Abstract
Burnout is not the failure of an individual to cope; it is the expected response to working in unbalanced systems where demands exceed resources.1 Traditional self-care resilience strategies that include a range of mindfulness and physiological are important individual skills but are not sufficient to address the intensity and duration of occupational stress in health care.2 Health workers (HCW) face chronic exposure to fatigue, trauma, loss, and moral distress. These four sources of stress injury can have an independent or cumulative effect that negatively impact patient quality and safety, individual team members well-being, team cohesion, and organizational trust. The concept of occupational stress injury versus stress disorder creates an opportunity for early recognition, intervention, and prevention efforts.3
Stress First Aid (SFA) is a peer and self-care support model that comprises a set of supportive actions designed to help emergency responders, hospital employees, and law enforcement personnel assist each other in reducing the negative impacts of stress. SFA was designed originally to support military personnel, and adapted to support structural firefighters, emergency medical services, law enforcement, and health workers.3 This method of assisting in ongoing stress is based on acknowledgement that stress can be ongoing and cumulative, resulting from multiple sources, and resistant to formal intervention for many reasons such as the chaotic nature of the ongoing adversity, stigma and cultural factors. SFA is designed to be attentive to multiple sources of stress, practical, flexible, and tailored to the specific styles and needs of those involved. It is informed by the “five essential elements” framework for early and mid-term stress recovery.4 This framework identifies elements that are related to better recovery in a variety of ongoing adverse situations, promoting a) psychological sense of safety, b) calming, c) sense of self-efficacy in ability to navigate through adverse events; d) social connectedness, and e) fostering hope,, meaning, and a sense of mattering.
SFA is used as a foundation for wellbeing by national organizations, academic and non-profit health systems, and community hospitals resulting in improved well-being, impact on team member communication with patients, peers, and leaders, and positive organizational impact.5,6,7
Notes
Presenter notes available in attached slide deck.
Bibliography included in attached slide deck.
References:
1. Westphal, R. J. (2022). Burnout Is Not the Problem: It Is a Stress Injury Symptom. Sigma Theta Tau International. International Nursing Research Congress.
2. Feist, J., C. Feist, and P. Cipriano. 2020. Stigma Compounds the Consequences of Health worker Burnout During COVID-19: A Call to Action to Break the Culture of Silence. NAM Perspectives. Commentary, National Academy of Medicine, Washington, DC. https://doi. Org/10.31478/202008b
3. Watson, P. J., & Westphal, R. J. (2020). Stress First Aid for Health Care Workers. U. S. Department of Veteran Affairs. National Center for PTSD. https://www.researchgate.net/publication/349537736_Stress_First_Aid_for_Health_Care_Workers_Manual_2020.
4. Hobfoll, S. E., Watson, P., Bell, C. C., Bryant, R. A., Brymer, M. J., Friedman, M. J., Friedman, M., Gersons, B. P., de Jong, J. T., Layne, C. M., Maguen, S., Neria, Y., Norwood, A. E., Pynoos, R. S., Reissman, D., Ruzek, J. I., Shalev, A. Y., Solomon, Z., Steinberg, A. M., & Ursano, R. J. (2007). Five essential elements of immediate and mid-term mass trauma intervention: empirical evidence. Psychiatry, 70(4), 283-315; discussion 316-269. https://doi.org/10.1521/psyc.2007.70.4.283
5. Convoy, S. P., Heflin, M., Alston, B. M., Hoffler, U., Barzee, M., Thompson, J. A., & Westphal, R. (2023). Stress First Aid for Health-care Workers: An Indicated Mental Illness Prevention Program for Nursing Education. Nursing Clinics of North America. https://doi.org/https://doi.org/10.1016/j.cnur.2023.11.006
6. Bellehsen, M. H., Cook, H. M., Shaam, P., Burns, D., D'Amico, P., Goldberg, A., McManus, M. B., Sapra, M., Thomas, L., Wacha-Montes, A., Zenzerovich, G., Watson, P., Westphal, R. J., & Schwartz, R. M. (2024). Adapting the Stress First Aid Model for Frontline Healthcare Workers during COVID-19. Int J Environ Res Public Health, 21(2). https://doi.org/10.3390/ijerph21020171.
7. Timmins, G., Williamson, S., Cassells, A., Davis, K., Dong, L., Tobin, J. N., Gidengil, C., Meredith, L. S., & Chen, P. G. (2025). Health care worker experiences with a brief peer support and well-being intervention during the COVID-19 pandemic. BMC health services research, 25(1), 1253. https://doi-org/10.1186/s12913-025-13268-6
Sigma Membership
Beta Kappa
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Other
Keywords:
Stress/Coping, Psychological Stress, Stress Management, Coping, Workforce, Labor Supply, Interprofessional/Interdisciplinary, Job Stress Prevention, Interprofessional Collaboration
Recommended Citation
Westphal, Richard J., "Stress First Aid: A Foundation for Creating Healthy Work Environments" (2026). Creating Healthy Work Environments (CHWE). 76.
https://www.sigmarepository.org/chwe/2026/presentations_2026/76
Conference Name
Creating Healthy Work Environments
Conference Host
Sigma Theta Tau International
Conference Location
Washington, DC, USA
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-05-06
Stress First Aid: A Foundation for Creating Healthy Work Environments
Washington, DC, USA
Burnout is not the failure of an individual to cope; it is the expected response to working in unbalanced systems where demands exceed resources.1 Traditional self-care resilience strategies that include a range of mindfulness and physiological are important individual skills but are not sufficient to address the intensity and duration of occupational stress in health care.2 Health workers (HCW) face chronic exposure to fatigue, trauma, loss, and moral distress. These four sources of stress injury can have an independent or cumulative effect that negatively impact patient quality and safety, individual team members well-being, team cohesion, and organizational trust. The concept of occupational stress injury versus stress disorder creates an opportunity for early recognition, intervention, and prevention efforts.3
Stress First Aid (SFA) is a peer and self-care support model that comprises a set of supportive actions designed to help emergency responders, hospital employees, and law enforcement personnel assist each other in reducing the negative impacts of stress. SFA was designed originally to support military personnel, and adapted to support structural firefighters, emergency medical services, law enforcement, and health workers.3 This method of assisting in ongoing stress is based on acknowledgement that stress can be ongoing and cumulative, resulting from multiple sources, and resistant to formal intervention for many reasons such as the chaotic nature of the ongoing adversity, stigma and cultural factors. SFA is designed to be attentive to multiple sources of stress, practical, flexible, and tailored to the specific styles and needs of those involved. It is informed by the “five essential elements” framework for early and mid-term stress recovery.4 This framework identifies elements that are related to better recovery in a variety of ongoing adverse situations, promoting a) psychological sense of safety, b) calming, c) sense of self-efficacy in ability to navigate through adverse events; d) social connectedness, and e) fostering hope,, meaning, and a sense of mattering.
SFA is used as a foundation for wellbeing by national organizations, academic and non-profit health systems, and community hospitals resulting in improved well-being, impact on team member communication with patients, peers, and leaders, and positive organizational impact.5,6,7
Description
The Stress First Aid (SFA) model is a flexible, evidence-informed framework for peer support, self-care, and organizational change. Developed in 2011 by the Department of the Navy, it has been adapted for high-stress professions including first responders and healthcare workers. SFA is used as a foundation for wellbeing by national organizations, academic and non-profit health systems, and community hospitals. SFA uses the Stress Continuum address stress injuries individuals and teams.