We are all familiar with stress. Some stress is termed “good” stress, or eustress. Eustress is beneficial stress; it motivates people to develop the skills they need to solve problems and meet personal goals. However, it is the distress that causes problems. Distress is a negative experience that can drain our energy. Increased stress and anxiety can trigger depression, cause confusion, and instill helplessness/hopelessness, causing fatigue. When we are faced with the stressful response, our brain responds, signaling all areas of our body. The stress response is also referred to as the “fight or flight response.” The fight or flight response is a survival mechanism by which our body and mind become immediately ready to meet a threat or stressor.

A stressor—that which triggers stress—can be real or perceived. Stress can be psychological (e.g., ethnic and religious conflicts occurring globally, terrorism, anxiety, guilt, or joy), or physical (e.g., stressful environment, starvation, loud noises, extreme heat or cold, or other disturbing physical condition). Stress can be psychosocial (e.g., threat to self-esteem, acceptance in a group, social status, and respect). Stress can also be spiritual (such as an existential crisis). When individuals feel “stressed out,” they may have trouble sleeping or eating, experience headaches or back pain, lose interest in favorite activities, feel tense and become irritable, and often feel powerless.

The two stress disorders identified in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) are posttraumatic stress disorder (PTSD) and acute stress disorder (ASD). Both disorders follow exposure to an extremely traumatic event, usually outside the range of normal experience (e.g., natural disasters, crime-related events, acts of terrorism, bombings, car or train wrecks, torture/kidnap, military combat, sexual assault, witnessing a violent death or mutilation, diagnosis of a life-threatening disease). Patients not only feel fear, but a sense of hopelessness and horror. The common element in all of these experiences is the individual’s extraordinary helplessness or powerlessness in the face of such stressors.

Although the prevalence of PSTD is about 7% in the general population (Black & Andreasen, 2011), the incidence of PTSD in Afghanistan and Iraq war veterans is 19% to 20% (RAND Corporation, 2008). War veterans of Iraq and Afghanistan who screened positive for PTSD were four times more likely to endorse suicidal ideation then non-PTSD veterans (Jakupcak, 2009) and have dangerous levels of alcohol use (Tull, 2010). Major depression frequently co-occurs with PTSD. Studies have found that when PTSD and major depressive disorder (MDD) go untreated or undertreated, there are many painful repercussions, such as marital problems, unemployment, heavy substance abuse, aggressive behaviors, and suicide (RAND Corporation, 2008; Glantz, 2010).

The main difference between PTSD and ASD is one of time. ASD lasts from 2 days to 4 weeks and occurs within 4 weeks of the traumatic event. PTSD can last for years if early treatment is not sought.

Assessment Findings/Diagnostic Cues:

• Maintains self-control without supervision

• Satisfaction with coping ability

• Satisfaction with close relationships

• Use of available social supports

• Increased psychological comfort

Patient will:

• Use three new effective relaxation strategies to help reduce tension and anxiety by (date)

• Talk about a traumatic event, fears, terrors, and experiences and demonstrate congruent feelings by (date)

• Participate in social skills training targeting specific previously identified behaviors

• Demonstrate a new sense of control over certain situations or events by (date)

• Agree to continue with treatment goals and management strategies by (date)

Patient will:

• Identify three coping skills he or she believes would improve his or her sense of well-being and functioning and agree to work on them with (nurse/staff/clinician) within 1 week

• Identify two problems that, if addressed, would improve patient’s quality of life and those of family/friends/coworkers/boss (e.g., impulse control, assertiveness, social skills)