Abstract

Trauma is widespread, and its symptoms can adversely impact wellbeing at end of life, a time when hospice seeks to maximize quality of life. This article reviews research on trauma at end of life, provides an overview of trauma-informed principles, and explores possibilities for applying trauma-informed care through an illustrative case study of a patient at end of life. The case discussion applies findings from the literature using Feldman’s Stepwise Psychosocial Palliative Care model as a roadmap. As shown in the case study, trauma-related symptoms may complicate care, making it an important subject of clinical attention for interdisciplinary hospice team members. As part of this team, social workers are particularly well suited to provide more targeted interventions where indicated, though all members of the team should take a trauma-informed approach. Lastly, this article reflects on the need for organizations to take a systems-level approach when implementing trauma-informed care and suggests implications for practice through a universal approach to trauma and the need for trauma-specific assessments and interventions at end-of-life, along with areas for future research.

摘要

创伤很普遍，它的症状会对临终时的健康产生不利影响，临终关怀旨在最大限度地提高生活质量。本文回顾了对临终创伤的研究，概述了创伤知情原则，并通过对临终患者的说明性案例研究探索了应用创伤知情护理的可能性。案例讨论应用了文献中的发现，使用 Feldman 的逐步心理社会姑息治疗模型作为路线图。如案例研究所示，创伤相关症状可能会使护理复杂化，使其成为跨学科临终关怀团队成员临床关注的重要主题。作为该团队的一部分，社会工作者特别适合在需要时提供更有针对性的干预措施，尽管团队的所有成员都应该采取创伤知情的方法。最后，本文反映了组织在实施创伤知情护理时采取系统级方法的必要性，并通过通用的创伤方法以及临终时针对创伤的评估和干预的必要性提出了对实践的影响，以及未来研究的领域。