Psychiatric hospital nurses' attitudes towards trauma-informed care

Abstract

WHAT IS KNOWN ON THE SUBJECT?: Research indicates many clients using mental health services have trauma histories. Consequently, mental health professionals must be aware of the impact of trauma and of how they can avoid retraumatizing service-users. Care delivered with this awareness is known as trauma-informed care (TIC). There is little research on attitudes towards TIC. To date, only one study explored these attitudes among MHNs exclusively. Additionally, a richer understanding of TIC attitudes using methods like in-depth interviews is needed. It is unclear whether knowledge of TIC results in more favourable attitudes. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: MHNs in this study had little knowledge of TIC but expressed overall favourable TIC attitudes. Traumatic histories were not appreciated as causes of challenging behaviour. On rehabilitation wards, clients come to be perceived as family members and this makes it harder for MHNs to not take challenging behaviour of clients personally. MHNs face work-related traumas which interfere with their ability to provide TIC. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Findings of this study can be used to guide plans to implement TIC in psychiatric hospitals. Policymakers are called to appreciate that ensuring MHN well-being on the workplace will facilitate their delivery of TIC. TIC training initiatives for MHNs must stress the importance of acknowledging traumatic histories as causes of challenging behaviour and of maintaining professional boundaries with long-term clients. This would benefit service-users by ensuring MHNs are more trauma-informed. More research on attitudes towards TIC among MHNs is needed. ABSTRACT: Introduction Quantitative studies exploring trauma-informed care (TIC) attitudes have not used samples made up exclusively of mental health nurses (MHNs). Qualitative methods were sparingly used. Aim To examine nurses' TIC attitudes at a psychiatric hospital. Method A mixed-method design was used. One hundred and thirty-six MHNs completed the Attitudes Related to Trauma-Informed Care scale. Data were analysed using inferential statistics. A focus group interview among ten MHNs ensued. Thematic analysis was used. Results MHNs demonstrated favourable TIC attitudes. Ambivalent attitudes for the subscale "Causes" were identified. MHNs employed for less than 5 years at the hospital and those in acute settings displayed more favourable attitudes on some subscales. Three themes "Awareness," "Unhealthy boundaries" and "Inhibition" emerged from qualitative analysis. Discussion Challenges uncovered in the provision of TIC include the unacknowledged impact of trauma on challenging behaviour among MHNS, the influence of blurred professional boundaries with long-term clients on the cycle of perpetuated trauma identified by previous research and MHNs work-related traumas. Implications for practice Identified challenges to TIC integration among MHNs can facilitate the implementation of TIC in hospitals. TIC educational packages for MHNs should acknowledge traumatic histories in the aetiology of challenging behaviour and stress the importance of maintaining professional boundaries with clients.

Keywords: attitudes; hospital; nurses; psychiatric; trauma.