Mount Carmel Hospital, Attard, Malta.
Department of Mental Health, University of Malta, Misda, Malta.
J Psychiatr Ment Health Nurs. 2022 Feb;29(1):75-85. doi: 10.1111/jpm.12747. Epub 2021 Mar 18.
WHAT IS KNOWN ON THE SUBJECT?: Research indicates many clients using mental health services have trauma histories. Consequently, mental health professionals must be aware of the impact of trauma and of how they can avoid retraumatizing service-users. Care delivered with this awareness is known as trauma-informed care (TIC). There is little research on attitudes towards TIC. To date, only one study explored these attitudes among MHNs exclusively. Additionally, a richer understanding of TIC attitudes using methods like in-depth interviews is needed. It is unclear whether knowledge of TIC results in more favourable attitudes. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: MHNs in this study had little knowledge of TIC but expressed overall favourable TIC attitudes. Traumatic histories were not appreciated as causes of challenging behaviour. On rehabilitation wards, clients come to be perceived as family members and this makes it harder for MHNs to not take challenging behaviour of clients personally. MHNs face work-related traumas which interfere with their ability to provide TIC. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Findings of this study can be used to guide plans to implement TIC in psychiatric hospitals. Policymakers are called to appreciate that ensuring MHN well-being on the workplace will facilitate their delivery of TIC. TIC training initiatives for MHNs must stress the importance of acknowledging traumatic histories as causes of challenging behaviour and of maintaining professional boundaries with long-term clients. This would benefit service-users by ensuring MHNs are more trauma-informed. More research on attitudes towards TIC among MHNs is needed. ABSTRACT: Introduction Quantitative studies exploring trauma-informed care (TIC) attitudes have not used samples made up exclusively of mental health nurses (MHNs). Qualitative methods were sparingly used. Aim To examine nurses' TIC attitudes at a psychiatric hospital. Method A mixed-method design was used. One hundred and thirty-six MHNs completed the Attitudes Related to Trauma-Informed Care scale. Data were analysed using inferential statistics. A focus group interview among ten MHNs ensued. Thematic analysis was used. Results MHNs demonstrated favourable TIC attitudes. Ambivalent attitudes for the subscale "Causes" were identified. MHNs employed for less than 5 years at the hospital and those in acute settings displayed more favourable attitudes on some subscales. Three themes "Awareness," "Unhealthy boundaries" and "Inhibition" emerged from qualitative analysis. Discussion Challenges uncovered in the provision of TIC include the unacknowledged impact of trauma on challenging behaviour among MHNS, the influence of blurred professional boundaries with long-term clients on the cycle of perpetuated trauma identified by previous research and MHNs work-related traumas. Implications for practice Identified challenges to TIC integration among MHNs can facilitate the implementation of TIC in hospitals. TIC educational packages for MHNs should acknowledge traumatic histories in the aetiology of challenging behaviour and stress the importance of maintaining professional boundaries with clients.
已知信息：研究表明，许多使用心理健康服务的客户都有创伤史。因此，心理健康专业人员必须意识到创伤的影响，以及他们如何避免使服务使用者再次受到创伤。具有这种意识的护理被称为创伤知情护理（TIC）。关于 TIC 态度的研究很少。迄今为止，只有一项研究专门探讨了这些态度。此外，需要使用深入访谈等方法更深入地了解 TIC 态度。目前尚不清楚 TIC 知识是否会导致更有利的态度。本文的新增内容：在这项研究中，精神科护士（MNH）对 TIC 的了解甚少，但总体上对 TIC 持有利态度。创伤史并未被视为导致挑战性行为的原因。在康复病房，客户逐渐被视为家庭成员，这使得 MNH 更难不将客户的挑战性行为视为个人问题。MNH 面临与工作相关的创伤，这干扰了他们提供 TIC 的能力。对实践的影响：本研究的结果可用于指导在精神病院实施 TIC 的计划。政策制定者需要认识到，确保工作场所 MNH 的福祉将有助于他们提供 TIC。必须强调的是，为 MNH 提供 TIC 培训计划必须强调承认创伤史是导致挑战性行为的原因，并与长期客户保持专业界限的重要性。这将通过确保 MNH 更加了解创伤来使服务使用者受益。需要对 MNH 对 TIC 的态度进行更多的研究。
