Lecture for medical students Faculty of Medicine, King Fahad Medical
City, Riyadh Saudi Arabia on December 22, 2014 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]
· Malaysian students: 18.6% had moderate and 5.1% had severe
stress[3]
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
· Physicians in emergency service experience more stress[14], [15]
· 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
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