Promoting Professional Wellness

Question 1

Stress is how many % of all medical visits?

Answer 1

60-90%

Question 2

AANA’s Wellness Initiative:

Name of person initiating who became addicted to anesthetics

Answer 2

Jan Stewart

Question 3

AANA’s Wellness Initiative

2 Objectives

Answer 3

1. Jan Stewart Memorial Wellness Lecture Series
2. Broad Based Wellness Services for memberss Covers MANY issues that affect professional and emotional well-being.

Question 4

Key element in quality of care

Answer 4

Relationship btw fitness for duty and patient safety

Question 5

Chemical dependency/addiction % among SRNAs, CRNAs, MDAs, Residents

Answer 5

10%

Question 6

MDA greater or less than other physicians?

Answer 6

greater

Question 7

Anesthetists highest drugs abused statistically

Answer 7

OR drugs + other drugs

Question 8

Aristotle’s

“Nothing in excess”

defines what?

Answer 8

Well-being

Question 9

Fear of disease

Fear of failure

“Change in behavior depend on perception of severity of problem, perceived susceptibility, the benefit of change, barriers to change, and perceived self-efficacy”

Answer 9

Health Belief Model

Question 10

6 Components of Wellness

(Hettler)

Answer 10

1. Physical
2. Emotional
3. Emotional
4. Occupation
5. Social
6. Intellectual
7. Spiritual

Question 11

These things define what?

Satisfaction with self

Acceptance of physical appearance

Valuing unique characteristics and abilities

Answer 11

Sense of worth

Question 12

3 Dimensions of Self-Direction

Answer 12

Sense of worth

Sense of control

Emotional awareness & coping

Question 13

Sense of control 9 components

Answer 13

1. belief in competence
2. confidence
3. self-efficacy
4. knowledge
5. skill
6. choice
7. influence
8. expectations
9. control

Question 14

Components of what?

1. Ability to express/disclose feelings
2. Response to life expectations
3. Sense of energy, appropriate responses to challenges, negative emotions, and enjoyment of positive emotions

Answer 14

Emotional awareness & coping

Question 15

Feeling of deep sympathy for another is stricken by suffering or misfortune

Answer 15

Compassion Fatigue

Question 16

Reduction of capacity of NMS to carry out its function. Causes sleep deprivation, boredom, work overload, physical exhaustion…

Answer 16

Physiological fatigue

Question 17

10 Principles of Wellness

Answer 17

1. Create long-term goal
2. Connect to your collegues
3. Enjoy what you do
4. Physical well-being
5. Keep in touch
6. Manage time
7. Make plans
8. Take time for self
9. Be realistic
10. Don’t think you can do it alone

Question 18

Symptoms of what

1. mental, social, physical manifestations
2. exhaustion
3. loss/inc apetite
4. h/a
5. sleeplessness or oversleeping
6. crying
7. feeligns of “alarm” frustration, or apathy

Answer 18

Stress

Question 19

AMA & APA sees dependency & addiction as diagnosable and treatable:

4 components

Answer 19

1. Availability of drug + urge
2. Urge is part of neurochemical makeup
3. Stress contributes to potential: Genetic predisposition and familial dysfunction, risk escalates
4. Cascade of behioral changes occur: progressively deteriorates

Question 20

Pleasure comes from increase _____ in the brain?

Answer 20

Increased dopamine

Question 21

Long term addiction

Change in brain

Answer 21

Loss of glutamate control

in prefrontal cortex

changes how brain processes info

and controls behavior

Question 22

Looking at cocaine for a drug abuser has physiological changes seen in brain in what pleasure part of brain?

Answer 22

Amygdala

Question 23

Last defense (think things thru) in brain.

Decision making

Priorities

“I won’t do drugs”

Answer 23

Prefrontal cortex

Question 24

Perception of drug procurement is more important than… (“feeding my 6 month old” i.e.)

Over-valuing drug high over …

What part of brain?

Answer 24

Prefrontal cortex

Question 25

Second step

Answer 25

Early downstream involvment

Question 26

Network of these areas in brain with addiction

Answer 26

**Nucleaus accumbens** (dopamine) **Amygdala** (neg feedback-Gaba) **Hippocampus** (where, who and what; part of the craving) **Prefrontal Cortex** (perceive, final "say so", priorities btw getting infection/losing job vs getting drug - **overvalues experience in the drug use**)

Question 27

Main neurotransmitters involved 3

Answer 27

Dopamine GABA glutamate

Question 28

Rob bank, kill, compulsive drug-seeking altered in what part of brain?

Answer 28

**Prefrontal cortex** Overweighs this information at this point. Normally PC would say it is not worth it. "Didn't like what the drugs caused in family, etc, but liked how the drugs made him feel and have no intention of quiting"

Question 29

Conspiracy of silence anything that allows addict to avoid consequences

Answer 29

Enabling

Question 30

**Treatment:** Predominant form of chemical tx inpatient/residential options must have aftercare contract

Answer 30

12-step program

Question 31

Laymens Terms 12 step

Answer 31

1. Admint 2. Hope 3. Surrender 4. Inventory 5. Confess 6. Readiness 7. Ask God 8. List of amends 9. Make amends 10. Continue the inventory 11. Pray/meditate 12. Help others

Question 32

Example of state-based program state physicians' programs look beyond licensure violations of cause of behavior, hold nurses/providers accountable, prevent harm to pt, retain experienced practitioners in the profession

Answer 32

KARE program

Question 33

drug addiction is a **_acute or chronic_** relapsing disease of the brain?

Answer 33

**chronic relapsing** **NOT time limited, NOT curable HIGH relapse risk** 1. typical s/s 2. demonstrated brain lesinos 3. predictable natural course 4. risk factors 5. early warning signs 6. dx criteria 7. recommended tx

Question 34

**Pleasure-sensory pathways** when showing picture of drug/related to user pleasure-reward system

Answer 34

**via** Dopamine, Glutamate, GABA **Nucleus Accumbens** **Prefrontal Cortex** (perspective: establishes priorities) **Amygdala** (decides good or bad, pleasure/or not) **Hippocampus** (memory: where when who) Higher dopamine concentration the greater the experience

Question 35

**Sends info (dopamine)** to all three areas (Amigdala, Nucleus Accumbens, Prefrontal cortex): **initial** pathway pleasure reward

Answer 35

**VTA** Ventral Tegmental Area

Question 36

list 4 substances involved with addictive disorders

Answer 36

**alcohol** **opioids** **cocaine** **amphetamine** inc dopamine - higher dopamine higher the high

Question 37

which experiences increase dopamine in nucleus

Answer 37

ALL EXPERIENCE (good and bad)

Question 38

Sends negative feedback to VT area

Answer 38

**Nucleus Accumbens** via **GABA**

Question 39

Amygdala, Hippocampus, Prefrontal Cortex use what main neurotransmitter

Answer 39

Glutamate

Question 40

3 steps in pleasure sensory pathway

Answer 40

1. Brain lesions of the changes made (inc value of HIGH, "normal" values reordered 2. early downstream involvement of amygdala and hippo (imprinting cues, craving, depression during abstention) 3. late downstream anterior cingulate gyrus & orbital frontal region of prefrontal (loss of inhibition, compulsive drug seeking)

Question 41

Progressively **OVERWEIGHS** information: integration of priorities, and inhibition abilities are faulty

Answer 41

Prefrontal cortex

Question 42

why dont substance users WANT to quit

Answer 42

out of control helpless to connect with rational thought CANNOT ask for help

Question 43

most difficult obstacle to overcome

Answer 43

**denial** normal psych defense protects from painful/difficult facts/ideas

Question 45

most common mechanism for assistance

Answer 45

**intervention** 12-step for chemical dep

Question 46

example of Peer-to-peer assistance program

Answer 46

Alcoholics Anonymous

Question 47

Resource for help

Answer 47

AANA Peer Assistance Helpline 800 654 5167