Abstract
Background
Trauma-informed health care for women living with human immunodeficiency virus (HIV)
attends not only to HIV treatment, but also to the many common physical and emotional
health consequences of trauma. One principle of providing trauma-informed care is
the acknowledgement that working with a population that has experienced extensive
trauma affects the team members who care for them in the clinic, as well as the interactions
between those team members.
Methods
To understand the needs of one primary health care team, we conducted in-depth interviews
with 21 providers, staff, and collaborators who provide care to patients within the
clinic. We used symbolic interaction and grounded theory methods to examine how interactions
unfold within the clinic and how they are influenced by trauma.
Results
The clinic team serves a highly traumatized and vulnerable population. Within this
context, interactions between clinic staff unfold and trauma surfaces, and power dynamics
play out along the lines of professional hierarchy. Although power differences cause
tension within the clinic, professional hierarchy also serves as an important division
of labor in times of medical crises.
Conclusions
Clinic power dynamics may be influenced to improve the care environment for patients,
and to realize a more effective and satisfying trauma-informed health care clinic
for both patients and staff.
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Biography
Carol Dawson-Rose, RN, PhD, is a professor of nursing at the UCSF School of Nursing. Her research focuses on implementing behavioral health interventions in HIV primary care settings.
Biography
Yvette P. Cuca, PhD, MPH, MIA, is a research specialist and project director at the UCSF School of Nursing. Her work focuses on sexual and reproductive health and rights for women living with HIV.
Biography
Martha Shumway, PhD, is an associate professor in the UCSF Department of Psychiatry. Her work focuses on measurement, research methodology, and the effectiveness of mental health services.
Biography
Katy Davis, PhD, LCSW, is the director of Trauma-Informed Care at the UCSF Women's HIV Program. Her research focuses on the roles of attachment and stigma in intimate partner violence.
Biography
Edward L. Machtinger, MD, is a professor of medicine and director of the Women's HIV Program at UCSF. His research focuses on the impact of trauma among women living with HIV and on developing and evaluating models of trauma-informed health care.
Article info
Publication history
Published online: July 01, 2019
Accepted:
May 28,
2019
Received in revised form:
May 16,
2019
Received:
July 30,
2018
Footnotes
This work was supported by the UCSF National Center of Excellence in Women's Health, United States.
Identification
Copyright
© 2019 Jacobs Institute of Women's Health. Published by Elsevier Inc.
