Patient trauma can have a significant impact on the ways in which patients interact with the healthcare environment and with its staff. Many patient behaviors can stem from trauma, including lack of adherence to care plans. In the context of patient safety, nonadherence stands to negatively impact collective aims in healthcare including patients’ outcomes and experiences, staff satisfaction, and the financial health of institutions. Trauma-informed care is an approach in which healthcare professionals and the systems in which they work acknowledge this relationship and take action to avoid the undesirable effects of trauma on patient adherence and related outcomes.
As a career nurse and now national leader in falls and pressure injury prevention, I have seen the relationship between trauma and patient adherence to treatment plans play out often in the context of preventing falls. Falls are an extremely costly patient event, with each fall costing hospitals an average of $27,5001 and each patient and their family immeasurable harm. I’m pleased to share some insights to help you navigate this important challenge.
Not all trauma looks the same
When you hear the word “trauma,” you may immediately conjure up images of violence or motor vehicle incidents. While those represent examples of acute trauma that some patients have indeed experienced, some have also experienced chronic trauma (e.g., childhood abuse) or complex trauma (layers of trauma over time). Medical trauma can be associated with any of these trauma types and may stem from medical or non-medical events. For example, a patient may loathe being touched by a healthcare provider as a result of past trauma involving unwanted contact outside of the healthcare system.
Patient adherence to interventions is affected by trauma
If a patient has a history of real or perceived harm inflicted by others or feels threatened by the loss of control, they may reject nursing interventions. In my experience working with hospitals across the country throughout my career, staff often report that patients object to staff staying with them while they toilet and refuse to call for help prior to rising, even when indicated in their care plan. Consider how these refusals might be driven by trauma.
These trauma-informed strategies can facilitate patient adherence to safety precautions
- Acknowledge internally how past or current trauma may influence your patient’s willingness to adhere to their safety interventions. Consider acute, chronic, and complex trauma, and both medical and nonmedical sources.
- Validate any relevant concerns shared outwardly by patients but remember that not all will be verbalized.
- Explain the fall prevention intervention with a focus on mutual goals. Describe the patient’s unique risk to fall and how the desired patient behavior can mitigate that risk.
- Offer acceptable choices.
Example: You are a male nurse treating a young female oncology patient whose primary goal is to beat cancer. Their trauma might invoke fear of losing control and independence, and this may result in the patient refusing to call for help getting up to use the restroom. Keeping their goal of successful treatment in mind, you might say: “You and I both want the same thing, for your treatment to continue and to be successful. A fall could completely derail your treatment plan and set you back. I know you feel well today and that you want to get up often to stay strong, but weakness and dizziness can set in many days after your recent treatment, and you may not feel it coming on. If a staff member can walk with you to the restroom and stay with you there, we have a much better chance of keeping you from falling. Would you like me to go with you to the restroom now, or would you prefer I ask one of the female nurses to go with you?”.
A systematic approach to trauma-informed care is also necessary
While individual licensed and unlicensed personnel can learn and apply techniques to address scenarios like the one above, a system-wide approach sets staff up for success. First, I recommend that the interventions in your fall prevention care plan are tailored to your patient’s unique fall risks as identified by a validated fall risk assessment (not screening) tool. A simple screening tool only identifies which patients are likely at risk for falling, where a risk assessment goes further to outline the specific risks that enhance a patient’s likelihood to fall. A robust assessment sets the stage for tailored care planning to address specific risks. In our example above, use of a validated assessment tool would give the nurse additional details to share with the patient during the fall risk discussion.
Next, I encourage training for all staff on the topic of trauma-informed care. Such learning can be woven into orientation for new employees as well as into annual competency assessments. It can also be tailored based on each learning group’s scope of practice.
I hope you will reflect on this topic, discuss with colleagues, and consider how you and your institution can leverage trauma-informed care to promote patient adherence to safety precautions.
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