Learning on the job
Nursing faculty member inspired to learn more about PTSD in palliative care
As an assistant professor in MacEwan University’s Post-Basic Nursing Practice: Hospice Palliative Care and Gerontology program, Gail Couch’s job—and passion—is teaching. But sometimes, it’s her students who inspire her to learn more.
Because Gail teaches in a post-diploma certificate program, her students are professional nurses who bring stories of their work to class discussions. Recently, during one such discussion, the topic of post-traumatic stress disorder came up. As students shared their experiences, Gail realized the topic was rarely discussed in the context of end-of-life patients. “We all realized that we probably have cared for individuals who had PTSD, and wondered how that might come into play in palliative care and gerontology. So all of our interests were really quite piqued.”
She channelled her curiosity into an in-depth analysis of literature on the topic. What she found was that PTSD is actually common at the end of life for various reasons. “Some individuals deal with PTSD on and off throughout their entire life, and then end-of-life medical conditions trigger it to come back,” she explains. “But other people only develop PTSD at the end of life, because as a terminal illness nears the end stages, it makes people reflect on their life and that can bring up old trauma.” According to the Diagnostic and Statistical Manual of Mental Disorders, life-threatening illness is considered a predisposal risk, meaning being diagnosed with a terminal illness can be enough in and of itself to cause PTSD.
Complicating matters, it can sometimes be difficult to differentiate PTSD symptoms from other medical symptoms. “Sometimes PTSD can exacerbate end-of-life symptoms, or end-of-life symptoms can bring back the PTSD, and they can be very difficult to differentiate,” says Gail. “Sometimes what looks like delirium caused by a terminal medical condition is actually PTSD rearing its head. Grief, depression and sadness may be a normal part of the process of nearing end of life, so it can be hard to recognize when these symptoms are actually being caused by PTSD.”
According to Gail’s research, backtracking is often the best way to determine whether PTSD is present. “One of the best things you can do is a life review,” she says. “A health-care provider will have the patient just talk about themselves—the highlights of their life, the good and the bad, the turning points. When you know their whole history and who they are as a person, you can identify traumatic events they have gone through and how those might be affecting them now.”
In addition to encouraging her students to be aware of PTSD in their practice, Gail is also sharing her findings with other health-care professionals who work in gerontology and palliative care. She presented her findings at Edmonton’s Palliative Care Rounds last fall and at the Canadian Gerontological Nursing Association Conference in Ottawa in May. Her hope is to raise awareness of end-of-life PTSD and inspire others to learn more, just as her own students inspired her.
“It’s so important to learn from each other as professionals, including my students,” says Gail. “Some of them have been practicing nurses for years, but they’re always learning and we learn from one another.”
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