Selecting a Practice Question: The Non-pharmacologic Approach to the Treatment of Post-Traumatic Stress Disorder (PTSD) Essay

Selecting a Practice Question: The Non-pharmacologic Approach to the Treatment of Post-Traumatic Stress Disorder (PTSD) Essay

 

The Non-pharmacological Approach to the PTSD Treatment

Post-traumatic stress disorder (PTSD) is a multifactorial condition with significant negative impacts on health, quality of life, and healthcare utilization. Martin et al. (2021) define PTSD as a “debilitating mental condition that can significantly impact the sufferer’s quality of life” (p. 1). In this sense, the condition manifests through various symptoms, including avoidance of reminders, intrusive symptoms, flashbacks, nightmares, and increased incidences of self-directed harm and suicidal ideation. The potential causes of PTSD are primarily past and present exposures to life-threatening and horrific incidences such as accidents, physical and sexual assaults, work-related traumatic events, childhood abuse, and serious health problems such as the presence of a critical health condition. Although PTSD results in multiple health ramifications, healthcare professionals rely massively upon pharmacologic interventions such as antidepressants and antiadrenergic drugs to address different symptoms. However, these interventions prove ineffective in improving the patients’ quality of life due to medication adherence and side effects issues. Therefore, this DNP project aims to explore and expound on the contribution of non-pharmacological interventions in treating and managing post-traumatic stress disorders among older adults in a psychiatric primary care setting (Please insert the site of the project here).

The Type and Focus of the DNP Project

Post-traumatic stress disorder (PTSD) is a prevalent challenge in psychiatric primary care settings. As stated earlier, older adults are susceptible to PTSD due to their occupational interactions, experience, and encounters with traumatic events such as the presence of chronic health conditions like cancer, dementia, and cardiovascular diseases. Pless Kaiser et al. (2019) argue that 50% to 90% of older adults in the United States have encountered at least one type of potentially traumatic event. For example, older veterans are at an increased risk of traumatic events throughout their lives. As a result, PTSD remains a profound mental health issue for older adults that requires health professionals to embrace evidence-based practices, especially non-pharmacological interventions, to improve patients’ quality of life. Eventually, the primary focus of the DNP project is to provide insights into non-drug approaches that have literature backings as ideal strategies for treating and managing post-traumatic stress disorder among older adults.

Analyzing a Patient Practice Problem

As stated earlier, older adults are more susceptible to multiple causative and contributing factors for post-traumatic stress disorder (PTSD) due to their past encounters with traumatic events such as combats, accidents, and life-threatening conditions like chronic diseases. According to Pless Kaiser et al. (2019), the estimated prevalence of PTSD among ethnic minority and non-minority groups ranges from 4% to 4.5%. Since PTSD is a multifactorial condition, 50% to 90% of older adults encounter trigger events such as accidents. However, veterans are susceptible to elevated risk for combat-related stress (Pless Kaiser et al., 2019). It is essential to note that PTSD results in adverse health effects on the patients. According to Martin et al. (2021), about 59% of patients suffering from post-traumatic stress disorder have severely impaired quality of life due to its association with other comorbidities such as depression and substance abuse disorders. Also, the condition leads to impaired judgments, declining cognitive functions, and a high risk of self-directed harm such as suicide. Therefore, it is essential to implement evidence-based and proven interventions that improve patients’ safety and well-being.

Evidence-Interventions Proposed to Address the Clinical Problem

The conventional approach for treating PTSD entails applying various pharmacologic interventions, including administering antiadrenergic and antidepressant drugs such as Benzodiazepines and cannabinoids. Other common medications for addressing PTSD symptoms include psychostimulants, sedatives, and steroids. However, administering these drugs may result in adverse health effects to older adults considering their susceptibility to side effects. Also, drug tolerance and adherence are profound challenges that compromise the effectiveness of pharmacologic approaches. As a result, non-pharmacologic strategies provide opportunities for improving the quality of life for patients as well as treating PTSD.

Many primary quantitative studies recommend non-drug treatment interventions such as prolonged exposure therapy, acupuncture, exercise, yoga, and mindfulness-based stress reduction interventions as ideal in addressing PTSD effects and symptoms. Carlsson et al. (2018) conducted a pragmatic randomized study to compare the effectiveness of cognitive-behavioral therapy (CBT) and cognitive restructuring (CR) in stress management among trauma-affected refugees in the Competence Center for Transcultural Psychiatry (CTP) in Denmark. The study revealed a positive correlation between CBT and CR in managing stress by causing body relaxation, breathing, and behavioral activation (p. 121). In a multisite randomized controlled trial, Davis et al. (2018) investigated the plausibility of applying mindfulness-based stress reduction (MBSR) and the present-centered group therapy (PCGT) in treating PTSD. The researchers exposed the positive contribution of the two interventions in reducing PTSD symptoms.

Another primary quantitative study by Knaevelsrud et al. (2017) supports the application of virtual non-pharmacologic interventions such as moderated exposure and cognitive reconstruction in treating PTSD. According to Knaevelsrud et al. (2017), internet-based intervention for older people with childhood traumatization promote access to quality, convenient, and affordable care services. Also, these approaches improve patients’ health by enhancing their coping and recovery capacity. These quantitative studies validate the plausibility of applying non-pharmacologic interventions in treating PTSD.

The Implementation Team for the DNP Project

Undoubtedly, implementing this DNP project prompts relevant stakeholders to embrace interdisciplinary collaboration to guarantee the project’s feasibility. In this sense, the interdisciplinary team will comprise nurse leaders, advanced practice nurses, registered nurses, psychiatrists, physical therapists, psychologists, physicians, patients, and social workers. Nurses, social workers, psychologists, physical therapists, and patients will collaborate in implementing non-pharmacologic approaches for treating and managing PTSD. On the other hand, nurse leaders, physicians, and advanced practice nurses will provide much-sought-after expertise and knowledge regarding PTSD diagnostics, improvement thresholds, and process monitoring. Also, they will communicate project objectives to prepare staff members to embrace change initiatives.

Measurable Patient Outcome and DPI Project’s Timeframe

This DPI project aims to improve patient outcomes by implementing evidence-based non-pharmacologic interventions and enhancing patients’ quality of life by preventing adverse effects of PTSD. The interdisciplinary team will assess patients’ outcomes by conducting pre-treatment, post-treatment, and follow-up activities. Also, they will utilize the post-traumatic stress diagnostic scale (PDS-15) to evaluate the severity of PTSD symptoms. Further, the team will apply the General Self-Efficacy Scale (GSE) to assess the levels of perceived self-efficacy before and after applying non-pharmacologic interventions.

While the DPI project’s feasibility relies massively upon implementing evidence-based interventions within eight months, the implementation team will emphasize proper delegation of responsibilities, pre-implementation evaluation, and effective collaboration to ensure effective implementation. Nurse leaders, physicians, and advanced practice nurses will communicate and educate other employees on thresholds for applying non-pharmacologic interventions for treating PTSD. On the other hand, nurses, psychologists, physical therapists, and social workers will collaborate with patients to develop patient-centered care and assess the levels of patient satisfaction towards care approaches. Finally, the team will conduct a progress-oriented evaluation to identify areas of improvement and investigate whether the project aligns with strategic goals.

Conclusion

Post-traumatic stress disorder (PTSD) results in compromised quality of life for patients, among other adverse ramifications. Older adults are more susceptible to PTSD due to their encounters with traumatic events such as accidents, occupational stress, and life-threatening health conditions. Despite their vulnerability, only a section of the population benefits from pharmacologic interventions. As a result, non-pharmacologic approaches such as prolonged exposure, cognitive processing therapy, acupuncture, exercise, yoga, and mindfulness-based stress reduction are evidence-based and proven interventions for preventing and reducing PTSD effects. Since the existing literature supports non-drug treatment options, this DPI project aims at exploring and expounding on the contribution of non-pharmacological interventions in treating and managing post-traumatic stress disorders among older adults in a psychiatric primary care setting.

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References

Carlsson, J., Sonne, C., Vindbjerg, E., & Mortensen, E. L. (2018). Stress management versus cognitive restructuring in trauma-affected refugees—a pragmatic randomized study. Psychiatry Research, 266, 116–123. https://doi.org/10.1016/j.psychres.2018.05.015

Davis, L. L., Whetsell, C., Hamner, M. B., Carmody, J., Rothbaum, B. O., Allen, R. S., Bartolucci, A., Southwick, S. M., & Bremner, J. D. (2018). A multisite randomized controlled trial of mindfulness‐based stress reduction in the treatment of posttraumatic stress disorder. Psychiatric Research and Clinical Practice, 1(2), 39–48. https://doi.org/10.1176/appi.prcp.20180002

Knaevelsrud, C., Böttche, M., Pietrzak, R. H., Freyberger, H. J., & Kuwert, P. (2017). Efficacy and feasibility of a therapist-guided internet-based intervention for older persons with childhood traumatization: A randomized controlled trial. The American Journal of Geriatric Psychiatry, 25(8), 878–888. https://doi.org/10.1016/j.jagp.2017.02.024

Martin, A., Naunton, M., Kosari, S., Peterson, G., Thomas, J., & Christenson, J. K. (2021). Treatment guidelines for PTSD: A systematic review. Journal of Clinical Medicine, 10(18), 1-14. https://doi.org/10.3390/jcm10184175

Pless Kaiser, A., Cook, J. M., Glick, D. M., & Moye, J. (2018). Posttraumatic stress disorder in older adults: A conceptual review. Clinical Gerontologist, 42(4), 359–376. https://doi.org/10.1080/07317115.2018.1539801

 

The identification of a relevant nursing practice problem at your practice site is the first step towards starting your DPI Project. Upon identification of a patient practice problem, the next step is to evaluate the practice problem to ensure it can be supported through an intervention, and if so, that the intervention is acceptable for your practice site.

The purpose of this assignment is to identify a valid patient practice problem at your practice site that can be realistically addressed through a DPI Project.

General Requirements:

Use the attached \”Selecting a Practice Problem\” worksheet to complete this assignment.
Use the \”PICOT-D Selection Guidelines,\” located in the DC Network, to assist in completing this assignment.
Use the \”Levels of Evidence in Research,\” located in the Class Resources, to assist in completing the assignment.
Use the \”Searching Nursing Databases,\” located on the Doctor of Nursing Practice page in the GCU Library, to assist in completing the assignment.
A minimum of two primary quantitative research articles, published within 5 years of your anticipated graduation date, are required to complete this assignment.
Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Learners will submit this assignment using the assignment dropbox in the digital classroom. In addition, learners must upload this deliverable to the Learner Dissertation Page (LDP) in the DNP PI Workspace for later use.
Directions:

Complete the steps on the \”Selecting a Practice Problem\” worksheet to identify a valid patient practice problem that you want to propose for your DPI Project. The proposed practice problem must meet the criteria for a PICOT-D and be supported by current primary quantitative literature.

If your instructor indicates that you have selected an appropriate topic, you will use your selected practice problem for all subsequent assignments in this course. Be sure to incorporate all feedback prior to beginning the next assignment. If you are directed to select a different practice problem, work with your instructor to select an appropriate topic prior to beginning the next assignment.

Attachments
DNP-801A-RS3-Selecting Practice Problem.d