Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Ann M. Mayo, DNSc, RN, FAAN, Chairperson; Ruth A. Bush, PhD, MPH, FAMIA, Member; Kathleen Stacy, PhD, RN, APRN-CNS, CCNS, FNSC, Member; Michelle Hamel, MD, PhD, FACS, Member


trauma recidivism, injury perception, risk perception, threat orientation, perceived likelihood of recurrent injury, perceived susceptibility


Purpose: To describe select sociodemographic and clinical variables, threat orientations, and the perceived likelihood of recurrent injury (PLRI) of individuals deemed at risk for trauma recidivism (TR).

Background: Injuries and violence are the leading cause of traumatic death among persons aged 1 to 44 in the United States. Trauma recidivism occurs when an individual experiences more than one significant injury requiring hospital care in a five-year period. The relationship between a trauma recidivist’s perception of recurrent injury and orientation towards a threat remains unclear.

Conceptual Basis: Trauma recidivism risk factors contribute to forming an individual’s PLRI. When individuals acknowledge the likelihood of recurrent injury, a specific threat orientation is formed based on their perceived risk. A person will either accept their risk for injury and take preventative action or ignore their risk and avoid preventative measures. As a result, the likelihood of TR either decreases or increases.

Designs and Methods: A quantitative cross-sectional study was conducted with Level II trauma inpatients (N = 84) in Southern California from October 2021-January 2022. Paper surveys containing sociodemographic information and three instruments were administered to participants before discharge. Clinical variables were later extracted from electronic health records.

Findings: The TR rate in this sample was 31%. The presence of mental illness (MI), the total number of MIs, depression, length of hospital stay (LOS), and the response of how likely one may experience TR were significant clinical variables associated with TR. In individuals with two or more diagnoses of MI, the odds of TR were approximately 6.5 times higher when controlling for LOS and participants’ awareness of how likely they may experience TR (PLRI item 1).

Implications for Research: There are currently no instruments to measure TR risk. This study suggests the PLRI and Threat Orientation Scale (TOS) instruments are not ready to measure perceived susceptibility and threat orientations in trauma recidivism research. Further testing of the PLRI and TOS is recommended to endorse their use in future TR studies. Trauma and public health nursing researchers are prime advocates for primary injury prevention and are encouraged to facilitate this instrumentation work.

Document Type

Dissertation: Open Access