Stress First Aid for Healthcare Workers: Facility Guide and FAQ
Stress first aid (SFA) was initially developed as a framework for military personnel to help address the adverse stress reactions that result from unrelenting workplace pressure. Although SFA wasn’t designed for clinical staff, it’s highly applicable in healthcare settings where nurses and other care team members routinely operate under high stakes while sustaining secondary trauma.
These experiences often exacerbate today’s biggest healthcare workplace challenges, amplifying crises like compassion fatigue and nursing burnout. By proactively supporting healthcare worker and nurse mental health across the stress continuum, facility leaders can boost clinician resiliency while protecting operational outcomes.
This facility-focused guide explores how stress relief for nurses and other team members can be applied in healthcare settings, with answers to common questions about SFA. Equipped with the information you need to provide real mental health support for healthcare workers, you can build lasting resiliency in nursing (and beyond) while tackling harmful professional expectations of stoicism among clinicians.
What Is the Stress First Aid Model? Overview
SFA is an evidence-informed model that outlines practical methods for implementing self-care and peer-support to help boost the resiliency of personnel within high-pressure environments. It features a set of supportive actions that improve identification and mitigation of sustained stress’s harmful effects, such as social withdrawal, decreased focus, and chronic fatigue.
Fundamentally, the SFA model is meant to posture stress responses as part of a continuum that ranges from impaired productivity to optimal effectiveness. It’s not intended to address the psychological fallout from a specific incident or support individual mental disorders like other models. Instead, the SFA framework directs healthcare workers and leaders to harness mentoring and problem solving to better:
- Identify stress reactions in themselves and others.
- Reduce the risk of injury related to stress.
- Promote coping skills and resilience for individuals and groups.
Stress First Aid for Healthcare Workers: FAQs
Healthcare worker emotional support and stress relief takes time, and SFA’s incremental step approach is meant to ensure longevity, rather than a quick fix. This means that a fully developed program requires ongoing learning and engagement from both staff and leaders. To help you get started on implementing (or bolstering) SFA initiatives at your facility, we’ll answer some of the most frequently asked questions about this model below.
What are the 7 Cs of stress first aid?
The SFA model outlines seven core actions (also known as the 7 Cs) that should be taken to identify and reduce stress reactions in both yourself and/or others. We’ve outlined these actions, along with example strategies, in the table below.
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1. Check |
Check on yourself and others to identify common stress indicators. |
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2. Coordinate |
Keep others informed and reach out for help. |
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3. Cover |
Ensure ongoing safety for yourself and the people around you. |
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4. Calm |
Slow down and reduce stress in the body and mind. |
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5. Connect |
Build relationships and find people who can provide social support. |
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6. Competence |
Build and foster skills that increase resilience to difficult situations. |
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7. Confidence |
Maintain a positive but realistic self-image. |
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How does the stress continuum model relate to SFA?
The stress continuum model is a visual tool that serves as a foundational component of the SFA framework. It portrays stress responses as a spectrum of severity, broken down into four main categories and color coded to indicate risk. It’s designed to help move personnel toward green (or maximum productivity), therefore assisting with individual and operational stress first aid.
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Ready (Green) |
Here, people are operating at their best. Environmental and personal factors contribute to optimal physical, mental, and spiritual fitness of healthcare workers. |
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Reactive (Yellow) |
In this zone, clinicians are managing mild triggers and workplace impairment (as evidenced by loss of focus or difficulty sleeping, for example). Resolution is often low risk and highly accessible. |
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Injured (Orange) |
At this stage, more severe distress poses a higher risk with potential for lasting stress injury. Panic, rage, and depression may indicate that grief or moral injury is affecting staff. |
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Ill (Red) |
This zone is associated with unhealed stress injuries (often requiring clinical intervention), displayed by persistent impairment and severe distress, often caused by unresolved PTSD, depression, or anxiety. |
Which resiliency building tools are supported by the SFA framework?
The 7 Cs is one of several mnemonic tools used by the stress first aid model. OSCAR (Observe, State observations, Clarify role, Ask why, Respond) is another helpful device within the framework. It guides the implementation of peer support actions that assist staff to maintain (or return) to the green (ready) zone on the stress continuum.
Using OSCAR also rejects the concept that healthcare workers should simply shake off difficult moments, allowing stress injuries to compound. Instead, the mnemonic establishes the imperative for identifying potential stress reactions and intervening via its titular step-by-step instructions, illustrated by the example below:
Observe: A nurse observes a coworker frowning and muttering while drawing up an IV medication into an unmarked syringe. That nurse then forgets to label the syringe.
State observations: The witness engages the irritated nurse. “Hey, are you doing okay? You seem like you’re having a hard day.”
Clarify role: The responder then makes it clear that they’re simply trying to be a helpful peer. “I’m caught up on my med passes, I can take over for you, if you’d like.”
Ask why: After, they immediately follow up with a question. “Things have been hectic tonight, but is something else going on that’s making this shift more difficult?”
Respond: The stressed nurse tells the observer that they’re struggling because one of their patients was just transferred to the ICU after a rapid response, and the patient who needs this medication is angry because it’s late. The intervening coworker says, “That’s really tough. How about I deliver this and explain that you’ve been busy with an emergency after you label this med? You deserve a minute to breathe after an RRT.”
Why is it important to help healthcare workers manage stress?
The SFA model helps workers take more practical, daily steps to build resilience, helping them overcome the stress responses triggered by their high-pressure environment. The benefits of long-term clinician and nursing stress relief include:
- Improved job satisfaction and employee morale.
- Better patient care due to reduced stressors that jeopardize patient safety (through medication errors, for example).
- Optimal productivity due to engaged, highly functioning staff.
- Reduced risk of burnout and compassion fatigue.
- A healthier workforce with reduced risk of serious health problems related to unhealed stress injuries.
SFA vs. psychological first aid vs. mental health first aid: What’s the difference?
There are many frameworks designed to help people struggling to cope with illness, trauma exposure, or post-incident stress. Where the SFA is meant to guide acute stress support (whether the reaction is big or small), other models have been created to frame proper post-event support or chronic mental health maintenance.
These models include the psychological first aid (PFA) model and the mental health first aid (MHFA) model. The PFA framework is largely intended to support disaster responses, helping those affected to manage their reactions to the incident-related trauma. The MHFA framework is used to help those suffering from mental illness or substance abuse disorders. They both share features of the SFA model, but differ in their target audiences and primary purposes.
Who should use the SFA model?
SFA principles can benefit all types of healthcare workers, regardless of their experience level or where they work. This model can be used by individuals who want a better handle on their stress, or by teams that want to create a more supportive work environment.
The SFA model outlines a range of strategies at the individual, group, and leadership level. For leaders, it’s important for instituting policies that foster a healthier work environment, while teaching staff how to utilize SFA for themselves and their colleagues.
Where can facilities find stress first aid training resources?
SFA encompasses a very detailed framework, requiring the use of professionally vetted training resources to be effectively implemented. Here are some helpful links to resources that you can visit to learn more about SFA or provide training for your staff:
- Veterans Affairs’ SFA training manuals, workbooks, and materials
- American Nurses Association’s stress self-assessment tool
- American Medical Association’s SFA toolkit and module
- First Responder Center’s in-person and online SFA training courses
Take Comprehensive Measures to Support Your Staff
Maximizing the benefits of providing stress first aid for nurses and other clinical staff requires a multimodal approach. For additional strategies, review our healthcare management tips and insights to better protect your work environment and tackle today’s most pressing operational challenges.