TRAUMA INFORMED PRACTICE: A PHYSIOTHERAPY PERSPECTIVE

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PHYSIOTHERAPY AND TRAUMA INFORMED PRACTICE


The primary elements of a trauma-informed approach
(1) Realizing the widespread impact of trauma exposure
(2) Identifying how ant type of trauma may impact patients, families, and staff
(3) Responding by applying this knowledge into practice
(4) Preventing re-traumatization of patients

WHAT DOES TRAUMA INFORMED PRACTICE MEAN?

This form of practice is a mind set. It is the knowledge and realization that many our patients come to us with varying traumatic experiences. Past traumas can include physical, emotional, psychological, sexual and many others. Trauma can have a great effect on each person and may even impact a patients ability for successful rehabilitation. Trauma can impact our patients in a variety of different ways, including:

1. Cognitively
2. Emotionally
3. Physically
4. Socially
5. Academically
6. Professionally

trauma informed blog

IMPORTANCE OF TRAUMA INFORMED CARE?

Many of our patients will come to us with previous trauma experiences. A trauma-informed practice allows practitioners to shift their focus from a persons problem or pain to more of a holistic approach. Taking into account a patients unique situation and experiences. This lens requires physiotherapists to shift the questions from, “what happened to you?” instead of “what is wrong with you?”
This engaging and respectful approach is important for therapists working with a variety of patents. Especially when assessing and treating a person who already may feel broken, unwanted, or unlovable.
Trauma-informed care is viewed as a paradigm shift, and it could be vital for all physiotherapists in practice. The trauma-informed care approach asks that physiotherapists use compassion and empathy and to be aware of the likelihood of trauma in their clients’ past. This is an important step in helping prevent re-traumatization of our patients and working towards our patients’ goals and aspirations.

TRAUMA INFORMED PRACTICE FOR HEALTH CARE PROFESSIONALS

Trauma informed practice introduces best practice initiatives and assists health care professionals in gaining insight into the theories around trauma.
Organizations that provide this services are also conscious that their services can retraumatize patients.

TRAUMA INFORMED PRACTICE FOR HEALTH CARE PROFESSIONALS

ENVIRONMENT OF CARE

Clean, well maintained and neutral
Overall quiet, unobtrusive
Neutral aroma
Soothing colors for decor and paint
Individual bathroom option
Individual chairs with discrete seating and treatment areas
Clear welcome sign and area

STAFF APPEARANCE

Good general hygiene practices
Easy to identify staff members
Professionalism attire
Clothing not sexually provocative
No religious icons
Discreet jewelry options

STAFF BEHAVIOR

Professional manners, and respectful to all patients
Immediate response to help requests
Speak clear with good eye contact
Smile and demonstrate a pleasant attitude
Initiate greetings
Avoid drink or eat in front of patients

ORGANIZATIONAL UNDERSTANDING

Trauma policy/philosophy in place
Commitment to trauma-informed care
Staff education on trauma and its impact
Behavioural crisis protocol or mental health first aid

 

TREATMENT CONSIDERATIONS

Patient centred goals
Informed consent explained with patients
Common language used when treating and assessing patients
Sensitivity to seating configuration and proximity of seating options
Culture of origin respected
Recognize the importance of physical boundaries and aware that touch—sometimes even a handshake—could trigger trauma
Recognize importance of social boundaries. Jokes, story telling, and speaking vaguely can potentially convey risk or threat

PATIENT ENGAGEMENT

Patient engagement correlates with creating a safe environment. According to Delaney and Johnson (2014), meaningful patient engagement forges a connection that conveys a sense and appreciation of an individual’s human struggle. This sense of empathy is a powerful way to let the patient know that you hear them.
When patients feel connected, they are more likely to respond or seek assistance individuals in moments of distress. This can can prevent or deescalate a personal crisis.

HOW TO REDUCE TRIGGERING PAST TRAUMA

Avoid asking the patient to reproduce the story or event.
Create a comfortable, supportive and relaxed environment
Acknowledging patient’s stories and show empathy by normalizing and validating feelings Encourage self care and mindfulness
Referring to proper support systems

Paraphrasing patients experience to let them know you are listening

BARRIERS TO TRAUMA INFORMED CARE?

Time constraints
Need of training
Confusing information and evidence on trauma-informed practices
Worry about further upsetting or retraumatizing patients.

When asked, many health care providers held favorable views to integrating TIC into their practice and had some prior awareness about how traumatic experiences may affect patients emotionally and behaviorally.

WHAT IS AN ADVERSE CHILDHOOD EXPERIENCE AND ACE SCORE?

Patient engagement correlates with creating a safe environment. According to Delaney and Johnson (2014), meaningful patient engagement forges a connection that conveys a sense and appreciation of an individual’s human struggle. This sense of empathy is a powerful way to let the patient know that you hear them.
When patients feel connected, they are more likely to respond or seek assistance individuals in moments of distress. This can can prevent or deescalate a personal crisis.

the ace pyramid

RESOURCES FOR REFERRALS

Physiotherapy alone may not be enough for our patients. We must ensure that we refer to appropriate resources that have the knowledge and expertise to help work with these individuals to overcome any challenges they may be having.
Edmonton Distress Line: 780.482.4357 Link
211 Information and Referral: 211 Link
Family and Community Support Services Link

Thanks for reading,

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