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
·
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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