College of Education, Psychology and Social Work, Flinders University, GPO Box 2100, SA, Adelaide, Australia.
South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
BMC Geriatr. 2021 Sep 10;21(1):492. doi: 10.1186/s12877-021-02441-1.
Geriatric hospital wards are highly medicalised environments with limited opportunities for choice and control, and can be distressing for older survivors of psychological trauma. While trauma-informed models of care (TIC) are effectively applied across mental health and other settings, the utility of these models in aged care settings has not been assessed. The objective of this study was to examine whether TIC can reduce responsive behaviour, chemical restraint, and improve staff skills and patient experiences in inpatient geriatric settings.
Four wards participated in this type I hybrid implementation-effectiveness study across southern Adelaide, Australia, including 79 beds. Using a co-design method, the principles of TIC were transformed into an implementation strategy including staff training, establishment of highly trained 'champions' on each ward, screening for trauma-related needs, and amending ward policies and procedures. Primary outcomes will be examined using an interrupted time-series design and are monthly incidence of responsive behaviour incidents and use of chemical restraint. Process evaluation will be used to examine secondary, implementation outcomes including the acceptability, feasibility, and fidelity to the implementation strategy.
Trauma-informed care has potential to improve the safety and accessibility of hospital wards for older people who have survived psychologically traumatic events and has an extensive evidence base supporting its effectiveness in other settings. Identifying trauma-related needs and amending care to reduce the risk of re-traumatisation and distress may also reduce the incidence of responsive behaviour change, which has a significant impact on the quality of life of hospital patients and staff and is very costly. The inclusion of a process evaluation will allow us to identify and report changes made on each ward and make recommendations for future implementation efforts.
老年医院病房是高度医疗化的环境，选择和控制的机会有限，对于经历过心理创伤的老年幸存者来说可能会感到痛苦。虽然创伤知情护理模式（TIC）在精神健康和其他环境中得到了有效应用，但这些模式在老年护理环境中的效用尚未得到评估。本研究的目的是检验 TIC 是否可以减少住院老年病房中的反应性行为、化学约束，并提高员工技能和患者体验。
澳大利亚阿德莱德南部的四个病房参与了这项 I 型混合实施效果研究，包括 79 张床位。使用共同设计方法，将 TIC 的原则转化为实施策略，包括员工培训、在每个病房设立受过高度培训的“冠军”、对与创伤相关的需求进行筛查，以及修改病房政策和程序。主要结果将使用中断时间序列设计进行检查，每月发生的反应性行为事件和使用化学约束的次数。将使用过程评估来检查次要的实施结果，包括实施策略的可接受性、可行性和保真度。
创伤知情护理有可能改善经历过心理创伤事件的老年人的医院病房的安全性和可及性，并且有广泛的证据支持其在其他环境中的有效性。确定与创伤相关的需求并调整护理以降低再次创伤和痛苦的风险，也可能降低反应性行为变化的发生率，这对医院患者和工作人员的生活质量有重大影响，且成本非常高。纳入过程评估将使我们能够识别和报告每个病房所做的更改，并为未来的实施工作提出建议。
