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Wellness is a state of mental and physical health and includes a balance between and work and personal life. In emergency medicine and nursing, there are many challenges to achieving a healthy state of being. Professional stress can negatively affect personal physical and mental health. Yet the benefits of attaining self and situational awareness in order to enhance work/life balance can enhance enjoyment and extend careers. Additionally, healthcare workers in a state of wellness, including good mental health, are better able to provide safe quality care for their patients.

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Emergency physicians and nurses spend more of their waking time at work than in any other single activity, and yet it is clear how important enjoyment of personal time is to a fulfilled life. As author/rabbi Harold Kushner has written1:

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“No one on his/her deathbed ever expresses the desire to have worked more or harder.”

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In order to more deeply understand the concept of this vital balance between work-life and home-life, it is helpful to start with several definitions (Table 13-1).

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Table 13-1 General Definitions of Balance, Wellness, Health, and Mental Health
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Stress and “burnout” are more likely to occur when individual providers do not have or develop work/life balance (wellness) strategies and when the workplace environment does not provide organized resources to address the stress. Emergency caregivers, in particular, are exposed to enormous stress as they must care for patients who may have life-threatening disorders, demand immediate attention, expect unrealistic outcomes, and who always arrive unscheduled. It is stressful to provide unscheduled care on a shift work basis in high-acuity, time-sensitive situations. An intact workforce capable of adequately performing its mission requires competent, healthy, high-functioning professionals.

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Hans Selye, an endocrinologist and Nobel Prize nominee, defined stress in his landmark book The Stress of Life.2 Acknowledging the contributions of the great physiologists Claude Bernard (who developed the concept of the “milieu intérieur”) and Walter Cannon (who described the body's “homeostasis”), Selye wrote that stress is a nonspecific response of the body to any demand. His work describes stress as potentially positive or negative, and that stress leads the body to various pathways of response, the “General Adaptation Syndrome” (Table 13-2).

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