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

One in five Canadians will experience a mental illness or substance use disorder in any given year. Despite this prevalence, there are significant gaps in service, access and co-ordination, which leads the emergency room to be the default entry point of care for individuals and families experiencing a crisis.

Led by a team of University of Calgary researchers, Exploring Mental health Barriers in Emergency Rooms (EMBER) is a study aimed at addressing the multiple levels of mental-illness stigma existing within emergency department (ER) settings. 

“Stigma remains the most pervasive and enduring barrier to accessing mental health and substance-use care,” says Dr. Jacqueline Smith, BN’09, PhD’15, an associate professor in the Faculty of Nursing and EMBER’s principal investigator. 

Funded by Calgary Health Foundation, the EMBER team engaged with patients, families and ER teams, including physicians, nurses, 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 abuse 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. 

Through interviews and focus groups, the EMBER team 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 concrete walls and no windows. Smith says 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.

“It was like a perfect storm,” says Smith. 

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

Partnering with the Fraser Health Authority (FHA), the EMBER team adapted Trauma Resilience Informed Practice (TRIP) training developed by the FHA. 

The team created 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. 

“The premise of our research became: we can’t give what we don’t have,” says Smith. 

Within the training, frontline staff also received some emotional-regulation tools and strategies to reduce stigma. 

“What we’re doing is teaching them how trauma is impacting them personally and giving them the skills to support their own wellness,” says Smith. “Once they could understand how they were impacted and could self-regulate, then they were able to transfer that skill to people coming in the door.”

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.

“This is a significant, validating and supportive gesture and practice for our frontline staff,” says Smith, who is also a former emergency room nurse. 

“We want to support their own resilience so they can give back in an empathetic way.”