PiNSProgram: Just-in-time Training...Signs of trouble warranting referral ØOngoing intrusions (nightmares, flashbacks, intrusive thoughts) ØOngoing hyper-arousal (anxiety, insomnia,

PiNS Program: Just-in-time Training

David Cates, Ph.D.Director, Behavioral Health

Nebraska MedicineVice Chair of Clinical Operations, Department of Psychiatry

University of Nebraska Medical Center

Thank you for volunteering!

AgendaØHICS structure ØUnique challenges for healthcare workers in a

pandemicØRisk factors for psychological distressØPsychological First Aid (PFA) Refresher

§ Primary objectives§ Signs of trouble§ Making referrals§ Dealing with anger

Ø Tracking contactsØ Self-care

Mental Health Unit Leader Inpatient Unit Leader, Outpatient Unit Leader, Casualty Care Unit Leader, Patient Registration

Unit Leader, Clinical Support Unit Leader

Medical Branch Director

HICS Structure

Ø Proper use of PPE / infection control protocolsØ Lack of organization and role clarityØ Changes in workflow and responsibilityØ Limited resources/suppliesØ Altered standards of care and ethical challenges (“moral injury”)Ø Separation from usual colleaguesØ Witnessing the death of patientsØ Illness and death in colleaguesØ Challenging team dynamicsØ Fear of contracting the illnessØ Concerns for safety of family and friendsØ Feeling misunderstood; pressure to justify workØ Stress with re-entry to regular unitØ Stigmatization, lack of appreciationØ Fatigue and limited rest timeØ Personal and team pressure to succeed in care of patientsØ Self-doubt

What Type of Challenges?

Ø Increased challenges → increased distress § Most healthcare workers are resilient and will not experience lasting

distress. § However, depending on stress during the response, 10 –20% of

healthcare workers are at risk for a new disorder they didn't have before the event (based on research with disaster responders).• Post-traumatic stress• Insomnia• Alcohol/drug misuse• Depression • Anxiety

§ Symptoms may appear after the outbreak is under control§ Symptoms usually decrease over time§ Relapses may occur, especially if:

• Pre-existing mental health conditions • Re-exposure to additional infectious disease outbreaks

Psychological Distress

ØPerception of heightened risk of infection

Ø Longer duration of high risk exposure

ØPrevious history of psychiatric illness

Ø Lack of social support

Risk Factors for Psychological Distress

Keep in mind the phase of the disaster and the expected reactionsPhases of a Disaster

Primary objectivesØ Take emotional temperatureØ Bring temperature of 8-10 down to 6-7

§ Unlikely to get down to 0-4 rangeØ Encourage actionØ Encourage self-relianceØ Convey that they are not aloneØ Provide information on common reactions to stressØ Convey that reactions are normal

PFA Refresher

What are common reactions to stress?PhysicalBack pain, muscle tension, stomach ache, headache, changes in appetite, sleep disturbance, fatigue, etc. EmotionalWorry, irritability, sadness, anger, anxiety, fear, depression, guilt, mood swings, hopelessness, etc.CognitiveDifficulty concentrating, trouble remembering things, feeling confused, catastrophizing, etc.BehavioralSnapping at others, overworking, impulsivity, pacing, withdrawing, poor self-care, using drugs or alcohol more than usual, increased conflicts, etc.

PFA Refresher

Signs of trouble warranting referral

Ø Ongoing intrusions (nightmares, flashbacks, intrusive thoughts)Ø Ongoing hyper-arousal (anxiety, insomnia, irritability, etc.)Ø Avoiding reminders of a traumatic eventØ Avoiding feelings by using substancesØ Feeling numb, spaced out or like things aren’t realØ When daily functioning is affected

PFA Refresher

Making referrals

Ø Be cautiousØ Peers might feel stigmatized

Ø Explain reasons carefully and respectfully

PFA Refresher

Dealing with angerØ Peers may be in the disillusionment phaseØ Stay non-defensiveØ Begin with a statement of empathy

Ø “It’s nice to meet you. I’m sorry it’s under these circumstances.”

Ø Focus on what they can do, not what they can’t doØ Show respectØ When people are upset, consider switching

temporarily to closed-ended questions

PFA Refresher

Ø Please indicate when the support is completed, including what assistance you provided, using the TEAMS site.

Tracking PiNS Contacts

Tracking PiNS Contacts

Ø There are additional resources in the Teams site:Ø PFA just-in-time trainingØ Handouts

Resources

Ø Find a buddy with whom to debrief

Ø Connect with your social supports

Ø Use your stress management technique

§ Mindfulness, deep breathing, body scan, etc.

Ø Limit media consumption

Ø Keep a gratitude journal

Ø Exercise, eat well

Ø Get sufficient sleep

Ø Spend time outdoors

Taking Care of Yourself

Questions / Discussion