Comm Lecture 3 PDF

😵‍💫 Lecture 3 Stress, Anxiety, Defense Mechanisms, Crisis Intervention, CRM Stress; state of mental or emotional strain. Physical; E.g. – wasp sting causes pain. Physiological; E.g. – anaphylaxis from sting. Psychological; E.g. - Fear...

😵‍💫 Lecture 3 Stress, Anxiety, Defense Mechanisms, Crisis Intervention, CRM Stress; state of mental or emotional strain. Physical; E.g. – wasp sting causes pain. Physiological; E.g. – anaphylaxis from sting. Psychological; E.g. - Fear of wasps Stressors; Internal perceptions or external events that cause ANS to respond Internal Stressors Products of emotions Sometimes referred to as anxieties Can be imaginary, having no relationship to real events External Stressors Events or observations that invoke a sensation of fright or fearfulness. Both can cause stress response in body that is the same. Long duration stressors can cause medically significant forms of mental illness Distress; bad stress Eustress; Good stress Lecture 3 1  Differences in Response to Stress. Men: Physically or verbally aggressive, Often use denial. Women: Internalization, Mulling it over. Children: Expression based off stage of growth/development OR based off patterns seen by caregivers response to stress. Act out their frustration (shouting, throwing things) Stress Theories Claude Bernard o 19th Century biologist o Body constantly changes to maintain homeostasis o Homeostasis = state of well being o Too much change causes death Walter B. Cannon o Harvard physiologist built on Bernard’s work o Additionally discovered the body adapts to stressors by releasing substances into bloodstream (epinephrine, cholesterol, glucose) Hans Selye o Developed Generalized Adaptation Syndrome (GAS) 1. Reaction stage: alarm response - Body’s protective measure of alerting itself to danger 2. Adaptation stage: if prolonged stress continues, body ‘adapts’ to survive, can’t last forever, once ‘adaptive energy’ depleted → disease and/or death 3. Exhaustion stage: adaptive abilities of body used up, disease and death occur 4. (hopefully) Return to normal stage: o PNS kicks in Lecture 3 2  o body functions return to normal o ↓ HR, RR, BP o Constricted pupils o Blood flow redirected to GI tract Return to homeostasis Holmes and Rahe Stress Scale. Developed by psychologists Thomas Holmes and Richard Rahe as a predictor of illness from stress.. Effects of Stress: migraine headaches, hypertension, allergies, low back pain, depression, ulcers. Other Effects: arthritis, infections, skin eruptions, cancers, autoimmune disorders, heart attack, angina, dysrhythmias, stroke, colitis, constipation, diarrhea, etc. 300 = ~80% chance of major health breakdown in next 2 years Reducing Stress Ways to reduce stress Sustained aerobic activity Breathing exercises Brisk walk Reduce caffeine & alcohol Get to appointments (classes!) early Find ways to express feelings Laugh Good nutrition Lecture 3 3  Meditation Short naps Anxiety: Definition: feeling of apprehension, worry, uneasiness, or dread frequently accompanied by physical symptoms. Different from fear – may occur at any time, develops from within, triggered by anything. 4 Levels – Mild, Moderate, Severe, and Panic * Levels of Anxiety Mild Moderate Severe Panic healthy, makes us Inability to focus on still alert & able to alert, productive, details, or focus Consumed with think clearly, but small increases in totally narrowed, escape terror focused on one task, epinephrine release can’t concentrate Sweating, ↑ HR Acute Hyperventilation: CRISIS: Sudden, unexpected, often life-threatening, time limited event. It temporarily overwhelms capacity to respond adaptively. Personal response to stressful event, Not a mental illness Factors that Tip the Scales Problem Too Huge Personal Significance Occurs During Period of vulnerability New Lecture 3 4  Usual Support Network Fails Characteristics of Crisis State Atypical behaviour from normal patterns of coping Extreme fatigue, helplessness, inadequacy, anxiety Changes in eating habits, sleep disturbances, ‘tunnel vision’, inability to consider alternative options Feeling ‘suspended in time’ Crisis Intervention. Temporary, active, and supportive entry into the life of an individual, family, or organization during a period of acute distress. Focused on the NOW, psychological first-aid Goals of Crisis Intervention 1. Mitigate the impact of a crisis on the people involved. 2. Facilitate normal recovery processes 3. Restore people to adaptive function, such as making simple decisions, caring for themselves and family members, or managing their affairs Seven Principles of Crisis Intervention 1. Simplicity: Keep it simple! People in crisis can’t follow complex instructions or do complex tasks 2. Brevity: Keep it short! 3. Innovation: Be willing to try new ideas to help. There is no textbook to providing perfect help in crisis. 4. Practicality: keep things practical. Suggesting impractical things will only confuse and frustrate your patients and shake your credibility. Lecture 3 5  5. Proximity: Operate within a safe zone that is close to the person’s home, workplace, or other place of familiarity. 6. Immediacy: Services must be provided right away for best effectiveness 7. Expectancy: Encourage the person in crisis that help is available, and that the situation is manageable (without giving false hope). Stages of Crisis Intervention Assess the Crisis Establish Rapport Explore the Crisis Problem Explore the Feelings and Emotions Generate and Explore Alternatives Develop & Implement a Crisis Action Plan Follow Up and Check on Plan’s Success Defense Mechanisms. Undoing. Denial. Displacement. Sublimation. Suppression. Projection. Regression. Repression. Rationalization. Compensation Lecture 3 6  Crew Resource Management 1. Effective Communication a. Clarity (announce goals & priorities, use eye contact) b. Call people by name (gets their attention) c. Close the loop (make sure your directions were heard and understood) 2. Leadership 3. Situational Awareness 4. Resource Utilization 5. Problem Solving Stress, Burnout & Paramedic Well-being Critical Incident Stress: ▷ Distress experienced after a severe, significant event that overwhelms a person’s (or gorup) ability to cope ▷ Normal functions are interrupted Crisis-oriented Staff support ▷ Comprehensive: addressing before, during, after traumatic events. ▷ Integrated: All elements- interrelated & blended ▷ Systematic: Order of supports = individual → small group → more individual → CISD → Family → follow up services → Closure of interventions or referrals. ▷ Multi-tactic: different types of services available; different people = different needs Typical Training For CISM (Critical Incident Stress Management) Lecture 3 7  1. Assisting individuals in crisis 2. Working with large & small groups 3. Suicide prevention, intervention tactics 4. Strategic Planning (if big events occur how would you deal with them) Some Commonly used Crisis-Intervention Tactics Intervention Timing Target Group Goals Large-Group Crisis Intervention Emergency Decompression, personnel, can be ease transition Rest, Information, & Transition at end of shift of for other large from intense to Session (RITS) or large scale event groups who less intense, ‘Demobilization’ experienced the education, meet same event basic needs. Usually Respite(rest), Respite Centre Ongoing emergency refreshment, personnel support Inform, control ongoing & post- Heterogeneous Crisis Management Briefing rumours, increase event large groups cohesion Small-Group Crisis Intervention Stabilization, Ventilation, Reduce acute 12 hours or less small Immediate Small-Group distress, focus on post-event (often homogeneous support or ‘defusing’ cognitive domain, done on-site) groups information, asses for debriefing Group Debriefing or ‘Critical 1-10 days post Small Increase Incident Stress Debriefing’ homogeneous cohesion, (CISD) ventilation, allow Lecture 3 8  Intervention Timing Target Group Goals groups with equal for emotional trauma exposure domain to be discussed, information normalization, reduce acute distress, facilitate resilience Exposed Ensure continuity Follow-up & / Or referral As Needed individual of care Critical Incident Stress Debriefing (CISD) Phases 1. Introduction, guidelines for CISD 2. Brief Situation review 3. Discussion - First impression 4. Discussion - part of incident - greatest personal impact 5. Discussion - signals of distress 6. Stress information & guidelines for stress management 7. Summary, Q&A period Goal of CISD ▷ Alleviate some of group members’ stress ▷ Enhance cohesiveness (united whole) ▷ Assist in return to duty ▷ Identify those needing additional help ▷ Support, not psychotherapy Lecture 3 9  Mental Resilience (Longevity & Wellness) Employee Opinions ▷ 54% of employees - believe disclosing mental illness to management would jeopardized promotion ▷ 26% of employees think supervisor effectively manages MH issues ▷ 39% of workers would not tell managers about a MH problem ▷ 64% of workers- concerned how work would be affected if a colleague had a MH problem Mental Health Continuum Model(Mental health commission of Canada) Healthy Reacting Injured ILL Anger outburst/ aggression, Normal mood Irritable/Impatient, Anger, anxiety, excessive anxiety/ fluctuations Calm & Nervous Sadness/ Pervasively panic attacks, takes things in stride overwhelmed sad/hopeless Depressed/ Suicidal thoughts Negative attitude, Overt Good sense of Displaced sarcasm, Poor performance/ insubordination, humour Performing procrastination, workaholic/ poor can’t perform duties, well, in control Forgetfulness concentration/ control behaviour or mentally decisions concentrate Normal Sleep Trouble sleeping, Restless disturbed Can’t sleep or stay patterns, few sleep Intrusive thoughts, sleep/ Recurrent asleep, sleeping to difficulties Nightmares images/ nightmares much or too little Muscle tension, Increased aches & Physically well, good Physical illnesses, headaches, Low pain, increased energy level constant fatigue energy fatigue physically & socially Decreased activity/ Avoidance, Not going out or active socializing withdrawal answering phone Lecture 3 10  Regular but Increased alcohol Alcohol or gambling No/limited alcohol controlled alcohol intake/ gambling- addition, other use/gambling use/gambling hard to control addition Mitigating(Alleviate) Stress The ‘Big Four’ (MHCC): originally developed in Navy seal/ military; training your brain to work under stress 1. Goal Setting: setting small goals to achieve 2. Visualization: Visualization increases your ability to do the skill 3. Self-talk: what you say to yourself is a reflection of what might happen (if your negative you will get negative results) 4. Tactical Breathing: Controlling your breathing Burnout ▷ Resulting disillusionment, frustration, & apathy that occurs from enduring prolonged stress Why healthcare people burnout (HAfEN) ▷ Idealistic exceptions get disappointed ▷ Difficult to measure accomplishment ▷ Low pay * (Depends of the region or place you work) ▷ Difficult calls e.g. triaging a pt out ▷ Long hours (shifts 12+) ▷ feeling unappreciated (e.g. getting verbally abused) ▷ high call volume * (depends on service you work for) ▷ feelings of powerlessness to change things ▷ Poor working condition* Lecture 3 11  Job environment at risk for Burnout ▷ Erratic hours, especially shift work ▷ Night shifts ▷ Professions where the customer is always right ▷ Seeing people die ▷ Making life & death decisions regularly ▷ Working with clients who complain ▷ Listening to, or mediating arguments ▷ Being a ‘sound board’ listening to people’s problems ▷ Being a working mother (especially single parent) Recognizing Burnout -Physical ▷ Exhaustion & Fatigue not corrected by good sleep ▷ Insomnia or other sleep disturbance ▷ Colds, flus, other illnesses of lowered immunity ▷ GI distress ▷ Headaches ▷ Weight loss/ gain ▷ Muscles aches, back pain ▷ loss of sex drive, etc Recognize Lecture 3 12