Perhaps it’s a particularly chaotic day in the hospital for everyone. Maybe a colleague at the clinic doesn’t seem to have the focus or patience that he or she usually displays while treating patients or interacting with peers. Or maybe you are witnessing someone who may be about put themselves or patients in harm’s way.

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When a colleague is experiencing a stress injury leading to this behavior, how can you calm the situation in the moment and for the long hall to ensure physical and psychological safety?

“We know that presence is important. Showing up and standing by and asking, ‘Is there anything I can do to help?’” said Richard Westphal, PhD, co-director of the Wisdom and Wellbeing Program at the University of Virginia School of Nursing in Charlottesville. “And in the patient-care environment, if there is a risk to the safety of a co-worker or patient, then you just say, ‘Stop. Freeze. Let’s look at what we’re doing.’”

Westphal co-created the AMA STEPS Forward™ toolkit, “Stress First Aid for Health Care Professionals,” which helps you learn how to “cover” and “calm” a co-worker, providing primary aid to anyone who is showing signs of a stress injury so they don’t harm themselves or others. A stress injury goes beyond burnout and is any severe and persistent distress or loss of ability to function caused by damage to the brain, mind or spirit after being exposed to overwhelming stressors such as fatigue, trauma, loss or moral injury.

The toolkit also outlines the stress first aid framework and helps physicians and others in health care recognize and respond early to stress injuries, and manage them as one would any other injury. The peer-support and self-care model that health systems can provide to improve self-care is based on years of research. It is practical, flexible and tailored to specific styles and needs of those involved in recuperating from stress injury.

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Here are some verbal and nonverbal techniques you can use to prevent a potentially dangerous situation.

Some immediate actions to cover the situation:

  • Ask, “Are you okay?”
  • Ask, “Do you need help?”
  • Suggest an alternate, safer course of action.
  • Forcefully command the person to stop.
  • Make eye contact.
  • Hold up your hands in a “stop” gesture.

Longer-term actions you can take:

  • Have a buddy or trusted colleague with whom the person can work through challenges.
  • Ask what feels unsafe and then help to improve safety.
  • Discuss lessons learned and engage in problem-solving after the unsafe situation.
  • Be a good role model for setting boundaries.

Calming yourself or others during situations that may trigger acute stress injuries is also important.

You can practice slow breathing to lower your heart rate or pausing for 15 to 30 seconds before making a major decision or responding to new challenges. You can help calm others by giving a person time to rest or take a break. You can also try asking them to help with something—a good way to empower and distract them.

Some other actions include:

  • Being a calm presence.
  • Maintaining eye contact.
  • Staying with the person.
  • Giving directions, such as “take a deep breath and focus with me.”
  • Coaching them in a breathing or grounding activity.
  • Using the person’s name and communicating exactly what is needed in a calm, methodical voice.

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It is important to create a culture that promotes actions around providing cover and calm, Westphal said.

“We’ve found that in units that have brought this stress-aid model into their unit, there’s a bit more grace and dignity in being able to ask for help, particularly in situations where psychological or physical safety is needed or where the team just needs to take a breath,” Westphal said.

Learn more in the toolkit about how to create that kind of environment over the long term.

The AMA STEPS Forward open-access toolkits are part of the AMA Ed Hub™, an online platform that brings together all the high-quality CME, maintenance of certification, and educational content you need—in one place—with activities relevant to you, automated credit tracking and reporting for some states and specialty boards.

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