← Return to Canadian Healthcare System: Issues & Insights

HLTH 4011 Portfolio. Click any image to view it full size.

Title: Safety at the Bedside. Two trauma- and violence-informed approaches for my respiratory therapy practice. Cherry Fan, HLTH 4011, Artifact 3.

Respiratory care is some of the most intimate care in the hospital: we put masks over people’s faces, suction their airways, and puncture their arteries. This artifact introduces trauma- and violence-informed care and two approaches I plan to bring to my practice.

What is trauma- and violence-informed care? Not treating trauma, but avoiding new harm for every patient. About 60% of adults have at least one adverse childhood experience. 1 in 5 adult ICU survivors have PTSD symptoms. Four principles: understand trauma and its impact; create safe environments; foster choice and collaboration; build on strengths.

Trauma- and violence-informed care recognizes the connections between violence, trauma, and people’s health and behaviour. Its goal is not to treat trauma, but to avoid causing new harm for every patient, whether or not we know their history (Public Health Agency of Canada, 2025). This matters because trauma is common: about 60% of adults have had at least one adverse childhood experience (Madigan et al., 2023), and about 1 in 5 adult ICU survivors report PTSD symptoms (Righy et al., 2019).

Approach 1: Interpreting resistance. Anxiety often comes out as anger; resistance is not danger. Pulling off the BiPAP mask may mean it feels like suffocating. Shouting or swearing may mean fear, pain, or panic. Pulling away from an ABG may mean touch without warning feels like a threat. An agitated sedated patient may be having frightening ICU experiences. Ask what happened to this person, not what is wrong with them.

Interpreting resistance is especially important at the bedside in acute care and the emergency department. Anxiety often comes out as anger, so I don’t want to assume a patient is aggressive and dangerous. Treating a reaction as “out of proportion” without considering what is behind it can re-traumatize, and touching someone without warning can trigger a fight-or-flight response (Public Health Agency of Canada, 2025). Instead, I want to pause and ask, “What happened to this person?”

Interpreting resistance at the bedside: speak to every patient as if they can hear you. Explain first, before I touch. Use a calm tone, even if they seem unconscious. Offer control with a stop signal and check consent. Orient them: who I am, where they are, what is next. Trauma does not end at ICU discharge: 1 in 3 had post-traumatic stress symptoms the week after ICU, and new PTSD fell from 13% to 5% with diaries explaining their ICU stay.

In practice, I will explain each step before I touch someone, use a calm tone, and offer whatever control I can, like agreeing on a signal to stop, much as the dentist in Ro (2024) explains every step and keeps checking for consent. A talk on ICU trauma inspired me to speak reassuringly even to patients who appear unconscious. The research supports this: a third of patients had significant post-traumatic stress symptoms within a week of leaving the ICU, and frightening, unreal memories were linked to worse symptoms (Valsø et al., 2020). Diaries explaining what really happened cut new PTSD from 13% to 5% (Jones et al., 2010).

Approach 2: A psychologically safe space, making room for the patient's story, choices, and voice. 1, no assumptions: I can't know their story by looking. 2, listen first: their side of the story, not my script. 3, plan together: options with them, not for them. 4, self-check: pause and notice my own stress and bias. Example question: Is there anything you would like to tell me that might be helpful for our work together?

I aim not to make assumptions about my future patients; even ACE scores cannot predict outcomes for an individual (Anda et al., 2020). I want to let patients tell me their side of the story instead of inserting my ideas about what they should do, using questions like the one above (Public Health Agency of Canada, 2025). And I want to build care plans together, choosing options with the patient rather than for them, and advocating for them when I can.

Pause, reflect, self-check: the step that is easiest to skip on a busy shift. Before I walk in: Am I tired or rushed? Am I carrying assumptions from report? How does my power feel to them? What do I need to stay well? Example, a patient with COPD not using their inhalers: instead of calling them non-compliant, I ask what gets in the way, then we plan around cost, side effects, or fear.

Pausing to reflect is the step I think is easiest to skip. PHAC emphasizes self-reflection on the power difference between providers and patients, and supporting our own well-being so we can keep caring well (Public Health Agency of Canada, 2025). If a patient with COPD is not using their inhalers, I want to ask what gets in the way before I label them non-compliant.

My commitments. Small actions at the bedside can make care feel safe. Read anger as fear: ask what happened, not what is wrong. Speak to be heard: explain and orient every patient, conscious or not. Share the plan: room for their story, choices, and voice.

I will read anger as a possible sign of fear, speak to every patient as though they can hear me, and make room for their story and their choices. Small actions at the bedside can make care feel safe.

References

Anda, R. F., Porter, L. E., & Brown, D. W. (2020). Inside the adverse childhood experience score: Strengths, limitations, and misapplications. American Journal of Preventive Medicine, 59(2), 293–295. https://doi.org/10.1016/j.amepre.2020.01.009

Jones, C., Bäckman, C., Capuzzo, M., Egerod, I., Flaatten, H., Granja, C., Rylander, C., Griffiths, R. D., & RACHEL group. (2010). Intensive care diaries reduce new onset post traumatic stress disorder following critical illness: A randomised, controlled trial. Critical Care, 14(5), Article R168. https://doi.org/10.1186/cc9260

Madigan, S., Deneault, A.-A., Racine, N., Park, J., Thiemann, R., Zhu, J., Dimitropoulos, G., Williamson, T., Fearon, P., Cénat, J. M., McDonald, S., Devereux, C., & Neville, R. D. (2023). Adverse childhood experiences: A meta-analysis of prevalence and moderators among half a million adults in 206 studies. World Psychiatry, 22(3), 463–471. https://doi.org/10.1002/wps.21122

Public Health Agency of Canada. (2025, August 7). Trauma and violence-informed approaches to policy and practice. https://www.canada.ca/en/public-health/services/publications/health-risks-safety/trauma-violence-informed-approaches-policy-practice.html

Righy, C., Rosa, R. G., da Silva, R. T. A., Kochhann, R., Migliavaca, C. B., Robinson, C. C., Teche, S. P., Teixeira, C., Bozza, F. A., & Falavigna, M. (2019). Prevalence of post-traumatic stress disorder symptoms in adult critical care survivors: A systematic review and meta-analysis. Critical Care, 23(1), Article 213. https://doi.org/10.1186/s13054-019-2489-3

Ro, C. (2024, February 26). A tooth examination can be terrifying for victims of rape and assault. These dentists want to help them. BBC. https://www.bbc.com/future/article/20240226-how-dentistry-is-becoming-safer-for-survivors-of-trauma-and-assault

Valsø, Å., Rustøen, T., Skogstad, L., Schou-Bredal, I., Ekeberg, Ø., Småstuen, M. C., Myhren, H., Sunde, K., & Tøien, K. (2020). Post-traumatic stress symptoms and sense of coherence in proximity to intensive care unit discharge. Nursing in Critical Care, 25(2), 117–125. https://doi.org/10.1111/nicc.12466

← Return to Canadian Healthcare System: Issues & Insights