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Posttraumatic Stress Disorderby Tom ColePurpose: To review the condition of PTSD from a nursing perspective, to design a patient care plan using the TRUEPIC model, and to explore the role of the nurse as an advocate for patients with PTSD.

Rationale: Debilitating mental health condition Can have a profound effect on a person's ability to function Nurses can play a critical role in assisting in treatment and recoverySummary: Overview of PTSD Brief critique of the study Design a patient care plan using TRUEPIC Address the role of the nurse as patient advocate

Evidence for Care:What is PTSD?

Experienced directly, witnessed, or learned about

(Videbeck, 2014) (Adriaenssens, de Gucht & Maes, 2012)Evidence for Care:Nursing TheoryInterpersonal Relations in Nursing theory by Hildegard Peplau

Major Concepts of theory: Purpose of nursing is to help others identify their difficulties Nursing is a therapeutic art for healing Nursing is an interpersonal processSteps: Orientation Identification Exploitation Resolution

(Videbeck, 2014)("Peplau's theory of," 2012)Evaluation of the Evidence:Summary of study methods and results

248 nurses; 15 hospitals

87%

Social Support

(Adriaenssens, de Gucht & Maes, 2012)

Evaluation of the Evidence:Critique of the Research Study

Limitations: What is trauma? Potential for subjectivity

(Adriaenssens, de Gucht & Maes, 2012)

Patient Care Design:Collaboration of Care

Social/Family Support

Peer Support

Emotional Support

Medication Support

(Adriaenssens, de Gucht & Maes, 2012)

TRUEPIC

Situation: ER nurses have the potential of developing posttraumatic stress disorder following seeing traumatic events in the emergency room, such as gruesome injuries or combative patients or their family members. Subjects may experience abnormally strong emotional, cognitive, or behavioral reactions that negatively affect emotional, social, or occupational well-being.

1.IDENTIFY the variables in this situationER NursesPTSDAn Anxiety Disorder

Emotional Stress Negative Effects

Fatigue

Loss of Job Satisfaction

2. RELATEOr put the variables together to form propositions.Primary Proposition: Pt. is experiencing PTSD because of exposure to traumatic emergency room situations.Possible Assumptions: Pt. is unaware that job as ER nurse leads to the potential development of PTSD.Possible Confounding Variables: Lack of understanding or recognition of effects on ER nurses by the nurse or the healthcare system.

3. UNDERSTANDthe importance of the propositions, assumptions, and confounding variables.Proposition: If situation is not addressed and stress increases, PTSD can develop.Significance of Assumptions: If pt. is not aware of the possibility or dangers of PTSD, the condition could negatively impact job performance and satisfaction, as well as lead to fatigue and burnout.Possible Confounding Variables: If pt. has a conviction that they should not be impacted by trauma due to their being a nurse, they may not accept the possibility that they could develop PTSD.

TRUEPIC4. EXPLAINthe significance of the situation to those involved based on their individual KSVMEProposition: In a way meaningful to the pt, explain what PTSD is, how trauma can contribute to it, and what undesirable conditions PTSD can contribute to during work in the ERAssumptions: Explain how recognition of potential complications can help benefit the patient and their work.

Confounding Variables: Explain how dismissing the potential for PTSD can negatively impact the job performance of the ER nurse.

5. PREDICTwhat will happen in this situation if one or more variables are not changed.

Proposition: If PTSD is suspected and is not resolved, then the ability of the ER nurse to perform their role at work might be hindered or compromised.

Assumptions: If the patient will cooperate with regular stress reduction techniques, then the risks of PTSD will be lessened.

Confounding Variables: If patient can accept that they may have the potential to develop and uses appropriate coping techniques, then the patient may be able to perform at their job more effectively.

6. INFLUENCEsomeone to change one or more variables in order to achieve a desired outcome or prevent an undesirable one.

Proposition: Make sure the patient understands the importance of maintaining a low stress level for optimal results.

Assumptions: Make sure the patient understands benefits of effective stress management and its relationship to PTSD. Encourage regular stress reduction techniques.

Confounding Variables: Encourage the patient to practice stress reduction techniques regularly in order to experience positive outcomes.

7. CONTROL- Patient (ER nurse) is required to complete in-service training on the signs, symptoms, causes, and coping mechanisms of PTSD.

Advocate RoleAdvocacy: Act on behalf of client Promote health and wellbeing

EmpathyEquity: Just, fair, impartial(Videbeck, 2014, p. 80)

9Advocate RoleEmpathy = key

(Adriaenssens, de Gucht & Maes, 2012)Advocate Role

(Adriaenssens, de Gucht & Maes, 2012)ReferencesAdriaenssens, J., de Gucht, V., & Maes, S. (2012). The impact of traumatic events on emergency room nurses: Findings from a questionnaire survey. International Journal of Nursing Studies, 49(11), 1411-1422. doi:10.1016/j.ijnurstu.2012.07.003

Peplau's theory of interpersonal relations: Hildegard, e. peplau. (2012, January 31). Retrievedfrom http://currentnursing.com/nursing_theory/interpersonal_theory.html

Videbeck, S. (2014). Psychiatric-mental health nursing. (6th ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.