BITTEN at the Bedside: An Application Guide for Nurse Practitioners

Patients with complex medical conditions may have a medical history that includes multiple negative/traumatic experiences with the health care system over the course of their diagnosis and treatment. The BITTEN (Betrayal history by health-related institutions; Indicator for health care engagement; Trauma symptoms related to health care; Trust in health care providers; Expectation of patient; Needs of patient) model posits that health care providers can recognize and respond in a way that encourages resisting patient retraumatization. We present a hypothetical case study applying the BITTEN model as a patient-centered framework to include in a standard visit. Increased awareness of the patient’s risk for institutional betrayal, trauma, and overall negative past health care experiences can help the NP better understand the patient’s current and future health care needs and expectations.