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Jessica Switzman, MSN, CRNA

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OBJECTIVES: Understand Addiction Stress Resilience The Importance of Practicing Wellness

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Practicing wellness can decrease STRESS and ADDICTION STRESS MAY LEAD TO ADDICTION HEALTHY COPING MECHANISMS MAY PREVENT ADDICTION

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Why Drugs are Misused Initially a chosen behavior; maybe because of lack of healthy coping mechanisms Want to feel relaxed/free of pain (emotional or physical) Often to NOT feel uncomfortable emotions such as: Feelings of Inadequacy or Unworthy Loneliness Insecurity/ fear Sadness WANT TO ESCAPE; want to feel good

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Risk factors: Type A Personalities DNA (we can change our jobs, our friends, even our families but not our genetics) Thrill Seeking Behaviors (sometimes this helps us in our profession) STRESS Knowledge (we know what the drugs do) Availability/Accessibility Chain of EVENTS can turn on the switch i.e. unexpected family illness or accident

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Behaviors we see Liable mood with frequent unexplained anger and/or overreaction Increased difficulty with authority Forgetful, Unpredictable, Confused, Lacks Concentration Frequent illnesses and Physical Complaints Comes to work earlier or stays later Takes out more drugs than necessary or usually needed.

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Drug Misuse Among CRNAs Opioids Benzodiazepines N2O Propofol Ketamine Barbiturates Alcohol

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ADDICTION IS A DISEASE

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No One Is Immune

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10% of Population Brain is hijacked (pathways altered) Incapable of making decisions. Brain evolves to becoming very successful at basic functions; almost like a survival mode. Main objective becomes obtaining addictive substance.

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Why Care? As nurses, we have the ability to help restore a collogue to optimal health. We value our colleagues. We are our brothers and sisters keepers We have the ability to save a career and a family; plus return a valuable resource to the health care community ADDICTION is a potentially fatal disease We cannot change DEATH PLUS As heath care professionals we have a ethical, moral and legal obligation to ensure patient safety.

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What to do??? Talk to your Supervisor Know signs and symptoms of ADDICTION Practice Wellness

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Treatment Acknowledgement of disease Medical Detox Six month minimum, 1 year preferred MD specialized in Addiction Psychiatric Evaluation 12 Step Model which includes ABSTANCE; is only proven method that works!!

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Help for Substance Addiction AANA www.aana.com/peer Vanderbilt University www.vanderbilt.edu/hrs/wellness Alcoholics- Anonymous ASA Hotline on Chemical Dependence All Assistance is Safe and ANONYMOUS

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Treatment Centers for Referral to Intervention Caron Foundation Hanley Center Betty Ford Center Father Martins Ashley

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What is Stress? Stress is natural and unavoidable. Sometimes motivational and other times devastating.

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STRESS? Stress is your mind and bodys response or reaction to a real or imagined threat, event or change. Stressors can be: internal (thoughts, beliefs, attitudes or external (loss, tragedy, change). What are we stressed about? EVERYTHING!

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Stress A particular relationship between the person and the environment that is appraised by the person as taxing of exceeding his or her resources and endangering his or her well-being. (Lazarus & Folkman, 1984)

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Its NATURAL A normal adaptive coping response that evolved over hundreds of millions of years to help our ancestors avoid sticks and get carrots. Rick Hanson, PhD

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Its DISTURBING TOO MUCH STRESS can cause: Fatigue/Insomnia Headaches Gastrointestinal disturbances Weight loss or gain Relationship Disturbance Depression Addictive behaviors

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Face the facts!

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CRNAs Nurse Anesthetists spend endless hours devoted to the workplace, where we are constantly exposed to a variety of stressors. Prolonged stress can have negative physical and mental consequences sometimes to the point of disability and may even affect patient care.

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CRNA/Student Reported Stress Student mean = 7.9 CRNA mean = 5.1 Educator mean = 6.3 Chipas, McKenna 2011

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What do you use to manage stress? AANA Module 2, Chipas, et al 2011

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The Cost of Stress $26 billion paid annually in disability claims related to stress. Estimated that $300 billion is lost annually due to job related stress and diminished performance and absenteeism. 60-80% of all work-related accidents are due to stress. Information from the American Institute of Stress

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Stress Related Illnesses

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Stress and your well-being Up to 90% of all visits to PCP are related to stress More than 50 % of lost work days are related to stress Of all workers almost 14 % say stress caused them to quit or change jobs in the last 2 years

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More than just a state of mind Physical components of stress include : tight muscles, headaches, difficulty falling asleep and restless sleep, abdominal pain, allergies, asthma, inflammation and HTN.

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WHY STRESS IS BAD We all know prolonged HTN may lead to heart disease, heart attack and stroke. Long term inflammation may lead to weight gain, diabetes, kidney disease and maybe even cancer.

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More BAD NEWS Modern life exposes us to Chronic Stress- multitasking, moving too quickly, being bombarded with stimulation. Unmitigated stress can lead to substance abuse and potentially addiction We are not designed to flee from predators 12-14 hours a day without breaks.

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BUT.GOOD NEWS Stress is natural and unavoidable! By practicing wellness, we develop RESILIENCE and this enables us to combat stress. We cannot avoid Stress, it is all around us and effects all things.

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RESILIENCE What is it? the capacity to recover quickly from difficulties; toughness. The capacity to withstand stress and catastrophe. Working through the emotions and effects of stress and painful events. Being Resilient doesnt mean you will go through life without experiencing pain and sadness. We all feel grief, sadness, and a range of other emotions after adversity; this is normal!!

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How to Build Resilience Cultivate social supports Pet have a pet Reconcile Relationships Serve one Another Rest Laugh Cry Create Appropriate Boundaries Envision a Better Future Offer Thanks Be Rich in Faith Hold Fast Hope Above All, Love

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Wellness A positive state of mind, body and spirit reflecting a balance of effective adaptation, resilience and coping mechanisms in personal and professional environments that enhance quality of life. -AANA, Health &Wellness

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Simple things YOU CAN DO TO BUILD WELLNESS

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BREATH EMOTIONS ARE CLOSELY RELATED TO OUR BREATHING. BY ALTERNATING OUR RESPIRATORY RHYTHM WE SHOULD BE ABLE TO CHANGE EMOTIONAL GEARS. Just by slowing our respiratory rate and making our exhalation longer than our inhalation we can activate the Relaxation Response and produce beneficial antidepressant, antianxiety and antistress effects.

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MUSIC

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REST The best way to quiet the body-minds stress response and support the relaxation response is to REST! Rest charges up the Para-sympathetic rest and digest system which powers the bodys reparative and digestive activities. When deep rest is in short supply you can support the Para-sympathetic activity by taking frequent short breaks; ideally every 2 hours.

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SLEEP TRY TO GET 1 EXTRA HOUR/NIGHT IMPROVE THE QUALITY by meditative practices, deep breathing and/or by exercising early in the day. Short Naps can be helpful; 30-45 min so as not to disturb the sleep cycle. STRIVE FOR 7-8 HRS/NIGHT.

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EXERCISE WALK /RUN BIKE / ROLLER BLADE SWIM SHOOT HOOPS STRETCH/ YOGA VIGOROUS EXERCISE decreases ADRENALINE GENTLER EXERCISE lowers CORTISOL PHYSICAL MOVEMENT HELPS US STAY STRESS-RESILIENT:

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NUTRITION A WELL FED BODY IS A RESILIENT BODY - better to handle stress and recover from hormonal floods. Try to keep SUGAR and FLOUR to a minimum while eating healthy fats and good protein will keep blood sugar on an even keel, supporting good energy, mental clarity, and stable mood. ALL leading to more grace under pressure!!!

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GOOD RULES OF THUMB Eating plenty of dark FRUITS and VEGTABLES. SHOP the perimeter of the grocery store; most foods located in the middle aisles are processed. EAT WHOLE GRAINS/ NUTS AND SEEDS. Drink plenty of WATER. LIMIT CAFFEINE AND ETOH.

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MEDITATION MINDFUL MEDITATON- becoming a calm observer of your thought and emotions stimulates the parasympathetic nervous system. Meditation can reduce frantic neurological activity in the amygdala, the alarm bell of the brain. Self regulation can shift activity to the neocortex or executive center.

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POSITIVITY Positivity Ratio 3:1 Even with strangers positive connections can improve our health. Studies have shown that the amygdala- based cell receptors for oxytocin increase when we foster feeling of love, compassion and connection.

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ON THE SPOT STRESS REDUCTION WALK EXHALE LONGER PAUSE TUNE INTO YOUR BODY PAY ATTENTION TO YOUR SENSES CONNECT WITH OTHERS BE PRESENT

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1. Smile Therapy A study published in the journal of Psychological science showed that breaking into a smile- one that engages the muscles around the mouth and edges of eyes- can lower HR after a stressful event.

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2. BE HERE NOW! According to new research done at the Center for mind and Brain at the University of a California Davis, focusing on the present moment can significantly reduce levels of stress hormone cortical. If you start to rehash the past or worry about the future, try drawing your attention back to the present by focusing on the sensations of your breath.

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3. Be In Good Company- Research at the University of Hawaii, shows that stress can be contagious. We pick up the negative particles of stressed out friends, family members, and colleagues.

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4. DIVE IN- Looking out at water is a mood enhancer. Perhaps because 60% of the human body is compromised of it. If you cannot get to a body of water why not try adding a water element to your patio.

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5. Sing Singing releases feel-good endorphins. A 2010 study, by researchers in the United Kingdom and Australia, found that singing lowers levels of depression and anxiety, and improves general sense of well being. The respiration involved in singing slows down the Heart Rate and calms the nervous system.

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LIFESTYLE CHOICES Your lifestyle choices hold incredible power over health. You have the ability to reduce or raise the risk of many preventable diseases. PRACTICE WELLNESS DAILY

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Confidential Peer Assistance MANA's State Peer Advisor: Jessica Switzman, CRNA, MSN, RYT Annapolis, MD 21409 p: 410-991-5046 (Cell) p: 410-550-0942 (work)

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STRESS WEBSITES Information on stress and how to manage it http://www.nlm.nih.gov/medlineplus/stress.html AANA Health and Wellness www.AANAWellness.com AANA Peer Assistance www.AANAPeerAssistance.com AANA Student Wellness www.AANA.com/StudentWellness Helpful tips on stress management: http://www.mindtools.com The American Institute of Stress: www.stress.org The Stress Management Society promotes up-to-date research and information: http://www.stress.org.uk

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Questions???

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REFERENCES Chipas, A., McKenna B. (2011). Stress and Burnout in Nurse Anesthesia. AANA J. 79(2) 122-128 Chipas, A., Cordrey, D., et al.(2012) Stress: Perceptions, Manifestations, and Coping Mechanisms of Student Registered Nurse Anesthetists. AANA J. 80(4) Gill, C. (2013). Professional Wellness Applied from Day One. AANA News Bulletin, 67(5) 30-31. Hanson, R. (2009). Buddhas Brain: The Practical Neuroscience of Happiness, Love and Wisdom. New Harbinger. Lazarus, R. & Folkman, S. (1984) Stress, Appraisal and Coping. McGraw-Hill Matta, C. (2012). The Stress Response. New Harbinger Roy-Bryne, P. (2013) The Relaxation Response Changes Gene Expression. New England Journal of Medicine. Spayde, J. (2013). The Science of Stress. Experience Life. Trunajek, S. (2006). Student Stress: a question of balance. AANA New Bulletin, 60 (5) 20-21