Posttraumatic Stress Disorder by Tom Cole Purpose: 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 recovery Summary: 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 Theory Interpersonal 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 process Steps: 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 SupportMedication 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 situation ER Nurses PTSD An Anxiety Disorder Emotional Stress Negative Effects Fatigue Loss of Job Satisfaction 2. RELATE…Or 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. UNDERSTAND…the 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.”

TRUEPIC 4. EXPLAIN…the significance of the situation to those involved based on their individual KSVME Proposition: 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 ER Assumptions: 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. PREDICT…what 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. INFLUENCE…someone 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 Role Advocacy: Act on behalf of client Promote health and wellbeing Empathy Equity: Just, fair, impartial (Videbeck, 2014, p. 80)

Advocate Role Empathy = key (Adriaenssens, de Gucht & Maes, 2012)

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

References Adriaenssens, 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), doi: /j.ijnurstu Peplau's theory of interpersonal relations: Hildegard, e. peplau. (2012, January 31). Retrieved from Videbeck, S. (2014). Psychiatric-mental health nursing. (6th ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.