Trauma-Informed Considerations of Restrictive Practices When Providing Serious Medical Treatment or Essential Care

When providing care to individuals who lack capacity, such as children, people with intellectual disabilities, or a person with dementia, it is crucial to adopt a trauma-informed approach. In this post, we examine some of the potential factors that may lead to trauma related to treatment, and in a follow-up post, we examine some strategies and responses based on these risk factors.

This potential for trauma is arguably heightened when delivering elements of care, such as a specific clinical procedure or treatment that requires the use of restrictive practices like restraint, which may be by mechanical, physical, psychological or pharmacological approaches. While they may be the most appropriate approach for that person at that time, these practices can and undoubtedly have and continue to cause trauma to some vulnerable individuals in support environments. Sometimes, even after careful consideration and even the permission of the Court of Protection, enforcing medical treatment on someone by its very nature is traumatising.

Therefore, a starting point would be for organisations and staff to be at least trauma-aware in their practice, starting with the expert and asking the person themselves for sources of trauma for them.

The very nature of the group of people we are focussing on here may mean for some they may not have either the words or shared communication strategies or cognition to be able to tell you. Therefore, a start may be considering the potential factors leading to medical treatment and care procedures causing or making existing trauma worse. We have listed some of those below.

Potential Causes of Trauma Delivering Serious Medical Treatment or Essential Care

Communication Barriers

Where adults and childrens’ cognitive abilities mean they lack capacity, it very often leads to communication difficulties for both parties. This inability to understand and process what is happening or the serious nature of why it is happening now can cause significant distress. In addition, if the person is unable to communicate their wishes for you to stop, or potentially worse, staff understand but continue, the potential for trauma is heightened for everyone.

Previous Experiences

Past traumatic events, particularly those involving medical procedures, can significantly impact how a person perceives and reacts to current treatments and procedures. Staff in supported care environments do not always know the previous experiences the person has had

Lack/Loss of Control

The fact the person may be actively dissenting to the treatment but staff or a family member is continuing can inevitably lead to feeling out of control or helpless during procedures and could be traumatising.

Physical Discomfort

Think about the times you have heard, witnessed or delivered a treatment that is painful, such as an injection. The physical discomfort associated with treatment procedures can contribute to the overall traumatic experience. Added to this is potentially an element of physical or mechanical restriction, which unknowingly, despite their best efforts, to staff is hurting the person.

Nature of the Procedure/Test/Treatment/Care

The specific procedure or test being carried out can influence the level of anxiety or trauma for all of us. For example, working with lots of special care dentists over the years, it never ceases to amaze the number of dental staff who are anxious about their own dental visits.

Post-Treatment Care

How the individual is cared for after the procedure can also impact their trauma response. Busy healthcare environments, especially with time constraints and workloads, can feel very uncaring and lacking in empathy. Not being able to be in your safe space with those you would choose heightens anxieties.

Frequency of Treatment

The regularity of the treatment can affect the individual’s mental state. A one-off procedure may be bearable, but repeated and frequent procedures could be perceived differently. Even for something as simple as foul-tasting medicine, we all know someone who has not completed the course because they could not continue with the thought of it several times per day. If they were someone who used “more than transient or negligible forcible restraint,” how would they feel then?

Presence of Family Members / Others

Treatment appointments in health and social care would quickly begin to fail if it were not for the significant help and support of family members or staff accompanying the person, (who knows them), bring. However, we have all experienced a parent or carer who brings their own fears and traumas into the procedure. As much as people want to, sometimes they are not the best person to be there for the individual, and without intending to, they can project their fears or previous traumas, which can increase the anxiety of the person receiving treatment.

Staff Confidence and Training

As more evidence emerges in the literature of higher-than-average exposure to early trauma than the general population, staff in all supported environments (healthcare, social care, education) are human too and have their own anxieties and worries. Professionals lacking in confidence or who have not received specific training both in trauma-informed care and in delivering clinical holding can inadvertently increase the patient’s anxiety and trauma.

Environment

The location of where treatment takes place can be a significant factor. A hospital with its smells, sights (e.g. Staff in uniforms), noise, chaotic clutter and busyness can easily exacerbate feelings of fear and helplessness in anyone. Conversely, feeling tranquil in your safe, low stimulus place (your bedroom, for example), having several people enter and then complete a procedure on you would potentially have lifelong effects for most of us if we were not able to communicate this and rationalise it in our heads.

Unforeseen/Unknown/Overlooked

The factors above are not the definitive list or only influences on trauma so also think about who you support and what might be missing from them.

Get in touch and let us know if you feel there are some glaringly obvious points we have left out.

In conclusion, understanding and addressing the potential causes of trauma when delivering serious medical treatment or essential care is crucial for those working with individuals who lack capacity. Factors such as communication barriers, past experiences, loss of control, and the physical discomfort of procedures can all contribute to heightened trauma. Additionally, the environment, staff training, and the presence of family members play significant roles in the patient’s experience. By adopting a trauma-informed approach, caregivers and healthcare professionals can better support the emotional and psychological well-being of these individuals, ensuring that care is delivered with empathy and respect.

Check out our follow-up post to this, where we use this information to consider effective ways to reduce the likelihood of trauma occurring.