Winnipeg Free Press - saturDAY, May 10, 2014 7
MAY 12-18, 2014 NURSING: A LEADING FORCE FOR CHANGE
In the Line of Duty
Traumatic stress has lasting impact on those who serve
By Jennifer McFee – For the Free Press
At many jobs, the stress ends when the shift is over. But for members of the RCMP and the Canadian Armed Forces, stress can linger and have a lasting impact on their lives. Nurse therapist Amber Gilberto works with these members, as well as with veterans, at the Oper- ational Stress Injury (OSI) Clinic based out of Deer Lodge Centre. “We can assess, diagnose and treat the OSI, which is exposure to any duty-related incident that has been traumatic in nature, not just deployment. It can be things that have been experienced in the workplace, any sort of harassment or anything that someone would consider to be traumatic,” Gilberto explains. “We see quite a few people who have been de- ployed to Afghanistan and Bosnia and other areas from the ’90s and earlier. With the RCMP, every day there seems to be something that could be trau- matic happening for them.” Under the OSI umbrella, conditions include anx- iety disorders, nightmares, depression and, most commonly, post-traumatic stress disorder. “So many people cannot stop thinking about cer- tain incidents. They seem to be more hyper-vigilant when they’re out. They have trouble with sleep. They have trouble being comfortable in social situations. It affects their life in all aspects,” Gilberto says. “We also see spouses and deal with some of the family issues that stem from OSI. It’s not just the individual. It definitely affects the entire family.” In her nursing role, Gilberto sees all new referrals for an intake assessment. These referrals can come from the medical officer on a Canadian Forces base, the RCMP divisional psychologist or representatives of Veterans Affairs. “We assess what’s going on with them, within their family, within their work environment. Symptom- wise, we get all the information from them. From there, we determine what needs to be the next step in the clinical process. Usually that is a psychologic- al assessment or a psychiatric assessment,” she says. “From that assessment, we are able to determine what the condition is and how we could best treat it.”
Most treatment protocols last 12 to 16 sessions and could include counselling services and medica- tions. But when it comes to recovery, treatment is only one part of the process. “There are other things that need to be con- sidered, such as transitioning out of the military or RCMP or reintegrating back into increasing social supports — anything that helps the person on their road to recovery,” Gilberto says. “We also have some groups that we offer. Often people will participate in the groups after they’ve completed their trauma-focused treatment. There are some residual symptoms that still need to be worked on, so that is a good way to expose people to interacting in a safe environment in group set- tings and to work on some of the issues that per- sist.” The journey to recovery is an ongoing process, she says, so clients can return for extra support whenever they need it. “People will have periods when maybe they might experience a resurfacing of some symptoms with stresses that might be going on currently in their lives. We try to prepare people for that, knowing that sometimes this can happen. It’s to be expected,” she says. “It doesn’t mean that you’ve relapsed. With life- altering events, they’re never forgotten, but certainly you can work through and process them and inte- grate them so that they don’t run your life.” Since the clinic launched a decade ago, Gilberto has noticed there is now less stigma associated with seeking help. “It’s getting better. I’m now hearing from some of the clients that their peer suggested they come here, so we have more of a presence. We’ve gained a good reputation. We have some really good rela- tionships with our referral sources,” she says. “I think there’s maybe more comfort with coming forward and maybe more knowledge with respect to what to do if you’re struggling with something. It’s not such a shot in the dark now. People know what the next step is and where they should be going and what to expect when they get here.” The impact of the clinic is evident in the ongoing work for the nurses and other staff. “In the last couple months, we’ve had over 20
referrals. The referral rate is steady and so is the clinic itself. There isn’t a day that’s not busy,” Gil- berto says. “We’ve evolved as a clinic over the last couple of years and we’ve made more room for the other things that need to happen prior to engaging in the treatment protocols and then following the comple- tion of treatment. So really, it’s more recovery ori- ented.” The clinic’s two nurses provide services to clients while they wait for treatment, and there’s followup after treatment. “The philosophy has shifted more to recovery-ori- ented and not just treatment-based. It’s more holis- tic and a broader approach,” says Gilberto, who is currently working on her master’s degree in psychi- atric therapy from Brandon University. She hopes to expand the services that nursing can offer at the clinic, since her thesis will focus on recovery from operational stress injuries. Her re- search centres on a meta-habilitation model that al- lows for an individualized approach while also in- cluding benchmarks of recovery. “This model speaks to the need to be more com- prehensive and to see the processes beyond the treatments as definitely more of a journey,” she says. “This is something that is going to help evolve the nursing role at the clinic and help expand the servi- ces that we provide to clients and families.”
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Nurse therapist Amber Gilberto works with members of the RCMP and military who are recovering from traumatic stress.
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