Peplau's Ghost
Psychiatric-Mental Health Nurse Practitioners (PMHNP) discussing using psychotherapy within their practice. Four PMHNP program directors and a biostatistician from across the Unites States sharing their passion on how psychotherapy can help people with nearly all their emotional problems.
Peplau's Ghost
Seven C’s, No Seasickness: How a Navy nurse (Dr. Richard Westphal) built a peer-support model that actually works
A sailor on a dark deck, a torn letter, and a young corpsman learning to spot distress without a sound—that’s where our conversation begins. From that simple observation grew Stress First Aid, a peer-driven framework that replaces stigma with language people can use in real time: green, yellow, orange, red. We sit down with Dr. Richard Westfall to unpack how one napkin sketch—and a crucial shift from “disorder” to “injury”—reframed leadership, changed how teams support one another, and brought practical mental health tools into the flow of work.
We walk through the seven C’s of Stress First Aid—check, coordinate, cover, calm, connect, competence, confidence—and show how they function like ABCs for the mind. You’ll hear why safety and calming come first, how to use connection without turning into a therapist, and why “help me understand” is one of the most effective lines you can carry into any shift. We explore meaning versus mattering—how purpose draws us in, but feeling valued keeps us—and discuss what burnout teaches at different stages of a career. Novices need micro-burnouts to learn limits and recovery; veterans crash bigger because they ride the wave longer. Neither is failure. Both are predictable—and coachable.
Dr. Westfall shares field-tested ways to use the color continuum in emergency settings to de-escalate quickly, and we talk about building cultures where peers step toward distress instead of away from it. If you lead a unit, precept a new clinician, or simply want better support at work, you’ll leave with language and structure you can use today: focus on safety, calm the body, connect as trusted others, build capability for the next hour, and restore confidence by reminding people they matter.
If this resonated, follow the show, share it with a colleague who could use the Seven C’s, and leave a review with one takeaway you’ll try on your next shift. Your story might be the cue someone else needs to move from orange back to yellow.
Let’s Connect
Dr Dan Wesemann
Email: daniel-wesemann@uiowa.edu
Website: https://nursing.uiowa.edu/academics/dnp-programs/psych-mental-health-nurse-practitioner
LinkedIn: www.linkedin.com/in/daniel-wesemann
Dr Kate Melino
Email: Katerina.Melino@ucsf.edu
Dr Sean Convoy
Email: sc585@duke.edu
Dr Kendra Delany
Email: Kendra@empowered-heart.com
Dr Melissa Chapman
Email: mchapman@pdastats.com
Yeah. Just my take on things. My answer number two. Identifying challenge in your beliefs. I discovery. Identifying challenge in your beliefs.
SPEAKER_03:I think we're recording. Welcome everybody. Back to another episode of Keplow's Ghost. And uh super excited to join our next guest here, Dr. Richard Westfall. You know, he's one of those guests. You know, I've been, I think all of us have been really looking to get on the podcast as soon as possible. And today is our day. So I'm really excited to have everybody joining us today. Um, Dr. Kate Molino from University of California, San Francisco, Dr. Melissa Chapman-Hayes, psychologist from Minneapolis, and Dr. Sean Convoy from Duke, um, who Sean and uh Richard have a close relationship. We'll try to keep them from getting too uh personal in their conversation. We'll see how that goes. But um, but again, very uh very excited to have Dr. Westwall here. Um he is a nationally recognized leader in mental health, trauma, and occupational wellness. Um, I believe he is a retired professor of nursing from the University of Virginia. Just recently. Just recently, congratulations. Um, and I assume still co-directs the university's wisdom and well-being peer support program, um, holds dual certification as advanced practice psychiatric nurse practitioner focusing on trauma, stress, loss and grief, end of life, and mental health promotion. Dr. Westfall served in the United States Navy for 30 years and had many roles there. We'll get into probably today. Um, and again, is widely known for co-developing the stress first aid model, a peer support uh framework designed to help clinicians and health professionals identify and respond to early signs of stress injury. Um, so again, thank you so much, and and please join me in welcoming Dr. Richard Westwall. Thank you so much uh for being here. That's uh it is a privilege for me. And um, so let's get started. You know, you've worn many hats in the Navy, psychiatric nurse practitioner, policy advisor, and professor. Um, so let's start. You know, where what drew you to the work of mental health and resiliency?
SPEAKER_04:Well, Daniel and team and colleagues, thank you very much for the invitation. I'm really excited uh to be here. And uh as as most stories and as many sea stories start, uh once upon a time, and I was a Navy hospital corpsman. I was trained as an operating room technician, but learned that I really didn't like being in the operating room. It's really hard to have a deep, meaningful conversation with your patients when they're necessitized. Uh, and and so fortunately I was assigned to a ship rather than an OR. And what came out of that experience is I recognized my ability to sense and understand when shipmates and colleagues were in distress and positioning myself in the right place at the right time. So, an early mental health intervention is that we would have mail call on board the ship. There's no email. It took six to eight weeks for a letter to get to the Pacific. And after mail call, I would go out to the back of the ship, the fan tail of the ship, and I would watch the sailors. And the sailors that got the Dear John letter, because we were all male at that time, and threw it up in the air. I really didn't worry about the sailor that threw it down into the wake and into the screws and then watched it for a while. I wondered about that particular sailor. And so, isn't that the foundation of nursing and psychiatric nursing intervention? We observe, something tells us this isn't right, and we approach and say, hey, help me understand. And so that was my first inkling of uh getting into uh psychiatry and mental health uh aspects. And uh I really learned and understood that this was going to be my calling when I was in nursing school at the University of Minnesota, and I was doing my psych rotation and my classmates linked arms and going lions and tigers and bears, oh my, as they're going to the diagnostic lock unit at the University of Minnesota. And I'm going, cool. Uh so that so that was my first sign. And then uh I'm I'm I worked pediatrics, I worked oncology, pediatric oncology and uh hospice, and I was the type of nurse that my med surge colleagues hated to follow. My charts were a mess, I didn't have things cleaned up, ready to hand off, because I spent too much time. I was literally counseled because I spent too much time talking to patients and families. Uh, so I figured I'd better go into an aspect of nursing that actually rewards me for that. And so in 1983, so here we are, 40 years later, that I uh was cross-trained to psychiatry. I was a very junior uh officer, and uh they kept telling me, well, we don't put ensigns in psychiatry, that requires an advanced skill. And so, as a good psychiatric nurse, I recognized what the pattern was, and I said, I really don't want to work there. However, I think it would be useful if you cross-trained me in case you needed an extra set of hands. I'm I'm I'm willing to do that if the organization needs it. Uh, so they cross-trained me in the week uh after I completed cross-training, a lieutenant got transferred to Okinawa, and I'm now working in psychiatry. And I have been working inpatient and as a psychiatric nurse uh since that time. So that's that's that's a bit of my my background that that pulled me into this.
SPEAKER_03:I love that. I mean, it's it's you know, it's it's usually I'm kind of always thinking in these podcasts, you know, what's a good title? And maybe we've already hit it, you know, the right place, right time, I think is a is a great, you know, thing. And I think that people who are open to those kind of experiences, it it reminds me, I I worked with a psychologist once who was working at the Red Cross, and and he told me when you came there, he was not told to, you know, go get a room and go start counseling people. He was said, go buy the um coffee or the water cooler and just kind of mill around there, and you'll hear stories, people will share their things. So it very much reminded me of those uh dear John letters that you were kind of seeing going on, too. So thanks. You're welcome.
SPEAKER_02:Dr. Westfall, I um gonna ask, I'm gonna ask two things of you. One, could you uh uh uh for those of you who are not aware, Dr. Westfalls was the co-author of Stress First Aid. So I'm gonna ask Dr. Westfall if you please give us your napkin story, followed by uh the uh how do I say this? Give us an elevator speech for anybody who's not familiar with Stress First Aid as to what it is and what it's designed to do.
SPEAKER_04:Wow, what a challenging question. I can talk about this for 15 weeks uh continuously, ask my students. Okay, so uh Sean mentioned a uh a napkin story. So I had completed my uh dissertation in 2004 at the University of Virginia, and I was the head of nursing research at Portsmouth. So that was facilitating nursing research for Navy Medicine East, the Eastern Seaboard and the Mediterranean. Oh, what a sweet gig. This is going to be how I was gonna wrap up my career. And my dissertation work was around this idea of stigma and career harm. Why do sailors and marines and service members not get access to mental health services? Because when you take a look at the typical dynamics of what is a barrier for mental health services, lack of insurance, lack of access, that didn't exist in the socialist republic of the Department of Defense. Uh, we had uh socialized medicine. So those barriers were not relevant, and yet we had this fundamental underutilization. As I was looking at the research, what kept coming up was fear of career harm was the major barrier. Well, I've been enlisted on board a ship, I'd been a psychiatric nurse in the Navy for probably 20 years at that point in time, and it did not ring true to me. As a mental health professional, something was off about that. And the beauty of the Navy is on a ship, I know exactly who can cause career harm. There's only two people, the command master chief and the commanding officer. The rest are bit players. And so I did a study about this idea of stigma and career harm. And what I discovered through that, I used a uh Foucault discourse analysis looking at power and social structures. Uh, and what I discovered from that is that there was these discourses. There was the discourse of fit for duty, whatever that meant, but basically being able to show up and nobody questioned whether you're competent to show up or not. And then there was unfit for duty. And these were individuals either organizationally or by you know self-report that said, I can't do this job. But when you take a look at the reality, most people function in the space between. Most of my career, I've not been 100% ready to show up to work, but I did it anyways. Uh, and and often my friends and my colleagues helped me through when I was in that space and I helped them. And so I knew that there was this social space between being green, ready to go, and red, all stop and not. And so um I'm now at a uh nurse, the Navy nursing conference in San Diego. This is the fall of 2006. I'm sitting at a table with uh Admiral uh Christine Bruce-Cohler, who was the the Admiral of the Navy Nurse Corps, the senior most officer in Navy nursing. And I I actually had a uh young ensign who's a psychiatric nurse sitting at the same table. Uh her name is Jean Fiesak, and and and Jean is now a full captain, has been a commanding officer. And so she gets to bear witness to this. And we're having a discussion about the stress of Navy hospital corpsmen and Navy nurses. So this is 2006. We have been continuously deploying individuals to Iraq and Afghanistan since 2001. We are well past the exhaustion point of most militaries. And when you take a look at military medicine, in particular Navy medicine, uh, we would deploy 25% of our healthcare workers to combat, and the remaining team members had to pick up all the extra effort. Uh, we had no opportunity to let down on the care that we were giving to our family members and our service members, and our severely combat wounded returning to our military hospitals. And then in six months, another 25% would uh rotate. So here we are by 2006. We have had well over 75% of all of our active duty healthcare personnel who have been deployed to war and back, some even two and three times. We were not okay. And so I wrote on the back of a napkin, Admiral Brussel Kohler, I've been thinking about this, and I think we're talking all wrong. We're using the wrong language here about our team members. And we expect people to be in the green, able to do their job, and we only get concerned when they're red. And then we have policies about medical boards and loss of career and whether they can function or not. But most of our team members are in the middle. So, what if we use this stoplight metaphor, green, yellow? And it said, there's something more in there. I'm not sure what to call it, and and and red. And she said, Well, uh, you know, Captain, that's really interesting. Um, you know, thanks for sharing. And I figured, oh, that's the end of it. I get to go back to my dream job. Uh, so then in uh December of 2006, I get a phone call from her assistant and said, uh, Richard, we'd like to have you come up to the Bureau of Medicine and Surgery, think of it as a Pentagon tour, uh, and and uh help you know do the work around taking care of our nurses and our hospital corpsmen. And my response is, I've spent most of my career avoiding Washington. I really don't want to go there. And I said, okay, um uh what if I say no? And they said, we'll move you anyways. And I said, Well, hey, is that position in Washington still open? And well, Captain, I'm glad you asked. It just happens to be. So I ended up moving my family uh from our quote retirement home and up to Washington, D.C. as the market's crashing and DC prices are high. So it's all this cacophony of chaos uh at this time. And then there was this really strangely wonderful thing that happened. It's only wonderful because of the opportunity it provided, and that is in February of 2007, the Washington Post ran an expose about the Army housing uh soldiers with traumatic brain injury in condemned buildings, uh, Walter Reed Medical Center. And that made the front page of the Washington Post. So Congress then decided to uh act. And we then had a$2.2 billion earmark in the Katrina Recovery Act shifted to support the uh PTSD and traumatic brain injury treatment for uh service members. Okay, so that's a that's a flush of money. What's really interesting, you think about federal funding and the chaos that's going on right now, the Katrina Recovery Act was not DOD money. The color of money was wrong. We had no authority or rules to be able to execute it. So here's the wonderful thing. I'm the functional program manager for the Department of the Navy of this fund. Give a psychiatric nurse access to$120 million with uh outsuitable controls, and we can make something wonderful happen. And that's something wonderful. Is I had a great team that I was working with, and my sole guidance to my team, because we we were getting proposals all over the place, uh, coming out of businesses and anybody that wanted to make a buck. And so I instructed my team if we cannot trace the benefit of this program to the E1 in their family, our most junior sailor and marine in their family, we will not fund it. Everything must be able to show benefit to that particular group. One of those projects, and Sean, I'm getting around to answering the second part of your question. Uh, and one of those projects uh happened to be this idea of stress first aid. And we started to do a uh, I was working with a team, we were uh writing uh the combat operational stress control doctrine for the Department of the Navy, all sailors, all marine. The lead author on that was Dr. William Nash, a Navy psychiatrist. This is a government document, so you know uh we we we don't get credit for the the work that we do. And one of the things that Bill had presented, and it fits very nicely with this idea of discourse and paradigm shift, in that he posited that we have service members that have a stress injury, not a disorder, and that a stress injury can have as severe a functional impairment in the short term as a disorder, if not more, without necessarily having people who are disordered. Why is that so fundamental? Well, if you think about military culture and discourse, you cannot have disordered people in an organization dedicated to order and discipline. And so what would happen is that as a line leader, I would have a moral obligation if I had a subordinate who had a disorder to remove them from my unit as rapidly as possible, get them to medical care, because that's the morally right thing to do as a leader. However, as a leader, if I have a subordinate who injured their ankle while playing softball at a command event, I am morally obligated to engage and support my team members that have been injured. So this idea of moving the discourse from disorder to injury shifted the moral prerogative and paradigm across the entire department of the Navy. That is a fundamental and powerful organizational shift. Well, what came out of that dialogue, uh, and I love working with uh uh Marines and in particular, and uh both the Marines and the senior enlisted um sailors, in essence, said, So, Doc, if we can have a service member with an injury, what's the first aid for the injury? Because the other core truth in healthcare and across the world is that when someone is injured, you apply first aid. I was a Boy Scout long, long before I ever went in the Navy. And the first thing I learned was you know, first aid, airway, breathing, circulation, the fundamentals of first aid. We teach it to children. And so now we had this request: well, what's the first aid? And so I led a team that included uh Dr. Bill Nash, Patricia Watson, uh Brett Litz, and myself. And we used some of this uh uh psychological health and traumatic brain injury funds to really do a deep dive and develop and test and evaluate the stress first aid model. Okay, now for the elevator speech. That's just the history. What is the stress first aid model? Stress first aid has three components. First, we have a stress continuum. We talk about stresses green, yellow, orange, and red. And it's a non-stigmatizing heuristic that allows people access to self-identify or identify where the team is at in this color scheme. There are four sources of stress injury. Burnout's just a subset. There's fatigue, there's loss, there's trauma, and there's something that we called inner conflict. It maps to moral distress and it maps to moral injury. And so when someone is injured, what is it that we can do in the immediate moment to be able to um uh enhance safety and prevent further harm or first aid issues? And then we developed stress first aid model. It came out of uh the literature by How Fall Watson Bell at all in 2007 that they identified that there's five essential uh needs that people have when facing high stress um uh domains. We were developing stress first aid for Navy hospital corpsmen. Think about 17, 18-year-old kids with really good intention in really scary places. And we needed to make it easy and accessible. And so we developed seven C's. I know I'm a sailor, there's seven C's, it rang true with the Department of the Navy. So uh it it it it hell. So the thing that we added to this, which is really unusual at the time for any other um psychological intervention, think of critical incident stress management, for example, it was all based upon an assumption that if somebody had an experience, there was the assumption that they needed something, and that's not necessarily true. So the very first C is check assessment, the next is coordinate, very much like other forms of first aid. We do in first uh uh BLS, any any or U O K get to AED. Um, that's what we do all the time. Then the next set of C's is the things that we must pay attention to whenever they're there, they're primary primacy, and that is cover and calm, safety and calming. How many times as psychiatric uh professionals have we been with a patient in crisis? And the first thing we think about are they safe? Am I safe? Uh, how do we make safe? And then take a deep breath, slow exhale, you're not alone. I know this is uncomfortable for you. So those of us as mental health professionals use uh cover and calm very much automatically, but that's really an airway breathing and circulation aspect of stress first aid. And then the final three C's is about how we transform and recover from stress and how we can also develop capacity to engage with workplace stress, and that is connect, social support, lots of literature about social support, competence, competence and coping. This is very much a uh uh AA 12-step model. Uh, can I make it through today? Uh, kind of thing, but also competence and having the skills to do the work that I need to do. And then this last one is confidence, which relates to meaning and mattering. And I'll I'll I'll just segue a little bit here. Uh, just recently, been doing more work and thinking about this idea of meaning and mattering. The meaning of what we do brings us to our work and is really important for the novice. Whether we matter or not keeps us in our work and is really important to the experienced professional. Most of our organizations bank on meaning. Well, it's meaningful to be a nurse, a doctor, or a clinician, and therefore we don't have to pay you as much because it's really meaningful work. Uh, and when you take a look at burnout in organizations, often what happens is that the organization is undermining mattering. It doesn't matter. I don't matter. So that's a quick overview of stress first aid, probably longer than what you wanted, uh, but I'll pause there.
SPEAKER_02:Actually, it's exactly what I needed and what I expected. I'll pass it to Katie. Thanks, sir.
SPEAKER_05:Thank you, Dr. Westfall. It was so amazing to hear about the development of all of how all of this came together. And I think as you were speaking, I realized that I'm so familiar with this model that I it is just sort of a taken for granted, you know, in in my practice and um, you know, working with lots of other people as well. I I want to ask you a little bit um about you know, one of the C's you mentioned, which was Connect and Peplaw called the nurse-patient relationship the foundation of practice. So my question is how does the peer support aspect, like what you're doing with the wisdom and well-being program, extend or reimagine that idea?
SPEAKER_04:So when I think about Peplow, uh one of the uh quotes I teach or taught theory. Uh and in Peplo's interpersonal relations theory, one of the things that stands out is that nurses did not have the authority to use a therapeutic voice. They were not allowed to speak therapeutically to patients. We we talk to patients all the time, but not therapeutically. And so what Peplow was able to do was to break that paradigm and thus uh really usher in the initiation of advanced practice nursing and psychiatric nursing. And what's fundamental to her uh interpersonal relations model is really this idea of making a human connection. And I I would tell my hospital corpsman and my novice nurses that uh as psychiatric nurses, we are knowledge workers. Our physical skill set is actually rather minor and rather simple. It's straightforward, but we're knowledge workers. And we also are have a responsibility for what I called rational translation. If I have a patient sitting in a corner, clapping their hands, going, and the devil and the devil and the devil, it's my job to figure out what that means. This is their best attempt at trying to communicate their needs. And so, as a psychiatric nurse, as a mentor, as a professor, I I've always used this idea of Peplau's interpersonal relations about what is that human connection? And so, how does this get woven into stress first aid then? Well, when we think about connect, historically in our culture, if we have a coworker that's having a bad day, we would say, sucks to be you. I'm gonna give you space and I'm really not gonna talk uh to you. Versus in the stress first aid model, it's we have a moral obligation to each other, our team, and our patients to talk with each other, to call attention to. And we first make the uh that connection, uh, it's built into check, it's built into calm, is really at an interpersonal level. One of the most powerful and ironically frequent ways that I have used Connect, even before we dreamed of what stress first aid uh would be, is I would have a peer who was in the medication room crying. By the way, that's a favorite spot for a lot of nurses to cry. You go in the bedroom, you're not supposed to be bothered, and that's where the silent tears can come down. Uh, and as a colleague, I pull alongside, touch shoulder to shoulder, and I would simply say, help me understand the tears. And so what that does, and so what we teach in uh stress first aid is you recognize someone's in distress, you don't confront, you come alongside, and you share space, empathy, understanding in that moment. And we build the relationship. We also talk about the difference between trusted and untrusted others, and and this goes to the the really the the I think one of the heart of Peplau's teachings is that our integrity as mental health professionals is absolutely non-uh negotiable. And my patients don't need to like me. Matter of fact, the number of thank you cards I've received across 40 years of psychiatric nursing is really, really small. Um and and and I don't always like my colleagues, and my colleagues don't always like me. However, we're always in a circumstance where we can say, your face is red, your veins are uh pulsing, your fists are clenched. This is a new look for you. Help me understand. I just witness that person yelling at you, that really made me uncomfortable. Help me understand how you're doing. And and and so what we do is we call attention to the behavior and then assess. We ask, how are you doing? So I I I hope that helps identify how I perceive connect, intersecting with Peplau's teaching and this idea of interpersonal relations.
SPEAKER_00:Thank you. Um I'm gonna take a different angle here and ask you. Um, so many of our listeners are practicing nurses and students, and if they're feeling stretched thin. Or even questioning whether they can keep going. What's one piece of wisdom you'd want to leave them with?
SPEAKER_04:Oh, uh uh Melissa, thank you for asking that question. Um, many people misunderstand me when I do this. They think I'm I'm uh uh maybe a little callous. Um, but I I'll listen, I'll I'll say to my students or or the young nurse, you know, you're really looking uh uh distressed, help me understand what's going on. And what I will hear most often is a variation of I didn't think it was going to be this hard. And we start to see echoes, the honeymoon is starting to get over. And the reality of what healthcare work is, and particularly for nurses, is and I don't think I can do this anymore. And so the follow-up question, what do you mean by this? Let's let's be really specific. And I will listen, I'll pause, and then my go-to line is congratulations, you're right on time. And what you're going through is expected. And when we think about burnout in particular, burnout gets such a bad rap. Um, and I think burnout is absolutely necessary early in our careers. This is how we learn where our limits are. And I I've never been able to teach a student, this is your burnout point, step back from it. It's, oh, I'm exhausted, I'm tired, I can't do this anymore, my paper's late, whatever it is, or I can't deal with this patient anymore. Congratulations, you're right on time. So early in our career, we need to have these micro-burnout periods, these periods of exhaustion that forces us to do soul searching and really ask ourselves, why am I doing this? And should I continue to do this? You know, we we have some colleagues that never really asked that question, and they should have asked that question really earlier in their careers and changed careers. Uh, and and so, why am I doing this? And when we when when I talk with them about you're right on time, early in our careers, we use this to learn where our limits are and our skills for recovery, what works for us. Um, and what's interesting about that, when we get more experienced and seasoned in our careers, we burn out more spectacularly. Because we've learned to ride the wave of exhaustion like a master surfer. And when we crash, we just we do it so wonderfully. Uh, and and why I bring this up is the dynamic of occupational stress and coping during the first four years of practice is fundamentally different than after four years. That four-year mark, absolutely, there's a fundamental change of how people perceive themselves. Because part of it, before for four years, if they leave the profession, whatever profession they're in, it's really an identifying that it for whatever reason wasn't a good fit. Now, unfortunately, we lose some really good people when we don't have to. Uh, but those who choose to stay after four years have done a little bit of soul searching and in essence have said, I know that sometimes this really sucks and it's hard. But I also know that I make a difference and I matter. So I think I can do this. So as a mental health professional, as an occupational stress specialist, even when I think about the stress first aid model, the discourse that we have with novices needs to be really different than the discourse we have with competent, proficient, and expert uh uh professionals. I hope that helps.
SPEAKER_00:Thank you very much. Thank you.
SPEAKER_03:Yeah, thank you very much, Dr. Westfall. This has been, man, I wish I could go another hour at least. I mean, I I know we've got kind of schedules that we're pushing up on against, but uh I, you know, I've written down several things, just kind of things that you had mentioned, and just you know, I mentioned one right place, right time. Obviously, we got the napkin story, you know, moving from disorder to that service-connected injury. Um, you know, I I love that idea of, you know, help me understand. Um, you know, I you know, I'm sure each of us could probably talk about that, but I remember, you know, early in my career, you know, having a psychologist come into my room and just flat out start crying, you know, it was the end of the day and it just completely and just, you know, she was early in her career, I was early in my career, so I didn't have maybe, you know, the the expertise to give her what she needed, but it was just maybe the space and allowing her to kind of express that. But uh I still work with her, so she made it past that four years you mentioned. So that's uh that's a blessing. But uh um, but I'll never forget that. That's one of those things. And uh uh and I love that. Congrats, you're on you, you're right on time. I'm those are things I'm gonna I'm gonna stick away in my my little toolkits and uh and share, and I'll I'll give you credit through each time I try to at least. So thank you. But but thank you very much for being on this podcast. I really appreciate your time and your expertise. Um, this has again been very enlightening, and uh, I know the listeners are gonna find this just super engaging. So thank you so much. And again, look for another episode coming out soon on Pep Lao's Ghost. Make sure we like, subscribe, and and please, please add comments. We want to hear from who you want to hear from next. And and sounds great. Sean, one thing.
SPEAKER_02:One thing. I just uh shameless plug. Dr. Westball's gonna be talking about stress first aid at the American Psychiatric Nurses Association national uh con conference uh later this month. So if anybody's interested, get them on your schedule.
SPEAKER_03:Yep, yep, absolutely. Nice plug, good job. Yep, so excellent. So otherwise, take care and thanks so much and listen to another episode. Take care. After dark with Pabla's ghost.
SPEAKER_04:Oh sorry, keep going. Oh no, no, uh a lot of my colleagues do that when you trust first date after dark. It's all right. So so Daniel, you talked about that you had a colleague, you're both early in your career, she comes in and she's crying. You don't quite know what to do, she doesn't know what to do. However, the peer support in that moment was more powerful than going any place else. You were probably the only trusted other in her immediate sphere and needed to connect with another human being. And so that's why we developed stress first aid in that we knew it would be the power of peers coming together. And so we never teach people how to talk to each other, we teach people what do you talk about? You talk about safety, you talk about calming, you talk about being connected, you talk about whether you have competence to do whatever it is you're supposed to be doing. And we talk about why do I keep doing this? Why should I come back tomorrow? And those are the things that we try to train 18, 19-year-olds to be able to do in the moment. And I bet those were some of the very things that you talked about or at least listened to in that moment many years ago. So I I just felt the need to to you know say that one. So thank you very much, all of you. It's been uh a pleasure. Um, obviously, I can I I have many more stories. 33 years in the Navy, I get a C story for every year. So I've got like 31 episodes left in me.
SPEAKER_03:Um, let's book it now. That's great. No, that'd be excellent. Awesome. Thank you again. This yeah, it it is it's one of those, you know, it's it's you know, sentinel memories that I'll have, you know, early in my practice. Because I honestly, I remember there was a seasoned psychologist that was it was the end of the day. So, you know, everybody's, you know, the office is dark and you know, just kind of everybody's closing up. And and there was a seasoned psychologist there too. And and she came in and just kind of collapsed. And I remember the the seasoned psychologist, which I kind of looked to like, help, you know, my eyes were kind of like little, but help me. And he just kind of walked away. And I was just kind of like, oh, okay. And then and like you said, I I just I didn't know what to do. So I just kind of was there. And uh, but yeah, I again, those listening and and hearing this, I hope we'll take away a little bit more and uh have that because again, those things happen early in our career so often. I mean, I'm sure Kate, Sean, Melissa, I mean, you guys could tell stories about this too. It's uh very much you know part of what we grow up in.
SPEAKER_00:Yeah, I know you're talking about nurses, but as a non-nurse, and honestly, the universe is funny. I something happened this morning that this for me could not have been a more timely episode. I mean, the occupational mental health challenges. Uh, so thank you.
SPEAKER_04:You're welcome. Good to go there.
SPEAKER_05:You know, I was gonna say it this really I have spent a lot of my career working in um the psych ICU, the acute impatient unit, psych emergency settings, and this is just so relevant to that. I mean, there's so much, so much moral injury and burnout and and things that go on in those settings. And uh yeah, Dan, your story absolutely resonates with me and and this entire model is so useful for so many um different types of situations.
SPEAKER_04:So, Kate, I'll just put in a plug. I did a rotation at uh um the San Francisco General Psych Emergency Room.
SPEAKER_05:Oh, yeah.
SPEAKER_04:And and and so uh when I think about the stress continuum in these images uh behind me, that we're having hospitals and locations starting to put up the stress continuum. And in an emergency and urgent settings. And one of the ways that I've used it during an urgent and emergent uh uh time is I'd say to a patient, here's a stress continuum, green, yellow, orange, red, red, mentally ill, green, everything is just fine. Where are you right now? Put your finger on the color. They often will put it deep orange, maybe even red, and we'll talk a little bit. Why are you here? Why now? And just the act of therapeutic listening. I haven't done anything yet. And then as we start to wrap up, I need to make my decision is it 5150 or not, whatever it is. Uh, I and I'll say, thank you for sharing with me what you've been able to share. Based upon the colors, where are you at right now? Their finger almost always moves to a light orange, sometimes even yellow. And now they are safer, they are calmer, they have a set of sense of control where they didn't have so, even with a population that has never ever seen it before, this can be a tool for crisis mitigation. So good luck with that.
SPEAKER_05:Love that. Thank you.
SPEAKER_03:All right, so we'll officially wrap up now. So thank you again. Appreciate that greatly. Have a great day, everybody. Take care, take care of it.
SPEAKER_01:Thank you, everyone. Thank you. Too much stuff like this, too much seasoning. Oh, they feel it, therefore it's true. Work hard until those thoughts are finally leaving. So you can be you, uh, they feel it therefore it's true. Work hard until those thoughts are finally leaving, so you can be you, guided discovery. Identifying challenging your beliefs, for beliefs framing your mind, negative thoughts release, let it go. Guided discovery, identifying challenging your beliefs, for beliefs for framing your mind, negative thoughts release, let it go. Cognitive distortions decrease until they cease.
