Trauma-informed care in practice: observed use of psychosocial care practices with children and families in a large pediatric hospital

Hospitalization for illness or injury can be experienced by children and their families as traumatic, which can impede recovery and lead to ongoing problems. The provision of quality trauma-informed or psychosocial care by hospital staff may mitigate trauma-related problems; however, there is great variability in the use of psychosocial care practices. Most previous research is based on self-report data and focuses primarily on nurses and physicians. The current study aimed to investigate the use of psychosocial care practices among a range of staff in a large urban pediatric hospital, using observations and interviews. A coding matrix of practices and a set of interview questions were developed based on previous research. Participants included 18 direct care hospital staff and 10 patients. Trained observers observed 13 staff and 10 patients, and coded instances of psychosocial care; 17 staff participated in interviews. A large number of instances of psychosocial care were observed but there was substantial variability in overall use and the use of individual practices. Interviewed staff reported many benefits of psychosocial care for patients and staff, although there were some costs, including emotional fatigue. Contrary to current evidence, most staff reported they rely on visible triggers of distress or need before providing psychosocial care. Future research could investigate the optimal ratio of psychosocial to physical care practices, taking into account patient feedback and psychosocial and medical outcomes. To improve the consistency of psychosocial care, training could incorporate the practice examples documented here, include staff self-care, and encourage informal avenues of learning. (PsycINFO Database Record (c) 2019 APA, all rights reserved).