Stress ManagementSinead O’Toole

Learning outcomes

2

• To develop an understanding of the components of psychological care that can be integrated with physical care.

• To develop an understanding of the impact of stress.

Why talk about stress

• The correlation between stress and illness is modest in strength (many factors influence health)

• Stress is implicated in many illnesses• Ill health is stressful• Working in healthcare involves working with

people who are stressed – patients, relatives, staff, ourselves

Theories

• Walter Cannon – Fight & Flight

• Hans Selye– General adaptation syndrome– Alarm, resistance, exhaustion

• Shelly Taylor– Tend & befriend

Theories

• Lazarus Primary appraisal,

Secondary appraisal

• Peoples appraisals of events determine what they find stressful

Stress & Medicine

Stress in Health Services & Palliative Care

Female Doctors

Public Health Nurses

ICU Nurses

Allied Health Groups

Hospice NursesDecreasing level of stress

Stress & Medicine

• 28% of doctors & other health professions show above threshold levels of stress ( Firth-Cozens, 2003)

• Medical staff seem to deny the effect of stress & fatigue on performance (Sexton, 2010)

Cost of Caring

• Continual and consistent provision of psychological care requires energy and has a high potential to become stressful (Vachon 1995)

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Staff stress

• “ ..if staff stress is unrecognized and no attempt is made to decrease it, then the stress of caregivers may come to parallel or even supplant that experienced by patients and their families. When this happens the care givers can no longer care effectively and patient/family care deteriorates and may become dehumanized” (Furlong, O’Toole,2005 )

Burnout Stress Optimal

Functioning Resilience Survival

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Psychological (Carr, 2004)

• Cognitive interventions– Negative automatic thoughts– Irrational Beliefs

• Reflect on self talk– Approve of yourself more – Be patient with yourself

• Think positively- set realistic goals and engage in realistic evaluations

• Sense of humor

Variations in stress tolerance

• Strong social support and optimism increase stress tolerance

Variations in stress tolerance

• It may be the absence of positive things that increase stress

Stress Management

• Time management • Relaxation• Exercise

– 30 mins x 3 times /week

• Diet• Sleep

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What makes a person happy?Very Important

• Love and Marriage– (Myers, 1999)

• Work– (Warr,1999)

• Personality– Past happiness (Diener

& Lucas, 1999)

Practicing strength (Secretan, 1989)

• The spirit soars, at work or play, when we practice and improve our strengths

• Doing what we already do well, even better, yields an ever deepening sense of self esteem and joy

• Kaizen

• Stress comprises two elements : discomfort and strain.

• People complain about the strain, but the discomfort is the problem.

• There is nothing wrong with being busy, active, committed, and strained — that is human nature — but the discomfort should not be there.

• (Karolinska Hospital in Stockholm)

• Remember • We are an

embodied species

• Sometimes We Just Have to Learn to Let Go……..

• Take care & be kind

Key Resources Erickson, R., Grove, W., ( 2007). "Why Emotions Matter: Age, Agitation, and Burnout Among Registered Nurses" Online Journal of Issues in Nursing. Vol. 13, No. 1.

Katz, R. When Professionals Weep Emotional and Countertransference Responses in End –of –Life Care Routledge 2006Leiter, M.P. & Maslach, C. (2001). Burnout and Health. Handbook of Health Psychology (pp. 415-426). London: Lawrence Erlbaum.

Onyett, S., Pillinger, T., Muijen, M. (1997). Job satisfaction and burnout among members of community mental health teams. Journal of Mental Health, 6(1): 55-66

Reivich, Karen; Shatte, Andrew (2002). The Resilience Factor: 7 essential skills for Overcoming Life's Inevitable Obstacles.

http://www.cci.health.wa.gov.au/resources ( Accessed 10/02/2013 )

http://www.mindtools.com ( Accessed 10/02/2013)

• Senge, P. (1998) ‘The Practice of Innovation’, Leader to Leader 9 http://pfdf.org/leaderbooks/l2l/summer98/senge.html• Senge, P. et. al. (1994) The Fifth Discipline Fieldbook: Strategies and Tools for Building a Learning Organization