- cynicism, negativism (withdrawal/isolation from coworkers/patients;
- altered work patterns (clock-waiting, arrive lately leave early, absenteeism);
- family conflicts;
- uncontrable crying;
- excessive death watch;
- substance abuse (drugs, alcohol, caffeine, nicotine).

Responses:

a. Physical: chronic fatigue, sleep disorders, GI disorders, headaches;
b. Emotional: hopelessness, powerlessness, guilt, detachment, depression.

2. Adaptive coping mechanisms:

- learn and apply principles of stress management;   -particpate in support groups;
- seek appropriate substance abuse treatment;
- seek appropriate family therapy.

Responses: