Data Sheet 1_Negative effects of adverse childhood experiences and absence of positive childhood experiences on healthcare employees: survey findings built on 10 years of trauma-informed development.docx

IntroductionExisting data on how history of trauma and adversity affects healthcare professionals is limited. This study sought to describe the prevalence of Adverse Childhood Experiences (ACEs) and Positive Childhood Experiences (PCEs) and their association with present-day workplace and wellbeing outcomes among a sample of healthcare teammates overall, as well as specifically among nurses. The paper also describes local trauma-informed care initiatives that supported study feasibility.
MethodsCross-sectional online survey data were collected in conjunction with promoting hospital-wide trauma-informed care training opportunities on two campuses that are part of an academic health system. Scales and items assessed independent variables PCEs and ACEs, and dependent variables including burnout, compassion fatigue, organizational belonging, adult resilience, access to support, and workplace violence (WPV). Demographic data were not collected to limit identifiability and encourage participation. Multivariable, hierarchical models regressed categorized total ACEs (ref 0, 1–3, 4–10) and total PCEs (ref 6–7, 3–5, 0–2) together on dichotomized dependent variables. Sub-analyses also adjusted for whether the participant was a nurse or reported serving in a different role.
ResultsParticipants included 349 clinical and non-clinical employees, of whom 61.1% had at least one reported ACE, but 24.9% reported 4–10 ACEs. 29.9% reported only having 3–5 PCEs in their childhood, while 23.2% reported 0–2 positive childhood experiences. Even when adjusting for ACEs, having 0–2 PCEs was associated with significantly reduced odds of getting needed emotional or social support (AOR = 0.14, 95% CI: 0.07, 0.29). Having 0–2 PCEs relative to 6–7 PCEs was also significantly associated with greater odds of past 2-week compassion fatigue, a lower resilience score, and decreased odds of reported organizational belonging measures. Adjusting for ACEs and PCEs, nurses reported lower resilience and higher workplace violence compared to all other participant roles combined.
DiscussionTeammate history of adversity was widespread and having fewer PCEs was associated with poorer adult workplace outcomes. These findings point to the value of a trauma-informed approach in healthcare, which offers healthcare organizations a framework for recognizing how trauma experiences affect wellbeing and intersect with the healthcare system, as well as how to create environments that are supportive of patients, staff, and providers.

引言：目前关于创伤与逆境史如何影响医疗团队成员的相关研究数据较为匮乏。本研究旨在描述医疗团队成员整体样本（并特别针对护士群体）的不良童年经历（Adverse Childhood Experiences, ACEs）与积极童年经历（Positive Childhood Experiences, PCEs）的流行率，及其与当前职场状况与健康福祉结局的关联。本文同时阐述了为本研究开展提供可行性支撑的本地创伤知情照护举措。
研究方法：本研究于某学术医疗系统下辖的两个院区开展，结合推广全院范围的创伤知情照护培训契机，收集了横断面在线调查数据。研究采用量表与条目评估自变量PCEs、ACEs，以及职业倦怠、共情疲劳、组织归属感、成人韧性、支持资源可及性与职场暴力（workplace violence, WPV）等因变量。为降低研究对象的可识别性并提升参与意愿，本研究未收集人口统计学数据。多变量分层模型将分类后的总ACEs（参照组：0个、1~3个、4~10个）与总PCEs（参照组：6~7个、3~5个、0~2个）一同对二分法因变量进行回归分析。亚组分析还针对参与者是否为护士或从事其他岗位进行了校正。
研究结果：本次研究共纳入349名临床与非临床医护人员，其中61.1%的参与者报告至少经历过1次不良童年经历，24.9%的参与者报告经历过4~10次不良童年经历。29.9%的参与者童年仅拥有3~5次积极童年经历，而23.2%的参与者童年拥有0~2次积极童年经历。即使校正ACEs的影响，拥有0~2次积极童年经历仍与获得所需情感或社会支持的比值比显著降低相关（调整后比值比Adjusted Odds Ratio, AOR=0.14，95%置信区间Confidence Interval, CI：0.07~0.29）。相较于拥有6~7次积极童年经历的群体，拥有0~2次积极童年经历的群体还与过去2周内出现共情疲劳的比值比升高、韧性评分更低，以及报告组织归属感的比例降低显著相关。在校正ACEs与PCEs的影响后，与其他所有岗位参与者合计相比，护士群体报告的韧性更低、职场暴力发生率更高。
讨论：医疗团队成员的逆境史较为普遍，而积极童年经历越少则成人期职场结局越差。本研究结果凸显了医疗领域推行创伤知情照护模式的价值，该模式可为医疗组织提供一套分析框架，用以识别创伤经历如何影响健康福祉、与医疗系统产生交互作用，以及如何构建支持患者、医护人员与服务提供者的友好环境。