The PTSD Toolkit for Nursing: Assessment, Intervention, and Referral of Veterans
Article Analysis
Article: The PTSD Toolkit for Nursing: Assessment, Intervention, and Referral of Veterans
Background: With an increase in veterans in the patient population, nurses need to be familiar with PTSD symptoms and resources to best serve their patients. Read the assigned article and think about how the assessments and interventions described can also be applied to other patient populations as well. As nurses with various backgrounds, we also have to recognize that stress and traumatic events in our own lives and careers can impact our ability to practice safely. While this article specifically discusses Nurse Practitioners, the Registered Nurse is also responsible for assessing and intervening (or recommending interventions). Once you have read the article, answer the following questions.
1. What are some of the main causes of PTSD for military members and how do they manifest in these individuals?
2. Describe the main symptoms expressed by patients with PTSD.
3. What are the recommended interventions for patients with PTSD symptoms?
4. How can the nurse motivate patients to seek treatment?
5. What resources are available for individuals with PTSD?
6. How could you use the information from the article to identify, assess, and care for a patient with PTSD?
8-10 points
Excellent
Answer is thorough and provides supportive evidence from the article.
5-7 points
Needs Improvement
Answer does not provide enough supportive evidence and is lacking in depth and thoughtfulness.
0-4 points
Significant Errors
Answer is missing components; no supportive evidence presented
Total Points:
60
(10pts each section)
r. H presented to the primary care NP complain- ing of nightmares interrupting his sleep, irritabil- ity, a very short temper, and a sense of detachment
from others. He deployed to Iraq in 2003 and then again from 2005 to 2006. He was exposed to numerous combat experiences, including witnessing a friend killed in action, surviving an injury from an improvised explosive device (IED), and experiencing mortar fi re while under an attack in a remote base.
Mr. H sought help for his symptoms at the army base and was advised to follow up with a mental healthcare pro- vider on his return to the United States. He deferred visiting the mental healthcare provider and managed well enough over the ensuing months. However, Mr. H continued to feel
M
Assessment, intervention, and referral of veterans
By Nancy P. Hanrahan, PhD, RN, FAAN; Kate Judge, BA; Grace Olamijulo, MS, BSN, RN; Lisa Seng, BSN, RN; Matthew Lee, MS, BSN, CDR; Pamela Herbig Wall, PhD, NC, USN, PMHNP; Sandy C. Leake, MSN, RN; Elizabeth Czekanski, DNP, MS, RN-BC, NE BC, VHA-CM; Suzanne Thorne-Odem, DNP, RN; Erika E. DeMartinis, MSN, RN; Ursula A. Kelly, PhD, ANP-BC, PMHNP-BC;
Lucas Blair, PhD; and Warren Longmire, BS
Abstract: Approximately 20% of veterans
suffer from posttraumatic stress disorder
(PTSD). NPs are well positioned to provide
early detection and assist veterans with
access to life-saving treatment. The PTSD
Toolkit for Nurses helps nurses improve
their skills in assessing PTSD and provides
a specialized intervention and referral
procedure that promotes help-seeking
behavior among veterans. Keywords: e-learning, PTSD, PTSD Toolkit for Nurses, public health intervention, simulation, veterans
The PTSD Toolkit for Nurses:
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46 The Nurse Practitioner • Vol. 42, No. 3 www.tnpj.com
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
The PTSD Toolkit for Nurses: Assessment, intervention, and referral of veterans
www.tnpj.com The Nurse Practitioner • March 2017 47
irritable and moody, which became a source of conflict between him and his wife.
In 2007, Mr. H deployed for a third time. When he began training exercises to prepare for deployment, his nightmares returned, and he was unable to shake off memories of his combat experience. He was also unable to sit through the training and lashed out at the commanding offi cer. Mr. H was having trouble getting to sleep and soon found he could not perform his job.
■ Military personnel Mr. H’s story is typical of a military person who develops posttraumatic stress disorder (PTSD) from traumatic experiences during military service. Nearly two-thirds (62%) of the 2.2 million troops that served in Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom in Iraq were exposed to serious training acci- dents, such as vehicle or helicopter crashes, coming under fi re, or suffering from wounds caused by an IED, physical violence, or sexual assault.1
In 2011 alone, nearly 1 million service members or veterans received a diagnosis of at least one psychological condition while they were active service members, and half of them had two or more psychological conditions diagnosed.2 PTSD is just one of many psychological con- sequences of war; other conditions include adjustment disorders, depression, anxiety disorders, and substance use disorders.
Signs and symptoms of PTSD or other psychological conditions are diffi cult to recognize, and veterans with these symptoms experience major barriers to reintegrating into society or the work force.2 Veterans may be stoical and not easily share their symptoms. Unfortunately, delays in receiv- ing help are common and raise the risk of negative conse- quences. With much stigma attached to mental illness, individuals with psychological problems tend to hide their conditions because they feel shame or guilt.3 Therefore, nurses need to be alert to patients who have served in the military so as to properly assess their stress responses and need for help.
Consequences of untreated psychological condi- tions affect service members and their families alike, with the degree of hardship and negative consequences increasing with the number of the service member’s expo- sure to traumatic or life-altering experiences.3,4 One dire statistic—a veteran commits suicide every 65 minutes— suggests that veterans need assistance.4,5 Psychological conditions resulting from experiences during military service or adjusting from military life to civilian life are treatable. Veterans and their families need to fi nd help early.
■ Nurses have impact RNs are the single largest group of healthcare professionals and work in all areas of healthcare.6 All RNs, including NPs, meet active military service members and veterans in health- care or community settings, such as churches, grocery stores, or social groups. RNs are in a unique position to make a difference in the lives of these men and women. First, the nurse must ask if the patient has served. In civilian dress, it is often not obvious that an individual served in the armed forces.
Once identifi ed, the RN assesses for psychological symp- toms of stress and trauma, determines the severity of the symptoms, intervenes, and refers the individual for help. RNs have the opportunity and position to help change the lives of service members and their families who experienced psychological trauma and continue to experience symptoms that disrupt their work or social lives. The PTDS Toolkit for Nurses is a self-directed online resource designed to teach or reinforce the nurse’s knowledge about the treatment of veterans with PTSD.
The PTSD Toolkit for Nurses (www.nurseptsdtoolkit. org), sponsored by the American Nurses Foundation, was developed to teach nurses about the psychological conse- quences of stress and trauma (including PTSD) among vet- erans, to build competence in helping veterans take action to get help, and make referrals specifi cally for veterans. The PTSD Toolkit for Nurses is web-based and provides videos alongside brief case summaries that highlight essential points for nurses to assess, intervene, and refer veterans with PTSD.
Additionally, the website has interactive simulation for nurses to practice the assessment, intervention, and referral skills. This article reviews key points of the PTSD Toolkit for Nurses that promotes assessment of PTSD and interven- tions for veterans and family members to seek the help they need. NPs assess, diagnose, and treat complex health chal- lenges, making them preferred providers for the often com- plex physical and emotional needs of veterans. NPs can use the PTSD Toolkit for Nurses to enhance their capacity for directed PTSD care.
■ Assessment Symptoms of PTSD vary. Fear-based reexperiencing, emo- tional, and behavioral symptoms may be dominant for some individuals.7 For others, a lack of pleasure in people or things that used to give them pleasure (anhedonia) or a persistent state of dissatisfaction, anxiety, restlessness, or fi dgety mood may be most distressing.8 For other individuals, reactivity and hypervigilance, including sensitivity to sounds, touch, and light, are prominent. In contrast, others have dissociative symptoms where they avoid or withdraw from people and places.8
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
The PTSD Toolkit for Nurses: Assessment, intervention, and referral of veterans
www.tnpj.com The Nurse Practitioner • March 2017 49
Some individuals exhibit combinations of these symptom patterns. In the case study of Mr. H, his anger and irritability are dominant psychological symptoms (see Mr. H). He is also emotionally distant and detached, avoiding his wife and others. He uses alcohol to help him sleep. His arousal system is on hyper-alert, exhibited as being easily startled. Flashback symptoms are triggered by loud noises, and Mr. H often relives an experience in which he witnessed his friend being killed in an IED explosion. Even though Mr. H’s psychological condition is painful, isolating, and threatening his marriage and job, he is embarrassed and reluctant to seek help.
Examples of traumatic events include shooting, mug- ging, burglary, physical or sexual assault, bullying, car crash- es, serious injuries, and life-threatening illnesses.9…
