AP Presentation_TMHPDN22_B3 PDF

Anxious when handling routine ward tasks TMHPDN22 Group B3 005 Chen Tsz Wai 029 Leung Chung Ching 050 Wong Hiu Yan 066 Ho Hoi Tik 084 Lo Ho Yin 1 ...

Anxious when handling routine ward tasks TMHPDN22 Group B3 005 Chen Tsz Wai 029 Leung Chung Ching 050 Wong Hiu Yan 066 Ho Hoi Tik 084 Lo Ho Yin 1  Aims To identify symptoms of feeling anxiety To introduce the concept of General Adaptation Syndrome and its relevance in understanding the physiological and psychological responses to stress To recommend practical strategies and coping mechanisms that can help alleviate anxiety 2  Table of Contents 1 Case introduction 4 Coping strategies 2 Symptoms of feeling anxiety 5 Conclusion 3 General adaptation syndrome 6 References 3  Contents 1. Case introduction 4. Coping strategies Case background Appraisal-focused strategies Potential underlying stressors Problem-focused strategies Emotion-focused strategies 2. Symptoms of feeling anxiety 5. Conclusion 3. General adaptation syndrome GAS progress related to 6. References physical change Psychological condition throughout GAS stages 4  1 Case Introduction I am currently undergoing placement in a ward, and I have recently noticed that one of my classmates becomes noticeably anxious when handling routine ward tasks. 5 What problems/ struggles did you encounter during your clinical placement? 6 Potential Underlying Stressors Interpersonal Stressors 1. Perfectionism 2. Self-doubt in own’s ability when facing criticism from patients, their relatives, harsh supervisors & comparison with peers 3. Overthinking / catastrophizing outcomes when making mistakes & fail to meet supervisor’s expectations 7 Potential Underlying Stressors Problems-Related Stressors 1. Unfamiliar environment of new ward setting 2. Unfamiliar with clinical skills 3. Heavy routine duty and fail in multi-tasking 8 Potential Underlying Stressors Emotional Stressors 1. Fear of making mistakes 2. Scared of facing challenges 3. Guilt for delaying routine tasks 4. Anxiety about being judged / criticized 5. Emotional impact of patient care (burnout or compassion fatigue) 9 Symptoms of feeling 2 anxiety 10 How did you feel when you encounter the stressful situation during placement? 11  Immediate Symptoms - Psychosocial Immediate feelings Low self-esteem / confidence of worry / fear (Nydegger, 2016) 12  Immediate Symptoms - Physical ↑ heart rate ↑ blood pressure ↑ breathing rate (Nydegger, 2016) 13 Immediate Symptoms - Behavioural Changes Avoidance of tasks Increased restlessness (Nydegger, 2016) 14  Long Term Symptoms - Physical Persistent fatigue Headache Gastrointestinal problems e.g. nausea, gastric pain (Nydegger, 2016) 15 Long Term Symptoms - Behavioural Changes Sleeping problems Decline in performance (Nydegger, 2016) 16  General adaptation 3 syndrome 17  What is General Adaptation Syndrome (GAS)? A theory of stress responding proposed by Hans Selye Stress: real or perceived threat to homeostasis, which involves the endocrine, nervous, and immune systems Trigger a cascade of stress hormones that produce well-orchestrated physiological changes (Galik et al., 2013) 18 GAS’s 3 stages (Learn my test, 2020) 19  GAS’s 3 stages s olved The End l em Prob Stage 1 Stage 2 Alarm Resistance Prob lem n ot so lved Stage 3 Exhaustion Alarm Stage: body initial response to stress Resistance Stage: body tries to repair itself after the initial shock of stress Exhaustion Stage: body no longer able to cope with stress because enduring stressors cannot relief 20  GAS progress related to physical change During the placement: → The classmate faces the heavy routine duty → Feeling stress → Body trigger the GAS 21  GAS progress related to physical change Facing stressors → immediate worry or fear Stage 1 Activate the sympathetic nervous system Alarm Release stress hormones e.g. adrenaline, noradrenaline, cortisol, etc Involve “fight or flight” responses 22 (Fink, 2016)  GAS progress related to physical change “Fight” Response Stay to cope with the problem As stress hormones has been released to the Stage 1 bloodstream, the body exhibits physiological changes Alarm Increase the heart muscle contraction Blood vessels become narrower As an outcome: ↑in heart rate ↑in blood pressure ↑in breathing rate, etc → to prepare body for perceived threats (Fink, 2016) 23  GAS progress related to physical change “Flight” Response Escape to avoid from threat When the stress is overwhelming, Stage 1 Classmate may exhibit avoidance behaviors Alarm e.g. Stepping back from the workload Delaying engagement with patients → to avoid tasks or situations that trigger the stress (Fink, 2016) 24  GAS progress related to physical change The classmate notices the stress Start active coping to manage ongoing stress Stage 2 Resistance Utilize strategies to try improve performance Outcome 1: Outcome 2: Effectively adapt to Inability to adapt & the stressor prolonged stress 25  GAS progress related to physical change Outcome 1 Stage 2 If the body can adapt to the stress Resistance → activate parasympathetic system → start to stabilise via homeostasis (Homeostasis: maintain a state of balance in our body) In this case: ↑ Stress ↑energy and ↓Stress Hormones released focus to ↓Hormones released ↑ Heart rate cope with Heart rate back to the problem normal 26 (Kelvin, 2016)  GAS progress related to physical change Outcome 2 If the body cannot adapt with the stress Stage 2 Resistance → prolonged or chronic stress → proceed to the next stage 27  GAS progress related to physical change Stress continues for an extended period Stage 3 Classmate fails to find effective ways to cope Exhaustion Body can no longer maintain its adaptation Become exhausted 28  GAS progress related to physical change Long term symptoms start shows, e.g. Fatigue ○ body used up all the energy Gastric pain Stage 3 ○ anxiety cause a hormonal state in the body that ↑ Exhaustion gastric juice ○ → causing damage to the stomach wall Headache ○ neck and scalp muscles become tense and contract due to stress → Finally result in sleeping problems and decline in performance 29  Psychological condition throughout GAS stages Stage 1 Alarm Emotional Impact: When the student encountered stressors, - Experience heightened anxiety or fear e.g. being judged by supervisors/ mentors - Impact focus and decision-making abilities - Feelings of inadequacy or self-doubt (Fink, 2016) 30  Psychological condition throughout GAS stages Stage 1 Alarm Cognitive Impact: When the student encountered stressors, - Experience racing thoughts about e.g. being judged by supervisors/ mentors what could go wrong - Rumination and increased anxiety (Fink, 2016) 31  Psychological condition throughout GAS stages Stage 21 Resistance Alarm Cognitive Appraisal: When the student try to cope with stressors, e.g. thinking how to solve the problem - Assess stressor and ability to cope with it - +ve appraisal → adaptive coping strategies - -ve appraisal → stress (Fink, 2016) 32  Psychological condition throughout GAS stages Stage 21 Resistance Alarm When the student takes action Problem-Solving Skills: e.g. asking mentor what the problem is - Engaging in clear, logical steps and voice out struggles - ↓feelings of chaos and help regain control (Fink, 2016) 33  Psychological condition throughout GAS stages Stage 21 Resistance Alarm When the student takes action Social Support: e.g. asking classmates for help - Seeking reassurance from classmates/mentors - Emotional comfort and validation (Fink, 2016) 34  Psychological condition throughout GAS stages Stage 3 Exhaustion If the coping strategies fail to relieve the stress, Emotional Burnout: Social Support: e.g. overthinking - -Seeking Continuous anxiety reassurance from→ feelings of classmates/mentors - helplessness Emotional comfort and validation. or disengagement (Fink, 2016) 35  Psychological condition throughout GAS stages Stage 3 Exhaustion If the coping strategies fail to relieve the stress, Cognitive Decline: e.g. constant preoccupated - Struggle with focus, decision-making,→ ↑errors in patient care - Cognitive overload ↑anxiety, creating a vicious cycle (Fink, 2016) 36  Psychological condition throughout GAS stages Stage 3 Exhaustion If the coping strategies fail to relieve the stress, Withdrawal: e.g. refusing to communicate and continue of placement - Stress accumulates → withdraw from social interactions and support systems - Further isolating and exacerbating anxiety (Fink, 2016) 37  Coping strategies 4 38 How did you solve these problems? 39 Appraisal-Focused Strategies 40  Appraisal-Focused Strategies 1. Set realistic goals (To cope with stressor - perfectionism) Methods: (1) Replace thoughts like "I must be perfect" with alternatives, like "I can strive for my best without needing to be perfect." → To encourage self-acceptance (2) Break tasks into smaller, manageable steps and focus on short term goal → To gain small accomplishment to reduce overwhelm (Bourne & Garano, 2020) 41  Appraisal-Focused Strategies 2.1. Detect negative self-talk (To cope with stressor - self-doubt) Methods: (1) Use a "thought record" to document negative self-talk, identify anxiety triggers after a stressful shift duty → To help rationalizing & disputing negative beliefs (2) Share negative experiences with peers. → To gain different perspectives & recognize shared challenges (Bourne & Garano, 2020) 42  Appraisal-Focused Strategies 2.2. Use positive reinterpretation (To cope with stressor - self-doubt) Methods: (1) After completing a task, request feedback from supervisors → To help identify strengths and weaknesses to reduce self-doubt in ability (2) Keep a journal to document personal strengths and daily successes on completing routine tasks smoothly. → To reinforce a sense of achievement (Bourne & Garano, 2020) 43  Appraisal-Focused Strategies 3.1. Reframing failure (To cope with stressor - catastrophizing outcome) Methods: (1) If encounter a failure in performing nursing skills / receive criticism, try to view them as stepping stones rather than a definitive failure. → To shift focus from negativity to growth (2) List out expectations from supervisors and evaluate the criteria needed to meet them. → To better understand and manage others’ expectations (Bourne & Garano, 2020) 44  Appraisal-Focused Strategies 3.2. Thought Stopping Techniques (To cope with stressor - catastrophizing outcome) Methods: (1) Visualize a stop sign when negative thoughts arise, followed by deep breathing. → To encourage a moment of pause to reset focus (2) Engage in a brief physical activity (like stretching) whenever negative thoughts arise during busy duty. → To clear the mind and redirect attention (Bourne & Garano, 2020) 45 Problem-Focused Strategies 46  Problem-Focused Strategies 1. Gradual Orientation and Familiarization (To cope with stressor - Unfamiliar Environment of New Ward Setting) 1: Request a ward orientation from a mentor, preceptor, or senior nurse. Become familiar with the physical layout Reduce anxiety by making the environment more predictable and less intimidating 2: Create a map of the ward Understand key areas and the place of resources Ensure quicker responses during tasks (Dias et al., 2024) 47  Problem-Focused Strategies 1. Gradual Orientation and Familiarization (To cope with stressor - Unfamiliar Environment of New Ward Setting) 3: Learn from a senior staff or mentor for the first few days Observe how they navigate the ward and handle tasks. Accelerate the learning process 4: Engage with staff members and ask questions Gain insights into the ward's workflow Eliminate guesswork (Loureiro et al., 2024) 48  Problem-Focused Strategies 2. Skills Development and Practice (To cope with stressor - Unfamiliar with Clinical Skills) 1: Schedule regular practice sessions in a simulation lab or with a mentor (Dias et al., 2024) Build muscle memory Make tasks feel automatic Reduce anxiety during real-world application 2: Break down each skill into smaller, manageable steps Practice them repeatedly until they feel routine Reduce fear of failure Increase the likelihood of success in clinical settings (Loureiro et al., 2024) 49  Problem-Focused Strategies 2. Skills Development and Practice (To cope with stressor - Unfamiliar with Clinical Skills) 3: Request feedback after each session Refine techniques Address errors immediately Boost confidence by highlighting improvements and correcting mistakes (Dias et al., 2024) 50  Problem-Focused Strategies 3. Time Management and Task Prioritization (To cope with stressor - Heavy Routine Duty & Failing in Multitasking) 1: Begin each shift with categorizing tasks by using Eisenhower Matrix Ensure that critical patient care are completed first Reduce feelings of being overwhelmed Urgent and Important: Assist with a medical emergency, Respond to a patient’s call light Administer medications Take vital signs, or perform bladder scan, ECG Postoperative assessment or treatment (Filomeno et al., 2024) 51  Problem-Focused Strategies 3. Time Management and Task Prioritization (To cope with stressor - Heavy Routine Duty & Failing in Multitasking) 1: Begin each shift with categorizing tasks by using Eisenhower Matrix Important but Not Urgent: Feeding Wound dressing Off foley or NG tube Change NG tube or foley because to due day Patient education (Filomeno et al., 2024) 52  Problem-Focused Strategies (Filomeno et al., 2024) 3. Time Management and Task Prioritization (To cope with stressor - Heavy Routine Duty & Failing in Multitasking) 1: Begin each shift with categorizing tasks by using Eisenhower Matrix Urgent but Not Important Answer phone calls or messages from instructors about scheduling Organize personal notes that contribute to learning or patient care Gathering patient information for PNC Not Urgent and Not Important Tasks that unrelated to learning or patient care 53  Problem-Focused Strategies 3. Time Management and Task Prioritization (To cope with stressor - Heavy Routine Duty & Failing in Multitasking) 2: Use tools like notebook or sticky notes to track and check off completed tasks Reduce feelings of being overwhelmed Increase efficiency 3: Request assistance when feeling overwhelmed Lighten the workload Promote teamwork (Dias et al., 2024) 54  Problem-Focused Strategies 3. Time Management and Task Prioritization (To cope with stressor - Heavy Routine Duty & Failing in Multitasking) 4: Group similar tasks together Reduce cognitive switching, which is mentally taxing and time-consuming Improve efficiency 5: Set time blocks for each group of tasks Stay organized Ensure that duties are completed in a timely manner (Dias et al., 2024) 55  Problem-Focused Strategies (Dias et al., 2024) 3. Time Management and Task Prioritization (To cope with stressor - Heavy Routine Duty & Failing in Multitasking) 6: Focus on completing one task at a time, instead of attempting multiple tasks simultaneously Prevent errors and stress Ensure accuracy and reduce cognitive overload 7: Learn to say " I’ll take this task after my on-hand task! " or request additional time when new tasks are assigned unexpectedly Let other nurses to know your workload They may assign the tasks to others Ensure completing current tasks effectively 56  Problem-Focused Strategies 3. Time Management and Task Prioritization (To cope with stressor - Heavy Routine Duty & Failing in Multitasking) 8: Schedule short breaks, such as toilet time every 2-3 hours Recharge Prevent mental exhaustion Help maintain focus throughout the shift (Dias et al., 2024) 57 Emotion-Focused Strategies 58  Emotion-Focused Strategies 1. To cope with stressor - Fear of making mistake Method: 1:Get enough sleep for both physical and mental well-being Enhance cognitive functioning (such as concentration, problem-solving) Improve emotional regulation Reduce mistakes and accidents by ensure sharper focus, better memory recall, and improved task accuracy (Spielman et al., 2020) 59  Emotion-Focused Strategies 1. To cope with stressor - Fear of making mistake Method: 2:Time management 60  Emotion-Focused Strategies 2. To cope with stressor - Guilt for delaying routine Method: 1:Progressive muscle relaxation Reduce physical symptoms of guilt (such as muscle tension, increased heart rate) Improve focus and motivation as you may feel less burdened by guilt and more clear-headed 61  Emotion-Focused Strategies 3. To cope with stressor - Anxiety about being judged or criticized Method: 1:Listen to soothing music Slow -paced instrumental musical can induce relaxation response Positive impact on lower blood pressure, heart rate, and stress hormone Nature sounds may also help calm individuals (e.g. bird singing) Singing bowl (Shrestha, 2018) 62  Emotion-Focused Strategies 3. To cope with stressor - Anxiety about being judged or criticized Method: 2: Write it down Record what we are worry (stress from mentor? ward staff?) Record what we are grateful for (e.g. grateful for no one judged me today) (Clark & Beck, 2023) 63  Emotion-Focused Strategies 3. To cope with stressor - Anxiety about being judged or criticized Method: 2: Write it down(The Elisenhower Matrix) Categorize your worries Hypothetical worries (about what might happen) Actual worries (about something that has happened) (Asana, 2024) 64  Emotion-Focused Strategies 4. To cope with stressor - Emotional impact of patient care Method: 1:Meditating Stress reduction (keep yourself in “Peace”) Allow thoughts to come and go without judgement Reflect on the feeling of emotional and physical afterwards =>Enhance self-awareness (increase the believe of yourself) (Mayo Clinic, 2023) 65  Emotion-Focused Strategies 4. To cope with stressor - Emotional impact of patient care Method: 2:Mindfulness Increase positive self-statement when taking care of patient (“I can cope with that”) According to Sussex Mindfulness centre, mindfulness can heightened emotional intelligence and greater self-management at work Effects are larger for longer Effects on stress Staff are significantly less courses are maintained stress after the course (16 hours or more) (Sussex Mindfulness Centre, 2024) 66  Emotion-Focused Strategies 5. To cope with stressor - Scared of facing challenges Method: 1:Exercising Suggest a quick, energizing workout before their shift To boost their confidence and mood E.g. 10 minutes of jumping jacks and stretches 67  Emotion-Focused Strategies 5. To cope with stressor - Scared of facing challenges Method: 2:Deep breathing (Five-Finger Breathing) Breath in deeply and slowly Focus on the air moving into the nose And moving out from the mouth The physical symptoms of stress (Cedars‑Sinai, 2022) 68  5 Conclusion 69  Conclusion Hope everyone can be the “chill guy” when facing the problem 70  6 References 71  References Asana, T. (2024, January 29). The Eisenhower Matrix: How to prioritize your to-do list Asana. https://asana.com/resources/eisenhower-matrix Bourne, E.J., & Garano, L. (2020). Pocket therapy for anxiety : Quick cbt skills to find calm. New Harbinger Publications. Cedars‑Sinai. (2022). Finding balance with five-finger breathing. https://www.cedars-sinai.org/content/dam/cedars-sinai/community-benefits/documen ts/five-finger-breathing.pdf Clark, D.A., & Beck, A.T. (2023). Anxiety and worry workbook. Guilford Publications. Dias, J. M., Subu, M. A., Al-Yateem, N., Ahmed, F. R., Rahman, S. A., Abraham, M. S., Forootan, S. M., Sarkhosh, F. A., & Javanbakh, F. (2024). Nursing students’ stressors and coping strategies during their first clinical training: a qualitative study in the United Arab Emirates. BMC Nursing, 23(1). https://doi.org/10.1186/s12912-024-01962-5 Fink, G. (Ed.). (2016). Handbook in stress vol. 1. stress: Concepts, cognition, emotion, and behavior. Academic Press. 72  References Filomeno, L., Chaoui, Y., Scinicariello, A., Minciullo, A., & Di Mario, S. (2024). Nurses and Managers’ Time Management Skills Assessment: A national survey in the Italian healthcare setting. Nursing Reports, 14(3), 2107–2116. https://doi.org/10.3390/nursrep14030157 Kelvin, J.A. (2016). Adaptive homeostasis. Molecular Aspects of Medicine, 49. 1-7. https://doi.org/10.1016/j.mam.2016.04.007 Learn my test. (2020, March 30). General Adaptation Syndrome, Stress, Anxiety, Depression, and Heart Disease. https://www.youtube.com/watch?v=LgZRcAJwjh4&t=167s Loureiro, F., Peças, D., Neves, A. C., & Antunes, A. V. (2024). Coping strategies and social support in nursing students during clinical practice: A scoping review. Nursing Open, 11(2). https://doi.org/10.1002/nop2.2112 Mayo Clinic. (2023, December 14). A beginner’s guide to meditation. https://www.mayoclinic.org/tests-procedures/meditation/in-depth/meditation/art-200 45858#:~:text=Meditation%20can%20give%20you%20a,on%20something%20that%20c alms%20you 73  References Nydegger, R. (2016). Dealing with anxiety. Bloomsbury Publishing USA. Shrestha, S. (2018). How to heal with singing bowls: traditional tibetan healing methods. Spielman, R.M., Jenkins, W.J., & Lovett, M.D. (2020, April 22). 4.2 Sleep and why we sleep - Psychology 2E. OpenStax. https://openstax.org/books/psychology-2e/pages/4-2-sleep-and-why-we-sleep Sussex Mindfulness Centre. (2024, November 25). Try to teach mindfulness. https://sussexmindfulnesscentre.nhs.uk/ 74  Thanks! CREDITS: This presentation template was created by Slidesgo, including icons by Flaticon, and infographics & images by Freepik. Do you have any questions? 75