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Goldstein E, Chokshi B, Melendez-Torres GJ, Rios A, Jelley M, Lewis-O’Connor A. Effectiveness of Trauma-Informed Care Implementation in Health Care Settings: Systematic Review of Reviews and Realist Synthesis. Perm J 2024; 28:135-150. [PMID: 38444328 PMCID: PMC10940237 DOI: 10.7812/tpp/23.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
PURPOSE Given the ubiquity of traumatic exposures and the profound impact of trauma on health, a trauma-informed care (TIC) approach in health care is critical. TIC seeks to promote safety within health care and prevent retraumatization. The lack of systems-level data has been a major barrier to TIC implementation. This study aimed to understand the mechanisms and outcomes effective in implementing TIC across health systems using a systematic review of reviews and realist synthesis. METHODS A systematic search of MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Applied Social Science Index & Abstracts identified reviews addressing TIC in health care published in the last 10 years in peer-reviewed journals. Realist synthesis methodology was used to develop context-mechanism-outcome configurations. Thematic analysis was performed to generate a framework for the mechanisms of implementation that produce successful TIC outcomes. RESULTS Sixteen articles featuring varied review types were included. The results, highlighting the strategies that lead to improved outcomes for patients and systems, were mapped to SAMHSA's 10 TIC implementation domains, including engagement and involvement; training and workforce development; cross-sector collaboration; screening, assessment, and treatment services; governance and leadership; policy; evaluation; progress monitoring and quality assurance; financing; and physical environment. CONCLUSION The findings support the use of SAMHSA's 10 implementation domains in varied health care contexts to facilitate effective TIC processes. Future work should continue to evaluate the effectiveness of TIC approaches and may consider how health equity and strengths-based approaches fit within SAMHSA's framework.
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Affiliation(s)
- Ellen Goldstein
- Department of Population Health Nursing Science, University of Illinois Chicago College of Nursing, Chicago, IL, USA
| | - Binny Chokshi
- Department of Pediatrics, Division of Military Child and Family Research, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Anna Rios
- Division of Women’s Health, Brigham and Women’s Hospital, Boston, MA, USA
| | - Martina Jelley
- Department of Internal Medicine, University of Oklahoma School of Community Medicine, Tulsa, OK, USA
| | - Annie Lewis-O’Connor
- Department of Nursing & Division of Women’s Health, Brigham and Women’s Hospital, Boston, MA, USA
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Lewis-O’Connor A, Linzer PB, Goldstein E. Nurses' Experience After First Wave of COVID-19: Implications for a Trauma-Informed Workforce. Perm J 2024; 28:124-134. [PMID: 37994032 PMCID: PMC10940250 DOI: 10.7812/tpp/23.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND The COVID-19 pandemic impacted nurses worldwide, increasing their risk of burnout and compassion fatigue. Although the literature on nurse deployment has been limited, this study describes nurses' experience and assesses their professional quality of life after the first phase of the pandemic and redeployment efforts. METHODS In 2020, nurses returning from their deployment to COVID-19 treatment units were invited to complete the Professional Quality of Life Survey and gather for debrief sessions, referred to as campfires, in which semistructured questions about their experiences were administered among clinical nurses and nurse leaders. Employing a mixed methods design, the authors conducted descriptive statistics for survey responses and inductive thematic analysis to identify emergent themes from open-ended questions. RESULTS A total of 19 campfires were held with 278 nurse participants. Of the 278 participants, 220 completed surveys. Of these, 194 (88%) represented 30 nurse leaders and 164 staff nurses. The majority of surveyed nurses in both groups reported compassion satisfaction despite reporting moderate levels of burnout and secondary traumatic stress. Qualitative themes from campfires with clinical nurses and nurse leaders revealed similarities, such as concern for safety and lack of choices and transparency, although each group faced unique challenges. CONCLUSIONS Findings related to post deployment and adverse psychological health suggest that a trauma-informed approach (ie, staff autonomy, physical and psychological safety, transparency, offering choices, leveraging voices, and collaboration) by leaders could enhance a culture of wellness, build resilience, and mitigate empathic burnout and also proactively and strategically thinking about preventive measures for future catastrophic events.
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Affiliation(s)
- Annie Lewis-O’Connor
- Department of Nursing & Division of Women’s Health, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Ellen Goldstein
- Department of Population Health Nursing Science, University of Illinois Chicago College of Nursing, Chicago, IL, USA
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Gosangi B, Wong A, Gujrathi R, Park H, Thomas R, Lewis-O’Connor A, Stoklosa HM, Khurana B. Imaging patterns of thoracic injuries in survivors of intimate partner violence (IPV). Emerg Radiol 2023; 30:71-84. [PMID: 36418488 PMCID: PMC9684831 DOI: 10.1007/s10140-022-02097-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 10/21/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To recognize the imaging patterns of thoracic injuries in survivors of intimate partner violence (IPV). MATERIALS AND METHODS A retrospective radiological review of 688 patients self-reporting IPV to our institution's violence intervention and prevention program between January 2013 and June 2018 identified 30 patients with 89 thoracic injuries. Imaging and demographic data were collected. RESULTS Thirty survivors with 89 injuries to the thorax were identified with a median age of 43.5 years (21-65 years). IPV was reported or disclosed as the direct cause of injury in 50% (15/30) of survivors, including all nine patients who sustained penetrating injuries. The most common injury type was fracture (72%, 64/89) with 52 rib, 3 sternal, 2 clavicular, and 7 vertebral fractures. There were 3 acromioclavicular dislocations. Among rib fractures, right lower anterior rib fractures (9-12 ribs) were the most common(30%, 16/52). There were 10 superficial soft tissue injuries. There were 12 deep tissue injuries which included 2 lung contusions, 2 pneumomediastinum, 7 pneumothoraces, 1 hemothorax. One third of patients had concomitant injuries of other organ systems, most commonly to the head and face, followed by extremities and one third of patients had metachronous injuries. CONCLUSION Acute rib fractures with concomitant injuries to the head, neck, face, and extremities with an unclear mechanism of injury should prompt the radiologist to discuss the possibility of IPV with the ordering physician. ADVANCES IN KNOWLEDGE Recognizing common injuries to the thorax will prompt the radiologists to suspect IPV and discuss it with the clinicians.
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Affiliation(s)
- Babina Gosangi
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT USA
| | - Andrew Wong
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Rahul Gujrathi
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Hyesun Park
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Richard Thomas
- Department of Radiology, Lahey Health System, Burlington, MA USA
| | - Annie Lewis-O’Connor
- C.A.R.E. Clinic (Coordinated Approach to Resiliency & Empowerment) Founder and Director, Brigham and Womens Hospital, Boston, MA USA
| | - Hanni M. Stoklosa
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Bharti Khurana
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA ,Founder and Director, Trauma Imaging Research and Innovation Center, Brigham and Women’s Hospital, Boston, MA USA
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Gujrathi R, Tang A, Thomas R, Park H, Gosangi B, Stoklosa HM, Lewis-O’Connor A, Seltzer SE, Boland GW, Rexrode KM, Orgill DP, Khurana B. Facial injury patterns in victims of intimate partner violence. Emerg Radiol 2022; 29:697-707. [PMID: 35505264 PMCID: PMC9064123 DOI: 10.1007/s10140-022-02052-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/22/2022] [Indexed: 01/21/2023]
Abstract
Purpose To evaluate the imaging findings of facial injuries in patients reporting intimate partner violence (IPV). Methods A retrospective review of radiology studies performed for 668 patients reporting IPV to our institution’s violence prevention support program identified 96 patients with 152 facial injuries. Demographics, imaging findings, and clinical data obtained from a review of the electronic medical records (EMR) were analyzed to categorize injury patterns. Results The study cohort consisted of 93 women and 3 men with a mean age of 35 years (range 19–76; median 32). At the time of presentation, 57 (59.3%) patients reported IPV as the mechanism of injury. The most frequent site of injury was the midface, seen in 65 (67.7%) patients. The most common fracture sites were the nasal bones (45/152, 29.6%), followed by the mandible (17/152, 11.1%), and orbits (16/152, 10.5%). Left-sided injuries were more common (90/152; 59.2%). A vast majority of fractures (94.5%) showed minimal or no displacement. Over one-third of injuries (60/152, 39.4%) demonstrated only soft tissue swelling or hematoma without fracture. Associated injuries were seen most frequently in the upper extremity, occurring synchronously in 11 (11.4%) patients, and preceding the index facial injury in 20 (21%) patients. Conclusion /advances in knowledge. The midface was the most frequent location of injury in victims of intimate partner violence, and the nasal bone was the most commonly fractured facial bone. Recognizing these injury patterns can help radiologists suspect IPV and prompt them to discuss the possibility of IPV with the clinical providers.
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Affiliation(s)
- Rahul Gujrathi
- Trauma Imaging Research and Innovation Center, Brigham and Women’s Hospital, Boston, MA USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Anji Tang
- Trauma Imaging Research and Innovation Center, Brigham and Women’s Hospital, Boston, MA USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Richard Thomas
- Trauma Imaging Research and Innovation Center, Brigham and Women’s Hospital, Boston, MA USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Hyesun Park
- Trauma Imaging Research and Innovation Center, Brigham and Women’s Hospital, Boston, MA USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Babina Gosangi
- Trauma Imaging Research and Innovation Center, Brigham and Women’s Hospital, Boston, MA USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Hanni M. Stoklosa
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA USA
| | - Annie Lewis-O’Connor
- C.A.R.E. Clinic (Coordinated Approach to Resiliency & Empowerment), Brigham and Women’s Hospital, Boston, MA USA
| | - Steven E. Seltzer
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
| | - Giles W. Boland
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
- Brigham and Women’s Physicians Organization, Boston, USA
| | - Kathryn M. Rexrode
- Department of Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, USA
| | - Dennis P. Orgill
- Department of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, USA
| | - Bharti Khurana
- Trauma Imaging Research and Innovation Center, Brigham and Women’s Hospital, Boston, MA USA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA
- Department of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, USA
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