It changes their outlook on everything : staff perspectives on the impacts of trauma- and violence- informed care orientation and training in two primary care settings

Trauma and violence are common, and they are linked to multiple health problems. Trauma survivors may be re-traumatized when seeking health care. Trauma- and Violence- Informed Care (TVIC) is care that is safe and accessible to trauma survivors. While there is a growing body of literature on trauma-informed care (TIC), prior studies have not explored how nurses and other multidisciplinary health care staff understand TVIC, which has an explicit focus on structural violence and ongoing interpersonal violence. Furthermore, few researchers have studied either TIC or TVIC in primary health care (PHC) settings. This analysis explores the perspectives of PHC staff on the impacts of orientation and training sessions on TVIC. These TVIC sessions were one component of a larger intervention to promote equity. This secondary analysis uses interpretive description to analyze fourteen in-depth interviews with multidisciplinary staff at two PHC clinics. While the impact of the TVIC sessions varied greatly across different participants and sites, all of the staff described enhancements in their awareness, knowledge and/ or confidence about trauma and violence. For some, this contributed to a shift in perspective that impacted their personal lives, their clinical practice, their organizational culture, and their motivation to address structural determinants of health. Intrinsic factors including presentations of data, facilitated discussions, the presence of researchers, and the timing of sessions influenced how participants understood, remembered and prioritized TVIC. Importantly, structural, organizational and personal contexts significantly influenced how participants took up and enacted TVIC in practice. This study contributes to knowledge about TVIC in PHC, and explores how health care providers understand and enact TVIC concepts. The findings point to the importance of challenging the biomedical paradigm in PHC and surface some of the difficulties health care providers may face when using a structural lens to inform clinical practice. Recommendations include assessing and planning for diverse contexts for TVIC implementation; explicitly attending to the biomedical paradigm that shapes PHC practice, framing TVIC as a paradigm shift but incorporating concrete tools and mentorship into TVIC sessions; attending to clients’ voices; and research-practice collaborations for sustainability and evaluation of TVIC.Applied Science, Faculty ofNursing, School ofGraduat