Podcast: Occupational PTSD in nursing and midwifery with Dr Finbar Hopkins

Episode: 44
Guest: Dr Finbar Hopkins.
Duration: 41:35
Tags: : Occupational trauma, PTSD, trauma-informed care, post-traumatic growth, workplace wellbeing
Soundcloud: Listen to Episode 44

Dr Finbar Hopkins is an experienced Wellbeing Consultant who delivers a suite of education and training programs to help a large Melbourne hospital improve the physical and emotional health of their staff. She is a registered nurse, mental health nurse and midwife who is using the wisdom she has gained from 30 years of experience to improve the health and wellbeing of healthcare workers.

She joined the Nurse & Midwife Support podcast to discuss why it’s imperative that employers and colleagues provide trauma-informed care to nurses and midwives who are vulnerable to occupational post-traumatic stress and post-traumatic stress disorder (PTSD).

“Trauma-informed care is an approach to healthcare. It recognizes and responds to the impact of trauma on individuals, and one of the number of things it does is to promote safety, trust and empowerment in the healing process. This approach is used with patients, but it's not only beneficial for patients, but also has a positive effect on the work environment.

It isn't about what is wrong with you. There's a shift in there from what is wrong with you, to what has happened to you. That's kept front and centre. Most team leaders and managers, when they are talking to nurses, they're talking to nurses about creating a physically safe and emotionally safe environment for them, being mindful. If you recently had a trigger, what was happening there? What could we do that could actually support you to feel less aroused, and be able to come to work feeling safe, and feeling that you're working in an environment that really cared for you.”

Finbar also explains some common strategies to manage and recover from PTSD and the concept of post-traumatic growth. Recovery is possible and can transform people’s self-perception.

“Your personal strength is tied in with resilience. People can come to understand, 'I have more courage than I thought I had. I didn't realise that I had this courage.' We saw that in COVID, people saying, "Oh, my goodness, I never thought I could get through that. And here I am!" They have a newfound sense of self and an appreciation of themselves.”

We’re grateful to Finbar for joining us to share her knowledge. We hope you will find this podcast helpful. If you’re struggling and need to talk, Nurse & Midwife Support is here to support you: 1800 667 877 or by email.

About Dr Finbar Hopkins

Dr Finbar Hopkins is employed as a Wellbeing Consultant at a large metropolitan hospital in Melbourne, since 2020. Finbar has over 30 years’ experience in nursing and midwifery as well as in tertiary education. She is a registered nurse, mental health nurse and midwife.

Her professional qualifications include Bachelor of Health Science in Nursing, Graduate Diploma in Women’s Health, MA in Women’s Studies, and Doctor of Philosophy in Nursing.

In her Wellbeing role, she is responsible for delivering a suite of Wellbeing education and training programs, some of which include, Critical Incident Defuse, Checking In training for managers following a critical Incident, Psychological First Aid, Reflective Practice, Peer Support, Compassion Fatigue, Burnout, Mindfulness, Leadership Capacity building for Nursing Managers and allied health Team Leaders to emotionally support their staff.

Since the advent of COVID-19 pandemic, nurses and midwives have experienced unprecedented rates of burnout and high rates of stress.

Finbar has a keen interest in the emotional and psychological cost of caring and on the impact of posttraumatic stress disorder (PTSD) on nurses and midwives. Her work as a Wellbeing Consultant brings her into contact with health care practitioners, many of whom have experienced challenging and critical incidents and require psychological first aid and critical incident defusing. Post-traumatic stress disorder and vicarious trauma are a real threat to the mental health and wellbeing of this group. This has given her a strong understanding of importance of providing immediate emotional support to prevent them developing Post Traumatic Stress Disorder. Her work is also informed by Post Traumatic Growth theory (PTG), to support health care practitioners find personal and professional growth following adversity. Her work is grounded in self-compassion and informed by the concepts of acceptance and commitment therapy.

Elle Brown [0:08] Good afternoon. Welcome to the Nurse & Midwife Support podcast: Your Health Matters. I'm Elle Brown, and I'm the Stakeholder Engagement Coordinator for Nurse & Midwife Support. I am a registered nurse. Nurse & Midwife Support is national, anonymous, confidential and free, available 24/7, and you can call anytime you need support on 1800-667-877, or contact us via the website, nmsupport.org.au.

I would like to begin by acknowledging the traditional custodians of the land on which each of us are listening. I pay my respects to First Nations Elders, past and present. I extend that respect to Aboriginal and Torres Strait Islander peoples listening to this podcast. Sovereignty was never ceded. 

Today I'll be speaking with Dr. Finbar Hopkins. She has over 30 years’ experience as a registered nurse, mental health nurse and midwife. Fin has a keen interest in the emotional and psychological cost of caring and the impact of Post-Traumatic Stress Disorder on nurses and midwives. 

Good afternoon, Fin.

Dr. Finbar Hopkins [1:25] Good afternoon, and thank you for inviting me here to participate in this lovely podcast, and a very timely one too!

Elle Brown [1:38] Fin, would you mind telling us, what is it about the nature of their work that predisposes nurses and midwives to getting PTSD?

Dr. Finbar Hopkins  [1:47] Of course, yes, I will. First I want to acknowledge [that] all nurses, midwives and healthcare practitioners in particular, every one of us has lived experience of some form of mental distress. I'll just preface my words with that. 

But really, when I think about post-traumatic stress, how does that work with nurses and midwives? It's the emotional exposure to traumatic events, because nurses and midwives work in high stress environments, as we know, where they encounter traumatic events regularly. They may also witness injuries, deaths, or other complications during childbirth as well, which can be emotionally overwhelming and lead to PTSD. It's quite complex. 

The other issues as well, such as emotional engagement. If we think about nurses and midwives, very frequently their work is relational. They're deeply involved in providing care to patients and their families. The emotional engagement, of course, comes at a cost, it can make them susceptible to the emotional impact of the work and lead to some of the symptoms of PTSD. 

Another factor could be that they work very long hours. Nurses and midwives working long shifts, that may increase chronic fatigue as well as sleep disturbances, and that can again contribute to the development of PTSD. We also know that hospitals have a history of being very hierarchical and lacking in support because of a lack of understanding, time, busyness, and also emotional support has been traditionally seen as being weak. 

There haven't been opportunities, either, for counselling or EAP Employee Assistance Programs have only started to come to the fore post-COVID. They have been there, but they haven't been taken up very well, because it hasn't been seen as very important, the emotional and mental health care. 

Of course, [that] leads me into the stigma. Asking for help is very stigmatised, or has been, I would say, pre-COVID. In my work now as a wellbeing consultant. I'm seeing nurses and midwives and other health professionals are much more readily coming forward with their mental health concerns. They are looking for support. 

The other thing of course, that can predispose nurses and midwives to PTSD is coping with loss. Often they're experiencing loss of patients, and they're expected to move on to the next patient and get on and you know, just keep going. That attitude is especially in big city areas where they're short staffed, and there isn't much time to stop and think, "Oh, how has this impacted on me?" To tune into themselves. 

Of course, there are workplace stressors. I mean, they're very fast, very dynamic, and especially working in areas like ED, where there's a high rate of patients coming in distressed and not enough beds, piling up like that. Those workplace stressors really do impact. 

The other thing that contributes to the work of nurses and midwives and developing PTSD can be the stage they're at in their career, particularly between the years of one to four years. They can be new and young, and they're quite vulnerable. If they don't get adequate preceptorship or mentorship, that can result in them being more vulnerable to the development of PTSD. We do know that recently there was a report that came out of the New South Wales Nurses' Association, together with the Rosemarie Bryant Foundation from Adelaide. They looked at 2300 nurses, this was in 2022. They found that there was about one in fifteen feeling totally overwhelmed, particularly young career graduates were very vulnerable. That is the mixture of the things that really can predispose people towards PTSD. 

It's important that I stress here that even though with all of those stressors, not all nurses and midwives will develop it. But they will have a natural stress response. If something that they perceive is critical or the impacts on them, a normal stress response will result in the alarm system in their body being triggered. That's the work that the body should be doing. It's saying 'something's not right here, so I'm triggering this alarm for you to check in with yourself and see what's happening.' That's a very healthy, normal response, but that stress response can take a few days, or even up to a week to settle down again. People can feel a bit hypervigilant during that time, but it doesn't mean they have PTSD. That's quite a different trajectory. 

Elle Brown [7:43] I'm asking you [this] because you have a history of being a wellbeing consultant, [because of] your work. How can workplaces, managers and peers help to prevent PTSD? How can they support nurses and midwives with PTSD?

Dr. Finbar Hopkins  [7:59] Post-COVID, I'm really gladdened [by] the way that some of the hospitals that I've been in contact [with] have really started to put in mental health education and training, especially in psychological first aid. It's a short training over a few hours of a day that really helped managers, in particular, and team leaders to be able to check in with their staff. When a critical incident is Code Black or Code Gray's being called, they are able to check in with them in a way that is actually very supporting and caring, and make sure that they are taking them away from the danger, and that they are checking out, they're not looking at [inaudible]. You're saying, "Are you okay, what do you need now? What could I get you? Will you be able to continue this shift? Should you go home? If you need to go home, is there somebody at home? Do we need to call somebody at home? Can I get you a taxi voucher? I will call you and I'll check in on you." 

So becoming much more sensitive and responsive to 'Hey, this is something big that's happened here for us. Let's support each other.' If a hospital has a wellbeing team, the larger hospitals will, but the smaller ones may not have a wellbeing team. There will be psychologists, or there will be other counsellors or pastoral care workers that may be trained to actually do some checking in with people. 

Then of course, EAP, the Employee Assistance Program also is a very useful service. They will do a critical incident defuse, as will some wellbeing team members. They can do that as a group. They can get the nurses together, particularly ones that were directly impacted and were involved, or they can do that individually or in group. That's usually done over a phone consultation, or in the room if it's a group, or online. These are some of the things.

The peer support program is very useful as well, where you get a colleague that's been trained, specifically a number of colleagues, and they're in the local area, and they're trained and they will generally wear a badge or [are] contactable via the switchboard. They will come and have a conversation with somebody after a critical incident. 

So defusing, as I said, it's important. When I say defuse, I mean, you're looking at the facts of what happened, who was there, when did it happen. You're trying to fill in the memory gaps that the person has, so that they don't concoct or develop false [ideas like] "I should have done this, I shouldn't have done that." It's not about blaming or apportioning blame at all, it's more about getting the facts together so they can be clear in their memory. "Oh, that's what happened. This is how it was. Of course I'm not to blame." That defusing is usually as I said, done by wellbeing or EAP, or somebody who's been trained in it, because it is pretty important that you lower the levels of arousal for people who have been involved in a critical incident. 

After that, there is a period of watchful waiting, where [for] up to four to six weeks, you actually check in on the person, see how they're going. But you do alert the person that they may have some changes in their behaviour, their emotions, their cognition, that may involve you know, not eating, not sleeping, or feeling nauseous, headaches, emotional irritability, cognitively having some thoughts or flashbacks. That doesn't mean you have PTSD, it's just the stress reaction that can be quite acute, especially over the first few days. 

Then that watchful waiting will be up to six weeks. That means you check in with your manager as well. The manager usually will be very supportive, giving you time, making sure you've got time off if you need to have time off, making sure you see your GP if you need to see your GP, and if you need any further support. Also making sure that you contact HR and see if there's any leave, because certain hospitals do have [it]. I think it's quite across the board, they have Injury Assist. Injury Assist is giving you some time, not taking it out of your sick leave, but time for an injury that occurred at work. These are helpful things.

Flexible work schedules are really important. If nurses or midwives are starting to feel ... "Even without any particular incident, I'm feeling really tired, I'm exhausted, things are happening in my life." Well then, let's see where we can take some of the pressure off you. A lighter workload is very helpful, making sure you don't schedule them with too heavy a load. Also making sure that if they need to go off early, or if they need to start later, stuff like that. 

Having a trauma informed environment [is important]. So being able to check in with your staff and say, "How's things going? Any adjustments that I can do to help you?" If it's an office space thing, can we have your office away from a high stimulus area? If you need low stimulus, or if you're working face-to-face with patients, making sure that you're a fairly good match and not around people that are too anxious or clients that might be traumatised themselves. So always checking in is really important, as well. 

The wellness programs ... most hospitals do run wellness programs now. So they are doing mindfulness. They are doing reflective practice stuff like clinical supervision, which isn't point of care supervision. It's more a reflective group, reflecting on your practice. All of those are designed to create a supportive work environment. 

But of course there are the social aspects as well, of making sure that people have their breaks, if there's a cake to be shared or somebody's birthday, these are really important things that help to contain. People feel supported and they feel valued. Feeling valued is a really important part of how nurses and midwives actually sustain themselves to do this really, it's pretty intense work. And it has been made more so by the effects of COVID. That has really brought it home to us all, the intensity of the work and the relentlessness at times. But then there's also the joy in that work. Really, most people love their work and to find that joy through the social and creative work environments that are around.

Elle Brown  [15:39] Thanks, Fin. You mentioned it just before, but can you tell me about trauma-informed care and how that benefits both the work environment for nurses and midwives, and also clinical care delivery?

Dr. Finbar Hopkins  [15:53] Yes, sure. Trauma-informed care is an approach to healthcare. It recognizes and responds to the impact of trauma on individuals, and one of the number of things it does is to promote safety, trust and empowerment in the healing process. This approach is used with patients, but it's not only beneficial for patients, but also has a positive effect on the work environment. 

It isn't about what is wrong with you. There's a shift in there from what is wrong with you, to what has happened to you. That's kept front and centre. Most team leaders and managers, when they are talking to nurses, they're talking to nurses about creating a physically safe and emotionally safe environment for them, being mindful. If you recently had a trigger, what was happening there? What could we do that could actually support you to feel less aroused, and be able to come to work feeling safe, and feeling that you're working in an environment that really cared for you. 

Sometimes, if we have trouble with our memory as a result of feeling a bit stressed, one of the things that can be helpful is to provide job-related responsibilities, writing it down. So these are the things that are really important today that I want you to get through. Allowing, as I said before, to have flexible work schedules, that's important. Taking time off for treatment or for appointments. Also, letting employees wear noise-cancelling headphones, if they're in the office area, in a busy area, to cut down on distractions. 

Increasing the amount of light in the working environment, making sure people work in [light]. If they can't do that, having plants and just trying to mimic the natural environment if it's not possible to have more light. Encouraging people to go for a walk outside and take five minutes or ten minutes and just go for a walk out into the garden area if there is a garden area attached to your work. Sit for a moment and have a drink or coffee, just tune into yourself. Feel "Oh yeah, how am I travelling now? What's happening for me? What are my thoughts like?"

These are a number of things that people [and] managers, in particular can do. If there are environmental triggers, say, for example, a client was behaving in a way that really triggered a staff [member], a nurse or a midwife, actually getting the nurse to move from that client and getting somebody else to work in that area if that's possible. If it's not, then there needs to be two people working with that client so that we don't allow the nurse or the midwife to feel completely alone and isolated with a client or a patient. I use ‘client’ because I come from a mental health background, but really what I'm speaking about here are patients. 

When nurses are going off shift as well, it's important that they are accompanied by somebody because recently there's been quite a number of attacks of nurses in car parks and not very well-lit areas. So getting security to walk them to their car. Making sure that they are safe, not just in the hospital but on their way home as well, getting home [safely].

Elle Brown  [20:07] Thanks, Finn. That's a whole suite of interactions and things for people to think about doing and helping to provide trauma-informed care. It's good. Can you tell me about Post-Traumatic Growth? How does that occur?

Dr. Finbar Hopkins  [20:28] Yes. It's a lovely concept, and it's really close to my heart, that these experiences, although they may be difficult when you are feeling traumatised by whatever the experience and the impact has had on you, to know that there is light at the end of the tunnel. There is actually hope, very much there. It was two psychologists who developed the idea of Post-Traumatic Growth back in the mid-1990s, around 1996, Richard Tedeschi and Lawrence Calhoun. I've heard them being interviewed at conferences and they say Post-Traumatic Growth has been around as long as trauma has been around, because people have always recovered and come back from that. 

I need to say that more women than men have experienced Post-Traumatic Growth, which is interesting that there is a gender, because when you look at Post-Traumatic Stress Disorder, more women than men are affected by it. But in Post-Traumatic Growth, it's certainly more women, to date. That's not saying that won't change. Of course, there are men too who experience Post-Traumatic Growth. 

What happens is, there is a change in perspective. This is one of the people who can flourish, and after a traumatic event the individual will feel a shift in their worldview. They reevaluate. They think, "Hmm. What was that about?" There is a sense of 'What's meaningful and important in my life?' 

They would have probably missed all of that, because they were so busy with their life, but this traumatic event stopped them in their tracks. So they start to question meaningful things and the important things in their life. There's an appreciation of the present moment, and focus on personal growth and wellbeing that they wouldn't have had before, which is quite an interesting thing. 

Their relationships are enhanced as well. They start to value and deepen their interpersonal connections, and they have a lot of compassion as well. Not just compassion for others, but also compassion for themselves. Because we often have a very strong self-critic inside us, all that can really derail us. 

One of the things they start to say to themselves, they have what's called fierce compassion. "I am okay, this is suffering. This is difficult. It doesn't mean that it's going to totalize me completely. I am more than this suffering. But this suffering is coming in, it's hard. And I'm going to accept it for what it is. But I'm not necessarily going to be feeling that this will be my whole life. It will grow and change as I grow and change and it will lessen as well." 

So they have a sense of great empathy for themselves, but also for other people that they see in suffering. I know that nurses will say, "I never understood what it was like for the families of an elderly patient whose mom or dad had a stroke. But when my dad had a stroke, and the first patient came into ED, oh, my goodness," they'll say. "I realised how hard it was for that family." It doesn't mean to say you [didn't have] empathy [before]. It just becomes something deeper and much more profound.

There's also an increased resilience. People think, 'Yes, I've got through this, I can get through this. I know that life will throw me curveballs. But it doesn't mean that I won't bounce back.' And can I say a word of caution about resilience? Resilience is very personal, it's very genetic. Some people who are very extroverted can really bounce back very quickly and be back. But others can take time, and it's very [important] to have compassion for the self and say, "It's going to take me time. I am going to feel a bit vulnerable. My resilience will come back, but I won't compare myself to X or Y, that's their journey. This is my journey." There's something about respecting that. 

Your personal strength is tied in with resilience. People can come to understand, 'I have more courage than I thought I had. I didn't realise that I had this courage.' We saw that in COVID, people saying, "Oh, my goodness, I never thought I could get through that. And here I am!" They have a newfound sense of self and an appreciation of themselves. 

There's also a thing called spiritual growth. This is not religious as such, but some people experience spiritual or existential [growth]. Some people, of course, may find solace in whatever faith they had, or they may develop a deeper meaning and purpose in life and a real appreciation. Their spiritual appreciation may rest on nature, it may be something to do with belief in a higher power, or it may be the sense that they are really appreciative of life and everything in life as well. 

A lot of people who have Post-Traumatic Growth will adopt healthier coping strategies, and they will prioritise self-care for example. Say "This is important, I need to do this for me." They're better tuned into themselves and what works best for them. They often engage in more stress-reducing activities. That might be going to yoga, doing mindfulness, attending pottery [classes], and they may [do] therapy as well. They may become more open to talking and trying to understand themselves. They reevaluate their goals, some people may leave a job, or they may leave partners or relationships. Or they may not do anything big like that. They may have smaller goals like going to bed earlier, or taking time out to sit and drink a cup of coffee on their veranda or in their garden, just being with nature. 

[There is] a lot of creativity involved in this, it is a very internalised process, but some of the behaviours are externalised. They may, as I said, tap into some creativity that they didn't know they had, it could be knitting, film editing or photography. Many nurses have reported to me, when I talk to them in my role as a wellbeing consultant, [that] as a result of COVID they developed new skills. We all know that we've been through a period where we're making sourdough bread! People thought, 'Oh, I could never do that. You can only buy that in the bakery.' But then they discovered it. There was some creativity that came to the fore during that time. 

Again, I want to say that not everyone will experience Post-Traumatic Growth, because I don't want people to [think], "Oh, yes, I'm going to experience this." It's an individual process. It's unique to each individual and the nature of the trauma, the person's coping mechanisms, their social support, their personal characteristics. They all play a role in determining whether Post-Traumatic Growth occurs, these are the contingencies. It doesn't negate that you will still have ongoing challenges, even if you have Post-Traumatic Growth. The symptoms of Post-Traumatic Stress could possibly be there, but it does at some level represent a positive transformation. With the distress, it can help very much. 

I want to say Post-Traumatic Growth is nonlinear. It's not, "I'll do this, and I'll get this." It takes time and professional support such as counselling or therapy, it can be helpful for individuals to process and explore themselves. It's time for that to happen, I think.

Elle Brown [30:02] Thanks, that was very profound. It's very timely, seeing that we all have been working, or trying to work through COVID and come out the other side. Do you have any further words of wisdom for our audience around Post-Traumatic Stress Disorder, Fin?

Dr. Finbar Hopkins [30:29] Yes. I'm as much in this as I'm speaking to you about it, because this is what it is to be human. The work that I do as a wellbeing consultant, but also that I've done as a nurse and [in] clinical supervision has informed a lot of where I am. I would say that first of all, there is no shame in seeking help and support. That's really important. Even if you think, "Oh, I'm going to be okay," it's still important to reach out to the Nurse & Midwife Support program, or your wellbeing [support] in your particular area. Know that you're not alone, because there's something that can [feel] very shameful and concealed [about it], 'Oh, I'm weak.' Your inner critic can really take off and say, "You shouldn't be looking for help." It can be really quite punitive and punishing. 

So reaching out to somebody, whether it's a peer supporter, Nurse & Midwife Support, EAP, or just a colleague that you go and have a cup of coffee with. People who will be understanding and not judging you. Don't reach out to just anybody. That's why we often say somebody professional.

I would also say to people, be patient with yourself. I've had a small cut on my finger, so small, but every time I bumped this finger, it was like, "Ow!" With trauma, it does take time, and [with] any really stressful event, just be patient, and practise a lot of self-compassion. Say to yourself, "This is difficult, and I do feel vulnerable. What do I need to do to look after myself?" When the self-critic comes up, 'You're a wimp, you're this [or that]," that's not helpful. Doing positive self-talk of saying "I'm vulnerable. I need help, and I need to wrap my arms around myself." 

The other thing that I'd say is, it's not your fault. That blame, the blamer part of ourselves ... trauma or stress is not your fault. It's essential to understand that the traumatic event is not solely down to you. You don't have to carry that. That's too much. It's really important. That's where your compassion will lie. Say, "Yeah, this is bothering me and I need to talk to somebody professional about that, because I keep blaming myself." And it's not your fault. 

Small steps. Any event that takes you out of your normal level of functioning, [it] can take time to come back to your secure base. The secure base is you feeling happy and confident, and that can take time. So just small steps, celebrate the small sense of progress, like, "Oh, I feel like having a shower, getting out and meeting friends today." Yeah, they are small success stories. 

Self-care. Nurses and midwives typically have a very well-developed sense of caring for others, and they do that beautifully. It's overdeveloped, in actual fact. The care for the self gets tiny, tiny and reduced. That's when it's important to put in place something that you're going to do. Intention-setting, I find, is very good. Setting your intention in the morning and saying to yourself,, "Yeah, today I intend to accomplish (whatever it is)." It could be writing a little note in my diary, sitting outside and having a cup of coffee or tea in the sunshine, or going for a walk in nature. 

There is research around to show the healing power of nature is huge. You get much more reduction of stress and reduction of arousal levels when you're walking in a park than you do when you're walking an urban street, even with trees. There's something about getting into nature, and spending a bit of time there that will help derail the mechanism. But it's also a self-care practice. 

The other thing I want to speak about that's really important is to check, to tune into your thinking, your relationship with your thoughts. When you're having a thought, you are not your thoughts completely. You don't have to believe every thought that you ever had, but you say "I'm having a thought about fear, avoiding something, or being scared." And then you can say, "This is a thought. This is just a thought. I will acknowledge [it]. I'm not going to try and push it away. I'm going to say I'm having the thought, but it's just a thought. It doesn't mean in the present moment there's anything in my environment that's threatening me. I'm doing the wash[ing] up. This is my alarm system trying to protect me." The body continues to try to protect us long after the event has occurred. That's just the body doing what the body has [always] done. 

Checking in with your values. What do I value? What's the things that I really value? I value honesty. I value friendships. It's really important to stay connected with people. People who are nurturing kind of people, not just any old people. They're supportive of you, they have your interests at heart as well. That's the kind of support network that you need. Especially when you are feeling vulnerable from a stressful or traumatic event. It's quite important. 

I also talk to staff about engaging in grounding techniques. We all feel overwhelmed at times, stress of work coming at us, different people wanting [things], we feel fragmented, pushed and pulled in different directions. Grounding techniques help you sustain the present moment, and they can be as simple as just checking into your breath. How's my breath at the moment? There is one resetting breath that's used, and it's breathing in for three, holding, and then breathing out for four. That helps to reset the old reptilian brain that's highly aroused and trying to help you when it doesn't need to, you don't need that kind of help. That simple breathing technique can be useful. Another distraction technique, if you're starting to feel aroused and a bit panicky, is counting backwards from 200. Especially at night, because often nighttime is when our fears can rise up. Counting backwards from 200 can really kind of help. 

The other thing is being mindful. When I speak about 'mindful', if you're doing the wash[ing] up, try and be fully in the moment. Feeling the water, the soap on your hands, the plate in your hand, or the fork or the knife. The same with eating or drinking. Starting to really be mindful, just building it in, in small little steps. You don't have to do it all the time. But when you remember, say, "Oh, I could be mindful now, when I'm washing my hair." Or, "I could be mindful going for a walk, just focusing on my footsteps." Yeah, so really been in tune with your body as well. 

I would ask people to avoid self-medication because I think that turning to any substances or drugs can be a signal that there's some other help needed. But if you do find that you're wanting to do that, it's important to speak to your GP and then GPs can refer you on to psychologists or psychiatrists, depending. These are important [things] to note. 

Set your boundaries as well, is another one I talk about. Set boundaries with yourself. "I'm not going to do [this]. This is outside my remit." Or, "I don't want to, this doesn't make me feel comfortable." Know when discomfort arises in your body, it's giving you a signal that something is out of your values. So you set boundaries. That's for yourself and also with others, making sure that your needs are met. 

As I said, trauma-informed care, making sure the workplace, especially managers and team leaders, show empathy, positive regard and respect for the person, and try to get them hooked in with the Nurse & Midwife Support program, or wellbeing [support] or EAP. Also it's useful for people to have some time talking to friends, being around friends that replenish and nurture you, and the things that bring you joy that you do in your life. Those are just some of my [thoughts] around all of this.

Elle Brown  [40:56] I'd call it wisdom. I thank you so much, Fin, for your time today and your fantastic answers to my questions. That's all for today's podcast. Please remember that support is available whenever you need it: Nurse & Midwife Support on 1800 667 877. The service is anonymous, confidential and free, and you can call 24/7. You can also contact us via the website: nmsupport.org.au. Your Health Matters. Thank you.