Emergency physicians’ experience of stress during resuscitation and strategies for mitigating the effects of stress on performance

ObjectiveThis study explored the perspectives and behaviours of emergency physicians (EPs), regularly involved in resuscitation, to identify the sources and effects of any stress experienced during a resuscitation as well as the strategies employed to deal with these stressors.MethodsThis was a two-centre sequential exploratory mixed-methods study of EPs consisting of a focus group, exploring the human factors related to resuscitation, and an anonymous survey. Between April and June 2020, the online survey was distributed to all EPs working at Australia’s largest two major trauma centres, both in Melbourne, and investigated sources of stress during resuscitation, impact of stress on performance, mitigation strategies used, impact of the COVID-19 pandemic on stress and stress management training received. Associations with gender and years of clinical practice were also examined.Results7 EPs took part in the focus group and 82 responses to the online survey were received (81% response rate). The most common sources of stress reported were resuscitation of an ‘unwell young paediatric patient’ (81%, 95% CI 70.6 to 87.6) or ‘unwell pregnant patient’ (71%, 95% CI 60.1 to 79.5) and ‘conflict with a team member’ (71%, 95% CI 60.1 to 79.5). The most frequently reported strategies to mitigate stress were ‘verbalising a plan to the team’ (84%, 95% CI 74.7 to 90.5), ‘implementing a standardised/structured approach’ (73%, 95% CI 62.7 to 81.6) and ‘asking for help’ (57%, 95% CI 46.5 to 67.5). 79% (95% CI 69.3 to 86.6) of EPs reported that they would like additional training on stress management. Junior EPs more frequently reported the use of ‘mental rehearsal’ to mitigate stress during a resuscitation (62% vs 22%; p<0.01) while female EPs reported ‘asking for help’ as a mitigator of stress more frequently than male EPs (79% vs 47%; p=0.01).ConclusionsStress is commonly experienced by EPs during resuscitation and can impact decision-making and procedural performance. This study identifies the most common sources of stress during a resuscitation as well as the strategies that EPs use to mitigate the effects of stress on their performance. These findings may contribute to the development of tailored stress management training for critical care clinicians.

Caregiver Stress: Biomarkers Linked to Disease Risk and the Psychobiology of Stress Reduction

Caregivers to older adults with chronic diseases frequently experience chronic stress which can negatively affect caregivers’ physical and mental health, and increase disease risk. This interdisciplinary symposium will highlight critical factors influencing caregiver stress, and the role of biomarkers in detecting caregiver disease risk. First, we will discuss the effects of stress and emotional experiences on risk for cardiovascular disease in caregivers of persons with dementia (PWD). In the first talk, Dr. Mausbach will examine relationships among perceived stress, blood glucose and risk of diabetes and cardiovascular disease in caregivers of PWD. Next, Dr. Losada-Baltar will discuss the degree to which caregivers’ ambivalent feelings towards providing care are associated with inflammatory markers of cardiovascular risk. Following this, two talks will investigate critical links between stress and caregiver emotional well-being. Dr. Liu will report relationships among the stress-related hormone cortisol, sleep, and anxiety in the context of adult day services. Dr. Beadle will examine the degree to which caregivers’ affiliative, empathetic interactions with others relate to their experience of stress through cortisol assessments and neuroimaging. The final talk by Dr. Jain will investigate the effects of a Mentalizing Imagery Therapy intervention for family PWD caregivers on stress, evidence for mindfulness as a causal mediator of stress reduction, and the relationship to brain networks associated with emotion regulation. Taken together, this symposium will identify relevant psychosocial and biological factors that contribute to caregiver stress, as well as discuss the psychobiology of amelioration of caregiver stress.

Walking It Off: More Stressors and Perceived Stressor Control Predict More Physical Activity in Daily Life

Research shows that, while the experience of stress relates to lower levels of physical activity (PA), people who perceive a greater sense of control engage in higher levels of PA. This study explores whether a sense of control specifically over stressful situations moderates the negative association between stressor exposure and PA in daily life. We used 8-day diary data from up to 1,236 participants (Age: Range = 43-91, M = 62.47, SD = 10.20) in the National Study of Daily Experiences. Somewhat contrary to hypotheses, people reported spending more time on light PA (but not moderate-to-vigorous PA) on days when they also experienced more stressors than usual. Perceived stressor control appears to magnify this effect, with people reporting even more light PA on days when they feel greater control. Initial findings suggest that a physically active lifestyle may help middle-aged and older adults cope with daily stressors.

Authentic Conversations About Self-Care with Fourth-Year Veterinary Medical Students

Expanding literature on well-being within veterinary medicine has been instrumental in recognizing the prevalence of psychological distress among students and practitioners, promoting awareness and advocacy for well-being within teaching institutions, professional associations, and the workplace. However, greater focus on distress has also been critiqued for overemphasizing illness and reactive interventions, and a call has been made for more balanced conversations about veterinary well-being, with focus on strengths and proactive interventions. This best-practices article highlights a proactive, strengths-focused intervention, aimed at increasing fourth-year students’ awareness of self-care while in training and in their transition to the profession. Authentic conversations about self-care is a required part of clinical training at Kansas State University College of Veterinary Medicine. All students attend a private meeting with a behavioral scientist, engaging in an authentic conversation about their experience of stress and coping strategies. Current practices in providing stress management interventions are restricted to pre-clinical training. Authentic conversations about self-care are presented here as an alternative to current practices, which the authors argue are not adequately addressing students’ needs during clinical training and the transition to the profession. Potential implications of providing self-care interventions during the clinical year of training include greater student engagement, increasing awareness, and self-efficacy as students make efforts to maintain well-being both in training and in the professional realm.

Smoking Protective and Risk Factors Among Transgender and Gender-Expansive Individuals (Project SPRING): Qualitative Study Using Digital Photovoice

Background Transgender and gender-expansive (TGE) adults are twice as likely to smoke cigarettes than cisgender individuals. There is a critical gap in research on effective and culturally sensitive approaches to reduce smoking prevalence among TGE adults. Objective This study aims to qualitatively examine the risk and protective factors of cigarette smoking among TGE adults through real-world exemplars. Methods We conducted a digital photovoice study among a purposeful sample of 47 TGE adults aged ≥18 years and currently smoking in the United States (March 2019-April 2020). Participants uploaded photos daily that depicted smoking risk and protective factors they experienced over 21 days on either private Facebook or Instagram groups. Next, we conducted separate focus group discussions to explore the experiences of these factors among a subset of participants from each group. We analyzed participants’ photos, captions, and focus group transcripts and generated themes associated with smoking risk and protective factors. Results We identified 6 major themes of risk and protective factors of smoking among TGE individuals: experience of stress, gender affirmation, health consciousness, social influences, routine behaviors, and environmental cues. We describe and illustrate each theme using exemplar photos and quotes. Conclusions The findings of this study will inform future community-engaged research to develop culturally tailored interventions to reduce smoking prevalence among TGE individuals.

Occupational Stress and Catholic Priests: A Scoping Review of the Literature

This study offers an exploratory review of the experience of stress and burnout syndrome among Catholic priests. Following Arksey and O’Malley's (Int J Soc Res Methodol 8(1):19–32, 2005, 10.1080/1364557032000119616) protocol, a scoping study was conducted. Given the scarcity of studies found on the subject, a broad selection criterion was used, which included quantitative, qualitative and mixed studies, literature reviews and comparative studies with other professions. The results reveal various risk factors: work overload among younger generations of priests, a sociocultural context that distrusts the clergy, neurotic, introverted, perfectionist and narcissistic personality styles, avoidant and complacent coping styles, living alone, not having sufficient support (especially from the Church authorities), excessive demands and lack of boundaries related to the priestly role and submissive obedience styles, among others. However, the studies reviewed also identified important protection factors: promoting optimism, an approach-based coping style and a collaborative way of resolving conflicts, frequent physical exercise, eating a balanced diet, finding time to rest, strengthening personal identity, social support (from parishioners, collaborators, colleagues, superiors) and leading an active spiritual life. Stress and burnout are associated with certain pathologies linked to smoking, alcoholism, obesity, diabetes, cardiovascular disease, anxiety and depression. Strengthening protective factors and minimizing the impact of risk factors would do much to improve the clergy’s occupational health.

The Mode of Trust and Experience of Stress in Customs Officers in Ukraine

The article presents the author’s position of studying organizational trust in customs service and specific experience of workplace stress that influences its formation. The study sample involved 77 customs officers in the following categories of customs personnel: customs inspectors and passenger inspectors. The scientific value of this study lies in establishing the empirical referents of the relationship between organizational trust and relief of organizational stress in customs officers at different organizational levels. The article proves that the empirical referents of the interrelation of organizational trust and experience of workplace stress in the customs group 3 are at the mezzo-level of organizational trust (concern from management, supported by indicators of organizational culture in the field of communication and management) and at the micro-level (increasing organizational stress in the forms of activity and productivity, the flexibility of behaviour, acceptance of others’ values and indicators of job satisfaction due to the expressed emotional commitment of these employees to their organization). The practical value of the obtained results allows one to understand the nature and the impact of organizational stress and the level of organizational trust on the effectiveness of customs officers’ professional activities. It also makes it possible to develop a further programme of psychological support for this professional group to improve psychological safety and well-being in the workplace.

Decomposition of inequality determinants of stressful events in Tehran; Oaxaca–Blinder analysis

Purpose Social determinants of stressful events (SE) play an important role in justifying the cause of inequality in the experience of SE. The purpose of this study is to investigate the determinants that impact on inequality in the experience of SE. Design/methodology/approach The statistical population of this study includes all residents of Tehran. The statistical sample was 5,895 people who were selected by multistage cluster method and were proportional to the population size. The research tool is a researcher-made questionnaire designed to measure SE in Tehran, which includes 11 psychological stressors. The Oaxaca–Blinder decomposing method was used to analyze data. Findings In a total of 11 psychological SE, in 6 of those events, there was significant inequality in the experience of SE. Concentration Index (CI) of political SE is (CI = −0.27, 95% CI: −0.47, −0.07) and in favor of the rich (pro-rich). Education (OR = 1.60) in poor group and region development in poor and rich (respectively in all of the following) (OR = 0.42–0.73) are the main determinants of inequality in this stressor. CI of neighborhood underdevelopment SE is (CI = −0.47, 95% CI: 0.66, −0.28) and pro-rich. Education (OR = 1.26–1.27) and region development (OR = 1.18–2.24) are the main determinants of inequality in this stressor. CI of livelihood problems SE is (CI = −0.58, 95% CI: 0.68, −0.32) and pro-rich. Education (OR = 1.40) and health status (OR = 1.63) in poor group are the main determinants of inequality in this stressor. CI of future uncertainty SE is (CI = −0.12, 95% CI: 0.34, −0.08) and pro-rich. Gender (OR = 1.22) in poor group and region development (OR = 0.24–0.58) are the main determinants of inequality in this stressor. CI of education problems (CI = 0.19, 95% CI: 0.05, 0.32) and pro-poor. Age (OR = 0.32–0.34) and education (OR = 3.65–3.30) are the main determinants of inequality in this stressor. CI of housing problems is (CI = −0.29, 95% CI: −0.49, −0.08) and pro-rich. Education (OR = 1.31) and region development (OR = 1.64) in poor group are the main determinants of inequality in this stressor. Research limitations/implications The first limitation is related to the level of data analysis, and the second limitation is the lack of comprehensive data on social determinants. Practical implications Social determinants affecting the formation of inequality in the experience of SE. Some social determinants, such as the level of education and development of the region, play a more prominent role in justifying inequality in the experience of stress between rich and poor groups. Social implications Inequality in the experience of SE is a serious threat to mental and social health. One of the ways to reduce the experience of psychological and social stress is to pay attention to social determinants that play a role in the formation of stress. Originality/value This original paper was conducted by examining the effect of social determinants on the formation of inequality in the experience of stress, which draws the serious attention of policymakers.