PTSD and nurses

Posttraumatic stress disorder(PTSD) is an anxiety disorder that can develop after exposure to one or more terrifying events in which grave physical harm occurred or was threatened.

It is a severe and ongoing emotional reaction to an extreme psychological trauma. This stressor may involve someone's actual death or a threat to the patient's or someone else's life, serious physical injury, or threat to physical and/or psychological integrity, to a degree that usual psychological defenses are incapable of coping. In some cases it can also be from profound psychological and emotional trauma, apart from any actual physical harm. Often times, however, the two are combined.

PTSD is a condition distinct from Traumatic stress, which is of less intensity and duration, and combat stress reaction, which is transitory. PTSD has also been recognized in the past as shell shock, traumatic war neurosis, or post-traumatic stress syndrome (PTSS).

PTSD is believed to be caused by psychological trauma. Possible sources of trauma includes experiencing or witnessing childhood or adult physical, emotional or sexual abuse. In addition, experiencing or witnessing an event perceived as life-threatening such as physical assault, adult experiences of sexual assault, accidents, drug addiction, illnesses, medical complications, or the experience of, or employment in occupations exposed to war (such as soldiers) or disaster (such as emergency service workers).

Traumatic events that may cause PTSD symptoms to develop include violent assault, kidnapping, torture, being a hostage, prisoner of war or concentration camp victim, experiencing a disaster, bad car accidents or getting a diagnosis of a life-threatening illness.

Children may develop PTSD symptoms by experiencing sexually traumatic events like age inappropriate sexual experiences. Witnessing traumatic experiences or learning about these experiences may also cause the development of PTSD symptoms.

The amount of dissociation that follows directly after a trauma predicts PTSD.

Individuals that are more likely to dissociate during a traumatic event are considerably more likely to develop chronic PTSD.

Which brings us to Nurses and PTSD.

I am a member of the "Bereavement Team" at my hospital. We are mostly concerned with families who lose babies before they are born, who birth dead babies or who deliver premature live babies who subsequently die.

Yet the nurses who care for these families undergo trauma and the more cases we have on a weekly or monthly basis, the more severe the trauma, or dare I say, PTSD.

Our team writes personal notes to the nurses involved in the more difficult cases, and we have a Care For The Care Giver at our yearly Bereavement Skills Day.

Yet this may not be enough.

Even though we are recognizing the condition, a note or a sympathetic nod will not erase the grief that a nurse often feels in these situations.

She may have lost a pregnancy in her past; she may have been sexually abused or raped when she was young; she may be an Adult Child Of An Acoholic; she may have addiction challenges herself.

She may have been raised in a war-torn country; she may have been or is a victim of Domestic Violence; she may have a debilitating chronic illness or perhaps someone close to her has this.

In any event, our bereavement team can help our nurses.

Examples of PTSD Triggers

* For an auto accident survivor: The smell of gasoline

* For a combat veteran: The sound of a helicopter or firecrackers

* For a rape victim: The sight of a person suddenly appearing around the corner

* For a carjacking victim: The song that was playing on the radio at the time of the assault

Symptoms of avoidance

Symptoms of avoidance are prominent in PTSD. You may persistently avoid situations that remind you of the traumatic event you experienced, minimize the event's significance, or push all thoughts of it out of your mind. Avoidance can also take the form of detachment and apathy.

Symptoms of avoidance include:

* Avoiding thoughts, feelings, or conversations associated with the trauma

* Avoiding activities, places, or people that remind you of the trauma

* Inability to remember important aspects of the trauma

* Loss of interest in activities and life in general

* Feeling detached or estranged from other people

* Feeling emotionally numb, especially toward loved ones

* Sense of a limited future (you don't expect to live a normal life span, get married, have a career)

Symptoms of increased arousal

PTSD can cause you to feel and react as if you're constantly in danger. In this state of chronic hyperarousal, your mind and body is on constant red alert, making it impossible to fully relax, be productive, or enjoy life.

The PTSD symptoms of increased arousal and anxiety include:

* Difficulty falling or staying asleep

* Irritability or outbursts of anger

* Difficulty concentrating

* Hypervigilance, or being constantly "on guard"

* An exaggerated startle response, or jumpiness

Treatments for post-traumatic stress disorder (PTSD)

Treatments for PTSD relieve symptoms by helping you deal with the trauma you've experienced. Rather than avoiding the trauma and any reminder of it, you'll be encouraged in treatment to recall and process the event that caused your PTSD. In treatment for PTSD, you'll also:

* Explore your thoughts and feelings about the trauma

* Work through feelings of guilt, self-blame, and mistrust

* Learn how to cope with and control intrusive memories

* Address problems PTSD has caused in your life and relationships

In addition to offering an outlet for emotions you may have been bottling up, treatment for PTSD will also help restore your sense of control and reduce the powerful hold the memory of the trauma has on your life.

Cognitive-behavioral therapy is believed to be the most beneficial treatment for PTSD. There are several types of cognitive-behavioral therapies.

* Exposure therapy - According to a October 2007 report issued by the Institute of Medicine, there is strong evidence for the effectiveness of exposure therapy in PTSD treatment. Exposure therapy for PTSD involves carefully and gradually "exposing" yourself to thoughts, feelings, and situations that remind you of the trauma.

Often, you'll start by focusing on a memory that is upsetting but still manageable, then slowly work your way up to more upsetting memories in a process known as systematic desensitization.

As you think about and re-experience these memories in a safe, controlled environment, they will start to feel less intense and overwhelming.

* Cognitive restructuring - In cognitive restructuring, the focus of treatment is to identity upsetting thoughts about the traumatic event'particularly thoughts that are distorted and irrational—and replace them with more accurate, balanced views. For example, you may blame yourself for failing to save a fallen comrade, even if you did everything you could. Cognitive restructuring would help you challenge this troubling thought and learn to look at what happened in a healthier way.

* EMDR (Eye Movement Desensitization and Reprocessing) - EMDR incorporates elements of cognitive-behavioral therapy with eye movements or other forms of rhythmic, left-right stimulation, such as hand taps or sounds. For example, in EMDR therapy you might talk about the traumatic event while following your therapist's finger back and forth with your eyes.

Eye movements and other bilateral forms of stimulation are thought to work by "unfreezing" the brain's information processing system, which is interrupted in times of extreme stress, leaving only frozen emotional fragments which retain their original intensity. Once EMDR frees these fragments of the trauma, they can be integrated into a cohesive memory and processed.

* EFT: Tapping on strategic pressure points while at the same time, saying phrases that release the anxiety associated with the trauma.

Positive ways of coping with PTSD include:

* Learning about trauma and PTSD.

* Joining a PTSD support group

* Practicing relaxation techniques

* Confiding in a person you trust

* Spending time with positive, supportive people

* Avoiding alcohol and drugs

Our Bereavement Team can guide our nurses in the direction of full recovery.