Trauma-informed care in geriatric inpatient units to improve staff skills and reduce patient distress: a co-designed study protocol

Abstract

Background Geriatric hospital wards are highly medicalised environments with limited opportunities for choice and control, and can be distressing for older survivors of psychological trauma. While trauma-informed models of care (TIC) are effectively applied across mental health and other settings, the utility of these models in aged care settings has not been assessed. The objective of this study was to examine whether TIC can reduce responsive behaviour, chemical restraint, and improve staff skills and patient experiences in inpatient geriatric settings. Methods Four wards participated in this type I hybrid implementation-effectiveness study across southern Adelaide, Australia, including 79 beds. Using a co-design method, the principles of TIC were transformed into an implementation strategy including staff training, establishment of highly trained ‘champions’ on each ward, screening for trauma-related needs, and amending ward policies and procedures. Primary outcomes will be examined using an interrupted time-series design and are monthly incidence of responsive behaviour incidents and use of chemical restraint. Process evaluation will be used to examine secondary, implementation outcomes including the acceptability, feasibility, and fidelity to the implementation strategy. Discussion Trauma-informed care has potential to improve the safety and accessibility of hospital wards for older people who have survived psychologically traumatic events and has an extensive evidence base supporting its effectiveness in other settings. Identifying trauma-related needs and amending care to reduce the risk of re-traumatisation and distress may also reduce the incidence of responsive behaviour change, which has a significant impact on the quality of life of hospital patients and staff and is very costly. The inclusion of a process evaluation will allow us to identify and report changes made on each ward and make recommendations for future implementation efforts.

Trauma‐informed care within residential aged care settings: A systematic scoping review

“…PCC is widely regarded as a best‐practice approach to caring for older people living in RAC 54,56–58 and is focused on interpreting and regulating unmet needs, relational aspects of care and the impact of environments on behaviours, 59 which aligns with the principles of TIC 6,17,31 . Additionally, the documented outcomes of PCC align with those of TIC, including improved resident wellbeing and quality of life, reduced psychological distress, improvements in staff job satisfaction and wellbeing and reduced burnout and work‐related stress 58,60–62 …”

“…6,17,31 Additionally, the documented outcomes of PCC align with those of TIC, including improved resident wellbeing and quality of life, reduced psychological distress, improvements in staff job satisfaction and wellbeing and reduced burnout and work-related stress. 58,[60][61][62] Whilst TIC is not specifically PCC as it is more broadly focused on the impacts of trauma on clients, staff and the organisation, there are highlighted overlaps from this review. This review highlighted examples where PCC approaches, which may be effective with some older people, are re-traumatising and problematic when that older person also has a trauma history 44 and is inconsistent with TIC.…”

“…Given the lack of a specific TIC intervention or model for RAC, and increasing requirements for TIC to be implemented in RAC, 13,64 there is an opportunity to draw on existing practice models used in other settings 18,20,62 and RAC staff experience to explore the development of a model of TIC for RAC settings. The findings from this review build on the existing evidence for TIC to inform several recommendations for further research: (1) the design of a TIC intervention for RAC, (2) the development and implementation of training for RAC staff and organisational leaders, (3) taking an organisation-wide approach to TIC for RAC settings, and (4) implementing systemwide approaches that support TIC in RAC.…”

Effectiveness of trauma-informed care interventions at the organizational level: A systematic review.

“…Studies were identified by searching two electronic databases: PsycINFO and PubMed. In protocol studies (e.g., Cations et al, 2021) or studies describing multiple projects (e.g., Longhi et al, 2021), a manual search was performed in Google to see if any additional or independent articles on each project had been published with results.…”

Delivering Trauma-Informed Care in a Hospital Ward for Older Adults With Dementia: An Illustrative Case Series

“…The third ward is a 12-bed specialized unit for people with dementia and associated behavior change, with single patient rooms and medical, nursing and allied health professional staffing. The staff were engaged in a training and mentoring program to improve the delivery of trauma-informed care within the service ( 17 ). However, none of the wards included staffing from psychiatry, psychology, or mental health nursing although consultation could be sought from external mental health services where needed.…”