The CAH Conditions of Participation require hospital staff to receive trauma-informed competency-based training and education. Additionally, CAHs with swing beds must also adhere to specific LTC Conditions of Participation. Specifically, §483.25(m) the “facility must ensure that residents who are trauma survivors receive culturally competent, trauma-informed care in accordance with professional standards of practice and accounting for residents’ experiences and preferences in order to eliminate or mitigate triggers that may cause re-traumatization of the resident.”
There are three major types of trauma—acute trauma, chronic trauma, and complex trauma. Acute trauma results from exposure to a single overwhelming event (i.e., death of a loved one, sexual assault, natural disaster) and may lead to characteristics like detailed memories, omens, hypervigilance, exaggerated startle response, misperceptions, or overreactions. Chronic trauma results from extended exposure to traumatizing situations (i.e., prolonged exposure to violence or bullying, profound neglect, series of home removals) and may be characterized by denial and psychological numbing, dissociation, rage, social withdrawal, or a sense of foreshortened future. Complex trauma results from a single traumatic event that is devastating enough to have long-lasting effects (i.e., mass casualty school shooting, car accident with fatalities, refugee dislocation) and is often characterized by perpetual mourning or depression, chronic pain, concentration problems, sleep disturbances, and irritability.1
So, why is this important for healthcare personnel to understand? Well, research has uncovered a link between traumatic experiences and a greater change in physical and behavioral health problems in adulthood, including chronic lung and heart disease, liver disease, viral hepatitis, liver cancer, autoimmune disease, sexually transmitted infections, and depression or other mental health conditions.2 Marginalized populations appear to have a disproportionately higher prevalence of trauma and adverse childhood experiences than the general population. This includes people living in low-income communities, ethnic and racial minorities, LGBTQ+ individuals, individuals with disabilities, and women and girls. This further underscores the importance of hospitals capturing social determinants/drivers of health and health equity information for each patient to better understand and/or be aware of possible traumas a person has experienced.
So what does this mean for us?
Hospitals must ensure in-depth patient assessments, including screening for anxiety, depression, substance abuse issues, social history, psychosocial screening and assessment tools, and a physical assessment. Additionally, clinical staff and hospital personnel must understand triggers, or psychological stimuli that prompt recall of a previous traumatic event, even if the stimulus itself is not traumatic or frightening. Triggers may include lack of privacy or confinement; exposure to loud noise or bright flashing lights; certain sights or objects that are associated with those used to abuse; sounds, smells, and even physical touch.
Hospitals must provide trauma-informed care principles, including safety, trustworthiness and transparency, peer support and mutual self-help, collaboration, and empowerment. This allows patients to feel a sense of emotional and physical safety, build relationships founded on trust, and have their choices and preferences honored in their care and decision-making.
Once patients are identified as having experienced a traumatic event, hospital staff must incorporate that knowledge into the patient’s care plan. This includes developing and implementing individualized interventions, identifying triggers that may re-traumatize the patient, identifying interventions to mitigate or decrease the effect of triggers, and monitoring whether the intervention has mitigated or reduced the impact of identified triggers to prevent re-traumatization.
In addition to trauma-informed care, hospitals must be trained in culturally competent care. Staff must understand culture and cultural competencies, including race, ethnicity, and language, be able to communicate and interact effectively with people of cultures different from their own, and implement cultural preferences within the patient’s care plan. Leadership must spearhead cultural competency to create an organizational culture that treats everyone with respect and dignity and supports self-worth, personal control of choices, and cultural preferences. Culturally sensitive care can include specific food preparation and choices, understanding clothing preferences such as covering hair or exposed skin, appropriate physical contact, and demonstrating cultural etiquette.
CAHS must implement trauma-informed care and cultural competency, not just to provide high-quality, respectful patient care, but also to comply with and prepare for surveys. Many F-tags are associated with this Condition of Participation for concerns related to:
- Development or implementation of culturally competent and/or trauma-informed care plan interventions
- For concerns related to outcomes or potential outcomes to the resident related to culturally competent and/or trauma-informed care
- The knowledge, competencies, or skill sets of nursing staff to provide care or services that are culturally competent and trauma-informed
- To treatment and services for residents with history of trauma and/or history of post-traumatic stress disorder
- Others related to behavioral and emotional status
For more information on the CAH Quality Inventory and Assessment, CAH Conditions of Participation, and/or Trauma-Informed and Culturally Competent care, reach out to our expert Carla Wilber, DNP, RN, NE-BS, CATC, CPHQ.