How Nurses Can Support Patients With Medical Trauma and PTSD
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Medical treatments, procedures, and hospital admissions can have a long-lasting psychological impact. Procedures and treatments can be traumatic events that trigger post-traumatic stress disorder (PTSD) in patients. One meta-analysis found 18.5% of patients who became conscious during surgery were later diagnosed with PTSD.
One in four who experienced a physical trauma that required hospitalization screened positive for PTSD roughly within three months after the event. This analysis indicates that physical trauma, which can happen during medical procedures, increases the risk of PTSD.
Often people picture mental health professionals when they think about treatment for PTSD, but this is somewhat limiting. Nurses can play a significant role in the treatment and recovery of patients with PTSD.
While a nurse may have been involved in the original medical trauma that triggered PTSD, that should not prevent them from being involved in a patient's recovery. Find out how nurses can help treat patients with PTSD.
6 Tips on How to Support Patients With PTSD
PTSD is difficult to live with and it can take a heavy toll on relationships, including family life and the patient-nurse relationship. Patients' PTSD symptoms can lead to the breakup of marriages, job loss, and substance misuse. It can be hard for those impacted by a patient's trauma not to take this kind of harm personally.
Nurses must remember that the PTSD patient may not always be able to control their behavior. The following suggestions can serve as a starting point to help care for patients with PTSD.
Nurses should work with the patient's therapist and family to discover strategies that work for the patient.
1. Be a Good Listener
One of the strongest communication strategies you can use is to be a good listener. When a person with PTSD chooses to talk, try to listen without any expectations or judgment. The person may need to talk about the event repeatedly, and it may be difficult to hear.
It is crucial that nurses are neutral and nonjudgmental. Any disapproving or negative response makes it unlikely the patient will open up to you again.
2. Build an Environment of Trust and Safety
Patients who have experienced trauma may see the world as a perpetually dangerous place. The experience damages a person's ability to trust others and themselves.
Nurses can reduce this effect by creating routines, keeping their promises, and emphasizing their patient's strengths. Look for ways to empower the patient so that it builds confidence and gives the patient more choice and control.
3. Learn and Manage Triggers
Individuals with PTSD often have triggers. This is a person, place, or situation that reminds them of the traumatic event. A trigger can set off PTSD symptoms and make it difficult for the patient to function.
There are common internal and external triggers. External triggers may include sights, sounds, smells, or locations. Internal triggers can include hunger, fatigue, sickness, or sexual frustration.
Other triggers include strong emotions, like feeling trapped or helpless, or bodily sensations that trigger a memory of the trauma, such as pain or a similar injury. With proper training, nurses can discuss known triggers with the patient and ask how they should respond to a flashback or panic attack.
4. Support Patients Dealing With Volatility and Anger
People with PTSD can have difficulty managing their emotions. Unfortunately, they live in a constant state of stress. Many have trouble sleeping, so they are often exhausted. This can increase the likelihood of overreactions.
Nurses should watch for signs that a person is getting angry and try to remain calm. Allow the person to have physical space so they don't feel threatened. Ask them how you can help.
It is essential that nurses always place safety first. This includes their own safety and the safety of other patients and staff.
5. Take Care of Yourself
Treating patients with PTSD for a long time can be a recipe for burnout. Nurses can develop trauma after consistently listening to traumatic stories or being exposed to PTSD symptoms. Nurses should take care of their physical needs for exercise, nutrition, and sleep to avoid nurse burnout.
Remember that support systems are vital to reducing stress. Additionally, nurses may have to set boundaries. This may mean caring for another patient population if dealing with patients with PTSD becomes overwhelming.
6. Share Decision-Making
The basis of cognitive behavioral therapy is a collaborative effort between the therapist and the patient. This is, in effect, shared decision-making. However, while few healthcare providers receive training on how to collaborate with patients, it is the foundation of holistic nursing to engage the patient in decision-making about their medical care.
There are significant benefits for shared decision-making in patients who have PTSD. The collaboration may increase a patients' confidence in making their own decisions and may give them a greater sense of control.
Additional Resources for Healthcare Professionals
Healthcare providers working in rural communities may not have access to as many tools for patients with PTSD as nurses in metropolitan centers. The Department of Veterans Affairs (DVA) provides a tool kit for the rural provider with information and resources to improve the lives of people with PTSD. These resources can help reduce obstacles to treatment and getting care.
Some people with PTSD prefer treatment with their primary care provider instead of a mental healthcare provider. The DVA also provides a toolkit for primary care providers that includes the PTSD clinical practice guidelines, information about shared decision-making, how an accurate diagnosis is made, and treatment guidelines.
Nurses caring for patients with PTSD may experience compassion fatigue. Mostly, nurses interact with patients during a difficult time in a patient's life. Over time, this can take an emotional toll.
Nurses can prevent compassion fatigue and cope with symptoms through some simple strategies. Take care to set a schedule that works for you. This can help reduce overworking. It also allows you to make time for yourself.
For their part, healthcare institutions and managers must also ensure they hire and staff sufficient numbers of nurses. They must also support nurses with resources and strategies to allow nurses to do this important work without burning out.
How the Tuskegee Study Contributed to Medical Trauma
The Tuskegee Study was conducted between 1932 and 1972 and represents one of the most reprehensible public health actions taken against U.S. citizens. Unfortunately, the experience has influenced the patient perspective of people of color toward the medical establishment.
The experiment was conducted by the U.S. Public Health Service on African American men. The men were told they were being treated for "bad blood," but they were in fact not given any treatment. They underwent X-rays, spinal taps, and blood tests as the public health agency tracked the natural progression of untreated syphilis.
In other words, over a 40-year period public health experts justified nontreatment based on cultural and medical racist concepts. Many in the medical establishment thought they were superior to Black people, and this horrific public display of abuse is a testament to how deeply these feelings ran.
During the experiment, researchers took steps to be sure the participants did not receive treatment for syphilis from private physicians. Scientists instead told participants they were being treated when they weren't, preventing them from getting treatment that could save their life.
The memory of this injustice has not been lost on the Black community and contributes to an underlying distrust for the medical establishment. It also plays a significant part in BIPOC's predisposition to medical trauma.
Many of the tips above that help to support patients with PTSD can be used to help rebuild trust in patients who may have difficulty getting past a deep-seated fear of the medical profession. Also, the medical establishment should prioritize finding ways to educate their nurses, doctors, and management in strategies to rebuild that trust.
Distrust is best addressed one medical professional at a time, not by attempting to encourage trust in the whole system.
The Importance of Trauma-Informed Care for Patients
By nature, medical examinations and procedures can feel intrusive. It is also important to recognize that trauma is common in people's lives. Practicing trauma-informed care means nurses and other healthcare professionals promote a culture of safety and healing, instead of intrusion and fear.
Trauma-informed care begins with the practice of specific principles to engage the patient in the process. This can be done by asking permission and offering them greater control. It shifts the focus of the interaction from "What's wrong with you?" to "What happened to you?"
The healthcare team needs a complete picture of the patient's experiences to provide appropriate and effective care in a nonthreatening manner. The goal of trauma-informed care is to recognize the prevalence of trauma in the patient population, including medical trauma, and integrating knowledge, experience, and practice to prevent retraumatization.
Nurses can use trauma-informed practices that may improve patient compliance, patient outcomes, and help reduce fear of the healthcare system.
In the process, nurses can help empower patients and increase the level of physical and psychological safety patients and their healthcare providers may experience.
Page last reviewed June 21, 2022
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