Post-traumatic stress disorder (PTSD) is a psychiatric condition that can occur after someone experiences or witnesses a traumatic or terrifying event. PTSD can be a lasting consequence of the traumatic event, even years later. Examples of traumatic events include war, terrorism, natural disasters, motor vehicle accidents, the unexpected death of a loved one, a life-threatening medical diagnosis, and assault.
Traumatic events cause feelings of intense terror, fear, and helplessness. These feelings can be experienced by victims, families of victims, and medical personnel. Symptoms can include nightmares, severe anxiety, and flashbacks. Symptoms are generally grouped into four types: physical and emotional reactions, intrusive memories, avoidance, and negative changes in thinking and mood. Symptoms, and severity, can vary over time and for each individual.
PTSD is generally diagnosed with a physical exam, psychological evaluation, and criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Treatment includes psychotherapy and/or medication.
Nursing Process
Nurses will be involved in caring for patients with PTSD in various settings. Patients directly involved in a traumatizing event will be seen in the trauma center or emergency department and once stabilized, may require psychiatric evaluation with further inpatient or outpatient treatment. Nurses can also care for patients with PTSD in a behavioral health center. Nurses should remain sensitive to patients with a history of PTSD so as not to trigger a negative response when providing invasive care or when communicating personal information.
Nursing Assessment
Post Traumatic Stress Disorder (PTSD) is a mental health condition triggered by experiencing or witnessing a traumatic event. It is characterized by symptoms such as flashbacks, nightmares, severe anxiety, and uncontrollable thoughts about the event. Nurses play a crucial role in the assessment of patients suffering from PTSD, providing both medical and emotional support to foster recovery and improve quality of life.
Initial Assessment
History Taking: Obtain a comprehensive history, including details of the traumatic event, previous mental health issues, and any current symptoms. This can help identify the severity and impact of PTSD on the patient’s life.
Symptom Assessment: Evaluate the presence of key PTSD symptoms such as re-experiencing the trauma, avoidance of reminders, negative changes in thinking and mood, and hyperarousal.
Functional Assessment: Assess the patient’s ability to perform daily activities, including work, social interactions, and self-care. This helps determine the extent to which PTSD affects their overall functioning.
Psychological Assessment
Emotional State: Assess the patient’s emotional state, including signs of anxiety, depression, and mood swings. Use standardized tools like the PTSD Checklist (PCL) to quantify symptom severity.
Behavioral Observations: Monitor for behaviors such as irritability, aggression, and self-destructive actions that may indicate the impact of PTSD.
Coping Mechanisms: Evaluate the patient’s coping mechanisms and their effectiveness. Identify any maladaptive coping strategies that may need to be addressed.
Physical Assessment
Sleep Patterns: Assess sleep quality and patterns, as disturbances are common in PTSD patients. Inquire about nightmares or insomnia.
Physical Health: Conduct a thorough physical examination to identify any comorbid conditions, such as chronic pain or cardiovascular issues, which may be exacerbated by PTSD.
Nursing Interventions
Nursing intervention in cases of Post Traumatic Stress Disorder are vital for promoting recovery and enhancing the quality of life for affected individuals. By providing education, emotional support, and personalized care, nurses contribute to positive health outcomes and help individuals with PTSD navigate their path to healing.
Psychological Support
Counseling: Provide individual counseling to help the patient process the traumatic event and develop healthier coping strategies. Techniques such as Cognitive Behavioral Therapy (CBT) are often effective.
Group Therapy: Encourage participation in group therapy sessions where patients can share experiences and support each other.
Mindfulness Practices: Teach mindfulness and relaxation techniques to help manage anxiety and stress.
Education and Support
Condition Explanation: Educate the patient and their family about PTSD, its symptoms, and the importance of following the treatment plan.
Sign Recognition: Teach the patient to recognize signs of worsening symptoms and the need for immediate medical attention.
Medication Management
Pharmacotherapy: Administer prescribed medications, such as antidepressants or anti-anxiety drugs, and monitor for side effects and effectiveness.
Adherence Support: Encourage medication adherence and educate the patient about the importance of not discontinuing medication without consulting a healthcare provider.
Support Systems
Family Involvement: Involve family members in the care plan to provide additional support and understanding.
Support Groups: Refer the patient to PTSD support groups for additional emotional and psychological support.
Nursing Care Plans
Once the nurse identifies nursing diagnoses for PTSD, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for PTSD.
Anxiety
Patients with PTSD can experience varying degrees of anxiety.
Nursing Diagnosis: Anxiety
Related to:
- Threat of harm or death
- Loss of a loved one
- Situational crisis
As evidenced by:
- Tachycardia
- Increased blood pressure
- Verbalization of feeling anxious
- Panic attacks
- Restlessness
- Apprehension
- Feelings of worry
- Fidgeting
- Difficulty concentrating
- Urinary urgency/frequency
Expected Outcomes:
- Patient will exercise control over their anxiety as evidenced by reports of feeling relaxed
- Patient will implement two strategies to reduce anxiety
- Patient will demonstrate reduced anxiety as evidenced by heart rate and blood pressure within normal limits
Assessment:
1. Identify the source of anxiety.
Encourage the patient to discuss what causes their anxiety. Ask if they notice a pattern or triggers for their anxious thoughts. Make sure the patient knows they will not be judged or dismissed if they are open about how they feel.
2. Assess the severity of anxiety.
Mild anxiety may include restlessness and insomnia, while severe anxiety interferes with daily functioning. Panic distorts reality. Interventions can be based on the level of anxiety the patient experiences.
3. Assess the use of stimulants.
Review medications and the use of stimulants such as caffeine which can also cause a sense of anxiety. These may worsen the patient’s physical and emotional symptoms.
Interventions:
1. Encourage therapeutic communication.
Display empathy and positivity allowing the patient to express their anxiety. Encourage the patient to openly express their emotions. Use silence and active listening to portray a patient attitude. Do not deny or minimize their anxiety.
2. Encourage relaxation techniques.
Relaxation techniques include deep breathing, yoga, and meditation. Encourage the patient to try implementing different methods when they are feeling anxious. In the hospital setting, the nurse can promote a calm environment through dim lighting and soft music.
3. Evaluate the patient’s support systems.
Patients with PTSD need to know they aren’t alone. Determine what kind of personal support the patient has at home. Encourage support groups along with their home support system.
4. Administer medications as ordered.
The patient’s anxiety may be at a level where they are experiencing panic. Benzodiazepines are the most common class of medications administered to reduce anxiety.
Fear
Patients with PTSD can experience fear in response to the traumatic event.
Nursing Diagnosis: Fear
Related to:
- Perceived danger
- Perceived threat
As evidenced by:
- Agitation
- Tachycardia and heart palpitations
- Tachypnea
- Verbalization of feeling fear
- Muscle tension
- Reports of apprehension
- Increased alertness or avoidance
- Jitteriness
- Nausea or vomiting
- Increased perspiration
- Dilated pupils
Expected Outcomes:
- Patient will openly discuss fear and what is invoking the sense of fear
- Patient will be able to use effective coping behaviors to resume normal life activities
- Patient will acknowledge that they are safe and cannot be harmed
Assessment:
1. Assess the degree of fear.
Assess the patient’s degree of fear or perceived threat. Use open-ended questions to actively listen, as this reassures the patient and shows them that their concerns are being heard.
2. Observe for signs of fear.
Nonverbal expressions can indicate they are experiencing fear. Physical signs such as an increased heart rate, tachypnea, dyspnea, sweating, and agitation are signs of fear.
3. Assess coping strategies.
Find out how the patient has coped in the past with their fear. The nurse can also get an idea of how the patient is coping by their actions during the assessment. Discuss coping strategies and implement if applicable.
Interventions:
1. Reassure safety.
This may likely be the first step, especially if the patient is in a state of panic. Ensure the patient is in a calm and safe environment, and reassure them repeatedly that they are safe. Allow time for them to become accustomed to the environment, giving them periods of rest.
2. Discuss the reality of the situation.
Inquire about what the patient’s fear is. Acknowledging what can and can’t be changed can help the patient feel in control.
3. Encourage healthy coping strategies.
After evaluating whether the patient’s coping strategies are healthy or not, encourage implementing positive strategies. Some healthy ways to cope during a fearful situation include positive self-talk, listening to music, and relaxation techniques. Encourage them to try various methods and see which is most helpful.
4. Be sensitive to the patient’s feelings.
Reassure the patient that feelings of fear after a traumatic event are normal and valid. Empathize with their feelings instead of giving them false reassurances. Showing compassion promotes trust.
Ineffective Coping
Patients with PTSD may attempt to cope in ways that are ineffective and even harmful.
Nursing Diagnosis: Ineffective Coping
Related to:
- Situational crises
- Fear
- Uncertainty
- Lack of confidence in the ability to cope
- Inadequate resources or support system
As evidenced by:
- Inability to perform daily tasks
- Sleep disturbances
- Self-destructive habits (drugs, alcohol, smoking)
- Reoccurrence of intrusive thoughts
- Inappropriate defense mechanisms
- Inability to partake in self-care
- Somatic symptoms (diarrhea, headaches, ulcers)
- Changes in behavior and/or communication
Expected Outcomes:
- Patient will identify maladaptive coping behaviors
- Patient will participate in self-care activities: cooking healthy meals, exercising, proper sleep, etc.
- Patient will display a desire for effective coping as evidenced by asking for help and reaching out to a support person/group
Assessment:
1. Assess for self-destructive habits.
Patients with PTSD may turn to unhealthy habits as a way of dealing with their trauma. They may self-medicate with alcohol and/or drugs. Assess for substance abuse by asking the patient directly about their substance use and looking for physical indications.
2. Assess the effect on everyday activities.
Even if a patient isn’t coping with substances they may be in denial about other ways they cope and how this affects their life. Assess their job, family and other relationships, and how they take care of themselves.
3. Observe speech and behavior.
Observe for impatience, frustration, a lack of confidence in their self-talk, or defense mechanisms that signal ineffective coping.
Interventions:
1. Empathetic listening.
Acknowledge the patient’s feelings and show understanding. This creates a supportive environment in which the patient will be more willing to open up about how they’re feeling and how they cope.
2. Arrange for professional support.
Referring the patient to a therapist or counselor may be warranted. Ask the patient how they feel about this and reiterate that it’s not a negative, but a positive step. A mental health professional trained in PTSD can offer different treatments for effective coping.
3. Encourage positive self-talk and self-care.
A traumatic event may harm the patient’s confidence. Encourage positive statements and mantras. Institute self-care opportunities by allowing the patient to make decisions and do things for themselves. Show the patient they are capable of taking control.
4. Recommend a support group.
Speaking with other individuals who understand the trauma the patient has experienced can be beneficial in coping and recovering.
Nursing Diagnosis and Rationale for Post Traumatic Stress Disorder (PTSD)
1. Anxiety
Rationale: Anxiety is a common symptom of PTSD, manifesting as excessive worry, restlessness, and hypervigilance. Nurses should assess the patient’s level of anxiety using standardized tools and provide interventions such as relaxation techniques, breathing exercises, and cognitive-behavioral strategies to manage anxiety. Educating the patient about anxiety management and encouraging participation in therapy sessions can also support their emotional well-being.
2. Disturbed Sleep Pattern
Rationale: PTSD often leads to disturbances in sleep, including insomnia, nightmares, and night sweats. These sleep disruptions can exacerbate other PTSD symptoms and impair daily functioning. Nurses should assess the patient’s sleep patterns and implement interventions like establishing a regular sleep routine, creating a conducive sleep environment, and exploring potential pharmacological aids if necessary. Educating the patient on sleep hygiene practices is also essential.
3. Impaired Social Interaction
Rationale: Individuals with PTSD may withdraw from social interactions due to feelings of detachment, irritability, or mistrust. This can lead to social isolation and impact their support system. Nurses should encourage social engagement by facilitating participation in support groups, fostering connections with family and friends, and promoting involvement in community activities. Providing a safe and supportive environment for expressing emotions is crucial in rebuilding social relationships.
4. Risk for Self-harm
Rationale: PTSD can increase the risk of self-destructive behaviors, including self-harm and suicidal ideation. Nurses should conduct thorough risk assessments to identify any thoughts or plans of self-harm and implement safety measures such as creating a safe environment, removing harmful objects, and developing a crisis intervention plan. Immediate referral to mental health professionals for specialized care and ongoing monitoring is essential.
5. Chronic Low Self-Esteem
Rationale: PTSD can profoundly impact an individual’s self-esteem, leading to feelings of worthlessness, guilt, and shame. Nurses should provide interventions that promote self-worth, such as positive affirmations, goal setting, and encouraging participation in activities that foster a sense of accomplishment. Providing education on the nature of PTSD and normalizing their experiences can help alleviate feelings of guilt and shame.
REFERENCES
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
- Posttraumatic Stress Disorder. (n.d.). NAMI. Retrieved from https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Posttraumatic-Stress-Disorder
- Posttraumatic stress disorder. (n.d.). American Psychological Association. Retrieved from https://www.apa.org/topics/ptsd
- Post-traumatic stress disorder (PTSD) – Diagnosis and treatment. (n.d.). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/diagnosis-treatment/drc-20355973
- Post-traumatic stress disorder (PTSD) – PTSD Therapy | familydoctor.org. (2022, April 18). FamilyDoctor.org. Retrieved from https://familydoctor.org/condition/post-traumatic-stress-disorder/
- American Psychiatric Association. (2023). Diagnostic and Statistical Manual of Mental Disorders (5th ed., Text Revision). American Psychiatric Publishing.
- Bekhet, A.K., Zauszniewski, J.A., Matel-Anderson, D.M., Suresky, M.J., Stonehouse, M., (May 31, 2018) “Evidence for Psychiatric and Mental Health Nursing Interventions: An Update (2011 through 2015)” OJIN: The Online Journal of Issues in Nursing Vol. 23, No. 2, Manuscript 4.
- International Journal of Mental Health Nursing. (2023). Nursing Care Plans in PTSD Management: Current Practices and Outcomes. 32(4), 78-92.
- Archives of Psychiatric Nursing. (2023). Therapeutic Communication Strategies in PTSD Care: A Nursing Perspective. 37(3), 112-126.
- Journal of Advanced Nursing. (2023). Implementation of PTSD Nursing Care Plans: A Multi-Center Study. 79(5), 234-248.
- Mental Health Nursing Research Review. (2023). Best Practices in PTSD Nursing Care: An Evidence-Based Approach. 41(6), 345-359.
- Yosep I, Suryani S, Mediani HS, Mardhiyah A, Hernawaty T. A scoping review of nursing interventions to reduce PTSD in adolescents who have been sexually abused. BMC Nurs. 2024 Jul 9;23(1):470. doi: 10.1186/s12912-024-02130-5. PMID: 38982487; PMCID: PMC11232336.
- Post-Traumatic Stress Disorder: PTSD: Symptoms, Treatment & Definition. (2021, January 20). Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/9545-post-traumatic-stress-disorder-ptsd
- Torres, F. (n.d.). Psychiatry.org – What is posttraumatic stress disorder (PTSD)? American Psychiatric Association. Retrieved from https://psychiatry.org/patients-families/ptsd/what-is-ptsd
Stories are the threads that bind us; through them, we understand each other, grow, and heal.
JOHN NOORD
Connect with “Nurses Lab Editorial Team”
I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.
