Trauma-Informed Care in ER: Emotional Resilience Strategies

The fluorescent lights buzzed overhead, casting a sterile glow inside the ever busy ER. Sarah, a young emergency nurse with bright green scrubs, scanned the waiting room. Tonight, the usual mix of coughs, scrapes, and worried faces was somewhat paused by a young woman, her head buried in her hands, shoulders shaking with silent sobs. This was Emily, a frequent visitor to the ER, often arriving with vague complaints of nausea or dizziness.

Sarah knew there was more to Emily’s story. Raised in a chaotic household marked by her father’s unpredictable temper, Emily had grown accustomed to a constant state of hypervigilance. Every loud noise, every raised voice, triggered a fight-or-flight response that left her feeling overwhelmed and on edge. This hyper-anxiety often manifested as physical symptoms, leading to her frequent ER visits.

What is the Root Cause of Emily’s Distress?

Sarah, having recently undergone training in trauma-informed care, recognised the signs. After Emily received a clean bill of health from the attending physician, Sarah took a different approach. Instead of focusing solely on the physical, she sat down with Emily in a quiet corner of the ER.

“Emily,” Sarah began gently, “I know these visits can be stressful. Would you like to talk about what’s been going on?”

Emily hesitated, tears welling up again. But Sarah’s calm demeanour and genuine concern offered a safe space she hadn’t experienced before. In a quiet voice, Emily shared her story – the constant fear at home, the feeling of never being able to relax. Sarah listened without judgement, validating Emily’s feelings and acknowledging the impact her upbringing had on her health.

Building Bridges of Trust

This empathic approach was a turning point. Over the following weeks, Sarah and Emily developed a rapport. Sarah learned that Emily had a hidden talent for music, playing the guitar with a passion that soothed her anxieties. However, the chaotic environment at home made it difficult for her to focus and truly connect with the music.

Emergency departments (ERs) are often the first point of contact for people experiencing physical and emotional trauma. From car accidents and assaults to sudden illness and mental health crises, ER staff witness a lot of pain and suffering. Patients arrive in various states of distress, and healthcare providers work tirelessly to address their physical needs. But what about the emotional toll emergencies take on everyone involved? This is where trauma-informed care comes in.

Trauma-informed care isn’t just about treating physical wounds; it’s about recognising that many patients may have experienced past traumas that can influence their current situation. By understanding this, ER staff can create a more supportive and healing environment for everyone.

What is Trauma?

Trauma is an emotional response to a terrifying or distressing event. It can be caused by a single incident like a car accident or violence, or by repeated experiences like abuse or neglect. Trauma can have lasting effects on a person’s mental, physical, and emotional health.

Here’s why trauma is relevant in the ER:

• Many ER patients have experienced trauma: Studies show a significant portion of ER visits are related to past traumas, either as a cause of the current situation (e.g., injuries from domestic violence) or influencing how a patient reacts to the crisis (e.g., anxiety attacks triggered by medical procedures). 
• Trauma can make emergencies more stressful: People who have experienced trauma may be more easily overwhelmed, hypervigilant (constantly on guard), or emotionally reactive in stressful situations like an ER visit.

What is Trauma-Informed Care?

Trauma is any experience that overwhelms a person’s ability to cope. It can be a single event, like a violent attack, or a long-term experience, like chronic abuse. Trauma can have lasting physical and emotional effects.

Trauma-informed care is an approach that acknowledges the prevalence of trauma and its impact on people’s lives. Here are some key principles of TIC:

• Realise the widespread impact: Trauma is more common than you might think. It can affect anyone, regardless of age, race, gender, or socioeconomic status.
• Recognise and respect reactions: People who have experienced trauma may react in different ways. Be patient and understanding.
• Empower and collaborate: Involve patients in their care decisions as much as possible. Treat them with respect and dignity.
• Focus on safety: Create a safe and predictable environment for both patients and staff.

The Importance of Trauma-Informed Care in the ER

Trauma-informed care in the ER is about creating a safe and supportive environment for everyone. Here’s how it benefits both patients and staff:

• Improved patient care: By understanding the potential impact of trauma, healthcare providers can better communicate with patients, reduce anxiety, and provide more effective care.
• Reduced staff stress: When staff recognize and address the emotional needs of patients, it can lead to a more positive and supportive work environment for themselves.

Why is TIC Important for ER Staff?

The Impact of Secondary Trauma on ER Staff

While providing care, ER staff are constantly exposed to the emotional pain of others. This can lead to secondary trauma, which shares many symptoms with post-traumatic stress disorder (PTSD). These symptoms can include:

• Burnout: Feeling emotionally drained and cynical about work.
• Compassion fatigue: A loss of the ability to feel empathy and care for others.
• Anxiety and depression: Feeling overwhelmed, hopeless, and irritable.
• Physical health problems: Headaches, stomachaches, and sleep disturbances.

STS can negatively impact both staff well-being and patient care. Staff who are struggling with STS may be less patient and compassionate with their patients. They may also be more likely to make mistakes.

How can One Build Emotional Resilience

There are many things ER staff can do to build their emotional resilience and prevent STS. Here are some key strategies:

• Self-care: This is the foundation of emotional resilience. Make sure you are getting enough sleep, eating healthy foods, and exercising regularly. Schedule time for relaxation and activities you enjoy.
• Social support: Connect with colleagues, friends, and family. Talk to them about what you are going through. Find a support group for ER staff.
• Mindfulness and relaxation techniques: Practices like meditation, deep breathing, and yoga can help you manage stress and stay present in the moment.
• Critical incident stress management (CISM): Many hospitals offer CISM programs that can provide support and debriefing after critical incidents.
• Set boundaries: It’s important to learn to say no and take breaks when you need them. Don’t feel like you have to be a hero all the time.
• Seek professional help: If you are struggling with STS, don’t hesitate to seek professional help. A therapist can teach you coping skills and help you process your experiences.

Creating a Trauma-Informed ER Environment

In addition to individual strategies, hospitals can create a trauma-informed environment that supports staff well-being. Here are some ideas:

• Training: Provide staff with training on trauma-informed care and the impact of trauma on both patients and staff.
• Peer support programs: Create programs that allow staff to support each other.
• Flexible scheduling: Offer flexible scheduling options to help staff maintain a healthy work-life balance.
• Recognition and appreciation: Recognise and appreciate the hard work and dedication of your staff.
• Reduce administrative burden: Streamline paperwork and other administrative tasks to reduce stress.
• Debriefing after critical incidents: Hold debriefing sessions after critical incidents to allow staff to process their experiences.

The Benefits of Trauma-Informed Care

Trauma-informed care benefits not only staff but also patients. When staff are well-rested, supported, and resilient, they are better able to provide compassionate and effective care. This can lead to better patient outcomes, including:

• Improved patient satisfaction
• Reduced healthcare costs
• Decreased length of stay in the ER

Emergency departments are places of great need, but they can also be places of great healing. By embracing trauma-informed care and investing in staff well-being, ERs can create a supportive environment where both patients and staff can thrive.  

The Benefits of Building Resilience

By building emotional resilience, ER staff can:

• Deliver better care: Feeling less stressed and more empathetic allows staff to connect with patients on a deeper level and provide more effective care.
• Reduce staff turnover: A supportive work environment helps retain valuable staff members.
• Create a more positive work environment: A culture that prioritises well-being benefits everyone, staff and patients alike.

Building Emotional Resilience: Strategies for ER Staff

Working in the ER can be emotionally demanding. Here are some strategies to build your emotional resilience and navigate the challenges of trauma-informed care:

1. Self-Awareness:

• Recognise your own triggers: We all have experiences that can make us feel stressed or emotional. Pay attention to what situations or patient behaviours trigger these feelings in you.
• Identify your coping mechanisms: What helps you de-stress after a difficult shift? Having healthy coping mechanisms readily available is crucial.

2. Building a Support System:

• Talk to colleagues: Connect with other ER staff members who understand the unique challenges you face. Sharing experiences and debriefing after difficult cases can be very helpful.
• Seek professional support: If you’re struggling to cope with the emotional demands of your work, consider seeking help from a therapist or counsellor who specialises in trauma.

3. Maintaining Healthy Habits:

• Prioritise sleep: Getting enough sleep is essential for both physical and emotional well-being. Aim for 7-8 hours of quality sleep each night.
• Eat healthy foods: Fuel your body with nutritious meals and snacks to maintain your energy levels and emotional stability.
• Exercise regularly: Physical activity is a great way to reduce stress and improve your mood. Find an exercise routine you enjoy and stick with it.

4. Mindfulness and Relaxation Techniques

• Practice mindfulness: Mindfulness techniques like meditation and deep breathing can help you stay present in the moment and manage stress.
• Progressive muscle relaxation: This technique involves tensing and relaxing different muscle groups in your body, which can help to release physical tension and promote relaxation.
• Visualisation: Imagine yourself in a calming place and focus on the sights, sounds, and smells of that environment. This can help to distract you from stressful thoughts and emotions.

5. Setting Boundaries:

• Learn to say no: It’s okay to set boundaries at work. If you’re feeling overwhelmed, don’t be afraid to ask for help from a colleague or delegate tasks.
• Take breaks: Schedule regular breaks throughout your shift to step away from the environment and recharge.
• Maintain a healthy work-life balance: Make time for activities you enjoy outside of work. This will help you to come back to work feeling refreshed and energised.

How to Create Trauma-Informed ER Environment

Beyond individual resilience, fostering a trauma-informed ER environment benefits everyone. Here are some suggestions:

• Training: Implement ongoing training for all ER staff on trauma-informed care principles. This can help staff understand the impact of trauma on patients and equip them with communication and de-escalation skills.
• Communication: Encourage open and respectful communication between staff and patients. This can be achieved by:
  • Using clear and concise language.
  • Validating patients’ feelings and experiences.
  • Offering choices whenever possible (e.g., which arm for a blood draw).
  • Explaining procedures clearly and beforehand.

• Environment: Create a calm and predictable environment in the ER whenever possible. This can include:
  • Having designated quiet areas for patients who feel overwhelmed.
  • Offering privacy screens for examinations.
  • Minimising unnecessary noise and disruptions.
  • Using calming colours and lighting.

• Collaboration: Build strong relationships with mental health professionals and social workers who can provide additional support to patients in need.
• Self-Care Support: Recognise that staff self-care is crucial for a trauma-informed environment. The hospital can support this by:
  • Encouraging breaks and time for staff well-being.
  • Offering access to employee assistance programs (EAPs) or on-site counselling services.
  • Promoting a culture of teamwork and mutual support among staff.

Building emotional resilience is an ongoing process. By implementing these strategies and fostering a trauma-informed ER environment, you can create a more supportive space for both patients and staff, ultimately leading to better outcomes for everyone. However, there are better, much more effective holistic tools that can help you strengthen your mind, process trauma better, and also prevent secondary trauma for people working in ER.

Coming Back To Sarah

Inspired by her training on trauma-informed care, Sarah suggested a novel approach – the Tomatis® Method. This auditory therapy uses electronically modified music to help the brain process sound more effectively. While not a mainstream treatment, research suggests it can improve emotional regulation and communication skills in individuals with trauma histories.

With some trepidation, Emily agreed to try it. The sessions were an unfamiliar experience. Wearing specially designed headphones, she listened to music filtered and amplified in specific frequencies. Despite initial discomfort, Emily persevered. Over time, she noticed a shift. The constant buzzing in her head began to fade, replaced by a newfound clarity.

The Power of Sound and Connection

The vagus nerve that runs from behind the ear controls many important functions such as digestion, heart-rate, breathing, emotional regulation, etc. This nerve, linked to the ear by a branch, regulates emotions and stress response. The Tomatis® Method utilises filtered music stimulates this nerve, improving sound processing and aiding emotional regulation. 

The Tomatis® sessions progressively, combined with Sarah’s continued support, had a profound impact on Emily. The hypervigilance lessened, replaced by a sense of calm. She began spending more time practising her guitar, the music becoming a refuge instead of a trigger. At home, the constant fear started to dissipate as she learned to communicate her needs more effectively.

This wasn’t a complete cure, but it offered Emily a powerful tool for managing her emotional state. She still visited the ER on occasion, but the visits became less frequent and more focused on addressing specific physical concerns. More importantly, Emily felt a renewed sense of agency.

A Journey of Growth

Sarah’s story highlights the importance of trauma-informed care in the ER. By recognising the potential impact of past experiences and creating a supportive environment, healthcare professionals can empower patients like Emily to find their own paths to resilience.

The Role of Familṭy Background and Social Support

It’s important to acknowledge the limitations of this case study. While the Tomatis® Method offered Emily a valuable tool, her progress wouldn’t have been possible without the foundation of trauma-informed care established by Sarah. 

Emily’s story doesn’t touch upon the potential lack of a support system outside the ER. Ideally, Emily’s family environment would change or she would have access to additional resources to address the root causes of her trauma. Nevertheless, Sarah’s intervention provides a powerful example of how ER staff, even with limited time and resources, can make a positive impact.

The Tomatis® Method may not be a one stop solution, but it increases emotional resilience along with focus and memory.  Emily’s story serves as a testament to the power of exploring various approaches to building emotional resilience. When coupled with trauma-informed care that fosters trust and patient empowerment, ERs can become not just places of treatment, but stepping stones on the path to healing and growth.

By addressing the emotional and psychological needs of ER staff, hospitals can not only improve the quality of care provided to patients but also enhance the well-being and job satisfaction of their employees. This holistic approach to emergency care is essential for cultivating an environment where both patients and healthcare providers can thrive even in the face of trauma.

If you want to find out if the Tomatis® Method is the right fit for you, schedule a free 20-minute consultation with Françoise Nicoloff, valued at AUD $125. She has more than 45 years of experience and can help you figure out how Tomatis® method can help you feel relieved and lighter along with increased mental focus and confidence in yourself.