Nursing Voices

Wednesday, March 28, 2007

Go Ask Mother

Welcome to another edition of Go Ask Mother. I'm receiving a lot of interesting questions from my readers, and I plan to make Go Ask Mother a regular part of Nurse Ratched's Place.

Last week, AZRN from researchgrrl wrote:

MJ, in your professional opinion, are there treatments for PTSD that work well? I don't know that much about psych nursing (it was a looong time ago :D)

Thanks for bringing up this important subject. I think we are going to see more PTSD as more soldiers return from Iraq.

I don’t know all the answers to this question, however, I will tell you how I help patients suffering from PTSD. Several years ago I had the privilege of meeting a psychiatric nurse practitioner who was helping Pentagon staff members deal with the aftermath of 9/11. I met with her at the Pentagon for lunch, and we talked about the techniques she was using to help staff members deal with PTSD. She said that her goal was to teach patients that they are having a normal reaction to an abnormal event, and that she used cognitive therapy techniques to achieve her goal. She said, “We are what we think,” and by changing our perceptions of the things happening around us, we can alter how we feel and, most importantly, how we act. She assisted her patients in devising strategies for dealing with their symptoms, such as insomnia and poor concentration, and she stressed that people suffering from PTSD mustn’t be allowed to fall into the sick role, or else they will not move forward with their lives.

When I work with patients suffering with PTSD, I’m careful not to demean or embarrass my patients by challenging their feelings. I tell them that they are not going "crazy," but that they are reacting to a crazy event that happened in their life. I taught one patient who could feel himself slipping into a state of panic to repeat the phrase, “here and now.” He said the phrase kept him in the present, and helped him to refocus when painful memories started invading his thoughts.

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Blogger marachne said...

Interesting you should bring up PTSD, as we've had some interesting presentations on it recently, over heah at the gov'ment. I totally agree that we're going to see a LOT of PTSD as a result of the Afghanistan and Iraqi wars you just can't have people under that kind of stress for that long w/o problems, esp. when so many are reservists who were not psychologically prepared to be in that situation at all.

One of the things that is currently being discussed is how, in the past we've mostly talked about PTSD in terms of the stress of being a victim of trauma, but there the issues related to having killed also need to be addressed -- I know of one person who talked about 'kicking severed heads around like footballs' (I'm assuming from explosions) as a way of trying to distance one's self from the horror...except now he's horrified by having done that. And then there's the issue of sexual trauma experienced by the women who have been deployed (heck, even Doonsberry is addressing that).

It's not gonna be pretty, I can tell you that.

2:26 PM  
Blogger poody said...

I used the same phrase to get thru the death of my friend and the loss of my ex. It really does help. I would catch myself becoming sad or panicked and I would say right now I am ok right now!

1:34 PM  
Blogger Runs With Scissors said...

I LOVE the headline pic for this posting. I hope you don't mind if I "borrow" it.

Now the PTSD ... is this not the situation where they are talking about removing traumatic memories with propranolol? I agree with your earler post about that being dangerous, especially concerning where to draw the lines and who decides.

Thanks for addressing both issues.

3:22 PM  
Blogger Mother Jones RN said...

Hi RWS....

You are welcome to borrow any image you see on my blog. I scanned the picture of our scholar out of one of my books, and added the wording with Photo Shop.

There are many treatment options for PTSD, and using propranolol is just one of those options. Cognitive therapy won't take away a bad memory, but it does help people live with memories that they wish could forget.


4:20 PM  
Blogger Fresh Hell, Texas said...

Propranolol does not remove memories.

I am currently working on finishing my Bachelors degree. One field I am very drawn to is becoming a Social Worker in the mental health part of the VA.

The number of PTSD cases are already soaring. Goodness knows there will be a demand for those jobs, but am I strong enough to do it? I don't know yet. I hope so.

4:46 PM  
Blogger Mother Jones RN said...

Hello Fresh Hell, TX

I hope you go into Social Work and help our men and women coming back from Iraq and Afghanistan. They are going to need all the help they can get from people who care for them just like you.


4:55 PM  
Blogger AzRN said...

Thanks for the link. I definitely believe that therapy is an important part of mental health care. Being the research nerd I am, I think it's an interesting concept using a beta-blocker to 'erase' memories. I'm not I agree with the ethics of doing so, but for those whose memories are so horrific would it be a useful adjuvant treatment?

Both my father and older brother experienced the horrors of war firsthand. My father was at Pearl Harbor on deck when the first Japanese planes came through. He jumped off the Oklahoma as she caught flame and sank. My brother was in Vietnam and had two experiences that involved killing others.

I don't know if I wouldn't want to forget some of those memories.

Thanks for the great food for thought. Yours is one blog I check and read frequently.

9:43 PM  
Blogger Kim said...

I wonder about our WWII vets - long before PTSD had a name, it had to have existed. How did they deal with it back then? Or even during the Civil War (reading Grant's memoirs so that comes to mind). The Civil War saw the wholesale slaughter of half a million men in four years - those veterans on both sides of the divide saw untold horrors. How did they handle in in the 1860s?

You know, that would be a great research paper. (You can tell I'm a student - everything comes down to a potential paper.)

4:48 PM  
Blogger Kim said...

Oh, and PS: I have got to get me Photoshop! : D

4:49 PM  
Blogger Smalltown RN said...

I don't think there will ever be enough health care workers to deal with all of the service personnel coming back from war....I hope and pray that those who truly need help are given it or that someone close to them helps them find the help they need....We think it's bad now....look out...

1:38 PM  

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