8/7/2018 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 S Objectives: Develop working knowledge of ‘stress’ and ‘Extreme incident’ 1) Understand various types of stressors and Extreme incidents 2) found in healthcare Understand the similarities between healthcare and law 3) enforcement professions regarding self-image and stigma Know concrete examples of how law enforcement overcame 4) barriers in response to prevention and mitigation of stress 1
8/7/2018 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 Shiftwork Other: S S Relationship/martial problems S Long hours S Financial difficulties S Special needs children S Heavy patient loads S Child custody S Demanding patients/ high S Commute S expectations Extracurricular activities S Etc. Always being “on” S S Balancing needs of clinical and S administrative staff 2
8/7/2018 Effects of Stress Physical Cognitive S S Circadian rhythm de- Decreased attention span S S synchronization Poor decision S Chronic fatigue/sleep problems making/concentration S GI problems Confusion/ memory problems S S Poor problem solving S Emotional S Mood swings Behavioral S S Anxiety, guilt, grief, fear, etc. Withdrawal/change in activity S S Loss of emotional control Outbursts S S Depression Appetite increase or decrease S S Excessive/inappropriate humor S 3
8/7/2018 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 4
8/7/2018 Extreme Incident Stress Impact Vicarious Too Much Too Much Too Ugly Too Ugly Too Soon 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 5
8/7/2018 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 6
8/7/2018 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 7
8/7/2018 Questions? John Nicoletti, Ph.D., ABPP nfadirector@aol.com Katherine McMann, Psy.D. drkmcmann@gmail.com 8
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