Advancing Nursing Through Inquiry and Research, Literature Review Example

Introduction

The purpose of this assignment is to analyze the research retrieved to determine if the research would give rise to advancement of nursing theoretical research. The topic I have chosen is Post-Traumatic Stress Syndrome-does it really exist. There is much research on PTSD on the internet, in medical journals and in various books written by medical professionals to support that PTSD is real.  The diagnosis is in fact supported by the American Medical Society of Physicians and Psychologists as a cognitive and behavioral disorder brought about by exposure to severe traumatic situations such as war, accidents and abuse. This syndrome differs from other diagnosis in that it manifests months after exposure to the tragic event in someone’s life and can exhibit symptoms even years after exposure if the patient is not properly treated for the disorder. Literature found in scholastic journals and medical journals support the theories that the diagnosis is real and can support nursing advances because nurses’ aid in the treatment of the disorder by accompanying doctor’s with clinical diagnosis in mental hospitals and closed doctor/patient settings such as private practices. Understanding the theory behind the diagnosis is essential for a nurse to aid a doctor with understanding the disorder. Further this understanding is essential to guide the patient through counseling sessions and aiding the in-patient or out-patient person whilst working as a nurse in a facility designed to help those with the disorder.

Summary and Analyses of Research

The Trouble with PTSD (1999) by Dr. Stratton commences with presentation of the tax benefits of being labeled PTSD in Australia as receiving free medical care for yourself and your children, free education for your children and a stipend of about $1100.00 per month permanently. The government is accused of labeling war veterans into a stereotyped category as PTSD’s rather than correctly diagnosis patients individually. This entanglement gets confused with litigation issues rather than clinical diagnosis. The reductionism theory supports the theory that there is more than one cause for PTSD. “Determination tries to minimize casual causes of PTSD such as A causes B.” (Stratton, 1999). The theory further focuses on the individual experiencing the problem rather than a group of people experiencing the problems. The articles are coherent and agree in content and these theories present research that is applicable to properly diagnosing patients with PTSD rather than simply putting taking some symptoms that appear to be that of PTSD and labeling a person of that such because they experienced a severe traumatic event in their life. This concept is the same as saying if we place a glass on a table it will break. Well the answer to that is the glass might break considering the circumstances of external forces.

Factsheets: Forensic Validity of a PTSD Diagnosis is supported by Claudia Baker, MSW, MPH and Cessie Alfonso, LCSW two well distinguished social workers and theorists of the mental health professional alliances. The article speaks about the ‘gate-keeper’ of diagnosis of PTSD which is synonymous to a correct diagnosis that of a patient being exposed to a severely traumatic event. “Experts agree the definition of traumatic event involves a two-fold of  “the person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others.” and “the person’s response involved intense fear, helplessness and horror.” (Baker, 2009).  This theory is cemented in defining how a patient should be diagnosed clinically as well as legally for it is vehement for attorneys’ to understand the nature of the diagnosis for defense reasons. I agree with the two-fold factor involved in the diagnosis and feel with an adequate and pronounced diagnosis clearly defined research can lead to better cures for the disorder or to help the patients deal with the causing factors of stress related to the disorder. Though it is deemed the causing action should be of physical nature the after effects are psychological which a nurse is trained to deal with to aide the patient’s recovery. “Because psychometric instruments are used by doctors and nurses to make diagnosis the nurse’s job is very important towards the diagnosis and treatment of PTSD.” (Baker, 2009).  Often nurses and psychiatric technicians work in this field of psychology to aid the psychiatrists. “Biological changes such as heart rate increase and blood pressure changes are often a cue to the disorder.” (Baker, 2009). Nurses are educated and skilled in noticing these changes.

Post-Traumatic Stress Disorder-Does it exist? by Sparr reflects the refining of the criteria to diagnose PTSD. The author states “often prosecutors try to twist and stretch the DSM-II to fit legal ramifications of the disorder to fit legal rules” (Sparr, 1995) which are not congruent with the real diagnosis semantics. The key to cutting out the legal idiosyncrasies is to elimination of the stresses that people refer to as PTSD mistakenly. This article can be properly referenced as facts and not theories of the diagnosis which can be used in any field of medicine. I agree that the diagnosis should be based on clinical findings through observations rather than distorted findings that are inferred by lawyers and the courts. Idle claims referred to as stresses or stress disorders should be eliminated and re-classified as another diagnosis. Obtaining the correct diagnosis is essential to the future field of psychiatry, nursing and the medical field for relevancy, reliability and validity factors associated.

The article Does the modified Stroop effect exist in PTSD gives evidence from dissertation abstracts and the peer reviewed literature written by PhD Psychologists from the University of Vermont in 26 June 2009. This research is considered valid and reliable for it is supported by two psychologists from the University sharing collaborative theories of research. “The modified Stroop effect (MSE) in which participants show delayed colour naming to trauma-specific words, is one of the most widely cited findings in the literature pertaining to cognitive bias in posttraumatic stress disorder (PTSD).” (Kimble, 2009). The top-drawer effect analysis was used for methodology purposes which is a well-known and established method based on positive findings in psychological research with relation to PTSD patients.

Post Traumatic Stress Disorders by Cyber Sarges (2009) is very informative and gives reference in an elementary style what just about anyone can understand about the disorder and what causes the disorder. Research speaks of potential patients from the military Gulf and Vietnam wars that are privy to having PTSD. From reading other articles on PTSD one might find some of the information to be credible. The article further speaks about PTSD being caused by traumatic effects from earthquakes and hurricanes which further research shows this can certainly be true. The article references points from the National Institute of Mental Health which is a credible source for obtaining information about PTSD. However, what I have a problem with is the fact there are no references to link to validate the information obtained on the website. Anyone can make a post and state the National Institute of Mental Health stated such a thing or idea. However, after reading other articles on PTSD most of the information in this article is true. The author needs to simply find a better way of supplying validation for the referenced material. If this information is validated this would be an excellent article to be used in the nursing and psychiatric fields because it gives useful generic and specific insight as to the causes of the syndrome and who are most likely to develop the syndrome. “The most interesting part of the article references future research and findings that psychologists hope to gain on the syndrome.” (“Post Traumatic Stress Disorder”).

The article PTSD: Two new programs; two big ignored questions reflects a new theoretical approach to PTSD studies. “There is evidence that only in the United States that the numbers of patients reported with PTSD continue to rise even long after the end of wars.” (Dubbs, 2009). Further the reported rates of veterans and soldiers with PTSD are much higher in the United States than in any other country. Dr. Seal has attributed this high rise in numbers and continued syndrome to repeated deployment of soldiers and no defined front lines in wars such as Iraq and Afghanistan. I agree with the first analogy but the second is perilous because there is never a definitive line in any country with relation to war. It normally takes a year for symptoms of PTSD to appear in a victim of traumatic stress therefore the doctors and nurses should be prepared to deal with the situations beforehand. This information is useful in theoretical studies on how to treat the disorder and U.S. doctors and nurses might release this information to the government so they can try to incorporate disorder prevention camps whilst in war. The Royal Marine Programme in the United Kingdom has already implemented the TRIM programme to head off trauma risk in times of deployment. They are taking an extra step towards proactive management of their soldiers’ emotional well-being.

The article DSM V Shadow Team Strikes Back at Psychiatric Establishment on PTSD (2009) takes a different approach to the study of PTSD. This article examines negative comments about the existence of PTSD and particularly how the military has refused to give the honorary Purple Heart to soldiers wounded in war due to PTSD. My question is why does a soldier that loses a limb or a finger deserve the Purple Heart whereas a soldier who loses his ability to live an emotionally peaceful life because of the war not deserves a purple heart? There remains to be the same stereotype that disadvantages the mentally ill in society across the world. If a person has heart disease and has to take medication he/she is considered cured for the moment and ‘normal’ in society as long as he/she takes his/her medication. But if a mental patient takes his/her medication and is considered ‘stable by a psychiatrist’ the community still frowns upon that person and questions their worth because they have a ‘mental’ rather than physical impairment. People cannot help what they are genetically born with or genetically prone to developing especially with relation to PTSD which is brought on by traumatic triggers in a person’s life. “The military states that because symptoms of PTSD develop as much as a year after combat there is no way to link the trauma to the actual combat.” (“DSM V Shadow Team Strikes Back at Psychiatric Establishment on PTSD”) This statement is actually contrary to the initial symptomatically diagnosis of the disease. The military just does not want to bring dishonour upon the military by awarding the mentally ill when in fact they are the cause of the mental illness. I agree with the points of the article but I disagree with the military’s standpoint with reference to the Purple Heart Award. Their standpoint is weak and a disgrace to the men and women who fight for our country. It is wise and useful to know how the military views the work that the sufferers of PTSD encounter when working as a nurse because it shows the indignant views that still exist in America and further helps with counselling sessions to help guide the patrons through the recovery process.

Sandor’s 2009 article “How Long Does PTSD Last references the fact that this disorder is uncontrollable and there is a perception change in the world as the person sees it.” (Sandor, 2009). The article further references the symptoms that occur as well as the outside symptoms including anxiety and depression. The article is supposed to discuss how long the syndrome will last but it does little to reference specificity to that matter. The article instead gives generalizations based on the relation of the traumatic effect and how well a person can manage the effects of the trauma. I am very displeased with this article in relation to theoretical applications for this is a learned article probably with hopes of simply inferring a message to the avid reader. Nothing in particular can be gained in hopes to apply this to nursing. There is not enough qualitative or quantitative data referenced to supply ample information to the medical and/or psychiatric fields. The article does give reference to other links but they are very simplistic in nature with no real value to the nursing field.

Tulls’s article “PTSD and Impulsive Behaviors gives rise to theoretical ideas that there is existence of relativity to PTSD and impulsive behaviors.” (Tull, 2009). These two symptoms can co-exist and often one can trick the doctor into diagnosis the wrong disorder. Though they co-exist the doctor may misdiagnose the patient as having another disorder close to the symptoms of PTSD. What is relevant in this article is the idea that impulsive behavior exists because of the nature of the stress perpetrated on the patient and this is useful to the nursing field in understanding future behavior of the patient. Understanding anticipated behavior helps to treat the patient with medication and counseling techniques.

“The final source Can There be a Cure for PTSD written by Baldwin, PhD raises issues written by Dennis Donovan and examines if there is a known or anticipated cure for PTSD.” (Baldwin, 2009). The author starts off with a poem that argues against the views shared by Donovan. The poem is one that creates an own demise because there is no hope for PTSD patients with relation to the poem. The author refers to this poem as comparing ‘bumble bees cannot fly’. Now we know that bumble bees can fly. “Though there is no causative agent of the syndrome, indeed, given the right circumstances, almost anything can be traumatogenic.” (Baldwin, 2009). Saying PTSD cannot be cured is the same as saying children from foster homes can never lead productive lives. True their journey may be more difficult than others but with the right mindset and support system anyone can overcome a tragedy. The doctor believes effort to make things better for his PTSD patients are delivered in ‘small steps’. Neural reorganization is driven by the infliction of positive experience in a person’s life.  I feel this doctor has supported his article both medically and spiritually. Spiritual forces are needed to recover from PTSD and with this said this article is especially beneficial to the nursing field. It can provide useful insight on how to tackle the long-term recovery of PTSD patients. It is a spiritual, emotional and physical recovery.

Conclusion

I have chosen to group the Summary and Analysis together for the purpose of this paper to better be able to contrast the reason for using these articles in the field of nursing.  The majority of the articles presented with reference to PTSD support the theories of research presented to further the study of nursing especially in the psychiatric nursing field. With respect to the physical ailments associated with PTSD as referenced, nursing is needed to evaluate the symptoms of blood pressure and possibility of stroke and heart failure associate with high levels of stress and anxiety. A few of the articles were interested but written as a generalization and not theoretically sound to present in the medical or psychiatric fields. I wanted to present a combination of useful and non-useful articles so that the reader could differentiate between articles of research that could advance the study of nursing with respect to PTSD.

References

Stratton, D. (1999) The Trouble with PTSD Retrieved November 25, 2009 from, http://www.fsu.edu/~trauma/Art4v5i1.html

Baker, C. (2009) Factsheets: Forensic Validity of a PTSD Diagnosis Retrieved November 25, 2009 from, http://www.svfreenyc.org/survivors_factsheet_98.html

Sparr, L. (1995) Post-traumatic stress disorder-Does it exist? Retrieved November 24, 2009 from, http://www.ncbi.nlm.nih.gov/pubmed/7643834

Kimble, M. (2009) Does the modified Stroop effect exist in PTSD? Evidence from dissertation abstracts and the peer reviewed literature Retrieved November 24, 2009 from, http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VDK-4VKDMTK-3&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1110146023&_rerunOrigin=google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=20535df3a23321a7e82916c25bbd1ace

Cyber Sarges (2009) Post Traumatic Stress Disorder Retrieved November 25, 2009 from, http://cybersarges.tripod.com/PTSD.html

Dobbs, D. (2009) PTSD:  Two new programs; two big ignored questions Retrieved November 25, 2009 from, http://scienceblogs.com/neuronculture/2009/09/ptsd_two_new_programs_two_big.php

DSM V Shadow Team Strikes Back at Psychiatric Establishment on PTSD (2009) Retrieved November 25, 2009 from, http://www.beforeyoutakethatpill.com/index.php/2009/03/24/dsm-v-shadow-team-strikes-back-at-psychiatric-establishment-on-ptsd/

Sandor, C. (2009) How Long Does PTSD Last? Retrieved November 25, 2009 from, http://scienceblogs.com/neuronculture/2009/09/ptsd_two_new_programs_two_big.php

Tull, M. (2009) PTSD and Impulsive Behaviours Retrieved November 25, 2009 from, http://ptsd.about.com/od/relatedconditions/a/ptsdimpulse.htm

Baldwin, D. (2009) Can There be a Cure for PTSD Retrieved November 25, 2009 from, http://www.trauma-pages.com/s/cure-me.php