Loading presentation...

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

Make your likes visible on Facebook?

Connect your Facebook account to Prezi and let your likes appear on your timeline.
You can change this under Settings & Account at any time.

No, thanks

POST TRAUMATIC STRESS DISORDER

No description
by

Jinju Baik

on 11 April 2015

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of POST TRAUMATIC STRESS DISORDER


ANXIETY: POST
TRAUMATIC
STRESS DISORDER

A presentation by Nightmare Dressed Like a Daydream Group
What are the first words that come to mind when you think of PTSD?
Sexual abuse
Childhood trauma
War
Anxiety
Nightmares
How about . . .
Torment
Suffering
Fear
Powerlessness
Mental Health Problems
A BRIEF OVERVIEW OF PTSD
CASE STUDY & SKIT
CASE STUDY & SKIT (CONT.)
SO WHAT IS POST TRAUMATIC STRESS DISORDER
?
THE THEORY
PATHOPHYSIOLOGY
PRECIPITATING STRESSORS
SYMPTOMATOLOGY

How do we
care
/
treat
clients with PTSD/anxiety?
Pharmacotherapy
CBT
Other forms of treatment include:
D
I
A
G
N
S
I
S
O
T
C
PCL
PTSD checklist
The Post-traumatic Stress Disorder Scale
The Davidson Trauma Scale
*For DSM-IV
*For DSM-IV

The Detailed Assessment of Post-Traumatic Stress is also a 104 item self-report assessing trauma exposure, 17 symptoms, and functional impairment.
The Impact of Event Scale
The Mississippi Scale
The Minnesota Multiphase Personality Inventory
and
the Personality Assessment Inventory
assess personality and psychopathology. They have special PTSD scales, assess comorbid disorders, associated clinical features, estimate severity of stressor, and evaluate bias.

There are specialized scales for Children such as check lists and self-reports. If you want more information about that Effective Treatments for PTSD from the International Society for Traumatic Stress Studies is a good book to read.
Flashbacks
Triggers
Crisis
Risk
Avoidance
Medical Management and Treatment for PTSD


i. Diagnostic Tests & Procedures
ii. Pertinent Assessment Protocols & Tools
iii. Common Medical Treatments & Approaches

• 1960’s anxiety disorders were treated with benzodiazepines
• In 1970’s and 1980’s it was found that Tricyclic antidepressants and MAO inhibitors were better at treating panic disorders

Antidepressants
discovered in treating some anxiety disorders consistent with the fact that anxiety and depression linked in patients
• 1990’s Selective serotonin reuptake inhibitors began their first line of treatment
• Most common substance used is self-administered and not prescribed which is alcohol

Antidepressants
• Most common are SSRI, SARI, and NaSSA
• SSRI paroxetine (paxil) and sertraline (zoloft), and the SNRI venlafaxine (Effexor) were most commonly chosen for PTSD

Medications target worry, anxiety, and tension in muscles, concentration, hyperarousal, low energy, restlessness, and insomnia

Focuses on cognition, the way people think, and behavior, the way people act
For PTSD this is,

conditioned fear and operant avoidance

Some examples of therapy include: systemic desensitization, relaxation training, biofeedback, prolonged exposure, stress inoculation training,
psychological debriefing
, cognitive therapy or cognitive process therapy etc.
Goals of care for one actively experiencing a stress response:
eliminate or moderate the stressor (if possible), reduce untoward effects of the stress response, and to facilitate the maintenance or development of positive coping. (Austin & Boyd, 2010)
The Post Traumatic Disorder Checklist is a self-report of PTSD symptoms: the civilian version, military version, and specific version where stressors are identified.
The PTSD Scale is a 49 item self-report measure.

It is divided into four sections: traumatic events, most distressing event, frequency and severity of symptoms, and functional impairment.
The Davidson Trauma Scale is a 17 item self-report assesses severity and frequency of each symptom on a 4 point scale over a month.
The Impact of Event Scale is most widely used self-report: 15 items where 7 assess intrusiveness of symptoms and 8 assess avoidance.

Because hyper arousal was not assessed a revised scale was made where 6 hyper arousal items were added and 1 dissociative item making it a 22 item scale.
The Mississippi Scale is a 35 item self-report assessing symptoms and features. Most common for combat related PTSD.
The characteristic symptoms that develop after a traumatic event involving a personal experience of threatened death, injury, or threat to physical integrity.

Examples:
- interpersonal trauma (physical and/or sexual assault as a child or an adult)
- military combat, natural disasters
- terrorist attack
- taken hostage
- incarceration as prisoner or war
- torture
- car accident
- diagnosis of a life-threatening disease
(Austin & Boyd, 2010, p.435)

Physical symptoms are viewed as an activation of the SNS fight or flight (stress response): increased heart rate, paleness, decreased saliva, increased breathing and diaphoresis (Shea, 1998).
Savannah developed PTSD after her traumatic experiences of being sexually assaulted. She was not diagnosed until she was 15, however she has lived with the symptoms for the whole duration of time.
Relates to Neuman's System Model: Normal Lines of Defense which helps maintain health and wellness.
Everyone develops a set of responses to stress that make up this line of defense.
When “physiological, psychological, socio-cultural, developmental, or spiritual influences” are unable to handle the stress, this line is broken = disease = PTSD (Potter & Perry, 2014, p.484).
Risk factors for PTSD include:
- prior diagnosis of depression or acute stress disorder
- pre-existing personality disorder
- gender (female)
- duration/intensity of trauma
- environmental issues
- coping style
- low self esteem
(Austin & Boyd, 2010, p.435)

Savannah had numerous precipitating stressors leading to her diagnosis. She grew up in a toxic environment for the first part of her life, she is female, and has never learned how to cope properly as she has had little support. This lead to her weak normal line of defense. All the events of her life leading up to the sexual assaults resulted in this breakdown.

The person re-experiences the traumatic event through distressing images, thoughts or perceptions (nightmares/terrors) (Austin & Boyd, 2010, p.864).
AVOIDANCE
The person will try to avoid flashbacks, extreme stress upon exposure to an event or image that resembles the traumatic event. People will avoid discussing the event all together. (Austin & Boyd, 2010, p.864).

HEIGHTENED AROUSAL
This is evidenced by difficulty sleeping, irritability, poor concentration, exaggerated startle response or hypervigilance (paranoia) (Austin & Boyd, 2010, p.864).
Symptom clusters must persist for at least 1 month for a diagnosis of PTSD to be made. (American Psychiatric Association, 2013)

Savannah has these three core symptom clusters constantly, as well as the 4th symptom of negative cognition. She has
nightmares
about the events always waking up crying and sweating. She
avoids
males, and feels she can not trust anyone. Savannah is constantly
irritable
and on edge; she is
paranoid
everywhere she goes and is
anxious
that someone is going to hurt her again.

3 Core Symptom Clusters
RE-EXPERIENCING
PNUR CONCEPTUAL FRAMEWORK AND PTSD
i. The Neuman's System Model
ii. 5 Variables
iii. Stressors
iv. Universal Experiences

Central Core
lines of resistance
normal lines of defense
flexible lines of defense
*Outer protective boundary to the NLD, LOR, and Core
*Is dependent on amount of
sleep, nutritional status, and the quality and quantity of stressors
( )
*If this fails to protect, the process continues towards the core
Since Savannah has been exposed to so much stress, the FLD are unable to manage with the stressors, affecting the NLD.
Savannah was sexually and emotional abused multiple times, has poor sleep due to nightmares, has poor nutrition due to limited finances/resources and lives in an impoverished living environment with poor coping skills etc.
All of these factors cause a threat to the wall that protects the basic structure, leading to
disharmony
and
illness.
When the stressors penetrate the NLD, the LOR are activated, resulting in the person displaying signs and symptoms of the illness.
Weakened immune system
Depressed, anxious, fearful, hypervigilant
Developing PTSD with severe symptoms
psychological
HEALTH
Illness occurs when there is a disequilibrium between these two components (Neuman, 2002).
Environmental Determinants
Part 2
Environmental events causing distress for Savannah:
·
Low socioeconomic status
· Minimum education
· Lack of employment
· Exposure to prior trauma
· Family dysfunction
·
Parental death
·
Exposure to repeated upsetting reminders
·
Subsequent crisis events
·
Financial issues
· Lack of social supports
· Health care issues
"
Trauma
is Contagious"
What is Vicarious Trauma?
Vicarious trauma is “the transformation or change in a helper’s inner experience as a result of responsibility for, and empathic engagement with traumatized clients”


An outcome of working with clients who are vulnerable to trauma issues
You begin to take on symptoms of trauma from hearing about trauma over + over
It is not a single event, It is a process that unfolds over time
It happens because you care
It happens because you feel committed

Who is at risk?
Avoid problems/difficult feelings, blame others, withdraw (poor coping)
Experienced trauma
Stress
No spiritual resources: source of meaning, purpose and hope
Lack social support and connections
Are exposed to work related trauma
Unsustainable work-life boundaries
Working in an organization that does not offer awareness programs: effective management, open communication and good staff care
How does VT affect RPN and patients?
· Difficulty managing our own emotions & anxiety
· Problems managing boundaries
· Problems with relationships (difficulty
connecting with people around you)
· Physical problems
· Loss of meaning and hope
· Affects one's prior beliefs and perception

What can you do? It's simple:
Savannah is a 20-year-old Caucasian female, slightly overweight, pink hair with untidy grooming. She came into the emergency at Surrey Memorial Hospital March 12, 2015. Ivana, a psychiatric nurse on the ACT team working with Savannah found her passed out on the floor at home with half empty bottles of Tylenol and Gravol next to her. Once stabilized, the emergency room RPN on shift came to assess her. Savannah confessed this was a suicide attempt. “I just want it all to go away, the thoughts never leave my mind, I always think about it.” After further assessment by a physician Savannah was admitted under the Mental Health Act as an involuntary patient and transferred up to the psychiatric assessment unit (PAU).

History
Savannah was diagnosed with PTSD at the age of 15 with a differential diagnosis of Major Depressive Disorder a few months after. For the first 6 years of her life she grew up troubled with an alcoholic mother and her father was on and off addicted to crystal meth. Savannah was very close to her father and was the only person she could ever count on, but he passed away when Savannah was 6 and she was taken into foster care. She was adopted by a loving family which unfortunately did not last for long. Savannah was first sexually abused at the age of 8 by her babysitter’s boyfriend and his friends. The babysitter’s boyfriend took her virginity. She began cutting her wrists at the age of 12. At age 14, Savannah was sexually assaulted again. At age 16 Savannah dropped out of school and moved into a woman’s shelter. She began to work as a prostitute and suffered severe physical and emotional trauma during that time. She has been in and out of emergency several times in the past few years for physical injuries, self-harm and suicide attempts. Currently, Savannah is in an unspecified relationship with her girlfriend Mary in an apartment in downtown Vancouver.

LEARNING OBJECTIVES
STRESSORS
developmental
sociocultural



Define Anxiety and PTSD
DSM IV-TR and V comparisons of PTSD
Case Scenario (skit)
Introduce relevant Mental Health Act forms and involuntary admission criteria
Pathophysiology, precipitating stressors, symptoms
Conceptual framework: Neuman's, 5 variables, and universal experiences
Assessment tools, procedures and tests
Medical management, treatment, and caring for our patients
Psychiatric Nurse Role for anxiety in general and Care Plan for case scenario
Environmental (positive and negative) and social determinants of health for people with PTSD: apply to case scenario
Media and portrayal
The issue for psychiatric nurses working with clients suffering from trauma/anxiety: Vicarious trauma (VT) definition and explanation, SKIT #2, how this affects our roles as students and RPN’s. What the RPN can do to avoid/cope from VT. How to address/ be aware of issue through trauma informed practice and other resources. Ethical issues regarding competence of RPN experiencing VT, SKIT #3, legal consideration for the “duty to report” under CRPNBC standards.
Self-Awareness and Safety


- Basic education
- No occupational skills
- Works as a prostitute
- Poor self-concept
intrapersonal
intrapersonal
intrapersonal
- Mother was an alcoholic
- Father was on/off crystal meth
- Had close relationship with father
- Sexual, emotional, physical abuse
- No close friends or relatives
- Suffered numerous relationship problems


- Poor personal boundaries with men
- Intense dislike for men
- Difficulty keeping in close contact with few friends


- No motherly figure, father passed at an early age
- Feelings of loneliness, abandonment

interpersonal
interpersonal
interpersonal
- Does not feel safe in her community
- Engaged in dangerous harmful activities
- Limited social services/mental health centres
- Been in foster homes
- Limited finances
- Abusive environment



- Substance abuse
- Psychological trauma from abuse
- Negative influences from her surrounding environment


- Grew up in a low class environment
- Lived in impoverished, prostituting environment

extrapersonal
extrapersonal
extrapersonal
Universal Experiences
CRISIS
COMFORT
HOPE
LOSS
POWER
RESILIENCY
INTEGRITY
How has Savannah's life been personally affected in relation to these universal experiences?
SKIT #2: The
ISSUE

What do you think the RPN can do to avoid/cope VT?
How can this affect our care for our potential patients?
What is ANXIETY?
What is PTSD?
Anxiety is an uncomfortable feeling of apprehension or dread that occurs in response to internal or external stimuli and can result in physical, emotional, cognitive, and behavioral symptoms (Austin & Boyd,2010).
A mental disorder characterized by persistent, distressing symptoms lasting longer than 1 month after exposure to an extreme traumatic stressor (Austin & Boyd, 2010).
What is the difference between Compassion Fatigue, Burn-out, and
Vicarious Trauma?
Vicarious Trauma as an Issue
Vicarious Trauma is...
NEGATIVE COGNITION AND MOOD
*New in the DSM V*
Involves negative alterations in thought and mood as characterized by symptoms like: inability to remember an important aspect of the event(s), persistent negative emotional state, persistent inability to experience positive emotions and others (Croft, 2013).
CRPNBC PRACTICE STANDARDS
Standard 6 Ethical
 Consistently applies deliberate consciousness/self-awareness within professional practice.

Environmental Determinants
Standard 3 Professional Responsibility
 Strives to maintain a level of personal health, mental health, and well being in order to provide competent, safe, and ethical care.
 Recognizes one’s own limitations and uses professional judgment when accepting responsibilities.

Standard 5 Legal
 Takes appropriate action to ensure that own and others’ practice conforms to acceptable standards.

Now, how about those who witness VT from colleagues?

LEGAL DUTY

Duty to Report under Health Professions Act (Practice Standard)

In B.C., the Health Professions Act establishes a legal duty for nurses to report situations in which there is a good reason to believe that a health professional's practice is impaired or incompetent and may pose a significant risk to the public.

ETHICAL DUTY

The ethical duty to report arises from nurses' primary responsibility, which is to provide competent and ethical care to clients (e.g. pattern of impaired practice).

(CRPNBC, 2013)
SOCIAL DETERMINANTS
SOCIAL JUSTICE
PTSD AND MEDIA
According to
Standard 6
, it is our duty to report abuse of client’s rights, unethical, incompetent and illegal practices.
In employment situations, nurses may report to their supervisor or employer, who will then report to the appropriate regulatory body.
if the supervisor or employer didn't take the appropriate actions to resolve this n
urses must report in writing to the appropriate regulatory body.


What should we do as nurses?


You are violating the Law
 May be the subject of a complaint, or maybe subject to disciplinary measures

What happens if a registrant does not fulfill their duty to report?
Safety for the patient is compromised
Impairs therapeutic relationships
Not competent enough to advocate for patient
Can impact overall recovery for patient
How does this issue relate to
Vicarious trauma is an issue for us as RPNs because it does not follow the standards of practice that we should abide by.
Skit #3
ESCAPE

REST
PLAY
TRANSFORM
How do we cope with and prevent Vicarious Trauma?
Trauma Informed Practice
Resources to help you address, prevent, and/or cope with VT:
REFERENCES
A combination of CBT and pharmacotherapy is proven to be the most effective form of treatment for patients with PTSD.
Eye movement desensitization and reprocessing
Hypnosis
Creative arts therapy
Psychodynamic therapy
Group therapy
School-based therapy
Psychosocial rehabilitation
Hospitalization and treatment of PTSD with comorbid disorders
What do the nurses have to keep in mind when administering anti-anxiety or antidepressant medications?
TREATMENTS
TREATMENTS
NURSING ROLES
Care of individuals experiencing stress
Hollistically assess biological, psychological, emotional, and environmental (physical & social) domains
Provide coping
resources
Changes in their life positive or negative
Recognize the potential for stress and to strengthen or develop positive coping skills
Sometimes a combination of these treatments can be used.
TR SKILLS
What TR skills are helpful in dealing with clients who are experiencing anxiety?
TR SKILLS
DSM-IV/TR AND DSM-V
COMPARISON OF PTSD
DSM-V:
Trauma and Stressor Related Disorder PTSD
DSM-IV-TR:
Anxiety Disorder PTSD
A. The person has been exposed to a traumatic event
C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma)
D. Persistent symptoms of increased arousal (not present before the trauma)
E. Duration of the disturbance (symptoms B, C, and D) is more than 1 month
F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

(American Psychiatric Association, 2000)
B. The traumatic event is persistently re-experienced
A. Exposure to actual or threatened death, serious injury, or sexual violence

B. Presence of one (or more) of the intrusion symptoms associated with the traumatic event(s)

C. Persistent avoidance of stimuli associated with the traumatic event(s)

D. Negative alterations in cognition's and mood associated with the traumatic event(s)

E. Marked alterations in arousal and reactivity associated with the traumatic event(s)

F. Duration of the disturbance is more than
1 month

G. The disturbance causes clinically
significant distress or impairment in
social, occupational functioning etc.

H. The disturbance is not
attributable to the physiological
effects of a substance or
another medical
condition
(American Psychiatric Association, 2013)
Case Scenario
As we act out the case scenario SKIT #1, underline, highlight, take notes on anything related to the 5 variables in the case study, and be prepared to answer some questions!
Serotonin syndrome, psychological/physical dependence of benzo's, increased risk of suicide
Risk factors for PTSD are divided into 3 categories: Pretraumatic, Peritraumitc, and Posttraumatic (American Psychiatric Association, 2013).

PRE TRAUMATIC
- factors that make Savannah more vulnerable to trauma (American Psychiatric Association, 2013)

PERI TRAUMATIC
- factors occurring around the time the trauma occurred

POST TRAUMATIC
- factors that occur after the traumatic event
(American Psychiatric Association, 2013)


IF YOUR COMPASSION DOES NOT INCLUDE
YOURSELF
it is incomplete
- Jack Kornfield
* The GOOD NEWS: Vicarious Trauma is
not permanent!
THOSE WHO:
Who is at risk?
We are.
What happens when the trauma of the client affects you?
*FIND FUN
Neat Fact: PTSD is also referred to as OSI (Operational Stress injury) among post-war soldiers because..
Employment/work
Income
Food insecurity
Housing
Early childhood development
Education
Healthcare
Social Exclusion
Social Safety Nets
Identity
Trauma awareness
Emphasis on safety trustworthiness
Opportunity for choice and collaboration
Strength based and skill building
American Psychiatric Association. (2000).
Diagnostic and statistical manual of mental disorders
(4th ed.,
text rev.). Washington, DC: Author.

American Psychiatric Association. (2013).
Diagnostic and statistical manual of mental disorders
(5th.
ed.). Washington, DC: Author.

Austin, W. & Boyd, M. (2010).
Psychiatric & mental health nursing for Canadian practice
(2nd ed.).
Philadelphia, PA: Lippincott Williams & Wilkins.

Cohen, J.A., Foa, E.B., Friedman, M.J, Keane, T. M. (2009). Effective Treatments for
PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies. New York
Guildford Publications Inc.

College of Registered Psychiatric Nurses of BC. (2013). Duty to Report under Health Professional
Act Practice Standard. Retrieved from http://www.crpnbc.ca/wp-content/
uploads/2014/04/2014-12-15-Duty-to-Report-under-HPA.pdf

Croft, H. (2013).
How Did PTSD Change from the DSM-IV to the DSM-5?
Retrieved from http:
www.healthyplace.com/blogs/understandingcombatptsd/2013/12/18/ptsd-change-dsm-iv-dsm-5/

Herman, J. L. (1997).
Trauma and recovery.
New York: BasicBooks.

Karim, M. (2014).
Vicarious Trauma
[Class Handout]. Department of Psychiatric Nursing. Douglas College.
Coquitlam, B.C.

Landau, E. (2009, November 7). Retrieved March 11, 2015, from http://www.cnn.com/2009/HEALTH/
11/06/military.psychiatrists.fort.hood/index.html?iref=24hours

McLeod, S. A. (2008). Erik Erikson. Retrieved from http://www.simplypsychology.org/Erik-Erikson.html

Neuman, B. M., & Fawcett, J. (2002).
The Neuman systems model.
Upper Saddle River, NJ: Prentice Hall.

Pearlman L. and Mckay L. (2008).
Understanding and Addresing Vicarious Trauma.
Retrieved from: http://
www.headington institute.org/files/vtmoduletemplate2_ready_v2_85791.pdf

Shea, S. C., (1998).
Psychiatric Interviewing, The Art of Interviewing
(2nd Ed.). Philadelphia, USA: W.B.
Saunders Co.


Social Justice is about how all individuals are responsible for the equal dispersion of goods and services in their society.
Savannah, is one of these individuals where lack of employment, social supports, education and early childhood development cause her to have poorer health outcomes when dealing with her PTSD.
Certain groups such as individuals that
live in poverty have poorer health outcomes
regardless of their genetics and biology because of the lack of supports. Inequities exist because of the many different social classes.
Normalization:
many people have anxiety because they worry about how other people view them, have you ever had this concern?
SOLER
Self-awareness, Progress response:
how does it feel for you, talking a psychiatric nurse about your life?
Open ended questions
Curiosity and compassion
Empower
Basic skills:
warmth, genuineness, empathy, paraphrasing, etc



http://www.melissainstitute.org/documents/meichenbaum_selfcare_11thconf.pdf

http://www.headington-institute.org/services-and-contact-info

https://compassionfatigue.ca/

NURSING CARE PLAN
How do we address the issue?
CRPNBC resources for VT on the site
As psychiatric nurses, we have the
legal
and
ethical
duties to report incompetent or impaired practice as well as unethical conduct.

CRPNBC

Standard 8 Professional
 Accepts responsibility and accountability for one’s own actions taking all necessary steps to prevent or minimize harm.
(CRPNBC, 2013)
*Represents a stability state for the person
*Includes behaviours such as
usual coping patterns, lifestyle, and developmental stage
Savannah's developmental stage is
young adulthood
(18-40) faced with
Intimacy vs. Isolation

- Poor coping skills
- Low self-esteem
- Low mood
- Ongoing ideations of suicide
- Anxious/distressed/sad/apprehensive/timid
- Prone to agitation and panic
- Prone to being triggered by sexual stimuli or interactions
- Constantly re-lives fear and terror
- Did poorly in school
- Finds it difficult for herself to trust people because her trust was violated
physiological

- Family hx of substance abuse
- Poor sleep
- Lack of proper nutrition
- Does not practice safe sex
- Suffered physical abuse (childhood and adulthood)
- Hostile living environment
- Engages in risk behaviours (drinking, drugs, prostitution)
intrapersonal
interpersonal
extrapersonal
spiritual
- Low self-esteem/image
- Does not value herself
- Lost pleasure in life
- Hopelessness
- No purpose
- Lost intimate relationship with dad
- Few connections
- Belief systems around distate for men
- Copes with: alcohol, substances, etc
- Lacks spiritual guidance
intrapersonal
interpersonal
extrapersonal
There are many treatments available for PTSD, but for the sake of applicability and relevancy, we will focus on 2 main forms of treatment:


Seven stages:
Psych nurse states purpose of meeting
Reviews patient’s reaction to trauma
Psych nurse attempts to access emotional reactions in the next stage
Once emotions have been expressed the psych nurse gets the patient to accept them as normal reactions to stress.
Planning of future coping with the patient
Disengagement occurs where other topics are discussed
Patient is advised to come for support again
Psychological Debriefing
Our
stress is commonly unrecognized by the public, so
we
have to take care of each other.
There are numerous private clinics that offer counseling
The Operational Stress Injury clinic at UBC
Workshops and seminars aimed at preventing VT put on by health authorities & unions privately

(Neuman, 2002)
(Neuman, 2002)
(McLeod, 2008)
(Neuman, 2002)
Pharmacotherapy & CBT
Austin, W. & Boyd, M. (2010). Psychiatric & mental health nursing for Canadian practice (2nd ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
(CRPNBC, 2013)
(CRPNBC, 2013)
(CRPNBC, 2013)
Pearlman and Mckay, (2008)
Pearlman and Mckay, (2008)
Pearlman and Mckay, (2008)
Pearlman and Mckay, (2008)
Pearlman and Mckay, (2008)
Pearlman and Mckay, (2008)

NURSING CARE PLAN
Full transcript