Objectives: Develop working knowledge of stress and Extreme incident - - PDF document

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Stress, Extreme Incidents, and Stigma:

How Healthcare Can Take a Page from Law Enforcement’s Book

John A. Nicoletti, Ph.D., ABPP (Police and Public Safety Psychology) Katherine K. McMann, Psy.D. Nicoletti-Flater Associates, PLLP

Objectives:

1)

Develop working knowledge of ‘stress’ and ‘Extreme incident’

2)

Understand various types of stressors and Extreme incidents found in healthcare

3)

Understand the similarities between healthcare and law enforcement professions regarding self-image and stigma

4)

Know concrete examples of how law enforcement overcame barriers in response to prevention and mitigation of stress

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Stress

S Definition: General response of the body to any unusual

demand made on it, pleasant or unpleasant, emotional, physical or mental.

S Short term or Long term S Acute, Delayed, or Cumulative

Stressors Common in Healthcare

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Shiftwork

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Long hours

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Heavy patient loads

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Demanding patients/ high expectations

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Always being “on”

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Balancing needs of clinical and administrative staff

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Other:

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Relationship/martial problems

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Financial difficulties

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Special needs children

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Child custody

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Commute

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Extracurricular activities

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Etc.

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Effects of Stress

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Physical

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Circadian rhythm de- synchronization

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Chronic fatigue/sleep problems

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GI problems

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Emotional

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Mood swings

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Anxiety, guilt, grief, fear, etc.

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Loss of emotional control

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Depression

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Cognitive

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Decreased attention span

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Poor decision making/concentration

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Confusion/ memory problems

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Poor problem solving

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Behavioral

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Withdrawal/change in activity

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Outbursts

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Appetite increase or decrease

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Excessive/inappropriate humor

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Extreme Incident

S An event or series of events that is TOO MUCH and TOO

UGLY

S Vicarious or Impact

Extreme Incidents

S Active shooter/ Lockdown S Patient injury to staff S Staff suicide S Death of child S Domestic violence S Others

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Extreme Incident Stress

Impact

Too Much Too Ugly Too Soon

Vicarious

Too Much Too Ugly Too Similar OR Too Different OR Too Long

Effects of Extreme Incident Stress

S Some people “bounce back” after an incident S Impact of sensory modalities (intrusions/flashbacks) S Shatters basic assumptions S Shatters comfort zone S Creates deviation from baseline

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Why Should You Care?

S Decreased absenteeism S Increased performance and focus S Employee retention S Stress is contagious S Improvement in both physical and mental health

Commonalities between Healthcare and Law Enforcement

S Shiftwork and long hours S Dealing with people in crisis S Disdain for the weak S “Buck up” and “be tough” culture; Fear of losing job 

Stigma

S Idea that showing emotion makes you vulnerable

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How Law Enforcement Deals with Stress/Extreme Incidents

S Prevention

S Training on stress during academy and during in-service

trainings

S Familiarity with EAP/Department psychologists S Normalizing stress response S Support at command/supervisory level S Having other resources that validate what they are going

through (i.e. book: Emotional Survival for Law Enforcement)

S Establishing Peer Support and Wellness Programs S Incentives for annual “resiliency check-ups”

SUPPORT FROM THE TOP IS CRUCIAL

How Law Enforcement Deals with Stress/Extreme Incidents

S Response

S Supervisors and peers trained in how to talk to a struggling co-

worker

S Referrals to competent providers who understand the job S After an Extreme incident, having providers available on-site S Mandatory vs. voluntary debriefs/meetings S Outreach from providers S Encourage work/life balance

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Questions?

John Nicoletti, Ph.D., ABPP nfadirector@aol.com Katherine McMann, Psy.D. drkmcmann@gmail.com