a broader vision for the women's health nurse practitioner role in trauma informed care

Trauma informed care is best initiated with adequate comprehension regarding trauma and its persevering effects on the individual. Trauma refers to an experience, or multiple experiences, that create a sense of fear, helplessness or horror and which overwhelms one’s resources for coping (Raynor et al., 2020). The relationship between a history of childhood trauma and adult health challenges is supported by abundant evidence (Burns et al., 2023). Amongst the overwhelming evidence is the groundbreaking California Kaiser study of adverse childhood experiences (ACES) in 17,337 individuals (Wholeben et al., 2022). Childhood trauma, or ACES, includes physical, sexual and emotional abuse in childhood and does not exclude neglect or household dysfunction. The term household dysfunction refers to exposure to interpersonal violence at home, living with someone with a mental illness, living with someone with substance use disorder, losing a parent through divorce or death and/or experiencing a parent being incarcerated (Burns et al., 2023; Wholeben et al., 2022). Screening for childhood trauma is limited in the primary care setting despite evidence that ACES are associated with health problems like cigarette smoking, binge drinking, chronic pulmonary disease, obesity, mental health challenges including depression, pain, disability, risky HIV behavior, and frequent ED visits (Burns et al., 2023; Wholeben et al., 2022). Transgender females, and even more so those who are minority transgender youth, experience elevated incidences of substance use, HIV infections and suicide ideations in comparison to cisgender youth (Raynor et al., 2020). The behavior of those who have experienced trauma requires an awareness that most trauma, especially for women and transgender people, is experienced in a hierarchical relationship. Trauma alters brain and body responses to common daily events. Hormones related to these events, like cortisol, continue secretion even after the trauma has ceased and are typically chronically elevated (Burns et al., 2023). Trauma-informed care must be holistic in order to support self-efficacy and resilience through 6 pillars: 1) the acknowledgment that trauma influences the individual as well as their social network, environment and treatment experience 2) respect for privacy in addition to emotional and physical safety 3) recognition of trauma history 4) patient-centered and regulated care 5) avoiding past trauma triggers and 6) avoiding repeating past trauma events (Wholeben et al., 2022)

Historically, the formative role of both midwives and nurse practitioners is rooted in improving healthcare access to the underserved (Sheer, 2020). For example, in 1925, advanced practice pioneer Mary Breckenridge founded the frontier care nursing service which continues to exist today as Frontier Nursing University.  And, in Colorado, Loretta Ford, in conjunction with Dr. Henry Silver, founded one of the initial nurse practitioner programs at the University of Colorado with a keen focus on the needs of underserved and disenfranchised groups (Sheer, 2020). This evolved in the creation of the Medicaid system in the 1960s. Given our historical roots, extensive training and focus on caring for the whole patient, our women’s health nurse practitioner (WHNP) cohort is well poised to lead and work with other members of healthcare teams in managing high-risk scenarios in the women for whom we will care. This is possible in both restrictive and non-restrictive state scenarios and would be especially well suited for rural and fringe rural areas (Pressley et al., 2022). These are the communities where prenatal substance use disorder (SUD) prevails and could improve the possibility for women to be cared for in their local communities (Martin et al., 2022). The foundation of our work, however, must begin with our firm recognition of substance use disorder as a chronic disease rather than mental disorder (Martin et al., 2022; Pressley et al., 2022) in order to diminish stigma and provide optimal and enduring care. We can pursue this work successfully while simultaneously politically advocating for a prioritization of underserved populations and increased WHNP professional autonomy in our ever-changing healthcare landscape (Raynor et al., 2020).

References

Burns, B., Borah, L., Terrell, S., James, L., Erikkinen, E., & Owens, L. (2023). Trauma-informed care curricula for health care professions: a scoping review of best practices for design, implementation and evaluation.  Academic Medicine 98(3), 401-409. https://doi.org/10.1097/ACM.000000000005046

 Martin, C., Thakkar, B., cox, L., Johnson, E, Jones, H., & Connolly, A. (2022). Beyond opioid prescribing: evaluation of a substance use disorder curriculum for OBGYN residents. PLos One 17(9), e0274563. https://doi.org/journal.pone.0274563

Pressley, B., Galvin, S., Ramage, M. & Johnson, E. (2022). Advanced practice provider-led medication for opioid use disorder programs for pregnant and parenting women. Journal of Midwifery and Women’s Health 67(3), 384-393. https://doi.org/10.1111/jmwh.13372

 Sheer, B. (2020) Celebrating our history. Journal of the American Association of Nurse Practitioners 32(12), 782-784. https://doi.org/10.1097/JXX.00000000000530

 Raynor, P., Nation, A., & Outlaw, F. (2020). Exploring substance use and mental health for minority transgender youth: implications for advance practice nurses. Journal of American Association of Nurse Practitioners 32(3), 229-243. https://doi.org/10.1097/JXX00000000000316

 Wholeben, M., McCreary, R., & Salazar, G. (2022). Validation of trauma-informed care instruments: emergency department environment and transitional secondary environment.  Journal of Trauma Nursing 29(6), 282-290. https://doi.org/10.1097/JTN.0000000000681