What is Trauma-Informed Care?

Trauma: An experience or event that causes significant psychological, emotional, or physical distress, overwhelming an individual's ability to cope effectively.

Trauma Triggers: Specific stimuli—such as sights, sounds, smells, or situations—that evoke memories or emotional responses related to a past traumatic event.

Re-traumatization: The process by which an individual is exposed to circumstances or experiences that evoke or replicate aspects of a previous trauma, causing renewed psychological or emotional distress.

Adverse Childhood Experiences (ACE) Scores: A measure of various types of events occurring during childhood—such as abuse, neglect, or household dysfunction—that are linked to long-term health and well-being outcomes.

Trauma-Informed Care (TIC): An approach that recognizes the impact of trauma on individuals and focuses on creating safe, supportive, and respectful environments that promote healing rather than re-traumatization.

Trauma-Informed Pedagogy (TIP): A teaching approach that considers how trauma can affect students’ ability to learn, participate, and thrive in the classroom.

The 4Rs Framework is a guiding model for trauma-informed care and education. It helps guide systemic changes in schools and institutions to shift their mindset and practices to create environments that are safe, supportive, and empowering for all learners—especially those impacted by trauma.

Realize

• Explanation: Understand that many students may have experienced trauma and/or adverse events, which can impact their learning, emotional regulation, decision-making, and social interactions.

• Example: Realizing that a student who appears easily overwhelmed in the various academic nursing environments might be experiencing trauma-related stress, not just lack of skill.

Recognize

• Explanation: Notice signs that a student may be struggling due to trauma, such as withdrawal, anxiety, difficulty concentrating, or behavioral changes.

• Example: Recognizing when a student is consistently avoiding certain assignments or clinical settings because they may trigger memories of past events.

Respond

• Explanation: Adapt teaching methods, policies, and communication to support trauma-affected students, promoting a safe and encouraging learning environment.

• Example: Providing alternative assignments or extra support for students who feel triggered by specific course activities, or offering check-ins to discuss their concerns confidentially.

Resist Re-traumatization

• Explanation: Create classroom and clinical environments that minimize triggers and avoid practices that could re-traumatize students.

• Example: Avoiding public criticism or harsh feedback in front of peers, and instead giving constructive feedback privately and respectfully.

Central to TIC are six key principles that guide educators in fostering safety, trust, collaboration, and empowerment while honoring the diverse cultural and historical experiences of individuals.

1. Safety

• Explanation: Create physical and emotional environments where students feel secure and protected.

• Example: In a nursing classroom or clinical, ensure clear expectations and respectful communication so students feel comfortable asking questions without fear of judgment.

2. Trustworthiness & Transparency

• Explanation: Be honest, clear, and consistent in communication and actions to build trust with students.

• Example: Clearly explain course requirements and grading criteria upfront, and provide timely feedback so students know what to expect.

3. Peer Support

• Explanation: Encourage connections among students to provide mutual support and understanding.

• Example: Facilitate study groups or peer mentoring programs where nursing students can share experiences and coping strategies.

4. Collaboration & Mutuality

• Explanation: Promote teamwork and equal partnership between educators and students.

• Example: Involve nursing students in curriculum planning or seek their input on teaching methods to create a more inclusive learning environment.

5. Empowerment, Voice & Choice

• Explanation: Support students’ autonomy by valuing their perspectives and giving them choices in their learning.

• Example: Allow nursing students to select topics for projects that align with their interests and goals.

6. Cultural, Historical, and Gender Issues

• Explanation: Recognize and respect the diverse backgrounds and experiences that influence students’ identities and responses to trauma.

• Example: Incorporate content on cultural humility in nursing education and create space for students to share how their backgrounds affect their learning.

Consider your experiences teaching undergraduate nursing students. Reflect on how trauma may have impacted their learning and behavior, and how your teaching practices have supported or could better support trauma-informed care. Use the following questions to guide your thinking about ways to create a safer, more supportive, and empowering educational environment.

1. Reflecting on past students, how have you seen trauma impact their academic performance or engagement?

2. Are there any classroom or clinical policies that could unintentionally re-traumatize students? How can you modify these?

3. How do you create both physical and emotional safety for your students in the classroom and clinical environments?

4. How transparent and consistent are you in communicating expectations, feedback, and course policies to foster trust?

5. Have you seen examples where peer support positively impacted student learning or wellbeing? How can you encourage this more effectively?

1. Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach (HHS Publication No. SMA‑14‑4884). U.S. Department of Health and Human Services. https://ncsacw.samhsa.gov/userfiles/files/SAMHSA_Trauma.pdf

2. Trauma Informed Oregon. (2016). What is trauma informed care? Portland State University. https://traumainformedoregon.org/wp-content/uploads/2016/01/What-is-Trauma-Informed-Care.pdf

3. Trauma Informed Oregon. (2018). Adverse childhood experiences. Trauma Informed Oregon. https://traumainformedoregon.org/wp-content/uploads/2019/10/Adverse-childhood-experiences_2018.pdf