A systematic review on implementing education and training on trauma informed care to nurses in forensic mental health settings

Background
Engaging in trauma informed approaches in non-forensic mental health settings improves therapeutic relationships, aids recovery, reduces patient post-trauma symptoms, improves staff wellbeing, and can foster hope and empowerment; yet little is known of its influences in forensic settings. This literature review explores trauma-informed education and its training implications for nurses working in forensic mental health.

Method
Using a range of electronic databases a systematic search of literature was carried out focusing on trauma informed practice in adult forensic mental health settings. Prior to searching pre-defined inclusion and exclusion criteria was agreed. After duplication removal, abstract review and full screening, nine articles met review criteria for inclusion. 
Findings and discussion
Thematic analysis of the literature identified two key themes: ‘Education for trauma informed practice’ and ‘Applying theory into practice’. Each had several subordinate themes. These focused on the method and effectiveness of trauma informed education; the influence colleagues and managers have on implementing and embedding trauma informed practice; governance and operational arrangements; and minimising the occurrence of vicarious trauma. 
Implications for forensic practice
By adopting a trauma informed approach forensic mental health nurses can better understand their patients’ traumatic experiences, improving their therapeutic relationships. Trauma informed practice also influences patient collaboration in their care. Delivering training in trauma informed care should start with nurses who will change their personal practice and can support and train their colleagues. Organisations and its staff must also recognise that operational change and ongoing training will be required.