UCalgary nursing researchers develop trauma and resilience training for frontline workers in ERs

Calgary, AB – A team of University of Calgary researchers has developed Trauma Resilience Informed Practice (TRIP) training for health care professionals to improve patient care.The practice lessens stigma in mental illness and substance use disorder care, particularly in emergency department (ER) environments. The TRIP training is the result of the Exploring Mental health Barriers in Emergency Rooms (EMBER) study.

The EMBER team engaged with patients, families, ER teams including physicians, nurses, and psychiatrists, psychiatric nurses and protective services at the Foothills Medical Centre to understand the experience of stigma in mental health and substance use care. They looked at stigma from three levels: structural, which looked at the policies and institutional practices that limit access to care, interpersonal, which looked at the prejudice and labelling of people with mental illness and substance use disorders by the public, and intrapersonal, which is when someone takes in this information from the public and internalizes it, leading to feelings of shame and guilt.  The study led to the creation of a training program for frontline staff in ERs that has shown success in providing better support for patients in mental health crisis, and helping health-care professionals involved in emergency care.

“Stigma remains the most pervasive and enduring barrier to accessing mental health and substance use care.”
 
Dr. Jacqueline Smith, PhD, associate professor in the Faculty of Nursing and EMBER’s principal investigator

Funded by Calgary Health Foundation, the EMBER team conducted interviews and focus groups and came away with four important findings:

• A lack of inpatient beds and significant wait times for individuals led to patients being held in temporary psychiatric rooms with no windows and concrete walls. The team heard repeatedly that this was a dehumanizing environment and patients felt like they were in prison.
• Frontline staff said they felt they had a lack of training for mental illness and substance use disorders. Patients and families also recognized that staff didn’t always understand what they were experiencing.
• There was a lack of trauma-informed training.
• There were high levels of occupational stress among frontline providers. 

The researchers took all this information and searched for an intervention that would be helpful for staff and patients in emergency departments. 

“We can’t give what we don’t have. This is a significant, validating and supportive gesture and practice for our frontline staff. We want to support their own resilience so they can give back in an empathetic way.” 
 
Jacqueline Smith

Partnering with the Fraser Health Authority (FHA), the EMBER team adapted the TRIP training that the FHA developed. The UCalgary team put together a four-hour training module for frontline staff, specific to emergency department environments. The premise of the training is to teach frontline staff to become more aware of their own responses to trauma exposure. It covered the neurobiology of trauma and how frontline workers could develop skills for resilience and self-compassion. 

Within the training, frontline staff also received some emotional regulation tools and strategies to reduce stigma. The results were noticeable. The team measured stigma, resilience, and self-compassion. After the training, they saw statistically significant reductions in stigma and increases in resilience. The team is now working towards accreditation of the TRIP intervention and are being supported by the Translating Research to Action (TR2A) service at UCalgary to develop a sustainability plan to continue to deliver the training. 

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Media inquiries

Brennan Black
Advisor, Media Relations, Office of External Relations
368-886-3135
Brennan.black@ucalgary.ca