Building a Trauma Informed Organization

BY: Diane Snyder Cowan, MA, MT-BC, CHPCA

CATEGORY: Medical and Clinical; News and Community

​Individual trauma results from an event, series of events or set of circumstances experienced by an individual as physically or emotionally harmful or life threatening that has lasting adverse effects on functioning and mental, physical, social, emotional, or spiritual wellbeing. (1)

The end-of-life care experience is especially susceptible to re-traumatization. Education on trauma informed care, including the prevalence of trauma and trauma symptoms, has been provided to all staff of Hospice of the Western Reserve.

There are multiple triggers at end-of-life. What triggers a person is unique to each individual. Triggers can be multi-sensory (sight, sound, smell, taste, touch), inner and outer physical sensations (e.g., heat, pressure, constriction), memories, thoughts or images, emotional states (e.g., fear or helplessness) or situations, being crowded or immobilized, for instance.  

What factors make the end-of-life care experience especially susceptible to re-traumatization?

Adverse Childhood Experiences (ACES), traumas accumulating over the life span, being old and medical care (e.g., second cancer diagnosis, intensive medical treatment, delirium, hospice diagnosis) contribute to the increased risk.

In addition to abuse, neglect and dysfunction in childhood, traumas accumulate over a person’s lifespan. These include bullying, rape, accidents, military combat, personal deaths, financial catastrophes, natural catastrophes, etc.

The natural process of life review that occurs at the end of life can trigger traumatic stress symptomology. Trauma informed care education teaches our staff to identify what could be a trigger so re-traumatization can be prevented and/or addressed.

To assist in this effort, Hospice of the Western Reserve developed a transdisciplinary team of “Trauma Champions”. These champions, who understand the impact of psychological trauma on the lives of patients, caregivers and themselves, are available to all staff. While the champions are there to do the job specific to their discipline, they also recognize the role trauma plays at the end-of life. They can identify trauma symptoms and advocate for patients and families.  

Editor’s Note: An hour-long CE program, “Trauma Informed End-of-Life Care,” is available to healthcare professionals.  To request this presentation for your organization, contact Cheryl Strang:, or 216.430.0955.

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