Trauma-informed care in geriatric inpatient units to improve staff skills and reduce patient distress: a co-designed study protocol

Monica Cations, Kate Laver, Leah Couzner, Stephen Flatman, Petra Bierer, Catherine Ames, Yan Huo, Craig Whitehead

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Background: Geriatric hospital wards are highly medicalised environments with limited opportunities for choice and control, and can be distressing for older survivors of psychological trauma. While trauma-informed models of care (TIC) are effectively applied across mental health and other settings, the utility of these models in aged care settings has not been assessed. The objective of this study was to examine whether TIC can reduce responsive behaviour, chemical restraint, and improve staff skills and patient experiences in inpatient geriatric settings. Methods: Four wards participated in this type I hybrid implementation-effectiveness study across southern Adelaide, Australia, including 79 beds. Using a co-design method, the principles of TIC were transformed into an implementation strategy including staff training, establishment of highly trained ‘champions’ on each ward, screening for trauma-related needs, and amending ward policies and procedures. Primary outcomes will be examined using an interrupted time-series design and are monthly incidence of responsive behaviour incidents and use of chemical restraint. Process evaluation will be used to examine secondary, implementation outcomes including the acceptability, feasibility, and fidelity to the implementation strategy. Discussion: Trauma-informed care has potential to improve the safety and accessibility of hospital wards for older people who have survived psychologically traumatic events and has an extensive evidence base supporting its effectiveness in other settings. Identifying trauma-related needs and amending care to reduce the risk of re-traumatisation and distress may also reduce the incidence of responsive behaviour change, which has a significant impact on the quality of life of hospital patients and staff and is very costly. The inclusion of a process evaluation will allow us to identify and report changes made on each ward and make recommendations for future implementation efforts.

Original languageEnglish
Article number492
Number of pages9
JournalBMC Geriatrics
Publication statusPublished - 2021

Bibliographical note

Funding Information:
This study is funded by the South Australian Hospital Research Foundation and the Australian Government Medical Research Future Fund. MCa is supported by an Early Career Fellowship from the South Australian Hospital Research Foundation and a National Health and Medical Research Council Medical Research Future Fund Emerging Leadership Investigator Grant. KEL is supported by an Australian Research Council Discovery Early Career Researcher Fellowship. The funders had no role in study design, methods, data collection and analysis, decision to publish or preparation of this manuscript. All authors had final responsibility for the decision to submit for publication.

Funding Information:
We would like to acknowledge SA Health and the Southern Adelaide Local Health Network Division of Rehabilitation, Aged and Palliative Care for their partnership on this project. In particular, we would like to acknowledge Josephine Crowley, Katherine Flynn, Amanda Burdon, Wendy Giles, Natalie Spence, and Rob Ball for their contribution to project development.

Publisher Copyright:
© 2021, The Author(s).


  • Behavioural and psychological symptoms of dementia
  • Hospital care
  • Inpatient geriatric care
  • Mental health
  • Psychological wellbeing
  • Trauma-informed care


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