Case Study: Using Trauma-informed Approaches to Uncover Sensitive Stories
What is this case study about?
This case study is about ‘Moments of Grace’, a co-created project about working-class experiences of marginalised health professionals in London.
The project was funded by Historic England’s Everyday Heritage Grants and led by community interest company On The Record, an organisation that explores places, communities and movements from multiple perspectives and specialises in oral history and cross-artform collaborations.
What are the key learnings?
- Use existing tools and expertise, such as the Circle of Care framework, to shape work that might illicit stories of trauma or sensitive issues
- Build relationships with healthcare professionals or organisations to ensure project participants feel fully supported
- Allow plenty of time in your project plan so that you can work slowly, patiently and collaboratively with participants
- Be aware of the particular issues faced by the specific communities you are working with, and the potential sensitivities that may arise in their stories
- Co-create your project with participants rather than treating them as subjects, to ensure that they are telling the stories they want to tell, in the ways that they want to tell them
What was the project about?
Moments of Grace captured the stories of nurses who have worked at Guys’ and St Thomas’ Hospital, London, from their experiences before, during and after the COVID-19 pandemic.
The interviews focused on the time nurses spend in hospitals and the extraordinary events, as well as the everyday rituals they experience in their roles. The main product of the project is a digital sound installation that explores time by distilling nurses’ 24-hour presence in the hospital and out in the community into a circular composition. The piece is punctuated by original music composed by Nicole Robson.
The project aimed to:
- Reach Guy’s and St Thomas’ Hospitals local ethnically and culturally diverse local population
- Connect nursing past, present and future by sharing sensitively edited oral histories and stories representing twenty-first century Black, Asian, and other minority ethnic nurses
- Build skills and confidence amongst disadvantaged young people from Lambeth
- Ensure accessibility of outputs for D/deaf audiences
- Make the oral histories accessible through the London Metropolitan Archives
The outputs of the project included:
- 45 new oral history recordings and over 60 field recordings
- 25 new musical compositions
- An online resource with d/Deaf captioning, and a number of print publications advertising the project to different audience groups.
- A new curriculum resource to be implemented at Kingston University, one of the UK’s leading programmes for mental health nurses
As a result of participating in this project:
- 96% of participants noted an improvement in their wellbeing and sense of self-worth as a result of participating in the project
- 88% felt a greater sense of connection between people of different generations
- 82% felt that their understanding of colleagues’ heritage and perspectives had increased
- Reported finding the trauma-informed approach therapeutic, as gathered through qualitative feedback
What is a trauma-informed approach and why was it needed?
Trauma-informed practice aims to increase practitioners’ awareness of how trauma can negatively impact individuals and communities, affecting their ability to feel safe or develop trusting relationships with health and care services and their staff. It aims to improve the accessibility and quality of services by creating culturally sensitive, safe services that people trust and want to use.
Moment of Grace project leaders recognised that Black, Asian and other minority ethnic people make up a large proportion of the nurse workforce at Guy’s and St Thomas’ Hospital and are often the most underrepresented in heritage projects.
In addition, Black and Asian nurses confronted specific challenges at the height of the COVID-19 pandemic due to the disproportionate impact of the virus on their communities. This included many nurses returning home to a second care shift with young children and ageing parents in addition to demanding, low-paid jobs.
On The Record knew they would have to be sensitive to these issues and strive to create psychological safety for all participants. Psychological safety is about creating a culture of trust where people feel safe and supported to speak openly.
How did Moments of Grace implement trauma-informed practice?
Through the relationships that On The Record had built with the NHS Trust, they became aware of Circle of Care, a framework to shape thinking and practice in high-quality compassionate care.
Within the framework is a ‘Skills Compass’ which helps practitioners navigate obstacles in the way of providing high-quality care. On The Record used this to approach the workshops and field recording sessions with participants to ensure they felt psychologically safe in sharing and reliving their stories.
By using these existing tools, and working slowly, patiently and collaboratively with participants, On The Record created trust allowing them to engage meaningfully and disseminate the project widely.
They did this by:
- Empowering narrators to choose which stories to share. Nurses appreciated that On The Record had adopted a life-story approach to both the interviews and the editing of the material rather than focusing on their trauma
- Facilitating breaks if someone became emotional and signposting them to wellbeing services where necessary
- Trialing regular 'listening cafe' drop-in sessions to empower participants to co-create and make decisions about the project
- Using a peer-to-peer format in which nurses and midwives were trained and supported to interview their fellow nurses and midwives. This gave an intimate and intergenerational feel to the recordings, which promoted psychological safety as there was an immediate understanding and trust between participants
- One-to-one meetings with the oral history and audio diary participants prior to recording, to discuss the stories they wished to share and ensure the nurses were active participants
- Gentle enquiry during recording, allowing the interviewees to set the pace for their comfort
- Debriefing with participants following recordings to check in on wellbeing. For those participants with time and inclination, they decided together which parts of their story to use
- Training for students and apprentices to record peer-to-peer trauma-informed oral histories
- Using a professional oral historian alongside young volunteer interviewers
- Adapting to locations most accessible to their participants, which included off- and on-hospital and community sites
Further reading
- For more information about the project, visit the Moments of Grace website
- Find out more about Circle of Care
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