Operationalizing Trauma-Informed Care in Undergraduate Clinical Supervision: An Integrative Review

Background: Traditional models of clinical nursing supervision have relied on hierarchical evaluation structures and corrective approaches to error remediation that may inadvertently impair student learning by triggering neurobiological stress responses. Despite growing endorsement of trauma-informed care (TIC) principles in health professions education, their operationalization in clinical supervision remains underdeveloped. Method: An integrative review following Whittemore and Knafl's method was conducted across five databases (CINAHL, PubMed, PsycINFO, ERIC, Scopus) for literature published from 2015 to 2025. Twenty-nine sources were analyzed using thematic synthesis. Results: Four themes emerged: (1) theoretical frameworks grounding trauma-informed supervision (5R framework, emotion-cognition-action model); (2) structural anxiety-reduction strategies (psychological safety contracts and graded assertiveness), (3) restorative error remediation (shame resilience and advocacy-inquiry debriefing); and (4) systemic implementation barriers (academic-practice gap and policy misalignment). Conclusion: Psychological safety is a cognitive prerequisite for clinical reasoning, not merely a wellness initiative. The evidence supports a shift from evaluative to relational supervision models. Gaps in longitudinal outcome data and in-situ clinical research warrant further investigation.