Is It the Patient Who Needs to Change, Or Is It Us? Being Trauma Informed and Recovery Oriented

As a nurse, I have witnessed remarkable recoveries, acts of resilience, and moments of profound human connection. But I have also observed care plans built around assumptions, interventions delivered without consent, and systems that fail to meet people where they are.

Sometimes, I hear phrases in healthcare settings that give me pause. Not because the people saying them are unkind or incompetent, but because the words reflect deeper problems with how we approach care.

“If they wanted to get better, they should have just done what we told them to do.”

“Sometimes we just need to teach them a lesson.”

These statements are often said quietly, maybe in frustration, maybe in resignation. They are not usually meant to be cruel, but they reveal a troubling dynamic: a system more focused on compliance than compassion, more concerned with efficiency than dignity, and more committed to standardization than individualization.

So I ask, genuinely, is it the person receiving care who needs to change, or is it us?

The problem with “doing to” instead of “doing with”

In many care settings, plans are created by professionals for patients, often without them. Interdisciplinary teams meet ahead of time to discuss what needs to happen. A second meeting might follow, where the patient and their family are invited to hear the plan, but by then, the decisions have already been made.

This is often called collaborative care planning. But is it truly collaborative if the person receiving care is not part of the actual planning?

And what happens when the same plan is tried repeatedly, regardless of whether it works? When we wait for the patient to become “ready,” instead of examining whether the plan was ever right for them in the first place?

We might call it individualized care, but if everyone is offered the same standard approach, are we really tailoring care to the person? Or are we asking people to fit themselves into a model that was never designed with their needs in mind?

The weight of our own expectations

Sometimes, it feels like health care clinicians are more invested in the outcomes than the person receiving the care. That makes no sense. We really should question who we are doing the work for. So much effort is focused on developing treatment plans, arranging follow-up appointments, and coordinating resources. But when a person does not engage with the plan, or cannot, because of trauma, poverty, or unstable housing, we often interpret this as non-compliance or resistance. The burden and the blame fall to the patient. I think we need to start looking at ourselves as a health care system and the outdated 20th century strategies we keep trying to replicate ineffectively for a 21st century population. 

What if the person is not failing the plan? What if the plan is failing the person?

Too often, discharge plans include a cascade of follow-ups and referrals for people who do not have a phone, a stable address, or reliable transportation. Then, when they miss an appointment, we label them as difficult or disinterested. In truth, they may be trying to survive in circumstances that we have not accounted for.

We need to ask ourselves, whose goals are we working toward? Are we offering people options they would actually choose for themselves? Or are we directing them down a path we have already decided is best?

The cost of control

In moments of acute distress, especially in mental health care, we sometimes lean toward control. We rationalize the use of restraint or seclusion by saying things like, “We needed to teach them a lesson,” or “It was the only option.”

But control is not care. And fear is not therapeutic.

These responses often stem from system pressures—understaffing, burnout, and the desire to prevent harm. But at what cost? When we remove choice, we remove dignity. When we “do to” instead of “do with,” we erode trust.

The most healing experiences I have seen, both as a nurse and as a parent, have not come from clinical precision or rigid protocol. They have come from relationships. From sitting down beside someone and saying, tell me what matters to you right now. From listening deeply, without judgment. From building a plan that reflects the person’s priorities, not just the healthcare system’s.

Reimagining care with compassion

What would healthcare look like if every care plan started with the question: what does a good life look like for you? Not, what is the right medication? Or, when is your next follow-up? But, what do you need today to feel safe, respected, and in control of your care?

This shift is not just philosophical. It is practical. When people are genuinely involved in shaping their care, outcomes improve. Engagement increases. Trust deepens.

It is not easy to transform a system structured around policies and metrics. But we can start with the way we think, the way we talk, and the way we show up.

A nursing perspective

Nurses have always been at the heart of person-centred care. But we are not just the heart. Nursing is the heart, the brain, the arms, and the legs of healthcare. We are there at the bedside, in the community, in emergencies, in long-term care, in clinics, and in boardrooms. We translate complexity into care. We see the barriers—poverty, racism, trauma—that shape people’s health long before they ever walk through the hospital doors.

We also see the possibilities. We know that healing happens when people are seen, heard, and empowered.

So let’s question the assumptions baked into our daily routines. Let’s reimagine what collaboration truly means. Let’s choose care that is relational, not transactional.

Because sometimes, the most important change does not need to come from the person in the bed.

It needs to come from us.