physiological measures of stress amongst healthcare professionals
Recovery following high demand situations is an essential component of being able to perform at a high level on a consistent basis. This is a common requirement of all healthcare professionals.
Healthcare is, by its nature, a high demand profession. Across all types of practice, the requirement to provide high quality patient care at high volumes and over a long duration of time is inherently high demand. This can lead to healthcare professionals experiencing high levels of stress. Over the past several years, the important issue of healthcare professional burnout has become more widely discussed. While there are several contributors to this situation, the high stress experienced by many professionals is a significant contributor.
Amongst all healthcare professionals, those performing technical procedures have an additional element of demand. Specifically, the requirement to perform physical skills which are, at times, complex and to do so under high consequence circumstances can create an additional layer of potential stress. The reality that these skills which are commonly performed have a direct impact on the health and wellbeing of other individuals and, at times, their life directly adds additional demand to an already high demand profession.
When we are exposed to a high demand, or stressful, situation our autonomic nervous system is the initial mechanism by which we respond. Depending upon the chronicity and nature of the situation, additional physiological mechanisms may become active. Under scenarios of prolonged, chronic stress the hypothalamic-pituitary-adrenal axis contributes to our response. The initial response, however, is largely determined by our autonomic nervous system. As an example, our heart rate frequently increases as does our respiratory rate. When we experience high demand and stressful situations, it is important that following completion of the task, we allow for sufficient recovery. This is necessary in order to be able to perform to our potential capabilities when the next high demand situation arises. Within the healthcare profession, as outlined above, it is commonly the case that such scenarios present themselves in rapid succession. This emphasizes the importance of recovery for all healthcare professionals.
There are several mind-based and body-based skills and strategies that we can develop to better help us manage during high demand, high consequence situations and to better recovery from such scenarios. There are physiological metrics that provide an objective measurement of the extent to which we have recovered. One of the more commonly used metrics is heart rate variability (HRV), a measure of the difference in time between successive heart beats. Under ideal circumstances, our heart should not beat at a consistent rate. Rather, there should be a degree of variability between beats. This is measured by HRV. When we are under a parasympathetic nervous system predominant state, typically manifested by greater degrees of relaxation and recovery, there will be increased HRV. Conversely, if we are in a sympathetic state, HRV is decreased. This explains why HRV is utilized as a measure of recovery. There are several measurement devices that can provide this data, including wearable technology.
As we develop the skills and strategies that promote recovery, we can track our proficiency through measurement of HRV. If one were to measure HRV during high demand activities, the data would reflect the extent to which the individual’s sympathetic nervous system was activated and thereby provide information regarding the extent of physical, emotional, or psychological stress. As can be appreciated, measurement of HRV can provide data regarding the extent of current demand as well as recovery.
Rieger et al (2014) reported a study several years ago regarding the extent of intraoperative stress amongst surgeons. They conducted a cross-sectional study of the impact of intraoperative stress on the autonomic nervous system of surgeons. Outcome measures included heart rate, HRV, and self-reported perception of stress using a questionnaire. They reported a significant difference in heart rate between those surgeons who perceived stress, with an average rate of 99.3 beats per minute, compared to those who perceived reduced levels of stress, with an average rate of 63.7 beats per minute. They also measured HRV during sleep and reported decreased HRV amongst those surgeons who perceived higher levels of stress. This finding indicates decreased recovery associated with increased stress levels.
The results of the study, reported nearly a decade ago, provide evidence regarding the impact of perception of stress on autonomic nervous system function, as measured with HRV. This information indicates that, on account of reduced HRV during sleep, the surgeons with greater perceptions of stress were not able to recover to the degree that those who perceived less stress were. In addition, the impact on the autonomic nervous system, through increased activation of the sympathetic branch leading to increased heart rate and decreased HRV, was demonstrated.
As discussed above, the ability to recover following high demand activities is an important component to managing high consequence situations. While it was beyond the scope of the study to investigate any changes on account of the development of skills and strategies to promote recovery, it has been well established in other populations that the result of such skill development is improved HRV.
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REFERENCE
Rieger A, Stoll R, Kreuzfeld S, Behrens K, Weippert M. Heart Rate and Heart Rate Variability as Indirect Markers of Surgeons’ Intraoperative Stress. Int Arch Occup Environ Health; 2014: 87(2): 165-174.