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Trauma Providers' Knowledge, Views, and Practice of Trauma-Informed Care

Bruce, Marta M. BSN, RN; Kassam-Adams, Nancy PhD; Rogers, Mary MSN, RN, NEA-BC; Anderson, Karen M. MSN, RN, PMHCNS-BC; Sluys, Kerstin Prignitz PhD, APRN; Richmond, Therese S. PhD, CRNP, FAAN

doi: 10.1097/JTN.0000000000000356

Trauma-informed interventions have been implemented in various settings, but trauma-informed care (TIC) has not been widely incorporated into the treatment of adult patients with traumatic injuries. The purpose of this study was to examine health care provider knowledge, attitudes, practices, competence, and perceived barriers to implementation of TIC. This cross-sectional study used an anonymous web-based survey to assess attitudes, knowledge, perceived competence, and practice of TIC among trauma providers from an urban academic medical center with a regional resource trauma center. Providers (nurses, physicians, therapists [physical, occupational, respiratory]) working in trauma resuscitation, trauma critical care, and trauma care units were recruited. Descriptive statistics summarized knowledge, attitudes, practice, competence, and perceived barriers to TIC and logistic regression analyses examined factors predicting the use of TIC in practice. Of 147 participants, the majority were nurses (65%), followed by therapists (18%) and physicians (17%), with a median 3 years of experience; 75% answered the knowledge items correctly and 89% held favorable opinions about TIC. Nineteen percent rated themselves as less than “somewhat competent.” All participants rated the following as significant barriers to providing basic TIC: time constraints, need of training, confusing information about TIC, and worry about retraumatizing patients. Self-rated competence was the most consistent predictor of providers' reported use of specific TIC practices. Despite some variability, providers were generally knowledgeable and held favorable views toward incorporating TIC into their practice. TIC training for trauma providers is needed and should aim to build providers' perceived competence in providing TIC.

Penn Injury Science Center, University of Pennsylvania, and Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia (Ms Bruce and Dr Richmond); Perelman School of Medicine, University of Pennsylvania, and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (Dr Kassam-Adams); Hospital of the University of Pennsylvania, Philadelphia (Mss Bruce, Rogers, and Anderson); Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden and Red Cross University College, Stockholm, Sweden (Dr Sluys).

Correspondence: Therese S. Richmond, PhD, CRNP, FAAN, 418 Curie Blvd, Fagin Hall 330, University of Pennsylvania, Philadelphia, PA 19104 (

The authors report no conflicts of interest.

Copyright © 2018 by the Society of Trauma Nurses.