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An Essential Guide to Trauma-Informed Care


By Carrie Clark, Catherine C. Classen, Anne Fourt, Maithili Shetty166 pp., London, UK: Routledge, 2015, hardback $155.00, paperback $52.95.


BRIEF:Treating the Trauma Survivor is a practical guide to assist mental health, healthcare, and social service providers in providing trauma-informed care. The authors include essential information for understanding the impacts of trauma by summarizing key literature in an easily accessible, user-friendly format. Providers will be able to identify common pitfalls and avoid retraumatizing survivors. Based on extensive experience and interactions with trauma survivors, the authors provide a trauma-informed framework and offer practical tools to enhance collaboration with survivors and promote a safer helping environment. Community healthcare, mental healthcare providers, and addictions personnel will find the framework and practical suggestions informative and useful.

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BRIEF: Sponsored by Orchard Place, this Des Moines, Iowa, charity offering mental health treatment and expertise for children and families, provides training and resources for organizations and individuals to address trauma and provide the best care. The goal of the Trauma Informed Care Project (TICP) is to educate the larger system, which delivers services or has some piece of a family's case, about trauma and how it may impact the system and/or affect the family, and to educate and train practitioners in evidence-based, trauma-informed services so that the community and the system can have available resources. TICP offers an annual conference, and training can be requested through a form on the website.

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Chaplaincy, Spiritual Care, and the Law


By Winnifred Fallers Sullivan


252 pp., Chicago, IL: University of Chicago Press, 2014, hardcover, $45.00, eBook available.


REVIEW: Although this content is written about chaplains, its topic of spiritual care in relation to law, primarily U.S. law, is pertinent to nurses interested in supporting patient spiritual well-being. Although this book explores the legal history, the anthropology, and the sociology of spiritual care, the exquisite and unique attention provided to the topic (especially in the Introduction and Chapter 1) provides insightful thoughts on the interrelatedness of law and religion. For me, a nurse who investigates how nurse clinicians think about and provide spiritual care and religious support, this material was eye-opening and thought-provoking.

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Sullivan, a religious studies professor with a law school affiliation, uses this venue to illustrate her adage: there is no religion without law and no law without religion. Her intent is to "better understand" how American law regulates religion and citizens' quest to understand their essential nature. She posits that until the late 1900s, the U.S. government actively engaged in applying the Constitution's First Amendment, dictating separation between church and state. She observes that more recently, however, U.S. courts have seen religion as both less threatening and less in need of protection. Concurrent with these legal trends is a society that increasingly opts for spirituality in lieu of religion. That is, American religiosity (perceived as top-down and institutional) is increasingly being replaced by the more subjective, egalitarian, individualistic, mix 'n match spirituality.


Given these trends, people receive religious support in the form of the generic and all-encompassing spiritual care in public sectors (e.g., hospitals, prisons, schools, work places) by "priests" (i.e., chaplains) who are not hired by a religious organization. (I read an article on spiritual care that compared the physician to the priest and referred to nurses as priestesses!) Sullivan challenges this phenomenon by addressing the question of whether such spiritual care is appropriate.


Illustrating this tension between protecting and providing religion, yet keeping it separate from the state, is a discussion in Chapter 1 about how military chaplains instituted a spiritual fitness program. The program guides chaplains in spiritual assessment and provides instructional spiritual programming for personnel. (The comparison with nursing spiritual assessment and care is not overlooked by Sullivan; however, it is a tangent in the book.) This military program, as Sullivan characterized it, is religion in disguise-religion "with the legally problematic bits [i.e., evangelization, sectarianism] removed" (p. 25). Thus, the issue is raised: Is religion promoted legally when the word for it is simply changed to spirituality? The U.S. courts supported the spiritual fitness program when it was challenged because it was optional, and because it was nonsectarian spiritual care.


Sullivan's discussion should raise the eyebrows of any nurse, not just the evangelical Christian nurse. Her book reminds us of the legal and ethical questions prompted by spiritual care. Do we use the term spiritual as a euphemism for religion and covertly seek to infuse religion into the lives of patients? Is our mandate to make a spiritual assessment and diagnosis reflective of our culture's long history of doing so to determine a person's worth or competence? (Puritans did spiritual assessment prior to choosing leaders. And remember the Salem witch trials?) For what purpose do we complete spiritual assessments? Sullivan suggests that the savvy way that chaplains bridge this secular-sacred tension is in their hallmark act of providing presence. The language and act of providing presence is religiously neutral and nonimposing. Nurses will do well to learn from chaplains in this regard. Researchers and educators will help nursing if they study and teach presence. Nurses at the bedside will help patients heal when they expertly provide presence as spiritual care.-Elizabeth Johnston Taylor, PhD, RN; Professor, Loma Linda University School of Nursing, Loma Linda, CA


Going Deeper

Going Deeper helps you dig deeper into JCN content, offering ideas for personal or group study with other nurses-great for Nurses Christian Fellowship groups!


* Trauma-Informed Care: Read Koetting, 206-213.


1. Prior to reading this article, how much did you know about trauma-informed care (TIC)?


2. What are the four essential features of TIC?


3. What six specific concepts define TIC?


4. What are the nursing implications of this statement? "Evidence supports that the experience of trauma in people's lives has a direct impact on their health behaviors, in particular, increasing the risk of mortality from chronic illness."


5. Briefly discuss the neurobiology of brain trauma, as related to this article.


6. Read John 4 and the sidebar on page 210. What additional insights do you glean from this account? What other biblical passages might be applicable to TIC?


* Improving Health Through Political Activism: Read Johnston and Landreneau, 225-229.


1. How do the authors suggest nurses influence public policy?


2. To what degree are you generally interested in public policy?


3. The authors state: "We can engage and make vital contributions to the nonprofit sector of the nation's health care, but must make wise choices." Discuss.


4. Read Micah 6:8. How might these verses encourage one to take action in working toward a positive outcome for a community issue?


* Equipping African American Clergy to Recognize Depression: Read Anthony et al., 230-237.


1. What do the authors state as some of the cultural beliefs held by African Americans related to depression?


2. What negative outcomes are related to delaying treatment of depression?


3. Familiarize yourself with the Depression Attitude (DAQ) instrument.


4. How can faith community nurses partner with clergy and mental healthcare professionals to assist with training and intervention?


5. Read Romans 12:1-2; Ephesians 4:22-24; Colossians 3:1-2. How might these verses relate to someone who is depressed?