Investigating Perceptions of Veterans Toward PTSD

Veterans Perceptions of Long-Term Care PTSD Treatment Grounded Theory Research Proposal [Type text] [Type text] [Type text] VETERANS PERCEPTIONS OF LONG-TERM CARE PTSD TREATMENT Perceptions of PTSD Treatment by Veterans Residing in Community Long-Term Care Facilities VETERANS PERCEPTIONS OF LONG-TERM CARE PTSD TREATMENT Perceptions of PTSD Treatment by Veterans Residing in Community Long-Term Care Facilities The wars currently occurring across the globe are occurring at a time when more soldiers are surviving to return home, but often with lasting mental health issues and physical disabilities.

Many people can name someone who suffers from PTSD as a result of having experienced a traumatic event. Diagnosis of PTSD is improving, and along with this has come recognition that the mental health issue can be a persistent and debilitating disorder ("Office of Public Affairs," 2014). Veterans being treated for PTSD may find themselves in long-term care facilities in community settings ("Office of Public Affairs," 2014).

The quality of care that these Veterans receive, coupled with their own belief in the veracity of the treatment approaches, will ultimately determine when and how they reintegrate into society and enjoy a lie free from the debilitating symptoms of PTSD ("Office of Public Affairs," 2014). The literature indicates that the perceptions patients have related to the quality of care they receive can be a pivotal factor in how well they respond to care (Polkinghorne, 2005). The current research will explore the perceptions of Veterans in long-term care regarding their PTSD treatment.

Background: Problem Description Post Traumatic Stress Disorder (PTSD) is a serious, complex disorder that affects Veterans from every conflict. In the general adult population, roughly 60.7% of men and 51.2% of women report having experienced at least one traumatic event in their lives ("National Comorbidity Survey (NCS)," 2002). Traumas were most frequently identified as follows: 1) Having witnessed someone being badly injured or killed; 2) having been in a fire, flood or natural disaster; 3) having been involved in a life-threatening accident; and 4) having experienced combat exposure.

In contrast to the trauma numbers in the general adult population, the estimated prevalence of PTSD is 7.8% overall, 10.4% for women, and 5% for men. These figures indicate that a relatively small proportion of individuals who have experienced traumatic events in their lives suffer from -- or report suffering from -- PTSD. Although people are affected by exposure to traumatic events in different ways, the report from the National Comorbidity Survey (2002) concluded that, "PTSD is a highly prevalent lifetime disorder that often persists for years.

The qualifying events for PTSD are also common, with many respondents reporting the occurrence of quite a few such events during their lifetimes" (p. 12). The prevalence rates for PTSD in Veterans of the Vietnam War are 15.2% for men and 8.1% for women. For Gulf War Veterans, the prevalence rate of PTSD is 12.1%.

In 2008, the RAND Corporation, Center for Military Health Policy Research, published a report on the prevalence of PTSD among Veterans of Operation Enduring Freedom and Operation Iraqi Freedom (Afghanistan and Iraq) derived from a study of 1,938 participants; the prevalence of PTSD for this group was 13.8%. In 2011, 476,515 Veterans with a primary or secondary diagnosis of PTSD were treatment at medical centers and clinics operated by the Department of Veterans Affairs (VA). When reviewing the prevalence of PTSD in various populations, consideration of the definition and parameters of prevalence is warranted.

Prevalence is a number that represents the proportion of people in a population with a particular condition or disorder at a particular time (Gradus, 2014). Even though prevalence represents the number of cases of a disorder that exist in a population or group, it is important to recognize that prevalence estimates can shift over time as prevalence is dynamic, changing over time, and changing with respect to people and places (Gradus, 2014). All Veterans who go VA facilities for the first time are screened for PTSD symptoms and depression.

Indeed, in 2010, Secretary Shinseki reduced the evidential requirements for qualifying Veterans for health care and disability compensation for PTSD. This change has made it a simpler, faster process that fosters more accurate decisions and quicker access to medical care by Veterans. The PTSD treatment offered to Veterans is recovery oriented, taking the needs and preferences of Veterans into consideration in order to help them identify and achieve meaningful personal goals and satisfying lives.

Literature Review Significant barriers exist for veterans who have been diagnosed with PTSD and are seeking a full course of treatment for their PTSD condition (Seal, et. 2010). Demonstrably effective treatments for PTSD take from 10 to 12 weeks to complete (Seal, et., 2010). Nearly 50,000 veterans received a new diagnosis of PTSD between 2002 and 2008 (Seal, et., 2010). Of these veterans from the Iraq and Afghanistan wars, fewer than 30% have completed the recommended course of treatment for PTSD (Seal, et., 2010).

Further, the report indicated that certain groups of veterans are less likely to receive the care they need (Seal, et., 2010). Specifically, the veteran less likely to receive care has one or more of these characteristics: male, under 25-years of age, living in rural areas, and diagnosed with PTSD by primary care clinics, and then referred to a mental health program (Seal, et., 2010).

The barriers to completing the regimen of care for PTSD include both system-level and personal barriers, both of which can cause difficulties with follow-up appointments and the like (Seal, et., 2010). Seal et al. (2010) determined that new, innovative ways need to be developed to overcome the barriers to care that impede the ability to deliver effective treatments for PTSD. Efforts to prevent PTSD through early intervention following traumatic events have largely been ineffective.

Brief counseling, psychoeducation, and prophylactic medication have all been tried in the immediate period following traumatic exposures ("PTSD Treatment Options," 2014). While some of these approaches appear promising, none of them have been shown to prevent PTSD ("PTSD Treatment Options," 2014). Early interventions serve as a component of the PTSD programs developed by public health organizations and Veteran's Associations ("PTSD Treatment Options," 2014). A substantive body of evidence supports the use of cognitive behavioral therapy for PTSD (Grohol, 2013; "PTSD Treatment Options," 2014).

Another promising early intervention is provided under the name of Psychological First Aid (ncptsd.org) ("PTSD Treatment Options," 2014). In addition, evidence-based research studies point to the efficacy of early Cognitive Based Therapy (CBT) and exposure-based treatments as early approaches to treating PTSD (Grohol, 2013; "PTSD Treatment Options," 2014). The significance of these interventions is whether or not they have the capability to actually decrease the likelihood of the development of PTSD following traumatic exposures (Grohol, 2013; "PTSD Treatment Options," 2014).

For this determination, considerable new research is needed to demonstrate the effectiveness of early intervention with those individuals who are less likely to receive effective treatment for PTSD as a result of the barriers to treatment that occur (Grohol, 2013). Indeed, research on effective treatments for preventing and treating PTSD are needed.

A case in point is seen with the use of Critical Incident Stress Debriefing (CISD), which is administered in compulsory groups; the use of CISD has been found to be ineffective for the prevention of PTSD following trauma exposure ("PTSD Treatment Options," 2014). Substantial barriers to treatment of psychological distress in combat personnel returning from Iraq and Afghanistan have been shown in other studies, as well (Hogue, et al., 2010; Tanielian & Jaycox, 2008).

The findings suggest that providing mental health services within the primary care setting will help to overcome the perceived barriers of mistrust, poor access, and stigma (Hogue, et al., 2010; Sundin, et al., 2010). Recent studies have shown that locating mental health providers in primary care clinics is a substantive encouragement to veterans to use the mental health services to treat their PTSD (Hogue, et al., 2010).

Indeed, the situation of mental health personnel in the primary care clinics enabled them to meet with and assess four times as many patients as did similar primary care clinics that conform to the usual referral procedures (Hogue, et al., 2010; Sundin, et al., 2010). In a research study that assessed the 2-year outcomes of treating psychological symptoms within the mental health care nested within a primary care facility, 48 referred patients were followed (Hogue, et al., 2010).

Fully 40 individuals or 83% confirmed that they found the availability of a mental health professional in a primary care unit to be helpful (Hogue, et al., 2010). Some of the reasons that the15 patients, who constituted 31% of the sample, specifically identified were the lack of stigma associated with seeking mental health services or the ease of accessing the services and benefits (Hogue, et al., 2010; Tanielian & Jaycox, 2008). Forty percent or 19 individuals refused treatment or dropped out from the group of people who agreed to be interviewed (Hogue, et al., 2010).

The conclusion was that veterans are more likely to use mental health services when they are located in primary care settings, and that these embedded mental health services are viable options for veterans returning from combat (Hogue, et al., 2010). Significance of the study: How would research contribute to knowledge? Psychologists who work with clients suffering from PTSD have noted that the perceptions of the clients regarding the efficacy of the therapeutic interventions they receive are associated with recovery (Polkinghorne, 2005).

Many treatments for PTSD are available in the marketplace, however, they have not all been shown to be equally effective with patients experiencing PTSD. There exists a need to continue identifying efficacious treatments for PTSD that can be implemented across venues. The literature also indicates that substantial barriers exist for Veterans seeking a full regimen of effective treatment.

A more thorough and comprehensive understanding of the perceptions of patients, who is in this study are Veterans in long-term care, being treated for their PTSD can contribute to the establishment of more robust, effective therapeutic interventions (Polkinghorne, 2005). Research aim: What is the aim of the study? The purpose of the current research is to explore the perceptions of Veterans with PTSD who are being treated for their disorder in community long-term facilities.

Provision of the results to clinicians and practitioners is indicated in order to support advancements in treatment interventions and efficacious support of Veterans with PTSD (Vive, et al., 2007). Research Question This qualitative research is intended to answer the question: What are the perceptions of PTSD treatment in veterans who reside in community long-term care facilities? Theoretical Nursing Framework Imogene King's theory of goal attainment supports the type of therapeutic interventions.

The tenets of King's theory are a good fit with cognitive behavioral interventions often used by psychotherapists to treat PTSD ("Imogene King," 2013.). Notably, the following propositions apply: The interactions between the nurse and the patient must be perceptually accurate for transactions to occur ("Imogene King," 2013.). When the nurse and the patient perceive that there is congruency between the role expectations and the role performance, transactions will occur ("Imogene King," 2013.). Should either the nurse or the patient experience role conflict, the nurse-client interaction will include stress ("Imogene King," 2013.).

A mutual goal setting and goal attainment will occur when the nurse has the special knowledge and skill to communicate appropriate information to the client ("Imogene King," 2013.). Moreover, King's theory holds that people are rational, sentient, social beings, with the capacity to set goals, select the means to achieve their goals, and make decisions ("Imogene King," 2013.).

King's theory asserts that individual health is dynamic and requires "continuous adjustment to stressors in the internal and external environment through optimum use of one's resources to achieve maximum potential for daily living" ("Imogene King," 2013.). Research Design Qualitative research methods are to be used in the proposed research; specifically, the study will employ a grounded theory research framework. Data analysis. The constant comparative method will be used for data analysis, as it is particularly appropriate for grounded theory research methods. Glaser and Strauss (cited in Lincoln & Guba, 1985, p.

339) present four phases of the constant comparison method as follows: 1) A comparison of the incidents applicable to each category; 2) the integration of categories and their properties; 3) using the integrated information to delimit the theory; and 4) finally, using the information gathered and analyzed to write the theory (p. 339). Goetz and LeCompte (1981) explain the constant comparison method as a process that "combines inductive category coding with a simultaneous comparison of all social incidents observed" (p. 58). The act of recording and classifying the information is embedded in cross-categorical comparison.

This means that as the relationships among the initial observations are discovered, hypothesis generation begins as an element of the emerging themes. The process is iterative such that the data collection and data analysis processes are continuously refined and, in this way, continuously inform the coding of categories. "As events are constantly compared with previous eventsnew relationships, may be discovered" (Goetz & LeCompte, p. 58).

The basis for a constant comparative approach is typically field notes gathered from direct observation and the personal narratives of the research participants, as provided through conversations and informal interviews (Dye, et al., 2000). Constant comparison begins in the absence of theory, although a researcher may have ideas or particular questions in mind (Dye, et al., 2000). The objective of a constant comparison method is to identify emerging themes (Dye, et al., 2000).

This is accomplished by reviewing the written documents for categorical indicators, which are given short names or tags and are assigned codes (Dye, et al., 2000; Ralph, et al., 2014). The data analysis processes are intended to identify coalescing categorical codes, such that similar codes are form a loose constellation centered on an emerging theme (Dye, et al., 2000). The researcher typically writes memos in the margins of the documents to record ideas and concepts that seem to be shaping the emerging themes (Dye, et al., 2000; Ralph, et al., 2014).

Coding continues until saturation occurs and no new codes associated with particular themes present themselves to the researcher (Dye, et al., 2000). The strength of the categories and emerging themes becomes more apparent as the coding progresses (Dye, et al., 2000). The researcher then examines the categories and themes that may have emerged in order to identify core or central category and axial categories (Dye, et al., 2000). Participants The research participants will be Veterans currently residing in community long-term care facilities within the 100-mile radius of the researcher's home.

The process of finding Veterans to participate in the current study will be facilitated by working with facility administrators. Sampling plan and frame. A sampling plan is an umbrella term for the processes that facilitate the identification and establishment of a sample (Savin-Baden & Major, 2013). A sampling frame determines which participants are most likely to provide or enable access to the information that will answer the research questions (Savin-Baden & Major, 2013).

This group of potential participants is referred to as the sample unit; the actual research sample is selected from the sample unit (Savin-Baden & Major, 2013). For a variety of reasons, every individual identified in the sample frame will not make it the actual sample (Savin-Baden & Major, 2013). Consider that the members of the sample must agree to participate in the study, and then they must be comfortable with the research conditions and the terms that ensure they give informed consent (Savin-Baden & Major, 2013).

Some selection procedures are designed to delimit the selection of the sample in order to make it manageable size or to ensure that the best match of participants is secured for the research (Savin-Baden & Major, 2013). For instance, research participant selection in qualitative studies may include a process known as snowballing, in which an individual study participant identifies or recommends that another person be included in the study (Savin-Baden & Major, 2013).

The decision to include others as research participants is made by the researcher, but sound reasons typically undergird this type of snowball recommendation, such that researchers give them due consideration (Savin-Baden & Major, 2013). The sampling plan includes a determination about how to best contact and communicate with the participants who seem to be a good fit -- this is known as purposive sampling (Savin-Baden & Major, 2013). Triangulation is a way of garnering the same information from different sources (Savin-Baden & Major, 2013).

This can be accomplished by asking participants the same questions and identifying where there are similarities in their responses (Savin-Baden & Major, 2013; Polkinghorne, 2005). It can also be accomplished by using different techniques -- such as extant document review and interviews -- within a research method to answer the research questions (Polkinghorne, 2005). When a participant is asked to review the data that a researcher has collected, along with the conclusions reached based on that data, the researcher has accomplished a member check (Kotler, 2003).

Research participants appreciate an opportunity to assess if data associated with them is accurate (Kotler, 2003). The process of completing member checks contributes substantively to trust building (Lincoln & Guba, 1985). Data can be assessed through the use of a data audit, a process that is easiest when the data set is both "thick and rich." When the points in a data set are salient, an auditor can determine how well the research applies to the circumstances and context (Lincoln & Guba, 1985). Data collection process.

In order for researchers to be positioned to accomplish meaningful data analysis, they must be willing to wallow in the data (Glasser & Strauss, 1967). Moreover, during the course of data collection, a qualitative researcher must proceed with exactitude, recording the explicit criteria on which category decisions are made (Dey, 1993, p. 100). Grounded theory data collection utilizes a technique called participant observation, in which the researcher functions as an observer, and to a certain degree, a member of the group that is being studied.