How Stress affects clinical Decision Making.

When we are frantically stressed, we get nothing done. When we are distracted or complaining to others, we can end up throwing away our time, energy and attention, instead of focusing on what our patients really need. In those moments, it is a skill to practice centering ourselves and bringing our attention back to what is needed and directly in front of us.

Be careful of your language and your time.

When you are in a situation where you are under pressure, perhaps an increased workload, a deteriorating patient or even lack of resources or staff that is out of your control, in these times, your language and attention becomes even more precious. It is understandable to feel emotions such as: anger, frustration, stress or feeling overwhelmed. Although these emotions hinder our productivity and close us off to any resources that are available to us 1. This mindset can negatively affect not just ourselves, but our patients and everyone else around us. For example when you have five things to do all at once, and someone walks past and says “Hi, How are you going?” if you choose to say; “Busy” that person will most likely respond with walking right past you, and continue doing their own work. Perhaps taking a pragmatic approach and instead saying: “Great thanks! J I just have 5 things due at the moment, and I also need to get ready for CT” they may respond with, “Oh, super, I have 5 minutes while my patient is on the toilet. Would you like a hand?”

Come back to the present moment.

Something so simple, though so difficult is to stay focused, calm and centered amongst the chaos of the storm. To place your attention on the tasks which need to be done, and using your time, smile, attention and team mates to achieve the highest priority tasks. Delegating, with a smile, collecting all the resources at once. Preparing all your medications and infusions at once, instead of when they are running out. All these strategies require analysis, logical thinking, prioritization and forward planning. All of which can only be done when we are in a calm state of mind. Reducing your own stress not only dramatically effects the way you feel within yourself, but about yourself. You will have less in your mind to process after your shift is done, making it easier for you to wind down, leaving you more satisfied in your personal life. You can also very importantly reduce the incidence of errors and risks of clinical incidences too. Though, it is easier said than done. Remember, you are not stressed, you are having a feeling of stress, start dissociating yourself from your emotions, you are experiencing emotions, you are not the emotion.

How to:

The first step is to become aware of your state and your emotions, and understand that you have an opportunity to practice bringing yourself back into a calm and centered state. One great strategy is to use the Dual Awareness Protocol (Craigie, Aoun & Hegney, 2014). Although originally developed to deal with flashbacks from post-traumatic stress disorder, it can help bring you back to the moment and stop the feeling that you are being overwhelmed. You will bring your attention back to the moment rather than letting your mind take over. You can practice this very easily, and even right now by:

-          Noticing two things you can feel

-          Noticing two things you can hear

-          Noticing two things you can smell

-          Noticing two things you can taste

Nobody needs to know you are doing this, and taking just one moment to centre yourself can save you a substantial amount of time, stress and risk of an error or clinical incident.

By Stephane Bouchoucha and Amy Benn

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