Discusses the challenges of grief and traumatic stress injury using the case of the combat medic as an example of resilience despite the sadness and confusion in the shadows of war.
La presentazione usata nel webinar dedicato alle novità del CSS introdotte con i nuovi moduli. All'interno della presentazione trovi tutte le specifiche CSS che ci mostrano la compatibilità con i browser moderni!
Puoi vedere la registrazione della LIVE a questo link: http://skillsandmore.org/futuro-css/
Like it or not, social media has changed the way you do business.
If you don’t adapt, you will find your business obsolete.
While it appears businesses are using social media marketing, it’s evident the return still isn’t there.
In a recent study by Aberdeen, it was found that 84% of marketers use social media, yet 28% say that lack of a strategy is their barrier to monetization.
So, how can your business push past that barrier and supercharge social media efforts?
Steps to effectively monetize your social media efforts!
Pinterest is a visual discovery tool that people use to collect ideas for their different projects and interests. People create and share collections (called “boards”) of visual bookmarks (called “Pins”) that they use to do things like plan trips and projects, organize events or save articles and recipes.
"Reintegrating Returning Warriors and The Subtleties of PTSD: Practice, Research and Policy"
by Col Jeffrey Yarvis, Chief of Soldier Behavioral Health Service, Carl R. Darnall Army Medical Center, Washington DC
question 1The goal of the Six Sigma program is to achieve a leve.docxIRESH3
question 1
The goal of the Six Sigma program is to achieve a level of quality that is as close to perfection as possible. Sigma is actually a statistical term used to gauge how far a process deviates from perfection. Explain how the disciplines within Six Sigma can improve hospital efficiency and hospital profitability?
question 2
What is your personal definition of continuous quality improvement? How would you relate this definition to operations in a health care organization? How do we try to build new methods of practicing based on profound knowledge, most of which already is tacit in the organization, as well as the new knowledge that the CQI process generates?
question 3
What is the value of supply chain management? How does supply chain management impact the financial position of an organization?
question 4
Why would an organization need to measure the capacity (throughput) of the various resources (x-ray equipment, exam rooms, length of stay, etc.)? How does capacity management support decision-making?
Assignment 1
For this assignment, you are required to write a research paper (4-6 pages) on methods of quality measurement. Your paper must include the following:
1) Detailed summary of at least two different methods of quality measurement.
2) Examples of how the methods may be used to improve organizational effectiveness.
3) Evaluation of the methods.
4) At least four references.
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
Assignment 2
For this assignment, you are required to write a reflection and self-evaluation of your understanding of health care business analyses. Your assignment should include a discussion of the following:
1) A summary of your understanding of health care business analyses: In your own words, why is it important? What does it entail?
2) What was the most significant concept you learned during the course? How did the course assignments assist in your understanding of this concept?
3) What questions do you still have about health care business analyses? Was there anything else you were expecting to learn that the course did not cover?
4) How would you rate your overall understanding of health care business analyses? What steps do you plan on taking to increase your knowledge and understanding?
PTSD
Post-traumatic stress disorder (PTSD) is a biopsychological condition associated with very stressful or life-threatening events such as abuse, rape, violence, military combat, severe accidents, and natural disasters. Symptoms include having intrusive thoughts about or reliving the event(s), withdrawing from others, and experiencing anxiety or hyperarousal for weeks or months following the event(s). People with PTSD may turn to drugs or alcohol to help them cope, they may exhibit signs of depression, their relationships may deteriorate, and they may manifest physical symptoms.
PTSD has been studied intensiv ...
PPT I created for a group presentation in my SOWK 503 Human Behavior course regarding article on the relation between combat-related trauma experience and male ego development, in addition to the impact of trauma on employment, marital and legal behavior.
THE UNIVERSITY OF MEMPHIS POST TRAUMATIC STRESS DISORDER.docxchristalgrieg
THE UNIVERSITY OF MEMPHIS
POST TRAUMATIC STRESS
DISORDER
EARLY INTERVENTION FOR OUR SOLDIERS
LESLIE JAYROE
4/25/2011
HPRO 7720
Post Traumatic Stress Disorder and Our Soldiers- Providing Earlier Intervention
History
There is a significant amount of information out there on post traumatic stress disorder and the
military, and this is mostly due to the fact that our combat soldiers were the ones observed over
time to determine the effects war has had on them. Post traumatic stress disorder (PTSD) can
be thought of as a "young" diagnosis. PTSD has been around for centuries, but it was n~t until
1980 that it was made an official disorder. However, throughout history, people have
recognized that exposure to combat situations can have an intensely negative impact on the
people who are involved in these situations. (Mathew Tull, 2009) PTSD has previously been
described ia-410J e ~s "combat fatigue," "shell shock," or "war neurosis," and is defined by the
American Psychiatric Association as an anxiety (emotional) disorder which stems from a
particular incident evoking significant stress. (Bentley, 2005) PTSD is not limited to combat
soldiers but can also be found among survivors of the Holocaust, of car accidents, of sexual
assaults, and of other traumatic experiences. War has always had a severe psychological effect
on people, and with the war our country is currently in, more and more of our soldiers are
suffering from PTSD. After a traumatic experience, the mind and the body are in shock, but as
the victim makes sense of what happened and processes his/her emotions, healing takes place
leading toward normal function once again. With PTSD, one remains in psychological shock.
The memory of what happened and their feelings about it are disconnected. In order to move
on, it's important to face and feel those memories and emotions. One effective approach is
through counseling. (Mathew Tull, 2009)
The symptoms of PTSD can occur all of a sudden, progressively, come and go over time, or
appear out of nowhere. Sometimes, symptoms are triggered by something that reminds a
31 Page
person of the original traumatic event, such as a noise, an image, certain words, or a smell.
While everyone experiences PTSD differently, there are three main types of symptoms:
(Bentley, 2005)
1. Re-experiencing the traumatic event
2. Avoiding reminders of the trauma
3. Increased anxiety and emotional arousal
According to the Graffiti of War Project, in 2007, the number of diagnosed cases in the military
jumped 50%. One in every five military personnel returning from Iraq and Afghanistan has
PTSD, and 20% of the soldiers who've been deployed since 2001 have PTSD which is over
300,000. More troops are serving their second, third or fourth tours of duty, which dramatically
increases stress according to medical heath experts. Also, extended tour lengths from 12
months to 15 months were done to prov ...
La presentazione usata nel webinar dedicato alle novità del CSS introdotte con i nuovi moduli. All'interno della presentazione trovi tutte le specifiche CSS che ci mostrano la compatibilità con i browser moderni!
Puoi vedere la registrazione della LIVE a questo link: http://skillsandmore.org/futuro-css/
Like it or not, social media has changed the way you do business.
If you don’t adapt, you will find your business obsolete.
While it appears businesses are using social media marketing, it’s evident the return still isn’t there.
In a recent study by Aberdeen, it was found that 84% of marketers use social media, yet 28% say that lack of a strategy is their barrier to monetization.
So, how can your business push past that barrier and supercharge social media efforts?
Steps to effectively monetize your social media efforts!
Pinterest is a visual discovery tool that people use to collect ideas for their different projects and interests. People create and share collections (called “boards”) of visual bookmarks (called “Pins”) that they use to do things like plan trips and projects, organize events or save articles and recipes.
"Reintegrating Returning Warriors and The Subtleties of PTSD: Practice, Research and Policy"
by Col Jeffrey Yarvis, Chief of Soldier Behavioral Health Service, Carl R. Darnall Army Medical Center, Washington DC
question 1The goal of the Six Sigma program is to achieve a leve.docxIRESH3
question 1
The goal of the Six Sigma program is to achieve a level of quality that is as close to perfection as possible. Sigma is actually a statistical term used to gauge how far a process deviates from perfection. Explain how the disciplines within Six Sigma can improve hospital efficiency and hospital profitability?
question 2
What is your personal definition of continuous quality improvement? How would you relate this definition to operations in a health care organization? How do we try to build new methods of practicing based on profound knowledge, most of which already is tacit in the organization, as well as the new knowledge that the CQI process generates?
question 3
What is the value of supply chain management? How does supply chain management impact the financial position of an organization?
question 4
Why would an organization need to measure the capacity (throughput) of the various resources (x-ray equipment, exam rooms, length of stay, etc.)? How does capacity management support decision-making?
Assignment 1
For this assignment, you are required to write a research paper (4-6 pages) on methods of quality measurement. Your paper must include the following:
1) Detailed summary of at least two different methods of quality measurement.
2) Examples of how the methods may be used to improve organizational effectiveness.
3) Evaluation of the methods.
4) At least four references.
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
Assignment 2
For this assignment, you are required to write a reflection and self-evaluation of your understanding of health care business analyses. Your assignment should include a discussion of the following:
1) A summary of your understanding of health care business analyses: In your own words, why is it important? What does it entail?
2) What was the most significant concept you learned during the course? How did the course assignments assist in your understanding of this concept?
3) What questions do you still have about health care business analyses? Was there anything else you were expecting to learn that the course did not cover?
4) How would you rate your overall understanding of health care business analyses? What steps do you plan on taking to increase your knowledge and understanding?
PTSD
Post-traumatic stress disorder (PTSD) is a biopsychological condition associated with very stressful or life-threatening events such as abuse, rape, violence, military combat, severe accidents, and natural disasters. Symptoms include having intrusive thoughts about or reliving the event(s), withdrawing from others, and experiencing anxiety or hyperarousal for weeks or months following the event(s). People with PTSD may turn to drugs or alcohol to help them cope, they may exhibit signs of depression, their relationships may deteriorate, and they may manifest physical symptoms.
PTSD has been studied intensiv ...
PPT I created for a group presentation in my SOWK 503 Human Behavior course regarding article on the relation between combat-related trauma experience and male ego development, in addition to the impact of trauma on employment, marital and legal behavior.
THE UNIVERSITY OF MEMPHIS POST TRAUMATIC STRESS DISORDER.docxchristalgrieg
THE UNIVERSITY OF MEMPHIS
POST TRAUMATIC STRESS
DISORDER
EARLY INTERVENTION FOR OUR SOLDIERS
LESLIE JAYROE
4/25/2011
HPRO 7720
Post Traumatic Stress Disorder and Our Soldiers- Providing Earlier Intervention
History
There is a significant amount of information out there on post traumatic stress disorder and the
military, and this is mostly due to the fact that our combat soldiers were the ones observed over
time to determine the effects war has had on them. Post traumatic stress disorder (PTSD) can
be thought of as a "young" diagnosis. PTSD has been around for centuries, but it was n~t until
1980 that it was made an official disorder. However, throughout history, people have
recognized that exposure to combat situations can have an intensely negative impact on the
people who are involved in these situations. (Mathew Tull, 2009) PTSD has previously been
described ia-410J e ~s "combat fatigue," "shell shock," or "war neurosis," and is defined by the
American Psychiatric Association as an anxiety (emotional) disorder which stems from a
particular incident evoking significant stress. (Bentley, 2005) PTSD is not limited to combat
soldiers but can also be found among survivors of the Holocaust, of car accidents, of sexual
assaults, and of other traumatic experiences. War has always had a severe psychological effect
on people, and with the war our country is currently in, more and more of our soldiers are
suffering from PTSD. After a traumatic experience, the mind and the body are in shock, but as
the victim makes sense of what happened and processes his/her emotions, healing takes place
leading toward normal function once again. With PTSD, one remains in psychological shock.
The memory of what happened and their feelings about it are disconnected. In order to move
on, it's important to face and feel those memories and emotions. One effective approach is
through counseling. (Mathew Tull, 2009)
The symptoms of PTSD can occur all of a sudden, progressively, come and go over time, or
appear out of nowhere. Sometimes, symptoms are triggered by something that reminds a
31 Page
person of the original traumatic event, such as a noise, an image, certain words, or a smell.
While everyone experiences PTSD differently, there are three main types of symptoms:
(Bentley, 2005)
1. Re-experiencing the traumatic event
2. Avoiding reminders of the trauma
3. Increased anxiety and emotional arousal
According to the Graffiti of War Project, in 2007, the number of diagnosed cases in the military
jumped 50%. One in every five military personnel returning from Iraq and Afghanistan has
PTSD, and 20% of the soldiers who've been deployed since 2001 have PTSD which is over
300,000. More troops are serving their second, third or fourth tours of duty, which dramatically
increases stress according to medical heath experts. Also, extended tour lengths from 12
months to 15 months were done to prov ...
Combatting Stigma: Encouraging Help Seeking in Soldiers | Solh WellnessSolh Wellness
Solh Wellness is breaking the stigma surrounding mental health, and promoting the importance of seeking help among soldiers. Read Help Seeking Practical Steps.
How treating psychological and social needs can improve the daily lives of the chronically ill, creating a new model for outpatient care, quality of life and aging, humanization of care, streamlining responsibilities of hospital staff and news around the world.
Dr. Figley shares his perspective on developing greater resilience capacity by focusing on building up the five capabilities of resilience; something that can be done before trauma strikes.
This is a Tulane University presentation sponsored by the Traumatology Institute: Treating traumatic stress injuries by Mark Russell, PhD (Antioch University of Seattle) and Charles Figley (Tulane University) that will be delivered Friday, April 5th in New Orleans.
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Drug Discovery and Development .....NEHA GUPTA
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Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
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Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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Ocv nola may2012_final-pdf
1. Charles R. Figley, Ph.D.
Tulane University Kurzweg Chair in
Disaster Mental Health
2. Presentation Dedication
This presentation is dedicated to the
thousands of combat medics who
served their country and must anticipate
and adopt to the deaths of all their
clients the rest of their lives
3. Acknowledgements
! Ted Rynearson and his team for choosing Tulane and
New Orleans for this training conference
! Dean Ron Marks and the Tulane University School of
Social for their support of this conference and my work
represented here
5. Purpose of the Presentation
Suggest that since combat medics
are among the most resilient in
adopting to violent death in combat
what may be the reasons and what
can we learn from them.
6. Objectives
After this presentation, participants will:
1. Be more familiar with the special circumstances of
modern combat medics as caregivers vulnerable
including the same challenges all caregivers face.
2. Be familiar with the combat stress injury model and the
four types of injuries including a grief/loss injury.
7. Objectives (cont.)
After this presentation, participants will:
3. appreciate the connection emotionally and socially
between what combat medics do and the importance of
building secondary stress resilience capacity
4. understand and apply knowledge about the "Spectrum
of Compassion Response as an indicator of the level
of thriving as human beings
8. Thesis
! Combat medics adapt to violent death by focusing on
their job, apart from the emotional reactivity
experienced by non-medic soldiers
! Thus, combat medics adapt to violent death through
effective self regulation that includes focusing on the
mechanics of their job as caregivers.
! Medics avoid stress injuries by a set of strategies that
include displays of leadership, soldiering, and medical
care.
9. Studies of combat vets
responses to death
! 1. Death was a central and profound experience for
vets the studied
! 2. Pre-military service predicts, like personality,
religious atmosphere at home, and contact with death,
reactions
! 3. Investment in life – family, life generally, and
education – increase death anxiety.
10. Other factors that influence
death anxiety
! Stress management generally manages any anxiety
! Strategic use of denial, desensitization, and
compartmentalization to manage death anxiety
! The value of life increases with each exposure to death
! Being near death is most often traumatizing but offers
important lessons that can make it worth it (Posttraumatic Growth)
11. Similarities of Disaster and War
Deployment
Characteristics
War
Deployment
Disaster
Deployment
Lots of Training Preparation
X
X
Away from home and family
X
X
Exposed to a range of
traumatic stressors
X
X
Work long hours in difficult
conditions for an extended
period
X
X
Expectations are to withhold
self care and endure the
conditions
X
X
Varying levels of danger and
uncertainty, and periods of
X
X
12. Who are Medics and
Navy Corpsmen?
1. Revered military role in all service branches
2. Critical to combat operations
3. Responsible for treating wounded Soldiers
and allies civilians and enemy combatants
4. Potentially conflicting Dual Role (Soldier/
Medic)
13. Combat Medics (cont.)
5. No studies specifically on combat medics
6. Focus on resilience or combat mettle to
enable them to survive and thrive mentally
and physically
14. Combat Medics
! Required to fight battles
! provide front line trauma care, often in the heat
of a battle, with limited resources and under
enormous stress.
! In modern warfare, however, they must be able
to transition from a soldier role to a medic role
quickly and decisively in accordance with the
tactical situation and rules of engagement.
15. Combat Medics
! They must not only understand the nature of war,
but also the nature of war-related injuries and
! the implications for medical procedures that will
be effective given the tactical environment,
current location, resources available, and
capabilities.
! must not only cope with the emotional burden
medic duties but also must be prepared to die and
to participate in a killing (Mazurek and Burgess,
2006)
16. Combat Medics
! All this plus endure war in the middle east
! changing rules of engagement,
! the stop loss and other war service-related rules
and regulations,
! The media limited slants on the wars efforts,
17. Combat Medics
! the changing and increasing deployment
schedule that prevents sufficient down time to
reach a healthy re-boot and
! more prepared psychologically for the next
deployment, and many other realities of these
post-9-11 wars.
18. From the Combat Medic s Prayer
! If I am called to the battlefield, give me the courage to
conserve and protect our fighting forces by providing
medical care to all that are in need.
! If I am called to a mission of peace and mercy, give me
the strength to lead by caring for those who need my
assistance.
! Finally, Lord give me the strength and insight to take
care of my own spiritual, physical, and emotional
needs.
19. Combat Medic Mettle: Our teams focus
! Dictionary definition of mettle: vigor and strength of
spirit or temperament
! Having “medic mettle” means possessing the right stuff to
adapt and thrive as a leader, healer, soldier, and person.
! Ours is part of a larger group conducting a longitudinal
survey of 848 combat medics in two continents since late
2009.
! This is our final year of the 3-year study.
21. Preliminary Findings
! First study to confirm medics
experience secondary trauma, like
other medical health care providers.
! Though witnessing significantly
more combat stress, medics scored
better in behavioral health measures
24. Getting Behind the
Statistics
! The Tulane Research Team was responsible for the
qualitative elements of the three-year study
! Our team conducted intensive video interviews with
17 named by the group as the best representation of
combat mettle.
! The first measure of CMM that will help build a model
of combat medic mettle that will assist us in measuring
the essence of what is required to thrive.
26. Purpose of the Interviews
! First identify key truisms about combat medics
that may contribute to medic mettle.
! Second, convert these observations into items
in the first draft of a Medic Mettle Scale
! Third, administer the scale to all 848 combat
medics and investigate the predictive power of
the Scale in predicting behavioral health
markers.
29. VGA Procedure for each
Video Interview using Quick
Time (video) Markers
Primary
Reviewer
Secondary
Reviewer
Tertiary
Reviewer
30. Example of Reviewer
Assignments for VGA Analysis
Subject # A Reviewer
B Reviewer C Reviewer
1
2
3
4
5
Secondary
Tertiary
Primary
Secondary
Tertiary
Primary
Secondary
Tertiary
Primary
Secondary
Tertiary
Primary
Secondary
Tertiary
Primary
31. VGA Methodology to
Generate Scale Items
Identify items for the scale that may be
truisms about being a combat medic:
! Personal experiences and observations
! Methods of coping with adversity and
change
! Words to live by in coping and resilience
32. Variable Generating
Activity s Five Variable
Domains
P te tiv
ro c e
F c rs
a to
(P )
F
9
B h v ra
e a io l
Ha
e lth
In ic to s
d a r
(B )
H
8
1
0
2
S so
tre s rs
(S
)
6
3
5
7
1
4
In rv n n
te e tio s
(I)
C lla ra
o te l
Ss m
y te ic
Im a t
pc
(C )
S
33. Video Data Analysis: Video
Generating Activity (VGA)
Assign Data
Analysis Roles
VGA
138-item Scale
35. COMBAT MEDIC
METTLE SCALE (v1)
Instructions:
! Thanks for helping medics. This Scale is composed of statements
by active duty medics interviewed in 2010 near their base.
! The purpose of the Scale is to help understand military resilience
and how to help combat medics be as resilient as possible in their
important work. The Scale is divided into four, color-coded
sections (Leadership, Personal Beliefs/Experiences, Technical
Skill/Medical Training, and Soldiering Skill/Training) that
represent medic skills sets.
36. COMBAT MEDIC
METTLE SCALE (v1)
Instructions (cont.):
! Please consider each statement as it applies to you and your
opinions and rate how the statement describes you during the last
week by selecting one of 4 options:
! 0= Not like me or NA; 1= Sort of like me; 2= Like me;
3=Very much like me; 4= That s totally me
38. Example of PERSONAL
BELIEF/EXPERIENCE Items
*%+,-
.$/0'
PERSONAL BELIEF/EXPERIENCE
27. I like to keep my mind occupied.
28. have taken prescription drugs to help with sleep but
they had no effect.
29. I have taken prescription drugs to help with sleep
and they worked well.
39. Examples of Technical/
Medical Training Items
*%+,-
.$/0'
PERSONAL BELIEF/EXPERIENCE
69. I value being called doc. .
70. I maintain a strong relationship with my chaplain.
71. My training helps me overcome any fears.
40. Examples of Soldiering Skills/
Training Items
*%+,-
.$/0'
SOLDIERING SKILL/TRAINING
92. I work hard, train hard, and am prepared.
93. I believe that my soldiers are like family to me.
94. I allow negative events to affect me.
42. Medic Mettle v2
! Strong psychometric properties
! Correlated with measures of
readiness, self confidence, resilience,
thriving
! Help build the statistics model of
medic resilience (mettle)
43. 9. Combat Stress Injuries and
Resilience
The following figure was
originally developed to identify
the process by which combatstress injuries could be predicted
and prevented.
44. 9. Combat Stress Resilience
Most deployed do well in both the short and
long-term.
However, some develop some form of
psychosocial stress injuries that require
attention.
The following describes a roadmap for
appreciating the psychosocial variables in
predicting the stressors and stress reactions
during deployments.
45. "&!
TRAIT RESILIENCE FACTORS
" Intelligence
" Trait Resilience (ER-89)
" Stress Adaptation Competence
" Self Confidence and Self
Confidence
Occupational Hazards
" Individual Demands
" Unit Demands
" Environmental Demands
" Family Demands
Trauma-RELATED STRESS INJURIES
AND RESILIENCES
" Physical Fatigue Injury and Resilience
" Grief Injury and Resilience
" Belief Injury and Resilience
" Trauma Injury and Resilience
5$%$/!*/'8&8/,9/!:;<#$/9+=/>!
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CD8&BE!
" "<D'$!8,!$F/!G,8$!
" "<%D0%+9!G,8$!H#F/'8#,!
" H#,$/I$@C%'/B!5$</''@!!
</BD98,-!H#0;/$/,98/'!
WORKER STRESS REACTIONS
" Biological Markers
" Psychological Markers
" Social Relationship Markers
" Behavioral Markers
" Spiritual Markers
Stress Injuries and
Resilience of Disaster
48. Occupational Hazards/Stressors
" Individual Demands – e.g., physical
" Unit Demands – e.g., frequent
deployments
" Environmental Demands – e.g.,
internal politics, weather
" Family Demands – e.g., pressures to
be home, financial stressors
49. WORKER STRESS REACTION
MARKERS
" Biological Markers – i.e., indicators
of immune suppression
" Psychological Markers -- e.g.
emotional indicators of stress, sleep
dysfunction
AND
50. WORKER STRESS REACTION
MARKERS
" Social Relationship Markers –social
support and colleague care
" Behavioral Markers –job competence
" Spiritual Markers –sense of direction,
hope, and fulfillment
51. Trauma-RELATED STRESS
INJURIES AND RESILIENCE
" Trauma Injury and Resilience – i.e.,
memory management and re-establishing
safety
" Physical Fatigue Injury and Resilience –
i.e., wear and tear
" Belief Injury and Resilience –moral and
ethical challenges
" Grief Injury and Resilience -- adaptation
to loss of person, place, thing
52. Inner Conflict
! Most recent and controversial (guilt, shame that can
lead to suicide)
! Most often due to conflict between moral/ethical
beliefs and
! current experiences such as
! taking action outside of the rules of engagement and
! where there is harm to an innocent life;
! not preventing harm to a buddy.
53. Grief Injury and
Resilience -nner Conflict — or beliefs injury is most often due to
conflict between moral/ethical beliefs and current
experiences such as taking action outside of the rules of
engagement and where there is harm to an innocent life;
not preventing harm to a buddy.
54. Enabling Medics to Recover from
Stress Injuries
! Estimating Functioning
! Using the Spectrum of
Combat Resilience to
determine the level of
functioning.
How do we
know to refer for
professional
help?
55. According to the Spectrum
Model (vs psychopathology)
! It takes a system to coordinate care for those
who require help
! versus those who deserve praise and respect
! without negatively affecting those who are
dysfunctional
! Functioning is defined by the presence of five
capabilities.
56. Combat Medic Functioning:
1. Physically
capable (measured by level of energy due to sleep,
health)
capable (measured by level of
enthusiasm, intellectual capability, morale, spiritual
support)
2. Psychologically
. Interpersonally capable (measured by level of social
3
support and cohesion with group)
4. Technical
and administratively capable (measured by
standard productivity, client satisfaction, and competence
scales)
(Care) Regulation capable (measured by the
existence of an EB self care plan and following it). EB
self care plan (see Greencross.org)
5. Self
57. Spectrum of Caregiver
Stress Resilience
! FIVE LEVELS OF FUNCTIONING
! Useful for caregivers to determine the
effectiveness of their self care plan and
for
! Leaders and role models in stress
resilience
58. Spectrum of Caregiver Resilience
Level 5
Level 4
Level 3
Level 2
Level 1
Highly
Resilient
Resilient
Challenged
Resilience
Supported
Resilience
Failed
Resilience
Exceptional
Role Model
Good
Functioning
Acceptable
Functioning
Unacceptable
Functioning
Dysfunctional
No challenges
in functioning
Challenged in
1 provider
function
Challenged
in 2 functions
Challenged
in 4-5
Functions
Failing in 1
or more
functions
Train and
Coach others
on the team
Maintain
Provide
Coaching and
Peer Support
Explicit Plan
Implemented
for Resilience
Immediate
behavioral
health
services
59. Level 5: Highly Resilient
! Many people are in this category
and are thriving in their career.
! They score high on thriving and
human development
! Tend to score high on trait resilience
and the other protective factors
60. Level 4: Resilient
! Most people are in this category and are
challenged but meet the challenge in their
career.
! They score moderately high on thriving
and human development and on trait
resilience and the other protective factors
! May have one of the five
61. Level 3: Challenged
Resilience
! Many are in this category and
require attention
! Acceptable Functioning
! Challenged in 1-3 Functions
! Provide Coaching and Peer
Support
62. Level 2: Supported
Resilience
# Unacceptable Functioning
# Challenged in 4-5
# Functions
# Explicit Plan Implemented for
Resilience
63. Level 1: Ineffective
Resilience
# Failing Resilience
# Dysfunctional
# Failing in 1 or more functions
# Need aggressive behavioral health services
# Benefit from the MASTERS Transformative
approach to establishing and sustaining an
appropriate self care plan
64. Conclusions
Combat medics are caregivers like social
workers, nurses, child welfare workers,
and others trying to help others
65. Conclusions
Stress and stress regulation are among the
biggest challenges in war and are
vulnerable to stress injuries that may
lead to mental disorders but can also
lead to growth.
66. Conclusion
! Medics and other caregivers secondary
stress reactions must be closely monitored
and given proper positive attention
67. Conclusion (cont.)
# Caregivers should utilize good self care,
practice colleague (buddy) care, and;
# Encourage supervisory support for
caregivers
68. Dedication: To the memory, life, and
contributions of LtCol Dave Cabrera, PhD, killed in
action October 29, 2011
71. The role of leadership in
promoting post-trauma resilience
Leadership characteristics:
! 1. Inspiring: Sense of mission and
history
! 2. Caring: Perceived to have the best
interests of the deployed and the
deployment teams in mind
! AND
72. The role of leadership in promoting
post-trauma resilience (cont.)
! 3. Skilled: Knows operations, experienced in a
variety of disasters and disaster mitigation
! 4. Personable: Knows team members by name
and duties
! 5. Role Model: Others see their efforts at self
care, sense of humor, and being ethical and
humane.