Nurses’ attitudes towards trauma-informed care at the state psychiatric hospital in Malta

Abstract

Background: Notwithstanding the possibility of a forthcoming, official diagnosis of Complex Post Traumatic Stress Disorder and the contemporary, international appeals for mental health care services to become trauma-informed, trauma-informed care is a foreign concept locally. Service providers’ attitudes towards trauma-informed care have been identified as a particularly mensurable outcome for ascertaining whether a system is trauma-informed. Objectives: The study gained an initial understanding of nurses’ attitudes towards trauma-informed care at the state psychiatric hospital in Malta. Design: A sequential explanatory, mixed method design was used. Settings: All the wards and units at the hospital. Participants: 136 completed questionnaires were returned, yielding a response rate of 68.3%. Ten nurses participated in a focus group interview. Methods: The quantitative phase consisted of a cross-sectional survey among all the 199 nurses working at the hospital. Participants completed the Attitudes Related to Trauma-Informed Care scale and provided some demographic data. Data was analysed through descriptive and inferential statistics. The qualitative phase involved formulation of the focus group interview schedule upon careful scrutiny of quantitative findings. The interview was audio-taped and transcribed verbatim. Thematic analysis was used to analyse qualitative data. Results: Mean scores for the five subscales of the questionnaire were positive, indicating favourable trauma-informed care attitudes of individual nurses. There was a statistically significant difference between subscale mean ranks for the subscale ‘Job behaviour’ by length of time working at the hospital. Moreover, statistically significant differences were obtained between subscale mean ranks for the subscales ‘Job behaviour’, ‘Self-efficacy’ and ‘Reactions’ by work setting of respondents. The three themes which emerged from the analysis of the focus group interview transcript were ‘Awareness’, ‘Unhealthy Boundaries’ and ‘Inhibition’. These revealed a shared reality among the nurses which encompasses an awareness of trauma-informed care issues, but also a series of contextual factors which inhibit their wellbeing and their capacity to provide trauma-informed care. Conclusions: Trauma-informed care was perceived as an important framework and more awareness is both needed and desired. Nurse educators must adequately respond to this growing need. For the hospital to become trauma-informed, the ambiguities in the context and the promotion of employee wellbeing need to be addressed.