Qi Gong practice led by long-time Nova Institute friend Mary Pinkard in the “Joy and Work” retreat with Professor and Chair of the Department of Family Medicine Dr. David Stewart (red shirt), Professor and Vice Chair of the Department of Family Medicine Dr. Rich Colgan (blue and green shirt), and several primary care clinicians.
Recognizing the unsustainable physical and psychological strain that COVID-19 had on their patients and staff, the University of Maryland School of Medicine Department of Family and Community Medicine contacted the Nova Institute for help. In response, Nova Fellow Chris D’Adamo and President Brian Berman developed a new demonstration project, Primary Care: A Bridge from Fear to Flourishing, which aims to to help primary care practitioners identify and support patients suffering from high levels of stress or trauma. The program introduces stress reduction tools and techniques to clinicians for their own self-care and so they can recommend appropriate stress reduction tools for patients.
One year later, the project is showing signs of success, with lessons along the way. The multidisciplinary project team comprises board-certified Family and Community Medicine physicians and licensed social workers, clinical researchers at several academic institutions, leadership from the National Institutes of Health, and Nova Visiting Visionaries Rebecca Etz and Valentina Morani.
The team first shared the project concept at a faculty meeting that included metrics evaluating current stress levels among clinicians and guided practices in stress management tools. When follow-up baseline questionnaires and stakeholder conversations revealed that sleep was the main area of concern, the team developed the “Better Sleep for Stress Management” video series. The first video includes practical sleep hygiene tips that physicians could start implementing for better sleep and the next two videos explain how essential oils can enhance sleep and relaxation through topical use and inhalation. The videos were shared with and well-received by more than 75 medical faculty and staff.
At a Grand Rounds presentation, the team shared evidence of stress management in clinical settings and helped clinicians better recognize stress and anxiety “red flags” in themselves and patients. Participants were also guided through healthy coping exercises such as a body scan, breathing meditation, and chair yoga.
Later the team led three stress management activities for the Department of Family and Community Medicine physicians’ “Joy and Work” retreat: nature immersion, a mindful walk, and guided breathing meditation. Each was followed by a reflection and discussion around stress, the physicians’ current needs, and what actions they were already taking.
Moving forward, the team is engaging patients by working with a Patient Advisory Council and developing a Patient Stress Screening Assessment with patient feedback. This screener aims to address the major gap of a brief, clinically practical tool for assessing stress in clinical care, and it is currently being deployed to 500 patients.
"The stress assessment and management being offered to our busy practice of over 30,000 visits per year has been spectacular! The training we are receiving and the benefits it will afford our clinicians and patients could not have come at a more appropriate time. Primary care physicians and Advanced Level Practitioners are experiencing a great deal of stress because of this pandemic, as are our patients. Being cognizant of these extraordinary factors and offered some tools on how to deal with them has been very helpful to our faculty and residents. We expect the benefits will be enjoyed even more so by our patients.”
Lessons Learned
By listening to the clinicians, we were able to hear directly about their concerns and adapt the project to overcome them. Some concerns were about getting “buy-in” and engagement around the idea of stress management, a lack of time for adding stress assessment and intervention into both patient care and their own lives, and uncertainty about patient receptivity.
Additional lessons learned have included:
- Engagement with a diverse set of stakeholders is essential to successful program implementation. Such engagement revealed factors precluding communication of stressors by patients to clinicians, including feelings of hopelessness that nothing could change their stress, lack of comfort in sharing their stressors, limited understanding of the ways stress may manifest in their lives, and what they perceived to be more pressing clinical needs or life challenges. This feedback has been incorporated into our Stress Screener and the ongoing development of the stress management tools for patients.
- Co-creation and co-ownership with clinicians is essential for the feasibility of implementing a novel program into primary care. Including clinicians in the planning and encouraging them to share with their peers created a rapport that secured interest, engagement, and openness with each other and to the project. This also provided valuable feedback that was incorporated into meetings, presentations, and videos.
To make it easy for both physicians and patients to understand and share evidence-based methods, the team is compiling a Clinical Stress Management Resource Compendium with dozens of practical and proven stress management tools.
The team is looking forward to working closer with patients and physicians to better help them assess and manage stress. Because of the project’s success, it is being expanded to the University of Maryland Medical Center Shock Trauma Center (STC), which is widely considered to be the leading critical care institution in the world. Stay tuned for more updates!
