Document Type

DNP Project


School of Nursing

Date of Degree

Spring 2024


Doctor of Nursing Practice (DNP)

Primary Advisor

Dr. Mercedes Echevarria


Trauma-informed care, ACEs, TIC education, policy, advocacy, nursing


Background: The prevalence of trauma exposure poses a significant concern for public health. Extensive research has established the correlation between trauma and adverse health consequences. Studies indicate that adopting trauma-informed care (TIC) can enhance satisfaction, communication, and overall patient health outcomes. However, the current state of TIC education in academic programs and professional practice settings needs to be improved.

Objectives: The goal of this policy analysis project was to devise specific language and strategies to promote the implementation of a TIC education mandate for Indiana nurses.

Methods: The design of this project was an analysis of governmental policies through an evidence-based model for policy change, which included eight key steps: identifying the issue, engaging stakeholders, assessing readiness, reaching out and educating, drafting policy, adopting policy, implementing policy, and evaluating its impact. The stakeholders in this project were the 2024 Indiana General Assembly and several professional organizations.

Results: Eighty-six Indiana legislators were contacted and provided with a TIC policy brief. Fifteen organizations across eleven states were identified and contacted. A systematic online search was conducted to identify sixty-three bills addressing TIC workforce training. Seven themes were identified: creating TI systems, upstream prevention, childcare/education, expanding behavioral health services, family support, reimbursement/financial, and supporting resilience. In October 2023, specific draft language for a proposed Indiana bill to mandate TIC education for nurses was drafted and shared with Senator Crider, who introduced Indiana Senate Bill 45 (2024) Trauma-Informed Care in January 2024.

Conclusions: Indiana has a record of bipartisan support when implementing TI initiatives despite the state's conservative political climate. The emphasis on TI systems in TIC workforce training legislation highlights the far-reaching impact of trauma and reinforces the necessity for multi-system approaches. The findings of this policy analysis revealed that employing an evidence-based policy change process, identifying effective strategies to introduce a TIC education mandate for Indiana nurses to lawmakers, and presenting well-crafted language to legislators were all instrumental in the successful proposal of Indiana Senate Bill 45 (2024) Trauma-Informed Care.

Open Access




To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.