cir-guidelines

How your body reacts to stress Stress is the response of your body to all demands made upon it. Understanding these demands and their effects can help you learn to recognize your own stress response, as well as ways to counteract distress leading to a healthier life.

• The basic stress response Your body responds to all stress, both positive and negative, by trying to get back to normal.

Hormones, like adrenalin, may surge. Your heartbeat and blood pressure will probably increase. Your blood sugar rises. These physical responses helped prehistoric humans survive by helping them run away faster or fight harder. By the time they were done, their bodies had discharged the tension of the moment and their stress response was followed by relaxation.

• Physical effects Today, we experience stressors that are very different from those early survival ones. Yet positive stressors such as getting married, or negative stressors such as family conflicts, still cause the same physiological fight or flight response.

If a stressful situation goes on far too long without any relief, you might be diagnosed with a disease or medical disorder, or experience reactions, such as colds, ulcers, asthma, heart attack or stroke.

You might feel tired, irritable, depressed or anxious. You may have trouble with sleeping, eating (either too much or too little), drinking and smoking.

• The mind-body connection Your mind and body are connected. When your mind is healthy, your body can resist illness better.

When your body is healthy, your feelings are more positive. During stressful times, take care of both your mind and body for maximum health and life satisfaction.

• Minimize the effects There are many ways to keep all the negative effects of different stressors to a minimum. Self-care can help you stay well as you begin to return your life to some semblance of normalcy. The goal of stress management is to bring your system into balance, allowing you to regain a sense of calmness and control in your life.

Self-care priorities Use these strategies to stay well: • Remember that your reactions are normal— allow yourself to recover at your own pace.

• Talk or write about the event or your reactions.

• Exercise. Even a little exercise, such as a short walk, can help you physically and emotionally.

• Be realistic about what you can do. Avoid the “tyranny of the shoulds.”

• Spend time with supportive people.

• Get enough sleep and eat a healthy diet.

• Do nice things for yourself. Take a hot bath, a walk in the woods, listen to soothing music.

• Stay away from mood-altering chemicals, such as alcohol and drugs.

• Reduce caffeine and sugar; you’ll feel less jittery or nervous, and you’ll sleep better.

• Practice stress reduction techniques such as deep breathing, meditation, progressive relaxation, etc.

• Keep your schedule as normal as possible.

Mercy Employee Assistance Program l 608.756.4681 or 855.612.HELP (4357) l MercyHealthSystem.org/EAP

Critical Incident Response (CIR) guidelines for managers Mercy EAP support is available to help managers stabilize a situation in which employees are affected by the occurrence of a traumatic event that has the potential of interfering with performance or productivity.

The most effective response is a collaborative partnership between managers and the EAP to offer supportive services to employees experiencing a difficult time.

1. Determine the level of worksite impact (tips on next page) 2. Designate a primary contact person on site to coordinate the most appropriate next steps with the EAP (for their work group and/or jointly with other managers involved) 3. Contact Mercy EAP to brainstorm possibilities. Be prepared to provide the following information: • Facts regarding the incident • Staff members immediately impacted • Nature of general staff concern • Availability of staff regarding timing/coverage issues • Location for possible EAP services 4. Provide updates to staff members on the evolving situation 5. Recognize “best practice” might involve an employee accessing FMLA for a few days 6. Consult with EAP to determine the most appropriate timing and type of response: • Supportive face-to-face meeting(s) • Individual phone processing session(s) • On-site small group debriefing with those directly impacted • On-site larger group defusing with those more generally affected • Management support and staff handout materials 7. Check back with employees regarding their adjustment to the situation 8. Follow-up consultation with the EAP to determine any next steps 9. Recognize that your offer of EAP services alone is appreciated as supportive!

Remember “the ripple effect”—the circle of impact Consider the goal or purpose of any team gathering following a critical incident.

• Whether you are providing general situational updates to your staff • Whether you are still investigating to determine the support needed for every level of involvement • Whether you are reviewing the situation as a post-operative assessment to make improvements in your team process or protocols • Whether only the staff immediately impacted is interested in a group debriefing to share and process the emotional complications they are still experiencing (with safety ensured)

Remember there is “no perfect timing” Consider that it is generally a very individualized need for processing this event.

• Immediacy may be counter-productive • Staff members are often initially in shock and unable to focus • It’s often more important to offer flexibility with staff coverage and the ability to adjust to unexpected emotional responses in the weeks and months ahead Please call Mercy EAP at (608) 756-4681 for more information on scheduling a management consultation to collaborate on a possible CIR.

How to talk to employees: tips for managers Management has a special role to play in helping its employees adjust in healthy ways after any critical incident and during periods of prolonged stress. Here are some tips on talking to your employees.

1. Communicate with your employees. When a critical incident becomes known, an update should go out to all employees. It should: • Convey the gravity of the situation • Reflect the normal fears and anxieties we all share • List any steps being taken to ensure the safety of employees • Remind employees of EAP resources available 2. Communication is a two-way process. Ask your employees how they are doing, what their main concerns are, and what they may need from you.

3. Provide updates or access to information as more becomes known.

4. Expect productivity to be briefly lower at such times, and be patient and compassionate about it.

5. Consider opportunities for gathering employees for lunch and/or support.

6. If you have concerns about how individual employees are reacting, or the impact on your team, call EAP for a management consultation.

7. Consider scheduling critical incident stress response services through the EAP. 8. Be aware that some individuals might have more intense reactions than is typical. Reactions can include panic attacks, crying, profound sadness or depression, confused thinking, and/or urges to self-medicate with alcohol or drugs. Persons at risk for such intense reactions include those: • Whose lives were directly impacted by the event or similar events • Who have experienced prior losses or traumas and for whom the current events serve to reactivate those emotions • Who are vulnerable to stress due to the complications of other mental health or grief concerns 9. Be sensitive to the fact that intense reactions can result from many unseen personal factors, including those listed above.

10.The best course of action for managers is to be patient, supportive and: • Signal your willingness to talk • Practice active listening • Problem solve with the employee regarding his work responsibilities • Make sure the employee knows where to get help • If an employee is already engaged in counseling, he might consider contacting his therapist for support. If not, a referral to EAP may be beneficial.

Tips for your employees The next two pages offer further explanation of critical incident stress, common symptoms and also self-care priorities. We encourage you to copy these pages for your employees as needed.

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Critical incident stress You have experienced a traumatic event or a critical incident (any event that causes unusually strong emotional reactions that have the potential to interfere with your ability to function normally). Even though the event may be over, you may now be experiencing, or may experience later, some strong emotional or physical reactions. How intensely you were impacted by the event will determine your response afterward. Your personal experience, values, attitudes, beliefs and support systems also shape your response.

It is very common, and in fact quite normal, for people to experience emotional aftershocks (or stress reactions) when they have passed through a horrible, demanding or stressful event. Sometimes the emotional aftershocks appear immediately after the traumatic event. Sometimes they may appear a few hours or a few days later. And, in some cases, weeks or months may pass before the stress reactions appear.

These stress reactions are usually temporary. The signs and symptoms of a stress reaction may last a few days, a few weeks, or longer, depending on the severity of the traumatic event. The understanding and support of loved ones usually cause the stress reactions to pass more quickly. Occasionally, the traumatic event is so painful that professional assistance may be necessary. This does not imply a mental health diagnosis or a personal weakness. It simply indicates that the particular event was just too powerful for the person to manage by themselves.

Common signs and signals of a stress reaction Physical*

Cognitive

Emotional

Behavioral

• Chills • Thirst • Fatigue • Nausea • Fainting • Twitches • Vomiting • Dizziness • Weakness • Chest pain • Headaches • Rapid heart rate • Muscle tremors • Shock symptoms • Grinding of teeth • Visual difficulties • Profuse sweating • Difficulty breathing • High blood pressure

• Confusion • Nightmares • Uncertainty • Hypervigilance • Suspiciousness • Intrusive images • Heightened or lowered alertness • Blaming someone • Poor problem solving • Poor concentration/ memory • Poor abstract thinking • Disorientation of time, place or person • Increased or decreased awareness of surroundings • Difficulty identifying objects or people • Poor attention/ decisions

• Fear • Guilt • Grief • Panic • Denial • Anxiety • Agitation • Irritability • Depression • Intense anger • Apprehension • Emotional shock • Emotional outbursts • Feeling overwhelmed • Inappropriate emotional response • Loss of emotional control

• Withdrawal • Antisocial acts • Intensified pacing • Hyper-alert to environment • Change in usual communications • Increased alcohol consumption • Change in appetite • Erratic movements • Change in sleep habits • Inability to rest or relax • Change in social activity • Change in speech patterns

*Any of these symptoms may indicate the need for a medical evaluation. When in doubt, contact a physician.

Mercy Employee Assistance Program l 608.756.4681 or 855.612.HELP (4357) l MercyHealthSystem.org/EAP 3