# A nurse is caring for a client with post-traumatic stress disorder (PTSD) who experiences frequent nightmares and flashbacks. Which nursing intervention would be most therapeutic for this client?

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> subject: Mental Health

## 문제

A nurse is caring for a client with post-traumatic stress disorder (PTSD) who experiences frequent nightmares and flashbacks. Which nursing intervention would be most therapeutic for this client?

## 보기

1. Encourage the client to discuss the traumatic event in detail during each interaction
2. Provide sedating medications before bedtime to prevent nightmares
3. Avoid discussing triggers to prevent re-traumatization
4. Teach grounding techniques to help manage flashbacks and dissociation **✔ 정답**

**정답: 4**

## 해설

Teaching grounding techniques is the most therapeutic intervention as it provides practical coping skills for managing PTSD symptoms like flashbacks and dissociation. Other options may retraumatize (discussing details), mask symptoms (sedating medications), or avoid necessary triggers.

## 심화 해설

Understanding PTSD and the Therapeutic Rationale

In post-traumatic stress disorder (PTSD), the brain's alarm system becomes hypersensitive. Traumatic memories are not processed as past events but are stored in a fragmented, sensory-rich format. This leads to involuntary re-experiencing symptoms such as flashbacks and nightmares, where the individual feels as if the trauma is happening right now. These intrusions are often accompanied by dissociation, a disconnection from the present moment and one's own body, which serves as a primitive defense mechanism against overwhelming distress [2]. The primary goal of nursing care during these episodes is not to delve into the trauma narrative, but to re-establish a sense of safety in the here and now.

Analysis of Options

**Option 1:** Encouraging detailed discussion of the traumatic event during every interaction is counter-therapeutic. Trauma-focused psychotherapies require a structured, titrated approach within a safe therapeutic alliance. Unpaced, repeated exposure without proper grounding can lead to re-traumatization and emotional flooding, increasing distress rather than resolving it [2].

**Option 2:** Providing sedating medications before bedtime may induce sleep but does not address the underlying hyperarousal and intrusive memory processing that cause the nightmares. While medication can be an adjunct, it is not the most therapeutic standalone nursing intervention for managing the core symptoms of re-experiencing and dissociation. Pharmacological approaches can also be limited by side effects and do not build the client's own coping skills [2].

**Option 3:** Avoiding all discussion of triggers might seem protective but can inadvertently reinforce avoidance behaviors, which are a central maintaining factor in PTSD. Avoidance prevents the processing of traumatic memories and can lead to functional impairment and a constricted life [2]. The therapeutic goal is to help the client manage their response to triggers, not to eliminate all triggers from their environment.

**Option 4 (Correct):** Teaching grounding techniques is a foundational, evidence-based nursing intervention for managing flashbacks and dissociation. Grounding techniques work by redirecting attention away from the internal, past-oriented traumatic memory and toward the external, present-moment environment. This directly counteracts the neurobiological process of dissociation, where the body-oriented trauma response remains unintegrated . By engaging the five senses (e.g., naming objects in the room, feeling the texture of a chair, taking slow, deep breaths), the nurse helps the client anchor their awareness in their physical body and current safety. This interrupts the intrusive cycle and empowers the client with a practical, immediately usable tool to regain control, aligning with body-oriented therapeutic principles that address the physiological imprints of trauma .References (research sources)

- [2]Toward Integrating Intranasal Esketamine with Traumatic-Memory Psychotherapy in Treatment-Resistant Depression: A Narrative Review and Feasibility-Oriented Protocol Proposal.Research articleRaffone F, Cattaneo CI, Pessina E, Martini A, Martiadis V. (2026) · DOI: 10.3390/bs16050771

## 임상 시나리오

Managing Flashbacks in PTSDPrioritizing Safety and Grounding
The primary nursing goal during a flashback is to re-establish safety in the present moment. Use grounding techniques to redirect focus from the internal trauma to the external environment.

Instruct the client to engage the five senses: identify 5 things they can see, 4 they can touch, 3 they can hear, 2 they can smell, and 1 they can taste. This interrupts the dissociative process.

CautionDo not pressure the client to discuss the trauma narrative during acute distress. Unstructured exposure can cause re-traumatization. Structured therapy occurs later in a controlled setting.

## 핵심 개념

- **PTSD (Post-Traumatic Stress Disorder)** — An anxiety disorder that occurs after experiencing a traumatic event, characterized by intrusive memories (flashbacks, nightmares), avoidance, negative changes in cognition and mood, and marked changes in arousal and reactivity.
- **Grounding Techniques** — A set of techniques to help focus on the present moment and reality during flashbacks, dissociation, intense anxiety, or panic attacks. It focuses on senses (5 senses), cognition (counting, naming objects), and body (breathing, muscle relaxation).
- **Flashback** — This is an intrusive symptom of PTSD where past traumatic events are vividly re-experienced. The patient may temporarily lose contact with reality.
- **Dissociation** — A state where the mind feels separated or disconnected from the body, emotions, memories, or environment. It can occur as a defense mechanism against trauma and includes derealization or depersonalization.
- **Re-traumatization** — Additional psychological trauma that occurs when exposed to traumatic memories or triggers without therapeutic support or appropriate coping skills. It can worsen symptoms.

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