PLANNING AND IMPLEMENTATION

Nursing intervention	Rationale
Maintain the client’s safety and integrity during posttrauma episode, using appropriate therapeutic interventions according to facility policy.	The nurse’s priority is to protect the client and others from harm or injury during posttrauma episode, since client may experience escalating anxiety , depression, or suicidal thoughts.
Conduct a suicide interview by questioning the client about self-destructive thoughts or plans. Also observe the client for self-destructive acts or gestures.	A suicide interview provides for the client’s safety; clients with posttraumatic syndrome may become depressed and suicidal. Specific plans indicate a greater risk for suicide.
Listen actively to the client’s details and rumination about the recollection surrounding the traumatic event.	Active listening builds trust, allows the client to vent, decreases feelings of isolation, and guides the nurse toward significant problem areas (guilt, self-blame, anger).
Encourage the client to identify and describe specific areas surrounding the traumatic event that are most troubling and that elicit powerlessness or loss of control (if part of the client’s treatment plan).	“Talking it out” with a trusted person helps the client bring the details of the event into the open during a safe, nonthreatening time. It gives the client an opportunity to gain some influence over the traumatic event and decreases apprehension about intrusive recollection.
Determine the client’s readiness to discuss traumatic event. Determine whether this approach is therapeutic or may result in increased anxiety.	If the client is not ready to vent or is being asked to repeat the story by too many staff member, this approach may not be therapeutic, and the client may need more time. Keen assessment is key.
Assist the client in structuring time for basic needs (hygiene, grooming, rest, nutrition).	Good hygiene and grooming increase self-esteem, promote health safety, and provide fewer opportunities for painful recollections of the traumatic event.
Monitor the client’s anxiety level.	Establishing the client’s anxiety level prevents escalation of symptom through early interventions.
Acitivate the client to communicate and interact within the milieu according to the client’s level of tolerance, as follows: o Engage in frequent one-to-one interactions with assigned staff o Eat all meals in the client’s room o Participate in recreational activities o Attend community meetings	The client’s interaction within the milieu provides the following therapeutic benefits: o Prevents or decreases feelings of isolation and detachment from others and the environment o Enhances socialization o Uses energy in rewarding here and now activities o Decreases opportunities for painful recollections of the traumatic event
Nontherapeutic responses o “you realy have to stop blaming yourself and get on with your life” o “don’t feel that way; it’s self-destructive” o “if I were you, I would break off with your old war buddies”	The client’s behaviors and decisions are best influenced by the client’s needs, desires, and lifestyle, not by the singular opinions of others. Preaching to the the client will elicit resistance and delay the therapeutic process.
Teach the client adaptive cognitive-behavioral strategies to manage symptom of emotional and physical reactivity (dread, terror, helplessness, sense of doom, cardiac palpitations, shortness of breath) that accompany intrusive recollection of the traumatic event. o Slow deep breathing techniques o Relaxation exercise o Cognitive therapy o Desensitization o Assertive techniques	Deep-breathing/relaxation exercise provide slow, rhythmic, controlled patterns that decreased physical and emotional tension, which reduce the effects of anxiety and the threat of painful recollection. Cognitive therapy helps the client substitute irrational thoughts, beliefs, or images for more realistic ones and thus promotes a greater understanding of the client’s actual role in the traumatic event, which may decrease guilt and self-blame. Systematic desensitization helps the client gain mastery and control over the past traumatic event by progressive exposures to situations and experiences that resemble the original event, which eventually desensitize the client and reduces painful consequences.
Assist the client to develop objectivity in perceptions of the traumatic event by providing a fresh perspective. o “rape is not a mutual sexual act; it is an act of violence that cannot be anticipated or prevented” o “No one could have predicted the accident, it just happened”	This objectivity may help promote a greater understanding of the client’s actual versus perceived role in the event and may reduce feelings of self-blame and guilt.
Problem solve with the client in areas in which some control is possible versus areas beyond control. o “No one can control who lives and who dies in war, but the survivor can be helped to deal with the memories” o “It’s hard to know if the robbery would have occurred if your door” o “the past can’t be changed, but the impact can be lessened in time”	Problem solving helps the client begin to let go of aspects that are impossible to resolve (death, loss, injury) and begin to focus on areas that can be influenced (attitudes, coping methods).
Involve the client in decisions about the client’s care and treatment. o “What are some of the behaviours and coping methods you use to decrease anxiety and control intrusive memories?” o “I notice the methods you’ve been using seem to reduce your symptoms effectively. What do you think?”	This involvlement helps foster feelings of empowerment, control, and confidence in the client rather than feelings of being a helpless victim of external effects.
Engange the client in group therapy sessions with other clients with posttraumatic stress disorder when the client is ready for the group process.	The group process provides additional support and understanding through involvement with others who may have similar problems. Also, seeing the success of other gives hope to the client.
Promote the client’s awareness of his or her own avoidance of experiences similar to the traumatic event.	Awareness gives the client the opportunity to integrate the past traumatic event into present and future life experiences without fear or apprehension.
Provide realistic feedback and praise whenever the client attempts to use learned strategies to manage anxiety and reduce posttraumatic stress response. o “The staff has noticed yopu practicing the relaxation exercises.” o “You handled your anger well in the assertiveness training class today.” o “Your thoughts about your self have become more realistic.”	Positive reinforcement promotes self-esteem and gives the client the confidence to continue working on the treatment plan.
Assist the client and family to develop realistic life goals (school, work, community, and leisure activities).	The client and family will be better prepared for a hopeful future that will absorb and alleviate the posttraumatic stress response.