UC San Francisco Dept. of Social and Behavioral Sciences, 3333 California St., Suite 455, San Francisco, CA 94118, USA.
Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, 3333 California St., Suite 335, San Francisco, CA 94118, USA.
Soc Sci Med. 2017 Aug;186:104-112. doi: 10.1016/j.socscimed.2017.06.003. Epub 2017 Jun 12.
In this paper, we delineate how staff of two complex care management (CCM) programs in urban safety net hospitals in the United States understand trauma. We seek to (1) describe how staff in CCM programs talk about trauma in their patients' lives; (2) discuss how trauma concepts allow staff to understand patients' symptoms, health-related behaviors, and responses to care as results of structural conditions; and (3) delineate the mismatch between long-term needs of patients with histories of trauma and the short-term interventions that CCM programs provide. Observation and interview data gathered between February 2015 and August 2016 indicate that CCM providers define trauma expansively to include individual experiences of violence such as childhood abuse and neglect or recent assault, traumatization in the course of accessing health care and structural violence. Though CCM staff implement elements of trauma-informed care, the short-term design of CCM programs puts pressure on the staff to titrate their efforts, moving patients towards graduation or discharge. Trauma concepts enable clinicians to name structural violence in clinically legitimate language. As such, trauma-informed care and structural competency approaches can complement each other.
在本文中，我们阐述了美国两家城市安全网医院复杂护理管理 (CCM) 项目的工作人员如何理解创伤。我们旨在：(1) 描述 CCM 项目的工作人员如何在患者的生活中谈论创伤；(2) 讨论创伤概念如何使工作人员将患者的症状、与健康相关的行为以及对护理的反应理解为结构性条件的结果；(3) 阐明具有创伤史的患者的长期需求与 CCM 项目提供的短期干预之间的不匹配。2015 年 2 月至 2016 年 8 月期间收集的观察和访谈数据表明，CCM 提供者将创伤广泛定义为包括童年虐待和忽视或最近攻击等个人暴力经历、在获得医疗保健和结构性暴力过程中的创伤。尽管 CCM 工作人员实施了创伤知情护理的要素，但 CCM 项目的短期设计给工作人员带来了压力，迫使他们努力让患者毕业或出院。创伤概念使临床医生能够用临床上合理的语言来命名结构性暴力。因此，创伤知情护理和结构能力方法可以相辅相成。
