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What Emergency Room Nurses and Other RNs Need to Know About PTSD

Few professionals will come into more contact with patients who have PTSD than nurses. This condition is estimated to affect one in 11 people in their lifetime — just under 10 percent of the population in the United States. 

Nurses are in a unique position to recognize the signs of PTSD, ensuring treatment efforts are sensitive to the condition and creating the opportunity for intervention. Find out what PTSD is, how to identify it, and what you can do to help the patients with whom you come into contact.

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What is PTSD?

PTSD, or post-traumatic stress disorder, is a psychological condition that can affect anyone who has suffered through a traumatic event. While the condition is often associated with soldiers returning from combat situations, PTSD can also be diagnosed for less extreme experiences such as witnessing or being the victim of violent crime, a serious accident, or a natural disaster. People diagnosed with the disorder experience disturbing thoughts and feelings related to the triggering event, lasting weeks, months, or even years after the fact.

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A person experiencing PTSD must navigate intense emotions, such as anger, sadness, and fear, that surface as they relive the triggering event. This can lead to nightmares, a disturbance in sleep patterns, hyperarousal, and chronic pains. People with PTSD often avoid reminders of the traumatic event, limiting exposure to loud noises, smells, and locations that could trigger a flashback. These experiences and the desire to control them can severely impact the person's quality of life, so intervention is critical to further suffering. 

Signs a patient may have PTSD.

People who have PTSD will often show reactive symptoms that are common signs of trauma. The difference for these patients is these symptoms continue long after the event has passed. Nurses should watch for patients who:

• flinch when touched

• startle easily from loud noises

• show signs of irrational irritability and anger

• have difficulty concentrating

• exhibit reckless or self-destructive behavior

• avoid discussing the triggering event

• have negative thoughts and feelings

• experience intense emotional responses, such as crying

To be diagnosed with PTSD, a patient should experience symptoms for at least a month after the traumatic event, but there are cases where PTSD sets in up to six months later. These patients often will not experience the full range of symptoms until the condition fully develops.

"It is possible that an individual will not present with full diagnostic criteria," says Dr. Tamar Blank, a licensed psychologist in New York and New Jersey with a practice in Riverdale, NY, "however, PTSD can develop even six months after the trauma. The diagnosis for such an individual is Delayed PTSD with Delayed Specification."

For nurses attempting to identify PTSD patients, Dr. Blank also mentions that symptoms cannot be due to illness, medication, or substance abuse.

How to treat patients with PTSD

If you've identified a patient you suspect has PTSD, there are several ways you can make their experience more comfortable. The American Nurses Foundation provides a PTSD toolkit that offers advice and resources, including verifying if PTSD is a factor more definitively. Several standard screening aids are available, such as the Primary Care PTSD Screen (PC-PTSD) or the PTSD Checklist (PCL-M). After confirming your patient shows the signs of PTSD:

1. Use "motivational interviewing" techniques with the patient and encourage them to seek professional help based on their readiness for change.

2. Show patience when your charge gets irritable, and remember that it is a symptom of their condition. It's important to remain calm.

3. Limit startle responses by announcing your arrival to the room and asking before touching the patient. Avoid making loud noises.

4. Accommodate requests to keep the door open or limit the number of people in the room at one time.

5. Make sure colleagues know their PTSD status before interacting with the patient.

Nurses are likely to encounter patients with PTSD frequently throughout their careers. Though the condition can be debilitating, RNs have a unique opportunity to intervene and encourage the patient to get help. By understanding the condition and knowing how to identify symptoms, nurses can ensure these patients receive quality care with the sensitivity needed to promote a positive experience.

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