Promoting Professional Wellness Flashcards
Stress is how many % of all medical visits?
60-90%
AANA’s Wellness Initiative:
Name of person initiating who became addicted to anesthetics
Jan Stewart
AANA’s Wellness Initiative
2 Objectives
- Jan Stewart Memorial Wellness Lecture Series
- Broad Based Wellness Services for memberss Covers MANY issues that affect professional and emotional well-being.
Key element in quality of care
Relationship btw fitness for duty and patient safety
Chemical dependency/addiction % among SRNAs, CRNAs, MDAs, Residents
10%
MDA greater or less than other physicians?
greater
Anesthetists highest drugs abused statistically
OR drugs + other drugs
Aristotle’s
“Nothing in excess”
defines what?
Well-being
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”
Health Belief Model
6 Components of Wellness
(Hettler)
- Physical
- Emotional
- Emotional
- Occupation
- Social
- Intellectual
- Spiritual
These things define what?
Satisfaction with self
Acceptance of physical appearance
Valuing unique characteristics and abilities
Sense of worth
3 Dimensions of Self-Direction
Sense of worth
Sense of control
Emotional awareness & coping
Sense of control 9 components
- belief in competence
- confidence
- self-efficacy
- knowledge
- skill
- choice
- influence
- expectations
- control
Components of what?
- Ability to express/disclose feelings
- Response to life expectations
- Sense of energy, appropriate responses to challenges, negative emotions, and enjoyment of positive emotions
Emotional awareness & coping
Feeling of deep sympathy for another is stricken by suffering or misfortune
Compassion Fatigue
Reduction of capacity of NMS to carry out its function. Causes sleep deprivation, boredom, work overload, physical exhaustion…
Physiological fatigue
10 Principles of Wellness
- Create long-term goal
- Connect to your collegues
- Enjoy what you do
- Physical well-being
- Keep in touch
- Manage time
- Make plans
- Take time for self
- Be realistic
- Don’t think you can do it alone
Symptoms of what
- mental, social, physical manifestations
- exhaustion
- loss/inc apetite
- h/a
- sleeplessness or oversleeping
- crying
- feeligns of “alarm” frustration, or apathy
Stress
AMA & APA sees dependency & addiction as diagnosable and treatable:
4 components
- Availability of drug + urge
- Urge is part of neurochemical makeup
- Stress contributes to potential: Genetic predisposition and familial dysfunction, risk escalates
- Cascade of behioral changes occur: progressively deteriorates
Pleasure comes from increase _____ in the brain?
Increased dopamine
Long term addiction
Change in brain
Loss of glutamate control
in prefrontal cortex
changes how brain processes info
and controls behavior
Looking at cocaine for a drug abuser has physiological changes seen in brain in what pleasure part of brain?
Amygdala
Last defense (think things thru) in brain.
Decision making
Priorities
“I won’t do drugs”
Prefrontal cortex
Perception of drug procurement is more important than… (“feeding my 6 month old” i.e.)
Over-valuing drug high over …
What part of brain?
Prefrontal cortex
Second step
Early downstream involvment
Network of these areas in brain with addiction
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)
Main neurotransmitters involved
3
Dopamine
GABA
glutamate
Rob bank, kill, compulsive drug-seeking altered in what part of brain?
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”
Conspiracy of silence
anything that allows addict to avoid consequences
Enabling
Treatment:
Predominant form of chemical tx
inpatient/residential options
must have aftercare contract
12-step program
Laymens Terms
12 step
- Admint
- Hope
- Surrender
- Inventory
- Confess
- Readiness
- Ask God
- List of amends
- Make amends
- Continue the inventory
- Pray/meditate
- Help others
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
KARE program
drug addiction is a acute or chronic relapsing disease of the brain?
chronic relapsing
NOT time limited, NOT curable HIGH relapse risk
- typical s/s
- demonstrated brain lesinos
- predictable natural course
- risk factors
- early warning signs
- dx criteria
- recommended tx
Pleasure-sensory pathways
when showing picture of drug/related to user
pleasure-reward system
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
Sends info (dopamine) to all three areas (Amigdala, Nucleus Accumbens, Prefrontal cortex):
initial pathway pleasure reward
VTA
Ventral Tegmental Area
list 4 substances involved with addictive disorders
alcohol
opioids
cocaine
amphetamine
inc dopamine - higher dopamine higher the high
which experiences increase dopamine in nucleus
ALL EXPERIENCE (good and bad)
Sends negative feedback to VT area
Nucleus Accumbens
via GABA
Amygdala, Hippocampus, Prefrontal Cortex use what main neurotransmitter
Glutamate
3 steps in pleasure sensory pathway
- Brain lesions of the changes made (inc value of HIGH, “normal” values reordered
- early downstream involvement of amygdala and hippo (imprinting cues, craving, depression during abstention)
- late downstream anterior cingulate gyrus & orbital frontal region of prefrontal (loss of inhibition, compulsive drug seeking)
Progressively OVERWEIGHS information: integration of priorities, and inhibition abilities are faulty
Prefrontal cortex
why dont substance users WANT to quit
out of control
helpless to connect with rational thought
CANNOT ask for help
most difficult obstacle to overcome
denial
normal psych defense
protects from painful/difficult facts/ideas
most common mechanism for assistance
intervention
12-step for chemical dep
example of Peer-to-peer assistance program
Alcoholics Anonymous
Resource for help
AANA Peer Assistance Helpline
800 654 5167
