Table 2.
Three E’s and Four R’s of Trauma-Informed Nursing Care for Patients With a History of Transracial Adoption
| 3 E’s of Trauma | Explanation | Behavioral Example |
|---|---|---|
| Event | Actual occurrence or perception of extreme threat of physical or psychological harm. | Witnessed intimate partner violence in biological family home of origin. |
| Experience of Event | How a patient assigns meaning to the event and is physically or psychologically disrupted. | Blames self for biological family separation and internalizes fear of authority and law enforcement figures. |
| Effect | Adverse consequences of traumatic stress that include both immediate and long-term emotional, psychological, and physical health problems; symptoms of posttraumatic stress disorder. | Everyday hassles unrelated to event trigger depressive and anxiety symptoms like intrusive thoughts, poor sleep quality. and avoidance behaviors (Brewin et al., 2002). |
| 4 R’s Assumed in Trauma | Explanation | Behavioral Example |
| Realize | The human response to overwhelming traumatic circumstances includes developing coping strategies that underlie their experiences and behaviors, including health seeking behaviors. | Patient requests the same nurse care for them whenever that nurse is on duty and files multiple patient complaints when a different nurse is assigned for care. The supervising nurse realizes this may be coping behaviors for a person with a history of foster care and adoption for experiences of difficulty trusting new caretakers and forming multiple therapeutic relationships. |
| Recognize | Identifying trauma experiences of each unique patient and assessing signs of trauma. | A patient with depressive symptoms discloses a history of adoption. The nurse administers the 10-item Trauma Screening Questionnaire (TSQ) as a focused and in-depth assessment of the patient’s trauma exDeriences (Brewin 2005: Brewin et al., 2002). |
| Respond | Principles of a trauma-informed approach (see Table 4) applied to all areas of nursing practice. | An adult patient seeking treatment for substance use disorder discloses an adoption history. The nurse therapeutically fosters an individual and unit practice environment expressing the belief that resilience, recovery, and healing from trauma are achievable goals. Resources with referrals for peer support groups are available on the unit. |
| Resist Re-traumatization | Reducing and eliminating triggers of traumatic events from the practice environment. | A patient with a history of child abuse and adoption exhibits aggressive behavior toward the nursing staff by name calling, swearing, and throwing objects at walls. Because seclusion and physical restraints are triggers of the patient’s abuse memories and history, the patient and the interdisciplinary team agree to a behavior contract that includes leaving the treatment facility without interacting with other patients or guests and, when instructed by staff, immediately taking 5-10 minutes in the facility gardens to “cool down.” They agree on other de-escalation activities, with immediate discharge if the patient does not follow the behavior contract. |