Flashcards in Sustainability, Resilience and Occupational Health Deck (43)
Mild-to-moderate mental health conditions are common and can affect what percentage of the population, what may they include?
Mild-to-moderate mental health conditions are common and can affect 15–25% of the general population at any one time.
- Generalised anxiety disorder
- Panic disorder
- Social anxiety disorder
- Obsessive compulsive disorder
- Post-traumatic stress disorder.
However, medical students have a higher prevalence of depression and anxiety than the general population
Recommendations to the GMC (Horsfall, S – 2014) ?
The GMC continue to work with medical schools to ensure that emotional resilience training is a regular and integral part of the medical curriculum
Both medical students and doctors in training have specific training modules in their curriculum that explain the implications should they be subject to a serious complaint and investigation
The GMC continue to work with medical students and doctors in training to promote its regulatory requirements
The GMC continue to work with all medical schools to ensure its standpoint on recreational drug use and alcohol is better communicated to students
GMC guidance – supporting students with mental health conditions?
- As well as supporting students who have mental health conditions, medical schools should also promote well-being among all of their students.
Some of the ways that medical schools can do this include:
- Delivering group learning exercises focusing on how to deal with stress
- Providing and promoting online resources on keeping healthy, including advice on healthy lifestyles
- Providing sessions on techniques such as mindfulness and meditation, and providing opportunities for physical exercise and yoga, which some people find useful to help them manage their stress levels.
Resilience – Definition?
The Oxford Dictionary -
'Resilience' ( a term imported from the language of physics) as:
The capacity to recover quickly from difficulties; toughness, or
the ability of a substance or object to spring back into shape; elasticity.
This term is also used in other disciplines such as physiology and psychology to refer to a person's ability to resist adversity without resulting in physical or psychological disability.
What is resilience?
Resilience is an emotional competence or a personality characteristic that deals with negative effects of stress and promotes adaptation.
Resilience can also, however, be an acquired virtue or behaviour and requires continuous improvement.
Resilience encompasses several dimensions including self-efficiency; self-control; self-regulation; planning and perseverance.
The medical profession, as many other professions, can be very stressful and we need to maintain emotional wellbeing and resilience.
What may lead to increased stress in athletes, medical students or other highly competitive jobs?
1) High internal and external expectations
2) Win at all costs attitude
3) Parental pressures
4) Long practices
5) Excessive time demands
7) Potential for inconsistent coaching
The personal strengths underpinning resilience?
1) High frustration tolerance
2) Self acceptance
3) Self belief
Behaviours supporting resilience?
1) Building / having support networks – positive relationships
2) Reflective ability
4) Avoiding procrastination
5) Developing goals – realistic plans and ability / motivation to follow them through
6) Time management
7) Work – life balance
Sources of burnout?
- Perfectionism, denial, avoidance, micromanaging, unwilling to seek help
- Being too conscientious
- Culture of invulnerability
- Culture of presenteeism
- Blame culture / silence
- Overwork, shiftwork, lack of oversight
- Chaotic work environments
- Lack of teamwork, fractured training
How might stress or burnout present in medical students?
1) Repeatedly failing or nearly failing
2) Handing in work late
3) Poor attendance
4) Absence due to illness
5) Behavioural issues
6) Fitness to practice issues
7) Lack of engagement with the course
8) Poor communication with staff, peers and patients
Resilience in practice?
How would you feel initially?
How would you react?
How might your reaction show your resilience or lack of it?
What does it mean to be resilient in this situation?
Doubt, anger, fear, worry, misunderstood, unappreciated, sorrow, regret.
1) Lead to reflection
- Did I make the right decision, could I have done things differently?
- Discuss with peers - SEA
2) Lead to improvement - Do I need to learn anything to prevent the same happening again?
3) Lead to returning wiser and better - How will I communicate better? Will I change my practice in the future?
Factors aiding resilience - Personal?
1) Intellectual interest - Job satisfaction, career progression, variability (if wanted), capacity to develop special interest
2) Self awareness and self reflection - Recognise and accept personal limits, establish boundaries in doctor-patient relationship, less self critical. Aided by mindfulness based stress reduction
3) Time management and work life balance - Ensuring time for hobbies, leisure, relaxation, self expression
4) Continuing professional development
5) Support including team working - Supportive relationships within and out-with medicine
6) Mentors - Help trainees adapt to change and react to stress
Factors aiding resilience - Professional?
1) Changing sense of perfectionism, presenteeism, culture of silence
2) Better support for those struggling or after difficult events
Factors aiding resilience - Societal?
1) Changing culture of blame, reduce perceived threat of complaints
2) Public acceptance of mistakes? Patients’ personal responsibility for health?
Factors aiding resilience - Structural?
Improved shift patterns, better work – life balance, less fractured training, regular breaks, a cup of tea
Factors aiding resilience?
Copiing reserve model Slide 41 learn to draw
A coping reserve that can be filled or emptied
Personality traits, temperament and coping style form the internal structure
Omits importance of organisational and sociocultural issues
1) Negative input
- Internal conflict
- Time and energy demands
2) Positive input:
- Psychosocial support
- Social/healthy activities
- Intellectual stimulation
Help services at aberdeen for students?
1) Counselling service
2) Student Welfare Officer
What is an occupational history?
An occupational and environmental history is a chronological list of all the patient’s employment with the intention of determining whether work has caused ill health, exacerbated an existing health problem or has ill health had an impact on the patient’s capacity to work.
A shortened history is possible within a GP consultation if the problem is acute and likely related to current work.
What information might/should be gather within an occupational history?
1) A description of the present and previous jobs from leaving school.
2) Identifying any exposure to chemicals or other hazards e.g. stress, overwork, adverse working environment, in this situation is the fact that role largely sedentary exacerbating or causing his back pain?
3) Did the symptoms improve when not exposed / not at work e.g. at weekends, holidays?
4) Determine the duration and intensity of exposure e.g. was it so noisy it was impossible to communicate
5) Is personal protection used e.g. what kind of mask? Or equally is an appropriate chair / desk provided?
6) What maintenance is in place for the protection measures?
7) Do others suffer similar symptoms?
8) Are there known environmental hazards in use?
9) Any hobbies, pets, worked overseas, moonlighting?
What options are available for GPs when patients present with illness/pain and need time of work?
1) Treat underlying condition e.g. pain = analgesia, advice, information regarding stretching, exercise or referral to physiotherapy
2) Consideration of a fit note
Information of the "Fit note"?
1) It’s purpose is to facilitate earlier discussion about returning to work and about rehabilitation.
2) It now includes items of consideration for employers when signing a patient’s return to work. E.g. Phased return, adjusted hours, adaptions to the work place and/or amendments of duties
3) It can only be completed by a Doctor
4) It is advice to patients as employees, is not binding on the employer and does not affect Statutory Sick Pay
5) It is required if the patient has been off more than 7 consecutive days ( including non working days)
Role of occupational health?
1) For patients who are off for longer periods of time or with more complex needs, referral to a specialist occupational health service is an option.
2) Occupational health specialists are ideally and uniquely placed to support and help people stay in work and live full and healthy lives.
3) They play a key role in ensuring the health and well being of the working population by preventing work-related ill health and providing specialist rehabilitation advice.
4) They provide independent, impartial advice to employers and employees on the effects of work on health and the effects of health on work.
For example, the opinion of an occupational health specialist might be crucial in determining how to manage a capability issue or in providing key evidence in a claim to an employment tribunal. As well as addressing issues that occur, a lot of the work of an occupational health service is proactive, aiming to reduce potential problems in the workplace.
Examples of occupational health role?
1) Help prevent work-related ill health
2) Advise on fitness for work, workplace safety, the prevention of occupational injuries and disease
3) Recommend appropriate adjustments in the workplace to help people stay in work
4) Improve the attendance and performance of the workforce – for example by assisting in the management of sickness absence
5) Provide rehabilitation to help people return to work, and give advice on alternative suitable work for people with health problems
6) Promote health in the workplace and healthy lifestyles
7) Recommend and implement appropriate policies to maintain a safe and healthy workplace
8) Conduct research into work related health issues
9) Ensure compliance with health and safety regulations including minimising and eliminating workplace hazards
10) Advise on medical health and ill-health retirement
Effect of unemployment of health?
1) There is a strong association between worklessness and poor health. This may be partly a health selection effect, but it is also to a large extent cause and effect. There is evidence that unemployment is generally harmful to health, including:
2) Higher mortality;
3) Poorer general health, long-standing illness, limiting longstanding illness;
4) Poorer mental health, psychological distress, minor psychological/ psychiatric morbidity;
5) Higher medical consultation, medication consumption and hospital admission rates.
6) There is evidence that re-employment leads to improved self-esteem, improved general and mental health, and reduced psychological distress and minor psychiatric morbidity. The magnitude of this improvement is more or less comparable to the adverse effects of job loss.
Definition of sustainability?
The Cambridge Dictionary defines sustainability the ability to be:
“Able to continue over a period of time”
Sustainability in the NHS?
It could be looked at in relation to low carbon clinical care and the environment.
It could be looked at in relation to the ability of the NHS to “Continue over time”
Low Carbon Clinical Care and NHS Sustainability?
1) Prioritise Environmental Health
2) Substitute harmful chemicals with safer alternatives. Reduce and safely dispose of waste
3) Use energy efficiently and switch to renewable energy. Reduce water consumption
4) Improve travel strategies
5) Purchase and serve sustainably grown food
6) Safely manage and dispose of pharmaceuticals
7) Adopt greener building design and construction.
8) Purchase safer more sustainable products
The SDU has shown that short term reduction of what percentage in emissions is technically feasible without compromising standards of care?
The SDU has shown that short term reduction of 40% in emissions is technically feasible without compromising standards of care.