Transcript Stress Survival Strategies for the Emergency Department

Stress Survival Strategies for
Health Care Professionals and
Patients
Victor S. Sierpina, MD
Nicholson Professor of Integrative Medicine
Department of Family Medicine
UTMB
What is stress?
• Stress is a non-specific reaction of an
organism to a demand placed on it
• Eustress vs. distress
What is stress?
Stress can be defined as a state one experiences
when there is a mismatch between perceived
demands and perceived ability to cope.
It is the balance between how we view the
demands and how we think we can cope with
them that determines whether we feels stressed
or otherwise.
Risks of stress in Medicine
• Burnout
• Early retirement, job/career change
• Family relations issues
• Drug/substance abuse
• “Compassion fatigue”
• Absenteeism/presenteeism
Some intrinsic stressors in Medicine
• Staffing
• Scheduling
• Time pressures
• Diagnostic
challenges
• Malpractice
• Sleep deprivation
and shift work
• PTSD
• Role ambiguity
among residents
• Depressed
immunity
Patient related stressors
• Communication issues with patients and
their families, verbal abuse
• Violence
• Exposure to infection: hepatitis, AIDS,
SARS, MRSA, DRE, other “bug du jour”
• Drug seekers
• Social, financial problems of patients
Central Nervous
System
Central Nervous
System
P
hypothalamus
Central Nervous
System
P
hypothalamus
C
Grand Central Station
in the conversion of
psychological stress
to physiological
function
Central Nervous
System
P
hypothalamus
C
Grand Central Station
in the conversion of
psychological stress
to physiological
function
P
central chemical
messengers
Central Nervous
System
P
hypothalamus
C
Grand Central Station
in the conversion of
psychological stress
to physiological
function
P
central chemical
messengers
Ex
•norepinephrine
•epinephrine
•corticotropin releasing
hormone
Autonomic Nervous
System
Autonomic Nervous
System
P
sympathetic nervous
system (SNS)
Autonomic Nervous
System
P
sympathetic nervous
system (SNS)
P
parasympathetic nervous
system (SNS)
Autonomic Nervous
System
P
sympathetic nervous
system (SNS)
C
part of the “ergotropic
system” (ES)
P
parasympathetic nervous
system (SNS)
Autonomic Nervous
System
P
sympathetic nervous
system (SNS)
C
part of the “ergotropic
system” (ES)
L
•prepares for action via arousal
•increase in skeletal muscle tone
•release of catabolic hormone
products
P
parasympathetic nervous
system (SNS)
Autonomic Nervous
System
P
sympathetic nervous
system (SNS)
C
part of the “ergotropic
system” (ES)
L
•prepares for action via arousal
•increase in skeletal muscle tone
•release of catabolic hormone
products
P
parasympathetic nervous
system (SNS)
C
part of the “trophotropic
system” (ES)
Autonomic Nervous
System
P
sympathetic nervous
system (SNS)
C
part of the “ergotropic
system” (ES)
L
•prepares for action via arousal
•increase in skeletal muscle tone
•release of catabolic hormone
products
P
parasympathetic nervous
system (SNS)
C
part of the “trophotropic
system” (ES)
L
•promotes withdrawal and
conservation of energy
•decrease in skeletal muscle tone
•release of anabolic hormones
Styles of Coping
(Lazarus, 1977)
• Direct action: actions to alter, master, or
flee stressor
• Palliation: when direct action is not
possible
– ego defenses: denial, rationalization
– medications to reduce anxiety, BP, etc...
– relaxation exercises/meditation
– cognitive exercises/restructure thoughts
– physical exercises/deep breathing
Organizational responses to stress
• Debriefing after traumatic events,
•
•
•
•
psychological support
Scheduling changes
Improved work conditions
Board certification in ER
Direct social support to nurses
What Can Be Done About
Stress?
• Biological interventions
• Psychological interventions
• Social interventions
Biological Interventions
•
•
•
•
Exercise
Improved nutrition
Proper sleep
Relaxation techniques
– progressive relaxation
– self hypnosis
– meditation
• Medications
Psychological Interventions
• Coping skills training
• Identifying and preparing for stressful
events
• Evaluating cognitions and expectations
• Assistance in stopping unhealthy
behaviors
– smoking cessation
– weight control
– drug and alcohol treatment
Social Interventions
• Identifying and implementing social
supports
• Social skills training
• Family and group psychotherapies
How do you unwind?
• Scream
• Get sick
• Get drunk
• Go to sleep
Or do you….
• Laugh
• Work on a hobby
• Play sports
• Meditate
All Effective Stress Management Programs
Recommend Some or All of the Following
• Exercise
• Mind-body approaches
• Time management (prioritizing)
Personal/social stress resilience
approaches found useful in studies
for Emergency Dept. personnel
• Music listening
•
•
•
•
•
and music making
Self reflection
Spiritual wellbeing, prayer,
religious practice
Massage
Essential oils
Cognitive
behavioral
strategies
• Biofeedback
• Humor
• Mindfulness based
stress reduction
• Psychodrama
• Imagery
• Relaxation
therapies
Some Simple Techniques
• Deep breathing
• Progressive Muscle relaxation
• Music
• Meditation