Tracy Stockstill, DNP, MSN, FNP-BC, RN, BSN

Abstract:

Background: Experiencing trauma is a unique and complex public health issue. An individual's experience with trauma may affect their relationship with the healthcare system. Personal medical questions, touch, removal of clothing, and vulnerable positions required for an exam may trigger and re-traumatize patients. Trauma-informed care (TIC) and trauma-informed practice (TIP) is a valuable approach that provides conscientious, ethical, professional, patient-centered care that prepares patients for difficult conversations, exams, and procedures. Objective: This project aimed to demonstrate the effectiveness of educational TIC training on clinician, staff, and leadership knowledge and attitudes related to TIC in the reproductive healthcare setting. The training included didactic education on TIC practices in a clinical setting, including language and physical exam techniques to facilitate a more trauma-informed workplace. Methods: A single-group pre- and post-survey quality improvement project (QI) evaluated change in knowledge and attitude of TIC practices for clinicians, staff, and leadership working in a reproductive community clinic in Los Angeles. The TIC training included a prerecorded 20-minute didactic computer training on TIC practices in a clinical setting, focusing on trauma, triggers, language, and physical exam techniques. Participants completed a 15-item survey before and after the training to determine change in TIC knowledge and attitudes. The results were evaluated using descriptive statistics and the Wilcoxon Rank-Sum Test. A statistician was consulted to analyze the statistical findings of the TIC pre- and post-surveys. Results: The QI project consisted of 12 participants: Nurse Practitioners (n=4), a Physician Assistant (n=1), Medical Assistants (n=5), and Clinic Supervisors (n=2). The course demonstrated no change in TIC knowledge (p=0.062) and a significant change in attitude (p=0.009). While there was no significant change in knowledge, an overall evaluation of the change in knowledge and attitude combined was significant (p=0.004). Conclusion: This QI project showed that a brief 20-minute training on TIC is feasible and can impact the healthcare staff's attitude toward TIC and TIP. The change in staff’s attitudes regarding TIC and TIP represents an increase in awareness of trauma and paths to recovery. Consistent with TIC attitudes, participants expressed interest in more training on TIC and TIP. The desire for ongoing learning of TIC and TIP in the clinical setting reflects an increased understanding of the complexity of trauma and dedication to support patients and communities.

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