How to Deal with Work-Related Trauma in Healthcare

Welcome everybody just acknowledging just sort of speaking so you hear? Hopefully it looks like your ears are working. Just going to give it a few minutes or minute or so for folks to to get in and to before we get started. I?m a big fan of dad jokes. Dad jokes is my way of using before while we're waiting for folks to trickle in. I usually give the opening line of the dad joke, and you see if anybody can guess the punchline. So I'll just tell it to you while we're waiting, and then we're going to start in a minute. So, the opening line of the dad joke: I'm making a video about ankles and toes. I'm making a video about ankles and toes. So, welcome everybody. I'm just giving it a minute before we get started. We will start in a moment. The punchline for that dad joke, then we'll start. So far, I've collected some nice footage. So far, I've collected some nice footage. All right, everybody, glad to have you here. My name is Amin Azzam, and you're here at Osmosis from Elsevier webinar on healthcare work-related trauma. So, feel free to ask questions in the chat. Just keep in mind that it can take time to answer them, so we'll do our best to address them before the end of the webinar. Thanks for your patience. Okay, I want to start with a land acknowledgment. I'm coming to you from the land of Oakland, California, which is the historical land and present land of the Ohlone, Muwekma, and Confederated Villages of Lisjan native peoples. I appreciate their traditions, coming together, and growing as a community, and I pay my respects to their elders, past, present, and future. I also invite you to consider the native-land.ca website, where you can learn more about the native peoples of the place that you are residing. I think it's a really cool way to learn more, and whenever I present remotely, I also learn about the people from the place I'm presenting. Today, I'm coming to you from home. Okay, I also want to do a couple more acknowledgments. So, there's an expression: a picture's worth a thousand words. I was wondering who that came from, so I looked it up on one of my favorite websites, Wikipedia. The Wikipedia entry says this is from a man named Arthur Brisbane, sort of a speechwriter, orator, and public relations professional. So, I'd like to paraphrase Arthur with the acknowledgment that a picture, in my opinion, is worth 10,000 words. So, I wanted to acknowledge my gratitude to the talented medical illustrator team at Osmosis, whose images I'm using frequently throughout today's presentation. I also need to do a war acknowledgment. So, Antonio Guterres, UN Secretary-General, back in October, a week after the Hamas attack on the innocent civilians in Israel, sort of made a statement that the hostages must be immediately released. He also called on Israel to provide rapid and unimpeded access for humanitarian aid in Gaza. In my own grief and processing the war that's happening, that has continued to this day, I was looking at historical sort of bombs, and 60 years earlier, John F. Kennedy presented to the UN General Assembly a quote that's resonated with me throughout the last seven, eight, nine months now. Chronic disputes, which divert precious resources from the needs of people or drain the energies of both sides, serve the interest of no one. The badge of responsibility in our modern world is a willingness to seek peaceful solutions. That really resonated with me, and this is really personally relevant. I just need to introduce you to my father, Nabil Aam. He's a PhD anatomist. He came to the US from Palestine and did his PhD here. Here he is as president of the student body in the 1960s and went on to teach generations of medical students and health professional students. Here he is putting his students to sleep, but I want to light-heartedly say I'm glad that my father's still alive, and he and I both agree, as Palestinian Americans, that the only solution is a two-state solution. So, I just need to acknowledge that because it's relevant to me as a Palestinian American, what's going on in Gaza. Okay, let me tell you a bit more about me. I am a Palestinian Armenian American. Here's my family, just so you know. I live in the Bay Area. My wife is Taiwanese American, and she is a pediatrician with a public health background. We are blessed with two kids. Professionally, just so you understand sort of my background for this presentation today, I'm an academic psychiatrist. I've been at UCSF on faculty for 23 years. I run psychotherapy groups for patients with chronic medical conditions?anybody with active symptoms and no cure. I have these other academic and non-academic affiliations. I'm privileged to continue to be a consultant to Osmosis from Elsevier, and I want to acknowledge that academia brings scholarly rigor and industry brings speed of innovation. So, I believe it's valuable to have a foot in both camps. That's who you're being presented by or to today. All right, here's what we're going to do today. All good talks have learning objectives, so on the right, you'll see I have three learning objectives that I'm hoping to address with you all today. I want to define workplace trauma in the healthcare workplace environment, and we'll talk about approaches you can use to build your workplace resilience. Then, we want to leverage self-care and stress management techniques in your own workplace. So, we'll do it in that order, and let's dive in. So, we have finished the land acknowledgment and disclosures, check. So, let's talk about healthcare workplace trauma. Okay, so I'm in the US, and so the US national or government organization, the Substance Abuse and Mental Health Services Administration, or SAMHSA, defines trauma as follows: events or circumstances experienced by individuals as physically or emotionally harmful or threatening that have lasting adverse effects on their functioning and physical, social, emotional, or spiritual well-being. So, I think a couple of key points to make here: lasting adverse effects. So, you know, for those of you?I'm not a hockey person?but I understand that sort of the Stanley Cup was like Edmonton lost to somebody else, and so for the fans of Edmonton, you may be disappointed about the loss, but we're not going to define it as trauma because it wasn't lasting adverse effects, even if it is emotionally harmful. And it wasn't physically harmful, but obviously, sort of physical harm that is relatively small and you recover from quickly is also not sort of threatening towards sort of life and limb, for example. So, we may not define that as trauma either. So, the key points here are lasting adverse effects on all of those subsequent things?any or all, I should say. All right, so in preparing for today's talk, I wanted to do some literature review, and so I want to just prepare for you how I'm going to structure some of what I present to you. So, I've gone and read the original literature articles for a couple of articles, and what I like to do is just give you some highlights. I'll give you some exemplar quotes from the articles verbatim in these blue text boxes, and then after that, I'm just going to give you my take?my sort of psychiatrist impression or key takeaways from the journals and from the articles that I reviewed to think about workplace trauma. Okay, so the first article?we're going to do four of these?the first one is from the Journal of Healthcare Leadership entitled "Trauma-Informed Care: A Missing Link in Addressing Burnout." So, a couple of key quotes here: "Trauma is highly prevalent in society at large, and health workers are further exposed to trauma in the routine course of our professional duties and studies." The second quote is that "we now know that trauma can include community or intimate partner violence, racism, discrimination, war, natural disasters, medical illness, and pandemics. So, we're really glad to see them acknowledge the trauma of the global pandemic. Their definition is consistent with SAMHSA's definition of trauma as broader than merely physical trauma. They go on to point out that common symptoms of what we think of as burnout?sort of a mental exhaustion, helplessness, detachment?may actually be manifestations of stress from trauma. Two more quotes that I thought were really important: in addition to the trauma of childhood, many of you may be familiar with the ACEs framework?key traumas that affect children's future trajectories?both primary and secondary traumatization are occupational hazards of our jobs in healthcare. So, in any given shift, we may experience microaggressions, workplace violence, or moral distress. And, of course, in healthcare, we may also witness pain, suffering, injustice, and death. We, as healthcare professionals, attend to the breadth of the human experience, including some of the most profound devastations of human lived existence. So, within our individual experiences of COVID, the pandemic served as a mass exposure to trauma and further uncovered the pressing need to invest in healing in our workforce?healing us as healthcare providers. The article goes on to talk about the framework of trauma-informed care, which I think they succinctly summarized as safety, empowerment, and healing through collaborative relationships in the healthcare workplace. So, I just want to point out the sort of key takeaways that I got from reading this article. First and foremost, trauma is widely prevalent. I don't want us to be misperceiving or projecting the misperception that it doesn't happen a lot?it happens a hell of a lot, and I think it's important to acknowledge that. The second point I want to make is the secondary pandemic of emotional distress is also widely prevalent. Their phrase "mass exposure to trauma" I think really captures it succinctly. We in mental healthcare would have predicted there was going to be a secondary pandemic of emotional distress, and I just appreciate that it's being explicitly labeled in journal articles. My last point is that trauma-informed care takes care of us while taking care of our patients. All right, so I'm going to invite you to just think for a second. I don't know you all, obviously, but I'm presuming many of you are healthcare professional students, or you're healthcare professionals, or you're healthcare adjacent. So, I invite you to think about your own healthcare workplace, however far along you are in training, and ask yourself: have you been experiencing any healthcare workplace trauma? Is this you? Does this resonate and relate to your own lived experiences? I hope that it's not surprising, but I'm just going to say I'm sure it has affected a lot of you. I'm sure there's been a lot of workplace trauma for many of you. With that, I want to think about healthcare workplaces as places of safety. To address safety, we think about it?we have bed rails to prevent our patients from falling out of bed, we have those sharps containers to put sharps away safely so none of us have accidental needle sticks or pokes, and a safety pin is also designed to do that. So, I just want to declare to each and every one of you that I want to encourage you to strive for both physical and emotional safety in your healthcare workplace. That's true for both patients and us alike. We need emotional safety in our healthcare workplaces too, and I think it's appropriate to expect?not only expect but perhaps demand?that of our healthcare workplace. They need to be safe for us emotionally too. All right, so that's the definitional stuff of healthcare workplace trauma and talking about how prevalent it is and what it actually means, let's talk about workplace resilience next. So, here I want to turn to a really fabulous example of a resilient workplace, and this comes from this nursing journal. These nurse editors, sort of frontline nursing faculty, presented an article about Kings County, a Level One Trauma Center in one of 11 acute care facilities in New York City. It houses 624 beds, employs more than 5,000 people, and serves 2.6 million residents of Brooklyn. In the article, they talk about their strategy to address well-being. Initially, their aim was to address these five points: the acute reaction to unanticipated and adverse work-related events, to deal with stress on the job, to address secondary vicarious complex and collective trauma (referring to the nursing and other workforce staff in the hospital), and to also address compassion fatigue and burnout. So, that was their initial aim. Then, there's this little global pandemic thing called COVID-19, which hit the world, and many of you will recall it hit New York City first in the United States. So, the leadership had to pivot, and they define in this article that the new goal was then to provide staff with the opportunity to discuss difficult experiences that they encountered daily, allowing them to bring their entire selves to work and feel comfortable doing so. What the leadership did was pivot and broaden the scope of the initiative to implement a more holistic approach that embraced other aspects of well-being, which included physical, psychological, socioeconomic, spiritual, and cultural elements of well-being. I wanted to show you a table from the journal article because it was just so impressive. As you look through this list of well-being foci or focuses, I want you to just take note and appreciate the, to my mind, ridiculously broad range of things that they made available to their frontline clinical staff. The nourishment stands were literally carts that they would push around to different units and that had free food. The dance movement and stretch elements?they learned and they talk about in the article how they actually realized that the movement and stretch stuff originally were 30 minutes long, and it was too long. People didn't have that much time to take away from their work shift, so they downsized it to 10 minutes on-site on the individual units. That was enough?just the movement stretch thing for 10 minutes, for example. You can see Schwartz Rounds, which is broadly used across many global health organizations, brought those in there too. Different types of meditation, group debriefs?when, if you scroll, if you look down a little bit further, when members of the healthcare workforce were also dying from COVID, they would have sort of opened up spaces to have reflection, almost like memorial places where you could write your memories of that beloved coworker who succumbed to COVID. So, really broadening what it meant to be a worker in healthcare. You see again some of those other things listed. I was just blown away by the diversity of resources that they made available to their frontline clinicians and trainees. So, my take on this success story?first of all, I want to point out this program was designed pre-COVID. It didn't take a global pandemic to see value in developing a resilient workforce. When the pandemic happened, the leadership at this hospital faced the need to pivot and broaden rather than retreat and ignore. Right? Like, when you're in the pandemic, that's when you expand these services rather than be like, "We don't have time; we're saving lives, and we don't have time to focus on our staff." I thought that was really, really valuable to see. And then, the third key point is I'm curious?I don't know?but I'd be curious to see how much they're sustaining these efforts now that we're sort of post-pandemic. And, you know, the next winter will tell us whether we're really post-pandemic or not. But I really think that it would be lovely to see that they haven't withdrawn some of these and hopefully are continuing all of them. And if not all of them, I'd be very curious to see which of these they have retained because they've been disproportionately valuable to the resilience of the healthcare staff at this particular hospital. All right, a third example I want to show you is from the Mental Health Commission of Canada. So, this is a fabulous sort of nationwide initiative in which they broadly define their task as improving mental health outcomes for all the people of Canada. You can see this from their website. You can see they believe that everyone should get the chance to achieve their fullest health potential. And notice that we're not talking about patients narrowly; we're talking about every human in Canada. On their website, they have an example of 13 factors that address mental health in the workplace. I think this is as good a place as any to just acknowledge my colleagues. My Osmosis colleagues are going to be posting some blog links in the chat intermittently throughout this talk?mental health-related articles or other resources that will complement or supplement what I'm sharing here in the presentation. So, I just invite you to click on those links and read those again in the future in your own time. I just remembered to share that now. So, our Canadian colleagues identified 13 factors that address mental health in the workplace, and now we're talking in the healthcare workplace specifically. I'm not going to go over all 13, but what I want to show you specifically is three or four of them. They produced some public posters that you can just print out and display in the healthcare workplace across the country. Obviously, it depends on each institution, but what I love about them is how simple and universal they are. Right, so if we just look at that first one: if you want to be a mindful employee, we get to think about the organizational culture of your hospital, your healthcare system, your med school, your nursing school. They invite us to be thinking about our behavior and how it impacts the psychological health and safety of our colleagues. If we think about noticing someone is struggling, we want you to approach your coworker or colleague who may be struggling. And I think particularly on the far right here, around psychological protection, we're inviting us all to be more than bystanders but really be sort of actively speaking up when we see violent, aggressive, or inappropriate behaviors and actions in the healthcare workplace. That can be directed towards patients or directed towards our colleagues as well. So, that little green box at the bottom, they're declaring across all of these posters that it's all of our collective responsibility to contribute to positive psychological health and safety. So, it's really cool to see these. They've got 13 different posters, each tackling one of the 13 psychological elements that affect mental well-being in the workplace. Here, I just want to make a couple of points. First, I just want to say that the burden of workplace resilience no longer falls on individual clinicians but should be shared with and by our employers. What I appreciate about this is these posters are not necessarily something we, as individual clinicians, should print up and bring to the office and put on the wall. We could?we absolutely could?but I also think that these are something that we can invite our administrative leadership to be a part of solution-creating. So, it's not our responsibility alone; it's our employers' responsibility as well to make it a safe space for all of us as healthcare employees to reduce trauma at work. And I just wanted to say, out of the shadows, like, yay Canada! For so many of your healthcare workplace environments, I suspect we'll see this in the Q?A, but I suspect that there isn't as much emphasis on workplace resilience and in building healthy workplaces for us as healthcare givers. And so, I was just really glad to see this and glad to see this across the nation and not just at one hospital or one institution or health system. All right, so that's all nice, you say to me, I'm sure, but like, great, great, that's all high-level administrative stuff. How do I apply this to my life? So, with that, I'm going to move us ahead. We'll say we at least have touched superficially on workplace resilience, so let's talk about self-care and stress management. All right, here I'm going to go to one more journal article. This one is in the Healthcare Management Forum Journal. As you see, the title is "The Healing Healthcare Initiative: Guiding Leaders to Heal a Traumatized Workforce." A couple of quotes from this one now. The first one: "In the wake of the profound impact of the COVID-19 pandemic, many healthcare workers are finding the human costs of being unable to meaningfully attend to patients' needs both untenable and likely leading them to an intent to leave the healthcare workforce, sort of burnout because of that sort of untenability of meaningfully doing the work that we were called to do." The second quote is that "among the attitudinal obstacles to health professional well-being are expectations of heroic self-sacrifice on our parts and the stigmatization of mental health issues by the general public and us professionals as well. So, you're weak if you're not a superhero." And then the third quote: "A consequence of these structurally embedded attitudes is that responsibility to address their negative consequences is deflected from institutions and systems and placed in the hands of affected individuals." So, on us, for example. The authors go on to say, "Courageous leadership is needed to call out the systemic and organizational factors that contribute to the twin pandemics we're witnessing?that being the pandemic of burnout and healthcare workforce trauma and, of course, the original COVID pandemic. We need to forge pathways to health and well-being for all." So, it's such beautiful writing. I just need to say it again: "Courageous leadership is needed to call out the systemic and organizational factors so we can forge pathways to healing and well-being for all of us." Here are a couple of key points I want to make. First of all, it's the same point I made about Canada. So, out of the shadows already. Sometimes journal articles can be sort of lost in the massive numbers of journal articles that are published, and we don't all have time to read them all. So, I just appreciate these authors for, in this sort of management-level journal article, really calling on healthcare workforce leaders to step up their game. I also want to really highlight the point here that we really need to stop pretending we're superhumans or superheroes. We need to bravely accept that we're merely? I say in quotes?merely imperfect humans. Because the moment we start acknowledging that we're all merely imperfect humans is the moment that we're all going to be better healthcare providers and healthcare perimeter of the circle. You have more precise feeling words that you can use, or you could do the opposite. You could say, "I'm feeling ashamed" over here on the sad sort of wedge wheel?I'm over at three o'clock?and ashamed. Maybe what you're really feeling is guilty, but really what you're feeling is sad. So, you can drill down to the core root emotion that's causing those feelings, or you can work out to a much more precise term. The key point I want to make here is that the human language capacity to describe emotions is tremendous. This is true across any language. It's beautiful that we have such precise words for feelings. A lot of times, we can feel overwhelmed by our feelings, and one thing we can do to feel less overwhelmed is to name them precisely or to name the core feeling we're having. So, these emotion wheels are all over the internet. Just do a Google image search for "emotions wheel," and you're off and running. They're drawn in different ways. Here's one that looks like a flower?same concept, drilling down to the core emotions or out to the more precise words. Here's one that's sort of targeted towards using a visual sort of feeling at the top and labeling them. Here's one that's for kids that looks like pizza. Here's another one that's a poster: "It's okay to feel your feelings." And I just need to say that again: it's okay to feel all of these feelings, this broad range of human emotion. Because if we don't own that we have all these feelings, we're suppressing our full humanity. So, it's okay to have fear, anger, disgust?it really is the negative half, if a lot of people think of that as the negative half of feelings. Here's another one. I think this is the one I have on my wall. It is. The quote at the bottom there is just to acknowledge that we can't stop feelings, but what we do with them, how we process them, how we handle them?that's the key point I'm trying to offer you here. So, I want you to be able to label them and own them, and then we can think about how you're going to address them in the healthcare workplace. And here's some ways how. So, my next practical tool is what a colleague of mine calls the "humanoscope." We all have our stethoscopes or other tools for listening, so I'm going to invite you to think about a humanoscope as listening to what's happening around you in the healthcare workplace, both for you and for your colleagues. Here's an example where the clinician is listening to a patient. We may look at that and say that this individual is using that stethoscope to listen to that patient's lungs, right? But I'm going to invite that clinician to think: are you listening only to the lungs? Are you listening to what else is going on around? Can you also hear how noisy it is outside of that clinical encounter? Should we have closed the door to the patient room so you can do a better job listening both to the heart sounds and to that patient? So, the second example: are you listening in all capital letters? Here, in this case, we're listening to the heart. Are we listening to that patient's facial expressions as well? Are we noticing what's going on there in this patient encounter? In these humanoscope examples, I'm really using those first two as patient examples, but I'm going to push you in this third picture. Here, that person looks to me like they're actively really listening. You can tell from their body language that they're sitting at the front of the table. Their arms suggest that they're not closed off; they're actually actively listening to the person whose back is in this picture. It looks like they're making good eye contact. I'm going to propose to you that that dark blue person, the one whose back is to us, could be a colleague. This could be a charge nurse talking to a nurse coming on shift, for example. They are actively, actively listening. So, that stethoscope is there too, but I'm just encouraging you to leverage your humanoscope because that tool is with you everywhere you go. Okay, and towards that end, another sort of practical tip that I like to offer people?some of you have heard about this English expression: if you have two ears and one mouth, you should listen twice as much as you talk. It doesn't automatically have to be that in every situation, but let's look at this picture here. I'm going to propose to you that this clinician is talking; they're not listening at all. Here's another picture: here's somebody that looks like they're not talking, at least they're not talking, but they're not really listening either. And here's someone who, again, I think is actually not talking but is really actively listening. Look at the body language, right? She's got her clipboard; she's not distracted by her clipboard. I think she's making good eye contact as well. She's smiling, Do something. I love to invite my trainees to also pay attention to the inverse of this: don't just do something, stand there. You're actively listening, you're actively bearing witness to what that other person is saying and expressing using your humanoscope, right? So, these three people could very easily be talking to somebody who looks like a patient here, right, in either of these examples. But I'm going to again propose to you that in the healthcare workforce, if we want to mitigate trauma, we should be actively listening to our healthcare workforce teammates as well. Right? So, that person in orange could easily be talking to a healthcare teammate or a physical therapy school classmate, right? Being fully present?two ears, one mouth, actively listening. Don't just do something, stand there. All right, let's talk about a couple more practical tips, and then I think we'll move towards the Q?A. One of my favorite, favorite, favorite examples of how we need to take care of ourselves in order to take care of others is the oxygen mask metaphor. If you've ever traveled on planes, they always tell you if the oxygen masks fall and you're traveling with someone who needs assistance, make sure you put on your mask first in order to care for those others. This is just to acknowledge that self-care and stress management is not selfish; it is actually selfless. By taking care of yourself first, you are going to be able to sustain the long-term healthcare careers that all of us need each of you to be in. So, I'm just going to acknowledge that self-care and stress management, when you do it well, it's so cool because then you have the reserve capacity to be there for your healthcare teammates. Right? So, this person in green is doing that self-care and stress management so they can help that person in blue. So, I want to make a couple of suggestions. Obviously, I don't know your local contexts, but I'm willing to bet that most of your environments, whether they are clinical or in training so far, are going to have not just a few but probably almost all of these available to you. If you're a student, there's going to be student health resources and mental health professionals there, as well as online resources. If you're a clinician or a healthcare employee, there are going to be employee assistance programs to offer you assistance. Certainly, there's human resources as well. Many healthcare systems now have well-being initiatives?maybe not as amazing as the one in Brooklyn, but there are going to be those as well. I'm definitely seeing some of the presentations at conferences and national and international presentations around these topics, and so healthcare hospitals have to catch up to each other to do this. I'm glad to see this is penetrating the healthcare workforce. If you're not at a place that has those yet, there are wellness apps. There's this huge explosion of wellness apps that are out there. Obviously, buyer beware?some are more robust than others?but I'm just thrilled, thrilled, thrilled to see how many are out there and available to be in your pockets. Many of us are carrying cell phones with us all the time. Lastly, I wouldn't be doing my due diligence if I didn't explicitly acknowledge, as a mental health professional, if your challenges are severe or significant and all of those earlier bullets are inadequate, please, please, please reach out to mental health professionals. In the US, there's the 988 national warm line that can connect you with mental health professionals locally. Obviously, healthcare insurance systems?if you have insurance, you want to be able to leverage those in-network resources. Take advantage of those. I'm really, really pleased to see how much stigma has been reduced with mental health and mental well-being these days. Over my career, it's been just awesome. You deserve mental wellness?that's part of your whole human self. All right, with that, those are just a few practical tips on self-care and stress management in the healthcare workforce. I am ready for questions, so I'm going to go ahead and look there. My colleague Stephanie has definitely posted some awesome links, just acknowledging all of those links in the chat for many of the useful resources in the blog and the other resources. So, I'm looking through it. Thank you to the colleague who posted that you still offer those programs at Kings County?that's way cool to hear. So now I know. Let's see the questions there. I have to go over here. Thanks, Stephanie. How do you know you won't be at risk of being stigmatized for using these services? Thank you for that awesome question. Okay, so I want to acknowledge you don't necessarily know that upfront. You're absolutely right that there is a risk of stigma and perpetuated stigma. I want to acknowledge that when we keep it in the dark, we actually perpetuate stigma because we make it inappropriate or uncomfortable to talk about mental health or mental well-being. So, there's some request to talk about some stigma. Recently, someone said that healthcare trauma is prevalent in the workforce, and I just wanted to check in with you. Part of my job as a colleague is to make sure that you're doing okay. Has there been any trauma or burnout that's going on that you want to talk about? Or, you know, I hear we have this great resource here for us as employees about the well-being program, and I didn't know if you knew about it. So, notice what I'm doing here is reducing the?what's the word I'm going to use?activation energy necessary to say these things, so that way it's easier to talk to each other and to others. Right, so I'm looking at some other questions. I hope that helps a little bit in terms of reducing stigma, and then we all can reduce stigma by saying, you know, people who are out and proud about their own emotional wellness struggles?they are role modeling. Especially, for example, like public health celebrities, when they're out and proud, that does a lot to reduce stigma. So, I applaud those in the public space who are doing that. Let's see some more questions. How do you deal with traumatic flashbacks that don't happen often but from time to time? I would just offer in that case, I'm going to invite you to talk to mental health professionals who can guide you with some ways to reduce traumatic flashbacks. Also, there are some apps that are addressing PTSD specifically, and so you can use some of those wellness apps to see if some of the techniques in the wellness apps will also be useful. What wellness apps do I recommend? There's a whole?I'll show you some. I'm going to keep sharing the screen but come out of this to show you, for example, from my own institution. So, psych.ucsf.edu, just because I happen to know that first. So, here we have?oops, you look here?talk about microaggressions and what you can do about them as if on cue. So, hooray to my colleagues in my institution. But I'm going to show you the patient care. We have this mental health topics and online resources, and then we have these?a bunch of resources. But we also have, I think it's mental health resources here, and then there are some apps. Where are the apps we use? Full wellness and mental health apps. So, I can probably post that in?I don't know if I can post in the chat. I think I can. Everyone, so here are some apps. And what I like about this is I tell my patients and colleagues these have been vetted by our institution, so you don't have to worry about them being internet trash. So, here's some meditation relaxation apps, anxiety depression apps, insomnia apps. So, there's lots of other places that might also do that. So, just acknowledging those are the ones that I'm familiar with, and some of you may be able to put in the chat some of your own. Let's go back to the talk. Okay, another question: At what point do you recommend seeking help out early? Okay, so there's no upper limit on emotional wellness and well-being, right? So, I think you can do some non-professional, sort of upstream wellness resources, wellness apps, that kind of stuff first. And then, you know, if that feels like it's inadequate and you want to seek professional help, this is where students?I want you to go to student well-being, I mean student health, because those are mental health professionals that can partner with you around whether additional professional resources are needed to be called into action. And same thing with the employees, right? So, you have your sort of employee wellness programs that can then connect you to mental health professionals as well. Peer support specialists?great resource. Totally agree, totally agree. They may not be licensed, but they often have solid suggestions. Totally, totally agree. In my own clinical work, I run psychotherapy groups for patients with chronic medical conditions, and those peers are helping each other a lot, a lot, in addition to me as a resource. Valentina asks, how can we push each other to prioritize mental health when we feel like we don't have the time? Okay, to that, I would just say if you down-prioritize this, you are going to burn out. And so, if you want to sustain a longitudinal healthcare career, which is amazing, right? I love what I do. I love being a clinician. Then it's not a choice. So, you want to role model for others. I've seen some email subscripts that now say, "I don't expect a response to this on weekends or evenings, even if I'm writing it on a weekend or evening," for example. Right? So, that's an example where you're saying, "Hey, people, take care of yourself, and I'm going to do that too." Right? So, you might?and my example of Right, so you might?and my example of showing you my family?that's also role modeling that I'm a whole human and that I have a personal life as well. So, I think we can push each other through good role modeling as well. Is it appropriate, and for how long, to suppress our emotions we cannot deal with at the moment, for example, on a shift? Yes, so obviously we need to be able to prioritize our patients, but sort of the suppression of emotions thing?I would advise sometimes clinicians that we're going to postpone the emotion, but we're not going to ignore it. So, we're going to come back to it. One thing you can do is schedule time for coming back to those emotions. So, tonight at 9:30, when I'm done with my other family duties, I'm going to have 10 minutes of dedicated time to think about how stressed I was at work and what happened, or what that negative outcome that happened with that patient was, for example. So, we're postponing rather than suppressing, if you will?postponing them. So, that's a key strategy: scheduled time to process emotions. Also, healthcare teams will debrief at the end of a shift, right? So, really excellent healthcare teams would be like, "Okay, we're going to process how clinic went today. Anybody want to talk about how it felt for them? Any other sort of workplace continuous quality improvements can we do for our team to make sure that we take care of ourselves and each other and our patients?" Right? So, debriefs are a place for emotional processing too. Next question: Is there a tipping point for when the trauma actually makes filing a worker's compensation claim appropriate? Or filing, sorry, filing. Yeah, in this case, I'm going to encourage you to be able to talk?it depends on your local context, right? So, I think you talking to your local employers around what is workers' compensation or what are the local regulations and local opportunities around filing those claims. I think that's a question I can't really answer. I don't know that there's a specific one tipping point. I think we'd be defining what the trauma is, and therefore, defining it as trauma will probably depend on local context and what resources, what happened, right? Special tips with pediatric patients: Right, so mental health professionals who specialize in children can comment on this better than I can. Obviously, our young people have developmentally appropriate?you want to use developmentally appropriate strategies for the children at the age-appropriate level. Usually, what tends to happen in my experience is that we tend to sort of baby them more than they need, meaning that we tend to sort of fear that talking about emotions is somehow going to be overwhelming to young people. But creating space to talk about feelings empowers them to sort of be able to process them with your guidance, with adult guidance. It's a good shout-out to talk about the Inside Out movies, both the first one and the second one that just recently came out. They're brilliant and beautiful, and you're role modeling a sort of range of human emotion for young people. If you haven't seen Inside Out 2, I strongly encourage you to see that too because it broadens the core emotions, and now you've got the broader ones. So, let's see if there's any more questions that are going to emerge. Oh, two more. How to show excitement properly so that onlookers and colleagues can understand it's not silly egos? Okay, I think on that one, the answer I'd give here is the excitement is to the others, not about you. Because if you're excited about them, it doesn't come across as egocentric at all. Seeing that we're getting close to the end of time here and I don't see any open questions in the chat, I'll come back to the slideshow version and say, check on the Q?A. Going to look at the three learning objectives just to remind you what we were trying to accomplish together: defining workplace trauma in healthcare, identifying approaches to build workplace resilience, and then leveraging self-care and stress management techniques in your own workplace. A couple of closing thoughts: So, this has been recorded, and this recording will be available at our osmosis.org events webpage. My colleague Stephanie will make this recording available about next week, so we won't go live tonight, but just give us about a week for the recording. I also want to acknowledge that for being here, we're happy to offer you a free two-week trial of Osmosis. I'm sure Stephanie's already posted that in the chat, so you just click on that. I think Osmosis is a phenomenal resource. I really love it. My students are using it?diverse tools and resources, including all these beautiful videos and illustrations from our professional voiceover artists and the professional illustrators. And then again, if you'd like more free content, more free great content, our blog's got lots got lots of resources I know Stephanie's already posted quite a bit of those but it's just great great resources written from about by health professionals. So and those were the extra chat. Thank you all for coming! Helping current and future clinicians. Focus learn retain and thrive.