Mental Health and Wellbeing in Clinical Practice 

 There are various aspects of the human mind and health which can affect the behaviour and lifestyle of the person in a long-term. Trauma and stress are such conditions which affect the engagement and behaviour of the individual with different persons and services to a great extent. The health care system with emerging best practises in trauma-informed care, on the other hand, is quite efficient for re-traumatising the patients with trauma history and allow them to lead a normal and healthy life (Dubay, Burton, & Epstein, 2018). The present paper will look into the trauma-informed principles and the supporting role of the nurses and midwife in helping those patients and providing better health care system.

The trauma-informed care is a patient-centric approach of the healthcare system which not only appreciate the value of trusting emotionally, supportive and collaborative relationship with the patient but also consider the decision-making, patient knowledge and other intense care requirements making it a distinct experience for the health care professionals as well as the trauma survivors (Koetting, 2016). Six principles have been offered by the Substance Abuse and Mental Health Administration concerning the trauma-informed approach (Centre for Disease Control and Prevention, n.d). The principal includes the safety of the patient which is not only the physical but also include the emotional aspect of the safety and security which must be provided by the health care professionals. Building trust and providing transparency concerning the health care setting are another principle for trauma-informed approach as this can mitigate and expedite the whole process of treatment and prevent the re-traumatization of the patient and recover from their valuable and miserable condition. another principle which has been provided as a pillar for the approach of trauma-informed care is empowering the patient and providing them the choice as well as voice which will help them to feel significant and also elevate the lack of confidence and insecurity in their personality produced as a result of the trauma. The collaboration is also a principle which required for the support of the peer as it can act as a solid approach to reduce and help recover the patient in the given healthcare settings by the nurses. Ultimately the approach which has been advocated by the Substance Abuse and Mental Health Administration is with respect to the respect for the diversity and culture. Since the potential of experiencing re-traumatization while interacting with the providers of the healthcare setting is high, the aviation approach can provide an assurance of the promotion of better physical and mental health outcomes of the patient.

The nurses/ midwife, with the approach of interpersonal interactions, can provide clear and direct communication which will empower the patient as well as the other staff of the health care system to work to create emotional safety for others(Stokes et al., 2017). It is also noticeable that the supporters of the trauma-informed approach have also detected the service setting of the health care system acting as a source of trauma. This suggests the significance of interaction and understanding the perception of the traumatized patient with the potential to re-traumatizing as it is fundamental to the structure of health care system (Dubay et al., 2018, p. 2).

The proper implementation of trauma-informed care demands policies, procedures and health care system to be trauma-informed. The nurses can be utilising this trauma-informed lens in Trauma-informed care to enhance the job satisfaction reducing the risk of burnout and improving the experience of the patient and the outcome of the whole treatment (Schulman & Menschner, 2018). The trauma-informed care requires nurses to have qualities such as awareness, sensitiveness and responsiveness cultivated towards the patient. There are few steps which when integrated into the healthcare system by the nurses will eventually integrate all the Trauma-informed care principles for the nurses.

The first one in this respect is regarding the proper introduction and expression of the role of the nurses to the patient during the interaction (Kwame & Petrucka, 2020). This will ensure that the patient is aware of the nurses and their significance in their care so that the patient himself get motivated to take care of their self. The gesture and the body position of the health care professionals particularly the nurses while working with the patient is also significant in this regard. The use of non-threatening body positions by the nurses during the interaction with the patient allowed them to develop a sense of trust and value resulting in the prevention of the threat detection areas of the brain of the patient. The other significant step to facilitate and provide the six principles of the trauma-informed care is to provide anticipatory guidance to the patient which will are the patient to understand the procedure of their care and other such aspects providing them with a sense of control during the whole hospitalisation period (Marsac, 2016). Having the knowledge and awareness about the activities reduces the potential of surprised and activation which ultimately empower the patient in the process of providing care by the health care professionals.

 Another significant process of the nurses to provide better care and treatment to the trauma-informed patient is to seek permission before touching the patients as most of the trauma survivors have the traumatic experience of inappropriate or unpleasant touch which activate a flight, fight or freeze response in the patients (Brunia, 2016). Touching the patient and helping them with the sitting or applying them any medicine for examining a wound is a procedure associated with the service of nurses. Taking verbal consent before doing any such activity by the nurses will allow to build trust and confidence in the healthcare professional for the traumatized patients and also provide them with a choice empowering them with some sense of control. Another significant step which will ensure the empowerment and respect of the dignity of the patient Traumatic informed- care is to protect the privacy of the patient (Menschner & Maul, 2016). Most of the time patients do not feel the empowerment and the security to ask another person to step out of the room during their healthcare. In such scenario, when the nurses provide them with this safety and protection of privacy, the patient gets a choice and respect for their dignity without getting indulge in any such act with which they are not comfortable. Building trust required to have nurses who are honest and providing them consistently about the realistic expectations which are dependable reliable and consistent for the trauma survivors and they don't get any unexpected or unpredictable expectations resulting into disruptive behaviour of the patient. transparency with the patient about the role of the nurses decreases the opportunities of any confusion and activation or any type of this regulation on the part of the patient.

The use of simple and clear language while conversing with the patient ensures that the patient is fully aware of their conditions and the requirements which are to be made for the proper care to be given to them by the health care setting. Teaching the patient ensures the building of confidence and awareness towards the issues with which the patient has been battling to recover and demands care from the health care professionals (The Commonwealth Fund, 2016). the nurses with a clear language with avoidance to any medical jargon will convey to the patient about their activities and the whole process allowing the patient to develop trust and confidence in their healthcare settings.

The implementation of universal precaution has been suggested by various Trauma-informed care experts instead of direct screening. The traumatized patient and its history are not considered for Trauma-informed care as the universal precaution is beneficial for the patient for the reduction of the risk associated with re-traumatization (Tello, 2018).

Considering the vicarious trauma in the nurse workforce is also considerable for providing proper care and facilitating the six guiding trauma-informed principles (Nurses and Midwife support, n.d). The application of principles of Trauma-informed care in the healthcare system of the traumatized patients is crucial as there is significant risk associated with secondary trauma for the nursing workforce. With proper training and assistance from the nursing workforce, the patient, as well as the nurses, can support each other by the recognition of any such secondary trauma risk as it can produce drastic results for the patients who have been scared by that particular nurse.

The introduction of best practices in trauma-informed care is significant and a very important achievement for the health care setting but it requires the implementation of the various guiding trauma-informed principles to produce the expected results. The principles can be effective and impressive if the nurses and midwife take some steps which will ensure the proper implementation of these guiding principles. The roles and significance of healthcare professionals like nurses and midwives are relevant for ensuring the proper care of the traumatic person in health care. One of the keys to implement and support the guiding principles is to have clear and concise interaction with the patient ensuring the building of trust and empowerment in the patient. Other principles like choice and collaboration with the peer can be developed with the various other steps taken by the nurses in the health care setting. These guiding principles can be an effective methodology to produce and help the patients from getting recovered from the trauma and prevention of any probability of having a re-traumatization case of the patient. The sensitiveness and the mental situation which also include the emotional and physical safety of the patient is significant to understand and evaluated by the nurses to ensure the implementation of these principles effectively in the care of the patient.

References for Facilitating the Six Guiding Trauma-Informed Principles

Brunia, A. (2016, September 16). The importance of trauma informed care. https://www.dmu.edu/news/2016/09/importance-trauma-informed-care/

Centre for Disease Control and Prevention. (n.d). Infographic: 6 Guiding Principles To A Trauma-Informed Approach. https://www.cdc.gov/cpr/infographics/00_docs/TRAINING_EMERGENCY_RESPONDERS_FINAL.pdf

Koetting, C. (2016). Trauma-Informed Care: Helping Patients with a Painful Past. Journal of Christian Nursing, 33. 206-213. 10.1097/CNJ.0000000000000315.

Kwame, A. & Petrucka, P. (2020). Communication in nurse-patient interaction in healthcare settings in sub-Saharan Africa: A scoping review. International Journal of Africa Nursing Sciences, 12, https://doi.org/10.1016/j.ijans.2020.100198

Marsac, M. L., Kassam-Adams, N., Hildenbrand, A. K., Nicholls, E., Winston, F. K., Leff, S. S., & Fein, J. (2016). Implementing a Trauma-Informed Approach in Pediatric Health Care Networks. JAMA pediatrics, 170(1), 70–77.https://doi.org/10.1001/jamapediatrics.2015.2206

Menschner, C. & Maul, A. (2016). Key Ingredients for Successful Trauma-Informed Care Implementation. Center for Health Care Strategies. https://www.samhsa.gov/sites/default/files/programs_campaigns/childrens_mental_health/atc-whitepaper-040616.pdf

Nurses and Mid wife Support. (n.d). Vicarious trauma. https://www.nmsupport.org.au/workplace/vicarious-trauma

Stokes, Y., Jacob, J. D., Gifford, W., Squires, J., & Vandyk, A. (2017). Exploring Nurses' Knowledge and Experiences Related to Trauma-Informed Care. Global qualitative nursing research, 4, 2333393617734510. https://doi.org/10.1177/2333393617734510

Tello, M. (2018, October 16). Trauma-informed care: What it is, and why it’s important. https://www.health.harvard.edu/blog/trauma-informed-care-what-it-is-and-why-its-important-2018101613562

The Commonwealth Fund. (2016, June 24). In focus: recognizing trauma as a means of engaging patients. https://www.commonwealthfund.org/publications/newsletter-article/2016/jun/focus-recognizing-trauma-means-engaging-patients

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