants answered the knowledge items correctly Table 2.
Table 2 Providers knowledge regarding injury-related posttraumatic stress. Almost everyone who is seriously injured or ill has at least one traumatic stress reaction in the immediate aftermath of the event.
It is inevitable that most individuals who experience a life-threatening illness or injury will go on to develop significant posttraumatic stress or PTSD. Disagree 96 Individuals who are more severely injured or ill generally have more serious traumatic stress reactions than those who are less severely injured or ill. Disagree 75 51 52 Individuals who, at some point during the traumatic event, believe that they might die are at greater risk for posttraumatic stress reactions.
Many individuals cope well on their own after experiencing serious illness or injury. The psychological effects of an injury or illness often last longer than the physical symptoms. Individuals with significant posttraumatic stress reactions usually show obvious signs of distress. Disagree I know the common signs and symptoms of traumatic stress in ill or injured patients.
Some early traumatic stress reactions in patients can be part of a healthy emotional recovery process. There are things that providers can do to help prevent longer-term posttraumatic stress in ill and injured patients.
There are effective screening measures for assessing traumatic stress that providers can use in practice.
The severe outbreak of novel coronavirus disease COVID , which was first reported in Wuhan, would be expected to impact the mental health of local medical and nursing staff and thus lead them to seek help. However, those outcomes have yet to be established using epidemiological data. To explore the mental health status of medical and nursing staff and the efficacy, or lack thereof, of critically connecting psychological needs to receiving psychological care, we conducted a quantitative study. This is the first paper on the mental health of medical and nursing staff in Wuhan. Notably, among medical and nursing staff working in Wuhan,
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Trauma Providers’ Knowledge, Views and Practice of Trauma-Informed Care
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Trauma-informed interventions have been implemented in various settings, but trauma-informed care TIC has not been widely incorporated into the treatment of adult patients with traumatic injuries.
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