About pressure, stress, fatigue, and norms, as well as how to manage them successfully, you can read here:
1. Pressure from All Sides and Possible Outlets
1.1. What Is Pressure?
If one puts someone under pressure, this might become uncomfortable: One can persuade someone to make a statement, or perform an action, thereby being adamant and stressing necessities and scarceness. One can increase the pressure by threatening someone with measures, withholdig, or consequences.
Of course, we remember such uncomfortable situations we have experienced. What did we feel? What other circumstances can cause pressure? How to best handle it?
1.2. Pressure We Exert on Ourselves
To exert a little pressure on oneself, is not a negative thing. Rather, this can help us to reach our goals if regulated well.
Certain personalities put considerable pressure on themselves and have almost unrealisable expectations of themselves concerning perfection in their work, the amount of work, but also the degree of difficulty.
If we don´t do our work with realistic expectations of ourselves, we will become stressed. If we avoid that, we avoid a negative spiral made of excessive demands, and exhaustion, declining accomplishment and dissatisfaction, because we cannot fulfill our expectations. Taken together, our achievement increases if we use pressure wisely.
1.3. How to Handle Pressure on Ourselves
We make our lives easier if we:
- plan realistically when we will complete what tasks
- identify the important issues and concentrate on them
- pay attention to the triangle between quality, time, and costs. We cannot max out all of them at the same time
- accept that the day has 24 hours for each one of us and that we should fit in recreation, and sleep, family and friends, as well
1.4. Pressure at Work
Projects should have been completed by yesterday, costs must be kept to a minimum, even tight deadlines must be met, the personnel should be fully productive, efficient, and highly concentrated at all times. In addition, everyone has future projects, optimisations, and visions in mind which they wish to elaborate.
Who does not recognise this? How much pressure is added by the manner in which we communicate the requests? What support have we got and what training programmes and mentoring are available to us?
1.5. How to Minimise Unnecessary Pressure at Work
Outlets for pressure at work comprise:
- assignment of tasks which correspond to the proficiency level of those involved and which offer the opportunity to grow
- realistic project planning with timelines which include a safety margin
- contingency planning for unforeseen events and outages, consideration of alternatives
- planning together with the team, listening to reservations and constructive problem-solving suggestions
- calculating costs honestly
- all items which you can name
1.6. Pressure in Our Teamwork
In the emergency service, it happens all to easily in a complex situation that one disregards the rules of good teamwork and, in the heat of the moment, assignes too many tasks to the team members at once. Consequently, they have to prepare the artificial respiration and the intravenous line, while drawing medication into syringes and, preferably, informing the right hospital at the same time. This creates pressure which is not necessary.
1.7. How to Avoid Pressure in Our Teamwork
We know how many team members we have got and that everyone has only got two hands, two feet and one head. Therefore, we have to discipline ourselves and assign tasks in manageable portions. Only when we have received the confirmation that one task has been carried out, and we have acknowledged that, we assign the next task.
It is important that the team members know that they should point it out if they have received too many, or too difficult tasks at once.
1.8. Pressure Which Customers Exert on Us
With our professional attitude, we consider it a matter of course that the customer is king. We do our very best to offer the right products, or services, and to advise well, to be courteous, and to fulfill our customers' wishes. Our customers should have certain expectations.
However, we have also experience with customers who have exceptional demands. In that case, we have to keep a fine balance between the fulfillment of a few extra wishes and not being pushed too much.
2. Stress Does Not Only Harm Us
How do we distinguish pressure, which we discussed above, and stress? One possibility might be that pressure is seen as one trigger of stress.
If we are exposed to negative stress, we suffer, and illnesses, which include even heart attacks, can occur in the long run. However, not only we ourselves experience considerable disadvantages. The stress that we feel can also compromise our work substantially.
2.1. Why We Address Stress in Detail in CRM
The Role of Stress in Air Disasters and in Critical Situations
Stress was a root cause in many aviation accidents. Stress can be caused by the actual situation as was the case on Qantas flight 32, when a damaged engine with subsequent numerous technical failures stressed the flight crew enormously.
Stress, on the other hand, can be preexistent and accompany crew members on the flight. Therefore, surely no one is able to forget about controversies at home or severe financial worries completely.
A Routine Call Includes Unexpected Stress
Once we tended to an elderly, full figured lady after a fall in the bathroom. We suspected a fracture of her femoral neck.
The venes on her hands and forearms were thin, difficult to find, and burst easily. Hence, it was a challenge to give her the necessary pain killers. Right from the start, the lady uttered her dissatisfaction with our achievements in an insulting manner.
We had to stay calm and polite, but firm. First, we applied medication nasally, in order to rescue her from her awkward position. Then, we started an iv line to administer further painkillers as needed.
The lady had already a hospital in mind, which could not treat the suspected fracture. Despite of this, her daughter had already called that hospital, as her mother was one of the professor's patients. Now, we received several subsequent, time-consuming phone calls.
During our debriefing session, we all agreed that we had felt stressed. Luckily, the actual call was a routine case, as stress and distraction can prompt avoidable mistakes.
2.2. How to Master Stressful Situations
There Is Strength in Calmness
First of all, we should keep calm, and within the team we can help one another to achieve that. If we stay calm and serene, this has a relaxing effect on the team itsself, as well as on those present at the scene. We keep our focus on the essential, we work steadily, but not rushed.
How to Assess the Situation Appropriately
We should approach any situation realistically: What can we do, what would be supernatural? What limitations cannot be changed, for instance, the wheather, icy roads, or pathless terrain, which prolongs the rescue time? How do we master our call under the given circumstances?
crew resource management
We apply CRM principles confidently and consistently. These offer schemes which help us to work our way through complex cases in a structured manner. We follow these schemes step by step.
We deploy all our resources purposefully. These also include additional aids and help provided by other teams. In the emergency medical service, we can call in further rescue organisations, for example, high-altitude rescue or water rescue services.
In two of my earlier blog articles, you can find useful information on stress, its causes and types of stress , as well as prevention and how to deal with it using CRM principles.
3. Fatigue Is Not Restored the Next Day
3.1. Definition of Fatigue
Fatigue is a type of chronic exhaustion, which has built up over time, due to heavy use of resources and too many obligations, one has tried to meet for too long. Energy resources are not restored until the ability to regenerate has been stretched too far.
If fatigue has occurred, it takes longer until we recover from it than it does after a short period of stress.
Factors, which may have contributed, include:
- the occupational situation and lasting stress at work
- a period of very hard work
- additional family obligations and household chores
- worries and problems,which are long-lasting and difficult to solve
- bodily, physical, and emotional stressors, which won't cease
- severe illnesses
3.2. Why We Address Fatigue in CRM
On the one hand, fatigue influcences our work and, thus, safety.
Fatigue impairs our ability to observe our surroundings attentively, and to make decisions, but also to concentrate, and to remember what we have learned.
On the other hand, there are possibilites to detect the signs and act early. In doing so, we can prevent what one participant has told us during a CRM trainer's course.
He had been on duty on a ship, which cruised the oceans for several months. There, he worked in shifts, and his circadian rhythm was disturbed substantially.
After having travelled home for Christmas around half the globe, he noticed on his arrival there that he had no memories of his more than one day long journey. He could not remember one single flight, transfer, or travelling to and from the airport.
He realised that something was seriously wrong, so he draw the obvious conclusion and left the industry. He understood that it must not be the norm that such exhaustion is regarded normal in any line of business.
3.3. Fatigue Is Measurable
As safety at work, but also the health of those involved are compromised to a threatening extend, there are questionnaires to assess fatigue and its degree.
They contain , for example, questions about physical and mental exhaustion. The answers carry certain numbers of points. The sum of the points shows the degree of the fatigue.
3.4. How to Deal with Fatigue
The first step is to notice the fatigue, either in oneself, or someone who is affected. Following that, we need to consider the trigger and evaluate, whether there is a single one, or if several have occurred simultaneously.
Then, we can work out solutions, which are very individual, depending on the factors we have identified and the current circumstances of the entire life.
Depending on the severity of the fatigue, additional breaks may be necessary, or learning how time and tasks can be scheduled individually. One should never self-medicate. If problems cannot be solved without help, coaching, or a consultation may be beneficial. Together with the GP, one can talk about treatment at a health resort, for instance.
3.5. Primary Prevention of Fatigue
Of course, preventing fatigue in the first place is best. For this purpose, it is important that we know that the problem exists at all. This holds especially true if we are extra eager to work hard. Many of us take on too many obligations and underestimate their own inertia.
A healthy balance between endeavour, challenging tasks and relaxation is key. Varied and nutritious food, and exercise, enjoying hobbies and time together with our loved ones, as well as sufficient and restful sleep help us to prevent fatigue.
4. We Encounter Norms More Often Than We Think
4.1. Why Do We Need Norms?
Norms are behavioural guidelines, which are valid within a society. If we act according to these guidelines, our actions become predictable and are not considered inappropriate.
In aviation, as in all other lines of business there are such behavioural guidelines. Some of them vary between different companies. Norms can support positive behaviour, or they can be ground-in, disadvantageous types of action, which we, subsequently, consider to be normal.
4.2. Disadvantageous Types of Action Are Not Norms
These adverse kinds of action may lead us to exceed safety margins, or carry out tasks insufficiently. Eventually, this may prompt mistakes, which endanger a flight or a patient.
Due to these norms, which actually are not norms, but bad habits, this term has its place within "The Dirty Dozen". If we remember the example above about the strenuous shifts on a ship, we clearly realise that considering this exhaustion as something normal is a disadvantageous norm. It goes without saying that it threatens safety gravely.
4.3. How to Preserve Good Norms, Spot Bad Habits and Eradicate Them
How do we recognise good norms and distinguish them from disadvantageous habits? Organisational blindness does not make this any easier for us.
How to Recognise Bad Habits as the Cause of Errors
As always in CRM, we search for the root causes of mistakes. Why have we made one? Have bad habits been the cause? If so, we need to find constructive and, importantly, practicable solutions, we can use as a team in order to eradicate the identified habit.
We also need to take near accidents and mishaps seriously as they can give us important hints to minimised safety margins. As soon as we have detected them, we apply measures to prevent further thinning of the safety margins.
How to Compare Our Norms and Habits and Learn More
We should always stay critical and examine our work methods, also in comparison to international guidelines. Moreover, we can enlarge our knowledge at conventions and when talking to colleagues. In doing so, we can adjust our norms continuously, spot adverse habits and work on them.
How to Apply our Advantageous Norms Deliberately
Last but not least, we have successfully established much together with our team, also valuable norms. If we have responded to a call well, or delivered a superb piece of work, we should always shed light on the reason for our successes actively in order to enable us to repeat them.
A huge praise to our team members spurs our team on and it gives us the positive energy to continue to deliver great work.
5. In the Next Blog Article We Will Complete "The Dirty Dozen"
In the third part of this series we will occupy ourselves with the lack of teamwork, lack of resources, lack of assertiveness, as well as lack of awareness. Again, we will compile for all four items how we can counteract them actively.
You can find more blog articles at the bottom of my blog page.
Author: Eva-Maria Schottdorf
Date: February 27th 2022