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PSYCHIATRIC NURSING.
Term Paper ID:29654
Essay Subject:
Nurse practitioners and victims of PostTraumatic Stress Disorder (PTSD).... More...
10 Pages / 2250 Words
8 sources, 24 Citations,
APA Format
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Paper Abstract:
Nurse practitioners and victims of Posttraumatic Stress Disorder (PTSD). Theories of PTSD; cause as an overwhelming trauma. Describes the condition. Discusses whether PCNs and PNPs are sufficiently trained to accurately diagnose PTSD. Cites several research studies and findings. Difficulty of diagnosis. Importance of screening after a critical trauma or incident.
Paper Introduction:
PTSD and the Psychiatric Clinical Nurse Specialist
Introduction and Analysis of the Issue
Psychiatric nursing has been defined as that branch
of nursing concerned with the prevention and cure of mental disorders and their sequelae. It employs theories of human behavior as a scientific framework and involves activities such as providing a safe therapeutic milieu, working with patients on the real problems they face, identifying and caring for the physical aspects of the presenting problem, and conducting psychotherapy (Psychiatric nursing, 1998).
Samson, Bensen, Beck, Price, and Nimmer (1999) have commented that primary care physicians and nurse practitioners are often intimately involved in the delivery of both medical and psy
Text of the Paper:
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This method, according to Antai-Otong (2 1), moves from anintroductory phase in which the interview provides immediate emotionalsupport, guarantees confidentiality, and reviews the ground rules of thedebriefing. Limitations intraining, a lack of a standardized model of care, limited prescriptiveauthority, and a lack of autonomy are among the barriers that often preventthese nursing specialists from effectively serving a client with PTSD andother psychiatric or psychological disorders. Further, Samson, et al (1999) have argued that some patients areresistant to the concept that a past traumatic experience can contribute totheir current physical complaints. Domestic violence andchildhood abuse appeared to be the primary traumas associated with PTSD,while increased use of medical services by patients later diagnosed withPTSD is commonplace. Lipschitz, D.S., Winegar, R.K., Hartnick, E., Foote, B., & Southwick,S. Next, nurses encourage the participants to focus on their reactions duringand after the event and to express their feelings openly. Debate exists among nurses as to whether or not PCNSs and PNPs aresufficiently trained to accurately diagnose and intervene in the case of apatient potentially suffering from PTSD (Paguette, 2 1). Left undiagnosed and ultimatelyuntreated, PTSD appears in theory to exacerbate other depressive, anxiety,substance use, and personality disorders. Assessmentsfocused on trauma exposure, PTSD symptomatology, other psychopathology, andpsychosocial, family, and school functions. ThePCNS in the clinical setting is in an ideal situation, therefore, toadminister psychiatric screening questionnaires to patients with symptomsof depression or anxiety and to deliver nursing/psychotherapeuticinterventions targeting PTSD. From the perspective of the PCNS, particularly those professionals whowork with patients either diagnosed as having PTSD or at-risk for PTSD dueto an overwhelming trauma, a clinical critical incident debriefingintervention may be an excellent strategy for eliciting information thatcan lead to appropriate therapeutic intervention. Given that there is often a long delay between the trauma andthe onset of physical symptoms, a patient may not be diagnosed in a timelymanner and interventions for depression or anxiety alone may be provided byprimary caregivers, including the PCNS. Further, the issue is significant in that manyindividuals with PTSD and other psychiatric disorders tend to be passivepatients, thus presenting a challenge to psychiatric nurses (Latvala,Janhonen, & Moring, 2 ). Posttraumatic stress disorder in hospitalized adolescents:Psychiatric comorbidity and clinical correlates. It is also associated withincreased risk of suicide and risk-taking behaviors, particularly amongseverely depressed patients and/or individuals who have been victims ofchronic abuse. Results of the study revealed that PTSD is oftenoverlooked or unrecognized in primary care settings and that PCNSs shouldimprove their awareness of PTSD. (1999). Samson, et al (1999) undertook an empirical examination of thestrategies used by primary physicians and nurse practitioners in anoutpatient facility of a large health maintenance organization in order todevelop an effective diagnostic approach for patients suspected assuffering from PTSD. Three categories of patients' participation wereidentified: passive recipient, responsible recipient, and responsibleparticipant. This researcher noted that workplace violence as wellas familial violence are increasingly common and that psychiatric nursescan use the critical incident stress debriefing protocol to minimizeadverse outcomes after a traumatic event. PTSD, according to the AmericanPsychiatric Association's (APA) DSM-IV diagnostic criteria, is an anxietydisorder characterized by chronic symptoms in response to traumatic eventsthat have elicited intense feelings of fear, helplessness, or even horror.Symptoms included repeated intrusive recollections, flashbacks, sleepdisorders and nightmares, avoidance of disturbing stimuli, emotionalnumbing, and disturbances of attention and arousal (Samson, et al, 1999). (1988). Passive patients: Achallenge to psychiatric nurses. M. Journal of Family Practice,48 (2), 222 - 23 . An approach designed to address the issue of PTSD was described byAntai-Otong (2 1) in the context of critical incident stress debriefing.A critical incident or acute stress response was defined by this researcheras referring to a powerful and overwhelming event that lies outside therange of usual human experience. (2 1). The issue is significant for Psychiatric Clinical NurseSpecialists (PCNS) because these nursing professionals encounterexpectations for performance beyond their trained role, limitations intraining, confusion about the roles of the nurse, and credentialing issues(Paquette, 2 1). PTSD is often cyclic in nature and can be accompanied by depression,certain risk-taking behaviors, academic and/or work difficulties, andincreased risk for drug abuse (Lipschitz, Rasmusson, Anyan, Cromwell, &Southwick, 2 ). Patients may not understand that theautonomic nervous system can remain activated after trauma as a protectivemechanism, leading to long-term physical symptoms. Data were collected byvideotaping different nursing situations in which ten nurses were involvedand recording interviews of 16 patients, 29 additional nurses, and 7nursing students. The first theory centers upon the comorbidity of PTSD with selectedpsychological and physiological symptoms that, in the latter instance,often present in the primary care clinical environment. Journal of the AmericanAcademy of Child and Adolescent Psychiatry, 38(4), 385-393. Samson, Bensen, Beck, Price, and Nimmer (1999) have commented thatprimary care physicians and nurse practitioners are often intimatelyinvolved in the delivery of both medical and psychiatric services tovictims of overwhelming traumas with symptoms manifested as posttraumaticstress disorder (PTSD). Perspectives in Psychiatric Care, 36(1),24-32. Results indicated a high degree of comorbidity of PTSD among clinicalpopulations of hospitalized adolescents with different forms of trauma anddifferent presenting psychiatric diagnoses. Paquette (2 1), in commenting that there is debate as to the properexpectations of a PCNS or Psychiatric Nurse Practitioners (PNPs), arguesthat the ideal advanced practice nurse would be a person with the knowledgeof the theory and practice of psychotherapy who also has prescriptiveauthority.Theory, Analysis and Application Two specific theoretical constructs form the conceptual framework ofPTSD. Patients with PTSDhave more somatic complaints than other patients, especiallymusculoskeletal, gastrointestinal, cardiovascular, neurological, andgynecological symptoms and also exhibit poorer general health and greaterfunctional impairment (Samson, et al, 1999). This ultimately results in themasking of PTSD. Samson, et al(1999), have pointed out that PTSD is recognized as increasinglycommonplace in selected populations, such as those that have experiencedfamily violence, urban violence, combat, natural disasters, motor vehicleaccidents, or rape. PTSD and the Psychiatric Clinical Nurse SpecialistIntroduction and Analysis of the Issue Psychiatric nursing has been defined as that branchof nursing concerned with the prevention and cure of mental disorders andtheir sequelae. The findings were significant, according to Latvala, et al (2 ),because responsible participation in nurse-mediated psychotherapy providesa foundation for better collaboration and ultimately, enhances interventionefficacy. (2 ). A second theory relevant herein is that PTSD is known to be a highlycomorbid disorder (Lipschitz, et al, 1999). References Antai-Ontong, D. Clinical and functional correlates ofposttraumatic stress disorder in urban adolescent girls at a primary careclinic. Adolescentinpatients participated in a structured diagnostic interview and providedstandard self-report measures to examine and evaluate such variables asgeneral trauma exposure, suicidal behavior, disassociation, and depression. Lipschitz, Rasmusson, Anyan, Cromwell, and Southwick (2 ) employeda sample of 9 female adolescents aged 12 to 21 who presented for routinemedical care at an adolescent primary care clinic and assessed thesesubjects via self-report questionnaires and interviews. Perspectives in PsychiatricCare, 37(4), 125-134. S., Rasmusson, A. (2 ). Mosby's Medical, Nursing & Allied HealthDictionary. (1998). L. MississippiScale for Combat Related Post-Traumatic Stress Disorder: Three studies inreliability and validity. A total of 114 patients suspected of suffering fromdepression or anxiety were referred for consultation and meet DSM-IVdiagnostic criteria for PTSD. M. Lipschitz, Winegar, Hartnick, Foote, and Southwick (1999) conducted astudy designed to analyze the diagnostic comorbidity and clinicalcorrelates of PTSD in adolescent psychiatric inpatients. Through aPCNS-initiated debriefing interview of individuals exposed to anoverwhelming trauma, the PCNS can gain clearer insight into the immediateand potential long-term psychological reactions to the trauma. M., Caddell, J. Latvala, E., Janhonen, S., & Moring, J. From the perspective of the PCNS, thestudy was significant in that it identifies the necessity of exploring thepossibility of PTSD symptom manifestation with a specific patientpopulation in the primary care setting. Additionally, female gender, prolonged childhoodseparation from a family, and family history of depression, anxiety, orantisocial behavior are theorized as increasing susceptibility to PTSD. Journal of Consulting and Clinical Psychology,56, 85-9 . The majority of the patients soughttreatment in primary care settings rather than mental health settings. In the thought phase, they areasked to reveal their thoughts, particularly with respect to safety issues. Because this is the case, itis often undiagnosed by clinicians. M., Anyan, W., Cromwell, P., &Southwick, S. Critical incident stress debriefing: Ahealth promotion model for workplace violence. The study is significant inthe present context in that it emphasizes the importance of obtainingspecific data on the likelihood that a traumatized patient subjectedpreviously to and surviving an overwhelming trauma may also be manifestingsigns of PTSD. Journal of the American Academy of Child and Adolescent Psychiatry,39 (9), 11 4 - 1112. Drawing upon both the literatureand a number of case studies, Antai-Otong (2 1) contended that a healthpromotion model using a structured clinical interview, emotional supportand education about normal stress reactions provided by the nurse, and theutilization of debriefing as a means of psychiatric prevention are highlyrecommended for nurses. The future of advanced psychiatric nursing.Perspectives in Psychiatric Care, 37 (1), 5+. These theories explain the phenomenon of PTSD as a disorder thatemerges when an individual has experienced an overwhelming trauma and hasnot been provided with a therapeutic intervention (often in the form ofpsychotherapy) that can assist the individual in overcoming the effects ofthe trauma and returning to a state of psychological and physical well-being. Latvala, et al (2 ) conducted a study with the purpose ofdescribing the psychiatric patients' participation in their own care in ahospital environment. Lipschitz, D. These researchers,as noted above, made the case that a failure to identify PTSD can inhibitrecovery of patients from the psychiatric as well as the physiologicalafter effects of being involved in a trauma. Samson, A Y., Bensen, S., Beck, A., Price, D., & Nimmer, C. For the PCNS, this study suggested strategies for assistingpsychiatric patients, including those with PTSD, in becoming moreresponsible participants in their own care. Keane, T. These strategies includedcollaboration, problem-solving, making decisions through anticipatorydialogue, awareness of the realistic resources available, and nursescommitment to the objectives that have been set by patients. It employs theories of human behavior as a scientificframework and involves activities such as providing a safe therapeuticmilieu, working with patients on the real problems they face, identifyingand caring for the physical aspects of the presenting problem, andconducting psychotherapy (Psychiatric nursing, 1998). As Samson, et al (1999) have contended, if PTSD remains undiagnosedand specific psychotherapy is not undertaken, optimal response may not beachieved. It is further theorized by Samson, et al (1999) that primary careproviders may identify symptoms of depression or anxiety and treat themwith medication - without subsequently diagnosing and specifically treatingPTSD. Results revealed that urbanadolescent girls typically are exposed to multiple types of trauma and mostdevelop at least one PTSD symptom. The nurse-patient relationship in the context ofpsychiatric care was the focus of this study. Therapeuticinterventions performed by PCNS professionals range from assuming the roleof social agent for the patient to providing leadership and clinicalassistance for other nurses and health care workers; such interventionsalso include assessment, diagnosis (in conjunction with other caregivers),and provision of a safe therapeutic milieu (Psychiatric nursing, 1998). As significantly, the literature reveals that medical serviceutilization tends to increase after a traumatic event. This research paper explores the efficacy ofPsychiatric Clinical Nurse Specialist's interventions with patientsdiagnosed as suffering from PTSD. Edition 5, 73 2. Research suggests that these individual patients require medicationand psychotherapy that is specifically focused on the past trauma. Paquette, M. Samson, et al (1999), also conducted a study affirming the importance ofidentifying PTSD in the primary care clinical setting. A clinical example of critical incident stress debriefing in caseswhere PTSD is likely to emerge as a consequence of trauma was described byAntai-Otong (2 1). M., & Taylor, K. (2 1). Results of the study showed that 64 percent of the patientswere passive recipients of care, 22 percent were identified as responsiblerecipients, and only 14 percent were responsible participants. In the second or fact phase, clients are asked to describe theevent and their reactions and perceptions. Psychiatric nursing. Deductive content analysis techniques were employed toanalyze written data. Thepurpose of the study was to determine how PCNSs could use variousstrategies of identifying PTSD among patients through taking psychiatrichistories, identifying physical complaints, assessing trauma history, andusing various instruments and semi-structured clinical interviews tocorrectly diagnose PTSD. The clinical significance of such atrauma is in its potential to exhaust the individual's usual copingmechanisms, thus creating psychological stress, disruption of normaladaptive functioning, and the potential for the onset of PTSD. (1999)Posttraumatic stress disorder in primary care. Screening after acritical trauma incident or in primary care and the psychiatric clinicalsetting can therefore improve the delivery of appropriate services to thepatient with PTSD.
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