Exploring the Impact of Educating Nursing Students in Higher Education on Trauma and Trauma Informed Care

Student summary

Why This Research Matters

Trauma is far more common than many people assume. Citing the landmark Adverse Childhood Experiences (ACEs) research by Felitti and colleagues (1998), this dissertation opens with a striking fact: more than half of the population has experienced at least one adverse childhood experience. That means trauma history walks into nearly every clinical encounter a nurse will ever have. The question this study asks is simple but important: are nursing students actually being taught how to recognize trauma and respond to it in a way that does not cause more harm, before they graduate?

The researcher, Meredith Kissel Malone, designed a quantitative, quasi-experimental study to answer that question. The approach was straightforward. Nursing students who were currently enrolled in a mental health nursing course first completed a pre-survey measuring their existing knowledge of trauma and trauma-informed care (TIC). Then the researcher personally delivered an education session on trauma and TIC. Afterward, the same students completed a post-survey covering the same topics. Comparing the two sets of scores let the researcher see whether the education session actually changed what students knew, rather than just assuming a lecture works.

To test whether any change was real and not just random variation, the researcher ran a paired t-test, which compares the same group's scores before and after an intervention. The results were clear: every single survey question showed a statistically significant increase in knowledge, with a p-value of 0.001 for all items. In plain terms, a p-value that low means there is only about a 1-in-1,000 chance the improvement happened by chance. The null hypothesis, which would have said the education session made no difference, was rejected. The alternative hypothesis, that the session did improve knowledge, was supported.

An interesting wrinkle in the findings is that students did not start out clueless. Many already had some baseline understanding of trauma and TIC, likely picked up from prior coursework, clinical exposure, or general health education. But even with that starting point, the education session still measurably reinforced and expanded what they knew on every individual survey item. That distinction matters for nursing education: it suggests dedicated TIC instruction adds real value even to students who feel reasonably confident already, rather than being redundant.

Why does this matter for future nurses? Trauma is not confined to psychiatric units. Patients with trauma histories show up in emergency departments, surgical units, maternity wards, and primary care clinics, often without disclosing their history unless a clinician creates a safe space for it. Trauma-informed care is not a single skill but a way of practicing that assumes trauma may be present, avoids re-traumatizing patients through insensitive questioning or procedures, and builds trust before diving into care tasks. If nursing programs treat TIC as an elective add-on rather than a core competency, graduates enter the workforce without a shared language or framework for recognizing trauma's effects on physical, emotional, and cognitive health, as the dissertation's opening argument makes clear.

As a student reading this study, it is worth noticing what the research does and does not show. It demonstrates that one researcher-delivered education session, embedded in one mental health nursing course, improved short-term knowledge scores measured immediately afterward. It does not tell us whether that knowledge held up months later, whether it changed how students actually behaved with real patients, or how it would perform across different schools, class sizes, or types of instructors. The abstract also does not report the exact number of participants, so readers should treat the sample as likely small and localized, consistent with many single-institution doctoral studies.

Still, the practical takeaway is encouraging and actionable. A relatively brief, structured education intervention was enough to produce a measurable, statistically significant knowledge gain across every survey topic. For students and new graduates, this is a reminder that trauma-informed care is a teachable, learnable skill set, not an innate trait some nurses have and others do not. If your own program has not covered TIC explicitly, this study is a good reason to seek out that training yourself, whether through electives, continuing education, or independent reading grounded in frameworks like SAMHSA's trauma-informed care principles.

Faculty notes

Educational Relevance

This Ed.D. dissertation by Meredith Kissel Malone (Delaware State University, 2019), disseminated through ProQuest LLC, investigates a persistent gap in prelicensure nursing curricula: the near-absence of formal trauma and trauma-informed care (TIC) education. The study opens with the well-established Felitti et al. (1998) Adverse Childhood Experiences (ACEs) finding that more than half of the general population has experienced at least one adverse childhood experience, framing trauma exposure as a near-universal clinical reality rather than a niche psychiatric concern.

The design is quantitative and quasi-experimental, using a one-group pretest-posttest structure: a pre-survey, a single researcher-delivered TIC education session, and an immediate post-survey, administered to nursing students concurrently enrolled in a mental health nursing course. The researcher analyzed pre/post score differences using a paired t-test, an appropriate choice for comparing the same subjects' scores across two time points on the same instrument. Every survey item returned a p-value of 0.001, indicating the null hypothesis (no change in knowledge) was rejected in favor of the alternative (the education session increased knowledge) across the entire instrument, not just in aggregate.

A notable nuance for classroom discussion is the finding that students already held some baseline knowledge of trauma and TIC prior to the intervention, yet the education session still produced significant gains on every individual item. This pattern is useful for framing a broader pedagogical point: perceived competence and measured competence are not the same thing, and even confident cohorts benefit from structured, dedicated instruction rather than incidental exposure through general coursework or clinical rotations.

For appraisal purposes, several methodological features deserve scrutiny in seminar. First, the design lacks a control group, so improvement cannot be fully isolated from testing effects (students may score higher simply from having seen the questions once already) or from maturation during the course. Second, the abstract as sourced does not report sample size, effect sizes, instrument validity/reliability data, or the length and content detail of the education session, which limits independent appraisal of the intervention's dose and fidelity. Third, this is a single-site, single-course study, so generalizability to other nursing programs, class levels (e.g., graduate versus undergraduate), or delivery formats (in-person versus asynchronous) is unproven. Fourth, outcomes were measured immediately post-intervention; there is no reported follow-up to assess knowledge retention or, more importantly, transfer to actual clinical behavior with trauma-affected patients.

Despite these constraints, the study contributes a concrete, statistically grounded data point to an area where the literature otherwise consists largely of calls to action. Contemporary nursing-education scholarship (e.g., trauma-informed practice frameworks built on SAMHSA's four Rs (realize, recognize, respond, resist re-traumatization)) argues that nursing curricula systematically under-prepare students to recognize trauma's physical, emotional, and cognitive sequelae. This dissertation offers empirical support for the intuitive claim that dedicated instruction, even a single session, can move the needle on measurable knowledge outcomes.

For faculty, useful discussion angles include: how TIC content might be integrated across a curriculum rather than isolated to a single mental health course; what a rigorous follow-up design (control group, delayed post-test, behavioral or simulation-based outcome measures) would look like; and how programs might use SAMHSA's TIC principles as an organizing framework for content development, given this study's demonstrated but narrowly scoped effect.