Reference — Mental Health
Trauma-Informed Care Reference
Trauma-informed care assumes a patient may have a trauma history and asks “what happened to you?”rather than “what’s wrong with you?” It rests on six principles and protects every patient from re-traumatization.
Educational use only. This reference summarizes a widely used framework (SAMHSA) for educational purposes; follow your facility’s trauma-informed and behavioral-health policies. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
The Six Key Principles
| Principle | What it means | At the bedside |
|---|---|---|
| Safety | Physical and psychological safety for patients and staff | Calm, predictable environment; explain what you'll do; minimize sudden stimuli |
| Trustworthiness & transparency | Decisions made with transparency to build trust | Tell the truth, be consistent, do what you say you'll do |
| Peer support | Survivor connection and shared experience aid recovery | Connect patients with support groups and peer resources |
| Collaboration & mutuality | Power is shared; care is done WITH, not TO | Involve the patient in the plan; level the power difference |
| Empowerment, voice & choice | Strengths recognized; the patient has real choices | Offer options; ask permission for touch; restore a sense of control |
| Cultural, historical & gender issues | Care is responsive to identity and past harms | Address bias; honor preferences; avoid stereotyping |
Grounding a Patient in Crisis
When a patient dissociates or has a flashback, grounding brings them to the present. Stay calm and speak quietly. Orient them: state your name, the place, the date, and that they are safe. Use the 5-4-3-2-1 senses technique (name 5 things you see, 4 you hear, 3 you can touch, 2 you smell, 1 you taste), slow diaphragmatic breathing, or feeling their feet on the floor. Do not touch without permission, corner the patient, or force eye contact.
Triggers & Avoiding Re-Traumatization
Triggers are reminders — sounds, smells, touch, exposure, restraint, anniversaries, or invasive procedures — that reactivate the trauma response. Ask the patient what triggers and what helps, explain procedures before doing them, ask permission for any touch, offer choices, and avoid unnecessary restraint or forced exposure. Pelvic, rectal, and other intimate exams are high-risk; offer a chaperone, go slowly, and stop if asked. The goal is care that does not repeat the powerlessness of the original trauma.
NCLEX Pearls
- ✦Trauma-informed care asks 'what happened to you?' not 'what's wrong with you?'
- ✦Six principles: safety; trustworthiness/transparency; peer support; collaboration/mutuality; empowerment/voice/choice; cultural/historical/gender.
- ✦Care is done WITH the patient — offer choices and ask permission to restore control.
- ✦During a flashback: stay calm, ensure safety, orient/ground to the present (5-4-3-2-1, breathing); don't touch without permission.
- ✦Anticipate triggers; explain procedures in advance and avoid unnecessary restraint or forced exposure.
- ✦Intimate exams are high-risk for re-traumatization — go slowly, offer a chaperone, and stop if asked.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Psychiatric Association (DSM-5-TR) · American Psychiatric Nurses Association (APNA) · SAMHSA. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →