Fitting it together
How a School of Nursing professor is using an artistic exercise to deliver trauma-informed care concepts in the classroom
Leigh Ann Breckenridge, D.N.P., RN, FNP-BC, clinical assistant professor in the Department of Family and Community Health Nursing, brings what might seem like an odd array of objects to class–plates, bowls, a hammer, glue and gold paint. She’s not teaching pottery or a craft course. She’s using those objects in an exercise to demonstrate concepts of trauma-informed care.
Nursing, at its core, embraces compassionate person-centered care. Trauma-informed care, the practice of acknowledging and responding to the health impacts of trauma, addresses immediate health care needs while also prioritizing emotional well-being and resilience.
Breckenridge shared more about the relationship between trauma and health outcomes, why it matters in patient care and how she’s conveying those lessons in the classroom.
Can you tell us about adverse childhood experiences (ACEs) and trauma-informed care?
We know that adverse experiences in childhood can have a huge impact on health outcomes later in life. The study I refer to most often was conducted by Kaiser Permanente. In that study, the ACEs they looked at were incarceration of a parent, abuse (physical, emotional or neglect) of the child or another family member, divorced parents, excessive alcohol intake or drug use of a parent and parent with mental illness.
How does trauma affect health outcomes? Why is acknowledging trauma an important part of patient care?
Researchers are beginning to look at children who are bullied at school, have poor school performance, and experience community violence and poverty as well. We know that when an individual is under constant stress there are epigenetic changes in the body. Some of these changes include increased cortisol and neuron pruning, a process in neurodevelopment where the nervous system refines its structure by eliminating unnecessary or redundant synapses between neurons. In childhood, these epigenetic changes can result in slowed development or underdevelopment in a young child.
What does this approach to care entail? What does trauma-informed care look like in a primary care setting?
There are several questionnaires in use to assess ACEs and how they might affect a patient’s health. The more prevalent the ACEs are, the higher they will score on the questionnaire and, as a result, likelier to suffer later in life from hypertension, obesity, diabetes, psychological disorders and risky behaviors.
How do you teach students to deliver trauma-informed care? What advice or strategies do you share with students to help them integrate it into their practice?
Because this concept is rarely taught in nursing or medical school, I have made it my mission to make sure students know it and how to integrate it into their practice.
I tell students that those who have had adverse childhood experiences can often be viewed as individuals who do not comply. They are late to appointments or miss them altogether. We talk about how to approach a patient with a high ACEs score.
For example, I get the student to consider how to make a sexually abused patient more at ease by doing more delicate exams. We discuss how to approach conversation with an obese patient who does not exercise perhaps because they live in a violent community and cannot get out to walk. Generally speaking, I encourage students to pause and spending time thinking of ways they can help their patient problem solve.
What is kintsugi and why do you use to instruct students on trauma-informed care?
First, I review ACEs and trauma-informed care concepts with students. Then, through kintsugi, the Japanese art of embracing flaws and imperfections, we talk about our role as care providers.
During the exercise, students select a plate or bowl. We talk about what a bowl or plate might represent for them. I always get such meaningful answers. Then, I ask them to hand the plate or bowl to a neighbor who breaks it with a hammer into several pieces. We pause and talk about what it feels like to be broken.
The students are then instructed to glue the plate or bowl back together. The process to make the plate or bowl whole again takes patience and often help from others. We talk about the repair and how it relates to healing from ACES/trauma. Lastly, we paint the broken lines with gold paint. That step highlights the evidence of trauma but makes the piece more beautiful than before.
Before leaving we discuss how the process reminds us of individuals who are broken. Sometimes there is a repair, and sometimes not. Regardless, we appreciate their beauty and acknowledge our effort to help them to be whole again.