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Stress and Emergency Healthcare Workers 1
Running Head: The Relationship between Stress and Emergency Healthcare Workers
Stress in Emergency Healthcare Workers
Tim Standon
University of La Verne
October 28, 2009
Senior Thesis Advisor – Kimberly Porter Martin
Stress and Emergency Healthcare Workers 2
Everyone everywhere is affected to some degree by the stresses and strains of
daily life. However, there are some in society who work and live under extraordinarily
stressful conditions. Professions like the military, air traffic control, and emergency
services are innately high stress work environments. The people who do these jobs must
cope not only with the stresses that affect everyone in society on a day-to-day basis, but
also the pressure to accomplish miracles through their work, followed by the stress of
actually trying to doing it.
The actual numbers of emergency workers is difficult to pin down due to the size,
diversity, and overlapping nature of the field. In the United States there are several
agencies that represent different factions of emergency personnel. The National Registry
of Emergency of Emergency Medical Technicians (NREMT) claims that there are over
1,000,000 active paramedics and EMT’s (National Registry of Emergency Medical
Technicians, 2009). The US Department of Labor states that as of 2006 throughout the
United States there were approximately 361,000 paid firefighting jobs, about 201,000
paid EMT and paramedic positions, and nearly 861,000 paid police officers. They also
state that there are approximately 2,505,000 registered nurses and 633,000 doctors
(United States Department of Labor, 2009). These statistics do not include any of the
volunteer positions or other related paid jobs within the different areas of emergency
care.
Stress
Stress is a word that is commonly used but is often not well understood. Kagan,
Kagan , and Watson (1995) define stress as a basic reaction experienced by all living
Stress and Emergency Healthcare Workers 3
organisms, that it is due to the tension that results from one’s basic vulnerability to the
surroundings, to one’s own circumstance, to one’s own impulses or needs, and to one’s
reliance on others. They further explain that stress is expressed emotionally, cognitively,
and behaviorally: and that one’s reaction to stress under different situations is determined
by one’s underlying personality, prior experience, and coping mechanisms. It is also
suggested that people may not be fully aware of their stressors under all conditions, and
that stress often is an out-of-awareness thing that happens (Kagan et al., 1995). Signs of
excessive levels of stress can often be noticed by observers before they are noticed by the
affected person. Stress, oddly enough, is different things to different people and even
different things to the same person at different times (Kagan et al., 1995).
A stressor can be defined as any stimulus that causes a stress response from an
individual which taxes their physiological or psychological resources and possibly elicits
a subjective physical or mental strain (Anisman & Merali, 1999). Stressors can be
physical and/or psychological. The response from stressors manifests in physical and
psychological ways. Some of the problems associated with being under stress are: a
higher incidence of alcohol and drug usage, increased risk for cardiovascular problems
like hypertension (high blood pressure) and myocardial infarction (heart attack),
increased risk of stroke, and insomnia as well as other sleep disorders (Anderson, 2009).
Physical Manifestations of Stress
According to Beaton, Murphy, Johnson, Pike, and Jarrett (1995), the International
Association of Firefighters (IAFF) claims that firefighting is one of the United State’s
most dangerous professions. The 1990 US Department of Labor statistics show that
firefighters are 9.2 times more likely to be injured and 4 times more likely to be killed on
Stress and Emergency Healthcare Workers 4
the job compared to workers in private industry. In 1992 the IAFF revealed that the
single most relevant cause of line-of-duty death is cardiovascular disease that leads to
death by stroke and cardiac arrest. This is surprising when one takes into account how
cardiovascularly fit firefighters are (Beaton et al., 1995).
Police and other Public Safety Officers have shown an increase in cardiovascular
disease as compared to others in society. After a 22 year follow up in a longitudinal study
of 970 Helsinki police officers, there was an association found between hyperinsulinemia
and increased heart disease independent from other risk factors. A study of Buffalo, New
York police officers was done to see if there was a difference in cardiovascular disease
markers between mildly or sub-clinically stressed and highly stressed officers. The study
showed that there was a decrease in coronary blood flow as officers’ stress levels
increased from mild to moderate to severely stressed. The dilation of the vessels was
nearly half that in severely stressed officers compared to sub-clinically stressed officers.
The study suggests that failure to turn off the stress mediator chemicals of the body, such
as cortisol, will cause an individual to continue to have high levels of stress which will
eventually generate wear and tear on the body and lead to disease (Violanti et al., 2006).
Post Traumatic Stress Disorder
Post-traumatic stress disorder or PTSD, as defined by Anderson (2007), is an
anxiety disorder which can build from an exposure to a frightening event or ordeal in
which serious physical harm occurred or was threatened (Anderson, 2007). Robbers and
Jenkins (2005) state that PTSD is also known as shell shock or battle fatigue. They
continue on to state that this disorder can overpower an individual and become
incapacitating by inducing symptoms such as panic, defenselessness, and avoidance.
Stress and Emergency Healthcare Workers 5
Frightening thoughts or memories of the critical stimuli can also invoke numbness,
fatigue, aggression, rage, or hyper vigilance (Robbers &Jenkins, 2005). According to
Anderson (2007), the National Institute of Mental Health has found that traumatic events
may trigger PTSD. Some of these events include violent personal assaults, natural or
human-caused disasters, accidents, or military combat. People with PTSD have persistent
frightening thoughts and memories of their traumatic event, they have an emotional void,
and are frequently unable to relate normally with others. This is especially true for
relationships with people to whom they were once close. Furthermore, they may
experience sleep problems such as insomnia or night terrors, and they can be easily
startled at any time (Anderson, 2007).
A study of women at a long-term treatment center in the USA, which was
reported by Brewerton (2008), shows a possible link between PTSD and eating disorders.
The strongest correlation between PTSD and eating disorders occurred in patients with
anorexia nervosa which is a binge-eating/purging type of disorder.
“It has been hypothesized that eating disordered behaviors, particularly
purging behaviors, serve to facilitate avoidance of traumatic material and to numb
the hyper-arousal and emotional pain associated with traumatic memories and
thoughts. Purging may also promote forgetting parts or all of a traumatic event,
for example: dissociative amnesia. Several studies have reported higher rates of
dissociative symptoms in bulimic patients than in controls, and in the National
Women's Study, 27% of patients with bulimia nervosa reported forgetting all or
part of traumatic memories compared with 11% of participants who did not have
an eating disorder. Thus, bulimia often serves as a maladaptive coping strategy in
Stress and Emergency Healthcare Workers 6
the same way substance abuse does in relationship to trauma and PTSD”
(Brewerton, 2008:2-3).
A prime example of an incident that caused PTSD in EMS workers is from the
September 11, 2001 terrorist attack on the USA. There was a huge loss of innocent life,
along with the loss of life of colleagues and even family members of the EMS workers on
that fateful day, not to mention the loss of life and the chronic illness associated with
working at ground zero of the World Trade Center in New York. Many individuals in the
first responding teams who were not killed in the collapse have suffered long lasting
medical problems from breathing polluted air and being exposed to toxic substances
while at the scene. Some of their primary medical complaints are from upper and lower
airway problems as well as esophageal problems. They put in long, physically and
emotionally draining days digging out a few survivors, but mainly finding those who
were deceased. This led some workers to develop PTSD (Herbert et al., 2006).
Another example of emergency workers developing PTSD can be found in 2004.
Robbers and Jenkins did a study regarding PTSD symptoms on the Arlington County
police officers that responded to the September 11, 2001 terrorist attack of the Pentagon.
The all of the sample population had responded to the incident within 90 minutes of the
attack. The officers worked an average of 136 hours at the site. Some of the officers did
not return to their homes for several weeks, because they felt a need to stay on the site in
order to clean up and restore the Pentagon. Initially the officers assisted the fire
department in rescue operations and also controlled traffic in the immediate area of the
Pentagon. Later, the police officers became part of the teams that sifted through the
rubble, searching for body parts, personal effects, airplane parts, and top secret
Stress and Emergency Healthcare Workers 7
information. Many of the officers came in contact with what they were looking for. One
experienced officer reported that after finding charred human remains, the thing that
troubled him the most was the unearthing of a small, pink child’s purse. Another officer
said that a burnt teddy bear was the most unforgettable picture left in his mind. The study
found that more than one third of these individuals had suffered from some symptoms of
PTSD over the three year time period. The research suggests that higher levels of PTSD
may be found in police officers due to the experience of disenfranchised grief after
exposure to traumatic events, because officers who experience emotional trauma are not
socially sanctioned to grieve. Furthermore, the increase in PTSD may also be related to
police organization and management. The police organization is para-militaristic; its
officers are required to be the helpers, not the helped. Basically the police are supposed to
be in control and they are held to higher moral standards by the community. And finally,
it is suggested that the police officers code of silence adds to the development of PTSD,
because many officers think that a cop who seeks mental health treatment is weak and not
reliable (Robbers & Jenkins, 2005).
Secondary Traumatic Stress
A related form of PTSD is referred to as secondary traumatic stress or STS for
short. It can be described as a healthcare worker being traumatized while trying to help
someone with PTSD by listening to their stories. This has occurred with mental health
professionals who work large incidents, like the September 11th tragedy. In the September
11th instance, social workers were exposed to the same event as those whom they were
trying to help. For many of the counselors, hearing the clients' stories interacted with
their own stress levels and concerns about the terrorist attacks, heightening the resultant
Stress and Emergency Healthcare Workers 8
STS reaction beyond the simple additive effects of the two factors taken alone (Pulido,
2007).
Other professionals such as firefighters, paramedics, police officers, and 911
Dispatchers can also experience STS from helping and wanting to help people who are
victims of trauma. It is suggested that repetitive exposures to critical incidents can lead to
problems from the cumulative effects of those exposures. Exposure to duty-related
trauma or critical incidents usually involves overwhelming exposure to injured,
mutilated, or dead and dying victims (Beaton, Murphy, Pike, & Corneil, 1998).
Burnout
Burnout is another concept that goes hand in hand with stress and PTSD.
Committed professionals who start out their careers with energy, efficiency, and
dedication to what they are doing can end up exhausted, inefficient, and cynical. Burnout
is characterized as having feelings of failure, being worn out or becoming exhausted by
excessive demands of the job. Burnout manifests both physically and behaviorally
causing emotional and physical exhaustion, diminished caring, and a profound sense of
demoralization (Bush, 2009). Cannon (2006) states that the American College of
Emergency Physicians lists the symptoms of burnout as: withdrawal from family then
friends, denial, overwork, anxiety, dread, anger, isolation, martyrdom, risk taking, and
depression even leading to suicide (Cannon, 2006). As reported by Anderson (2008), a
study of 119 nurses in the Caribbean was done on work-related depression. They looked
at the nurses’ role, their work and social factors, stress, burnout, depression, absenteeism,
and turnover intention. The researchers found that burnout was the sole predictor of
Stress and Emergency Healthcare Workers 9
depression, which directly predicted both absenteeism and turnover intention (Anderson,
2008).
A 2005 study of Taiwanese firefighters, suggests that major life stressors often
leads to depression and a decrease in the quality of life for an individual experiencing
them. The article goes on to propose that those individuals with a poor quality of life
often will not return to work. A finding of the study, done by the Taiwan Department of
Health, showed a connection between depression and suicide; and as a result of that
finding, high risk groups such as firefighters are being encouraged to receive mental
health screenings as an attempt to reduce suicides (Chen et al., 2007).
A survey study of nurses in Finland was done in 2001-2002 to see if there was an
association between nursing management behavior and burnout among nursing personnel
in health care. Six-hundred-twenty-seven nurses were randomly selected from a frame of
900 Finnish nurses, most of them women, in different patient contact practices. They
found small correlations between leadership styles in the organization and burnout in
nurses. Style of leadership is both positively and negatively associated with burnout
among nurses. A Nurse Manager who has an active and future-oriented transformational
leadership style will have fewer nurses working under him/her who experience burnout.
This management style tends to protect employees from emotional exhaustion,
depersonalization, and to increase feelings of personal accomplishment. On the other
hand, nurse managers who use a passive leadership style are setting the employees up for
burnout. Subordinates working under this kind of leader are particularly vulnerable to
emotional exhaustion and depersonalization. The information obtained from this study
suggests that the management team must be aware that their actions as well as their
Stress and Emergency Healthcare Workers 10
omissions are powerful and can make the difference between an emotionally healthy
workforce and an emotionally unhealthy one (Kanste, 2008).
The Sacramento Medical Society studied 454 physicians and found that 40% of
those studied were depressed, had thought of leaving the profession at least once in the
previous 12 months, would not choose to go into medicine if they had it to do over again,
and would discourage others from becoming doctors . The study suggests that the level of
a physician’s professionalism or traditional professional stance, their attitudes, their self-
expectations, and especially their training has made doctors particularly vulnerable to
stress. Every year in medical schools across the country, the freshman class begins with a
sense of privilege and excitement about becoming doctors. Four years into medical
school, the excitement has changed to cynicism and numbness. By graduation, the
students have learned how to diagnose and treat patients but they have forgotten why they
wanted to (Remen, 2001).
A similar issue was raised by a longitudinal study from 1997–2000 in England.
The study of 800 British doctors in revealed that there may be a causal relationship
between stress and burnout in doctors. Mayor reported an increase in stress for doctors
who were emotionally exhausted, which leads into a vicious circle of being more
exhausted and then even more stressed. He also reports that an increased work load and
having to treat patients as individuals in order to reach higher personal goals is another
reason for the doctors increasing stress levels. Mayor then recommended that to reduce
stress, doctors should reduce their workload (Mayor, 2002).
Stress and Emergency Healthcare Workers 11
Stress in EMS
Emergency Medical Personnel belong to a subset of the healthcare system. It is
comprised of many different factions of both public and private employees. The positions
involved in EMS are primarily, but not limited to: paramedics, emergency medical
technicians (EMT’s), firefighters, police officers, doctors, nurses and dispatchers. These
people are directly involved in the job of saving lives and trying to create some sort of
order out of chaos.
Field rescue personnel are put into harm’s way from the start of a call by driving
with lights and sirens (Code-3) quickly through traffic, sometimes running red lights or
going down the street on the wrong side against the flow of oncoming vehicles. Once
there the scene may be filled with violent people or laden with many kinds of chemicals
or bio-hazards that could harm or kill them. They must deal with patients and with the
situation at hand; many incidents are mundane and simple enough to deal with, but then
there are others that are not. Situations with multiple critical patients, large fires, active
shoot outs, pregnant patients having a complicated delivery, trapped and dying
individuals from accidents, or senseless acts of violence towards people make the job
much harder to do (Vettor & Kosinski., 2000). Working on injured and/or ill patients
places the emergency healthcare worker at risk for exposure to air-borne and blood-borne
pathogens that can transmit diseases like Tuberculosis, Hepatitis, and HIV (Beaton et al.,
2005). Besides taking care of the needs of the patient, the rescuers are dealing with
bystanders who can be not only a nuisance but can also pose a threat to the rescuers
safety. Many times the EMTs and paramedics then face dangers during the process of
Stress and Emergency Healthcare Workers 12
transporting the victims to the hospital. At the hospital the stress may stop for some of the
EMS personnel but it is just starting for others, like the receiving hospital staff.
EMS workers are expected by the public to thrive in stressful situations and to
come through it unscathed (Carolan, 2007). This expectation is often contradictory to the
comments of people in society who say things like: “you could not pay me enough to do
your job”, “I could never deal with the things you see and do”, or “I don’t know how you
do what you do”.
Kanner (1991) points out that the physical stressors of the EMS work
environment can cause career limiting injuries for EMS workers. He continues in the
article to suggest that despite wellness classes for EMS workers to educate them on
proper lifting and safe work practices designed to reduce on-the-job injuries; they will be
expected to do their job under conditions that cannot be planned for or that set them up
for injury. Examples include police officers having to chase suspects over/ under/ through
many different obstacles and over dangerous terrain, paramedics who have to lift people
from a bath tubs, or firefighters who may have to carry patients through tight spaces and
down stairways while wearing heavy cumbersome equipment. He also states that back
injuries are the most common injury occurring in this line of work. Finally he suggests
that regular training and enforcement of good body mechanics does help reduce the
chance of EMS workers hurting themselves (Kanner, 1991).
A study of 101 volunteer French Firefighters was done and reported on by Lourel,
Abdellaoui, Chevaleyre, Paltrier, and Gana in 2008. The researchers looked into the
Firefighter’s workplace and its impact on their mental health. They stated the study
revealed that job demands predicted depersonalization and emotional exhaustion.
Stress and Emergency Healthcare Workers 13
Personal achievement, on the other hand, was not linked to job organization. The
researchers also found that the duties of firefighting seem to be a strong source of stress
and mental strain. This occupation may create psychological trauma that could turn into
post-traumatic stress disorder (Lourel et al., 2008). Something else thing to take into
account regarding working conditions is that, besides military personnel, firefighters and
paramedics may be the only occupations that must respond to a potentially life-
threatening emergency from a state of sleep (Beaton et al., 1995).
A study of stress levels according to the beginning or end of shift was done on
200 Italian police officers. One hundred were traffic officers and 100 were based in the
office. It was found that with both groups there were more mal-adaptive responses to
stress such as anxiety and aggression at the end of a shift compared with the start of the
shift. However there was a significant increase in the traffic officers scores compared to
those of the office workers. Part of the explanation for the field officers scores might be
due in part to the chronic exposure to hazardous substances from automobiles and
industry. Chronic exposure to carbon monoxide appears to lead to chronic
poisoning which manifests as headaches, blurred vision, poor
concentration, confusion, and irritable or violent behavior. Also,
psychiatric symptoms can be found following exposure to carbon
monoxide, lead and mercury. Another interesting anomaly is in the
increased maladaptive coping at the end of the shift that single
mothers have over the rest of the population studied. Being a single
working mother seems to dramatically increase work-overload and
stress in general (Tomei et al., 2006).
Stress and Emergency Healthcare Workers 14
Effects of stress on EMS Family Members
The effect of stress and PTSD on emergency workers can encompass more than
the individual; it can spill out onto the workers family. Emotional and psychological
issues arise from exposure to stressors; this often includes anger, irritability, depression,
and detachment from relationships. Work stress and negative mood negatively affect the
quality of family life, primarily causing problems within a marriage and in relationships
with children. This in turn leads to reduced family cohesion (Thompson, Kirk, & Brown,
2005).
Reported by Johnson, Todd, and Subramanian (2005), the stress of emergency
work is thought to cause some police officers to abuse their spouses or engage in other
types of family violence. The abuse is sometimes physical but more often is verbal and
psychological. There are several theories about what the cause is for family violence such
as: “isolationism (sociological theory), violence exposure (posttraumatic stress
syndrome), job burnout (occupational stress theory), authoritarianism/control (feminist
theory), and substance abuse (bio-psychological theory)” (Johnson, et al., 2005:3).
Johnson testified before congress in 1991 that she had done a study of 425 police officers
and the study revealed 40% of them had been involved in domestic violence of some sort,
ranging from pushing/shoving to the use of firearms on their loved ones (Johnson et al.,
2005).
According to Regehr (2005), paramedics and other emergency workers are
frequently exposed to high trauma incidences. Having family support through these
Stress and Emergency Healthcare Workers 15
events significantly reduces the emotional and psychological traumas that the emergency
worker faces. Those individuals with a high level of family support are less likely to take
mental stress leave from work after a critical incident. Often the significant other of an
emergency worker has negative feelings toward the relationship caused by the negative
mood of the emergency responder. The skills needed to be an emergency worker, such as
making quick decisions, being in control, and emotional detachment are often the other
end of the spectrum of what it takes to be a good family member or spouse. Also,
opening up to the family members about the details of traumatic events that have been
experienced at work, it can cause STS in the family members. Another problem faced by
family members of an emergency worker is the impact that shift work has on the family.
Mandatory overtime is unpredictable and plans often need to be changed or discarded,
this leads to feelings of neglect and abandonment in addition to being unsure about the
loved ones safety (Regehr, 2005).
Children who are continually exposed to traumatized first responders to whom
they are emotionally linked may develop secondary traumatic stress symptomatology.
The psychological condition of the emergency responder is one of the predictors of their
children developing psychological and emotional problems after a traumatic event. A
study of 8,236 New York children, ages 9-21 that was done six months after the
September 11th terrorist attacks showed that the highest rate for the possible development
of PTSD came from children with EMT/paramedic family members. This was followed
by children with police officers as family members and lastly by children with
firefighters as family members, who scored the same as children with no family in
emergency service. The study suggests that the difference could be partially attributed to
Stress and Emergency Healthcare Workers 16
the fact that EMT/paramedics are found to have higher levels of stress compared to
firefighters and police officers, as well as the children’s exposure to the 9/11 incident,
and possibly their demographics (Duarte et al., 2006).
Coping with Stress
There are some beliefs and feeling amongst emergency workers that stress comes
with the job and that it is a necessary evil that comes attached to the excitement and joy
of having a rewarding job, being able to save someone’s life. These professionals know
the destruction that stress can wreak upon life, but they are too often blind to the effects
that it has on them at the moment. Despite their knowledge of stresses destructive power,
they often wear it like a badge of honor and courage to show that they can handle
whatever is thrown at them (Heyworth, 2004).
It is widely known that many emergency personnel often use a negative coping
mechanism that is referred to as the "John Wayne" syndrome. It is characterized by a
worker who hides their feelings and emotions to cope with the hard reality of some of
their calls. They found that this is a strong predictor of burnout for Firefighters. It is then
suggested that individuals who exhibit this behavior should be monitored, given regular
debriefing sessions, and have access to a permanent system of social and psychological
support. There seems to be no difference as to age, sex, and level of experience of the
person who has a highly stressful job and their likely hood to reach burnout (Lourel et al.,
2008).
Another long held belief is that humor counteracts stress. Humor in emergency
workers is often crude, callous, and macabre. Often referred to as gallows humor, it is a
way in which emergency workers cope with the doom and gloom of their profession.
Stress and Emergency Healthcare Workers 17
Humor is a proven beneficial and useful tool in fighting off stress, specifically it is a
cathartic mechanism that should not be underestimated in helping emergency personnel
cope with the work they do (Scott, 2007).
There are other coping mechanisms that may be good to look at for people dealing
with the stress of emergency care such as: on-site aroma therapy massage, critical
incident stress debriefings, and staff support systems. All of these seem to hold some sort
of benefit for most of the people who use them; however there is no generally agreed
upon treatment of choice for PTSD. The severity, prevalence, and lack of commonly
agreed on beneficial interventions is a strong argument for the development of a plan to
avoid PTSD, especially in high-risk populations (Everly et al., 1995).
Everly and Mitchell define Critical Incident Stress Debriefing (CISD) and
defusing processes as
“group meetings or discussions about a traumatic event or series
of traumatic events. Although they are not considered psychotherapy, the
CISD and defusing processes are designed to mitigate the psychological
impact of a traumatic event, prevent the subsequent development of
PTSD, and serve as an early identification mechanism for individuals who
will require professional mental health follow-up after a traumatic event.
CISD is intended to accelerate the recovery of traumatized people”(Everly
et al., 1995:176).
Lowery and Stokes wrote that paramedic students and police trainees may be particularly
susceptible to PTSD. And they suggest that debriefing and having a social network of
peers to discuss traumatic events with, as well as to get advice from, is quite effective for
Stress and Emergency Healthcare Workers 18
dealing with stressors. The degree to which one is affected by PTSD is related to the
amount of emotional display or repression. Those individuals who suppress their
emotions in order to appear “tough” are not processing the emotions of the event and
therefore they increase the likelihood of developing deeper and stronger psychological
trauma to themselves. A study of seventy-four Australian ambulance paramedic students
showed that there were positive results when they could openly and securely talk over
incidents with others who had gone through similar things. However there was also a
presence of dysfunctional peer support; some paramedic students revealed on their
questionnaire that they felt they could not emotionally open up to their peers, because if
they did they would become social outcasts and/or be shunned for doing so (Lowery et
al., 2005).
Morrissey points out in her article that employers have a responsibility to protect
their employees from harm, both physical and mental. She goes on to state that
employers often make it difficult for the employees to get the help they need after dealing
with a traumatic event. She suggests that they make the effort to start debriefing sessions
as soon after the traumatic event as possible to make the best impact on the employees’
mental strain. She explains that in emergency settings the personnel involved often need
to go on to the next emergency before dealing with their stress from the first. Other
sections of medicine do not necessarily have the same type of constraints as emergency
care. For example in parts of the Royal Belfast Hospital for Sick Children the nursing
staff is allowed to work in non-direct patient care jobs after the exposure to a traumatic
incident with a patient, in order for them to deal with their mental strain from the stress
(Morrissey, 2005).
Stress and Emergency Healthcare Workers 19
A 2007 study about the effects of on-site ‘aroma therapy massage with music’ on
the anxiety levels, caused by work-related stress, of Australian emergency nurses found
that there was a marked decrease in the anxiety levels of the nurses after receiving the
therapy. Thus it is suggested that since high levels of anxiety and stress can be harmful to
the physical and emotional condition of emergency nurses there should be a support
mechanism such as on-site massage as an effective a tool for coping with stress (Cooke,
Holzhauser, Jones, Davis, & Finucane, 2007).
Kimbrough-Robinson reported that the Dart Center for Journalism and Trauma
recommends several things to help reduce stress and the possibility of developing PTSD.
Take care physically by eating healthy foods, eating regularly, getting plenty of sleep,
and engaging in physical activities. Take care psychologically by writing in a journal,
decreasing the stress in your life, reading something unrelated to work. Take care
emotionally by seeking out the company of those you enjoy, playing with children, and
allowing yourself to cry. And take care spiritually by singing, meditation, giving to
causes you consider important, spending time in nature, and joining a spiritual
community. It is also strongly suggested that if the recommendations don't work then the
individual should seek professional help. The real sign of courage is getting help when
you need it. There is no shame in asking for help. However, it would be a misfortune if
the need for help was ignored, as we humans are not immune to tragedies of life
(Kimbrough-Robinson, 2005).
Stress and its effects are felt by everyone in all types of societies and cultures.
This is especially true for emergency healthcare workers. Stress has become one of the
largest mental health problems in the United States today. The manifestations of stress,
Stress and Emergency Healthcare Workers 20
PTSD, STS, and burnout not only affect the person that is directly touched by the stressor
but also those who are close to that person. Marriages, friendships, and family ties are
often stretched to the breaking point and sometimes past it. This in turn can cause more
stress and possibly the loss of a support group making coping more difficult. So it is
important to recognize when there is a problem with stress and to have a game plan in
place to deal with it as it occurs.
Research Questions
RQ 1: What is stress like for emergency workers?
RQ 2: What kinds of stress do emergency workers face?
RQ 3: How do stressors affect emergency workers?
RQ 4: What do emergency workers do when they feel stress?
Stress and Emergency Healthcare Workers 21
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