Learning Objectives
By the end of this section, you will be able to:
- Define post-traumatic stress disorder (PTSD)
- Identify referrals and resources for a client with PTSD
- Describe the nurse’s role in assisting trauma clients
Post-traumatic stress disorder (PTSD) is a pervasive and challenging mental health condition that affects not only the general population but also presents as a particularly serious issue within the military veteran population. Characterized by debilitating symptoms stemming from exposure to trauma, PTSD poses complex clinical challenges. In the realm of psychiatric-mental health nursing, there is an urgency to address the unique psychological and emotional burdens faced by military veterans, who often grapple with the enduring effects of combat-related traumas. Psychiatric-mental health nurses, as frontline health-care providers, are tasked with the mission of delivering specialized care, employing trauma-informed approaches, and advocating for evidence-based treatments to foster recovery and improve the overall mental well-being of veterans.
PTSD Defined
Post-traumatic stress disorder (PTSD) can develop after a person experiences or witnesses a traumatic event. These events can include military combat exposure, natural disasters, accidents, physical or sexual assault, and other life-threatening incidents. PTSD can manifest through a range of symptoms, such as flashbacks, nightmares, intrusive thoughts, avoidance of triggers, emotional numbness, and heightened anxiety. It can significantly impact an individual’s daily life, relationships, and overall well-being. Treatment options, including therapy and medication, are available to help individuals manage and overcome PTSD, enabling them to regain a sense of control and improve their quality of life. PTSD is a complex and deeply distressing condition, but with appropriate support and care, many individuals can make significant progress in their recovery.
According to the U.S. Department of Veterans Affairs (2023b), PTSD is a particularly prevalent and complex issue within the military community, where service members often face intense and traumatic experiences during their deployments. Combat exposure, witnessing injuries or death, and the constant threat of danger can lead to the development of PTSD symptoms. These symptoms may include recurrent flashbacks, hypervigilance, nightmares, irritability, and emotional numbness. PTSD in the military can be especially challenging due to the stigma associated with seeking mental health support and the fear of potential career consequences. There is a growing recognition of the importance of addressing PTSD within the military, however, and various support mechanisms, including specialized therapy programs and peer support networks, have developed to assist service members in their journey toward healing and recovery.
The DSM-5-TR (American Psychiatric Association, 2022) outlines the criteria for diagnosing PTSD, which includes exposure to trauma, intrusive symptoms, avoidance of triggers, negative changes to cognitions and mood, arousal and activity, duration of more than a month, and functional impairment.
Treatment for PTSD typically involves a combination of therapies and, in some cases, medication (Hoeft et al., 2019; American Psychological Association, 2020). The choice of treatment depends on the individual’s specific symptoms, preferences, and the recommendations of their health-care provider. It can include CBT, exposure therapy, or EMDR. Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based therapy specifically designed for children and adolescents with PTSD. It incorporates CBT techniques to address trauma-related symptoms.
Potential medications used to treat PTSD include antidepressants and, off-label, Prazosin. The only medications that are FDA-approved for the specific treatment of PTSD are the SSRIs sertraline (Zoloft) and paroxetine (Paxil) (American Psychological Association, 2017). SNRIs, such as venlafaxine (Effexor), are also frequently used to manage symptoms of depression and anxiety in PTSD. The U.S. Department of Veterans Affairs (2023a) recommends that, of the antidepressants available, the SSRIs sertraline and paroxetine and the SNRI venlafaxine are found to be most effective for PTSD. Prazosin may be used off-label to alleviate nightmares and sleep disturbances associated with PTSD. Some other techniques used with PTSD clients include:
- Group therapy: Group therapy sessions provide a supportive and nonjudgmental environment where individuals with PTSD can share their experiences, learn coping strategies, and receive validation from peers who have faced similar challenges.
- Family therapy: Involving family members in therapy can help improve communication and relationships.
- Mindfulness and relaxation techniques: Techniques, such as mindfulness meditation, deep breathing exercises, and progressive muscle relaxation, can help individuals manage stress and anxiety.
- Complementary therapies: Some individuals find relief through adjunctive, complementary therapies like acupuncture, yoga, or art therapy.
- Self-help strategies: Encouraging individuals to engage in self-help strategies like journaling and maintaining a healthy lifestyle can complement formal treatment.
Referrals and Resources
Referrals and resources for clients with PTSD, including military veterans with PTSD, are crucial in ensuring that individuals receive comprehensive care and support. Here are specific examples of organizations and resources that provide assistance:
- Veterans Affairs (VA): The U.S. Department of Veterans Affairs is a primary resource for veterans with PTSD. VA medical centers and clinics across the country offer specialized PTSD treatment programs, including evidence-based therapies, such as CBT and EMDR. Veterans can access mental health services, medication management, and peer support through the VA.
- Wounded Warrior Project (WWP): WWP is a nonprofit organization that provides a wide range of programs and services to support veterans and service members who have experienced physical or mental health challenges, including PTSD.
- Substance Abuse and Mental Health Services Administration (SAMHSA): SAMHSA offers a Behavioral Health Treatment Services Locator to help individuals find treatment facilities that offer services for PTSD.
- National Center for PTSD: This center, affiliated with the VA, offers a wealth of information and resources on PTSD. It also conducts research and provides training for health-care professionals.
- Give an Hour: This nonprofit organization connects veterans, service members, and their families with mental health professionals who offer free counseling and support.
- Veterans Crisis Line: Operated by the VA, the Veterans Crisis Line provides immediate assistance to veterans in crisis. Veterans, their families, or concerned individuals can call, text, or chat online for confidential support.
- National Alliance on Mental Illness (NAMI): NAMI offers education, advocacy, and support for individuals and families affected by mental health conditions, including PTSD. It has local chapters and support groups that can provide information and referrals.
- Local community mental health centers: Many communities have mental health centers or clinics that provide services for PTSD.
- Online resources: There are various online resources, including websites, forums, and mobile apps, that provide information, self-help tools, and community support for individuals with PTSD. Examples include the PTSD Coach app and the Military OneSource website.
Nurse’s Role
The nursing process in care of clients with post-traumatic stress conditions includes specific assessment items to help focus the interventions. The therapeutic relationship, specifically the working phase, builds trust, assures safety, and establishes boundaries. The nurse functions as educator regarding medication, if indicated, coach for coping skills, and advocate for the client’s self-management.
Assessment
Assessment is a critical component of nursing care for clients with PTSD. It involves gathering comprehensive information about the client’s condition, including their physical and mental health, trauma history, and the impact of PTSD on their daily life. Key aspects of the assessment process for clients with PTSD include:
- Trauma history: Ask about the type of traumatic event(s) the client experienced, the timing and duration of the trauma, and any past or ongoing exposure to traumatic stressors.
- Symptom assessment: Assess the symptoms the client experiences, such as intrusion symptoms like recurrent distressing memories, nightmares, flashbacks, and intense psychological or physiological reactions that represent triggers to the trauma; avoidance symptoms, such as thoughts, feelings, conversations, places, people, or activities that remind them of the trauma; and arousal/reactivity symptoms, such as irritability, anger outbursts, reckless behavior, hypervigilance, exaggerated startle response, sleep disturbances, and problems with concentration.
- Functional ability assessment: Assess how PTSD symptoms impact the client’s daily functioning, including their ability to work, maintain relationships, engage in self-care, and participate in activities of daily living.
- Safety assessment: Evaluate any potential self-harm, harm to others, or suicidal thoughts and ensure the client has a safe environment.
- Co-occurring conditions: Assess for co-occurring mental health conditions, such as depression, anxiety disorders, or substance use disorders, as these often accompany PTSD and may require integrated treatment.
- Cultural sensitivity: Recognize that cultural factors can influence how individuals experience and express their PTSD symptoms (Health Care Toolbox, n.d.).
- Client preferences and goals: Ask about the client's treatment preferences, goals, and concerns, because this information can guide care planning.
Clinical Safety and Procedures (QSEN)
QSEN Competency: Client-Centered Care, Trauma-Informed Care
Definition: Recognize the client as a full partner in control of all decisions when providing compassionate and coordinated care based on respect for the client’s preferences, values, and needs.
Knowledge: Understand how trauma-informed care is an approach that acknowledges the prevalence of trauma and its effects on an individual’s mental, emotional, and physical well-being. It is essential to provide care that is sensitive to the trauma in order to establish rapport, gain the survivor’s trust, and facilitate disclosure of their experiences.
Skill: Provide compassionate, trauma-informed care to victims or suspected victims of trauma while incorporating client values, preferences, and expressed needs in the treatment plan.
Attitude: Respect and encourage individual expression of client values, preferences, and needs in a nonjudgmental manner.
Medication Management, Monitoring, and Education
Medication management, monitoring, and client education are crucial aspects of nursing care for clients with PTSD. In terms of medication management, nurses play a key role in assisting clients in understanding their prescribed medications, including potential side effects, and how to take them correctly and reporting concerns to the health-care provider for prompt adjustments. For many individuals with PTSD, medications may help manage symptoms of depression, anxiety, and intrusive thoughts.
Monitoring is a continuous process in PTSD care, involving regular assessment of the client’s response to treatment, changes in symptoms, and any potential side effects of medications. Nurses collaborate with the health-care team to track the client’s progress and communicate any necessary adjustments to the treatment plan. Monitoring also extends to assessing the client’s safety, particularly with respect to medication changes or when there’s a risk of self-harm or worsening symptoms.
Client education is essential for promoting self-management and understanding the condition. Nurses educate clients about the nature of PTSD, coping techniques, and the importance of engaging in psychotherapy or counseling alongside medication for holistic treatment. Client education empowers individuals with PTSD to participate in their recovery and make informed decisions about their care.
Collaborating with the client to set achievable goals related to their mental and emotional well-being is considered wellness coaching. Nurses help clients identify strategies for managing their symptoms and improving their overall quality of life. This can include developing healthy routines, encouraging physical activity, and addressing sleep disturbances, all of which play a role in PTSD recovery.
Stress management is essential for clients with PTSD who often experience heightened stress levels and anxiety. Nurses teach stress-reduction techniques, such as mindfulness, deep breathing exercises, and progressive muscle relaxation. These strategies empower clients to cope with stress more effectively and reduce the intensity of PTSD symptoms. Assessing coping mechanisms is vital to understand how clients are managing their condition. The inability to employ personal strategies to manage psychological distress is considered ineffective coping. Some individuals with PTSD may resort to ineffective coping strategies, such as substance misuse or self-harm. Nurses work with clients to identify healthier coping mechanisms, fostering resilience and adaptability.
Client safety is a paramount concern, especially in cases where individuals with PTSD are at risk of self-harm or have a history of suicidal ideation. Nurses conduct ongoing safety assessments, ensuring that clients have access to crisis intervention resources and appropriate support systems.
Therapeutic Relationship/Trauma-Informed Care
Trauma-informed care is an approach to health care that recognizes and responds to the impact of trauma on individuals. Every client receives trauma-informed care regardless of known trauma history (Fleishman et al., 2019). This approach emphasizes creating a safe and supportive environment for those who have experienced trauma by integrating an understanding of the prevalence and effects of trauma into all aspects of care. The key principles of trauma-informed care include promoting safety, trustworthiness, collaboration, choice, and empowerment. It involves recognizing the signs and symptoms of trauma, avoiding retraumatization, and offering support that is sensitive to the unique needs of individuals who have faced traumatic experiences. Trauma-informed care is applied across various settings, including health care, social services, and education, to ensure a compassionate and healing approach that considers the complex effects of trauma on an individual’s physical and mental well-being.