The patient is a 14-year-old girl, Julia, who visits a doctor with her mother. Julia describes her health as good. She is well-groomed, and her appearance corresponds with her age. She is not very communicative, but she is ready to answer all questions and explain her complaints. At the beginning of the conversation, she admits that her main complaint is her headache that could last for days. The mother sees the computer and the phone as the main reasons for why Julia has a headache. The girl spends much time using these technologies. In her turn, Julia admits that she used her computer and phone as an opportunity to distract her from pain. No similar cases have been observed before. She is a good student. She lives in a good family the members of which do not have any health problems. She does not have any other complaints and behaves normally in regards to the kind of pain she has.
Further Questions for Julia
Do you observe a headache from the early morning?
What methods have you tried to fall asleep?
Have you recently survived some accidents or situations that made you upset, nervous, or anxious? (insomnia and PTSD)
How often do you observe your sleeping problems?
Do you have a headache when you sleep well?
How long does a headache last? (migraine and PTSD)
Do you feel vomiting or nauseous? (migraine and PTSD)
What kind of a headache do you experience? (migraine)
Do you have some sensitivity to light? (migraine)
What is the location of your headache? (migraine)
Do you have nightmares? (PTSD and insomnia)
Do you use some pain reliefs? (PTSD)
Have you ever visited a psychiatrist? (PTSD)
Differential Diagnoses
Insomnia (G47.0): is the disorder that is characterized by some difficulties in falling asleep and sleeping at nights, and the adolescents are at high risk of having insomnia problems (Roberts & Duong, 2013, p. 66). The relations between a headache and insomnia have been reviewed by a number of researchers, and it was proved that sleeping problems could be the reason for why people suffer from headaches that could last for days (Tran & Spierings, 2013, p. 168; Uhlig, Engstom, Odegard, Hagen, & Sand, 2014, p. 746). The patient suffers from a headache and admits that she could not sleep well. She spends only 5-6 hours on sleep. Julia explains such short period of sleep by the inability to fall asleep as soon as it is required. She spends much time in front of her computer and phone.
Migraine, unspecified, not intractable, without status migrainosus (G43.909): is a type of a headache disorder that is usually characterized by the tension-type headache (Balottin, Poli, Termine, Molteni, & Galli, 2012, p. 112). The symptoms of migraine cannot be defined as specific, and even experts have some difficulties in diagnosing it (Evans, 2015, p. 313). They could include mood changes, frequent urination, and sleep problems. A headache is a significant symptom of migraine that cannot be neglected. Migraine is usually identified as a certain type of pain a person could experience in their head. Julia underlines her constant headache and the inabilities to sleep well during the last days. Still, the examination does not introduce a clear picture of why migraine could influence Julia in that way. The reason for why she has a headache could be explained by a frequent usage of her computer and phone.
Post-Traumatic Stress Disorder (F43.1): is a type of traumatic stress disorders the symptoms of which could be identified during the next several months. It is a complex disorder that could change human social and educational functioning considerably (Trickey, Siddaway, Meiser-Stedman, Serpell, & Field, 2012, p. 122). Sometimes, adolescents do not want to talk about the situations that could lead to PTSD even with their parents. Therefore, the situation Julia has could be interpreted in a number of ways. The impossibility to answer what makes her sleep badly and suffer from a headache could be connected with some events recently experienced. Besides, it is necessary to clarify why Julia wants to change real life communication to phone and computer activities.
Body Systems to Examine
Three differential diagnoses have several systems that could undergo some abnormalities in common.
Immune system – insomnia (sleep influences human process memories, metabolism, and healing processes).
Circulatory system: migraine (strokes could be caused by the frequent constriction of blood vessels).
Nervous system: PTSD (brain problems that could lead to certain neurochemical changes that could be observed with the help of special technologies only).
Specific Lad/Testing To Offer
Julia could be suggested to take two types of tests to clarify if there are additional symptoms in her body system that could prove/disprove the differential diagnoses offered. For example, it is possible to take:
Blood tests are used to analyze the count of blood cells, the level of immunoglobulin, and lymphocyte count (Nagai, Hoshide, Nishikawa, Shimada, & Kario, 2013, p. 984).
ECG should help to discover the nature of heart problems caused by migraine (Del Torre, Pellegrinet, Motz, Sechi, & Cavarape, 2015).
References
Balottin, U., Poli, P. F., Termine, C., Molteni, S. and Galli, F. (2012). Psychopathological symptoms in child and adolescent migraine and tension-type headache: A meta-analysis. Cephalalgia, 33(2), pp.112-122.
Nagai, M., Hoshide, S., Nishikawa, M., Shimada, K., & Kario, K. (2013). Sleep duration and insomnia in the elderly: Associations with blood pressure variability and carotid artery remodeling. American Journal of Hypertension, 26(8), 981-989.
Roberts, R. E., & Duong, H. T. (2013). Depression and insomnia among adolescents: A prospective perspective. Journal of Affective Disorders,148(1), 66-71.
Tran, D. P., & Spierings, E. L. (2013). Headache and insomnia: Their relation reviewed. CRANIO®, 31(3), 165-170.
Trickey, D., Siddaway, A. P., Meiser-Stedman, R., Serpell, L., & Field, A. P. (2012). A meta-analysis of risk factors for post-traumatic stress disorder in children and adolescents. Clinical Psychology Review, 32(2), 122-138.
Uhlig, B. L., Engstrom, M., Odegard, S. S., Hagen, K. K., & Sand, T. (2014). Headache and insomnia in population-based epidemiological studies. Cephalalgia, 34(10), 745-751.
This response paper seeks to analyze the results of a study conducted on women with breast cancer. The study sought to determine various dynamics that characterize optimism among women diagnosed with breast cancer. Such research undertakings suffice as correlative as opposed to experimental because they gear towards realization of basic ideals that describe scientific investigations (Crombie, 2012). Investigative studies must adhere to scientific paradigms in order to satisfy procedural and contextual thresholds. It is difficult for researchers to influence or manipulate such studies because different dynamic realities are used in their propagation (Crombie, 2012). In many cases, divergent factors play an important role in determining the outcomes of scientific studies. Inherent fluctuations influence the overall orientation and disposition of scientific research undertakings (Crombie, 2012). In absence of such controls, it would be difficult for experts to rationalize and propagate accurate outcomes. Research studies revolve around credibility, accuracy, and precision. Therefore, it is important for research experts to ensure and guarantee adherence to methodologies and guidelines that define scientific inquiry (Crombie, 2012).
This study covers a pertinent facet with regard to the plight of cancer victims in different social contexts. Its design and propagation exhibits recurrent efforts that seek to establish and demystify realities that cancer patients encounter in modern society (Erban, 2012). The credibility of this exercise is evident because it involved social scientists and experts from diverse scientific areas of interest. Credible research studies should exhibit accuracy, acuity, and precision in order to reflect a representative demeanour (Erban, 2012). However, various discrepancies manifest with regard to the initiation and propagation of research studies. In most cases, researchers exercise restraint whenever they elucidate outcomes that relate to investigative exercises. For instance, they avoid generalizations because they create discrepancies and alter the accuracy of research studies (Erban, 2012). Such efforts require general paradigms such as assumption and selection of representative samples. Devoid of such considerations, it would be difficult for research experts to relay accurate and precise outcomes. Pre-emptive measures support computation of data and relevant information that ultimately adds value to overall research outcomes (Erban, 2012).
This particular study had weaknesses that tilted outcomes and elucidations. For instance, participation was voluntary and researchers had no authority or wherewithal to determine it (Erban, 2012). It was also difficult for researchers to determine or influence accuracy and candour. Such factors affect accuracy and credibility with regard to research outcomes. In this particular study, it was difficult for researchers to convince women to participate. In order to guarantee success in such undertakings, experts should sensitize participants on the need for accuracy and candour in providing information (Erban, 2012).
Although the study was satisfactory and consistent with expectations, it would have obtained better results if more people participated. The relevance of this observation revolves around a recurrent need for accuracy and precision (Gosling, 2010). Another limitation relates to the scope and orientation of the study. It failed to illustrate the inherent relationship between correlation and causation. The study illustrated various aspects of optimism with regard to actual medical procedures involved in cancer treatment. The results failed to show basic existential realities that affect cancer patients (Gosling, 2010). Overly, this research exercise was credible because outcomes were similar to those exhibited by similar scientific exercises. This reality made it a valid representation of factors that affect cancer patients (Gosling, 2010).
References
Crombie, K. (2012). Research in Healthcare: Design, Conduct and Interpretation. London: John Wiley & Sons.
Erban, J. (2012). Breast Cancer: A Multidisciplinary Approach to Diagnosis and Management. Newyork: Demos Medical Publishing.
Gosling, S. (2010). Advanced Methods for Conducting Research Studies. Newyork: CENGAGE.
Whenever the term health is mentioned, people tend to attribute it to being free from pain, injury and diseases. However, the term health broadly means being physically, socially and mentally well and not just being free from infirmity or disease (Corbin et al, 2009, p. 22). Many strategies are used in promoting health and wellness. These are both physical and mental strategies. The term ‘health triangle’ is used to refer to these strategies. We need to understand that maintenance of health and wellness is a continuous process that comprise of personal strategies as well as assistance from healthcare providers. This paper aims at looking at some of the health problems such as stress, diabetes and tobacco related problems. It will also focus on their causes, effects and ways of controlling or managing them.
Health and wellness
There is no clear distinction between health and wellness. The terms health and wellness are broad and covers social, intellectual, physical and spiritual aspects. Wellness refers to how we take life and our ability to work effectively. Health and wellness depend on personal qualities (Corbin et al, 2009, pp. 64-69). Hence, it is wrong to compare ourselves with others since we have distinct qualities. Instead, we need to concentrate on our strengths and work on our weaknesses.
Dimensions of health and wellness
Health and wellness have physical, intellectual, social and emotion dimensions. The physical dimension involves the state of the body while intellectual dimension entails the ability to build up skills and knowledge to improve our life. Emotional health and well being refers to our ability to deal with our emotions as well as the emotions of those around us. Social dimension entails the ability to build and maintain friendly relationships with others ((Corbin et al, 2009, p. 74). Health and wellness are not complete without the spiritual dimension. This is the ability to cope with our beliefs.
Factors that influence health and wellness
There are copious factors that influence our health and wellness. Our eating habits as well as regular exercise influence our physical health. Moreover, our intellectual wellness is influenced by attitude such as positive thinking when faced with problems. Our ability to handle stress and cope with our weaknesses greatly affects our emotional wellness (Corbin et al, 2009, pp. 70-76). Embracing diverse cultural practices and having positive self esteem significantly influence our social health and wellness.
Stress Management
It is difficult to overcome stress in our day to day life. Generally, we tend to look for ways of living with stress rather than struggling to overcome it. However, it is imperative to note that there is hope of overcoming stress if proper stress management strategies are implemented. To effectively deal with stress, we ought to first identify its origin and evaluate the methods we use to overcome it. There are numerous sources of stress that range from domestic crisis, financial problems to working environment (Corbin et al, 2009, pp. 309-312). Some of the symptoms that we use to determine if we are suffering from stress include suffering from back pain and stiff neck, having rapid heart beat, frowning face and having sweaty hands.
Physical and emotion problems caused by stress
Stress leads to both physical and emotional health problems. One of the physical health problems associated with stress is high blood pressure. Stress leads to the body releasing adrenalin which constricts the blood vessels eventually rising blood pressure. If this condition continues for long, it may lead to one suffering from hypertension. Apart from physical health problems, stress leads to emotional health problems. One of these problems is depression (Corbin et al, 2009, p. 315).
Stress management strategies
Several measures can be taken to manage physical and emotional health problems associated with stress. For instance, stress emanating from working environment may result from poor organization. To avoid this, we need to manage our time well and come up with a time schedule. This is to help us in ensuring that we are not overwhelmed by work. Emotional stress results from our perceptions about life. It is imperative that we change our perceptions about life so as to set ourselves free from stress (Corbin et al, 2009, pp. 316-319). This is by taking life positively and living within our standards.
Diabetes
Diabetes (at times referred to as diabetes mellitus) refers to a group of diseases which result from excess blood sugar in the body. This may result from failure of the body to produce insulin or failure of the cells to respond to produced insulin. Diabetes is divided into three types. These are Type 1 diabetes, Type 2 diabetes and Gestational diabetes. Type 1 diabetes comes as a result of body’s failure to produce insulin. Normally, the disease is diagnosed at childhood. It may also occur at adulthood especially in people who consume a lot of alcohol. Type 2 diabetes results from failure of the body cells to use the secreted insulin (Corbin et al, 2009, pp. 95-98). At times, this diabetes is known as insulin resistant. The disease is mostly diagnosed at adulthood. Gestational diabetes occurs in pregnant women. Despite the disease healing after the women delivers, a woman suffering from this type of diabetes is susceptible to suffering from type 2 diabetes. Women suffering from gestational diabetes tend to give birth to huge babies.
Effects of diabetes
All forms of diabetes harbor long-term complications. Type 1 and type 2 diabetes lead to a condition known as hyperglycemia. If this condition lasts for long it leads to damage of nerves, blood vessels and eye retina eventually causing blindness. It may also damage kidney vessels leading to kidney failure. Nerves damage may lead to patients getting paralyzed (Corbin et al, 2009, pp. 99-101).
Coping with diabetes through changing our lifestyle
Complications associated with diabetes have called for people to change their lifestyles. In our study, we have learnt that some of the causes of diabetes include eating habits and weight gain (Corbin et al, 2009, pp. 101-104). Consequently, we ought to change our eating habits and be physically active to avoid suffering from diabetes. It is the high time that we star enrolling in aerobics and participating in resistance training. We need to eat foods with high fiber content such as whole grains, vegetables, nuts and fruits. This will help in regulating blood sugar in our bodies.
Tobacco
Tobacco is the sole cause of avertable death in the world. There are numerous fatal illnesses that result from tobacco smoking. These illnesses normally affect lungs, heart and at times hands and feet. One of the major health problems that result from tobacco smoking is cancer. Lung cancer is the most prevalent problem. The problem does not only affect those who directly smoke tobacco but also those who inhale tobacco smoke (Corbin et al, 2009, p. 382). For women who smoke tobacco, they are likely to suffer from cervical cancer and miscarriages. Another problem associated with tobacco smoking is cardiovascular disease. Carbon monoxide gas found in tobacco smoke leads to reduction in amount of oxygen in blood. In addition, tobacco contents narrow blood vessels leading to their blockage and subsequent heart attack or stroke.
Strategies for breaking from nicotine addiction
Prolonged tobacco use leads to nicotine addiction which becomes hard to detach from. Numerous strategies are employed to break from nicotine addiction and they all need to be implemented for a long time. Some of the strategies involve training our brains to use only the required amount of nicotine which is referred to as nicotine replacement therapy. This method uses nicotine patch or nicotine gum which when used release limited amount of nicotine to the bloodstream. Nicotine patch is applied on the skin and absorbed by the body (Corbin et al, 2009, pp. 384-388). There are also non-nicotine pill that are used to cut down our longing for nicotine as well as withdrawal signs. Examples of the pills are Bupropion and Varenicline. Despite the pills helping in alleviating nicotine addiction, they have their side effects such as insomnia, head aches, skin rashes and change in appetite.
Conclusion
Health and wellness maintenance is a continuous process that comprise of personal strategies as well as assistance from health care providers. To ensure our health we ought to understand the underlying factors that may compromise our health. For instance, we need to understand causes of stress so that we cope with it. Managing our time well and changing our perceptions about life will go a long way in helping us manage stress. Problems such as paralysis and blindness caused by diabetes can be avoiding by changing our lifestyle and eating habits (Corbin et al, 2009, pp. 101-104). Moreover, we need to check on our tobacco consumption so as to avoid suffering from cancer and cardiovascular diseases associated with tobacco. The above discussion has greatly helped in identifying the various problems associated with tobacco consumption, stress as well as diabetes. Besides, we have learnt on measures we can use to prevent these problems as well as importance of ensuring that we live a healthy life.
Reference List
Corbin, C., Corbin, W., Welk, G. & Welk, K. (2009). Concepts of Fitness and Wellness. New York, USA: McGraw-Hill.
Post-traumatic stress disorder, commonly abbreviated as PTSD, refers to a severe anxiety disease whose onset is influenced by the exposure to a traumatic life episode. This disorder occurs in around 8-14% of the US populace, and its prevalence among females (12-18%) in the country is about twice higher than that of their counterparts (Togay and El-Mallakh, 2020). PTSD has been associated with a substantial burden on the wider society and individuals. Furthermore, Togay and El-Mallakh (2020) underscore the increased likelihood of PTSD patients to utilise drugs and sustaining psychological functioning impairments. Most of the individuals with this illness typically match the diagnostic criteria for other mental conditions; this includes anxiety and major depression. The paper highlights the disorder’s pathophysiology to foster the understanding of its underlying aetiology.
Noradrenergic System
Adrenoreceptors, typically abbreviated as ARs, relate to a grouping of receptors, particularly the G protein-coupled ones, which consist of three primary categorisations: β, α1 and α2 with related subtypes. This system prompt sympathetic autonomic reaction and CNS activity via cell bodies situated within the coeruleus locus. It later extends towards the structures of the limbic system and prefrontal cortex, implicating it in discriminatory response to fear and stress-related feedbacks and aversive and rewarding stimuli (Sakellariou and Stefanatou, 2017). Through physiological processes’ dysregulation, hyperadrenergic actions trigger mental illnesses, such as anxiety, traumatic brain injuries and major depression. Its impact on pertinent fear signalling and amygdala functioning further play a crucial role in PTSD’s onset.
Recent ongoing research reveals the involvement of NET (noradrenaline transporter) in PTSD manifestation. Studies demonstrate the interconnection between severe distress exposure and the increased availability of noradrenaline synaptic within cortical regions, reduced presence of NET within coeruleus locus and the AR system’s dysfunction (Togay and El-Mallakh, 2020). Reboxetine, a selective NRI (noradrenaline reuptake inhibitor) medication has been shown to antagonise the availability of noradrenaline synaptic and minimise the reaction of foot shock distress (Kelmendi et al., 2016). The aforementioned outcome has also been demonstrated by human PET (positron emission tomography) surveys that reveal a reduced NET availability in PTSD patients (Kelmendi et al., 2016). The delineated modification in the response of homeostatic distress could trigger phenotypes related to depression and anxiety, which typify PTSD.
A study aimed to ascertain the efficacy of various PTSD therapies in veterans diagnosed with alcohol dependence and PTSD uncovered the effectiveness of using an amalgamation of naltrexone and NRI desipramine in minimising these conditions. This treatment approach was compared with the combination of naltrexone with either paroxetine or SSRI (Salellariou and Stefanatou, 2017). The latter proved to be slightly inefficient in improving the clinical manifestation associated with this disorder.
Exposure to trauma may trigger emotional dysregulation and decreased impulse control. Studies indicate that atomoxetine, a medication typified by an increased NET affinity, aids in minimising symptoms related to ADHD with concomitant PTSD and anxiety diagnoses and elevating inhibitory reaction control (Kelmendi et al., 2016). The aforementioned medication can be efficient in managing phenotypes demonstrating noticeable impulsive and hyperarousal deportments. Studies also reveal the clinical utility of venlafaxine, a drug categorised as an SNRI, in decreasing numbing/avoidance and recurring symptoms, as well as fear extinction (Kelmendi et al., 2016). This underscores its efficacy as a supplement therapy for PTSD exposure. NET’s interaction with other distress systems, for example, dopaminergic emphasise the effectiveness of amalgamating medicines such as SNRIs and integrated therapies which influence NET functions to enhance better PTSD management outcomes.
Serotonergic Receptors: 5-HT1B, 5-HT1A
5-HT – serotonergic receptors relate to a grouping of receptors, particularly the G protein-linked ones and 5-HT3, a distinguished ligand-gated channel of ion, which consists of several categorisations, i.e., 5-HT1 to 5-HT7 with their correlated subclasses. According to Ayers et al. (2016), the 5-HT framework is implicated in the regulation of behaviour or deportment, processing of emotions, and cognition. Studies involving humans and animals exhibit this system’s role in triggering various mental illnesses’ pathophysiology; this includes PTSD, alcoholism and depression (Sakellariou and Stefanatou, 2017). Sakellariou and Stefanatou, (2017) further link threat responsiveness and fear regulation with the signalling of 5-HT within the amygdala; this is an area within the brain deemed essential in comprehending the reaction to fear and aetiology of PTSD. Furthermore, they reveal the selective role assumed by 5-HT agonists in inducing flashbacks associated with trauma and anxiety attacks among individuals with PTSD. The reaction triggered by this agonist fosters the understanding of 5-HT’s role in the disorder’s aetiology.
5-HT1A refer to a type of receptors situated on the cell bodies of 5-HT within the raphe presynaptically and in other regions of the brain, postsynaptically. 5-HT1A postsynaptic receptors are commonly found in the limbic and frontal cortices’ astroglia, and they trigger trophic-factor S-100β’s release, consequently fostering cytoskeletal maintenance and serotonergic system growth (Sakellariou and Stefanatou, 2017). The neuropathological deviations demonstrated in the paralimbic and limbic cortical regions with regard to mood disorders may be ascribed to the impaired functioning of the 5-HT1A receptor. These presentations facilitate their capacity to influence various PTSD-related symptoms.
On the other hand, 5-HT1B receptors are highly expressed within the ventral tegmental region, substantia nigra, nucleus accumbens, pallidum, and striatum. They function as autoreceptors presynaptically on the terminals of the axon linked to 5-HT receptors that consist of neurons and on non-5-HT-bearing neurons as heteroreceptors (Kelmendi et al., 2016). The 5-HT1B receptor operates as a heteroreceptor by regulating the action of several neurobiological components within the brain; this includes GABA, glutamate, acetylcholine, dopamine and noradrenaline in regions interlinked to PTSD pathogenesis. Therefore, this means that the alteration in the levels of this component may trigger PTSD.
Patients diagnosed with PTSD and those exposed to trauma often exhibit the decreased binding potential of 5-HT1B. This occurs within the cingulate cortex, particularly the anterior one, amygdala, and caudate with observable incontestable interconnections linked to symptom severity and trauma history. Recent surveys link density modifications in 5-HT1B to certain PTSD-related symptomologies, implying that these alterations may account for specific elements of PTSD clinical phenotypes (Ayers et al., 2016). Therapies that target the action of 5-HT1B can foster clinical utility in PTSD treatment; this includes appropriate medications for comorbid illnesses that affect one’s mood.
Corticotropin-Releasing Factor – CRF and 5 Hypothalamic-Pituitary-Adrenal Axis – HPA
The HPA axis relates to a neuroendocrine distress-response system, which connects the CNS (central nervous system) to the endocrine structure; its dysfunction triggers several psychiatric and psychosomatic illnesses. The CRF, on the other hand, refers to a neuronal signalling component generated by hypothalamus cells in retaliation to mental or physical distress (Togay and El-Mallakh, 2020). High CRF levels within the hypothalamus typically cause the HPA axis’ activation or stimulation and the elevated cortisol secretion. Researchers argue that the increased CRF levels during trauma can enhance the traumatic evocation encoding procedure and anxiety-related effects. Patients with PTSD often demonstrate aberrations in systems linked to the HPA axis and elevated CRF levels in the cerebrospinal fluid. This, in turn, reveals the efficacy of medications that enhance the dampening of the hormones linked to the HPA axis and CRF system in PTSD therapy (Kelmendi et al., 2016). Studies aimed to assess the CRF-1 antagonists’ is necessary to determine the efficacy of this medication on PTSD therapy.
Opioid System
Several studies implicate opioid-related systems in PTSD’s pathophysiology. According to Sakellariou and Stefanatou (2017), opioid receptors, commonly abbreviated as ORs are classified under receptors of the G protein-linked category. They are categorised further into three subtypes: μ (morphine preferring), κ (dynorphin choosing) and δ (encephalin preferring) (Sakellariou and Stefanatou, 2017). Empirical surveys implicate dynorphin OR in multiple brain diseases, for instance, Alzheimer’s disorder, Tourette’s syndrome, epilepsy and substance abuse, especially psychostimulants. It has also been linked to the manifestation of distress-triggered deportments.
Established preclinical findings identify k-ORs as therapy development targets for clients diagnosed with phenotypes linked to anxiety and depression. A particular survey revealed the efficacy of dynorphin OR antagonists in managing learned and involuntary fear due to their antidepressant-anxiolytic features compared to fluoxetine, an SSRI subtype. There is a threefold scientific proof suggesting the involvement of opioid systems in PTSD’s aetiology:
Victims of violence, particularly those involving intimate partners, can demonstrate pain-related syndromes.
An interconnection exists between exaggerated opioid use rate in adulthood and sexual trauma in childhood.
Morphine’s use in trauma-linked cases may decrease the probability of consequent PTSD development following traumatic injuries, especially among adult patients, children, burn survivors and military experts.
Additional research on k-OR’s role in PTSD will play a crucial role in fostering the comprehension of its circuity and therapy implications.
Conclusion
The essay highlights the recent developments in studies related to the pathophysiology of PTSD and the relevancy of these findings on understanding the disease’s aetiology. Current practices involving PTSD diagnosis depend on clinical interviews and screening approaches. Therapy is restricted to the management of symptoms instead of the pertinent biological aetiology. Therefore, there is an increasing need to foster a detailed comprehension of PTSD’s pathophysiology and its clinical presentations to promote the development of effective therapeutic strategies.
When coping with a psychiatric condition or trauma, it is not uncommon for individuals to seek assistance. When dealing with trauma and its long-term consequences, friends and professional therapists may be invaluable resources. People from many walks of life are touched by a traumatized victim’s tale (Marsac & Ragsdale, 2020). Trauma to caregivers frequently has behavioral consequences that children unintentionally encounter. If a parent has Post-Traumatic Stress Disorder (PTSD), the child may ultimately suffer mental anguish, even if the youngster did not see the traumatic incident directly (Kellogg et al., 2018). When someone learns about the personal trauma experiences of another, they are put under emotional pressure, which is known as secondary traumatic stress. The trauma of maltreatment, violence, environmental catastrophes, and other unpleasant experiences affects over ten million American children every year (Secondary traumatic stress, N.D.B). Behavioral and emotional issues resulting from these events may have long-term effects on children’s lives, putting them in touch with child-serving professionals.
Review of literature
Trauma responses or PTSD may be “passed on” to children in two ways. For example, secondary trauma may be passed down through the generations in perhaps the most technical sense-via one’s D.N.A. Although the idea is still in its infancy, a recent study has shown that PTSD may be handed down from one generation to another (Smoller, 2016). For the most part, children who experience firsthand circumstances have close acquaintances or distant relatives. There is a lot of touch and interaction between them, and this affects their mental health. Such exposures may result in PTSD. Traumatic childhood experiences and early life stressors are associated with increased behavioral and health issues in children (Akinsulure‐Smith et al., 2018). Also, the authors added that traumatic stress contact has often had a link to emotional fatigue, depersonalization, eating disorders, sleep disruption, and decreased self-esteem due to burnout (Akinsulure‐Smith et al., 2018).
It is critical to screen and evaluate children because it gives parents the chance to intervene and alter the course of their child’s life. Listening to the tales of traumatized children may be emotionally draining for psychiatrists, child welfare professionals, caseworkers, and other professional experts who deal with traumatized youngsters (Menschner & Maul, 2016). Protecting workers’ health and guaranteeing that children get the best medical service from those dedicated to assisting them begins with raising awareness regarding the consequences of indirect victimization among supervisors and employees alike.
It is important to examine secondary PTSD in children to discover an effective method to protect children’s mental welfare and subsequent generations in the United States and abroad. It is crucial to examine the children of veterans who have PTSD (Katz, 2019). Additionally, the study analyzes ten different pieces of literature to enhance the understanding of the complex topic. Specifically, incorporating the facts from all the sources can help identify the specific factors exposing children to secondary PTSD and the negative consequences associated with the condition. Thus, this short discourse takes advantage of a mixed methodology to understand the complexity of this issue. The presented facts offer a foundation for future studies seeking to create community members—[See figure 1 that illustrates the conceptual framework].
Conceptual Framework for Secondary PTSD in Children
The Definition and Significance of the Study
Understanding child PTSD is a fundamental element in determining or predicting the future tendencies and outcomes of future life in terms of health, behavior, and social well-being. Knowledge of this topic will help identify children undergoing traumatic experiences in society, either at home or school (Sachser et al., 2018). This will aid in the early diagnosis and treatment of the victims (Rezayat et al., 2020). It has also been proven that this information will contribute towards the apprehension of child offenders, a crime sector that has been on the rise across many areas in the United States (Cloitre et al., 2021). Most of the children who have PTSD are usually misunderstood, with a majority of them being tagged as rude, “different,” or anti-social (Cloitre et al., 2021).
This study aims at providing sufficient data that, in conjunction with the already existing information, will help formulate and, after that, ensure that the correct and prompt diagnosis is made. This study will advise on the appropriate treatment accorded as it has been noted that PTSD is misdiagnosed and treated as depression in most cases (Rezayat et al., 2020). Finally, the study will create awareness among public and medical practitioners as to what PTSD is, the causes and effects in children (Sachser et al., 2018). The relationship between parents’ experiences and interactions with the onset of PTSD in children will be explored.
The Quality of Existing Literature and Research on PTSD
Research has been conducted targeting various areas of interest in children’s mental health. Children’s primary mental health components include social well-being and psychological and emotional wellness (Grant et al., 2020). PTSD in children received less attention over the past few decades, because many believe that youngsters and adolescents are not stressed because they are cared for by parents (Garza & Jovanovic, 2017). This angle of view is not entirely proper, owing to the research and publications reviewed in this article. There is vast information on the management of treatment and prevention of PTSD in children (Hamblen & Barnett, 2018). Many law offenders in the United States have been found to have been victims of traumatic experiences in their childhood (Sherman et al., 2016). This discovery goes a long way in demonstrating the prognosis of the young victims of PTSD.
PTSD has just recently been recognized as a viable diagnosis in America. This late consideration is responsible for the scant research done on this topic. A lot more data is needed to ensure a better understanding of the aspects of post-traumatic stress disorder in children and adolescents. This deficiency in information calls for an advanced study of this topic to provide enough information to supplement the existing data (Yue et al., 2020). The information will also inform the government policy, medical practice, and child support in providing better child care services (Van Ee et al., 2016). Therefore, there is an apparent need to conduct more detailed research soon concerning the areas that have not been adequately covered.
Study Gap in Literature Review
As determined in the review of existing scholarly literature, certain areas of PTSD in children have not been covered. This study aims to cover those areas to provide an adequate awareness of the condition. The following aspect will be explored upon the successful completion of this study:
The causes of traumatic stress in children
The effects of post-traumatic stress disorder in children
The involvement and awareness of children’s PTSD
What Causes Secondary Traumatic Stress in Children?
To delve more into this topic, it is essential to understand what exactly causes secondary childhood trauma. According to medical specialists, parental genes and contact with someone who has firsthand PTSD are critical contributors to the disorder. Trauma survivors might pass on secondary stress disorder to their children and grandchildren (Marsac & Ragsdale, 2020). In addition, talking to or listening to a disturbed person might harm the listener’s psychological health and perhaps set off the illness (Malarbi et al., 2017).
Due to proximity, it is not uncommon for children to be exposed to their parents’ distress. Children who hear their parents discussing, mentally reliving, or demonstrating signs of PTSD after experiencing trauma may begin to exhibit trauma responses of their own (Secondary traumatic stress, N.D.A.). Numerous triggers cause the rush of memories, including sounds, images, smells, and in some cases, nothing at all. These traumatic events are frequently accompanied by strong emotions such as fear, sorrow, and rage, and they might feel so vivid that the person with PTSD believes the incident is repeating itself (Malarbi et al., 2017). Even if it is difficult for a caregiver to go through the trauma repeatedly, the young ones who witness it can be worried and confused.
How does Secondary PTSD Affect a Child?
The other question relates to how secondary PTSD affects children and how a medical practitioner can determine if a patient has PTSD. The symptoms of vicarious trauma can range in severity from mild to severe. Some of the less severe symptoms include insomnia and food issues such as bulimia nervosa and anorexia nervosa. On the other hand, stress, worry, and negative behavioral and emotional alterations are severe indicators and symptoms (Smoller, 2016).
Anxiety and physical ailments, such as tiredness and a weaker immune system, can result from secondary PTSD in youngsters. When the first symptoms of a mental illness are noticed, parents should immediately take their children to see a mental health professional (Secondary trauma affects teens and young adults, 2020). Secondary PTSD necessitates treatment like any other illness or condition. This condition can be prevented and treated with the support of psychotherapists (Meiser‐Stedman et al., 2017). Compassion fatigue prevention and treatment strategies fall into two categories: non-pharmacological and pharmacological. Non-pharmacological approaches include seeing a psychologist, using self-validation and insight meditation, engaging in regular physical activity, daily scheduling, and keeping a sleep routine and journal (Menschner & Maul, 2016). Recurrent stress disorder can be prevented or treated with medication. Pharmaceutical approaches involve specific modulators and neurotransmitters that address the psychological adversities associated with the children’s exposure to traumatic events (Katz, 2019). In conclusion, both treatment approaches are crucial for the welfare of unfortunate children.
Are Parents Aware of Their Children’s PTSD?
Over the past many decades, there have been cases where parents have been surprised to learn that their child has had PTSD. Most parents observe a child’s behavior and classify them generally as quiet, emotional, rude, or high tempered (De Young & Landolt, 2018). Many of these parents are not aware that these traits may as well be an indication of PTSD. This study, therefore, aims at determining the level of parents’ knowledge and involvement in their children’s mental health status. Some of the questionnaires and interviews in this study will seek to obtain information that answers this phenomenon. Data obtained will help medical practitioners and child psychiatrists stipulate relevant guidelines and recommendations and inform government policy of prevention and treatment protocols.
Methodology
This study will use a mixed methodology that includes qualitative and quantitative research design. The study recruited 100 adults or random races using systematic sampling with children between the ages of 10 and 18. 30% were male, while the remaining 70% were female. The respondents’ age ranged from 35 to 65 years old. The selected individuals understood the aim of the study and provided consent. The survey provided the participants with 10 questions to determine whether they knew their children’s mental health conditions.
Research Design
The researcher views the mixed methods approach as appropriate for this study due to the following qualities.
It ensures that the findings of the study are focused on the experiences of the participants.
It improves the accuracy of the study results.
It accommodates all the variables of the study.
It offers the best utilization of resources.
It consumes the least time compared to other methods.
It involves the collection of two types of data at the same time (Malarbi et al., 2017).
Questionnaire and Interview
The survey included the following questions to help ascertain whether the caregivers in Kern County and other American regions are aware of their children’s exposure to the secondary PTSD:
Do you have any concerns about your child’s mental state? Why?
Do you understand how the environment exposes your children to secondary PTSD?
How often do you disagree with your spouse? Do you think this affects your children’s mental health?
Do you have a history of post-traumatic stress disorder in your family? Have you ever been worried that your children might develop the same undesirable conditions?
Do you see any signs related to the mental condition in your children? What measures have you taken to ensure that your child does not fall victim to undesirable mental disorders?
Are your children aware of the complex secondary PTSD?
Do you think your children are proud of your parenting strategy? Do your approaches safeguard their mental welfare?
Do you think your parental skills influence how your children handle the traumatic events they face? Can you support your argument?
Do you think your children are optimistic about achieving their future goals? Are you sure you are motivating them to maintain their focus despite their interaction with traumatized persons?
How do you feel about the need for regular screening and treatment of mental health conditions to reduce PTSD?
After collecting the data from the respondents, the researcher will use triangulation to analyze the data and provide recommendations to reduce the children’s risk of secondary PTSD. Thus, incorporating qualitative and quantitative research approaches would guarantee that the study efforts to enhance understanding secondary PTSD are successful (Shannonhouse et al., 2016). This research study will endeavor to guarantee the professionalism and qualification of the entrusted mental health specialists by ensuring an in-depth understanding of the complex secondary PTSD.
References
Akinsulure‐Smith, A. M., Espinosa, A., Chu, T., & Hallock, R. (2018). Secondary traumatic stress and burnout among refugee resettlement workers: The role of coping and emotional intelligence. Journal of Traumatic Stress, 31(2), 202-212.
Cloitre, M., Brewin, C. R., Kazlauskas, E., Lueger‐Schuster, B., Karatzias, T., Hyland, P., & Shevlin, M. (2021). Commentary: The need for research on PTSD in Children and adolescents–a commentary on Elliot et al. (2020). Journal of Child Psychology and Psychiatry, 62(3), 277-279.
De Young, A. C., & Landolt, M. A. (2018). PTSD in children below the age of 6 years. Current Psychiatry Reports, 20(11), 1-11.
Garza, K., & Jovanovic, T. (2017). Impact of gender on child and adolescent PTSD. Current Psychiatry Reports, 19(11), 1-6.
Grant, B. R., O’Loughlin, K., Holbrook, H. M., Althoff, R. R., Kearney, C., Perepletchikova, F., & Kaufman, J. (2020). A multi-method and multi-informant approach to assessing post-traumatic stress disorder (PTSD) in children. International Review of Psychiatry, 32(3), 212-220.
Hamblen, J., & Barnett, E. (2018). PTSD: National Center for PTSD. Behavioral Medicine, 366-367.
Katz, S. (2019). Trauma-informed practice: The future of child welfare. Widener Commonwealth. L. Rev, 28, 51-83.
Kellogg, M. B., Knight, M., Dowling, J. S., & Crawford, S. L. (2018). Secondary traumatic stress in pediatric nurses. Journal of Pediatric Nursing, 43, 97-103.
Malarbi, S., Abu-Rayya, H. M., Muscara, F., & Stargatt, R. (2017). Neuropsychological functioning of childhood trauma and post-traumatic stress disorder: A meta-analysis. Neuroscience & Biobehavioral Reviews, 72, 68-86.
Meiser‐Stedman, R., Smith, P., McKinnon, A., Dixon, C., Trickey, D., Ehlers, A., & Dalgleish, T. (2017). Cognitive therapy as an early treatment for post‐traumatic stress disorder in children and adolescents: A randomized controlled trial addressing preliminary efficacy and mechanisms of action. Journal of Child Psychology and Psychiatry, 58(5), 623-633.
Menschner, C., & Maul, A. (2016). Critical ingredients for successful trauma-informed care implementation. Trenton: Center for Health Care Strategies, Incorporated.
Rezayat, A. A., Sahebdel, S., Jafari, S., Kabirian, A., Rahnejat, A. M., Farahani, R. H., & Nour, M. G. (2020). Evaluating the prevalence of PTSD among children and adolescents after earthquakes and floods: A systematic review and meta-analysis. Psychiatric Quarterly, 1-26.
Sachser, C., Berliner, L., Holt, T., Jensen, T., Jungbluth, N., Risch, E., & Goldbeck, L. (2018). Comparing the dimensional structure and diagnostic algorithms between DSM-5 and Psychiatry. Eur Child Adolesc Psychiatry, 27(2), 181-190.
Shannonhouse, L., Barden, S., Jones, E., Gonzalez, L., & Murphy, A. (2016). Secondary traumatic stress for trauma researchers: A mixed methods research design. Journal of Mental Health Counseling, 38(3), 201-216.
Sherman, M. D., Gress Smith, J. L., Straits-Troster, K., Larsen, J. L., & Gewirtz, A. (2016). Veterans’ perceptions of the impact of PTSD on their parenting and children. Psychological Services, 13(4), 401-410.
Smoller, J. W. (2016). The genetics of stress-related disorders: PTSD, depression, and anxiety disorders. Neuropsychopharmacology, 41(1), 297-319.
Van Ee, E., Kleber, R. J., & Jongmans, M. J. (2016). Relational patterns between caregivers with PTSD and their nonexposed children: A review. Trauma, Violence, & Abuse, 17(2), 186-203.
Yue, J., Zang, X., Le, Y., & An, Y. (2020). Anxiety, depression and PTSD among children and their parent during 2019 novel coronavirus disease (COVID-19) outbreak in China. Current Psychology, 1-8.
Workplace stress among American nurses became a problem during the peak of the coronavirus pandemic. This systematic review aimed to discuss workplace stress among American nurses during the period and to suggest measures that should be taken when addressing a similar problem in the future. Data were obtained from specific peer-reviewed journals available in medical research databases. Study eligibility criteria, participants, and interventions, study appraisal and synthesis methods, results, and limitations are discussed in the paper. The study shows that the stress was caused by excess work and the constant threat of contracting the deadly disease.
Introduction
Rationale
When the Coronavirus (COVID-19) pandemic struck, the United States relied on its health care providers to combat it. Nurses played a major role in offering care to those who contracted the virus. They also had to continue caring for their patients suffering from other conditions. Arnetz et al. (2020) explain that nurses had to work for longer hours than before because of the crisis. Cases of burnout and workplace stress became normal during the period. The government was unable to recruit additional nurses to address the emerging needs. Although some nurses considered quitting the job, making an already bad situation worse, most of them were able to overcome the challenge (Hines et al., 2021). In this systematic review paper, the researcher seeks to discuss workplace stress among American nurses during the peak of the coronavirus pandemic in the country.
Objectives
It is necessary to develop PICOS research questions to facilitate the collection of data from various sources. The following are the questions used to collect data for the study;
P: Who were the most affected nurses during the peak of the COVID-19 pandemic in the United States?
I: What can be done to ensure that the affected population is protected from similar future pandemics?
C: Which country handled the pandemic in the best way to protect their nurses?
O: What would be the outcome of the new measures in case there is a similar pandemic in the country?
S: What is the most appropriate study design that can facilitate effective collection and analysis of data on this topic?
Methods
Protocol and Registration
In this systematic literature review, there was a review protocol used to collect and process data. First, the researcher developed PICOS questions to define the nature of data needed from the field. The inclusion criteria used to gather data from the field were then defined. All the source materials must have been published within the period that the country experienced the pandemic (2020-2021). The search strategy involved using keywords to identify journal articles that met the set criteria. Most of the data were obtained from specific nursing journal databases, especially CINAHL, MEDLINE, and PsycINFO.
Eligibility Criteria
It was necessary to define the eligibility criteria for the materials used in this study. Based on the PICOS questions developed above, one of the important characteristics of the materials included in the study was the place of publication. The materials must have been published in the United States and at least one of the authors had to be a practicing nurse during the period of the COVID-19 pandemic. The material had to be at least 5 pages, published in English, in the 2020 or 2021 timeframe. It had to be a peer-reviewed journal to meet inclusion criteria. These characteristics had to be met to ensure that the material was credible.
Information Sources
As mentioned above, the study involved the use of peer-reviewed articles on nursing. The sources had to be from specific databases, which included CINAHL, MEDLINE, and PsycINFO. All the sources were published either in 2020 or 2021. The research did not have any contact with the authors of these articles.
Search
The researcher conducted a simple search in the databases selected. The questions above were keyed into the databases and specific articles selected based on how well they answered those questions. The keywords used include ‘workplace stress’, ‘American nurses’, and ‘coronavirus pandemic’.
Study Selection
When the search was conducted, it was important to screen the materials to determine their eligibility before they could be included in the systematic review. Each of the articles had to meet the criteria explained above in terms of their year of publication, authors involved, the area of focus/topic, length of the material, and if they are peer-reviewed.
Data Collection Process
Once a journal article was selected for the review, the next step was to collect data from them. The researcher used piloted forms to extract data from the reports. It involved defining the name of authors, the country of the population (which had to be the United States), and year of publication (2020-2021). Other factors include study design (cohort study, case report, or clinical trial), the sample size, the affected individuals, vaccination, efficacy of interventions, the safety of nurses, and adverse effects after vaccinations
Data Items
Based on the PICOS question above, the dependent variable was workplace stress among nurses. The independent variable included long hours of work, the constant threat of contracting the deadly virus, the inability to help dying patients, lack of counseling, and inability to spend time with family members. The assumption made was that all the nurses were exposed to similar risks and challenges.
Risk of Bias in Individual Studies
The risk of bias in the study was assessed by determining the authors of the report. Articles with all the authors being nurses affected by the pandemic were likely to be biased. Priority was given to articles published by nurses and other professionals to reduce the level of bias.
Summary Measures
The researcher was keen on assessing the risk ratio (by determining the authors of the articles) as a measure of addressing the problem of individual bias in the reports used.
Synthesis of Results
Data were analyzed qualitatively to help achieve the research aim. It involves identifying themes that explained the causes of workplace stress, how it affected the population, how it was managed, and the way forward.
Risk of Bias across Studies
There was a possible risk of bias across studies that could affect the cumulative evidence. The researcher was keen to identify and eliminate journals with selective reporting, especially those that underscore the burden and threat that other healthcare professionals such as doctors and clinical officers faced.
Additional Analyses
The researcher also used statistical analysis in this study based on the nature of the research question.
Results
Study Selection
The table below shows the selection criteria used to screen the studies in the report. It provides numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage.
Table 1: Flow Diagram of Screening and Selection
Inclusion criteria
Number of studies
The topic of the article (workplace stress among American nurses during COVID-19 pandemic)
120
Place published (must be in the United States)
65
Language (English)
48
Pages (5 and above)
21
Year (2020-2021)
21
Authors (At least one is a practicing nurse)
3
Study Characteristics
Each of the studies met the inclusion criteria discussed above. As Choi et al. (2020) observe, the researcher ensured that data characteristics in the articles focused on the problem the nurses faced based on actual data collection. Each of them had a sample size of more than 50 practicing nurses.
Risk of Bias within Studies
The risk of bias, as discussed in item 12, was a major concern that had to be addressed. The authors in the selected articles did not statistically present the information.
Results of Individual Studies
A study by Arnetz et al. (2020) reports that over 96% of nurses in the United States were highly stressed during the period. The common causes of stress included long hours at work, the threat of contracting coronavirus, constant deaths at the hospitals, and limited resources (Choi et al., 2020). A study by Hines et al. (2021) recommends the need for the government to enhance the capacity of healthcare institutions to avoid similar challenges in the future. Counseling for the affected nurses is also encouraged to help them overcome stress.
Synthesis of Results
All the selected materials used in this study had a confidence level of 95% and a measure of consistency was also taken into consideration to ensure that the data was reliable and valid. They reaffirmed the massive workplace stress that American nurses endured during the period.
Risk of Bias across Studies
As explained in item 15, the researcher made an effort to eliminate bias across studies. As such, the articles selected addressed this risk factor effectively.
Additional Analysis
Besides the primary analysis method used (thematic analysis), the researcher also used statistical analysis in presenting the percentage of those who were affected by the problem,
Discussion
Summary of Evidence
The findings of the review show that an overwhelming majority of nurses in the United States were stressed by various factors during the pandemic. Some of them lost their lives in their line of duty. The screening method conducted meant that the evidence presented in each of the articles was as credible as possible. The outcome of the study is relevant to nursing administrators, healthcare management teams, policy-makers, and government officials keen on improving the workplace environment for nurses. Future scholars will also find the document essential in their future studies.
Limitations
The main limitation of this study is that, as a systematic review, data were obtained only from secondary sources. It would have been appropriate to interview nurses who were affected by the problem. Although the risk of bias was managed, it could not be eliminated because some of the participants are nurses.
Conclusions
Results from this systematic review show that the majority of American nurses were overwhelmed with the work during the peak of the COVID-19 pandemic. Although they were all concerned about the threat of contracting the deadly virus and the burden, the fact that they had to watch helplessly as many died was even more stressful. Future research should focus on investigating how nurses can cope with such traumatizing events.
Funding
In this systematic review, there was no need for external funding for the study. The researcher only needed to pay a subscription fee to have access to specific databases discussed above. As such, the study was fully self-funded by the researcher.
The most difficult sexual dysfunctions in terms of their treatment include sexual aversion and post-traumatic stress disorder (PTSD) due to experienced violence or circumcision. Both disorders are unrelated to bodily pathologies that have an impact on the quality of sexual life (Metz et al., 2017). This aspect causes difficulties in prescribing therapy, since the latter requires a thorough study of the psychological nature of the problems.
In the treatment of sexual aversion disorder, a doctor needs to investigate a complex of many psychological and mental factors. Previous disorders, the manifestation of accentualization of personality, violation of gender-role behavior, primitive culiura are among them. All these aspects require a long and thorough psychological diagnosis, which may be complicated by a patient’s unwillingness to verbalize the traumatic experience (Metz et al., 2017). Besides, PTSD treatment may be associated with difficulties in collecting anamnesis. It is also complicated by the need to work with the patient’s close people, who may not be ready to provide proper psychological support for the patient.
Among all the possible ways of treating sexual dysfunctions recognized in medicine, I cannot name those that would go against my cultural, religious and ethical beliefs. A competent doctor is free to choose any necessary medical and psychological methods of treatment. These methods should be prescribed individually and in a timely manner. If they are, the usage of such methods is justified since they contribute to patients’ recovery.
As the ovaries age, the female ability to produce eggs suitable for fertilization and release sex hormones decreases, which weakens sexual reactions. An age-related decrease in estrogen levels, especially during menopause, reduces sexual desire (Ghizzani, 2020). The decrease in male libido and erectile function becomes more noticeable after the age of sixty, which, in part, can be explained by an age-related decrease in testosterone levels. All these changes underlie age-related changes in sexual behavior.
The PLISSIT model includes four levels of therapy: permission, information limit, special advice and intensive therapy. Each of them is aimed at a deeper level than the previous one. At the first level, the therapist assures the client that thoughts, feelings, fantasies, desires, and behaviors that enhance satisfaction are normal (Hudson-Allez, 2019). At the second level, the therapist provides the patient with information about the problems that bother him. The third stage is reduced to exercises. In intensive care, or psychosexual therapy, the therapist uses interpretation and reflection to help clients become aware of unconscious feelings.
References
Ghizzani, A. (2020). Healthy aging: Well-being and sexuality at menopause and beyond. WSB Publishing.
Hudson-Allez, G. (2019). Sexual diversity and sexual offending: Research, assessment, and clinical treatment in psychosexual therapy (1st ed.). Routledge.
Metz, M. E., Epstein, N., & Mccarthy, B. (2017). Cognitive-behavioral therapy for sexual dysfunction (1st ed.). Routledge.
After a patient has experienced serious trauma or a life-threatening incident, post-traumatic stress disorder (PTSD) develops. Every veteran’s post-traumatic stress disorder develops in a unique way. These might be persistent memories of the traumatic experience, such as troubling thoughts, nightmares, or flashbacks, which cause strong emotional and physical reactions (Mobbs & Bonanno, 2018). Avoidance of objects that remind you of the traumatic incident is another symptom of PTSD. Detachment from social life, as well as losing interest in any activity, are examples of this. PTSD manifests itself in unpleasant changes in thoughts and attitudes, such as amplified negative beliefs (Mobbs & Bonanno, 2018). Severe depression might result from an inability to experience good emotions. Post-traumatic stress disorder (PTSD) is a complicated issue that affects a significant portion of today’s population. According to data, over 20% of Iraq and Afghanistan veterans and more than 15% of Vietnam veterans are affected (Reich et al., 2019). Veterans may overcome the effects of PTSD with a variety of community alternatives and an openness to new ideas.
Trauma-focused psychosocial care is the most effective evidence-based nursing intervention for post-traumatic stress disorder. It is also highly influenced by community options, especially the availability of private nurse practitioners. Recovery from post-traumatic stress disorder entails removing mental and emotional stress as well as assisting the nervous system’s recovery (Reich et al., 2019). Nowadays, PTSD is treated in several ways, including holistic care and non-pharmacological approaches like recreational therapy, yoga, or meditation. In the context of nursing, the most typical kind of assistance is cognitive behavioral therapy or counseling (Reich et al., 2019). This entails progressively exposing the patient to thoughts and sensations that are similar to those experienced during the trauma (Reich et al., 2019). Identifying erroneous and unreasonable beliefs about the incident and replacing them with a more balanced image is also part of therapy.
References
Mobbs, M. C., & Bonanno, G. A. (2018). Beyond war and PTSD: The crucial role of transition stress in the lives of military veterans. Clinical Psychology Review, 59, 137-144.
Reich, K., Nemeth, L., & Acierno, R. (2019). Evidence-based psychotherapy interventions to improve psychosocial functioning in veterans with PTSD: An integrative review. Journal of Psychosocial Nursing and Mental Health Services, 57(10), 24-33.
Occupational stress contributes to mild depression.
The patient drinks a glass of red wine daily (most likely to cope with stress).
No time or desire for healthier coping strategies.
Risks and Goals:
Patient’s family has a history of diabetes. Her poor diet, stress, and lack of activity are associated with an increased risk of diabetes.
Goals:
Short-term:
Improve patient’s quality of life and with the help of exercise.
Address headaches.
Long-term:
Improve diet and habits.
Intervention
Evidence-based practices:
Physical exercise is helpful for the patients with work-related stress and anxiety (Freitas, Carneseca, Paiva, & Paiva, 2014).
Physical exercise helps alleviate work and stress-related pains in different parts of the body (Freitas-Swerts & Robazzi, 2014).
It also helps the workers with stress and burnout feel happier and enjoy a better quality of life (Freitas et al., 2014).
Steps of intervention:
Discussion of the problem (headaches, work-related stress, lack of activity, poor diet, daily drinking of alcohol).
Demonstration and explanation of EBPs and tips for the improvement of the patient’s condition and quality of life (academic articles and websites with healthy lifestyle advice).
Detailed outline of what the patient is recommended to change in her daily life (stop drinking wine, add more nutrients and vitamins to her diet, do mild exercise sessions, go for walks).
Discussion of the patients’ daily schedule and ways to fit the intervention into her life (finding free time and resources).
Checking the patients’ understanding of the strategy and readiness to commit to it.
Exercise:
Yoga (beginner level, short routines of 20-25 min);
Walks (15 min);
Exercise at work (self-massage of shoulders and neck, moving around the available space, stretching).
Vitamin B complex (“Why your job is causing you headaches—and what to do about it,” 2014).
Hydration (no less than 1.5 or 2 liters of water daily).
Final steps:
Testing the patient’s understanding of the importance of intervention.
Checking her level of readiness to commit to the practices outlined in her plan.
Asking her to list her tasks regarding her diet and daily exercise.
Providing her with a list of necessary practices. Possibly, helping her create a schedule of healthy practices matching her daily routine.
Offering additional tips for pain and stress and migraine relief options – massage, a visit to a chiropractic, meditation.
During the intervention, the patient will be informed about the likely connection between her occupational stress, overloaded working schedule and her headaches, drinking, and poor diet. Further, a couple of evidence-based practices described in recent academic articles will be used in order to help the patient understand that her problem can be addressed with the help of exercise.
A simple language will be used during the educational session in order to ensure the patient’s understanding of her problem and the required intervention. The latter will be broken down into bullet points and tasks with detailed descriptions and provided alongside a set of tips helping address her issue so that she can choose the strategies that are the most suitable for her daily life.
Since the patient is an atheist but is interested in Buddhism, she may respond well to a suggestion to use yoga as a form of stress release and mild exercise. She could either find time to go to a yoga class once or twice a week or simply try some of the safe and easy routines at home. Also, she will be recommended to go for short but brisk walks on a daily basis or every other day and do other forms of active exercise such as light jogging or cycling (The Migraine Trust, 2017).
As for her diet, she is recommended to consume more protein to improve the level of her energy and also add more oils in her diet and hydrate regularly.
According to Healthy People 2020, only 36% of employees report having access to occupational stress reduction programs (ODPHP, 2017).
The employees suffering from work-related stress and its symptoms need to be equipped to manage the condition independently if their workplace does not provide a corresponding initiative
Evaluation
Method:
The patient will be asked to mark the healthy activities in a journal on a daily basis. This would serve as an activity log led by the patient.
The primary markers of the positive result of the intervention will be the decreased severity of headaches, their diminished frequency, or complete disappearance.
Also, the patient will be asked to register her headaches and vomiting or fainting incidents and the time when they occur or how long they last.
Desired Outcomes:
Minimized severity of headaches.
Diminished frequency of the headaches.
Complete disappearance of pains.
Better moods daily.
Higher level of satisfaction with day-to-day life.
Alleviation of the patient’s mild depression.
A higher level of energy.
Lower frequency of fainting and vomiting incidents caused by headaches.
Additional Steps (in case of ineffectiveness of the intervention):
Evaluation for depression and burnout using standardized assessments and scales.
Recommendation of therapy for occupational stress.
If headaches continue or become worse – start assessment for an alternative cause other than occupational stress.
In her activity log, the patient will be asked to put down the activities she accomplished (such as walking, exercise, meditation session) and healthy diet components she added (vitamins, oils, fish, and white meat). She will be requested to mark the time when the practices were carried out and the length of the ones that are lasting (such as yoga session at 11 am – 20 minutes). This approach will help the patient maintain self-discipline and motivation. Most importantly, this method will help me, as a practitioner, see how well the patient followed the instructions. The patient’s records of headache, vomiting, and fainting incidents will help track the improvement (if any) and correlate it with the practices thus identifying the most effective ones.
Summary
The patient is suffering from headaches and mild depression most likely caused by her unhealthy lifestyle and overloaded working schedule.
The intervention targets her diet and physical activity as strategies to improve quality of life and reduce stress.
The patient will be given an educational session focusing on the nature of her problems and the need for intervention.
An activity log will be used as an evaluation method of the intervention and improvement or lack thereof.
References
Freitas, A. R., Carneseca, E. C., Paiva, & Paiva, B. S. R. (2014). Impact of a physical activity program on the anxiety, depression, occupational stress and burnout syndrome of nursing professionals. Revista Latino-Americana de Enfermagem, 22(2), 332-336.
Freitas-Swerts, F. C., & Robazzi, M. L. (2014). The effects of compensatory workplace exercises to reduce work-related stress and musculoskeletal pain. Revista Latino-Americana de Enfermagem, 22(4), 629-636.
Most of Julie’s physical health problems developed because of her poor mental state. Several adverse events in the girl’s life led to exhaustion and burnout, affecting relationships within the family with her children and her husband. In this regard, Julie, first of all, needs to accept the situation as it is, to appreciate the things and the context that she is no longer able to change. Almost any stress management strategy or technique begins with this step (Yevdokimova & Okhrimenko, 2021). In consulting with a specialist, Julie must assess all her main problems, break them down into smaller ones to find the critical approach to each, and reduce all their negative consequences to zero.
The main direction where all the vitality of Julie goes is in her work. First of all, you need to deal with the problem of deadlines: you need an integrated approach. Julie should muster up the courage to tell management about these negative consequences on behalf of the company’s employees. Suppose the company does not resolve the issue. In that case, Julie should resort to the social support of colleagues, and the reorganization of her working hours, where there will be mandatory breaks and opportunities for comfortable rest. When Julie comes home, she should do a cognitive restructuring: focusing on negative thoughts about work should be replaced by positive moments of spending time with her family. According to this technique, a change in the vector of ideas can change the patient’s emotional state accordingly (Ugwoke et al., 2018). This issue should be brought up for discussion with the husband so that the family also tries in every possible way to meet halfway in this challenging situation so as not to aggravate it.
Since the work still needs to be done, the patient’s mother also needs help that cannot be denied. Therefore, it is necessary to focus not on the problem and adapt your behavior accordingly but on emotions that create a nervous background and shape conduct in this situation. Emotion-focused strategies are just used in cases where the patient does not control external factors that cause stress. Techniques like these require a distraction that you can do with your family by going out to mum’s house cleaning and then to a picnic, two important things together. Although the emotional disclosure of Julie can occur in quarrels, the meditation technique must be additionally introduced. Such a psychological strategy promotes awareness and acceptance rather than suppression of problems and distraction from unpleasant thoughts (Crowe & Van Puymbroeck, 2019). As a result, the harmony necessary for calm problem-solving without nerves is achieved.
Finally, Julie can use cognitive restructuring techniques more comprehensively by turning to reframing. This strategy requires a new look at stressors in light of their positive aspects. Julie may ask for a vacation during which she will need to discuss a possible job change, gain strength and rethink her techniques for dealing with deadlines. If the load is significant and can affect Julie’s physical health, serious action must be taken. Otherwise, if it is enough to rebuild her emotional background, and use the social support of employees, then Julie should only optimize her working time, paying more attention to rest and breaks. As a result, the girl will be able to look at all things more positively, bring her mother to a full recovery, and charge and recharge with an optimistic mood in the family.
