Occupational Health Clinics for Ontario Workers, Inc. OHCOW

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Occupational Health Clinics for Ontario Workers,
Inc. (OHCOW)
STRESSED OUT !!!
Deborah Hellyer MD, Ivan Bauer
BScN, Veronica Kaschalk December 6, 2005
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Even a vacation sounds like too much of an
effort to be worth it. Nothing I can think of
sounds like fun to me.
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Agenda

• Global stress
• What is stress?
• Causes of workplace stress
• Specific industry stress related triggers
• Discussion of top 3 stressors
• Stretch
• Long and short term effects of stress on the body
• One time hazard vs. chronic exposure
• Workplace stress solutions
• Personal solutions
• Conclusion

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Dolphin Stress Test

• This is a simple test designed to indicate if you
  have too much stress in your life
• Its a picture of 2 dolphins who appear normal to
  a person who is stress free
• Its quite simple, if there is anything that
  appears different about the dolphins, it is an
  indication of potential stress related problems
• Sit upright, take a deep breath, breath out and
  look at the picture
• If anything is out of the ordinary, you need to
  consider taking things a little easier

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Well?
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Test Your Knowledge

• Answer True or False to the following questions
• Nearly 50 of Canadian adults over 30 are
  frequently stressed
• Prioritizing tasks will NOT help you cope with
  stress
• Its OK to have some stress in our life
• Stress can lead to unhealthy habits such as
  smoking, overeating and inactivity
• Its a good idea to get professional help if
  stress becomes too great

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Test Your Knowledge Contd

• Stress Management programs usually include ways
  to eat healthy, sleep better and get physically
  active
• Yoga, meditation, reading a book or watching a
  movie can help reduce stress
• Consuming alcohol is a good way to help manage
  stress
• Workplace stress is the most common source of
  stress
• Employers can help workers deal with stress by
  providing programs on financial planning and
  conflict resolution

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Expectations

• Instant gratification
• Fast food restaurants
• Automated tellers
• Check outs
• Multitasking
• Language reflection (24/7, just in time delivery,
  road rage, air rage, burnout)
• Work-life balance
• Live life to the fullest

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Reality

• Global economy
• Aging population
• Downsizing
• Constant change
• Job Insecurity
• Part time and contract work
• Multicultural workplace
• Moving away from a manufacturing base to a
  digital service economy
• Travel
• Media if it bleeds it leads

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Workplace Change

• Nine to fivers in the minority
• One in three Canadians worked in a permanent
  full-time 9-5
• Shiftwork on the rise
• 3.5 million workers (32). One third of
  shiftworkers are parents of children under 16
• Overtime work prevalent
• 1.9 million (17) worked overtime in 1997. More
  than half were not compensated

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Karoushi
Sudden death due to overwork!
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Repairs
Garden
Volunteer
Pets
Home
children
Community
Church
spouse
Family
extended
Education
Hobbies
Work
Self
Exercise
Union
Nutrition
Health Safety
Sleep
committees
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What is Stress?
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What is Stress?

• Negative stress
• Stress can be negative-work deadlines
• Physical, mental, emotional illnesses-rising
• 1 out of every 2 Canadians over 30-stressed
  frequently
• 51 Canadians say work is a contributing cause
• In Canada, employee absence costs 8.6
  billion/year
• Its hard to be competitive when you have a
  stressed out workforce
• (Linda Duxbury)
• The Health Communication Unit of the Centre for
  Health Promotion, University of Toronto

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What is Stress?

• Stress can be positive-promotion
• Tolerable levels of stress are stimulating
• Mental and nervous disorders- top conditions
• (used to be musculoskeletal)
• The World Health Organization concerned re
  increase in stress related problems

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What is Stress?

• Internal Personal Stressors
• Confidence, self acceptance levels
• Trust issues
• Health and disability problems

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What is Stress?

• External Personal Factors
• Job stability or change
• Economy, finances
• Threat of war ot terrorism
• Family and personal relationships
• Divorce or separations
• Death of family or friends

• Change of location
• Shifts in responsibility
• Problems related to travel to and from work
• Boredom

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What is Stress?

• Two Types of Stress
• Short Term (acute)
• -immediate reaction fight or flight
• -any situation that is perceived as alarming
• Note once acute response has passed-response
  inactivated relaxation
  response occurs

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Yipes!!!
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Oh No!!!
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Physiologic Response to Stress
Physiologic Response to Stress

• Acute threat
• Systems ready jet taking off
• Brain
• Lungs
• Heart
• Muscles

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Body Response
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Health Effects
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Heart
Increased heart rate
Increased blood pressure
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LUNGS
Increased respiratory rate
Increased oxygen uptake
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Spleen and Blood Flow
Spleen discharges red and white blood
cells allowing more oxygen and inflammatory cells
Blood flow increases 300-400
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Immune System
Defense system readied!
Steroid hormones dampen parts of the immune
system
White blood cells and infection fighters are
redistributed
Sent to skin, bone marrow and lymph nodes
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Rest of Body

• Mouth and Throat
• Fluids are diverted from the mouth
• Dryness and difficulty in talking
• Spasms of the throat muscles
• Difficulty in swallowing
• Skin
• Diverts blood flow from skin
• Cool, clammy and sweaty skin
• Scalp tightens hair sticks up
• Metabolic response
• Shuts down digestive activity

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Relaxation Response Resolution of Acute Stress
Stress hormones return to normal.
Bodys systems normalize.
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What is Stress?

• Long Term (chronic)
• -If stressful situations continue, fight or
  flight suppressed
• -common stressors ongoing high pressured work,
  loneliness,
• long term relationship problems, persistent
  financial worries

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Stress Related Conditions Negative Health
Effects

• Accumulation of persistent negative situations
• High pressured work and unhappy relationship
• Persistent stress
• An inefficient or insufficient relaxation
  response
• Acute stress in people with serious illnesses.

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Health Consequences of Stress

• Psychological Effects
• Heart Disease
• Stroke
• Susceptibility to infections
• Immune Disorders
• Sexual and reproductive dysfunction

• Cancer
• Gastrointestinal Problems
• Eating Problems
• Diabetes
• Pain
• Sleep disorders
• Memory concentration and learning

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Psychological Effects
Two thirds of subjects who suffered a stressful
situation had six times the risk of developing
depression within a month of the stressful event.
Disrupts levels of serotonin nerve chemical for
feelings of well being.
Stress diminishes quality of life reducing
feelings of accomplishment and pleasure
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Heart Disease
Controversial
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Heart Disease

• Arteries constrict reducing blood flow to heart
• Alter heart rhythms
• Blood becomes stickier - clots
• Impairs clearance of fat molecules
• raised blood cholesterol
• Reduce estrogen levels

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Stroke
2001 study higher risk of stroke in adult
Caucasian men during times of stress.
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Infections

• Blunt immune response
• Increase risk for infections
• Impair response to immunizations
• Low white blood cell counts
• Vulnerable to colds
• More susceptible to viral activation
• Faster progression of HIV to AIDS

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Gastrointestinal

• Irritable Bowel Syndrome
• Peptic ulcers
• Inflammatory Bowel

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Eating Problems
Weight gain
Weight loss
Eating Disorders
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Sexual and Reproductive Dysfunction

• Sexual function
• Decreased sexual desire
• Inability to achieve orgasm
• Temporary impotence
• Reduced blood flow
• Premenstrual syndrome
• Fertility
• Stops/reduces menstruation
• Effects on Pregnancy
• 50 increase in miscarriage
• Lower birth weights
• Increased prematurity

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Cancer
? Effect on immune function and tumour growth
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Cancer
Other Disorders

• Allergies
• Skin Disorders
• Unexplained hair loss
• Teeth and Gums

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Other Effects
Memory, concentration and learning
Sleep disturbances
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Diabetes
Other Disorders
Development of insulin resistance
Exacerbate existing diabetes
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Substance Abuse
Alcohol affects receptors in the brain that
reduce stress
Nicotene has calming effects in women
People under chronic stress frequently Seek
relief through alcohol and tobacco.
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Workplace Injury
Other Disorders
Stressful working conditions interfere with safe
work practices and set the stage for injuries at
work
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I wake up tired, I go to sleep tired, I dont
seem to have the energy to do much of anything
anymore.
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Early Warning Signs

• Headache
• Sleep disturbance
• Difficulty in concentrating
• Short temper
• Upset stomach
• Job dissatisfaction
• Low morale

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Stress Symptoms

• Frequent illnesses
• Sadness or depression
• Severe mood swings
• Lack of appetite or binge eating
• Poor hygiene
• Isolation from others

• Grinding teeth or clenched jaw
• Muscle aches
• High blood pressure
• Constipation/diarrhea
• Backaches
• Tiredness
• Slow decision making

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Post Traumatic Stress Disorder
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Recognition of Stress is a 21st Century Phenomenon
Occupational stress is being seen as the next
big thing in high cost civil liabilities or
the back pain of the 21st century.
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Other Disorders
Cost of Stress
Health care expenditures are nearly 50 greater
for workers who report high levels of
stress Journal of Occupational and Environmental
Medicine
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Workplace Stress

• What is Workplace Stress
• NIOSH harmful physical, emotional responses when
  job doesnt match the capabilities, resources or
  needs of worker
• Job stress can lead to poor health and injury
• 2/3 of Canadians employed
• Spend 60 of hours awake at work
• Cowan, D. Power to the Healthy Employee Health
  and Productivity, March 1998

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Workplace Stress

• Increasing evidence-work affects health- mental
  hazards
• Threats to mental healththreats to physical
  safetydistraction
• Workplace stress and related illness- 5
  billion/yr.
• Working conditions- certain conditions stressful
  to most-shift
• Health Canada, 2000- toxic stress in the
  workplace-paramount health and safety issue in
  Canada
• Shain, Dr M. Best Advice on Stress Risk
  Management in Workplace
• The Canadian Mental Health Association

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Workplace Stress

• Factors that contribute to Workplace Stress
• Work Design
• Management style
• Interpersonal Relationships
• Work/Union Roles
• Work/Life Balance
• Job Concerns

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Workplace Stress

• Work Design
• Noise
• Heavy workload
• Infrequent rest breaks
• Long work hours
• Shift work
• Crowding

• Second hand smoke
• Cold/hot temperatures
• Organic solvents/fumes/vapours
• Equipment/tools not maintained
• Inadequate lighting
• Lack of ergonomic input

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Workplace Stress

• Management Style
• Lack of worker input into decisions
• Poor organizational communication
• Lack of family friendly policies
• Lack of management support
• Supervisors non-supportive of work related
  concerns

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Workplace Stress

• Interpersonal Relationships
• Poor social environment
• Lack of support or help from coworkers and
  supervisors
• Lack of acceptance of injured workers

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Workplace Stress

• Interpersonal Relationships Contd
• Harassment Issues
• Age
• Being male
• Being female
• Race, colour, ethnic origin
• Marital or family status
• Sexual orientation

• Same sex partner status
• Disability
• Religious beliefs
• Verbal/Physical threats
• Bullying
• Conviction for which a pardon has been granted

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Workplace Stress
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Workplace Stress

• Work/Union Roles
• Lack of appropriate training
• Contradictory instructions from supervisor
• Answering to more than 1 supervisor
• Lack of support from management
• Lack of control

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Workplace Stress

• Work/Life Balance
• Pregnancy
• Birth of a family member
• Serious personal injury or illness
• Single parenting
• Caring for elderly/ compromised
• family member/friend
• Too many hats to wear

• Relocation of home
• Change in finances
• Substance abuse among family members
• Separation/divorce
• Upcoming retirement
• Death of a family member

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Workplace Stress

• Job Concerns
• New hires
• New processes that require training
• Automation
• New products
• Plant closure
• Lack of opportunity for
• growth and advancement

• Lay off
• Takeovers
• Job out sourcing, contracting in or out
• Speed up and/work intensification
• Globalization

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Workplace Stress

• The Heart and Stroke Foundation says the top 5
  causes of workplace Stress are
• 1. Unfair bosses-study-unfair boss-higher blood
  pressure
• 2. Low man on the totem pole-study-3x more likely
  to develop heart disease than administrators
• 3. Shift Work-higher risk for heart disease, high
  blood pressure (BP), gastrointestinal disorders,
  report high levels of job stress
• 4. Lack of Appreciation-study-work not
  appreciated, 2x as likely to develop
• heart disease or stroke
• 5. Unhealthy behaviour- anger on the
  job-increased heart rate and BP
• can increase chance of having heart attack

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Workplace Stress
What are the costs to Employers? Direct Costs
WSIB, disability, medication Indirect Costs
absenteeism, replacement labour, equipment
damage Opportunity Costs lost innovation,
decreased productivity and quality The
Health Communication Network for Health
Promotion, University of Toronto
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• Men who increased work hours had
• More than twice the odds of experiencing an
  unhealthy weight gain
• More than twice the odds of increasing daily
  smoking
• Women who increased work hours had
• More than twice the odds of increasing alcohol
  consumption
• More than four times the odds of increasing daily
  smoking
• More than twice the odds of having experienced a
  major depressive episode in the twelve months
  prior to being surveyed

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We love to work Because work gives us Genuine
happiness the Posing and solving of Problems,
the joyful exercise Of imagination Joyce Carol
Oates
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Stress, Health and Productivity
Characteristics of Healthy Organizations
Recognition of employees for good work performance
Opportunities for career development
Organizational culture that values the individual
worker
Management actions that are consistent with
organizational values
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What can be done about job stress?

• Stress Management
• Educate about nature and sources of stress
• Effects of stress on health
• Personal skills
• EAP
• Organizational change
• Identification of stressful aspects of work
  (excessive workload)
• Design strategies to reduce or eliminate the
  identified stressors

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Organizational Factors That Produce Stress

• Work overload or underload
• Role uncertainty and job conflicts
• Responsibility for others
• Isolation
• Job dissatisfaction
• Job insecurity

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How to Change the Organization to Prevent Job
Stress

• Recognize that stress is a workplace issue
• Ensure that the workload is in line with the
  workers capabilities and resources
• Design jobs to have meaning, stimulation and
  opportunities for workers to use their skills
• Clearly define workers roles and
  responsibilities
• Give workers opportunities to participate in
  decisions and actions affecting their jobs

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Job Stress Prevention What is Needed

• Build general awareness about job stress (causes,
  costs and controls)
• Secure top management commitment and support the
  program
• Incorporate employee input and involvement in all
  phases of the program
• Establish the technical capacity to conduct the
  program (specialized training for in house staff

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How to Change the Organization to Prevent Job
Stress

• Improve communications
• Provide opportunities for social interactions
  among workers
• Establish work schedules that are compatible with
  demands and responsibilities outside the job

American Psychologist
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Steps Toward Prevention

• Step 1 Identify the Problem
• Step 2 Design and Implement Interventions
• Step 3 Evaluate the Interventions

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Step 1 Identify the Problem

• Hold group discussions with employees
• Design an employee survey
• Measure employee perceptions of job conditions,
  stress, health and satisfaction
• Collect objective data
• Analyze data to identify problem locations and
  stressful job conditions

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Step 2 Design and Implement Interventions

• Target source of stress for change
• Propose and prioritize intervention strategies
• Communicate planned interventions to employees
• Implement interventions

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Step 3 Evaluate the Interventions

• Conduct both short and long-term evaluations
• Measure employee perceptions of job conditions,
  stress, health and satisfaction
• Include objective measures
• Refine the intervention strategy and return to
  step 1

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Personal Solutions to Stress

• Take Care of Yourself
• Get enough sleep
• Eat 3-6 small well-balanced meals /day
• e.g. whole grains, fruit and veggies
• Cut down on fats and increase fibre
• Drink 6-8 glasses of water/day
• Learn to Say No
• Have a health check-up

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Personal Solutions to Stress

• Take Care of Yourself Contd
• Set realistic Goals
• Stop Smoking
• If overweight, talk to health care provider about
  weight control
• Exercise, Exercise e.g. brisk walking 20-30
  minutes 3x/week, swimming, yoga, tai chi (tones
  and strengthen muscles while relaxing, deep
  breathing and meditating)
• Benefit elevates mood, improves concentration
  and ability to focus

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Personal Solutions to Stress

• Take Time for Yourself
• Set aside time each day for relaxation
• Take long weekends and vacations
• If stress at home, plan 1-2 hours away each week
• Listen to music-study 2001-students listened to
  classical music during stressful task and
  decreased anxiety, heart rate and blood pressure
  (BP)
• Own a pet-study 2001-pet owners decreased BP v.
  non-pet owners
• Join an interest group e.g. hobby, sport, social
  activity

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Personal Solutions to Stress

• Build Good Relationships
• Make time for family and friends
• Give and accept support
• Volunteer in your community
• Find strength in numbers-share with others who
  have experienced the same issues

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Personal Solutions to Stress

• Coping Strategies
• Have a positive attitude, keep perspective
• Humour- research very effective in coping with
  stress
• Vent feelings to a trusting individual
• Dont roll troubles into a large one- break it
  down
• Be willing to resolve-dont hold anger
• Dont worry about things you cant control

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Personal Solutions to Stress

• A Step by Step Approach
• See the stress for what it is
• Think about how to deal with it most effectively
• Recognize the possibilities of resolutionpersonal
  and management
• Deal with anger
• Improve self assertion, discussion with
  supervisors
• Improve knowledge and skills to cope better

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Personal Solutions to Stress

• Step by Step Approach Contd
• Set up personal contacts for communication
• Re-evaluate present situation
• Continue physical activity/healthy way of life
• Learn to focus on positive outcomes
• If job too difficult-plan and make career change
• Seek professional help when needed

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Personal Solutions

• Relaxation Techniques
• Deep breathing- during stress breathing is
  shallow and rapid
• -practice 10 seconds in, 10 seconds out x 5
  rotations
• Muscle Relaxation
• Meditation
• Massage therapy

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Personal Solutions

• Muscle Relaxation Exercise
• Tense each muscle as tightly as possible
• Release completely
• Breathe in for a count of 10 and the out for 10

• Neck
• Shoulders
• Arms
• Hands

• Fingers
• Chest
• Belly
• Abdomen

• Thighs
• Calves
• Feet

• Forehead
• Ears
• Eyes
• Mouth

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Stretch
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Summary
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Resources
Canadian Centre for Occupational Health and
Safety www.ccohs.ca Canadian Mental Health
Association (CMHA) www.cmha.ca Canadian Health
Network (CHN) www.canadian-health-network.ca He
alth Canada www.hc-sc.gc.ca Heart and Stroke
Foundation www.heartandstroke.ca National
Institute for Occupational Health and Safety
(NIOSH) www.cdc.gov/niosh
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Resources
Occupational Health Clinics for Ontario Workers
Inc. (OHCOW) www.ohcow.on.ca Workers Health
and Safety Centre (WHSC) www.whsc.on.ca Local
Resources Canadian Mental Health Association
255-7440 Occupational Health Clinics for Ontario
Workers Inc. 973-4800 Sandwich Community Health
Centre 258-6002 Windsor Essex County Health
Unit 258-2416
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Whether you believe you can or cant, youre
right. Henry Ford
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People spend most of their lives worrying about
things that never happen. Moliere.
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What you can do is only limited by what you can
dream. Dick Rutan, Voyager Pilot
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For peace of mind, resign as general manager of
the universe. Larry Eisenberg
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He who deliberates fully before taking a step
will spend his entire life on one leg. Chinese
proberb
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We can outrun the wind and the storm, but we
cannot outrun the demon of hurry. John Jensen
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A smile is a light on your face that lets people
know your heart is home
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Count your joys instead of your woes Count your
friends instead of your foes Irish proverb
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Those who dream by day are cognizant of many
things which escape those who dream only by
night. Edgar Allan Poe