A patient is admitted for a procedure you have seen several times before. You introduce yourself, prepare the equipment and explain what needs to happen. Then, as you move closer, their whole manner changes. They become tense. They pull away. They stop answering questions. Perhaps they become angry and tell you not to touch them.
It would be easy to focus on the task and think, Why are they making this so difficult?
Trauma-informed care asks a different question: what is happening for this person right now, and how can I deliver the care they need without adding to their distress?
That does not mean deciding that the patient has experienced trauma. It means recognising that healthcare itself can involve vulnerability, exposure, touch, uncertainty and loss of control, and adjusting your approach so that care feels as safe, predictable and collaborative as possible.
Trauma-informed care starts before you know someone's history
Psychological trauma can follow an event, series of events or circumstances experienced as harmful or threatening, and its effects can extend into physical, emotional, social and psychological wellbeing. Experiences associated with trauma can include abuse, neglect, violence, serious illness, accidents, bereavement, displacement and discrimination, but two people can experience similar events very differently.
This matters because you will not necessarily know that a patient has experienced trauma. It may not be documented. They may never have disclosed it. They may not describe their experience using the word trauma at all.
You therefore do not need a disclosure before practising in a trauma-informed way. In Scotland, the National Trauma Transformation Programme describes trauma-informed practice as recognising when someone may be affected by trauma, collaboratively adapting how we work, preventing further harm and supporting recovery. Current Scottish guidance is built around the NHS Education for Scotland Knowledge and Skills Framework for Psychological Trauma and the National Trauma Transformation Programme.
The practical message for a student nurse is simple: do not make the patient prove that they have a reason to need sensitive care.
What might you actually notice on placement?
Return to the patient who pulled away when you approached. Their behaviour tells you that something has changed, but it does not tell you why.
They may be frightened of the procedure. They may be in pain. They may not understand what you are doing. They may have had a previous distressing healthcare experience. They may have experienced trauma that makes touch, restraint, exposure, particular environments or loss of control especially difficult. There may also be a completely different explanation.
This is where trauma-informed care is different from trying to diagnose trauma from behaviour. Anxiety, anger, withdrawal, hypervigilance, freezing, reluctance to engage or repeatedly asking to stop can occur in people affected by trauma, but none of these responses proves that trauma is the cause.
Your job is to notice the change and become curious rather than judgemental.
Instead of documenting or describing someone simply as 'difficult' or 'non-compliant', ask what the observable problem actually is. Did the patient decline the examination? Did they become distressed when the curtain was opened? Did they ask for a particular member of staff? Did they say they did not understand what was happening?
That gives the team useful clinical information without attaching a judgement to the patient.
Safety, trust, choice, collaboration and empowerment
Trauma-informed practice can sound abstract until you see what these principles look like during ordinary nursing care.
Safety is not only physical safety. A patient may be medically safe while feeling frightened, exposed or trapped. Closing the curtain properly, explaining who is in the room, reducing unnecessary exposure and avoiding unexpected touch can all matter.
Trust grows when what you say matches what you do. If you tell a patient you are going to explain each step before proceeding, explain each step. If there will be a delay, tell them. Predictability can reduce uncertainty.
Choice does not mean offering options that are not clinically possible. It means recognising the choices that genuinely exist. Which arm would they prefer? Would they like a moment before you begin? Would they prefer the door closed? Would they like you to explain the equipment first?
Collaboration changes care from something being done to a person into something being done with them. Even when an intervention is important, the patient should be involved in understanding what is happening and why.
Empowerment means recognising the patient's strengths, preferences and right to participate in decisions about their care rather than treating distress as something that simply needs to be controlled.
Scottish trauma-informed practice also describes five Rs: realising how common trauma and adversity are, recognising the different ways they can affect people, responding appropriately, resisting re-traumatisation, and recognising the importance of relationships. You may also encounter the established SAMHSA framework, which describes four Rs: realise, recognise, respond and resist re-traumatisation. The wording differs between frameworks, but the clinical direction is similar: recognise the possibility of trauma and organise care in ways that reduce avoidable harm.
Now imagine you need to take blood
You explain that a blood sample is required. As soon as the tourniquet appears, the patient pulls their arm against their body and says, 'No.'
A purely task-focused response might be to repeat that the blood test is necessary and ask them to keep their arm still.
A trauma-informed response starts by noticing what has happened.
'I can see you're uncomfortable. I'll stop for a moment. Would it help if I explained what we need the blood test for and what will happen before we do anything else?'
Nothing in that response assumes trauma. You have not asked, 'What happened to you?' or encouraged the patient to disclose personal experiences. You have stopped, acknowledged their distress, restored some predictability and created space for them to communicate.
If they are willing to continue, explain the procedure before touching them. Ask permission before proceeding. Tell them what they are likely to feel. Where possible, agree how they can tell you to pause.
If they continue to refuse, trauma-informed care does not mean quietly doing the procedure anyway, nor does it mean that clinically important care is simply abandoned. Consent, capacity, urgency and the clinical consequences of refusing an intervention all matter. As a student nurse, involve your supervising registered nurse and work within local policy and your level of competence.
The important point is that trauma-informed care does not remove clinical boundaries; it changes how we work within them.
Consent is more than getting a yes at the beginning
Healthcare can recreate features associated with previous traumatic experiences: unfamiliar people entering personal space, being told to undress, intimate examinations, being physically positioned, having little control over the environment or not knowing what will happen next.
This makes ongoing consent especially important.
A patient agreeing to an examination does not mean you should assume that every subsequent action is acceptable. Explain before you expose an area of the body. Explain before touching. Check that the patient is still comfortable to continue. If their behaviour suddenly changes, notice it.
This is particularly important during intimate care, personal care, invasive procedures and examinations involving significant exposure or vulnerability. A trauma-informed approach also considers whether the environment can be made more private, whether unnecessary people can leave the room, and whether the patient has expressed preferences that can reasonably be accommodated.
None of this is an optional extra added after the 'real' nursing care. Respecting dignity, communicating clearly, seeking consent and involving people in decisions are fundamental professional nursing responsibilities.
What if a patient tells you about trauma?
Sometimes sensitive care creates enough trust for a patient to disclose something significant. A patient might tell you about abuse, violence, exploitation or another traumatic experience.
Your role is not to investigate the story or ask for every detail. Listen. Take the disclosure seriously. Avoid expressing disbelief or asking unnecessary questions simply because you are curious. Consider whether there is an immediate safety, safeguarding or clinical concern and involve your supervising registered nurse promptly.
What happens next depends on the situation, the patient's age and circumstances, immediate risk, local safeguarding procedures and the service in which you are working. Follow local escalation and referral pathways and document relevant information appropriately and objectively.
Trauma-informed care is also not the same as trauma treatment. A student nurse is not expected to diagnose post-traumatic stress disorder or provide specialist psychological therapy. Where PTSD is suspected or already diagnosed, assessment and treatment sit within appropriate professional roles and relevant clinical guidance, including NICE guideline NG116.
So what should you take onto placement?
You do not need a special trauma-informed script. The approach is visible in ordinary interactions: introducing yourself properly, explaining what will happen, asking before touching, protecting privacy, offering genuine choices, noticing distress and not treating refusal as a personal challenge.
When a patient's behaviour changes, think beyond the task in front of you. Ask yourself: Do they understand what is happening? Do they feel safe? Have I given them as much appropriate control as I can? Is there something I could change about my approach before I try again?
And remember that you may never know whether trauma sits behind the patient's response. You do not need to know.
Trauma-informed nursing is not about finding trauma in every patient. It is about delivering care in a way that makes avoidable fear, helplessness and loss of control less likely for everyone.
References
- NHS Education for Scotland (NES) (2017). Transforming Psychological Trauma: A Knowledge and Skills Framework for the Scottish Workforce.
- National Institute for Health and Care Excellence (NICE) (2018). Post-traumatic stress disorder. NICE guideline NG116.
- Scottish Government (2023). Roadmap for Creating Trauma-Informed and Responsive Change: Guidance for Organisations, Systems and Workforces in Scotland.
- Nursing and Midwifery Council (NMC). The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates.
- Substance Abuse and Mental Health Services Administration (SAMHSA) (2014). SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach.