Happy Tuesday, everyone. Thank you for attending our last webinar for 2024. For this final talk, we're going to do something a little different for this forum. We're going to take a break from talking about vascular disease, protocols, or criteria, and instead, we're going to focus on the technologists and their well-being. Because if we're not well, physically and mentally, if we're burned out, for example, how can we give our all to our patients? So tonight, the title of our talk is The Mind of the Sonographer Beyond the Physical Strain. My name is Lori Lizianski, and I'm the chair for the SVU eLearning Educational Committee. And before we begin, I want to go through our regular announcements from the SVU office. First, this webinar is going to be recorded and available online for attendees through the SVU website at no charge. Let's take a minute to familiarize yourself with the GoToWebinar program in case you've not used it before. Everybody should see a question section along the right side of your screen. There's a menu choice near the bottom just above chat for questions. So while our speaker is presenting, just type in any questions that come to mind during the presentation, and then at the end of tonight's talk, we should have some time for discussion. Now, importantly, to receive your CMEs from tonight's lecture, you just need to wait for an email from the SVU office that's going to contain an evaluation. And then you should get that email in about 7 to 10 business days, and when you get it, when you complete that evaluation, your CME certificate will pop up automatically. Okay. So that's all we have for announcements. And so let me give you a little background on tonight's speaker. Erin Williams, she's currently the lead vascular sonographer at the Christ Hospital in Cincinnati, Ohio. Erin attended the University of Cincinnati, where she graduated in 2002 with a bachelor's degree in biology. But after struggling to find a position in the science industry, she stumbled into the field of vascular ultrasound five years after graduation, just by doing an in-house training program through Midwest Ultrasound. And then Erin received her RVT certification in 2008. And now most of her career has been spent in a large hospital setting. However, she did spend three years in a vascular surgery office, where she had the opportunity to focus primarily on surgical patients, along with venous disease. And then because of that position, she sat for her RPHS exam. And Erin is currently a member of the Diversity, Equity, and Inclusion Committee with SVU, where there's an emphasis on building diversity and inclusion in the field of sonography. And I don't know if you've seen it, but lately there's been several studies and publications recognizing the physical and mental stresses in health care, including issues within our own profession. So I'm really happy to have Erin presenting for us tonight. And I hope you find this session helpful. And with that, Erin, take it away. All right. Thank you so much, Lori. Good evening, everyone. I'm so happy to be able to present this topic. I did present this at the hospital that I work for to our current sonographers. So it's a pleasure to be able to present to other people. So I appreciate being asked to speak. So, I don't have any disclosures. And as far as the objectives of the talk today, I wanted to go through and discuss the nature of the field of sonography and how our mental health may be affected. I also wanted to correlate light deprivation and how that may affect us as well, along with managing workplace stress and mental health barriers that we may encounter. I did an in-house survey with the hospital that I work for, so I'll go through that, as well as our results, and then handling difficult patients, and then what we can do about that. I did first, I began to think of this topic right after COVID kind of was taken over, and I feel like the mental strain became a little bit more for the healthcare industry, a lot more, to be honest with you. So, it just kind of dawned on me that this is a topic that we may not readily discuss and that it would be good to bring to light. So, just as an overview, again, I think this is a very important topic in today's environment that may at times be overlooked. Like Lori said, there are some articles that are out there now that are beginning to talk about the mental strain, but we do spend a lot of time focusing on the physical strain of our job in ultrasound sonography, so much so that there is an hour-long CME on work-related musculoskeletal disorders for IAC accreditation. So, we do focus on that physical strain, which is very, very important, but I also feel like we should start looking at the mental strain. Again, for the overview, I wanted to use known correlations between light deprivation and depression and anxiety, along with the fact that we are working with a primarily sick population that can affect work-related stress. And ultimately, how is the job performance and satisfaction affected? So, some just general factors that can affect our technologists today are the season or the time of year. So, you may experience winter blues, the time change, cold. All this is depending, I understand, on what part of the world you live in. I am located in Ohio, so we do get the cold winters, the kind of gloomy winters. So, that can affect the technologists, as well as your environment. Do you work alone primarily all day, or do you have coworkers? Are you in a group setting where you can talk to other people? If you are alone, there can be factors of isolation that occur when all you are working with are your patients. And I do, you know, know that you kind of get stuck in that room with your patient, and you become almost a sounding board for your patient, which can add stress to you, as well. You want to be a good listener, but you're also trying to do a test. You're also trying to get good images. So, sometimes it's nice when you have coworkers you can talk to or vent to. Again, in your environment, just as a side note, you may want to check on your coworkers and see how they're feeling, how their day is going. You never know what someone may be going through outside of work. Your shift can also affect you. Are you primarily a day, working the daytime, or do you do a night shift? You know, that could affect your sleeping patterns, things of that nature. Patient population, what type of population do you primarily work with? Are you in a surgical setting? Are most of your patients very sick? Are you in a hospital where you may have ICU patients? All of this can affect you differently. Are you in mostly an outpatient center where your patients can come in and walk and talk to you? The volume of your testing, are you doing a high volume? You know, are you stressed because of that? And then the test types. So, some technologists may like doing the same type of test, you know, kind of over and over again. Someone may feel like that's monotonous. That may bring you down. You may want a variety of test types. So, all of these factors can affect the technologist's mindset. So, I just wanted to do some fun facts for a quick second about daylight savings time because that actually affects or kind of is a segue into what we're going to talk about as far as the white deprivation. So, with daylight savings time, let me see. We usually will hear spring forward or fall back. So, what daylight savings time is supposed to do is to make use, better use of daylight hours in the summertime. So, if you were to look at this map, you can see what's considered summer in the northern and southern hemispheres. Thirty-four percent of the world's countries observe daylight savings time. In all the states in the U.S., except for Hawaii and Arizona, observe it. Except for the Navajo Nation in Arizona, they do observe it. Several ancient societies adopted seasonal changes to make better use of daylight. So, this goes way back to ancient times, but winter is considered our standard time. So, when we think of fall back, we're just going back to our normal time. And that's where we want to talk about the light deprivation is in the wintertime. So, SADD, this is Seasonal Affective Disorder. And what this is, is an increase in depression noted during the winter months. So, Seasonal Affective Disorder is more common in people that already experience depression. However, it is good to note that this is a thing. So, if you notice that in the winter months or when it's fall or, you know, it's not light out as often, as long during the day, you may feel a little more down. This is a real thing. So, Seasonal Affective Disorder, and this is where you're getting less natural light, the days are shorter, and what is affected is your circadian rhythm, which is our internal clock. So, in our internal clock, serotonin and melatonin levels can be out of balance due to the lack of light, which can affect our sleeping patterns and in turn affect our mood. So, with this, I just wanted to kind of just talk about it because not everyone may know that there are things that do occur with the change of the seasons. So, how does this relate? I did find a study where rats were kept in the dark for six weeks. And what the scientists found when this happened was that the rats exhibited depressive behavior. They suffered brain damage in the regions that are underactive in humans during depression. So, there is a physical response that's happening in the brain. Neuronal death, so the neurons that produce common neurotransmitters involved in emotion, pleasure, and cognition were in the process of dying after the six-week period. And this was accompanied by a compromised synaptic connection. So, what the scientists are thinking is this may be the mechanism that is underlying seasonal affective disorder. So, if we were to compare that to the field of ultrasound, this is kind of a typical room. I know it's kind of an older picture, but in a typical room, we're going to keep that room pretty dark. The majority of sonographers do work an 8- to 10-hour day. And most of that time, you're going to be in the dark or in muted light to do your testing. You may or may not take breaks outside depending on your work schedule, the type of facility you're in, how many patients you may have. And in the winter, if it's cold outside, you may not want to go outside. We typically will prefer dimmable lighting to adjust in between patients. So, that would help in the fact that you could turn the light back up when you're not doing a patient, but some rooms don't have that capability. You're usually going to have a private room where it's just you and the patient, and you're going to shut your door or your curtain. And again, most of the rooms that at least I've worked in have no windows, or you would have dark shades to keep the glare off of your screen. So, that's your typical room that you would be working in an 8- to 10-hour day. I know personally in the hospital that I work in, we are in the center of the building and more on a bottom level. So, we're not near any windows. You have to walk a little bit of a distance to even get to the perimeter of the building where there would be any windows. So, we're just central in that building. So, when you have a lack of natural light, what could be happening? What are the effects that can happen in our body? And what I found from reading is that you can have a weakened immune system. So, we get that from vitamin D. So, vitamin D plays an important role in keeping our immune system up to shape by boosting immune cells production of pathogen-fighting proteins. So, when we have a weakened immune system, we're definitely more susceptible to getting the flu, a cold, other infections, which is not good, especially during flu season. It can also cause low energy, so a decrease in serotonin levels, which may trigger a state of fatigue. So, serotonin is the hormone associated with producing a sense of calmness and boosting mood. So, if you have a decrease in that, your energy and your mood can change. A lack of natural light can also cause weaker bones. So, again, your vitamin D, which helps your body absorb calcium and phosphorus, is decreased. This can lead to fractures and osteoporosis. So, again, if we're talking about our physical strain as well, I mean, we've got both factors coming into play. This can also cause weight gain, so a decrease in metabolism due to a decrease in nitrous oxide production. So, there are many factors that a lack of natural light can cause in our bodies. But what can you do during the course of your day? So, again, if you're able to, one option would be to make sure that you take your breaks and lunches first of all. But if you can take them outside or near a window with natural light, that would be the best thing to do. If you're working in a large facility, maybe try to go for a walk around the building or within your facility. Our hospital has a walking path, which is kind of on the main level. So, we get some sunlight through the windows. It's on a different floor of the hospital, kind of gets you out of your environment, which I think helps your mindset. If you can mix that up and step away for a moment when possible. Another option that I want to go into is light therapy. So, we'll talk about that next. So, when all else fails, you can try light therapy, which is also known as phototherapy or heliotherapy. And what that is, is exposure to specific wavelengths of light that can help improve your mood and treat depression. So, I did find a couple of studies that I just kind of went through. And what the studies show is that if you introduce yourself to fluorescent light, you know, certain times of the day, that can help mimic the sunlight that you're missing. So, some methods are using broad spectrum light, light boxes or lamps, light therapy glasses, and an infrared sauna. Light therapy, however, is FDA approved to treat seasonal affective disorders. So, there has been enough research on that that it is FDA approved. So, with broad spectrum light, it's full spectrum natural white light, and this mimics the sun. So, what this can do is improve your mood by increasing serotonin levels in the brain, which again will increase your energy concentration and elevate your overall mood. It can also improve your sleep. For those who have sleep disorders or insomnia, that is something to try. It boosts effectiveness of antidepressants as well, if someone's already taking an antidepressant. And this is most effective for those with seasonal affective disorder. So, in using that light, you can get a light box or a lamp, and this is the most common form of therapy because it can be used at home or work. You would look for lamps with full spectrum light, 5000 to 6000 Kelvin, and again, this would help to increase energy, reduce fatigue, and elevate mood. The suggested usage is 20 to 30 minutes per day, but you would want the lamp to be 16 to 24 inches away from you, and you definitely don't want to look directly into the box. So, just like you wouldn't want to stare at the sun, you don't want to stare at it. It's just more of a background presence. And to get the most, the best effect, you would want to repeat that daily. What I also read was that there are different color light therapies, as a side note. So, red, I believe it said red and green light is best for skin therapy, and then they have another light that you can use for migraines. So, that's something that if anyone is experiencing those issues, you can look into that as well. Light therapy glasses, now, these are not approved for treating depression, but they have shown success at increasing alertness in those with sleep disorders, such as narcolepsy. They're also used in preventing jet lag when traveling across time zones. So, just something a little bit different. And then an infrared sauna is a box that emits infrared radiation. And this can be used to increase mood by, again, increasing the serotonin levels and also relaxing the muscles. So, kind of a two-fold method. Just as a disclaimer, you always want to talk to a health care provider before trying new therapies. There are some noted side effects, and there are some conditions where you maybe would not want to use light therapy. So, just a disclaimer. So, I do want to kind of move into managing stress overall in health care. So, beyond the fact that as a sonographer, you know, we're correlating light deprivation to changes in our mood, beyond that, we're also in the health care industry. And that, in itself, can be very rewarding, but it can also be very stressful. So, we want to find ways to manage and be able to cope with that in the health care environment. So, different methods that can be used are meditation, aromatherapy, pet therapy, music, massage chairs, and break rooms. The study that I read focused on an informal meditation using an app as a possible strategy throughout the workday. So, I'm going to just go through that study and just show what these individuals found that worked. So, with that particular study, they wanted to describe stress. So, it was described as being tired, not being able to think clearly, feeling overwhelmed, and or anxious. So, in that study, 3,000 nurses were surveyed. 42% were emotionally exhausted. So, the app that was used was called One Moment Meditation. And what they did was they had 50 participants that volunteered. They were in all different fields throughout the hospital. And they kept a log for 10 shifts. Of the 50, 46 logs were returned. 38 people used the app. And they took premeditation and postmeditation scores, which overall show favorable to doing the meditation. So, based on what the study found, there was a positive impact of doing a brief meditation. So, one comment was, I find myself retraining my brain to focus on the present. So, that just brings you back to mindfulness of the present moment. The staff reported that when they're feeling stressed, a lot of it is anticipation of stress of the day. So, for example, I'm expecting a tough day. It's a Monday. I know we're going to be busy. You're kind of walking in already expecting that stress. A lot of the participants noted personal life issues. So, they may come in with issues outside of work. But the meditation helped them to calm and refocus on, again, the present. And several of the participants noted that they would plan to keep doing it. So, overall, I think that in healthcare, it's a stressful, ever-changing landscape. It's important to thrive and not just survive. So, if you practice mindfulness, which uses motivators such as self-awareness, body stretching, meditation, it can help focus on the here and now rather than expending energy on the past or future. So, you're not walking in expecting bad things to happen. You're not thinking about yesterday or tomorrow. You would focus on the now. And then meditation can be used for grounding, nurturing your inner thoughts and emotions, and then maintaining your self-control. Throughout the day, you may have difficult situations. You may be pulled here and there. But that can kind of help you refocus and ground yourself back. So, what we did was an internal survey that I created for our cardiovascular sonographers in our facility. So, I asked, you know, what are some of the things that you would do So, I asked eight questions and just kind of sent that out to everyone and just to get an overview of a real-time situation of what my coworkers were feeling. So, just out of curiosity. So, the results came back, and this is just kind of a snippet of what I found. So, the summary of the written answers, which I asked were, How many years are you in ultrasound? All respondents that sent back were more than 10 years. I was hoping to get a variety of some of the newer sonographers and older just to see if there's a difference in stress and anxiety based on how many years you've been doing ultrasound. But all respondents were over 10 years. As far as hours per week, the majority work 40 hours. Some are 32, a few are 24 hours. So, if you look, I know that these are a little bit small. But if you look, you can see that 90% of respondents did note that they experienced feelings of anxiety or depression at work. So, that's a huge percentage. Then I wanted to see, well, how many people work in the hospital? Because we have hospital and we have testing centers. So, the majority, 60% were the testing centers and 40% were hospital. Everyone said they do take their regular lunch breaks. And it was 50-50 on the question, do you listen to music regularly during your work day? I do remember that question and some of it was, oh, I had another question I just didn't add on here where I said, like, what type of music do you like to listen to? So, it was kind of a variety. Some techs would listen to what they were interested in. Of course, being mindful of the patients and making sure that it's appropriate. Some would listen to just musical, you know, no words. But 50-50. And then, as far as the question regarding lunch breaks, I asked, do you typically stay in your room or do you go outside during your lunch break? And 70% of people stay in their room. So, they're not getting out, they're kind of staying in the same environment, just eating their lunch and continuing to work. So, this final question was, do you feel that you would take advantage of mindfulness practices if you found something or, you know, if the opportunity presented itself? So, most of the respondents were interested or definitely would. A few said they would not. So, I found that that was very promising that we are interested in finding different techniques to help us throughout the day. But I also wanted to note that, again, 90% of the respondents felt stress, anxiety, depression throughout the day. So, unfortunately, there's roadblocks to everything whenever you do want to present something new. Some of these challenges that we may have are, of course, there's a mental health stigma in society. So, a stigma just refers to a negative attitude, belief, stereotype that someone may hold towards those who experience mental health conditions. And that is, unfortunately, something that exists. Stigmas can take many forms, from structural stigmas, which involve laws, regulations, and policies, public stigma, which include negative attitudes and beliefs, from individuals or from larger groups towards people with mental health conditions. Self-stigma is where it's coming from within the person with a mental health condition. So, people living with a mental health condition may believe they are flawed or blame themselves for having the condition and be less likely to seek help. When the stigma leads to discrimination, people living with mental health conditions may and oftentimes are treated negatively. For example, people may experience being excluded by others in their social groups due to their mental health conditions. So, with these stigmas, it may be harder for someone to seek help or express that they are feeling a certain way in society. So, what can we do is we want to try to dispel the stigma. By doing this, we would need policies and practices that would support people with a mental health condition to reduce barriers they face in the settings like the workplaces and healthcare. We want to have open conversations around mental health, and this includes using non-stigmatizing language when we're talking about it. We want to treat those living with a condition with understanding, empathy, and acceptance so that no one feels they need to hide. So, this doesn't just go for if we're feeling that we're having any trouble in our own lives when we're working, but a lot of our patients may be feeling this way or have conditions. So, I think that it's easy to have these stereotypes and these biases that come out, but if we really think about them as a person or think about what you may be going through, I think it helps to dispel the stigma, and then we can talk about it and have a better resolution or better help for everyone. So, beyond that, other issues that may affect healthcare workers as a whole are excessive workloads, workplace bullying, workplace culture that is unsupportive of well-being. It could be more of a mentality of you just get in, you do your work, not so much of how are you doing, and also inappropriate and difficult patients come into play. So, I wanted to just do a piece just on difficult patients and handling inappropriate behaviors because I think that we do all come across this as well, and I think this can weigh heavy on your mindset. You know, it can make the day be a lot harder when you do have difficult patients that you're with. Again, you're in that room usually by yourself with that patient. So, dealing with these patients can be emotionally and mentally draining as well as increasingly frustrating for practitioners and their staff members. Behaviors that you may see displayed are patients that have unrealistic expectations or demands. I think in our world, an example may be, tell me the result, or what do you see, or things like that. Some patients don't let up, that kind of thing. Some may exhibit rude, unpleasant, threatening, or aggressive behaviors that may potentially escalate over time into violence. Sexual nuances can occur. Patients who are making inappropriate comments will usually first test the waters and they'll make an inappropriate joke or a mild comment to gauge your response. So, if they are dismissed, they will likely continue with the inappropriate conversation if you don't address that. Inappropriate touch is anything that makes you uncomfortable. So, I just wanted to go through real fast this survey that I happened to find. It was a survey carried out in the UK. So, it included nurses, paramedics, pharmacists, admin workers, and cleaners in a facility. So, they got back over 8,000 responses. Of those 8,000 responses, it says 1 in 10 people reported being sexually harassed in the past year. Verbal abuse was 64%. So, that's unwanted remarks, jokes, that kind of thing. About 22% reported harassment and that they had been sexually assaulted. The majority of the nurses say they had been sexually harassed by a patient. Of those, 90% were female. Females tend to under-report their incidences. And then they did a look at physical therapy professionals and they completed a survey as well and there was an 84% prevalence of harassment. So, the psychological impact can be devastating for some and it says that more than half ended up isolating themselves or avoiding colleagues or situations at work. More than a third said the harassment affected their mental health or confidence and others, over 40%, have ended up wanting to leave their job. More than a quarter kept quiet about the harassment. Only 1 in 5 reported it to human resources. So, I think that a lot of things happen, it's not addressed, it's not talked about. So, we need to kind of do better with that because that can also affect our mental well-being. In general, what can we do? For the most part, we want to set healthy boundaries. You want to not accept that behavior. There's a fine line between allowing a patient the freedom to speak and setting a healthy boundary Bring a supervisor in if you need to to help set those boundaries and know that you are in charge and should feel empowered to stop your test if you need to. You should be able to do your job in peace. What can employers do? Advocate for the employee and help in setting these healthy boundaries and provide open communication for a more comfortable environment. So, just practical ways we want to nurture our mental health. We want to try to remove the stigmas. Recognize the trauma that was caused by COVID-19 and since then. If companies can conduct mental health screenings just to see how their employees are doing. Encourage the use of apps and virtual support or if a company has some type of support system that you can use. Recognize the signs of burnout in the employees and your co-workers and yourself. Implement relational leadership. Encourage self-care, that's very important and provide any resources that you can. So, the main takeaway from this evening that I hope came across is that health care as a whole is definitely rewarding yet can be very challenging on many different levels. It's just important to recognize this and be mindful the employers and the employees. Sonography in particular also deals with the challenges associated with the like deprivation which can affect mental well-being along with already proven physical strain of the field. It's important to make this a topic that we speak on and act on in ways that can help remove the stigma and provide support on all levels. Ultimately, this would, I feel, improve job performance and satisfaction. So, I just wanted to before I open up for any questions I just wanted to thank everyone for taking the time out of their evening I'm very happy, again, to have been able to present it and I hope that you were able to take something away from it. Thank you, Erin, for that presentation. Personally, I never even thought of mindfulness practice like meditation or light, for example, as something to give myself. I just always figured that more help was the only solution but some of your points are really great ideas to try since, again, in many cases the outlook for adding staff is bleak. Right. If there's time in the day or if anyone just even has a moment there are apps or even if you can just try it at home and just see if that helps as well. Yeah, definitely. Sometimes when you were talking about that I was thinking sometimes the patients are lovely but it's their family that stresses you out. Yes, you have that as well. I think it's hard to set boundaries but I think if we have support of managers or just if we can set expectations before you start the test maybe that can be helpful. Have you ever had any conversations with your administration about that type of support that you need that? I know with our company they're pretty open. We talk with our managers and they're pretty easy to get a hold of if we need them. There's not anything truly set in place per se but I think that they are supportive if we do come to them with any issues. I know our hospital is really good about having wellness benefits and things of that nature. They have employee health benefits where you can talk to someone or things like that. That's great. Thank you.

sonographers

mental health

stress management

burnout

Seasonal Affective Disorder

workplace policies

mindfulness

wellness resources