Jennifer Grubb, our Nurse of the Week, is a military veteran who is now deploying her hard-earned experience to help others as a nurse.
The PA native started her career in 2003 at the age of 20, when she served in Afghanistan at the height of the post-9/11 military action. Grubb was a combat lifesaver and worked security details in a place where saving lives was often impossible, and no one could afford to feel secure. She saw comrades die in attacks, witnessed the wretched collateral damage suffered by civilian adults and children, and picked her way through minefields.
Like so many soldiers, she struggled as her psyche attempted to process things that most people are not meant to process. In an interview with her hometown Pennsylvania newspaper, The Daily Local, she recalled, “I saw so many gruesome sights. I just hated where I was and decided my best route was just to feel nothing… I started writing less, I started calling less, I started eating less.” Finally, after Grubb had lost 80 pounds during her quest to seal off the horror of war, the Army medevacked her back to the US with an honorable discharge. Then, again like so many other soldiers, she found that even 7000 miles somehow failed to provide a safe distance from the war. As she describes it, “you don’t fit in in your own life anymore. I was always looking over my shoulder. The slightest thing made me jump.”
The nightmares were so intense that they seemed to taint her waking hours, so she tried her best to avoid sleeping and numbed the trauma with drugs. Eventually, she slid to one of those make-or-break low points: “I was just going to use drugs until it killed me. I had one moment where I had a glimmer of hope, and I prayed to God to save me. Two hours later, I was pulled over and arrested for possession of crack cocaine.”
Things began to arc upward when the court allowed her to enter a drug program, and Grubb’s new therapist diagnosed her with PTSD. “I wasn’t Jenn anymore; I was PTSD, with all of my symptoms, and allowing it to really consume my entire life.” With the help of her therapist, though, and treatment at her local VA medical center, she says, “I started to smile more. And the nightmares became a little less. And not every social situation I was in made me jump out of my skin. And I just tried to stay sober, just one day at a time.”
In 2015, Grubb’s life asserted itself as being on an upward swing when she was invited to a women’s vet breakfast with then-first lady Michelle Obama and Jill Biden. During the gathering, Obama noted, “So much of your rise had to do with that reaching out and realizing that there are so many folks out there that are ready to just take your hand.” Grubb realized she was in an ideal position to help other vets sidestep the pitfalls of the self-reliant military ethos and the notion that “we can do anything by ourselves, and I don’t need your help.” She adds, “And there’s such a stigma attached to reaching out.”
As the urge to serve and help others is part of her nature, the recovering vet soon sought ways to do that. While PTSD is chronic – Grubb will always do her best to avoid crowds and can only tolerate sitting in an auto passenger seat if her trusted husband is driving – the treatment allowed her to acclimate. “PTSD is not hopeless,” she says. “There are ways to make it a part of you rather than have it define you.” Once she felt that her demons were tightly reined in, Grubb became an LPN, then a director of patient services at an SUD treatment facility. When the latter’s lack of resources had her teetering on the edge of burnout, she then found a position at the VA center where she first received help herself, the Coatesville VA Medical Center.
Now, the LPN, Almost-BSN is caring for fellow vets and helping them navigate their own trauma ordeals. The military connection is powerful. “These guys and these gals, they’re my brothers; they’re my sisters. There’s a closeness and a bond even with strangers that I can’t really explain to the rest of the population. There’s a level of trust that comes with it.” Deciding that she had a calling to pursue, Grubb earned a BA in Psychology, then entered Immaculata College’s accelerated BSN program, where she will graduate in 2022.
Becoming a nurse came naturally to Grubb. She was moved by the nurses who cared for her when her daughter was born, and realized, “When I left the service, I missed being in service to people.” Today, she’s finishing her BSN program and working as a communications specialist at the Coatesville VA, where “I’m good at my job because of the personal connection I have to it. With the veteran population, they want other veterans to be their caregivers. They want people who really get it.”
For more details about Jennifer Grubb, see the excellent Daily Local article here.
Some healthcare professionals see blood, mangled bodies, and death every day, yet certain days are worse than others. As when, for instance, a dozen police officers are gunned down or 20 kids are killed in their elementary school in a mass shooting. Because public mass shootings happen nearly every 6 weeks in America, these tragedies are having a more frequent impact on the healthcare workforce.
Research data are sparse. One study surveyed 24 surgical residents working at Orlando Regional Medical Center in Florida in 2016. On June 12 that year, a gunman shot 49 people to death and wounded 53 others at the mass shooting at the Pulse nightclub. Three months later, rates of post-traumatic stress disorder (PTSD) and major depression were two and four times greater among the 10 residents on call that night versus the 14 off-duty residents. Though the differences didn’t reach statistical significance, assessments were revealing. A survey of the same residents 7 months after the mass shooting found that PTSD persisted in those affected in the on-call group but completely resolved in the off-call residents.
As part of an ongoing effort by MedPage Today to explore job stress and burnout among healthcare professionals, reporter Shannon Firth talked at length with physicians and nurses who shared personal experiences with mass shootings and how they affected their lives and careers.
Three Encounters With Mass Shootings
“After I Saw What I Saw, I Really Thought to Myself, ‘I Hope I’m Not Broken:'” Richard Kamin, MD (Sandy Hook school shooting, 2012)
“The Worst Night of My Professional Career:” Brian Williams, MD (Dallas police sniper attack, 2016)
“I Still Get That Pit Feeling in My Chest of, I Can’t Believe This is Happening:” Megan Duke, RN, CEN (San Bernardino terrorist attack, 2015)
MedPage Today intern Amanda D’Ambrosio assisted with reporting for these stories.
Originally published by MedPage Today.
Posttraumatic stress disorder (PTSD) affects a large portion of our population, in particular veterans and victims of sexual or physical assault. While the current standard is to treat PTSD with antidepressants, these medications are not always effective and are associated with low remission rates. This is especially true for combat veterans who are notably resistant to pharmacotherapy. As cannabinoid receptors play a big role in PTSD, the use of medical cannabis offers a novel mechanism of treatment.
“Cannabinoids help the mind with the natural process of forgetting painful memories. This has been extremely positive for those who have experienced traumatic events. The ability to forget the trauma helps with anxiety, night terrors, and depression. Many times, patients suffering from PTSD treat those symptoms with multiple medications that have their own side effects. Access to medical cannabis has helped patients improve their quality of life after major trauma,” says Nikki Wright, the COO and co-founder of Medical Marijuana 411.
Changes in brain pathophysiology are linked to PTSD, in
which activity in the fear center of our brains, the amygdala, increases while
areas associated with executive function and memory decreases, upsetting the
body’s ability to respond to stress. PTSD is further marked by an imbalance of
important neurotransmitters, such as serotonin and norepinephrine, and symptoms
present as intrusive memories, avoidance, negative changes in thinking or mood,
and alterations in arousal and impulsivity.
The active ingredient in cannabis is a class of compounds
called cannabinoids. While we most often associate cannabis with tetrahydrocannabinol
(THC), there is another cannabinoid at play that deserves our attention. Cannabidiol
works to minimize the “high” from THC with neuroprotective and
anti-inflammatory properties that help mediate pain, nausea, muscle spasms, and
Our body has its own endocannabinoid system loaded with
receptors that help us maintain homeostasis in response to change; they affect
memory, mood, appetite, stress, sleep, metabolism, immune function, and
more. Stimulation of cannabinoid receptors has been shown to increase
behaviors that allow us to cope with stress, as well as fire off serotonin and
norepinephrine, facilitating the release of both excitatory and inhibitory neurotransmitters
needed to maintain balance.
In PTSD, the role of cannabinoid receptors should not be
underestimated. A decrease in active cannabinoid receptors has been observed in
patients with PTSD, and using medical cannabis provides a different
mechanism of action in which receptors found in altered regions can be
activated. Stimulated cannabinoid receptors in the amygdala, for example,
potentially decrease unpleasant memories, fear, and anxiety, while receptors in
the hippocampus decrease hypervigilance and hyperarousal.
Medical cannabis shows promise to provide significant relief from PTSD symptoms, but the concern of developing a cannabis use disorder should be weighed, especially among a vulnerable population. Additional hurdles for the medicinal use of marijuana is differences in state eligibility, non-standardized distribution policies among dispensaries, and financial barriers in which medical cannabis is not covered by insurance.
Are service dogs allowed in medical facilities, including doctor’s offices and hospitals, in the United States? If so, what is the responsibility of nurses to care for individuals accompanied by a service dog?
We ask these questions because there are currently more than 500,000 service dogs in the U.S., and the service dog community is growing in popularity. Types of service dogs include: guide dogs for the blind, emotional support, mobility assistance, medical alert, autism support, and more.
The American Disabilities Act (ADA) defines a service dog as one that is “individually trained to do work or perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability.”
This includes psychiatric service dogs who support those suffering from Post-traumatic stress disorder (PTSD), such as individuals active in the military or veterans. For those suffering from PTSD, it can be difficult for them because you can’t see the condition, but fortunately the service dog is trained to do so.
When A Patient Has a Service Dog
As a nurse, what are your responsibilities when a patient enters your medical facility attended by a service dog?
A little known fact is service dogs are not required to wear any specific labeling or attire to indicate visually that the animal is a service dog. Also, the ADA only classifies dogs as an approved service animal.
According to the ADA, you can ask the following two questions to a patient with a service dog:
- Is your animal required because of a disability?
- If so, what tasks is your service dog trained to do for you (the owner)?
You cannot ask the individual about her disability, to see any paperwork about the dog’s specific training, to have the dog demonstrate its tasks, or order the owner to make the animal wear a “service dog” vest.
Working with Patients and Pups
So as a nurse, what can you do to care for your patient? It’s twofold. First, your primary responsibility is to “protect the rights of the disabled patient,” and second, you want to make sure the owner keeps control of the animal.
Next, you want to follow the safety guidelines for your facility, which may include the restriction of animals in locations where the animal might compromise the environment, including sterile areas such as operating rooms or labs.
If you require want further instructions, you can always check with your facility manager or go to the ADA website to find out more.
With more and more service dogs assisting those with disabilities across the U.S., the likelihood of seeing an increase in service animals in medical facilities should be anticipated as is the proper treatment of these types of patients.
This story is brought to you by Michael O’Keefe at Consumers Advocate.
Jeffrey Ballard, R.N. and Army Veteran, began his medical career as an emergency medical technician (EMT). After gaining experience as a paramedic and a licensed practical nurse (LPN), he became a registered nurse in the Emergency Department at a Level 1 Trauma Center. He was deployed to Afghanistan two years later as an infantry medic, where he sustained injuries in combat. Following a year and a half of surgeries and physical therapy back home, Ballard returned to emergency nursing, but his struggle with PTSD prompted his departure within a year.
Ballard received care at the Manchester VA Medical Center, and he decided to continue his nursing career there. “I wanted other Veterans to have the same comfort I experienced,” he said.
Today, Ballard has been working with the VA for nearly five years and serves in a program that helps elderly Veterans maintain their independence. Working alongside compassionate nurses and caring for combat Veterans like himself has helped Ballard rediscover his passion and flourish in his career. With his experience, he’s been able to better understand and build trust with Veterans in a way that generates comfort and healing for both parties. Recently, Ballard won the title “Red Sox Nurse Hero of 2018” and was invited to throw a game-opening pitch at the historic Fenway Park.
VA offers Veterans not only life-changing care but also life-changing careers. Join our team and discover the unique rewards that come from serving our nation’s heroes. To get started, search for opportunities near you and apply today.
This story was originally posted on VAntage Point.