The effect Post Traumatic Stress Disorder (PTSD) has on nurses is a growing professional concern.
Nurses have been dealing with a long history of being at risk for burn out and compassion fatigue for many years prior to the pandemic.
In addition to suffering from burnout and compassion fatigue, researchers are expecting the number of nurses and physicians with PTSD to rise, up to 40 – 50%, in the aftermath of COVID-19.
My first awareness of symptoms and manifestations of PTSD began in caring for Veterans at the end of life, a decade ago. Although I had experienced the existential suffering of patients dying in hospice care, many of them war veterans, I did not have the new understanding of how the body experiences trauma, until attending a three day conference, “Veterans, Trauma, and Treatment”. At this conference I was introduced to Dr. Bessel van der Kolk. Soon after this time with him, and other trauma experts, at the weekend workshop, Dr. van der Kolk released his best selling, and now classic, book on how trauma is experienced in the body, “The Body Keeps the Score”.
I was catapulted into offering methods for trauma recovery which did not include medications or psychotherapy. I came to understand my brother’s existential suffering at the time of his death, requiring palliative sedation, as undiagnosed PTSD.
Healthcare Professionals Caring for traumatized populations with PTSD
In the role as Veteran Care Liaison, I developed educational programs and workshops for hospice professionals caring for our country’s veterans at the end of life, which needed to include understanding the military culture, and PTSD. Changes in policy and standards were implemented to include “veteran centric care”. Increasing concern was for those Veterans with physical manifestations of PTSD, out of control anger, sudden bursts of anger, nightmares, and terminal agitation. With a limited life expectancy of a few months, a few weeks, a few days, traditional treatments of psychotherapy and medications were not feasible options.
With this growing knowledge and body of research, new interventions were being more widely accepted, including trauma sensitive yoga. Receiving my yoga teaching certification from Warriors at Ease (WAE), teaching trauma sensitive yoga in military communities, Trauma Sensitive Yoga would benefit even those who were bedbound. I learned from WAE teachers and mentors teaching yoga in the polytrauma centers in the VA, Veterans who were severely wounded physically and emotionally, with paralysis, amputations, needing assistance from wheelchairs and bed bound, experienced decreased frequency and severity of symptoms of PTSD.
Workshops I developed, offering demonstrations of yoga and breathing for trauma recovery, I did not even call this “yoga”. Synchronizing our breath and co-creating rhythms, and presencing, healing energy is shared. A safe healing space is created for calm and groundedness, by activating the Parasympathetic Nervous System with breathing. The participants experienced the breath as a powerful self regulator.
Trauma Recovery for Healthcare Professionals experiencing PTSD
Presenting this information,which included leading brief demonstrations of yoga and breathing, holding the space for the room, opening the container, I would notice several people in the room were crying. One or two would leave the room. All I knew to do was honor and respect the emerging emotions and feelings, as a trauma sensitive yoga teacher and as a nurse.
Nurses and social workers with tears in their eyes, and those who left the room, may have been suffering from PTSD. I began to hear the trauma stories of living with fathers who were Vietnam Vets, tears in their eyes. I began to hear stories of wives, children, and grandchildren, who lived with WWII Vets. As horrific stories were shared, wives and children did not want to hear these horrific stories. The physical reaction of nausea, queasiness, is overwhelming listening to stories of horror. It is as if the story is being experienced by the listener. The story takes on a life of its own, over and over in your mind, possibly causing sleep difficulties, and sudden anger, symptoms of PTSD.
The next year, I was diagnosed with PTSD. Due to a difficult situation with the Director of my Department, resulting in disciplinary actions, and being referred to EAP, by a very insightful HR Specialist, I received much needed mental health care. Having this experience living with PTSD, receiving EMDR, a treatment for PTSD, experiencing fragmented pieces of self brought back together, I felt like I had come back home.
Then I knew the existential suffering of my brother, requiring palliative sedation, was trauma residue frozen in his body for 35 years, undiagnosed PTSD. Then I understood the effect my caring for him, and bearing witness to his suffering had on my mental, emotional, and physical wellbeing.
Over the next six to twelve months we will see the unprecedented impact of COVID-19, and of PTS as the effects take its toll, very much like soldiers experience when they return home from war. Optimizing the well being of nurses must be a priority. In the aftermath of this pandemic the need for trauma recovery must be included in healthcare organizational recovery plans.