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Stress and Fatigue Management

When your body reacts to a physical, mental or emotional stimulus, it can cause stress that interferes with your health or normal functioning. Stress occurs when situations put more pressure on you than you think you can handle. One symptom of long-term stress is fatigue, defined as physical or mental exhaustion. Fatigue causes a dulling of your senses, thought processes and reflexes.

Calling attention to the “red flags” of stress and fatigue is an important part of the Crew Resource Management (CRM) family of skills, which help caregivers function as effective team members. With routine monitoring of stress and fatigue, you can anticipate behavior that leads to ineffective teamwork and risks to patient safety.

Stress frequently originates from your own reaction to a situation, rather than from the situation itself. You create most of your own stress, and you can also manage it. However, if stress continues or isn’t managed, it leads to pain, illness, injury, emotional problems, fatigue and disruptive behavior, all of which inhibit your own effectiveness and that of your team, as well as seriously affect patient safety.

Understanding Stress and Fatigue

Stress results from stimuli such as overwork, anxiety, fear, worry, illness, injury or trauma. It also follows major life events such as job or marital changes, financial difficulties, the death of a family member and so on. Even positive events like an awards presentation or a wedding act as powerful stressors, since something is usually given up in return for getting something better.

In addition to dealing with stressful situations outside the job, you face a high-pressure environment every day. As you work long hours, juggle various tasks and deal with multiple patients and other issues, you may feel that it’s impossible to take time to rest, exercise, sleep or eat properly. The demands of your job cause stress; ignoring your body’s basic needs adds to it. If this continues without relief, you experience fatigue, exhaustion, depression, burnout, illness, pain, and suppression and degeneration of the immune system. You may also exhibit irritability and disruptive behavior, which interferes with your team’s effectiveness and can create disciplinary problems for you.

When the mind perceives a stressful event, the body automatically begins the biological “fight or flight” stress response: releasing adrenaline, tensing muscles, boosting heart rate, constricting blood vessels, slowing the digestive system, causing “tunnel vision” and so on. Without proper rest, exercise and nutrition to counteract these effects, the body continues producing the stress response until it is fatigued or exhausted.

When you are fatigued, you have a limited attention span and little energy to function effectively. Some common effects of fatigue include physical weakness, mental sluggishness, forgetfulness, restlessness, euphoria, slow reflexes and reaction time, and microsleeping (“nodding off” for a few seconds at a time). Fatigue severely undermines your performance, especially during irregular or high-risk procedures. Research has shown that more than 20 percent of all serious incidents and bad patient outcomes are fatigue-related.

When you experience fatigue, you can’t concentrate, causing you to easily lose situational awareness (SA)—the constant state of knowing what’s going on in your immediate environment, why it is happening and what is likely to happen next. Also, fatigue causes more stress from inattention to details, poor decision-making and unintentional medical errors. Sometimes, fatigue can be resolved by sleeping sufficiently or leaving a high-stress environment; however, continuing poor sleeping habits or not coping with that environment produces chronic fatigue.

In addition to fatigue, dozens of other disorders result from stress. Stress affects the nervous system—especially through the digestive and intestinal systems—and the hormone-producing adrenal and thyroid glands. Stress can begin with simple headache, backache and neck pain. As the stress accumulates over time, you are susceptible to ailments like insomnia, irritability, dizziness, depression, high blood pressure, impotence, loss of appetite, cardiovascular conditions, colitis, digestive disorders, ulcers, hair loss, anxiety and nervous disorders, obsessive-compulsive behaviors, premenstrual and menstrual disorders, skin conditions, temporomandibular joint (jaw) pain and clicking, and weight loss or gain.

Managing stress and fatigue is important for maintaining a culture of quality and patient safety. To reduce the damaging effects of stress and fatigue, you must address the core problems and learn how to cope. You shouldn’t ignore root causes, symptoms and effects on your body, mind and behavior. In some cases, you may need a team member or counselor to help you manage your stress and fatigue.

 


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