2 0 1 6 S A L P N P R O F E S S I O N A L D E V E L O P M E N T D A Y Mental Health Considerations for Community Service Providers Hans Larsen

INTRODUCTION

Topics of Discussion 1. Parallels between the community services of nursing & policing. 2. Defining various types of work place stressors. 3. Personal experiences with Critical Incident Stress and CISM interventions.

Topics of Discussion 4. The prevalence of post traumatic stress in front line workers. 5. Recognizing and mitigating stress complications for yourself and your co-workers.

So What Are Our “Parallels” Anyway? POLICE MISSION Deliver professional service to the community (Public Service First)   VISION Partner with the community (Working Together to Keep Regina Safe) VALUES Be respectful, Be professional and Serve

So What Are Our “Parallels” Anyway? NURSES (Code of Ethics & Standard of Practice) Provide safe, effective, compassionate and ethical care to members of the public Foster the respect and trust of their clients, health care colleagues and the public.  Ensuring that their practice and conduct meet both the standards of the profession and legislative requirements.  

So What Are Our “Parallels” Anyway? NURSES (Code of Ethics & Standard of Practice) Practice nursing in collaboration with clients and other members of the health care team to provide and improve health care services in the best interests of the public. Demonstrate Honesty, Integrity and Trustworthiness in all interactions!

PARALLELS Professional Public Service Partnerships & Collaboration Respectful & Ethical Practice

Home Stress? … Work Stress? DEFINING STRESSORS Home Stress? … Work Stress?

TYPES OF STRESS EUSTRESS – positive motivating stress (The Good Stuff!) DISTRESS – coping skills get challenged (Unusually uncomfortable) DYSFUNCTION – loss of mastery (Sense of overwhelm is obvious)

EUSTRESS Sporting events Work outs Completing tasks that are manageable Training Planning fun stuff Inspirational settings that challenge us

DISTRESS Forgetting important stuff Being assigned work that you know you cannot complete Negative public interaction Critical incidents Too many tasks and not enough day Family complications Important friendship breaks down

DYSFUNCTION Major critical incident exposure View of a safe & good world gets rocked Loss of a family member or good friend Divorce Repeated exposure to deeply stressful incidents (how bad was it and how long did it last)

Potential Examples of Eustress in Nursing… High volume of work in a highly effective team setting Doing what you love to do (your job) under moderate pressure Training in skills that interest you and challenge you Life saving efforts when you know you have a chance

Potential Indicators of Distress and Nursing… Volume of work is excessive (heavy patient loads) Negative interaction with a patient who is outwardly ungrateful for your efforts Treating patients that resemble family or friends Inability to preserve a life even if it was out of your control Inadequate of work/life balance (shift work hours!)

Potential Causes of Dysfunction in Nursing… Prolonged negative interaction with patients. Feeling like you will never be good enough Major critical incidents involving self-blame Dealing with deeply moving situations that don’t make sense. (i.e. Child abuse) A violent interaction at work. Death of a child in or near your care. Death of a patient following significant and prolonged lifesaving efforts

“When it’s one of those nights when you can’t sleep or whatever it is, that’s when the images come to you. You always think, ‘why can’t I forget those things?’ You wonder. You don’t know why. Are they there so you can help someone else? I don’t know. All I know is that they’re stuck in my head and I wish I could get rid of them, but I don’t know how to do that or if I even could if I tried.”

“I think in some ways we are trying to preserve our humanity, but assault after assault changes our ability to do that – changes our ability to find the humanity and be human. It’s almost like you take a little piece away – you don’t want them to see that you’re cold, because you’re not cold – but you almost have to protect that little piece of yourself.”

MY STORY ACUTE CRITICAL INCIDENT – Officer Involved Shooting PROLONGED EXPOSURE – 3 Consecutive Days of Emotionally Heavy Calls For Service

OFFICER INVOLVED SHOOTING

LUNCH BREAK

3-DAYS

Prevalence of Post Traumatic Stress in Front Line Community Service Workers 10-15% OF LAW ENFORCEMENT 10-30% OF FIRE FIGHTERS 16% VIETNAM VETERANS 14% NURSES (NurseCore Article 2013)

It’s estimated that 14% of all nurses exhibit some type of PTSD symptom, four times higher than the general adult population. Experts point to the constant exposure to death and mortality as the cause for the high risk factor among nurses

Recognizing & Mitigating Stress Complications COGNITIVE (Thinking) EMOTIONAL BEHAVIORAL PHYSICAL SPIRITUAL

Symptoms of Distress COGNITIVE EMOTIONAL BEHAVIORAL PHYSICAL SPIRITUAL Sensory distortion Confusion Preoccupation Difficulty with making decisions Guilt Anxiety Irritability Anger Mood Swings Depression Impulsiveness Disrupted sleep patterns Withdrawal Family Discord Alcohol / Drug use Tachycardia Bradycardia Hyperventilation Muscle Spasms Indigestion Fatigue Anger at God Withdrawal from church community Crisis of faith

Symptoms of Dysfunction COGNITIVE EMOTIONAL BEHAVIORAL PHYSICAL SPIRITUAL Hallucinations Suicidal Disabling Guilt Panic attacks Immobilizing depression PTSD Violence Abuse of Others Diminished personal hygiene Self medication Persistent irregular hear beats Numbness or paralysis Inability to speak or understand speech Cessation of Faith Religious hallucinations

A Word on PTSD Post-traumatic Stress (PTS) is a normal survival response. Post-traumatic Stress Disorder (PTSD) is a pathologic variant of that normal survival reaction.

Predicting PTSD 1. Dose - response relationship with exposure 2. Personal identification with event 3. Very important beliefs violated

PTSD Results From a Violation of … 1. Expectations 2. Deeply held beliefs (Worldviews) 3. Extreme physical pain

Recognizing & Mitigating Stress Complications BASELINES – What do you know about yourself when things are relatively normal? (What are your co-workers baselines?) AWARENESS – Do you know what things to look for? RESPONSE – Are you willing to seek assistance or help someone else get assistance? (Looking out for each other) What will your response look like? (And what should be avoided)

The Challenge of Mental Wellness… Acknowledge that this is a real situation with a large ripple effect. Can you get past stigmas Helping others doesn’t just start and end with patient care to discharge … sometimes it involves helping someone wearing the same uniform as you. Know the programs available to you and use them!

Questions?