A firefighter survived a fire after escaping a blaze. Several other firefighters were trapped in the burning building and died. After working with this firefighter in counseling, the nurse evaluates which as positive outcomes for this client? Select all that apply.

In the aftermath of a mass-casualty event, survivors often experience survivor guilt, a hallmark of Post-Traumatic Stress Disorder (PTSD) where the individual questions why they lived while others perished. Positive nursing outcomes focus on emotional regulation, the integration of the traumatic event into their life narrative, and the utilization of healthy coping mechanisms to prevent long-term psychological impairment. Rationale: A. Verbalizing stress regarding the return to work is a positive outcome because it indicates self-awareness and the ability to process anxiety. Rather than suppressing emotions or using avoidance, which can lead to a crisis later, the client is openly communicating their struggle, which is a necessary step in stress management and rehabilitation. B. Identifying a social support system is critical for long-term resilience. Traumatic events can lead to social withdrawal and isolation. Therefore, an active effort by the client to recognize and engage with community resources or peer groups indicates a shift toward active coping and emotional stability. C. Reporting nightmares and flashbacks is a diagnostic manifestation of the trauma, not a positive outcome. It is important for the client to share these symptoms with the nurse, but a positive goal would be a decrease in the frequency and intensity of these intrusive thoughts, rather than their continued presence. D. Expressing guilt through nondestructive means, such as journaling, talk therapy, or memorializing fallen colleagues, is a highly positive outcome. It demonstrates that the client is moving through the stages of grief and finding ways to externalize their internal pain without resorting to self-harm or substance abuse.