Department of Nursing, North Carolina Central University, Durham, North Carolina, USA.
School of Nursing, Duke University, Durham, North Carolina, USA.
Issues Ment Health Nurs. 2021 Apr;42(4):321-331. doi: 10.1080/01612840.2020.1795762. Epub 2020 Aug 18.
The unique, individual nature of traumatic experiences and trauma symptoms and the limited healthcare resources typically allocated for individual patients pose barriers to implementing trauma-informed care. Developing knowledge on how survivors of violence engage in healthcare and self-advocate can lead to more empowering and efficient implementation of trauma-informed care. However, survivor perspectives on trauma-informed care are underrepresented in current literature and survivors' strategies for navigating healthcare are understudied. The aims of this participatory Photovoice study were to describe the healthcare experiences of female survivors of violence and their strategies for dealing with difficult healthcare experiences, healthcare providers, and the healthcare system. A sample of community-based women participated in an iterative series of five Photovoice meetings. Participants discussed multifaceted vulnerability in healthcare settings with regard to past traumatic violence, triggering or retraumatizing health care experiences, medical knowledge, and provider-patient relationships. They agreed that providers believing their symptoms, health concerns, and trauma disclosures was essential for positive provider-patient relationships and healthcare experiences. Findings on the importance of perceived belief with regard to trauma disclosure and health concerns and survivors' healthcare strategies are unique contributions to the literature. Providers should be accountable for integrating survivors' self-knowledge in collaborative healthcare decision-making, for making medical records and information easily accessible, and for expressing belief in trauma disclosures and health concerns. Future research should continue using participatory methods to assess evolving trauma-informed practices and patient engagement among survivors and to hasten progress toward trauma-informed care that effectively meets the needs of survivors.
创伤经历和创伤症状的独特性和个体性，以及为个体患者分配的有限医疗资源，都对实施创伤知情护理构成了障碍。了解暴力幸存者如何参与医疗保健和自我倡导，可以更有效地实施以创伤为中心的护理，并赋予他们更多权力。然而，目前的文献中对创伤知情护理的幸存者观点的代表性不足，对幸存者在医疗保健中的应对策略的研究也不足。本参与式摄影心声研究的目的是描述暴力幸存者的医疗保健经历，以及他们应对困难的医疗保健经历、医疗保健提供者和医疗保健系统的策略。一组社区女性参与了一系列迭代的五次摄影心声会议。与会者讨论了在医疗环境中多方面的脆弱性，包括过去的创伤性暴力、引发或重新创伤性的医疗体验、医疗知识和医患关系。他们一致认为，提供者相信他们的症状、健康问题和创伤披露是建立积极的医患关系和医疗体验的关键。关于创伤披露和健康问题的感知信任以及幸存者的医疗保健策略的重要性的发现，是对文献的独特贡献。提供者应负责将幸存者的自我知识纳入协作式医疗保健决策中，使医疗记录和信息易于获取，并对创伤披露和健康问题表示信任。未来的研究应继续使用参与式方法评估幸存者的创伤知情实践和患者参与情况的演变，以加快实现有效的创伤知情护理，满足幸存者的需求。
