“Can mental health nurses working in acute mental health units really be trauma‐informed?” An integrative review of the literature

Abstract

The term trauma, from the Greek word meaning "wound," was originally used to refer to an injury of the body. More recently, it has also been applied to include experiences that are psychologically distressing or disturbing (Oxford University Press, 2018). A traumatic event is defined as an actual or threatened death, injury, or violence (American Psychiatric Association, 2013). Complex trauma refers to a type of trauma that occurs repeatedly and cumulatively, usually over a period and within specific relationships and contexts (Courtois, 2008).Trauma and the role it plays in the development of mental health conditions have changed many courses over the years, from the proposed trauma models of the schizophrenogenic mother, to biological determinism, with more recent views holistic yet arguably dominated by the biomedical constructs (Deacon, 2013;Harrington, 2012). It is well known that trauma has long been linked to the development of several mental health conditions and chronic physical illnesses (Felitti et al., 1998). Trauma can lead to changes that are both structural and neurological in the prefrontal cortex and hippocampus, with implications for cognitive processing, emotional regulation and memory (Patel, Spreng, Shin & Girard, 2012). A systematic review conducted by Ahmed-Leitao et al., (2016) found bilateral reductions in the hippocampus and the amygdala in adults with childhood trauma. There is also a statistically significant relationship with adverse childhood experiences and the development of cardiac disease, cerebral vascular diseases, obstructive pulmonary diseases and auto-immune diseases (Felitti et al., 1998;Oral et al., 2016). Trauma is also related to several health risk-taking behaviours (Felitti et al., 1998).The estimated prevalence of trauma among consumers accessing mental health services is approximately between 70% and 90% (Cusack, Frueh & Brady, 2004;Cusack Grubaugh, Knapp & Frueh, 2006;Phipps et al., 2019). Consumers who access mental health inpatient units (MHIPUs) can also experience trauma or retraumatization when accessing such services (Ashmore et al., 2015).Trauma and re-traumatization occur secondary to several common coercive practices such as seclusion, restraint, involuntary treatment and enforced medication compliance, involuntary transport by police or ambulance; the environment in itself is also commonly reported as traumatizing (Wilson, Hutchinson & Hurley, 2017; New South Wales Ministry of Health, 2017). In addition, treatment for trauma is not commonly offered or explored as a treatment option in MHIPUs (Kezelman & Stavropoulos, 2012).There is great variability among the type of coercive practices used in mental health settings internationally (Steinert et al., 2010).Recent Australian data show 57% of mental health admissions were involuntary, 4.2 hr being the average seclusion event and 11.3

Trauma‐informed care in acute mental health units through the lifeworld of mental health nurses: A phenomenological study

“…Much of the discourse around MHN is centred around a highly vulnerable workforce, with imminent workforce shortages, insufficient resources, high rates of workplace violence and aggression, substance use and unpredictably unsafe environments (Cranage & Foster, 2022). Previous TIC studies have highlighted the urgency for a critical review into MHN experiences of compassion fatigue, vicarious trauma and the subsequent implications for TIC (Wilson et al, 2021). Very few studies have explored the positive or affirmative processes that support the proliferation of TIC in lieu of the abovementioned challenges.…”

“…To the best of our knowledge, only four reviews have explored TIC from the perspective of the MHN in the acute mental health environment or hospital setting, with many of the cited studies within these reviews being outdated and lacking robust methodological rigour (Muskett, 2014; O'Dwyer et al, 2021; Wilson et al, 2017, 2021). What is evident from these reviews is that there are multiple challenges and knowledge gaps when integrating TIC in acute MHN roles.…”

“…Challenges have been identified as staffing dynamics, policy and processes, clinical incidents, key performance indicators (KPIs), quality assurance processes, funding and resource arrangements, training and education, technology and equipment, and leadership and culture challenges (Isobel, Wilson, Gill, & Howe, 2020; Isobel, Wilson, Gill, Schelling, & Howe, 2020; Wilson et al, 2017). Other influencing factors for TIC include the inherent power dynamics between the medical team and the MHN profession, prioritization of organizational tasks and medical duties over interpersonal components of healing and care (Wilson et al, 2021).…”

The biological paradigm of psychosis in crisis: A Kuhnian analysis

“…Popper (1970, p. 53) proposes that those undertaking normal science could be considered ‘victims of indoctrination’, working within paradigms which are not accepting of novel theories. Mental health nurses are perhaps an interesting group to be considered in relation to this notion of indoctrination, as one could argue that mental health nurses are often working within , but not necessarily of biological or medical model paradigms (Isobel & Edwards, 2017; Wilson et al, 2021). In this sense, mental health nurses could be viewed as an oppressed group (Roberts et al, 2009), often working within a paradigm underpinned by an epistemology which is of limited use to them (O'Donovan, 2007).…”

In their own words: Mental health nurses' experiences of trauma‐informed care in acute mental health settings or hospitals

“…Existing research on TIC in mental health settings has consistently reported that MHNs also experience trauma and re-traumatisation; with limited investigation into the role of the TIC model vis-à-vis these identified challenges (Isobel et al, 2020;Jacobwitz et al, 2015;Wilson et al, 2021). Notably, only a limited number of studies have exclusively centred on the implications of TIC for the MHN profession within hospital or acute mental health settings (Wilson et al, 2021(Wilson et al, , 2023. It is imperative to explore the implications of TIC on the MHN profession within this context to enhance the quality of care for people living with mental health conditions.…”