Research Article| Volume 44, P107-113, June 2023

Download started.


Nursing students' views on trauma-informed pediatric nursing care and family-centered care


      • Age-appropriate interventions for patients gained significance, by realizing that hospitalization is a traumatic experience.
      • The study revealed that the majority of nursing students had no trauma-informed practices.
      • It is highly important to incorporate TIC practices systematically in the education of health professionals.



      We studied the views of nursing students on family-centered care (FCC) and their knowledge, opinions, self-rated competence, current practice, and perceived implementation barriers with regard to trauma-informed pediatric nursing care.


      This survey was a descriptive correlational study. The sample consisted of 261 nursing students, 3rd and 4th years, who had completed the Child Health and Diseases Nursing Course. The data were obtained using the “Student Information Form,” “Family-Centered Care Attitude Scale,” and “trauma-informed care (TIC) Provider Survey.”


      Nursing students were knowledgeable and held favorable opinions about TIC. The survey showed that students with higher levels and those with a hospitalization experience during childhood had higher scores regarding TIC. A positive relationship was found between the students' TIC to mean score and FCC attitude mean score.


      Nursing students are not competent to practice TIC, especially with pediatric patients. Therefore, they need to develop relevant skills for helping pediatric patients.

      Practice implications

      Efforts to improve nursing students' trauma-informed pediatric care should highlight specific skills related to helping pediatric patients manage emotional responses to difficult medical experiences. By integrating TIC into the baccalaureate curricula, nursing educators can provide the students with appropriate skills and facilities so that they can provide holistic and highly effective care to highly vulnerable patients.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Psychiatric Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Alabdulaziz H.
        • Cruz J.P.
        Perceptions of female Saudi undergraduate nursing students toward family-centered care.
        Nurse Education Today. 2020; 89104421
        • Alnajjar H.
        • Elarousy W.
        Exploring family needs in neonatal and pediatric intensive care units at king Khaled Hospital-Jeddah.
        Clinical and Medical Investigations. 2017; 2: 1-7
        • American Association of Colleges of Nursing Essentials
        The voice of academic nursing.
        (Retrieved from)
        • Aware A.
        Screening tools. State of California Department of Health Care Services.
        (Retrieved from)
        • Banh M.K.
        • Saxe G.
        • Mangione T.
        • Horton N.J.
        Physician-reported practice of managing childhood posttraumatic stress in pediatric primary care.
        General Hospital Psychiatry. 2008; 30: 536-545
        • Bruce M.M.
        • Kassam-Adams N.
        • Rogers M.
        • Anderson K.M.
        • Sluys K.P.
        • Richmond T.S.
        Trauma providers’ knowledge, views and practice of trauma-informed care.
        Journal of Trauma Nursing: The Official Journal of the Society of Trauma Nurses. 2018; 25: 131-138
        • Burke N.J.
        • Hellman J.L.
        • Scott B.G.
        • Weems C.F.
        • Carrion V.G.
        The impact of adverse childhood experiences on an urban pediatric population.
        Child Abuse & Neglect. 2011; 35: 408-413
        • Burton C.W.
        • Williams J.R.
        • Anderson J.
        Trauma-informed care education in baccalaureate nursing curricula in the United States: Applying the American Association of Colleges of Nursing Essentials.
        Journal of Forensic Nursing. 2019; 15: 214-221
        • Cannon L.M.
        • Coolidge E.M.
        • LeGierse J.
        • Moskowitz Y.
        • Buckley C.
        • Chapin E.
        • Warren M.
        • Kuzma E.K.
        Trauma-informed education: Creating and pilot testing a nursing curriculum on trauma-informed care.
        Nurse Education Today. 2020; 85104256
        • Care C.o.H.
        Family-centered care and the pediatrician’s role.
        Pediatrics. 2003; 112: 691-696
        • Choi K.R.
        • Seng J.S.
        Pilot for nurse-led, interprofessional in-service training on trauma-informed perinatal care.
        The Journal of Continuing Education in Nursing. 2015; 46: 515-521
        • Coughlin M.
        Trauma-informed, neuroprotective care for hospitalised newborns and infants.
        Infant. 2017; 13: 176-179
        • Ding X.
        • Zhu L.
        • Zhang R.
        • Wang L.
        • Wang T.-T.
        • Latour J.M.
        Effects of family-centred care interventions on preterm infants and parents in neonatal intensive care units: A systematic review and meta-analysis of randomised controlled trials.
        Australian Critical Care. 2019; 32: 63-75
        • Felitti V.J.
        • Anda R.F.
        • Nordenberg D.
        • Williamson D.F.
        • Spitz A.M.
        • Edwards V.
        • Koss M.P.
        • Marks J.S.
        Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study.
        American Journal of Preventive Medicine. 2019; 56: 774-786
        • Fitzgerald M.
        • Ward J.
        Using standardized actors to promote family-centered care.
        Journal of Pediatric Nursing. 2019; 45: 20-25
        • Foster M.
        • Whitehead L.
        • Maybee P.
        The parents', hospitalized child's, and health care providers' perceptions and experiences of family-centered care within a pediatric critical care setting: A synthesis of quantitative research.
        Journal of Family Nursing. 2016; 22: 6-73
        • Gerritsen R.T.
        • Hartog C.S.
        • Curtis J.R.
        New developments in the provision of family-centered care in the intensive care unit.
        Intensive Care Medicine. 2017; 43: 550-553
        • Glaser D.
        The effects of child maltreatment on the developing brain.
        Medico-Legal Journal. 2014; 82: 97-111
        • Goddard A.
        • Janicek E.
        • Etcher L.
        Trauma-informed care for the pediatric nurse.
        Journal of Pediatric Nursing. 2022; 62: 1-9
        • Gold J.I.
        • Kant A.J.
        • Kim S.H.
        The impact of unintentional pediatric trauma: A review of pain, acute stress, and posttraumatic stress.
        Journal of Pediatric Nursing. 2008; 23: 81-91
        • Goldfarb M.J.
        • Bibas L.
        • Bartlett V.
        • Jones H.
        • Khan N.
        Outcomes of patient-and family-centered care interventions in the ICU: A systematic review and meta-analysis.
        Critical Care Medicine. 2017; 45: 1751-1761
        • Grasso D.J.
        • Ford J.D.
        • Briggs-Gowan M.J.
        Early life trauma exposure and stress sensitivity in young children.
        Journal of Pediatric Psychology. 2013; 38: 94-103
        • Hemmelgarn A.L.
        • Glisson C.
        • Dukes D.
        Emergency room culture and the emotional support component of family-centered care.
        Children’s Health Care. 2001; 30: 93-110
        • Hemmelgarn A.L.
        • Glisson C.
        • James L.R.
        Organizational culture and climate: Implications for services and interventions research.
        Clinical Psychology: Science and Practice. 2006; 13: 73-89
        • Hockenberry M.J.
        • Wilson D.
        Wong’s nursing care of infants and children-E-book.
        Elsevier Health Sciences, 2018
        • Holtslander L.
        • Solar J.
        • Smith N.R.
        The 15-minute family interview as a learning strategy for senior undergraduate nursing students.
        Journal of Family Nursing. 2013; 19: 230-248
        • Kahana S.Y.
        • Feeny N.C.
        • Youngstrom E.A.
        • Drotar D.
        Posttraumatic stress in youth experiencing illnesses and injuries: An exploratory meta-analysis.
        Traumatology. 2006; 12: 148-161
        • Kalmakis K.A.
        • Chandler G.E.
        • Roberts S.J.
        • Leung K.
        Nurse practitioner screening for childhood adversity among adult primary care patients: A mixed- method study.
        Journal of the American Association of Nurse Practitioners. 2017; 29: 35-45
        • Kara A.
        • Tüfekci F.
        The Impact of Family Centered Care Training on Attitudes in Child Nurses.
        Atatürk University, 2018 (Doctora Thesis)
        • Kassam-Adams N.
        • Butler L.
        What do clinicians caring for children need to know about pediatric medical traumatic stress and the ethics of trauma-informed approaches?.
        AMA Journal of Ethics. 2017; 19: 793-801
        • Kassam-Adams N.
        • Marsac M.L.
        • Hildenbrand A.
        • Winston F.
        Posttraumatic stress following pediatric injury: Update on diagnosis, risk factors, and intervention.
        JAMA Pediatrics. 2013; 167: 1158-1165
        • Kassam-Adams N.
        • Rzucidlo S.
        • Campbell M.
        • Good G.
        • Bonifacio E.
        • Slouf K.
        • Schneider S.
        • McKenna C.
        • Hanson C.A.
        • Grather D.
        Nurses' views and current practice of trauma-informed pediatric nursing care.
        Journal of Pediatric Nursing. 2015; 30: 478-484
        • Kazak A.E.
        • Kassam-Adams N.
        • Schneider S.
        • Zelikovsky N.
        • Alderfer M.A.
        • Rourke M.
        An integrative model of pediatric medical traumatic stress.
        Journal of Pediatric Psychology. 2006; 31: 343-355
        • Kazak A.E.
        • Swain A.M.
        • Pai A.L.H.
        • Canter K.
        • Carlson O.
        • Vega G.
        • Joffe N.
        • Deatrick J.
        Caregiver perspectives on psychosocial care in pediatric hematopoietic stem cell transplantation (HCT).
        Clinical Practice in Pediatric Psychology. 2020; 8: 67-78
        • Ko S.J.
        • Ford J.D.
        • Kassam-Adams N.
        • Berkowitz S.J.
        • Wilson C.
        • Wong M.
        • Brymer M.J.
        • Layne C.M.
        Creating trauma-informed systems: Child welfare, education, first responders, health care, juvenile justice.
        Professional Psychology: Research and Practice. 2008; 39: 396-404
        • Kosman K.A.
        • Levy-Carrick N.C.
        Positioning psychiatry as a leader in trauma-informed care (TIC): The need for psychiatry resident education.
        Academic Psychiatry. 2019; 43: 429-434
        • Kuzma E.K.
        • Cannon L.M.
        • Coolidge E.M.
        • Harris M.
        • Buckley C.
        • Chapin E.
        • Harbor M.A.-W.
        Faculty, preceptor, and students’ perceptions of the need for trauma-informed education: Recommendations for implementation.
        Nurse Educator. 2022; 47: E80-E85
        • Li Y.
        • Cannon L.M.
        • Coolidge E.M.
        • Darling-Fisher C.S.
        • Pardee M.
        • Kuzma E.K.
        Current state of trauma-informed education in the health sciences: Lessons for nursing.
        Journal of Nursing Education. 2019; 58: 93-101
        • Marsac M.L.
        • Kassam-Adams N.
        • Hildenbrand A.K.
        • Nicholls E.
        • Winston F.K.
        • Leff S.S.
        • Fein J.
        Implementing a trauma-informed approach in pediatric health care networks.
        JAMA Pediatrics. 2016; 170: 70-77
        • Mirlashari J.
        • Brown H.
        • Fomani F.K.
        • de Salaberry J.
        • Zadeh T.K.
        • Khoshkhou F.
        The challenges of implementing family-centered care in NICU from the perspectives of physicians and nurses.
        Journal of Pediatric Nursing. 2020; 50: e91-e98
        • Moore K.A.C.
        • Coker K.
        • DuBuisson A.B.
        • Swett B.
        • Edwards W.H.
        Implementing potentially better practices for improving family-centered care in neonatal intensive care units: Successes and challenges.
        Pediatrics. 2003; 111: e450-e460
        • Moss K.M.
        • Healy K.L.
        • Ziviani J.
        • Newcombe P.
        • Cobham V.E.
        • McCutcheon H.
        • Montague G.
        • Kenardy J.
        Trauma-informed care in practice: Observed use of psychosocial care practices with children and families in a large pediatric hospital.
        Psychological Services. 2019; 16: 16-28
        • Moss K.M.
        • Ziviani J.
        • Newcombe P.
        • Cobham V.E.
        • McCutcheon H.
        • Montague G.
        • Kenardy J.
        Pathways to increasing the use of psychosocial care with hospitalized children.
        Psychological Services. 2019; 16: 29-37
        • O’Malley P.J.
        • Brown K.
        • Krug S.E.
        Patient-and family-centered care of children in the emergency department.
        Pediatrics. 2008; 122: e511-e521
        • Oral R.
        • Ramirez M.
        • Coohey C.
        • Nakada S.
        • Walz A.
        • Kuntz A.
        • Peek-Asa C.
        Adverse childhood experiences and trauma informed care: The future of health care.
        Pediatric Research. 2015; 79: 227-233
        • Rooks R.N.
        • Ford C.
        Personal reflection: Reflections on a family health history assignment for undergraduate public health and nursing students.
        International Journal for the Scholarship of Teaching and Learning. 2013; 7: 1-21
        • Shonkoff J.P.
        • Garner A.S.
        • Siegel B.S.
        • Dobbins M.I.
        • Earls M.F.
        • McGuinn L.
        • Committee on Early Childhood Adoption and Dependent Care
        The lifelong effects of early childhood adversity and toxic stress.
        Pediatrics. 2012; 129: e232-e246
        • Spenrath M.A.
        • Clarke M.E.
        • Kutcher S.
        The science of brain and biological development: Implications for mental health research, practice and policy.
        Journal of the Canadian Academy of Child and Adolescent Psychiatry. 2011; 20: 298-304
        • Stuber M.L.
        • Schneider S.
        • Kassam-Adams N.
        • Kazak A.E.
        • Saxe G.
        The medical traumatic stress toolkit.
        CNS Spectrums. 2006; 11: 137-142
        • Vasquez M.L.
        • Boel-Studt S.
        Integrating a trauma-informed care perspective in baccalaureate social work education: Guiding principles.
        Advances in Social Work. 2017; 18: 1-24
        • Ward-Begnoche W.L.
        • Aitken M.E.
        • Liggin R.
        • Mullins S.H.
        • Kassam-Adams N.
        • Marks A.
        • Winston F.K.
        Emergency department screening for risk for post-traumatic stress disorder among injured children.
        Injury Prevention. 2006; 12: 323-326
        • Williams T.M.
        • Smith G.P.
        Does training change practice? A survey of clinicians and managers one year after training in trauma-informed care.
        The Journal of Mental Health Training, Education and Practice. 2017;