Page 18 - ANZCP Gazette-August-Booklet

ADVERSE OUTCOMES AND PERFUSION STRESS:
HOW ARE YOU COPING?
Jane Ottens CCP, FANZCP, Chief Perfusionist, Ashford Hospital
This topic was originally presented by Dr Michelle Epstein, a Sydney Clinical psychologist, at the 34th ASM in Melbourne in 2017. While relevant in 2017, it seems even more so now, as we are all exposed to increased stress during the COVID-19 pandemic. For those who were not fortunate to hear Dr Epstein, or have forgotten, I thought it was pertinent to go back and think about what she talked about and also think about stress.
Stress is a normal psychological and physical reaction to the demands of life (1). A small amount of stress can be good, motivating us to perform well. But multiple challenges daily can push us beyond our ability to cope. Your brain comes hard-wired with an alarm system for your protection. This ‘fight-or-flight’ response fuels you to deal with the threat (stress). Once the threat is gone, your body is meant to return to a normal, relaxed state. Unfortunately, the nonstop complications of modern life mean that some people's alarm systems rarely shut off.
Sound familiar?
The stress of long hours, working with life threatening situations, frequently ending in adverse outcomes, is an important reality that must be acknowledged in our profession. Occupational hazards such as burn-out, trauma and compassion fatigue all add to the professional and personal stress routinely faced by perfusionists.
Dr Epstein stated that it is incumbent on all health professionals ‘to monitor their own stress and the impact of it on their own work and wellbeing’.
There are many factors that can influence how we interpret and attribute adverse outcomes and mistakes during stress. Our personal histories can unconsciously bias our thinking and may also dictate the kinds of coping strategies we employ. ‘When each individual’s reactions are being driven by powerful unconscious forces, multidisciplinary teams can mimic the dynamics of dysfunctional families.’
To monitor your stress, first identify your triggers (1). What makes you feel angry, tense, worried or irritable? Do you often get headaches or an upset stomach with no medical cause? Some stressors, such as job pressures, relationship problems or financial concerns, are easy to identify. But daily hassles and demands, such as waiting in a long line or being late to a meeting, also contribute to your stress level. Even essentially positive events, such as getting married or buying a house, can be stressful. Any change to your life can cause stress.
We are now vulnerable to added emotional stress caused by the current pandemic. In a recently published paper, Pfefferbaum and North (2) highlighted the many concerns that we are faced with such as:
1. Risk of exposure to the virus
2. Concern about infecting and caring for loved ones
3. Shortages of personal protective equipment
4. Longer work hours
5. Involvement in emotionally and ethically fraught resource- allocation decisions
They also comment that ‘other than the stresses inherent in the illness itself, mass home-confinement directives (including stay- at-home orders, quarantine, and isolation) are new to most of us and raise concern about how people will react individually and collectively’ (2).
A recent review of psychological sequelae by Brooks (3) in samples of quarantined people and of health care providers revealed numerous emotional outcomes including stress, depression, irritability, insomnia, fear, confusion, anger, frustration, boredom, and stigma associated with quarantine; some of which persisted after the quarantine was lifted. Specific stressors included greater duration of confinement, having inadequate supplies, difficulty securing medical care and medications, and resulting financial losses.
Stress management gives you a range of tools to reset your alarm system (1). It can help your mind and body adapt (resilience). Without it, your body might always be on high alert. Over time, chronic stress can lead to serious health problems. Don't wait until stress damages your health, relationships or quality of life. Start practicing stress management techniques today.
Once you've identified your stress triggers, think about strategies for dealing with them. Identifying what you can control is a good starting point. For example, if stress keeps you up at night, the solution may be as easy as removing the TV and computer from your bedroom and letting your mind wind down before bed.
Other times, such as when stress is based on high demands at work or a loved one's illness, you might be able to change only your reaction.
Don't feel like you have to figure it out on your own. Seek help and support from family and friends, whether you need someone to listen to you, help with child care or a ride to work when your car is being serviced.
15 SEPTEMBER 2020 | www.anzcp.org