Federal Regulations require that residents with a history of trauma or post-traumatic stress disorder (PTSD) receive appropriate services and correct the problem or, at the least, to attain the highest level of psycho-social well-being.  Persons with a history of trauma or PTSD are susceptible to developing psychosocial adjustment difficulties.  In a large study of the general population, more than 60% of men and 50% of women reported experiencing some type of trauma during their lifetime.  Women had a higher incidence of PTSD among those reporting trauma in this study.

What is appropriate treatment and services?

Person-centered approaches intended to correct the assessed problem or to help the resident attain and maintain the highest psycho-social well-being are appropriate.  Approaches that aren’t resident centered are inappropriate.

Examples of treatment and service for residents with psychosocial adjustment difficulties include providing opportunities for autonomy; keeping residents in touch with their communities, cultural heritage, former lifestyle and religious practices; maintaining resident contact with family and friends.


A close relationship exists between mental and psychosocial adjustment difficulties and histories of trauma and PTSD.


 Adjustment difficulties:

  • Occur within 3 months of the onset of a stressor and last no longer than 6 months after the stressor or its consequences have ended;

  • Are characterized by distress that is out of proportion to the severity or intensity of the stressor

  • May be related to a single event or multiple stressors and may be continuous or recur over and over again

  • May cause a depressed Mood, anxiety and/or aggression

  • May be diagnosed following the death of a loved one the intensity, qualityor persistence of grief exceeds what normally might be expected

  • Can occur with or without PTSD or a history of trauma


History of trauma:

  • Involves psychological distress following a traumatic or stressful event that is often variable

  • May be connected to feelings of anxiety and/or fear

  • Often involves expressions of anger or aggressiveness

  • May lead to PTSD



  • Involves the development of symptoms following exposure to one or more traumatic, life-threatening events

  • Usually develops within the first 3 months after the trauma occurs but may be delayed by months or years.

  • Symptoms may include re-experiencing or re-living the stressful event (flashbacks, nightmares, etc), emotional and behavioral expressions of distress such as outbursts or anger, irritability or hostility, extreme discontent ment or inability to experience pleasure, detachment from reality or social withdrawal, hyperarousal (increased startle response)

  • May be severe or long-lasting when the stressor is interpersonal and intentional such as torture or sexual violence

PTSD is commonly viewed as a disorder experienced only by military veterans.  Individuals who have been physically or sexually assaulted or who experience a terrorist attack or natural disaster may also be affected by PTSD.  Some older nursing home residents who lived through a time of genocide, “ethnic-cleansing”, or the systematic destruction of a racial, political or cultural group may also be affected.


Moving from the community to a nursing home can be a very difficult transition and cause a worsening or reemergence of symptoms.  Also, the structured environment at many nursing homes can trigger memories of traumatic events.


Physical manifestations related to psychosocial adjustment difficulties, a history of trauma/PTSD may include:

  • Impaired verbal communication without physiological cause

  • Social isolation and withdrawal inconsistent with the resident’s usual demeanor

  • Sleep pattern disturbance

  • Deviation from past spiritual beliefs or rituals

  • Inability to control behavior, anger, and the potential for physical harm to oneself or others

  • Stereotyped response to any stressor—the same response regardless the stimulus


Some widely accepted nursing approaches for persons with adjustment difficulties and a history of trauma or PTSD are:

  • If the resident is anxious, first reduce your own anxiety level—take deep breaths and focus on relaxing—and encourage the resident to do the same; move to a quieter space if possible; provide reassurance and comfort

  • If the resident is fearful, acknowledge and discuss the fears; enc. Resident to express and share their feelings; enc. use of relaxation techniques such as deep breathing, progressive muscle relaxation and guided imagery

  • If the resident expresses feelings of powerlessness, enc. resident to make as many decisions as possible, enc. self-care practices if realistic

  • If the resident is self-isolating, demonstrate acceptance with frequent, brief contacts; allow extra space and be cautious with directly touching the resident; offer support and presence if resident agrees to attendance at social events


Your responsibility is:

  • Ask staff of the community about how to care for residents with adjustment difficulties, a history of trauma or PTSD—and listen to their response!

  • Ask about where you might find care plan tips to help you in delivering person-centered care for each resident

  • Know how to support residents who are expressing or indicating feelings of distress—reassure the trauma survivor that their feelings are normal and usually temporary, emphasize the social support from family, friends and staff, ask open ended questions and allow time to respond, practice reflective listening—understand what the resident says and confirm the resident is understood

  • Communicate the conversation back to the person in charge





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