Getting to know our patients through the lens of trauma informed care

ABSTRACT

Background: It was not mandatory for Skilled Nursing Facilities (SNF) to screen patients for trauma before November 2019, when CMS initiated Trauma-Informed Care (TIC). With this requirement;however, CMS did not provide specific guidance for implementation. The purpose of TIC was to obtain traumatic experiences, identify approaches to manage reoccurrences of certain triggers, and to prevent re-traumatization thus providing a safer environment and more effective care. Here we communicate the accumulated experiences of the first-year implementation of TIC in one SNF. Methods: Budd Terrace at Wesley Woods, a non-profit, 250 bed long-term care and SNF, providing short-term rehabilitation and long-term placement. Without implementation guidance for TIC, our Interdisciplinary Team (IDT) added TIC questionnaires in the Baseline Care Plan, which is within 48 hours of admission. The admission nurse developed a process to guide the collection upon admission including the creation of a system encompassing a 6-part approach emphasizing the sensitive nature of trauma - Trust, Readiness, safe Atmosphere, Understanding, Minimize exposure, and Accommodation Results: We collected data from 473 new admissions from November 2019 to November 2020. Of these, 4.9% (n=23) reported experiencing trauma. Survivors ranged in age from 25 to 97 years old and reported a broad range of trauma experiences including sexual assault (43%, all women);complicated grief (13%);COVID-19 (13%);combat-related PTSD (8.7%);intimate partner violence;racial discrimination;emotional abuse;other medical trauma;and accidents (all at 4.3%). The IDT was informed of the survivors' experiences. The social worker created a comprehensive person-centered care plan for the patient, addressing the trauma, goals, and interventions. Based on information gathered from this process we engaged in therapeutic approaches and take measures to prevent re-traumatization while in our care. Conclusions: During this implementation and ongoing pandemic, we recognized the profound importance of TIC in the SNF setting. Our process enabled us to connect better with our patients as their own self, with their own distinct experiences and needs that are often overlooked in medical charts. It has equipped us with a unique and valuable lens to view our patients, through which we can strive to provide a holistic, personalized, and a compassionate based care.