Table 3 Strategies for performing trauma-informed care procedures
From: Trauma-informed care (TIC) best practices for improving patient care in the emergency department
Usual care approach | SAMHSA’s six principles | Trauma-informed care approach |
|---|---|---|
• Touching patients without asking • Holding down or restraining a patient’s extremity during the procedure • Starting the procedure before the patient is ready to proceed and/or properly anesthetized | Safety | • Acknowledge that while the procedure is routine to you, it is not routine for the patient • Achieve pain relief before starting procedures • Instruct the patient how to position their extremity without restraining the extremity • Stop the procedure if instructed by the patient |
• Not announcing procedure steps before proceeding • Assurances that do not validate a patient’s feelings (i.e., it is just a simple procedure) • Questioning the patient’s level of pain, history, choices • Providing prescriptive care and treatment, rather than offering choices | Trust & transparency | • Partner with patients during the procedure and identify ways the patient best copes • Respecting the patient’s preferences without judgment • Explain each step of the procedure including equipment used • Provide anticipatory guidance for sounds and sensations (e.g., burn from lidocaine) if desired |
• The patient is unable to communicate patient preference to the care team • The team fails to offer or denial of the presence of a support person | Peer support | • Inquiring about supports available to the patient • Closed-loop communication among team members around patient’s preferences • Offer the patient to have a chaperone or support person present (consider virtual options as well) |
• Failure to offer or honor adjustments requested by patients • Failure to communicate the results of the procedure • Lack of coordination among services if consulting services are involved | Collaboration & mutuality | • Promote shared decision-making • Inquire about how previous healthcare procedures have been tolerated • Make adjustments based on patient preference (i.e., patient positioning, support person, music) • Discuss results of procedure with patient at conclusion of procedure |
• Failure to inform patients of the option to stop or take a break at any time • Failure to offer adjustment and choices | Empowerment, voice, & choice | • Increase proactive, shared decision-making during the procedure • Involve the patient in the procedure if they choose (i.e., hold drape, self-insert speculum, position so they can watch) • Acknowledging the patient’s strengths and attributes • Empower patients to request to slow down, pause, or stop at any time • Allow choices where possible (i.e., position of comfort, music, support person, narration) |
• Having preconceived assumptions about certain populations, for example, bias against people with substance use disorders, mental health challenges, communities of color, and LGBTQIA • Not reflecting on and taking measures to address one’s unconscious bias | Cultural, gender, historical issues | • Seek to increase self-awareness of unconscious bias and stigma, including bias related to pain thresholds and pain management • Understand that patient reactions may be related to past trauma including medical trauma and experiences with structural systems |