by Stuart Overlin, NurseZone
Post-traumatic stress disorder (PTSD) can strike anyone who has survived a horrifying and life-threatening experience such as war, terrorism, natural
disaster, violent crime, or rape. Its victims—males and females of all ages,
ethnicities and backgrounds—suffer in varying degrees from its effects. Often
misunderstood or undiagnosed, PTSD does have some very clear symptoms: recurring
"flashbacks" and nightmares, emotional numbness, insomnia and a sense
of impending danger long after the actual threat is gone.
The National Mental Health Association (NMHA) reports that at least 3.6 percent of U.S. adults, or 5.2 million Americans, suffer from PTSD each year.
Yet another byproduct of traumatic events, secondary PTSD, affects rescue
workers, police officers and caregivers, including nurses. Post-traumatic stress
therefore demands the special attention of nurses, both in caring for their
patients and for their own mental well being.
Basic Facts About PTSD
"Post-traumatic stress disorder" is a recent clinical term for a
phenomenon presumably as old as trauma itself. Only in the wake of the Vietnam
War, as the veteran population was being studied more closely than ever before,
did researchers establish the connection between "combat fatigue" and
the disorder among many victims of rape, child abuse, train wrecks, earthquakes,
the Holocaust and other severe traumas. The American Psychiatric Association
formally defined PTSD in 1980, listing it in the "Diagnostic and Statistical
Manual of Mental Disorders—Third Edition" as an anxiety disorder.
According to "The Post-Traumatic Stress Disorder Sourcebook,"
written by Glenn R. Schiraldi, PTSD is a natural human reaction to an
overwhelmingly terrible experience, but not everyone who experiences trauma will
suffer from it. PTSD most often surfaces within three months of the trauma. The
disorder is labeled as acute if resolved within those three months, and chronic
if the problem extends beyond that. Deliberate human traumas—such as murder,
terrorism, and rape—can cause particularly devastating cases of PTSD by
eroding the victim’s faith in humanity.
Seemingly ordinary sights, sounds or smells can trigger a sudden flashback,
in which the person believes he or she is actually reliving the traumatic
experience, as explained by the American Psychiatric Association article, "Let’s
Talk Facts About Posttraumatic Stress Disorder." Anniversaries
and reminders of the event are often especially painful. Many who suffer from
PTSD attempt to "self-medicate," abusing alcohol or drugs to ease the
pain of their flashbacks, nightmares and unpleasant thoughts. The disorder is
closely associated with depression, and a person with chronic PTSD may be at
risk for suicide.
The Ripple Effect: Secondary PTSD in Caregivers
Nurses and other caregivers who are frequently exposed to trauma victims are
susceptible to what is known as secondary traumatic stress disorder, or
"compassion fatigue." Witnessing the effects of traumatic events, when
combined with job stress and long hours, can lead to symptoms that resemble
those of direct PTSD: intrusive images and thoughts, emotional withdrawal,
irritability and anxiety, as explained by the International Society for
Traumatic Stress Studies, Indirect
Trauma." According to a recent report from the Washington-based
Advisory Board Company, which studies healthcare trends, 90 percent of intensive
care unit nurses show some symptoms of secondary PTSD.
"What we see most often with nurses is a post-traumatic stress reaction,
which is not the same thing as full-blown PTSD," says Penelope Buschman,
RN, MSN, CS, director of the Psychiatric Mental Health graduate program at
Columbia University. "Nurses, especially in acute care units or burn units,
are sometimes traumatized vicariously by what they see. Some of the telltale
signs of trouble are fatigue, burnout, absenteeism, alcohol abuse and poor
judgment. Even so, it can be difficult for us as nurses to recognize it in
ourselves because we’re the ones who are supposed to be ‘OK.’ We’re the
ones giving care."
Treatment of PTSD
Fortunately, the potentially debilitating effects of PTSD are very treatable.
The basic treatment methods are:
- Psychiatric care: With cognitive-behavioral therapy and group therapy, the
patient repeatedly relives the frightening experience under controlled
conditions to help him or her work through the trauma. Mental health
professionals also use relaxation techniques such as hypnotherapy.
- Medication: Antidepressant medications such as Prozac and Zoloft have
proven helpful in managing the symptoms of depression and anxiety and
- Support groups: Connecting with others who have survived similar
experiences can be very important in the healing process. A variety of
support groups, many of them based on the Alcoholics Anonymous 12-step
model, are available throughout the United States.
Nurses play a vital role in helping people who suffer from PTSD. "By
virtue of their communication skills and knowledge base, nurses can help assess
PTSD in their patients," says Laura Cox Dzurec, dean and professor at the
University of Connecticut School of Nursing. "They can refer patients with
post-trauma difficulties to a mental health professional or their local
department of mental health for follow-up."
Secondary PTSD: Caring for Yourself
For nurses whose work exposes them to trauma,
coping with secondary PTSD begins with candid self-assessment. Dr. Michael
Skopek, a practicing psychiatrist in San Diego, California, told NurseZone
that nurses should look within while considering a few simple questions:
"Do you constantly deal with life-and-death issues or serious trauma
issues? How often do you take home fear and a sense of helplessness? Does your
work with trauma victims cause recurring thoughts, images or nightmares? Do you
experience physiological reactions? Do you attempt to avoid thinking about work
or talking about it, and do you feel detached or numb to it?"
If you find yourself answering "yes"
to these questions, you may be suffering from secondary PTSD. Most cases can be
treated through basic self-care:
- Eat a nutritious diet: Limit your intake of
sugar, caffeine and alcohol.
- Get enough exercise (a major
- Balance work with recreation and rest.
- Take adequate breaks from working with
- Ventilate: Talk openly with friends, family
and colleagues about what you’re experiencing.
In more severe cases of secondary PTSD,
consulting a mental health professional is sometimes necessary. Even then, help
is available within the nursing ranks: "Look at a roster of advanced
practice psychiatric nurses in your area," suggests Buschman.
"But what’s really important," she
added, "is that nurses watch out for each other and interpret the signs
whenever there is trauma and high stress."
Association of America
Phone: (301) 231-9350
National Center for Post-Traumatic Stress
Phone: (802) 296-5132
National Mental Health
Phone: (800) 969-NMHA
October 12, 2001© 2001 NurseZone.com. All Rights Reserved.