Stress Survival Strategies for Health Care Professionals and Patients Victor S. Sierpina, MD...

Stress Survival Strategies for Stress Survival Strategies for Health Care Professionals Health Care Professionals

and Patientsand Patients

Victor S. Sierpina, MDVictor S. Sierpina, MDNicholson Professor of Integrative Nicholson Professor of Integrative

MedicineMedicineDepartment of Family MedicineDepartment of Family Medicine

UTMBUTMB

What is stress?What is stress?

• Stress is a non-specific reaction of an Stress is a non-specific reaction of an organism to a demand placed on itorganism to a demand placed on it

• Eustress vs. distressEustress vs. distress

What is stress?What is stress?

Stress can be defined as a state one Stress can be defined as a state one experiences when there is a mismatch experiences when there is a mismatch between perceived demands and between perceived demands and perceived ability to cope.perceived ability to cope.

It is the balance between how we view the It is the balance between how we view the demands and how we think we can cope demands and how we think we can cope with them that determines whether we with them that determines whether we feels stressed or otherwise.feels stressed or otherwise.

Risks of stress in MedicineRisks of stress in Medicine

• BurnoutBurnout

• Early retirement, job/career changeEarly retirement, job/career change

• Family relations issuesFamily relations issues

• Drug/substance abuseDrug/substance abuse

• ““Compassion fatigue”Compassion fatigue”

• Absenteeism/presenteeismAbsenteeism/presenteeism

Some intrinsic stressors in Some intrinsic stressors in MedicineMedicine

• StaffingStaffing

• SchedulingScheduling

• Time pressuresTime pressures

• Diagnostic Diagnostic challengeschallenges

• MalpracticeMalpractice

• Sleep deprivation Sleep deprivation and shift workand shift work

• PTSDPTSD

• Role ambiguity Role ambiguity among residentsamong residents

• Depressed Depressed immunityimmunity

Patient related stressorsPatient related stressors

• Communication issues with patients Communication issues with patients and their families, verbal abuseand their families, verbal abuse

• ViolenceViolence

• Exposure to infection: hepatitis, AIDS, Exposure to infection: hepatitis, AIDS, SARS, MRSA, DRE, other “bug du jour”SARS, MRSA, DRE, other “bug du jour”

• Drug seekersDrug seekers

• Social, financial problems of patientsSocial, financial problems of patients

Central NervousSystem

Central NervousSystem

hypothalamus

P

Central NervousSystem

hypothalamus

P

Grand Central Stationin the conversion of psychological stress

to physiologicalfunction

C

Central NervousSystem

hypothalamus central chemicalmessengers

P P

Grand Central Stationin the conversion of psychological stress

to physiologicalfunction

C

Central NervousSystem

hypothalamus central chemicalmessengers

P P

Grand Central Stationin the conversion of psychological stress

to physiologicalfunction

•norepinephrine•epinephrine•corticotropin releasing hormone

ExC

Autonomic NervousSystem

Autonomic NervousSystem

sympathetic nervoussystem (SNS)

P

Autonomic NervousSystem

sympathetic nervoussystem (SNS)

P P

parasympathetic nervoussystem (SNS)

Autonomic NervousSystem

sympathetic nervoussystem (SNS)

P P

part of the “ergotropic system” (ES)

C

parasympathetic nervoussystem (SNS)

Autonomic NervousSystem

sympathetic nervoussystem (SNS)

P P

part of the “ergotropic system” (ES)

C

parasympathetic nervoussystem (SNS)

•prepares for action via arousal•increase in skeletal muscle tone•release of catabolic hormone products

L

Autonomic NervousSystem

sympathetic nervoussystem (SNS)

P P

part of the “ergotropic system” (ES)

C

parasympathetic nervoussystem (SNS)

part of the “trophotropic system” (ES)

C

•prepares for action via arousal•increase in skeletal muscle tone•release of catabolic hormone products

L

Autonomic NervousSystem

sympathetic nervoussystem (SNS)

P P

part of the “ergotropic system” (ES)

C

parasympathetic nervoussystem (SNS)

part of the “trophotropic system” (ES)

C

•prepares for action via arousal•increase in skeletal muscle tone•release of catabolic hormone products

•promotes withdrawal and conservation of energy•decrease in skeletal muscle tone•release of anabolic hormones

L L

Styles of CopingStyles of Coping(Lazarus, 1977)(Lazarus, 1977)

• Direct actionDirect action: : actions to alter, master, or flee stressor

• PalliationPalliation:: when direct action is not possible– ego defensesego defenses: : denial, rationalization– medicationsmedications to reduce anxiety, BP, etc....– relaxation exercises/meditationrelaxation exercises/meditation– cognitive exercises/restructure thoughtscognitive exercises/restructure thoughts– physical exercises/deep breathingphysical exercises/deep breathing

Organizational responses to Organizational responses to stressstress

• Debriefing after traumatic Debriefing after traumatic events, psychological supportevents, psychological support

• Scheduling changesScheduling changes

• Improved work conditionsImproved work conditions

• Board certification in ERBoard certification in ER

• Direct social support to nursesDirect social support to nurses

What Can Be Done About What Can Be Done About Stress?Stress?

• Biological interventionsBiological interventions

• Psychological interventionsPsychological interventions

• Social interventionsSocial interventions

Biological InterventionsBiological Interventions

• ExerciseExercise

• Improved nutritionImproved nutrition

• Proper sleepProper sleep

• Relaxation techniquesRelaxation techniques– progressive relaxationprogressive relaxation– self hypnosisself hypnosis– meditationmeditation

• MedicationsMedications

Psychological InterventionsPsychological Interventions

• Coping skills trainingCoping skills training

• Identifying and preparing for stressful eventsIdentifying and preparing for stressful events

• Evaluating cognitions and expectationsEvaluating cognitions and expectations

• Assistance in stopping unhealthy behaviorsAssistance in stopping unhealthy behaviors– smoking cessationsmoking cessation– weight controlweight control– drug and alcohol treatmentdrug and alcohol treatment

Social InterventionsSocial Interventions

• Identifying and implementing social Identifying and implementing social supportssupports

• Social skills trainingSocial skills training

• Family and group psychotherapiesFamily and group psychotherapies

How do you unwind?How do you unwind?

• ScreamScream

• Get sickGet sick

• Get drunkGet drunk

• Go to sleepGo to sleep

Or do you….Or do you….

• LaughLaugh

• Work on a hobbyWork on a hobby

• Play sportsPlay sports

• MeditateMeditate

All Effective Stress Management All Effective Stress Management Programs Recommend Some or All of the Programs Recommend Some or All of the FollowingFollowing

• ExerciseExercise

• Mind-body approachesMind-body approaches

• Time management (prioritizing)Time management (prioritizing)

Personal/social stress Personal/social stress resilience approaches found resilience approaches found useful in studies for Emergency useful in studies for Emergency Dept. personnelDept. personnel• Music listening Music listening

and music and music makingmaking

• Self reflectionSelf reflection• Spiritual well-Spiritual well-

being, prayer, being, prayer, religious practicereligious practice

• MassageMassage• Essential oilsEssential oils• Cognitive Cognitive

behavioral behavioral strategiesstrategies

•BiofeedbackBiofeedback

•HumorHumor

•Mindfulness Mindfulness based stress based stress reductionreduction

•PsychodramaPsychodrama

• ImageryImagery

•Relaxation Relaxation therapiestherapies

Some Simple TechniquesSome Simple Techniques

• Deep breathingDeep breathing

• Progressive Muscle relaxationProgressive Muscle relaxation

• MusicMusic

• MeditationMeditation