6.1 Trauma and Violence-Informed Approach to Communication

When working in healthcare, it is essential to engage in communication from a trauma and violence-informed approach, which involves integrating an understanding of the need for:

• physical and emotional safety
• choice and control
• empowerment

(Trauma-Informed Practice Guide, 2013, p. 12).

A trauma and violence-informed approach can be used as one part of therapeutic communication. It involves emphasizing confidentiality, identifying the interview purpose, letting the client set the pace of the interview and shaping it based on their needs, and engaging in the collaborative intervention so that the client is in control and empowered. As you apply this approach, you should always consider how to promote safety, control, and choice for the client.

Given how pervasive trauma is in clinical practice, it makes sense to incorporate a trauma-informed approach into your communication and way of being with clients. This approach is beneficial because you will often not know which of your clients has experienced trauma or the circumstances of their trauma. Trauma includes the emotional consequences of a distressing event (Centre for Addiction and Mental Health [CAMH], 2023). Many circumstances can lead to trauma, including child abuse and neglect, sexual assault and intimate personal violence, bullying and harassment, car accidents, the death of someone close to you, natural disaster, and war.

Because the trauma and violence-informed communication approach assumes the presence of trauma, it does not require the client to disclose their experience and thereby risk retraumatizing them through repeated disclosure (Trauma-Informed Practice Guide, 2013).

Case Study 1 (An example of a trauma and violence-informed approach to interviewing)

A 19-year-old client presents alone at urgent care. The reason for seeking care noted on the client’s chart is pain, swelling, and bruising on the index and middle digits of the left hand and a suspected fracture. Upon entry into the examination room, the nurse observes healed bruising under the client’s right eye and contusions on the client’s neck.

RN: Hello, Franco Alonso; my name is Pita Kora, and I will be your registered nurse today. You can call me Pita, and my pronouns are she/her. What would you like me to call you, and what pronouns do you use?

Client: Franco and he/him are fine.

Rationale: Introduce yourself using your first and last name and explain your designation — this action promotes accountability for your actions, as it demonstrates that you are taking responsibility through disclosure. Asking what the client wants to be called and their pronouns contributes to their sense of control and well-being. It also conveys respect for their chosen identity.

RN: Everything we discuss will remain confidential and only be discussed among healthcare team members involved in your care.

Rationale: This emphasizes confidentiality, including the parameters about who will be privy to the information. This is important to disclose and does not mislead the client to believe that any information they provide will end with you. Indeed, as a nurse, you must report the data you collect. This honesty is fundamental to building trust and ensuring safety in a trauma-informed approach.

Client: Ok.

Rationale: In this case, you wait for the client to acknowledge your statements, which conveys respect.

RN: Today, I will ask questions about your injury and conduct a physical assessment. I will explain all steps as I go along. It will take about 15 or 20 minutes. Does that work for you?

Client: I think so …

Rationale: By providing the client with the purpose and general plan of the interview, you share control and minimize unpredictability. By asking the client if it works for them, you include them in the process and convey collaboration. Certainty and control are essential parts of creating a safe space for dialogue.

RN: Can you tell me what happened to your fingers, Franco?

Client: They were crushed in a car door. It hurts. I think it may be broken.

Rationale: In this case, you ask an open-ended question without assumptions. This approach is better, to begin with than a series of closed-ended questions directed by you. In this case, allowing the client to share their story in their own words is essential.

RN: Ok. I am sorry to hear. That sounds painful. We will assess for any fractures. How long ago did this happen?

Rationale: You express empathy by responding to the client’s words instead of how the fingers look. Responding to what the client is telling you is important to build trust. Also, the statement “we will assess for any fractures” offers the client reassurance that the injury will be attended to and acknowledges the initial concern that “it may be broken.” It is essential to acknowledge the client’s concern and not dismiss it.

Client: Last week. Initially, I did not think much of it, but the swelling has not disappeared, and the bruising seems worse. I was not sure if I should come.

RN: Ok, sure, I can understand that. I noticed some other bruises under your right eye and on your neck. Are they related to your finger injury?

Rationale: You convey empathy by stating that you can understand the client’s decisions without judgment. You ask a closed-ended question about other injuries but should allow the client to respond at their pace.

Client: Not really. They happened around the same time, but they are not related.

RN: Ok [allow for silent pause].

Rationale: Silence can be a powerful form of communication. It works in two ways in a trauma-informed approach: first, it conveys to the client that you are unhurried and invested in what they are saying; second, it can allow the client to think through their responses, which can alleviate pressure on the client and promote their self-determination.

Client: It is a long story. I am sure you are busy.

RN: I will make time. Tell me more.

Rationale: The client may test your interest and investment to gauge trust. It is essential to foster trust within the client and tell them you are reliable. If this is not possible, explain to the client why you may not have the time but when you will. For example, “I have an urgent matter down the hall, but I will return in 5 minutes to discuss further.” In such cases, it is important to follow up on your promise and not let the client down because this will likely damage any trust that has been built.

Activity: Check Your Understanding