On the Front Lines: Treating Veterans with PTSD

Mental health remains a pressing concern for the country’s armed forces. Many veterans have trouble adjusting to civilian life and struggle with PTSD, depression, and even the threat of suicide. There were over 6,000 veteran suicides each year from 2008 to 2016, and 78 Air Force officials have committed suicide this year alone. From 2005 to 2016, veteran and non-veteran adult suicide rates increased 25.9% and 20.6%, respectively, which shows the problem is only getting worse.

Civilian and army nurses are responsible for caring for veterans during combat and after they’re returned home, but caring for veterans is much different than caring for civilian patients. We’ll take a look at how nurses should approach treating and caring for veteran patients and why this work is so important.

Veterans and PTSD

The rate of PTSD (post traumatic stress disorder) remains high among the veteran population. Service members may feel constantly on edge, emotionally distant, and isolated from others once they return home and begin adjusting to civilian life. Calculating the number of veterans with PTSD tends to vary widely by service area as the nature of warfare continues to change. Many service members may choose not to report their PTSD, making it difficult to understand the full scope of the problem.

According to U.S. Department of Veterans Affairs, the number of veterans with PTSD include:

• About 11-20 out of every 100 veterans who served in Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF) have PTSD in a given year.
• About 12 out of every 100 Gulf War veterans (or 12%) have PTSD in a given year.
• About 15 out of every 100 Vietnam veterans (or 15%) were currently diagnosed with PTSD at the time of the most recent study in the late 1980s. It is estimated that about 30 out of every 100 (or 30%) of Vietnam veterans have had PTSD in their lifetime.

PTSD occurs after a person has experienced severe trauma or a life-threatening event. The nervous system has two ways of responding to extremely stressful situations:

• Mobilization, also known as fight-or-flight, in which the person’s blood pressure rises, their muscles tighten, and their heart pounds faster. Once the danger has passed, the person’s nervous system returns to normal.
• Immobilization, which usually results from sustained exposure to stress and trauma, is when the person’s nervous system does not return to normal even though the danger has passed. The person’s heart will continue to pound at an accelerated rate, their muscles will remain tight, and their blood pressure will remain high. This is the definition of PTSD.

Another form of PTSD in the military is what’s known as military sexual trauma (MST). This occurs after a person has experienced sexual assault or harassment in the military. Among veterans that use VA healthcare, 23% of women have reported sexual assault in the military, and 55% of women and 38% of men have experienced sexual harassment in the military.

Symptoms of PTSD include:

• Distressing thoughts, nightmares, and flashbacks where the person continues to relive the stressful situation
• Withdrawing from friends, family and reminders of the stressful situation, such as loud noises, surprises, and sudden movement
• Negative thoughts about themselves or the world, persistent feelings of guilt, shame or fear
• Irritability, anger, reckless behavior, difficulty sleeping, strong emotional reactions, hypervigilance, and even substance abuse

Treating Veterans with PTSD

As more veterans seek care outside of the VA system, The American Nurses Foundation has released a PTSD Toolkit for Nurses, which shows healthcare providers how to care for veterans suffering from PTSD or those at risk of suicide. Treating veterans requires a different set of skills than treating civilian patients. The first step is to ask the patient, “Have you ever served?” But according to the report, 56% of community healthcare providers don’t routinely ask patients if they have served.

If a nurse suspects their patient may be suffering from PTSD, they can use the Primary Care PTSD Screen (PC-PTSD) and PTSD Checklist (PCL-M) to screen for PTSD among veterans.

Once a healthcare provider recognizes whether the patient has PTSD, the next step is to intervene by keeping the conversation focused on finding help, but this decision must come from the patient themselves, not the nurse. Some helpful intervention strategies include:

• Creating conversation that evokes change
• Listening and asking open-ended questions for a more collaborative conversation
• Keeping the conversation focused on the client as an individual
• Helping the patient identify which behaviors they’d like to change

Once the patient states they are ready to change, the healthcare provider will need to make a referral to either online or offline support groups for veterans and others suffering from PTSD, treatment centers and local VA offices specializing in PTSD treatment, mental health professionals, or 24/7 hotlines for those suffering from PTSD.

Those looking for more information on treating veterans and those suffering from PTSD should download the PTSD Toolkit for Nurses or visit The American Nurses Foundation website.

Photo: Veteran Vision Project