Exploration of the implementation of Trauma Risk Management (TRiM) in an Irish maternity care setting
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Date
2026-04-27
Authors
Lyons, Aoife
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Publisher
University College Cork
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Abstract
Maternity staff are frequently exposed to potentially traumatic clinical events, yet there remains limited understanding of how workplace support is experienced or what shapes staff engagement with it. Existing literature has tended to focus on prevalence and broad outcomes, with less attention to the psychological and organisational processes through which support is encountered, and very limited attention to the experiences of those delivering peer-led support. This thesis addresses this gap by examining Trauma Risk Management (TRiM), a structured peer-led model of post-incident support, within a regional Irish maternity directorate, drawing on participant and practitioner perspectives.
Chapter 1 presents a critical review of trauma in maternity care, arguing that staff responses to traumatic events are shaped not only by exposure itself but by relational and organisational conditions. It introduces Self-Determination Theory (SDT) as a framework for understanding how support is experienced in relation to the basic psychological needs for relatedness, autonomy, and competence, and argues that clinical psychology is well placed to operate across individual and organisational levels in this developing area of staff support.
Study 1 (Chapter 2) provides the first empirical account of maternity staff experiences of TRiM. Thirty staff in a regional Irish maternity service completed a cross-sectional mixed-methods survey, with open-text responses interpreted through SDT. Quantitative findings showed TRiM was generally evaluated as useful, with the strongest perceived impact on understanding of trauma responses. Perceived change in personal psychological outcomes was more limited, with approximately a third reporting no change in stress or wellbeing. Qualitative findings, interpreted through SDT, suggested that engagement depended on whether basic psychological needs were supported or undermined in how TRiM was introduced and delivered. Staff were more likely to engage with TRiM when it was introduced clearly and experienced as supportive and psychologically safe. Mismatched expectations and dismissive senior responses limited its perceived value.
Study 2 (Chapter 3) addressed a further gap by examining the experiences of peer-facilitators delivering TRiM. Semi-structured interviews with nine trained practitioners were analysed using reflexive thematic analysis. Practitioners described delivering TRiM within an organisational context shaped by hierarchy, fear of blame, and limited protected time, where psychological safety and managerial endorsement were central to engagement. Their confidence and way of delivering TRiM developed through experience rather than being established through initial training, and the role carried emotional demands that required active support to sustain. Practitioners also described TRiM as legitimising emotional conversations among colleagues and contributing to a workplace culture more open to acknowledging staff distress. Access to clinical psychology supervision was identified as essential to making the role sustainable and safe.
Chapter 4 develops a multi-level account of how TRiM operates in maternity care. Drawing on implementation science, psychological safety, and SDT, it integrates findings across the two studies and examines where participant and practitioner accounts converge and diverge. It argues that TRiM’s perceived value is conditional and contextually shaped, depending less on its content than on how it is implemented and sustained within the organisation over time. Across both accounts, TRiM was experienced as more useful where leadership endorsement legitimised engagement and where psychological safety supported open participation.
This thesis contributes to an underdeveloped evidence base by providing the first combined examination of participant and practitioner experiences of TRiM in a maternity setting. It extends existing work by showing that peer-delivered trauma support is shaped by how it is implemented within its organisational setting. The findings suggest that introducing and sustaining TRiM in maternity services requires attention to practical conditions such as pre-briefing, role clarity, protected time, and supervision, while also highlighting the emerging contribution of clinical psychology to staff support in maternity care.
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Keywords
Maternity staff , Peer support , Trauma Risk Management (TRiM) , Psychological safety
Citation
Lyons, A. 2026. Exploration of the Implementation of Trauma Risk Management (TRiM) in an Irish maternity care setting. DClinPsych Thesis, University College Cork.