PDF(Pubmed)
Abstract：
BACKGROUND: COVID-19 impacted the mental health of healthcare workers, who endured pressures as they provided care during a prolonged crisis. We aimed to explore whether and how a Trauma-Informed Care (TIC) approach was reflected in qualitative perspectives from healthcare leaders of their experience during COVID-19 (2020-2021).
METHODS: Semi-structured interviews with healthcare leaders from four institutions were conducted. Data analysis consisted of four stages informed by interpretative phenomenological analysis: 1) deductive coding using TIC assumptions, 2) inductive thematic analysis of coded excerpts, 3) keyword-in-context coding of full transcripts for 6 TIC principles with integration into prior inductive themes, and 4) interpretation of themes through 6 TIC principles (safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and awareness of cultural, historical, and gender issues).
RESULTS: The actions of leaders (n = 28) that were reported as successful and supportive responses to the COVID-19 pandemic or else missed opportunities reflected core principles of Trauma-Informed Care. To promote safety, leaders reported affirmative efforts to protect staff by providing appropriate physical protection, and enhanced psychological safety by providing channels for communication about emotional well-being. To promote trustworthiness and transparency, leaders listened to their staff, shared current COVID-19 information, and increased frequency of meetings to disseminate accurate information. To promote mutual support, strategies included wellness check-ins, sharing uplifting stories, affirming common goals, articulating fears, and leading by example. Examples of empowerment included: making time and adjusting modalities for flexible communication; naming challenges outside of the hospital; and functioning as a channel for complaints. Reported missed opportunities included needing more dedicated time and space for healthcare employees to process emotions, failures in leadership managing their own anxiety, and needing better support for middle managers. Awareness of the TIC principle of cultural, historical, and gender issues was largely absent. Results informed the nascent Trauma-Informed Healthcare Leadership (TIHL) framework.
CONCLUSIONS: We propose the Trauma-Informed Healthcare Leadership framework as a useful schema for action and analysis. This approach yields recommendations for healthcare leaders including creating designated spaces for emotional processing, and establishing consistent check-ins that reference personal and professional well-being.
METHODS: Semi-structured interviews with healthcare leaders from four institutions were conducted. Data analysis consisted of four stages informed by interpretative phenomenological analysis: 1) deductive coding using TIC assumptions, 2) inductive thematic analysis of coded excerpts, 3) keyword-in-context coding of full transcripts for 6 TIC principles with integration into prior inductive themes, and 4) interpretation of themes through 6 TIC principles (safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and awareness of cultural, historical, and gender issues).
RESULTS: The actions of leaders (n = 28) that were reported as successful and supportive responses to the COVID-19 pandemic or else missed opportunities reflected core principles of Trauma-Informed Care. To promote safety, leaders reported affirmative efforts to protect staff by providing appropriate physical protection, and enhanced psychological safety by providing channels for communication about emotional well-being. To promote trustworthiness and transparency, leaders listened to their staff, shared current COVID-19 information, and increased frequency of meetings to disseminate accurate information. To promote mutual support, strategies included wellness check-ins, sharing uplifting stories, affirming common goals, articulating fears, and leading by example. Examples of empowerment included: making time and adjusting modalities for flexible communication; naming challenges outside of the hospital; and functioning as a channel for complaints. Reported missed opportunities included needing more dedicated time and space for healthcare employees to process emotions, failures in leadership managing their own anxiety, and needing better support for middle managers. Awareness of the TIC principle of cultural, historical, and gender issues was largely absent. Results informed the nascent Trauma-Informed Healthcare Leadership (TIHL) framework.
CONCLUSIONS: We propose the Trauma-Informed Healthcare Leadership framework as a useful schema for action and analysis. This approach yields recommendations for healthcare leaders including creating designated spaces for emotional processing, and establishing consistent check-ins that reference personal and professional well-being.
摘要：
背景：COVID-19影响了医护人员的心理健康，他们在长期危机中提供护理时承受着压力。我们的目的是探讨创伤知情护理（TIC）方法是否以及如何从医疗领导者的定性角度反映他们在COVID-19（2020-2021）期间的经验。
方法：对来自四个机构的医疗保健领导者进行了半结构化访谈。数据分析由解释现象学分析提供的四个阶段组成：1)使用TIC假设的演绎编码，2)编码摘录的归纳主题分析，3）6个TIC原则的完整转录本的关键字上下文编码，并集成到先前的归纳主题中，和4)通过6项TIC原则解释主题(安全性；可信赖性和透明度；同行支持；协作和相互性；授权，声音,和选择；以及对文化的认识，历史,和性别问题)。
结果：据报道，领导人（n=28）对COVID-19大流行的成功和支持性反应或错失机会的行动反映了创伤知情护理的核心原则。为了促进安全，领导人报告说，通过提供适当的人身保护来保护工作人员的积极努力，并通过提供有关情感幸福感的沟通渠道来增强心理安全性。促进诚信和透明度,领导人听取了他们的工作人员，共享当前的COVID-19信息，并增加会议频率以传播准确信息。促进相互支持,策略包括健康登记，分享令人振奋的故事，确认共同目标，表达恐惧，以身作则。赋权的例子包括：为灵活的沟通腾出时间和调整方式；在医院外命名挑战；并充当投诉渠道。报告的错失机会包括需要更多的时间和空间让医疗保健员工处理情绪，领导管理自己焦虑的失败，需要更好的支持中层管理人员。认识到TIC的文化原则，历史,性别问题基本上不存在。结果为新生的创伤知情医疗领导（TIHL）框架提供了信息。
结论：我们提出创伤知情医疗领导框架作为行动和分析的有用模式。这种方法为医疗保健领导者提供了建议，包括创建指定的情绪处理空间，并建立参考个人和职业福祉的一致签到。
方法：对来自四个机构的医疗保健领导者进行了半结构化访谈。数据分析由解释现象学分析提供的四个阶段组成：1)使用TIC假设的演绎编码，2)编码摘录的归纳主题分析，3）6个TIC原则的完整转录本的关键字上下文编码，并集成到先前的归纳主题中，和4)通过6项TIC原则解释主题(安全性；可信赖性和透明度；同行支持；协作和相互性；授权，声音,和选择；以及对文化的认识，历史,和性别问题)。
结果：据报道，领导人（n=28）对COVID-19大流行的成功和支持性反应或错失机会的行动反映了创伤知情护理的核心原则。为了促进安全，领导人报告说，通过提供适当的人身保护来保护工作人员的积极努力，并通过提供有关情感幸福感的沟通渠道来增强心理安全性。促进诚信和透明度,领导人听取了他们的工作人员，共享当前的COVID-19信息，并增加会议频率以传播准确信息。促进相互支持,策略包括健康登记，分享令人振奋的故事，确认共同目标，表达恐惧，以身作则。赋权的例子包括：为灵活的沟通腾出时间和调整方式；在医院外命名挑战；并充当投诉渠道。报告的错失机会包括需要更多的时间和空间让医疗保健员工处理情绪，领导管理自己焦虑的失败，需要更好的支持中层管理人员。认识到TIC的文化原则，历史,性别问题基本上不存在。结果为新生的创伤知情医疗领导（TIHL）框架提供了信息。
结论：我们提出创伤知情医疗领导框架作为行动和分析的有用模式。这种方法为医疗保健领导者提供了建议，包括创建指定的情绪处理空间，并建立参考个人和职业福祉的一致签到。
