Principles of Trauma-Informed Care and Practice

This article discusses the principles of trauma-informed care and practice in mental health nursing. It explores the issues that contribute to problematic substance use and how they inform collaboration with the patient to achieve personal recovery. The article also highlights the application of trauma-informed care when engaging with the multidisciplinary team in the care planning process.

Running head: PRINCIPLES OF TRAUMA-INFORMED CARE AND PRACTICE 1
Principles of Trauma-Informed Care and Practice
Student’s Name
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PRINCIPLES OF TRAUMA-INFORMED CARE AND PRACTICE 2
Principles of Trauma-Informed Care and Practice
The issues demonstrated in the video which may have contributed to the problematic
substance use
Mental health symptoms are mostly treated through the prescription of certain drugs that
assist the patient to overcome the related symptoms leading to normal functioning of the patient.
In the case, three issues have been presented that have contributed to problematic substance use
(Elder, Evans, & Nizette, 2012). The first issue is the relapse of mental illness due to the failure
of Lisa to take the prescribed drugs. This is seen through the clinical signs of agitation and
fidgeting that make her behave like she is responding to a stimuli in the reception. As seen in the
case, she seems disturbed and looks like there is something that is communicating to her.
The second issue presented in the case is the expression of paranoia that makes Lisa feel
like a voice is communicating to her. This has made her believe that Jona her boyfriend has
inserted a transmitter in her stomach which allows him to see everything that she does. She
further feels that there are cameras in every room that are watching her and she needs to protect
herself.
The last issue is the auditory command hallucinations that seem to be driving her actions.
Hear, the voices are telling her to protect herself which have made her sleep in the garden with a
knife. This means that she possesses a risk to others since these voice commands can make her
harmful and she too fears that she may harm Jona. Although she knows that Jona has never
harmed her, she prefers to listen to the auditory hallucinations rather than her past with Jona.
Principles of trauma-informed care and practice
According to Lisa, Critelli & Rinfrete (2011), one of the principles is safety which
focusses on ensuring that the patient feels secure at all times. This means that the environment

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that the patient meets the practitioner is critical in determining how the patient responds to the
care practice. Chiesa (2014) suggests that this implies that the physical settings that the patient
and the practitioner engage is other is important in developing a good relationship with the
patient since it makes him/her feel secure and able to relate freely. As seen in the case of Lisa,
the patient seemed to be disturbed when in the reception because she looked like she was
responding to stimuli or something that was seeking her attention.
From the case, the counselor seemed to be aware of this issue and applied the principle
effectively by exploring the issues that she was facing thus making her feel comfortable.
Through building rapport, we see Lisa in the case study slowly regrouping herself and seemed to
be engaging with the counselor in a better way. The role of this principle is to ensure that the
patient feels safe based on the way the counselor approaches the issue (Holm & Severinsson,
2010). Here the counselor approached the case by exploring all the issues that Lisa was facing
and even using verbal cues and probing to allow her to open up thus feeling comfortable in the
long run. By explaining to the patient the causes of the issues she is facing, Lisa is driven into
seeking the solution to her problem which makes her agree meeting the mental health counselor.
The second principle is trustworthiness and transparency. The principle is based on the
nature of the relationship between the patient and the counselor (Bosch & Mansell, 2015). In this
case, the client benefits well and works easily with the professional if he or she feels that the
process is being done openly and decisions are made transparently. Thus by being transparent,
the counselor ensure that the patient understands everything that is going. As seen in the case of
Lisa, the counselor has been as transparent as possible because even when making the call to
inquire about the intervention from a mental health worker, the decision is requested from Lisa

PRINCIPLES OF TRAUMA-INFORMED CARE AND PRACTICE 4
before calling the counselor. Through proper communication skills, transparency is achieved by
explaining the issues clearly to Lisa to make her understand what needs to be done about her life.
On the other hand, trustworthiness is based on the ability to be relied on. This means that
the practitioner has to put herself ready to engage and serve the needs of the patient through
exploring the issues faced by the patient to build. One role that communication skills play in
therapeutic relationships is to build trust between the practitioner and the patient. Wilkinson,
Rance, & Fitzsimmons (2017) suggests that therapeutic relationships are established through
proper communication skills that allow the practitioner to relate well with the patient thus
increasing trustworthiness. Through the use of transparency and establishing trustworthiness
with the patient, the counselor was able to establish rapport with the patient, create a feeling of
safety and make Lisa able to relate freely.
The last principle is mutuality and collaboration with the patient. This entails partnering
with the patient through reducing the power differences that define the relationship between the
practitioner and the client. In client-based approaches, the practitioner views the patient as a
partner rather than one who relies heavily on the practitioner (Imel, Baer, Martino, Ball, &
Carroll, 2011). In this case, mutuality is based on establishing the needs of the patient and
developing a care plan that reflects such needs. By developing mutual relationships, the
practitioner achieves the intended goals by cutting down the power difference this ensuring that
the patient is able to relate well in the therapeutic process thus leading to the best clinical
outcomes.
In addition to that, Ribeiro, Ribeiro, Gonçalves, Horvath, & Stiles (2013) suggest that
collaboration is based on making the decision from the side of the patient in order to develop a
care plan that reflects the needs of the patient. For example, to address the issue of hallucination

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and auditory commands that Lisa is facing, it is important to work collaboratively with the
patient to come up with a care plan that addresses the issues that Lisa is facing. Further, the
counselor tried to focus on patient safety and other people safety to ensure that Lisa is able to be
assisted to address the risks that she can expose other people like Jona.
How the issues inform the mental health nurse’s collaboration with the person to achieve
their personal recovery
Collaborative healthcare is the process through which the practitioner and the client work
together to achieve the intended clinical outcomes. Thus the role of therapeutic care is to address
the internal issues that the patient is facing. This entails the mutual relationships that
professionals develop and how their areas of work converge to meet the needs of the patient
(Sullivan, Kiovsky, Mason, Hill, & Dukes, 2015). In this case, the release in mental health,
paranoia and delusional thinking and the commanding auditory hallucinations have to be
explored to understand the underlying causes and develop patient-centered solutions. Since the
main cause of the challenges that Lisa is facing are from the relapse of the mental health
problem, then the practitioner needs to explore them and find ways of addressing them. Through
diagnosis, clinical priorities and therapeutic plan need to be developed to assist the patient
resume her normal life. The role of collaboration here is to ensure that the practitioner seeks
specialized assessment like in the case of mental health.
Since the patient has relapsed in her medication and the mental health problem seems to
have escalated, then the collaborative analysis is important in developing a new medical plan that
will address the issues that Lisa if facing. The fact she is disoriented and cannot even remember
the last time she took her medication means that she presents a difficult mental health problem
that has led her to the use of drugs. Through counseling, the patient will be assisted to adjust her

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lifestyle through behavior therapy that will assist her to solve the mental problem that she is
facing (Andvig, Syse, & Severinsson, 2015). The main challenge that Lisa is presenting is
commanding auditory hallucinations and paranoia which have made her behave abnormally. She
has resorted to personal protection based on what the auditory commands are instructing her
which has led to her being a risk to others. This means that the professional intervention needs to
be collaboratively based on healing the mental health problem and at the same time behavioral
counseling to deal with the maladaptive issues in the life of the patient.
Through collaborative healthcare, a comprehensive healthcare plan is developed for the
patient to solve all the problems that the patient is facing. As seen in the case, Lisa requires the
assistance of a mental health professional and a counselor who need to work collaboratively to
develop a plan that accommodates the principles of the two professionals. The outcome will lead
to better clinical outcomes which will assist Lisa to improve her health problems. One issue that
needs to be emphasized is the concept of trustworthiness that is developed through being
transparent and use of patient-centered care. According to Holm & Severinsson (2010), patient-
centered approaches increase clinical outcomes since they involve the input of the patient in
developing a care plan that reflects her needs.
On the other hand, safety is an issue that needs to be analyzed based on the new
behaviors of Lisa. The fact she is experiencing perceptual disturbance and auditory
hallucinations on the voices that are commanding her. Thus the counselor and the mental health
worker need to work together to develop a care plan that can address the behaviors of Lisa and
reduce the risk that she possess (Correa, Ribeiro, Pinto, & Teixeir, 2016). The fact she is using
spade and cannabis at a higher level than before means that the mental health problem may

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increase in future if the issue is not addressed. Thus the counselor and the mental health worker
need to work together to assist the patient to overcome this problem.
To address the safety fears, transparency needs to be applied to ensure that Lisa
understands the threat that she possess and how this challenge can be reduced. Since both the
counselor and the mental health worker are involved in the case then it means that the patient has
to understand every intervention that is being made in her life. Lisa needs to be made to
understand that her mental health problem is escalating and thus the need to mutually work with
other practitioners to achieve better outcomes. Without addressing this problem, the secondary
problems that Lisa is facing, therapeutic healing may be a challenge to both the patient and
professionals. This collaboration leads to the development of a comprehensive plan that
addresses patient issues through the assistance of other professionals. Mayo & Woolley (2016)
adds that sometimes patient situations present a varying range of clinical outcomes that require
the counselor to work collaboratively with other professionals to address the issues that are
beyond the area of practice.
Application of trauma-informed care by the nurse when engaging the consumer and
another member of the mental health multidisciplinary team with whom the mental health
nurse would be engaged in the process of care planning
Trauma-informed care principles are important when working with members of a
multidisciplinary team to develop the best strategies that meet the needs of the client. One
applicable principle is collaboration and mutuality. This entails balancing the power differences
that exist between other practitioners and the client to achieve the best outcomes (Reeves,
Pelone, Harrison, Goldman, & Zwarenstein, 2017). This means that professionals are supposed
to ensure that their power differences are mutually beneficial and they need to observe the

PRINCIPLES OF TRAUMA-INFORMED CARE AND PRACTICE 8
professional boundaries that they have. This means that the input of other professional is
important in understanding how the needs of the client will be met. In professional collaboration
three levels of working need to be established to ensure that the counselor, Lisa, and the other
professionals need to be developed and aligned to meet the needs of both the client and the
counselor.
Further, the principle of safety is used to protect both the life of the patient and the other
people that are involved in her life. Lisa presents mental health challenges through auditory
commanding hallucinations that seem to be affecting her. The counselor needs to ensure that the
principles of care are observed to meet the needs of the patient (Rickert, 2012). When in the
reception, Lisa seems to be disturbed and looks like she is responding to a stimulus in the
reception. Thus when transferring the patient to the mental health worker, the practitioner needs
to ensure that the safety of the patient is maintained as a way of protecting her needs. Thus, in
this case, the collaboration between the practitioner, the patient, and the mental health worker
needs to be based on mutual collaboration to resolve the issues that Lisa is facing.

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