Interview with Richard J. Westphal, PhD, RN, FAAN, and Patricia Watson, PhD, on recognizing and responding early to stress injuries in health care professionals. To learn more on this topic, review the related Stress First Aid toolkit.
- Richard J. Westphal, PhD, RN, FAAN; advanced practice psychiatric nurse; professor, University of Virginia School of Nursing
- Patricia Watson, PhD; clinical psychologist, National Center for Posttraumatic Stress Disorder
- Jill Jin, MD, MPH; senior physician advisor, American Medical Association
Speaker: Hello and welcome to the AMA STEPS Forward® podcast series. We'll hear from health care leaders nationwide about real-world solutions to the challenges that practices are confronting today. Solutions that help put the joy back into medicine. AMA STEPS Forward® program is open access and free to all at stepsforward.org.
Dr. Jin: My name is Jill Jin and I am a physician advisor with the AMA and an editor for STEPS Forward® as well as a practicing internist at Northwestern. Today we are discussing the very important module on stress first aid, and I have here with me the two authors of the module, Dr. Richard Westphal and Dr. Patricia Watson. Welcome, and thank you so much for being here with me today.
Dr. Westphal: Thank you, Jill.
Dr. Jin: Could you please introduce yourselves to the audience?
Dr. Westphal: Most certainly. My name is Richard Westphal. I'm an advanced practice psychiatric nurse. I'm a professor at the University of Virginia School of Nursing. And I have been working in the field of occupational stress since the early nineties, and I'm one of the original authors of the stress continuum and stress first aid model.
Dr. Watson: I'm Patricia Watson. I work at the National Center for Posttraumatic Stress Disorder as a clinical psychologist, developing educational materials and interventions. Prior to that, I was in the Navy for eight years as a clinical psychologist.
Dr. Jin: Thank you. So, let's dive right in. What is stress first aid?
Dr. Westphal: Well, thank you, Jill. Stress first aid is a process like other forms of first aid, where we recognize when somebody has a stress injury, like a physical injury. And we respond to that stress injury with compassion, with empathy, to create a path of honor and dignity for some of our colleagues that have been injured, doing the work that they are doing
Dr. Jin: And what are the steps that one would take to apply the core functions of stress first aid?
Dr. Westphal: So, stress first aid has three core steps that we've outlined in STEPS Forward®. The first step is to recognize when a stress injury has occurred. Second is to have the skills and the ability to engage with our peers that has a stress injury and, third, help those peers connect with additional resources that will be helpful in the moment, in the time, to either make it through the shift, make it through the day, make it through the week, make it through the month. So it's very much like all other forms of stress first aid. Recognize an injury, prevent further harm and promote recovery.
Dr. Jin: Within those three steps there are of course, the seven Cs that describes kind of the seven core functions. Patricia, do you want to tell us about those?
Dr. Watson: The seven Cs of stress first aid are based on five core human needs that we pulled together with a group of experts from around the world and maps into the seven core functions of stress first aid, where the first is to check and to make sure that the person is actually affected by stress, because sometimes we have stress on the job and people aren't really injured by it, or aren't affected by significantly.
The second one is to coordinate. So, with any first aid that you'd always want to have other resources available if the first aid is not enough or isn't the proper aid for that person. Then the five core elements are to help move a person towards a more psychological sense of safety to calm them, to provide social support for them, to help them feel more competent or able to get through the situation that they're having trouble with, and to help them feel more confident either in themselves or in the system or people around them. And that also maps onto hope and meaning so that they feel a greater sense of meaning and connectedness to the work that they're doing.
Dr. Jin: Yes. Which is so important, that last point. This module describes in detail each of those seven Cs within those three steps of providing stress first aid. There are plenty of examples as well as downloadable materials for clinicians, for health care leaders, for organizations to use. We obviously won't be able to go through all of that today here, but are there any pearls of wisdom, any key points that you want our listeners to be aware of right off the bat?
Dr. Westphal: What I'd like to think about when you ask about pearls is that stress first aid isn't complex, it's just not easy. In that we work with really challenging, dedicated, motivated people that are trying their best to really take care of other people. That compassion that we give to our patients sometimes is not conveyed to each other. And so, in this high stress, high stakes world of health care, we really need to have a way to have a dialogue that supports each other, the advantage of STEPS Forward® and stress first aid is that it gives insights as to not how to talk to someone else, but what do you talk about.
Dr. Watson: Yes, and I would add to that one of the things I always say when I'm giving trainings is that if I came back six months from now and anybody was implementing stress first aid the way I would, I would consider that a training failure, because what we want you to do is take the framework and map it onto what's possible in the situations that you're in. If you don't have a capacity to support your coworkers, then apply it to yourself. And if you have the ability to make a difference with a person in front of you, we want you to move to move towards that rather than away from it. We hope that the framework and the tools would give people the impetus and the confidence to maybe take a moment or two to try to connect with somebody who might be stressed.
You don't need to use all of the five, you know, essential functions of stress first aid. You just pick and choose whichever one make makes the most sense, because we think that it's only in those moment-to-moment encounters you have with people that are familiar, that you guys are going through a similar thing, that people can mentor each other, can problem solve with each other, can laugh with each other, can support each other in the ways that make the most sense. So, also when I give trainings, I say, look, I know that what we're doing is reminding you of the things that you're already doing. We're not teaching you to do new things, but we are reminding you that these things are really important. Don't take them for granted, keep doing those things that do make a difference in people's lives in the long run.
Dr. Jin: There's that saying that the perfect is the enemy of the good, which in many ways can be true when we're so hard on ourselves as clinicians. But yes, I think in this module, we have tried to cover each ends of those spectrum, you know, providing this framework and providing as much practical information as possible with recognizing the challenge that one, that framework cannot be applied in a certain way to each situation because of the uniqueness of each situation. Thank you both so much for speaking with me today, this is such an excellent module that will help so many people, so many of our readers, so many patients and clinicians alike. So, thank you very much.
Speaker: Thank you for listening to this episode from the AMA STEPS Forward® podcast series. AMA’s STEPS Forward® program is open access and free to all at stepsforward.org. STEPS Forward can help put the joy back into medicine by offering real world solutions to the challenges that your practice is confronting today. We look forward to you joining us next time on the AMA STEPS Forward® podcast series, stepsforward.org.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.