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COVID-19 and PTSD: Preserving Self-Care While

Managing Symptoms of PTSD During Patient Care

Education for CNAs

Presented June 18th, 2020

Presented by

Roberta Gule, BSN, RN, CHPN

Learning and Development-RN Training Specialist

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Successful Completion Criteria

• Log in to virtual classroom

• Remain for entire presentation

o 1 hour

• Participate and ask questions if you have them via the chat box in the lower right corner

• Complete evaluation

o You will be redirected to a post-activity survey when webinar ends

Send questions to [email protected] and our Community Education team will be happy to help.

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Declarations

• This program is provided to you by Seasons Hospice & Palliative Care.

• There is no commercial support for this educational event.

• The speaker declares that they are an employee of Seasons Hospice &

Palliative Care, which provides the service described herein.

• Planners, presenters, faculty, authors and content reviewers declare no

conflict of interest.

oRoberta Gule, BSN, RN, CHPN

Learning and Development-RN Training Specialist

FOR REFERENCE ONLY NOT FOR DISTRIBUTION

COVID-19 and PTSD: Preserving Self-Care While

Managing Symptoms of PTSD During Patient Care

Education for CNAs

Presented June 18th, 2020

Presented by

Roberta Gule, BSN, RN, CHPN

Learning and Development-RN Training Specialist

FOR REFERENCE ONLY NOT FOR DISTRIBUTION

COVID-19Disclaimer

Please note: Seasons Hospice is dedicated to providing the most up to date

information related to the Coronavirus. With the rapidly changing, daily

evolution of this situation, it is recommended that attendees follow up with

the CDC (Centers for Disease Control) and WHO (World Health

Organization) websites for the most up to date information.

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Objectives

• Define Post-Traumatic Stress Disorder (PTSD)

• List symptoms of PTSD

• Explain the role that COVID-19 plays in PTSD

• Describe ways to preserve self-care during COVID-19

• Explain how to identify and manage symptoms of PTSD in patients

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http://ncgwg.org/june-is-ptsd-awareness-month-2/

June is PTSD Awareness month

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What is PTSD?

• Post Traumatic Stress Disorder (PTSD) is an anxiety disorder that develops in reaction to physical injury or severe mental or emotional distress

• A serious mental health condition

• Can be different for each person

• Fight or flight response

• Diagnosed when symptoms last longer than one month

• PTSD no longer applies only to war veterans

• PTSD can affect anyone who experiences a traumatic event in their lifetime

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Anatomy&

Physiology

A “re-ordering” of the brain

Pic reference- http://i0.wp.com/www.strengthofawarrior.org/wp-content/uploads/2014/12/PTSD_brain.png

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Types of Traumatic Events that can cause PTSD

• Combat or other military experience

• Sexual or physical assault

• Child sexual or physical abuse

• Serious accidents like an auto accidents

• Natural disasters like a tornado, hurricane, flood or earthquake

• Terrorist attacks

• Cyberbullying/bullying

• Hate crimes

• Pandemics/COVID-19

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Signs & Symptoms of PTSD?

Behavioral Symptoms

• Anxiety

• Avoidance

• Flashbacks

• Negative thoughts and feelings

• Emotionally numb

• Hyperarousal and hypervigilance

o Being on edge, looking over shoulder

o Over reactive outbursts

o Difficulty concentrating or sleeping

Physical Symptoms

• High blood pressure

• Rapid breathing, distress

• Sweating

• Rapid pulse

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Common TriggersExternal

• Sights, sounds, or smells

• People who may have been present or can recall the event

• Dates or times

• Weather or season

• Confining situations

• Funerals, medical centers, hospitals

• Relationships, family, money pressures, arguments

Internal

• Physical discomfort

• Bodily sensations that recall the trauma

• Strong emotions

• Feelings toward family members

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COVID-19 Statistics Say it All!

• Health care support services rank number 1 for most dangerous job in America during the coronavirus oTotal number of workers: 4.1 million

oPercent exposed at least once a month: 96%

oPercent exposed at least once a week: 77%

Thank you to all who spent time on the front line!

• https://www.cnbc.com/2020/05/30/here-are-the-most-dangerous-jobs-in-america-during-coronavirus.html

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Healthcare Workers and COVID-19

• High numbers of infected patients

• Personal Protective Equipment (PPE) shortages

• Equipment and supply shortages

• Emotional struggles – Caring vs. Fear

• Patients cannot see their loved ones

• Rise in patient deaths

Pic reference https://npuh82iut7x3aosxba3ol14m-wpengine.netdna-ssl.com/wp-content/uploads/2020/06/combat-COVID-19.jpg

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Role that Covid-19 Plays in PTSD

• Fear, panic, isolation

• People are dying alone

• Shelter in place

• Social distancing

• Job loss

• Food, water, basic living needsThis Photo by Unknown Author is licensed under CC BY-ND

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Self-Care Reflection

• Recognize the symptoms of stress you may be experiencing:oAngry, irritable

oFearful, nervous, anxious

oHelpless, powerless

oLack of motivation

oTrouble sleeping

oTrouble concentrating or staying focused

o Sad, depressed

• Self-care and coping skills can help

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Coping Strategies

• Breathe

• Take media breaks

• Remember your “Why”

• Connect with others

• Build trusting work relationships

• Keep a positive attitude

• Set boundaries to provide healthy work/life balance.

• Get enough rest

• Find what brings you joy

• Recognize and appreciate your own uniqueness, You Are Valued!

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Pic reference - https://3.files.edl.io/1aca/20/03/16/174041-10ffca1c-f65c-4a85-bae7-b06bdf045229.jpg

Pic reference https://1canoe2.com/products/simple-self-care-postcard

Find what

brings you

joy!

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Patient Care

• Check your own anxiety

• Provide social support

• Be a good listener

• Build trust, create a safe place

• Allow the patient to feel in control

• Expect triggers and know how to handle them

• Watch for signs of anger or potential violence

• Contact your manager if you don’t feel safe

Pic reference: https://www.mcnhealthcare.com/wp-content/uploads/Home-Nurse-e1493223112817.jpg

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PTSD in Veterans

• War veterans may display anxiety when their health changesoFunctional status declines

oThey are unable to care for themselves

oBedbound status can be a trigger

• Knowledge of war can be helpful

• So what can you do?oProvide comforting presence and a listening ear

oOffer emotional support and reassurance

oOffer distraction – go for a walk, play cards, read to the patient

• Always follow the care plan and report any changes to the nurse

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Vietnam Veteran Case Review

• JP was a hospice patient

• Vietnam veteran

• Extreme agitation at end of life, medications not helpful

• A family member provided some history

• A fan circulated overhead and reminded him of his war days

• Once the fan was turned off, this man was able to die peacefully

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PTSD in a Cognitively Impaired Patient

• Consider this - Is this combative behavior PTSD?

oDid something terrible happened to her?

oTrigger - another person washing her body

oReminder of her vulnerability.

• Treating with medication may help but it won’t comfort the fears she may be feeling. What would you do?

• It’s important to understand how to care for patients with PTSD.

• An elderly woman with dementia unable to care for herself.

• Known as a “fighter” and “feisty.”

• Combative during her bed bath

• Medication given to calm her

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What Would You Do?

• Provide reassurance

• Introduce self, explain what you are doing

• Be patient, kind and understanding

• Sit and talk with her first, earn her trust

• Offer her a drink, snack or meal first

• Ask her if she has a favorite lotion she would like to use

• Always follow the care plan and report any changes to the nurse

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Stroke Patient Case Review

• EM -a stroke patient, residing in a private room of LTC facility

• Total care, unable to communicate due to her stroke

• Husband would visit frequently

• Tearful and extremely agitated after husband would leave

• Staff thought it was because she missed her husband.

• Staff interrupted and found husband abusing her

• Trend when the behaviors are occurring

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In Summary

• PTSD is an anxiety disorder

• Caused by traumatic, life changing events

• Abnormal behavioral and physical symptoms

• Healthcare workers during pandemic highly susceptible

• Self-Care is important to combat anxiety and stress

• Check your own anxiety before caring for patients

• Provide calm, reassuring, supportive care to those with PTSD

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Resources for Assistance

• If you or someone you love is experiencing PTSD, please reach out for help. Check with your employer to see if they have an employee assistance program (EAP) available.

• CDC recognizes the importance of this topic and has many supportive resources on their website.

• cdc.gov

o National Suicide Prevention Hotline – 1-800-273-TALK (1-800-273-8255)

o National Domestic Violence Hotline – 1-800-799-7233

o Disaster Distress Hotline – 1-800-985-5990

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References for Veterans

• If you or someone you love is a veteran experiencing PTSD you will find more resources:

• https://www.ptsd.va.gov/

• We Honor Veterans is a program offered to communities and caregivers of veterans who are nearing the end of life. These veterans have unique needs when it comes to PTSD. You will find more information on the We Honor Veterans website:

• www.wehonorveterans.org

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References• https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd

• https://www.cdc.gov/coronavirus/2019-ncov/community/mental-health-healthcare.html

• https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html

• https://www.cnbc.com/2020/05/30/here-are-the-most-dangerous-jobs-in-america-during-coronavirus.html

• https://dailynurse.com/prevent-burnout-with-these-six-self-care-strategies/

• https://www.kevinmd.com/blog/2017/08/ptsd-can-happen-end-life.html

• https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml

• https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd

• https://www.psychologytoday.com/us/blog/the-aftermath-trauma/202004/bracing-epidemic-ptsd-among-covid-19-workers

• https://www.ptsd.va.gov/

• https://www.socialworktoday.com/news/enews_0616_1.shtml

• www.wehonorveterans.org/

• https://youtu.be/BEHDQeIRTgs

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COVID-19 and PTSD: Preserving Self-Care While Managing Symptoms of PTSD

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