Center for Injury Research and Prevention

What Nurses Know About Trauma-informed Care

January 12, 2015

Moderator’s Note: This post was authored by Christie Alminde, RN, CPN, who served as an outreach coordinator for the Center for Pediatric Traumatic Stress. Prior to CPTS, she was a Surgical/Trauma Nurse at CHOP. As of July 2016, Ms. Alminde has left CIRP@CHOP to pursue her career elsewhere.

Nurses play a key role in children’s physical and psychological recovery from injury. We are often the first to recognize and respond to the emotional impact of injury on families. A new study published in the Journal of Pediatric Nursing provides the first systematic look at what nurses think and do with regard to trauma-informed care for children.

A body of research from CIRP@CHOP investigators and others around the world has shown that traumatic stress reactions following an injury are common and that a significant minority of injured children and their parents go on to have persistent symptoms affecting physical recovery and their daily lives. Thus, a trauma-informed approach in healthcare is important. Bedside nurses in trauma units are the front line in providing this care for injured children.

Researchers from Hershey Medical Center and The Children’s Hospital of Philadelphia surveyed over 200 nurses in Level I and II Pediatric Trauma Centers across Pennsylvania to determine their knowledge and opinions about trauma-informed care and their current trauma-informed practices. Results show that:

• Trauma nurses are knowledgeable about traumatic stress after injury, and they recognize the importance of attending to psychosocial needs as part of trauma nursing care.

• The vast majority of nurses report helping children and their parents manage pain and anxiety during procedures and encouraging parents to turn to family and friends for support.

• Nurses' current practices vary the most with regard to directly asking children and parents about their emotional reactions and providing specific teaching about coping with difficult or painful experiences. 

Gaps in Knowledge Can Be Addressed With Training

Together with recent studies that found only 1 in 5 Trauma Centers routinely screen children and youth for traumatic stress responses, these results help to identify gaps in current practice and point to potential policy and training needs. Many of the nurses surveyed identified a need for additional training and support in practicing trauma-informed care. As one nurse shared with the researchers, “Many times I recognize the potential for PTSD but feel unsure knowing what to say or do outside of everyday care and support to help them cope and hopefully prevent PTSD or minimize its effects in the long run.”

The good news is that pediatric nurses’ skills and experience are already well suited to provide excellent trauma-informed care. And, now there are free online tools available at to help them enhance their nursing practice. The set of brief online courses with free continuing education credits for nurses highlights specific skills based on the D-E-F Protocol developed by experts from the Center for Pediatric Traumatic Stress and the National Child Traumatic Stress Network. “D-E-F” is a quick and easy way to remember Distress, Emotional Support, and the Family as key elements of trauma-informed health care. 

When we incorporate an understanding of traumatic stress into our routine interactions with children and families, we can provide trauma-informed nursing care that not only reduces the impact of difficult or frightening medical events for our pediatric patients, but also helps with their emotional reactions to illness and injury.