Posttraumatic Stress Disorder
In medical-surgical settings, especially in emergency depart-ments, burn units, and rehabilitation centers, nurses care for ex-tremely anxious patients who have experienced devastating events that are typically considered to be outside the realm of normal human experience. Many of these patients suffer from posttrau-matic stress disorder (PTSD).
PTSD has been described as a condition that generates waves of anxiety, anger, aggression, de-pression, and suspicion that threaten the person’s sense of self and interfere with daily functioning. Specific examples of events that place a person at risk for PTSD are rape, family violence, torture, terrorism, fire, earthquake, and military combat. Patients who have suffered a traumatic event are often frequent users of the health care system by virtue of their extensive injuries, the vari-ous treatment modalities that they require, and the overall emo-tional and physical difficulties experienced.
The physiologic responses noted in people who have been se-verely traumatized include increased activity of the sympathetic nervous system, increased plasma catecholamine levels, and in-creased urinary epinephrine and norepinephrine levels. It has been postulated (Gelles, 1997; Gelles & Loseke, 1993) that peo-ple with PTSD lose the ability to control their response to stim-uli. The resulting excessive arousal can increase overall body metabolism and trigger emotional reactivity. In this situation, the nurse would observe that the patient has difficulty sleeping, has an exaggerated startle response, and is excessively vigilant.
Older people are more susceptible to the physical effects of trauma and the effects of PTSD because of the increased neural inactivation associated with aging. It has also been speculated that when people have a preexisting tendency to become ex-tremely anxious, their vulnerability to PTSD increases (Nursing Research Profile 7-2).
Symptoms of PTSD can occur hours to years after the trauma is experienced. Acute PTSD is defined as the experience of symp-toms for less than a 3-month period. Chronic PTSD is defined as the experience of symptoms lasting longer than 3 months. In the case of delayed PTSD, up to 6 months may elapse between the trauma and the manifestation of symptoms (American Psychi-atric Association, 2000). For more information see Chart 7-9.
It is often thought that the incidence of PTSD is very low in the overall population; when high-risk groups are studied, however, the results indicate that more than 50% of study participants have PTSD (McCann & Pearlman, 1990). Therefore, it is important that nurses consider which of their patients are at risk for PTSD and be knowledgeable about the common symptoms associated with it.
The sensitivity and caring of the nurse creates the inter-personal relationship necessary to work with patients who have PTSD. These patients are physically compromised and are strug-gling emotionally with situations that are outside the realm of normal human experience–situations that violate the commonly held perceptions of human social justice. Treatment of patients with PTSD includes several essential components: establishing a trusting relationship, addressing and working through the trauma experience, and providing education about the coping skills needed for recovery and self-care. The patient’s progress can be influenced by the ability to cope with the various aspects of both the physical and the emotional distress.