Dealing with “difficult” patients and families: Making a case for trauma-informed care in the intensive care unit

Trauma is an experience of emotional or physical harm that has lasting adverse effects on an individual’s functioning or well-being. Critical illness is increasingly recognized as a source of primary trauma. Patients or their family members who have a history of trauma are likely to exhibit predictable adaptive responses when facing the traumatic experience of critical illness. Clinicians and administrators may view these protective responses as disruptive or “difficult,” leading to systematic and institutionally supported restrictions on patient- and family-centered care. We propose that a trauma-informed care (TIC) model of care delivery will improve our care of individuals facing critical illness as a retraumatizing event, and is a necessary complement to patient- and family-centered care to prevent these efforts from worsening existing disparities in critical care.