1. Building Resiliency to Better Manage Occupational Stress S. Joshua Kenton, Psy.D. LCDR USN Staff Clinical Psychologist Naval Medical Center, San Diego

2. Work Related Stress Unreasonable demands for performance Lack of interpersonal communication between the employer and the employees Lack of interpersonal relationship among the employees The fear of losing one's job/job insecurity Long working hours Less time to spend with the family Under utilization of skills

3. Psychological Symptoms Mood swings Anxiety Depression Irritability Poor decision making Poor decision making Lack of concentration

4. Physical Symptoms Suppression of immunity resulting in infection Headaches Increased appetite leading to weight gain. Sleeplessness Loss of sexual drive Memory disturbances

5. Behaviors you may display… Change in friends Change in friends Withdrawal Withdrawal Changes in appetite Changes in appetite Inability to rest Inability to rest Pacing Pacing Change in sexual functioning Change in sexual functioning Increased Alcohol consumption Increased Alcohol consumption Emotional outbursts Emotional outbursts Erratic movements Erratic movements Change in speech patterns Change in speech patterns

6.  A beliefs injury  Due to conflict between moral/ethical beliefs and current experiences INNERCONFLICTINNERCONFLICT  A fatigue injury  Due to the accumulation of stress over time Wear & Tear Tear Wear & Tear Tear  A grief injury  Due to loss by death or separation of people who are cared about LOSSLOSS Stress Injury Sources: Impact  A trauma injury  Due to events provoking terror, helplessness, horror, shock Intense or Prolonged Stress

7.  Facing decision about balancing Pt. care with Self-Care  Feeling disillusioned INNERCONFLICTINNERCONFLICT  Long shifts  Frequent Deployments  Staffing shortages, and changes; PCS Wear & Tear Tear Wear & Tear Tear  Loss by death of critical care pts. suicide, etc.  Loss of job/role, relationships, etc. LOSSLOSS Stress Injury Sources: Impact  ER Trauma Care  Psychiatric Emergencies Response  ICU, NICU, etc Common Examples in Healthcare Setting

8.  “ Fit & Focused ”  Well-trained and qualified  Positive command climate  High morale  Strong cohesion  Good order and discipline  Clear sense of mission  Exhibits ethical and moral behavior behavior  Balanced & healthy relationships READY READY REACTING INJURED ILL HEALTHY GREEN ZONE

9. READY REACTING INJURED ILL REACTING  Anxious, irritable, sad  Poor concentration  Trouble sleeping, fatigued  Changes in appetite  Apathy, loss of interest  Negative, pessimistic  Increased interpersonal conflict conflict  Poor decision-making RECOGNIZING STRESS REACTION

10. INJURED READY REACTING ILL INJURED  Poor emotional control  Major sleep difficulties  Guilt, shame, fear  Loss of interest  Disruption of moral values  Substance Abuse  Decreased confidence  Poor morale  Family disruption RECOGNIZING STRESS INJURY

11. READY REACTING INJURED ILL Chronic and severe distress Substance dependence Major disruptions of sleep, appetite, mood Significant problems at work Panic, rage, guilt, and shame Symptoms that persist or get worse over time Injuries that don’t heal without help Family/relationship violence or abuse RECOGNIZING STRESS ILLNESS

12. What Doesn’t Help Using alcohol or drugs Violence or conflict Overeating/restricting diet Working too much Blaming others Withdrawing from pleasant activities

13. Building, Maintaining and Restoring Your Resiliency Create small goals Stay in the here and now Don’t run from the problem/Keep things in perspective Maintain an outlook of hope More fun Rely on good relationships Exercise Breathing/Relaxation

14. Conclusion Managing stress takes practice Be preventative Stay in the Green/Yellow Look out for each other Know when to get professional help.