480 - Trauma-Informed Care Education in the Neonatal Intensive Care Unit: Using Interactive, Case-Based Electronic Modules to Move Toward a More Trauma-informed Unit

Publication Number: 480.6681

Hannah Gersch, Children's National Health System, Washington, DC, United States; Emily Mungovan, Eastern Virginia Medical School, Norfolk, VA, United States; Binny Chokshi, Usuhs, Washington, DC, United States; Lamia Soghier, George Washington University School of Medicine and Health Sciences, Washington, DC, United States; Lisa S. Wallace, ChristianaCare, Newark, DE, United States

Background: Parents of infants in the Neonatal Intensive Care Unit (NICU) can experience toxic stress resulting in lasting negative effects on well-being and function. Trauma-informed care (TIC) seeks to mitigate these effects by addressing parents’ pre-existing trauma, as well as their potential ongoing trauma from experiences in the NICU itself. Although providing TIC may improve the experience of NICU parents, there is a paucity of case-based TIC curricula for NICU providers.

Objective: To evaluate whether novel, interactive, case-based, electronic TIC education modules (e-modules) can increase NICU providers’ knowledge, attitudes, and practices of TIC.

Design/Methods: Prospective study conducted from 2022 to 2024 at two NICUs in a single metropolitan area. Study population included attending physicians, registered nurses, fellows, pediatric residents, advanced practice providers, and students. Participants completed a demographic survey, two case-based TIC e-modules lasting 30-minutes, and an adapted version of a previously validated Likert scale-based survey on “Knowledge, Attitudes, and Practices of Trauma-informed Care” (TIC KAP) at three time points: immediately before and after completing the e-modules, and 30 days later. We analyzed TIC KAP survey data using paired t-test and ANOVA.

Results: At baseline, participants thought TIC was important, but initially reported knowledge and practice deficits (Table 1). Nurses scored lower for initial knowledge but higher for initial practices of TIC compared with residents and fellows respectively (ANOVA p < 0.05, post-hoc analysis p < 0.005 (Bonferroni correction)). Knowledge of TIC increased significantly from pre-test to post-test for all participants and sub-groups (p < 0.05). Attitudes and practices of TIC also increased from pre-test to post-test for all participants; however, attending and fellow subgroups did not show significant change (Table 2). Among participants completing the 30-day post-test, the increase in TIC KAP was sustained (Table 3). There were significant challenges with maintaining engagement: of 109 initial survey participants, 55 (50%) completed the post-test, and 16 (15%) completed the 30-day post-test.

Conclusion(s): Thirty-minute case-based TIC e-modules significantly increased knowledge, attitudes, and practices of TIC among neonatal providers, with sustained improvement after 30 days. Next steps include evaluating parental experiences in the NICU related to TIC and whether learning and practicing a trauma-informed approach can decrease emotional exhaustion and burnout in participants.

Table 1. Baseline knowledge, attitudes, and practices of TIC by demographic group
All participants reported high initial scores for attitudes toward TIC, but lower baseline scores in knowledge and practice of TIC. Among provider groups, ANOVA testing showed significant differences, with residents reporting higher baseline knowledge than nurses, and nurses reporting higher baseline practices than fellows (p < 0.05 for ANOVA, p< 0.005 for post-hoc test with Bonferroni correction). Among age groups, 20-29 years olds reported significantly higher baseline knowledge compared to 30-39 year olds, and 40-49 year olds reported significantly higher baseline practices of TIC compared with 30-39 year olds (p < 0.05 for ANOVA, p < 0.016 for post-hoc test with Bonferroni correction).
a. All participants did not answer all questions on the demographic survey
b. Presented for groups with N > 5



Table 2. Pre-test and immediate post-test scores of TIC KAP by demographic group
Overall, participants showed a statistically significant difference in KAP with increased scores from pre-test to post-test. The only sub-groups that did not share this trend for attitudes and practices of TIC were attendings, fellows, and providers with age 40+ years old (p > 0.05). Difference in KAP scores from pre-test to post-test compared between provider groups and between age groups was not statistically significant (ANOVA p > 0.05). Demographic groups with N < 5 completing the post-test were not included in this analysis.
a. Significant paired t-test values (p < 0.05)
b. Includes all participants in the 40 – 49, 50 – 59, and 60+ age groups who completed both pre-test and post-test


Table 3. Change in knowledge, attitudes, and practices of TIC over time
There was a significant increase in all three categories from pre-test to post-test and 30-day post-test. There was not a significant change or decline in any category over 30 days following the training from the immediate post-test to the 30-day post-test. Analysis by provider type and age group was not pursued due to too few participants within each group.
a. ANOVA p-value significant p < 0.05
b. Significant p-values for post-hoc analysis based on Bonferroni correction (p < 0.0167)