1. Trauma Informed Education in the Care of Homeless Veterans
Marilyn Hughey DNP(c), MSN, RN, CNE
Chair: Barbara Sartell EdD, ANP, BC, WCC
Project Purpose
Theoretical Frameworks for Evidence-based
Nursing Practice
References for Theoretical Frameworks
Neuman Systems Model
Question:
Does Trauma-Informed Care (TIC) education given to staff and volunteers who work with homeless veterans enhance their knowledge to deliver trauma-sensitive care to these veterans?
Goal:
Enhance staff knowledge of Trauma-Informed Care (TIC) approaches (Dinnen, Kane and Cook, 2014).
Enhance staff skills to give trauma-sensitive care
Using trauma-sensitive interventions will help to create a nonthreatening environment of care.
When homeless veterans develop a trust with the staff, hopefully they will be more likely to comply with seeking healthcare, and agree to temporary and permanent housing options.
Goal is that the homeless veteran will agree to safe, secure housing settings.
These interventions are aimed at eliminating the veterans’ health disparities, and helping them to better meet the goals of Healthy People 2020 (U.S. DHHS, 2011)
Dinnen, S., Kane, V., & Cook, J. M. (2014). Trauma-informed care: A paradigm shift needed for services with homeless veterans. Professional Case Management, 19(4), 161 – 170. Retrieved from
Neuman, B. (Ed.). (1995). The Neuman Systems Model (3rd ed.). Stanford, CT: Appleton & Lang.
The DNP student had the honor of meeting and discussing her DNP project with Dr. Betty Neuman, Dr. Jacqueline Fawcett and Sister Callista Roy, PhD
The Neuman Systems Model (NSM) was utilized as the nursing theoretical framework.
wellness-illness orientation
Theory addresses the unmet biological, social, economic, and environmental needs of homeless veterans.
use to promote stability and balance in these veterans’ environment.
framework for assessing, planning, evaluating and providing evidence-based nursing interventions and outcomes.
A Trauma-Informed Care (TIC)
acknowledges the negative influences that trauma can have on one’s physical and emotional well-being.
ensures that the individual feels safe and secure by creating a non-threatening environment.
offer treatment for previous traumas and to prevent another traumatization. TIC model fits well with the stressors in the NSM. Both the NSM and TIC theories are person-focused.
Evidence that Supports the Project
Carlson et al (2013) studied traumatic exposure to stress in 115 homeless veterans.
Results showed that trauma impacts negatively on health and well-being
Study supports the DNP interventions of assessing for past and present trauma and instituting trauma-sensitive approaches to prevent further traumatization.
Dinnen, Kane, and Cook. (2014) conducted a retrospective study of the trauma histories of homeless veterans.
Study supported a link between histories of exposure to trauma and homelessness
The study and the DNP project have a similar focus on utilizing trauma-sensiiive interventions for positive outcomes.
Portland VA Medical Center (2011) systematic review of literature
Showed lack of current literature on homelessness and a need for further research.
Study supports that the DNP project’s topic is a worthwhile one to pursue.
Montgomery and Byrne (2014) completed a secondary analysis study of a gender-based comparison of recently homeless veterans.
Data showed that women are a significant segment of the veteran population
Study reinforced the need for the DNP project to address the healthcare needs of both male and female veterans.
Choi and Seng (2015) studied TIC training intervention for staff that work with posttraumatic stress in childbearing women in the perinatal setting.
Nurse-led and used a single-group, pre-post-test method design
Participants had heterogenous knowledge and expertise levels.
Both the study and the DNP project addressed the group dynamics of heterogenous participant groups.
Results
All participants reported a statistically significant change in their ability to address TIC after education based on the questions asked (p-value ≤ 0.001).
Additionally, based on effect size analysis (r) this change in ability was at least moderate (R-value> 0.3).
Participants
54 attendees; 48 returned packets
2 packets not complete
Sample size (n) = 46
Gender: Male 8 (17%); Female 38 (83%)
Age: % (21); % (6); % (5); % (7);;
61 or over 15% (7)
Current practice is trauma informed: Yes 14 (30%); No 32 (70%)
Conclusions and Recommendations for
Future Practice gy
Conclusion:
The learning module was a beginning introduction to TIC and trauma-sensitive approaches.
The project alone was not expected to make the participants TIC experts.
The hope was that the intervention would spark an interest in the participants to continue to learn more about TIC approaches and techniques.
Recommendations for Future Practice:
TIC approaches can help APRNs advocate for vulnerable, at-risk populations
TIC can be applied to all nursing specialities.
TIC can help build client trust so they accept and use healthcare services and interventions
Methodology
An extensive literature review was done.
A pre-test – post-test method was used
Based on this review an evidence-based learning module on Trauma-informed Care was developed.
Participants’ packets included: a participant informed consent, a demographic survey, a pre- and post-presentation survey , and a presenter/presentation evaluation
Quantitative analysis was completed on the answers to the paper 10-item, 4-point Likert scale questionnaire
A Wilcoxon Signed-Ranked Test for Paired Samples compared the pre and post means of each question . The p values were calculated to assess statistical significance.
Themes in the participants’ comments to the 2 qualitative post intervention questions supported attitudinal changes toward the acceptance of TIC as a valuable approach to care of homeless veterans.
Variable
Description
Count (n)
Percentage
Gender
Female 38 17
Male 8 83
Age
18-30 21 46
31-40 6 13
41-50 5 11
51-60 7 15
61 or over
Current practice is trauma informed
Yes 14 30 No 32 70
Ethnicity/Race
Asian/Pacific Islander 1 2
Black/African American
Hispanic 3
White/Caucasian 65
Multiple ethnicity/Other
Demographic statistics of participants
Sample n = 46