Lecture for
medical students Faculty of Medicine, King Fahad Medical City, Riyadh Saudi
Arabia on December 10, 2013 by Prof Omar Hasan Kasule Sr.
Learning objectives
·
To identify typical stressors in the life of a health care
professional
·
Introduce a range of strategies for dealing with stress
Key words:
·
Stress management
·
Stress coping strategies
Issues for discussion
·
Stress and time pressures as experienced by themselves and
others
·
The positive and negative aspects of stress
·
Practical strategies for coping with stress
Definition of stress
·
Stress is a psychological, emotional, and physiological
reaction to a stressor. It is considered part of normal human adaptation if it
is within certain limits.
·
Stress becomes abnormal or pathological in situations of
over-reaction such that the adverse consequences of the stress reaction cancel
out the advantages.
·
The stress threshold varies from person to person and from
stressor to stressor. What stresses one person may not stress another one. The
same individual could react to the same stressor in different ways depending on
the social and personal context.
·
The underlying cognitive and spiritual qualities modulate
reaction to stressors.
Prevalence of stress in
students
·
High levels of psychological
stress in Jordanian dental students[1]
·
High levels of stress among
Nigerian medical students with psychological morbidity[2]
Prevalence of stress in
physicians
·
High prevalence
·
Varies by practice and work
situations
Causes of stress-general
·
Stressful events are traumatic,
uncontrollable, and unpredictable.
·
It is part of human nature to be
inpatient. Thus when confronted by a problem that cannot be resolved quickly
they become stressed.
·
Patience is called for in moments
of difficulty. However many people when in trouble forget this and fall into
stress.
·
Life is full of difficulties. Each
difficulty is accompanied by what makes it easy.
Causes / correlates of
stress – medical student
·
No association between consumption
of caffeinated beverages and academic stress[4]
·
Perceived stress in French
students associated with alcohol misuse, eating
disorders and cyber addiction[5].
·
Stress in Chinese students
associated with coping strategies and depression[6]
Causes / correlates of
stress – practicing physician 1
·
Relation between stress and work
varies by country and also by professional autonomy[7]
·
Job satisfaction and higher
rewards associated with less stress in physicians[8]
·
Underlying personality determines development of stress[9]
·
Long working hours and occupational stress associated with
depression[10]
·
Stress related to depression[11]
·
Stress in academic physicians related to time pressure and
conflict of interest[12]
·
Younger physicians experience more stress[13]
Causes / correlates of
stress – practicing physician 2
·
Working in a neonatal unit was more demanding for physicians[16]
·
Collaboration with other healthcare providers, and access to
specialised services was a cause of stress among primary care physicians[17].
·
Sleep quality related to stress[18]
·
Workplace environment had an effect on stress[19]
Reaction to stress
·
Psychological reactions to stress is anxiety, anger,
aggression, apathy and depression, cognitive impairment.
·
The physiological reaction to stress manifests as the usual
signs of adrenaline releases. Stress associated with ECG changes[20].
Professional stress in physicians was associated with markers of inflammation
that could related to cardiovascular effects[21].
Physicians on night call had more arythmias and increased neuro endocrine
response[22]
·
Stress caused disordered eating in female students[23].
·
Long-term stress affects good health.
Coping with stress 1
·
People cope with stress in different ways. Coping with
stress may be by denial, projection, repression, rationalization, or reaction
formation.
·
The type of reaction also depends on the personality type,
spiritual preparation, and experience in life. The underlying psych capital
determines reaction to and coping with stress[24].
·
The quickest treatment for stress is to remove the stressor.
This however does not always succeed in returning the person to the normal
state because memories of unpleasant stressors may continue eliciting stressful
reactions for a longer time.
Coping with stress 2
·
Cognitive approach to stress is to make the person realize
that there is no rational basis for the stress over-reaction. Cognitive
behavioral therapy[25]
[26]
[27]
·
Spiritual approaches involve repairing the relation to the
Creator so that the victim feels empowered to cope more effectively with the
stressor or even ignore it altogether.
·
Others: Chewing gum reduced stress[28]
Eliminating the trigger:
·
Emotional disequilibrium is a disease that must be treated. Every
disease has a treatment.
·
Once emotional disorders have occurred, the best approach is
to remove the cause if it can be identified.
·
Then we undertake the task of rebuilding, repairing, and
restoring faith. This is supplemented by supplication,
Restoration of faith:
·
The most effective approach to dealing with emotional
disorders is to correct the faith. This requires clarifying certain relationships
and clarifying the issues of causality.
·
A person must know the correct relation with God, with his
own body, with other humans, and with the eco-system. Any defect in any one of
these relationships will lead to emotional disequilibrium.
·
Understanding causality removes a big burden of guilt from a
person for what has gone wrong. Nothing happens without God’s permission. This
however does not remove personal responsibility for actions.
Cognitive approach:
·
Empirical analysis of the problem may lead us to conclude
that it is not worth worrying over. We need to understand that problems are a
test. The final result is not having a problem but knowing how to deal with it.
·
Ignorance of human limitations (physical, cognitive,
sensory) makes humans stress themselves over failures. If they were wiser they
would not blame themselves because they would known that some tasks are beyond
their ability.
·
Human perception is not accurate. What is perceived as a
problem may not be a significant problem or may not a problem at all and this
would become obvious with passage of time.
·
Counseling was found to decrease physician stress in a
3-year cohort follow up[29]
Supplication
·
Supplication is very effective in dealing with emotional
disturbances.
·
Its effects are dual. On one hand there is supplication to
God to relieve the stress. On the other hand there is the feeling of relief
because the problem has been referred to a higher and stronger power
References
[7] Soc
Sci Med. 2010 Jul;71(2):298-304.
[8] Int Arch Occup Environ Health. 2012
Oct;85(7):819-28.
[9] Int J Emerg Ment Health. 2012;14(4):257-68.
[10] Occup
Med (Lond). 2011 May;61(3):163-70.
[11] Ind Health. 2011;49(2):173-84. Epub 2010
Dec 16.
[13] Int Arch Occup Environ Health. 2010
Apr;83(4):373-9..
[14] Croat Med J. 2011 Feb;52(1):8-15.
[15] Emerg
Med J. 2011 May;28(5):397-410.
[16] Rev
Lat Am Enfermagem. 2010 Jan-Feb;18(1):67-72.
[17] Qual Prim Care. 2009;17(3):215-23.
[18] Health Psychol. 2009 Mar;28(2):194-200.
[19] Radiat
Oncol. 2009 Feb 6;4:6..
[21] Rom J Intern Med. 2010;48(1):57-63.
[22] Eur Heart J. 2009 Nov;30(21):2606-13.
[24] BMC Public Health. 2012 Mar 21;12:219.
