BACR Conference 8BACR Conference 8thth - 9 - 9thth October 2009 October 2009 Benefits of a Benefits of a

“One Day Stress “One Day Stress Management Workshop” Management Workshop” A Menu Based Option for A Menu Based Option for

Cardiac Rehabilitation Cardiac Rehabilitation PatientsPatients

Katrina Fisher Katrina Fisher Senior Occupational Therapist Senior Occupational Therapist Cardiac Rehabilitation Team Cardiac Rehabilitation Team

Luton & Dunstable Hospital NHS Foundation Luton & Dunstable Hospital NHS Foundation Trust BedfordshireTrust Bedfordshire

ToolkitToolkit

Patient’s PerspectivePatient’s Perspective

One Day Stress Management One Day Stress Management Workshop for Cardiac Workshop for Cardiac Rehabilitation PatientsRehabilitation Patients

Morning WorkshopMorning Workshop

• Welcome and introduction to the dayWelcome and introduction to the day• A-Z of coping strategies – on arrivalA-Z of coping strategies – on arrival• Ice breaker – list patient’s expectations of the dayIce breaker – list patient’s expectations of the day• Definitions of stress and anxietyDefinitions of stress and anxiety• Causes of stress in relation to Human Performance Causes of stress in relation to Human Performance

CurveCurve• The Autonomic fight / flight responseThe Autonomic fight / flight response• Comfort break………Comfort break………• Signs and symptoms of stressSigns and symptoms of stress• Complete another HADSComplete another HADS• Show “Don’t lose Heart video”Show “Don’t lose Heart video”• Feedback HADS scoresFeedback HADS scores• Break for lunch………Break for lunch………

A-Z Coping StategiesA-Z Coping Stategies

AAROMATHERAPY ROMATHERAPY JJOKESOKES S SWIMMINGWIMMING

BBOWLINGOWLING KKITE FLYINGITE FLYING TTALKINGALKING

CCROSSWORDSROSSWORDS L LAUGHTER AUGHTER UUNDERSTANDINGNDERSTANDING

DDISTRACTION ISTRACTION MMUSICUSIC V VISITINGISITING

EEXERCISEXERCISE N NOTHINGOTHING W WALKINGALKING

FFISHINGISHING O ORGANISINGRGANISING X XYLOPHONEYLOPHONE

GGOLFOLF P POSITIVEOSITIVE Y YOGAOGA

HHUMOURUMOUR QQUIZZESUIZZES Z ZOOOO

IIRONING RONING R RELAXATIONELAXATION

Morning WorkshopMorning Workshop

• Welcome and introduction to the dayWelcome and introduction to the day• A-Z of coping strategies – on arrivalA-Z of coping strategies – on arrival• Ice breaker – list patient’s expectations of the dayIce breaker – list patient’s expectations of the day• Definitions of stress and anxietyDefinitions of stress and anxiety• Causes of stress in relation to Human Performance Causes of stress in relation to Human Performance

CurveCurve• The Autonomic fight / flight responseThe Autonomic fight / flight response• Comfort break………Comfort break………• Signs and symptoms of stressSigns and symptoms of stress• Complete another HADSComplete another HADS• Show “Don’t lose Heart video”Show “Don’t lose Heart video”• Feedback HADS scoresFeedback HADS scores• Break for lunch………Break for lunch………

Afternoon workshopAfternoon workshop

• Welcome back and Welcome back and introduction to coping introduction to coping strategiesstrategies

• A-Z coping strategies A-Z coping strategies • Cycle of change (Ref Cycle of change (Ref

Prochaska and Diclemente Prochaska and Diclemente 1982)1982)

• Teach 4-5 coping strategiesTeach 4-5 coping strategies• Inform patients of other Inform patients of other

support available: 1:1 session, support available: 1:1 session, referral to clinical psychologist, referral to clinical psychologist, counselling arranged via GPcounselling arranged via GP

• Make sure expectations have Make sure expectations have been metbeen met

• Evaluation forms completed Evaluation forms completed • Close session.........Close session.........

                                                                                                           

Choice of coping strategiesChoice of coping strategies

• Changing unhelpful thoughts into helpful thoughtsChanging unhelpful thoughts into helpful thoughts• Anger management techniques Anger management techniques • Energy conservation and pacing techniques using Energy conservation and pacing techniques using

MET valuesMET values• Goal setting using SMART principleGoal setting using SMART principle• Assertiveness training Assertiveness training • Problem solving techniquesProblem solving techniques• Sleep hygiene techniquesSleep hygiene techniques• Time management principlesTime management principles• Stability zonesStability zones

Diaphragm Breathing and Diaphragm Breathing and Relaxation TechniquesRelaxation Techniques

• Diaphragm breathing techniquesDiaphragm breathing techniques

• Relaxation techniques:Relaxation techniques:– Progressive Progressive

– Autogenic Autogenic

– Visualisation Visualisation

Afternoon workshopAfternoon workshop

• Welcome back and Welcome back and introduction to coping introduction to coping strategiesstrategies

• A-Z coping strategies A-Z coping strategies • Cycle of change (Ref Cycle of change (Ref

Prochaska and Diclemente Prochaska and Diclemente 1982)1982)

• Teach 4-5 coping strategiesTeach 4-5 coping strategies• Inform patients of other Inform patients of other

support available: 1:1 session, support available: 1:1 session, referral to clinical psychologist, referral to clinical psychologist, counselling arranged via GPcounselling arranged via GP

• Make sure expectations have Make sure expectations have been metbeen met

• Evaluation forms completed Evaluation forms completed • Close session.........Close session.........

                                                                                                           

Key Findings From the One Key Findings From the One Day Workshop EvaluationDay Workshop Evaluation

• 64% attended – 29% UTA and 7% DNA (2009)64% attended – 29% UTA and 7% DNA (2009)

• 94% patients reported “delivery of the workshop 94% patients reported “delivery of the workshop was just right”was just right”

• 93% reported “the length of the session was just 93% reported “the length of the session was just right”right”

• 90% “felt their knowledge of stress management 90% “felt their knowledge of stress management had improved”had improved”

• 12% patients referred for a clinical psychology 12% patients referred for a clinical psychology assessmentassessment

Key Findings From the Two Key Findings From the Two Month Follow up Evaluation of Month Follow up Evaluation of

the Workshopthe Workshop

• 93% reported that “they still use the ways of 93% reported that “they still use the ways of coping identified on the day”coping identified on the day”

• 88% reported that “these ways of coping help 88% reported that “these ways of coping help them to manage their stress more effectively”them to manage their stress more effectively”

• 80% HADS scores have reduced 80% HADS scores have reduced

20% significantly to within normal range 20% significantly to within normal range

Future PlansFuture Plans

• Running a follow up day for patientsRunning a follow up day for patients

• Offering a similar stress management workshop for Offering a similar stress management workshop for partners and other family memberspartners and other family members

• Providing a professionally printed manual to Providing a professionally printed manual to support the content covered in the workshop. support the content covered in the workshop. Patients would be able to continue to use this as a Patients would be able to continue to use this as a reference tool to maintain effective stress reference tool to maintain effective stress management techniquesmanagement techniques

• Continue to develop the emergency in-patient Continue to develop the emergency in-patient Clinical Psychology referral serviceClinical Psychology referral service

Any Questions?Any Questions?