Helping Primary Care Patients Heal Holistically via Trauma-Informed Care

Selwyn, Candice N.; Lathan, Emma C.

doi:10.1016/j.nurpra.2020.06.012

Cited by 11 publications

(8 citation statements)

References 17 publications

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“…Authors characterized advocacy as interventions to assist patients to meet basic needs (Brooks et al, 2018), obtain the best possible treatment (Esden, 2018), navigate complex health systems (Ford-Gilboe et al, 2011; Hartney et al, 2020), and connect with appropriate care and resources (Roberts et al, 2019). In several accounts, the referral of patients to mental health services was essential for addressing trauma and managing sequelae-like substance use that can exacerbate health problems (Roberts et al, 2019; Selwyn & Lathan, 2021). Other authors pointed to the importance of forming local partnerships, such as with social workers, support groups, legal and court systems, and community health delivery systems for helping patients meet basic needs of food, housing, transportation, counseling, and vocational services (Chambers, 2019; Hartney et al, 2020).…”

Section: Resultsmentioning

confidence: 99%

“…In 26 of the 31 articles, authors identified knowledge and/or training of staff, providers, and organizations as an antecedent of TIC. Recommendations made by authors for training and education to enhance competence including building awareness of trauma (Coles et al, 2015; Roberts et al, 2019), developing knowledge of basic and advanced trauma concepts (Chambers, 2019), cultivating familiarity with the impacts of trauma on health and health behaviors (Raja et al, 2015; Selwyn & Lathan, 2021), training in the nonverbal signs of distress (Hamberger et al, 2019; Roberts et al, 2019), and practicing nonharmful interpersonal responses to minimize retraumatization (Chambers, 2019; Chaudhri et al, 2019; Ghandour et al, 2015). Other recommendations to create competence in TIC included development of trauma screening skills (Dawson-Rose et al, 2019), recognition of trauma-related barriers in following care plans (Esden, 2018), trauma-specific primary care treatments (Barnes & Andrews, 2019), and awareness of local reporting laws (Palmieri & Valentine, 2021).…”

Section: Resultsmentioning

confidence: 99%

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Trauma-informed care in the primary care setting: An evolutionary analysis

Varghese

Emerson²

2021

J Am Assoc Nurse Pract

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Background: The high prevalence of trauma in the United States and its adverse effects on patient wellbeing has led to the adoption of trauma-informed care (TIC) in some specialized health care services. However, the implementation of TIC in primary care, where many nurse practitioners (NPs) provide services, is relatively uncommon and the concept not well-defined. Trauma includes physically and emotionally devastating experiences that have a lasting impact on individuals.Objectives: To synthesize a definition of TIC in the primary care setting for NPs to guide future practice and research.Data Sources: We searched CINAHL, PsycINFO, Social Work Abstracts, Scopus, and PubMed for articles published 2010-2020 that described the use of TIC in primary care. Rodgers' evolutionary method and the framework method of analysis were used to identify attributes and contexts of TIC in primary care and synthesize a definition. Thirty-one articles from nursing, medical, and social work sources were selected, including data-based studies (n = 15) and thought pieces (n = 16). Attributes, antecedents, and consequences were combined to provide a definition grounded in the literature. Conclusion:Trauma-informed care in primary care is a strengths-based approach in which trained, trauma-aware health care professionals provide services that prioritize safety, empowerment, and support, resulting in improved patient satisfaction and health care engagement in individuals who have experienced trauma.Implications for practice: A clearly defined concept provides a starting point for developing strategies to help NPs recognize and respond more effectively to the needs of patients who have experienced trauma.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Trauma-informed care in the primary care setting: An evolutionary analysis

Varghese

Emerson²

2021

J Am Assoc Nurse Pract

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“…These experiences often include a history of institutional betrayal, medical or other traumas, and/or disrupted patient-provider trust. Each of these factors can directly influence patients’ emotional health and their healthcare engagement behaviors, 16 as well as providers’ perceptions of and approach to the patient. For example, a patient with an IB history might delay treatment seeking, withhold health-related information, not comply with treatment regimens, or behave in other ways providers may perceive as ‘difficult.’ BITTEN offers HCPs a framework for navigating these ‘difficult’ healthcare encounters in a trauma-informed, patient-centered manner.…”

Section: Discussionmentioning

confidence: 99%

They’ve been BITTEN: reports of institutional and provider betrayal and links with Ehlers-Danlos Syndrome patients’ current symptoms, unmet needs and healthcare expectations

Langhinrichsen‐Rohling

Lewis

McCabe

et al. 2021

Therapeutic Advances in Rare Disease

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Introduction: Patients with rare and/or care-intensive conditions, such as Ehlers-Danlos Syndrome (EDS), can pose challenges to their healthcare providers (HCPs). The current study used the BITTEN framework1 to code EDS patients’ open-ended written responses to a needs survey to determine their self-reported prevalence of healthcare institutional betrayal and its link with their expressed symptoms, provider perceptions, unmet needs, and on-going healthcare-related expectations. Methods: Patients with EDS ( n = 234) were recruited via a rare disease electronic mailing list and snowball sampling. A total of one-hundred and six respondents (45.3%) endorsed having unmet healthcare-related needs; of these, 104 (99%) completed an open-ended prompt about these needs. Responses were coded for components of BITTEN, a framework designed to link patients’ past, current, and future healthcare-related experiences in a trauma informed manner. Results: Many respondents with ongoing needs endorsed experiencing past institutional and provider betrayal (43%; n = 45), current mental health symptoms (91.4%; n = 95), negative expectations for future healthcare (40.4%; n = 62), and a lack of trust in their healthcare provider (22.1%; n = 23). There were no significant differences in post-traumatic stress disorder (PTSD)/anxiety, depression/sadness, or isolative symptoms between respondents coded for institutional betrayal ( n = 45) compared with those not ( n = 59). However, EDS respondents reporting institutional betrayal were significantly more likely to self-report anger and irritability symptoms, a lack of trust in their HCPs, and more negative expectations for future healthcare than those not reporting institutional betrayal. Discussion/conclusions: The frequent spontaneous reporting of past healthcare betrayals among patients with EDS implies the need for trauma-informed care and provider education. Given that experiences of institutional betrayal are associated with increased anger and irritability, as well as with negative expectations for future healthcare interactions, efforts to repair healthcare provider and system-wide relationship ruptures might have positive healthcare consequences. Plain language summary Reports of Institutional and Provider Betrayal and Links with Ehlers-Danlos Syndrome Patients’ Current Symptoms, Unmet Needs and Future Healthcare Expectations What is EDS? Ehlers-Danlos Syndrome (EDS) refers to a group of rare genetic connective tissue disorders that are primarily characterized by skin hyperelasticity, joint hypermobility, and tissue fragility. Connective tissue is largely responsible for the structural integrity of our bodies, and there are several EDS subtypes which each describe a specific connective tissue problem. In addition, there is significant overlap between EDS types and other kinds of connective tissue disorders. As a result, recognizing, diagnosing, and treating EDS is often challenging. What is Institutional betrayal? Institutional Betrayal here refers to a harmful action (i.e. commission) or lack of action (i.e. omission) on the part of a healthcare institution, individual provider/healthcare team, or insurance company. When a patient trusts that the healthcare system will act in their best interest, and trust is violated, institutional betrayal occurs. What is BITTEN? BITTEN is an acronym for Betrayal, Indicator, Trauma symptoms, Trust, Expectations, and Needs. It is a framework meant to capture previous problematic healthcare-related experiences in EDS patients, then to consider how those experiences influence a patient’s current symptoms, provider trust, future expectations in healthcare encounters, and on-going needs. Why was this done? EDS, like many rare diseases, is hard to recognize and manage. We aim to: Give voice to EDS patients and their common unmet needs and healthcare-related expectations. Highlight how healthcare providers can apply BITTEN to improve care practices in rare disease patient encounters. What did we do? Using a newly articulated applied model of healthcare, BITTEN, we analyzed the open-ended responses of EDS patients describing their unmet emotional and mental health needs. What did we find? Nearly half of EDS patients who indicated they had unmet needs reported experiencing institutional betrayal. EDS patients who reported institutional betrayal also expressed anger, a lack of trust in healthcare providers, negative expectations for future healthcare, and more unmet needs more frequently than EDS patients who did not report institutional betrayal. What does this mean? The EDS patients in this sample were not directly asked if they had experienced institutional betrayal, so the exact prevalence is not known. Furthermore, responses were obtained voluntarily via the internet, so caution should be taken when generalizing these findings. However, results indicate that too many patients with EDS have experienced healthcare betrayals; these experiences are associated with current anger and negative expectations for future healthcare interactions. The prevalence of past negative healthcare experiences, along with current unmet needs and future negative healthcare expectations in EDS patients who have experienced institutional betrayal, highlights the need for healthcare providers to tend to these experiences, mend patient-provider barriers, and provide higher quality healthcare.

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“…15,16,28 Providers' personal adversity histories and just world beliefs have also been found to play a role in their uptake of TIC. 34 Given the importance of PTSD screening within the primary care setting, further exploration of system-and provider-level barriers to PTSD screening that are unique to Grady Memorial Hospital is needed in order to develop system-specific interventions targeting said barriers and to enact trauma-informed policy change.…”

Section: 8mentioning

confidence: 99%

Primary Care Providers' Knowledge, Perceptions, and Practice of Trauma-Informed Care in a Public Health Care Setting

Lathan,

Haynes,

Langhinrichsen-Rohling

et al. 2023

Family &Amp; Community Health

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Despite serving patients with especially high rates of trauma exposure and related sequelae, many primary care providers do not receive specialized training in the provision of trauma-informed care (TIC). This study sought to document primary care providers' baseline rates of TIC training and their knowledge, perceptions, and practice of TIC at a large, urban public hospital in the Southeastern United States. Participants (n = 67; 68.7% women; 44.8% white; M age = 36.7 years, standard deviation [SD]age = 9.8 years) completed an online self-report survey on their TIC training status, trauma-related knowledge, perceptions, and practices, as well as burnout and secondary traumatic stress. Less than half of participants (43.3%) endorsed TIC training exposure. Participants generally had adequate levels of trauma-related knowledge (76.5% of items correct) and favorable perceptions of TIC (endorsed 89.7% of TIC-supportive statements). Most participants (86.6%) endorsed recently using trauma-informed practices, but only 47.8% reported routinely screening for trauma-related disorders. Participants who reported receiving prior TIC training scored better on knowledge items and endorsed recently using more trauma-informed practices than those who did not have training exposure. TIC training status' associations with current screening practices and perceptions of TIC were trending toward significance. TIC training status was not related to burnout, and trained participants reported greater secondary traumatic stress than those without training exposure. Results point to system-wide TIC training as a well-received, translational strategy that can enhance the trauma-informed nature of primary care provision.

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Helping Primary Care Patients Heal Holistically via Trauma-Informed Care

Cited by 11 publications

References 17 publications

Trauma-informed care in the primary care setting: An evolutionary analysis

Trauma-informed care in the primary care setting: An evolutionary analysis

They’ve been BITTEN: reports of institutional and provider betrayal and links with Ehlers-Danlos Syndrome patients’ current symptoms, unmet needs and healthcare expectations

Primary Care Providers' Knowledge, Perceptions, and Practice of Trauma-Informed Care in a Public Health Care Setting

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