Trauma-informed care (TIC) is a patient-centered approach to healthcare that calls on health professionals to provide care in a way that prevents re-traumatization of patients and staff. TIC is applied universally regardless of trauma disclosure. Grounded in an understanding of the impact of trauma on patients and the workforce, TIC is conceptualized as a lens through which policy and practice are reviewed and revised to ensure settings and services are safe and welcoming for both patients and staff. The TIC framework is being implemented in healthcare and should be incorporated in daily practice, especially in nursing. Nurses have ample opportunities to influence the experience of patients and colleagues, and nursing is a critical field in which to introduce a trauma-informed approach. However, TIC implementation can be challenging if it’s unclear what to do. This article discusses trauma-informed care, and TIC in healthcare and provides strategies for trauma-informed nursing practice, followed by organizational considerations for the nursing workforce.

Introduction: Medication-assisted treatment (MAT) for opioid use disorder (OUD) is underused in primary care. Little is known about patient demographics associated with MAT initiation, particularly among models with an interdisciplinary approach, including behavioral health integration. We hypothesize few disparities in MAT initiation by patient characteristics after implementing this model for OUD. Methods: Electronic health record data were used to identify adults with ≥1 primary care visit in 1 of 2 study clinics in a Pacific Northwest academic health system between September 1, 2015 and August 31, 2017 (n = 23,372). Rates of documented OUD diagnosis were calculated. Multivariate logistic regression estimated odds ratios of MAT initiation, defined as ≥1 electronic health record order for buprenorphine or naltrexone, by patient covariates. Results: Seven percent of the study sample had an OUD diagnosis. Of those patients, 32% had ≥1 MAT order. Patients with documented psychiatric diagnoses or tobacco use had higher odds of initiating MAT (odds ratio [OR] = 1.62, P = .0003; OR = 2.46, P < .0001, respectively). Uninsured, Medicaid, and Medicare patients had lower odds than those commercially insured (OR = 0.53, 0.38, and 0.31, respectively; P < .0001). Patients who were older, of a race/ethnicity other than non-Hispanic white, had documented diabetes, and had documented asthma or chronic obstructive pulmonary disease showed lower odds of initiation. Discussion: MAT initiation varied by patient characteristics, including disparities by insurance coverage and race/ethnicity. The addition of behavioral health did not eliminate disparities in care, but higher odds of initiation among those with a documented psychiatric diagnosis may suggest this model reaches some vulnerable populations. Additional research is needed to further examine these findings.

Primary care clinics are developing treatment models for opioid use disorder, but few are integrating comprehensive behavioral health strategies to improve outcomes. Although Medication Assisted Treatment (MAT) models that emphasize medications may be effective, 1 failure to offer robust psychosocial services can yield suboptimal outcomes, especially in complex patients.We implemented a behavioral health-focused model for MAT to expand access, better engage patients in treatment, and improve health outcomes. This was built on concepts of harm reduction and improvement in functioning, emphasizing behavioral health counseling in addition to medications. WHO & WHEREWe created a multidisciplinary team at a rural health clinic and a federally qualified health center in the Pacific Northwest to address the biopsychosocial needs of patients, with the goal of expanding access, improving retention, reducing relapse, and supporting primary care providers in treating addictions. Masters-and doctoral-level mental health clinicians are integrated into the primary care team to address psychosocial needs, teach coping skills and relapse prevention, and build resilience. This is a valuable benefit to improve abstinence over existing models focused on physician-only care. HOW

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In this chapter we highlight findings and practices from Psychology that can be applied to mitigate the impact of critical illness and the ICU environment on patients, families and staff. The substantial accumulating evidence for detrimental health effects of traumatic stress is highly relevant for the care of patients on the ICU, who are potentially traumatized by the experience and who may bring a history of trauma with them. The fields of trauma psychology and rehabilitation psychology share foundational principles to guide patient-centered and systemic changes to ICU care, and these principles guided our selection and presentation of material. Our discussion of how to implement these principles within a healthcare system is informed by selected findings from social, organizational and behavioral psychology, which also are summarized.