Safety
Promote physical safety in the environment and psychological safety with interpersonal relationships. |
Seek permission before entering a patient’s hospital room, providing bedside care, or initiating physical touch.
Provide time and space for patients to ventilate emotions. Look for nonverbal clues like long verbal pauses, sighs, and restlessness that could signify anxiousness or activation. “I know talking with others about this [topic/issue] can sometimes be overwhelming or cause feelings of anxiety. If you’d like, we can pause here and take a break to just breathe.”
Respect patient boundaries regarding time spent having difficult conversations and number of providers in the room.
Consider an established “safety” word(s) or gesture (e.g., moving the bedside table, turning on the TV) to end the conversation if the patient feels unsafe.
Recognize triggers of trauma symptoms (e.g., physical touch, medication administration like suppositories without anticipatory guidance, power dynamics that may come from increased need for nursing care).
Educate staff on appropriate care modifications with patient preference in mind.
Be mindful of documenting only the minimal necessary elements of the trauma. This reduces the risk of re-traumatization for patients who access their chart. |
| Trustworthiness & Transparency Provide consistent information and build rapport. |
Follow through with care tasks that are offered to the patient in a timely manner. If timing of interventions is unknown, explicitly acknowledge this and provide frequent anticipatory guidance to increase transparency. “I wish I could tell you the exact timing of your MRI this week. Unfortunately, we can’t predict this because the schedule changes frequently based on new emergencies. What we can do is make sure we let you know of updates as soon as we can.”
If a clinician misspeaks or misinterprets an aspect of the patient’s care, acknowledge this, and offer a plan to rectify. “I apologize for the word I just used-I know that was upsetting and going forward I will avoid using it.” |
Peer Support
Increase healing by sharing of stories and lived experiences. |
If someone discloses a prior traumatic experience, acknowledge you hear them, thank them for sharing, and offer empathetic statements.
You can apologize for harm occurred from past experiences without taking responsibility for it—“I am sorry that happened to you.”
Uplift sources of strength and comfort. Offer specific members of the care team whom the patient trusts to be present for difficult conversations and ask if there are others as caregivers, community contacts, or other trusted figures (e.g., primary care clinician, spiritual leaders, etc.) they would like to be present. |
| Collaboration & Mutuality Promote a sense of control by leveling power differences. |
Partner with patients and caregivers each day around care, resisting hierarchical structures and rigidity in providers’ care plan.
Elicit and understand the patient’s communication preferences and incorporate this into medical decision-making and patient communication. “Some people like to hear all the details about their medical care, and others prefer just the main points, but not the details. What is your preference?” |
| Empowerment, Voice, & Choice Encourage autonomy and use of internal resources. |
Promote opportunities for choice. For example, the timing of non-urgent care or the number of clinicians in the room. The goal is to mitigate the loss of control in the healthcare setting. This is especially crucial for patients with serious illness who already experience progressive decline from an illness beyond their control. “I have a few other team members with me today. Would you prefer to talk to just me and one other person, or is it okay if our whole team joins?”
When choices are limited, provide guidance around what to expect. |
Cultural, Racial, Historical, and Gender-specific experiences
Identify and consider the impact of intersectional identities. |
Explore patient’s past experiences with clinicians and the healthcare system. Allow time to hear responses as this exploration can elicit experiences of mistrust, racism, and/or varying types of discrimination.
Ask “How do you like to be addressed?” to explore identity preferences.
Explore other life events which may inform their experience with serious illness. “Has your current serious illness reminded you of anything else in your life?”
Ensure that communication and daily medical care reflects cultural and spiritual preferences and crucial belief systems. See Fast Facts #216 and #478.
Educate yourself about a patient’s or family’s region of origin and if there are relevant traumatic experiences, such as war or genocide that may inform their views on aspects like starvation, medically administered nutrition, urinary catheters, a specific place of death, etc.
With the patient’s permission, provide relevant sociopolitical trauma history (ex. survivor of genocide) in the EMR if you feel doing so can improve the awareness and responsiveness of other clinicians on the clinical team. |
