Stress Reduction: Simple Steps You Can Take for Better Living

SUZANNE ARIZA, CRNA, MSN, CCRNPANA STATE PEER ADVISORPANA SPRING SYMPOSIUM

MAY 5, 2018

Learner Objectives

• Recognize how learning to reduce stress can provide personal and professional benefits to yourself and your team

• Reproduce demonstrated stress reduction techniques into your professional life

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Discussion Outline

• Definition of stress

• Stress as it relates to home and work life

• The cost of stress

• Stress-related illnesses

• How to build resilience

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What is stress?

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• Stress (noun) is defined as:

• Pressure or tension exerted on a material object

• A state of mental or emotional strain or tension resulting from adverse or very demanding circumstances

• Stress (verb) is defined as:

• Give particular emphasis or importance to (a point, statement, or idea) made in speech or writing

• Subject to pressure or tension

Definition of Stress

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Stress

• Stress is natural

• Stress is unavoidable

• Stress can be motivational

• Stress can be devastating

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Stress is Natural

“A normal adaptive coping response that evolved over hundreds of millions of years to help our ancestors avoid sticks and get carrots.” –Rick Hanson, PhD

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Job/Life Stressors

• Deadlines

• Internet

• Social Media

• Cell Phone

• Text Messaging

• Email

• How many accounts do YOU have?

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FacebookTwitterSnapchatInstagramTumblrFlickrYelpWaze

Google +SkypePinterestLinkedlnMeetMeMeetupTinder Grindr

Social Media

Approximately

40 million American adults suffer from anxiety disorders

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National Institute of Mental Health (2008)

The Cost of Stress

•$26 billion paid annually in disability claims

•Estimated that $300 billion lost annually due to job related stress and diminished performance and absenteeism. (2009)

• 60-80% of all work-related accidents

www.americaninstituteofstress.org

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The Cost of Stress

•Up to 90% of all PCP visits

•More than 50% of lost work days

•Of all workers, almost 14 % say stress caused them to quit or change jobs in the last 2 years

www.americaninstituteofstress.org

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CDC’s Definition of Job Stress

• Job stress can be defined as the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker. Job stress can lead to poor health and even injury.

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https://www.cdc.gov/niosh/docs/99-101/default.html

Stress Traps

• Saying “YES” before realizing how much time it would take

• Wasting time on things that are not important or do not make you happy

• Not being busy does not equate to being lazy or being irresponsible

• “Tomorrow I’ll get that done” or “Next summer I’ll take that trip”

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Tunajek, S., 2012, pg. 36

Workplace Stress

• It’s not the job, it’s the person-environment fit that matters

• Sense of control

• Decision-making latitude

www.americaninstituteofstress.org

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Work Stress

• Daily work pressures:

• Quick turnovers

• Overtime

• Trauma cases

• Layoffs

• Anesthesia group takeovers

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CRNAs

• We are constantly exposed to a variety of stressors

• Prolonged stress can have negative physical and mental consequences sometimes to the point of disability and may even affect patient care

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Early Warning Signs of Job Stress

• Sleep disturbances

• Headaches

• Difficulty concentrating

• Short temper

• Upset stomach

• Job dissatisfaction

• Low morale

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TOO MUCH STRESS can cause:

• Fatigue/Insomnia

• Headaches/inflammation

• High Blood Pressure

• Gastrointestinal disturbances

• Weight loss or gain

• Anxiety/Depression

• Relationship problems

• Addictive behaviors

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Why Stress is Bad

•We all know prolonged HTN may lead to heart disease, heart attack and stroke

•Long term inflammation may lead to weight gain, diabetes, kidney disease, and maybe even cancer

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• A healthcare provider who is fatigued, anxious, depressed, dealing with turmoil, life-event, or maybe addicted is not fit for duty

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AANA Code of Ethics

•According to The Code of Ethics for the Certified Registered Nurse Anesthetists, set forth by the AANA, anesthetists must be fit for duty to ensure that the high level of care can be delivered as promised

AANA Code of Ethics

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CRNA/Student Reported Stress

0

5

10

15

20

25

30

35

Low 1 2 3 4 Average5

6 7 8 9 Extreme10

Student

CRNA

Educator

Student mean = 7.9CRNA mean = 5.1Educator mean = 6.3

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More than just a state of mind…

Physical components of stress include:

tight muscles, headaches, difficulty falling

asleep and restless sleep, abdominal pain,

allergies, asthma, inflammation and HTN.

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What do you use to manage stress?

0

10

20

30

40

50

60

Student

CRNA

Educator

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It is Impossible to Avoid Stress

• Stress is natural and unavoidable!

• By practicing wellness, we develop RESILIENCEand this enables us to combat stress

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Defining Resilience

•Resilience is:

“The ability to adapt well in the face of adversity, trauma, tragedy, or stress”

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Tunajek, S., 2008, pg. 26

Defining Resilience

•Resilience is:

“Resilience is bouncing back to be the best we can be through perseverance, positivity, and adaptation”

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Spiri, C. (2017) pg. 28

Resilience

• The capacity to recover quickly from difficulties; toughness

• The capacity to withstand stress and catastrophe

• Working through the emotions and effects of stress and painful events

Ways to Build Resilience

• Cultivate social relationships

• Adopt a pet

• Reconcile relationships (forgive or ask for forgiveness)

• Serve one another

• Adequate sleep

• Laugh

• Cry

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Ways to Build Resilience

• Create appropriate boundaries

• Picture and strive for a better life/future

• Be thankful

• Be rich in faith

• Above all, love

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Wellness

• “AANA defines wellness as a positive state of the mind, body, and spirit reflecting a balance of effective adaptation, resilience, and coping mechanisms in personal and professional environments that enhance quality of life”

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www.aanawellness.com

Finding Balance

• Need to prioritize time to rejuvenate and rest our bodies

• Develop all the dimensions of of our health and well-being:

• Physical

• Mental

• Social

• Spiritual

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Tunajek, S., 2012, pg. 36

Finding Balance

•Physical:•Exercise

•Healthy eating

•Mental:•Visualizing future

goals

• Intellectual vitality

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Finding Balance

•Social:

•Relationships with people

•Spiritual:

• Faith and core values

•Beliefs

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Finding Balance

• Saying “no” without feeling guilty

• Make quiet time for yourself

• Talk with your friends

• Change up your daily routine

• Learn to better manage your time

• Look at your habits, will your actions impact others or yourself

• If you need help, ask

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Tunajek, S. 2008, pg. 40

Rest

•The best way to quiet the body-mind’s “stress response” and support the “relaxation response” is REST

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Sleep

• Strive for 7 to 8 hours a night

• Improve your quality of sleep by meditative practices, deep breathing, and/or by exercising early in the day

• Short naps can be helpful

• 30 to 45 minutes so as not to disturb the sleep cycle

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Exercise

• Physical exercise helps us stay resilient:

• Walk/run

• Bike

• Swim

• Shoot hoops

• Stretch

• Yoga

• Vigorous exercise decreases adrenaline

• Gentler exercise lowers cortisol

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Nutrition

A WELL FED body is a RESILIENTbody

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Good Rules of Thumb

• Eating plenty of dark FRUITS and VEGTABLES

• EAT WHOLE GRAINS/ NUTS AND SEEDS

• Drink plenty of WATER

• LIMIT CAFFEINE AND ETOH

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Meditation

• MINDFUL MEDITATON-becoming a calm observer of your thought and emotions stimulates the parasympathetic nervous system

• Meditation can reduce frantic neurological activity in the amygdala, the alarm bell of the brain

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Positivity

• “Positivity Ratio” 3:1

• Even with strangers positive connections can improve our health

• Studies have shown that the amygdala-based cell receptors for oxytocin increase when we foster feeling of love, compassion, and connection

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Be In Good Company

• Having supportive relationships is one of the strongest predictors of well-being

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http://www.cdc.gov/hrqol/wellbeing.htm#five

Laughter

• It’s no JOKE, laughter is a great form of stress relief

• Laughter:

• Enhances your intake of oxygen-rich air

• Stimulates your organs

• Increases endorphins released in the brain

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www.apa.org/monitor/2012/07-08/ce-corner.apx

Sing

• Singing releases feel-good endorphins

• A 2010 study, by researchers in the United Kingdom and Australia, found that singing lowers levels of depression and anxiety, and improves general sense of well being

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Lifestyle Choices

• Your lifestyle choices hold incredible power over health

• You have the ability to reduce or raise the risk of many preventable diseases

• PRACTICE WELLNESS DAILY

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AANA Peer Assistance and Wellness

• Peer Assistance

• Established in 1983

• Wellness Program

• Established in 2004

• Develop and promote wellness, balance, and self care for AANA members

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Help for Drugs and/or Alcohol

• HELPLINE:

• 1-800-654-5167

• Workplace resources available at:

• www.aana.com/sudworkplaceresources

• AANA Peer Assistance for CRNAs, SRNAs, administrators, colleagues, or family members for concerns, questions, or to get help for drugs and/or alcohol

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References

• Chipas, A., McKenna B. (2011). Stress and burnout in nurse anesthesia. AANA Journal, 79(2) 122-128.

• Chipas, A., Cordrey, D., Floyd, D., Grubbs, L., Miller, S., & Typr, B. (2012, August). Stress: Perceptions, manifestations, and coping mechanisms of student registered nurse anesthetists. AANA Journal, 80(4), S49-S55. Retrieved from https://search-proquest-com.ezp1.villanova.edu/docview/1321120425/fulltextPDF/EA914427DE4B4551PQ/1?accountid=14853.

• Gill, C., (2013). Professional wellness applied from day one. AANA News Bulletin, 67(5) 30-31.

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References

• Hanson, R. (2009). Buddha’s brain: The practical neuroscience of happiness, love, and wisdom. New Harbinger.

• Lazarus, R. & Folkman, S. (1984) Stress, Appraisal and Coping. McGraw-Hill.

• Matta, C. (2012). The stress response: How dialectical behavior therapy can free you from needless anxiety, worry, anger, and other symptoms of stress. Oakland, CA: New Harbinger.

• O’Keeffe, G. S., Clarke-Pearson, K., (2011, April 4). Clinical Report—The Impact of Social Media on children, adolescents, and families. The American Academy of Pediatrics. 127(4) 800-804.

• Quinlan DS., Peer assistance : A historical perspective. AANA News Bulletin 1996: 50(1) 14-15.

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References

• Roy-Bryne, P. (2013) The relaxation response changes gene expression. New England Journal of Medicine.

• Spayde, J. (2013). The science of stress. Experience Life.

• Spiri, C. (2017). Resiliency and mentorship for nurse anesthetists. Retrieved from https://www.aana.com/docs/default-source/wellness-aana.com-web-documents-(all)/resiliency-and-mentorship---nov-2017.pdf?sfvrsn=63e046b1_4.

• Tunajek, S. (2006, May). Student Stress: a question of balance. AANA New Bulletin, 20-21.

• Tunajek, S. (2008, June). The art of being selfish. AANA New Bulletin, 40-41.

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