“Real change is not the sole domain of leaders and so-called heroes; rather, change is driven forward by the choices and actions of each and everyone one of us.”
-Jodie Wilson-Raybould (2022, p. 23)
We are at a pivotal time in our world, perched at the confluence of historically significant movements and events with an ever-increasing awareness of the impacts of our decisions on others and the environment. The Covid-19 pandemic has indelibly changed the landscape of healthcare and continues to affect individuals and teams who care for people, including those who have experienced intentional and unintentional trauma. Research on trauma, and our knowledge of this complex and highly subjective experience, continue to grow and evolve.
As nurses work in many areas beyond acute care settings, including in the community, long-term care, assisted living facilities, forensic systems, and postsecondary institutions, developing an awareness of the prevalence and impacts of trauma, while building on a strengths-based approach that prioritizes psychological safety, is crucial in helping all nursing professionals to work effectively and compassionately. Any client in any healthcare context, and any of our colleagues, may have experienced trauma. Since nursing practice is grounded in connection, it is vitally important we root our praxis in an understanding of how trauma can shape individual experiences and responses, while extending our gaze to consider how the systems in which we practice can more effectively support the physical, cultural, and emotional safety of people accessing care, as determined by clients themselves.
Within postsecondary education, estimates vary, but it is believed that as many as 89% of college students have potentially experienced at least one traumatic event, with the peak age of trauma exposure occurring between the ages of 16-20. Women, particularly racialized women, also report higher rates of trauma (Valdez, 2023). Students experiencing traumatic stress may have difficulties with learning and memory, attention and focus, problem-solving, and executive function, resulting in higher rates of absenteeism (Levi-Gigi, 2012). Therefore, it is vital that educators consider the experiences of learners to help mitigate the potential for retraumatization in the classroom, and help students learn within psychologically safe environments, all the while fostering resilience and building on a learner’s strengths.
This new year will mark a two decade-long milestone since graduating with my nursing degree and starting my first clinical role at a busy trauma and neurosurgery unit at an inner-city hospital in Toronto, ON. I have been reflecting on how much my own understanding of nursing as a profession, and of myself as a nursing professional, has shifted over time. It was during my graduate studies that I started to become aware of the need for creating trauma-and-violence-informed and culturally safe environments for clients, families, and healthcare providers alike while working with Indigenous women who had experienced violence after listening to their experiences of seeking healthcare. As I pursued additional education in forensic sciences, completing my Forensic Nurse Death Investigator micro-credential [FNDI-MC] in 2023, I have developed a keen awareness of how the very systems meant to support and care for people can instead perpetuate violence and retraumatize them. As a society, and especially as nurses, we must move away from blaming survivors and victims of trauma, both in subtle and overt ways, and instead be cognizant of how our understanding of trauma shapes how we show up and engage with clients, colleagues, and society more broadly.
It has been suggested that a career in nursing requires openness, humility, and the ability to embrace the inherent complexity of healthcare systems and relationships. As human beings we integrate and assess vast amounts of information every day and our brains are primed for maximum efficiency. Yet, busy healthcare and teaching environments can create conditions that leave us all vulnerable to bias, stereotyping, and assumptions (Persaud, 2019). In turn, our implicit biases can create barriers to safe and equitable classrooms and healthcare environments even though that may not be our intent (Newlove, 2021) - this is why it is important to continually address and unpack our assumptions, and to operate from a place of moral courage, empathy, and respect.
Learning about trauma has been critical for me not only in my professional roles but in the volunteer work that I do as an investigator supporting families of missing persons. As the current Decolonizing Lead for a nursing program at a postsecondary institution in BC, I have been working closely with other faculty students, and staff in advancing Truth and Reconciliation within our program. Through this work, I have developed a renewed appreciation of the importance of self-compassion, mindfulness, self-awareness, and self-reflection in how I engage and help to lead this work under the guidance of indigenous elders, knowledge-keepers, scholars, and collaborators. The recent indigenous cultural safety, cultural humility, and anti-racism standard from the British Columbia College of Nurses and Midwives [BCCNM], for example, draws attention to the expectations of the regulatory body for registrants on providing culturally safe and anti-racist care for indigenous clients. The standard considers Canada’s shameful history of colonialism and the legacy of intergenerational trauma that continues to reverberate through Indigenous communities negatively impacting healthcare experiences and outcomes for many Indigenous peoples (In Plain Sight, 2020). Developing awareness of the various forms of trauma, and how trauma impacts health, benefits not only everyone seeking care but is also deeply transformative for healthcare providers. It is crucial that all nurses be willing to learn and unlearn while leaning into the discomfort of how we are complicit in some of the healthcare policies and practices that continue to perpetuate trauma and violence, and in doing so, cause harm.
I very much appreciate how the opportunity for deep reflection and engagement is woven throughout the pages of this book, and how Dr. Stephany provides numerous opportunities for readers to consider specific examples to help bring the concepts and ideas she explores within its pages to life. There are questions for further consideration that educators can build on for rich classroom discussions, as well as recommended strategies that help provide readers with helpful scripts and actions they can incorporate into their communication with peers, instructors, and clients. In my experience as an educator, providing learners and faculty with opportunities to consider and work through examples can help consolidate learning, and over time, shift one’s practice. Dr. Stephany also centers on self-care in this book, normalizing some of the more challenging aspects of nursing school and providing an affirmative, validating, and thoughtful approach by focusing on strengths, resilience, and on finding joy in one’s work. While there can be a tendency to pathologize trauma in some of the literature, I have found a more useful reframe to look at trauma as a normal response to abnormal events (Haskell & Randall, 2009) as Dr. Stephany does in this book as well.
Being a nurse has been an honour and a privilege. My life has been forever changed in innumerable positive ways by the beautiful mosaic of connections and experiences I have had with colleagues, clients, and learners throughout my career. I am delighted to say that nearly twenty years on, I continue to learn and grow with every new role I take on and I am certainly never bored. Despite the many challenges within healthcare and postsecondary settings, it is an exciting time to be a nurse and a nurse educator. The opportunity and potential for nurses to follow their curiosities and their passions and to create the nursing roles of tomorrow are limited only by our imaginations.
I finished reading Dr. Stephany’s book with a renewed sense of possibility and inspiration and I am grateful that someone with her training and expertise, and her heart, is doing this work. I found her approach to this book both compelling and timely. Engaging with the book’s content will help readers start to build an awareness of the complexity of trauma and trauma experiences while appreciating the role of the nurse’s unique and privileged position in providing compassionate, non-judgemental care that extends its focus beyond the individual to the broader systems at large. Much work remains to be done and I remain ever hopeful as to what we can achieve when we all work together.
