FEATURE Take a breath References Arnsten, A. F. (2009). Stress signalling pathways that impair prefrontal cortex structure and function. Nature reviews. Neuroscience, 10(6), 410–422. https:// doi.org/10.1038/nrn2648. Bradshaw, P. (2019) Good communication reduces risk of a complaint or claim. BMJ 2019;367:l6160. Briñol, P., Petty, R., and Wagner, B. (2009). Body posture effects on self-evaluation: A self-validation approach. European Journal of Social Psychology. 39. 1053 - 1064. 10.1002/ejsp.607. British Medical Association, (2021) Medical staffi ng in England report. Available at (Accessed 4th January <strong>2022</strong>). Emergency medicine is amongst the most stressful, challenging, and demanding specialities within healthcare. It’s faced paced, dynamic with life and death responsibilities bestowed upon clinicians who are often working long, unsocial, and mentally taxing shifts. Handovers, especially pre-alerts, within this department often involve individuals wanting lots of information from you in a short space of time and expect you to deliver it clearly, accurately, and concisely. However, when placed under conditions of stress, the brain’s primal fi ght or fl ight center (amygdala) activates and suppresses the brain’s thinking center (neocortex) meaning that it is very diffi cult to think logically when you’re stressed (Arnsten, 2009). This explains ‘exam phenomenon’ where individuals can easily recall knowledge outside of an assessment setting, but once placed under stress (exam conditions) they can become unable to think, act and perform. In order to combat this, experts recommend engaging in box breathing. Box breathing, or deep breathing exercises, have been proven to stimulate your parasympathetic nervous system and calm your amygdala (Ma et al, 2017). By doing so, it allows your neocortex to reestablish dominance and provide you with the ability to think clearly (Ma et al, 2017). So, when you arrive at hospital, start deep breathing so that by the time you are ready to deliver your handover you are calm, confi dent, and focused. Hereen, A., Ceschi, G., Valentiner, D.P., Dethier, V., and Philippot, P. (2013) Assessing public speaking fear with the short form of the Personal Report of Confi dence as a Speaker scale: confi rmatory factor analyses among a Frenchspeaking community sample. Neuropsychiatr Dis Treat. 2013;9:609-618. Loseby, J. (2013) Clinical handover of the trauma and medical patent: a structured approach. Journal of Paramedic Practice. Ma, X., Yue, Z. Q., Gong, Z. Q., Zhang, H., Duan, N. Y., Shi, Y. T., Wei, G. X., and Li, Y. F. (2017). The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults. Frontiers in psychology, 8, 874. https://doi. org/10.3389/fpsyg.2017.00874. Manias, E., Geddes, F., Watson, B., Jones, D., and Della, P. (2015) Communication failures during clinical handovers lead to a poor patient outcome: Lessons from a case report. SAGE Open Med Case Rep. 3:2050313X15584859. Marie Curie. (2016) A long and winding road. Improving communication with patients in the NHS. Available at (Accessed 3rd January <strong>2022</strong>). Nair, S., Sagar, M., Sollers, J., 3rd, Consedine, N., and Broadbent, E. (2015) Do slumped and upright postures affect stress responses? A randomized trial. Health Psychol. 2015 Jun;34(6):632-41. doi: 10.1037/ hea0000146. Epub 2014 Sep 15. PMID: 25222091. National Health Service. (2018) Overview - Generalised anxiety disorder in adults. Available at (Accessed 4th January <strong>2022</strong>). AMBULANCE <strong>UK</strong> - AUGUST National Health Service. (2021) Agenda for change - pay rates. Available at (Accessed 3rd January <strong>2022</strong>). National Health Service. (2020) Social anxiety (social phobia). Available at (Accessed 4th January <strong>2022</strong>). Offi ce for National Statistics. (2020). Personal and economic wellbeing in Great Britain. Available at (Accessed 4th January <strong>2022</strong>). Taylor, M. (2020). Why is there a shortage of doctors in the <strong>UK</strong>? The Bulletin of the Royal College of Surgeons of England. 102. 78-81. 10.1308/rcsbull.2020.78. 106 For further recruitment vacancies visit: www.ambulanceukonline.com
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