Being sick or injured and in the hospital can be a frightening experience for a child of any age. Even the most effective and sensitive medical care may include elements that are frightening or distressing for a child. Separation from parents, pain that is difficult to manage, feeling out of control or feeling helpless - each of these increases the risk a child will experience traumatic stress symptoms related to a medical event.
The moment a child passes through the hospital doors, healthcare professionals have an opportunity to intervene in ways that prevent, or reduce, child traumatic stress reactions. Trauma informed care provides a framework for minimizing potentially traumatic aspects of medical care while also taking into account that some children have a prior trauma history which could influence their emotional responses to medical experiences.
In a recently published article in the American Medical Association’s Journal of Ethics, Dr. Lucas Butler and I explore how the principles of trauma informed care embody core principles of medical ethics.
Several core principles of biomedical ethics give us a clear ethical framework for the provision of trauma informed care:
- The principle of respect for autonomy requires that healthcare professionals respect their patient’s ability to make decisions and control their course of care. While a child’s parents will make most medical decisions, giving a child developmentally appropriate information, and chances to be in control of some aspects of their care will also help to lessen the traumatic stress impact of illness, injury, and treatment.
- The principles of beneficence and nonmaleficence emphasize that healthcare professionals should avoid causing additional emotional distress. In recent years, a wealth of research has shown appropriate pain management and the use of distraction techniques can, in part, help to manage the anxiety and distress associated with medical care. Efforts to provide care with the intention to do good and avoid distress can be enhanced with specific training in trauma informed care, pain management, and distraction techniques. Staying up to date on current best practices will ensure healthcare professionals are well prepared to address the emotional needs of their patients and families.
- The principle of justice means that healthcare professionals must be aware of, and work to reduce, health disparities and their effects on traumatic stress responses among their patients. Providing effective trauma informed care requires healthcare professionals to take into account the patient’s cultural background and beliefs about health and sickness, be aware of systematic disparities in care, and have an open mind to explore one’s own potential unconscious biases when caring for patients.
We conclude that providing trauma informed care for children is consistent with good ethical practice, and helps both individual professionals and hospital systems fulfill their mission of providing sensitive and effective pediatric care for the children they serve.
Healthcare professionals interested in learning more can use the DEF Protocol for Trauma Informed Care as a practical guide to implementing trauma informed care or register for free online courses to enhance trauma informed care at the bedside.
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