Before, during and after: Trauma-informed care in burns settings.

Trauma-informed care (TIC) is a model for the relationship of care between service users and service providers that recognises the importance of trauma, past and present, on that person's experiences, vulnerabilities and recovery. Burn injuries are a complex area of healthcare where trauma and the mental health disorders associated with trauma can both precede and proceed a burns injury with complications for recovery. Incorporating a model of TIC in the assessment and treatment of burns patients will proactively work to mitigate and arrest trauma responses, mental disorders and their sequelae in this population. With reference to the existing TIC knowledge base, we propose development of a model for the TIC of burns patients divided into three stages; before, during and after initial engagement with the patient. In the before stage, TIC will require clinical-level change, organisational integration, training and time. In the during stage, five elements are identified; creating safety, screening, collaborative inclusion of the patient in the intervention and recovery planning process, psychoeducation of the patient and supporters, and the use of peer-led services. In the after stage, patients need to be proactively supported through outreach and follow-up. Implementation of a trauma-informed model of care for burns injury patients provides significant opportunities to burns services and benefits towards their patients' recovery.

Moving the lenses of trauma - Trauma-informed care in the burns care setting.

Trauma impacts people's coping mechanisms with their ability to function posing risks to their capacity to manage and respond appropriately to stressors, and to recover. Trauma informed care recognises the needs of survivors by focusing on system-wide design and support during recovery, minimising the risk of re-traumatisation, and maximising choice and empowerment for new adaptations and post-traumatic growth. The principles of TIC are currently not being fully utilised in burns practice, including for severe burns, with the nature, extent and impacts of trauma not being fully understood or acknowledged. Those who sustain a burn injury have an increased risk for developing psychosocial issues that can extend to the family unit, and people with pre-existing mental disorders are more likely to sustain a burns injury, experiencing extended hospitalisation and rehabilitation and being less likely to adhere to burns care. With the application of trauma-informed care within the burns setting, along with an understanding and acknowledging the link between trauma, burns injuries and mental health, health care professionals can minimise potential negative psychological impacts. Investing resources is now essential to effectively address the "trauma deficit" in the area of burns recovery.

Understanding trauma as a system of psycho-social harm: Contributions from the Australian royal commission into child sex abuse.

This article examines how particular understandings of trauma as a systemic form of psychosocial harm framed the establishment of the Australian Royal Commission into Institutional Responses to Child Sexual Abuse, informed its successful investigatory process, and shaped its recommendations and outcomes. In so doing, the Royal Commission makes an important contribution to the field of trauma studies, which has been characterized by contested histories and is subject to continuing debate in clinical and academic research. For much of the twentieth century, trauma and its impacts have been typically articulated through a bio-medical discourse of individual harm and health outcomes. We argue that the establishment of the Royal Commission reflected an expanded understanding of trauma, constitutive of moral, political and psychological arenas as evidenced in its methodology, conceptual approach and treatment of survivor testimony. We also argue that the institutionalization of an historically situated and politically engaged approach to trauma within the Royal Commission itself was effective in contesting narrow psychological or juridical concepts of harm by developing approaches to trauma as a system of harm with complex impacts on families, communities and indeed the nation. We evaluate the implications and consequences of this shift in the work of the Royal Commission, with particular attention to the development of an interdisciplinary relational approach to the study of trauma as a key principle in the emergence of a trauma-informed culture.

TRAUMA-INFORMED CARE AND PRACTICE IN NURSING.

Trauma comes in many guises--from accidents, natural disasters (single incident trauma) to complex trauma such as child abuse and growing up with domestic violence. Illness, medical procedures, treatments and hospitalization are themselves often traumatic, with recent traumas compounding those experienced previously.