Stress management

Welcome

STRESS MANAGEMENT

BY-YASHODHARA GHOSH

MSC. NURSING STUDENT

Definition • Stress is a nonspecific response of the body to any

demand , whether it is caused by or result is pleasant or unpleasant conditions

• by Hans seyle

• Stress is mind and body’s response or reaction to a real or imagined threat, event or change.

• A physical or psychological stimulus that can produce mental tension or physiological reactions that may lead to illness."

LEVELS OF STRESS

• Eustress or positive stress occurs when the level of stress is high enough to motivate to move into action to get things accomplished.

• Distress or negative stress occurs when level of stress is either too high or too low and body and/or mind begin to respond negatively to the stressors.

GENERAL ADAPTATION

SYNDROME : STAGES OF STRESS

ALARM STAGEWhen we experience a stressful

event or perceive something to be stressful psychological changes occur in the body. This experience or perception disrupts body’s normal balance and immediately body begins to respond to the stressor(s) as effectively as possible.

RESISTANCE STAGE During this stage body tries to

cope or adapt to the stressors by beginning a process of repairing any damage the stressor has caused..

EXHAUSTION STAGE

During this stage the stressor is not being managed effectively and the body and mind are not able to repair the damage.

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For example

• A promotion may be a positive stress but a nurse may still respond with various emotional , cognitive and physical reaction such as anxiety , cognitive dissonance , or gastric pain.

• Perceived level vary from person to person depending upon individual personal factors such as heredity, habits, personality, past experiences, illness and previous coping mechanisms.

STRESS DIAGRAM BASED ON SELYE , H(1991)

Stage5: change in stress eliminated or change in person: coping or no change

Stage 4: physical reaction to stress increased blood pressure fatigue, sleep alterations

Stage 3: cognitive or intellectual response positive or negative thinking

Stage 2: emotional reaction: surprise, shock, anger, happiness

Stage 6: adaptation or burn out

Stage 1: flight or fight response, increased adrenaline

Perceived stress

Stage 1Alarm Reaction

Stage 2Resistance

Stage 3Exhaustion

NormalLevel ofResistance

General Adaptation Syndrome

CAUSES OF STRESS

• At work place• At Organizational Level• At Personal Level• Inter personal factors• Individual factors

Stressors of nurses

• Environment • Change• Consumer demands• Public demands• Nurses role

Workplace stressors of staff nurses

• Workload• Inadequate staff cover• Relationship with other clinical staff• Leadership and management style • lack of adequate supervisory support• Coping with emotional needs of patients and their families• poor patient diagnosis• Death and dying• Shift working• Lack of reward

At Organizational Level

• Technical – emergence of new technologies

• Strategic – globalization, privatization, take-overs,

• Competition• Increasing urbanization

At Personal Level

Life events Entries & exits to the familyChange in job

Daily events Unexciting but tight routineStruggle of day to day life

Social support Economic, physical & emotional support from friends, family & others

Inter personal factors

• Interpersonal relationship within the nursing profession and between other professions

• Shorter stay for patients• Supervision of assistive personnel• Interdisciplinary conflict

Individual factors

• Marriage• Pregnancy• Purchasing a new home

ROLE CONFLICT AND ROLE AMBIGUITY

• Role conflict occur when an individual has two competing roles such as nurse manager both assumes a patient care assignment and needs to attend a leadership meeting

• Role ambiguity results from unclear expectations for one’s performance.

• Role under load and under utilization: Being underutilized or not having much responsibility may be seen as stressful by a person who is a high achiever or who has high self esteem.

Signs of over stressing individual PHYSICAL MENTAL SPIRITUAL

Physical signs of ill health

Increased flue cold or accidents

Change in sleeping habitsfatigue

Dread going to work everyday

Rigid thinkingbeing unable to tolerate

any changes

Sense of being a failure disappointed in work performanceAnger and resentment towards clients , colleges and managers

Chronic signs of decreased ability to

manage stressa. Headacheb. Hypertensionc. Gastrointestinal

problems

Being forgetful and anxious about work to be

done , errors and incidents more frequent

Lack of positive feeling toward others

Cont..

Use of unhealthy coping activities

a. Increased use of drugs and alcholol

b. Increased weight

Returning home exhausted Confusion about duties and roles

Cynicism toward clients , blaming them for their problemsExcessive worry , insecurity Lowered self esteem Increases family and friend conflicts

Signs of over stressing individual

CONSEQUENCES OF STRESS• prolonged anxiety, phobias, or a

persistent state of fear or free floating anxiety that seems to have many alternating causes

• Depression• abrupt changes in mood and

behavior• perfectionism• physical illness like peptic ulcer,

arthritis, colitis, hypertension, MI. • burn out

STRESS MANAGEMENT STRATEGIES

physical

Acceptance of physical limitations

Nutrition ;high carbohydrate ;low sugar

Exercise; enjoyable activity three times a week for 30 min

Make your physical health a priority

Sleep quatity and quality Relaxation : meditation,

massage,yoga

Mental

Learn to say NoUse cognitive restructuring and self talkImageryDevelop hobbiesPlan vacationsLearn about the system and how the problems are

handledLearn communication, conflict resolution and time

management skillsTake continuing education course

Spiritual

Use meditationSeek solace in prayerSeek professional; counselingParticipate in support groups Participate in net working Communicate feelingsAsk for feedback and clarification

To manage stress

• Personal methods• Organizational methods

Personal methods

Recognize the stressors Caring for yourself physically and

developing effective habits

– Role redefinition– Improved time management – Relaxation techniques

Role redefinition

• Involves clarifying the roles and attempting to integrate or tie together the various roles individual play.

TIME MANAGEMENT PRINCIPLES Goal setting Time analysis Priority determination Daily planning and scheduling Grouping activities and minimizing routine work Implementation Interruption control Evaluation

Time management techniques

• making daily list of activities to be accomplished

• Prioritizing the activities by importance and emergency

• Scheduling activities according to the priorities set

• Knowing daily cycle and handling the most alert and productive

Relaxation techniques

• listening,• reading, • socializing with friends. • hobbies and recreational activities • Taking regular vacations

Eliminate self-defeati ng behaviors

Resist perfectionismClean up your actFlip your negative thinking

FIND WAYS TO DISPEL STRESSGet time away.

Talk it out. Cultivate allies at work

Find humor in the situation

An administrator

1. Is role ambiguity or conflict creating stress?

2. Is manager using appropriate leadership style?

3. Would additional training or education help reduce stress?

4. Is the stress due to low self esteem of self worth?

5. Are counseling services available in the organization?

ORGANIZATIONAL METHODS

• Supportiveness

• Employee assistance program

• Formal discussion group

• Rites and rituals

• Time management • Formal stress management

programs • Humor • Offering small incentives in

terms of money and paid leaves • Praising employees for

performance

When stress is job related

ю Proper matching of the job with the applicant during the selection and hiring process

ю Skill training ю Developing a programme of job enrichment

matched to the individual goals and desires often increase autonomy

ю Communication and social support

• POLICIES LIKE• Reducing the number of hours in night shift, holiday work

assignments• Providing opportunities for break and meals

The effectiveness of current approaches to workplace stress management in the nursing profession: an

evidence based literature review• the effectiveness of current approaches to workplace stress

management for nurses was assessed through a systematic review. Seven randomised controlled trials and three prospective cohort studies assessing the effectiveness of a stress management programmes were identified and reviewed. The quality of research identified was weak. There is more evidence for the effectiveness of programmes based on providing personal support than environmental management to reduce stressors

A descriptive study of stress management in a group of pediatric oncology nurses

• Pediatric oncology nursing is associated with highly stressful and emotional situations. • This article describes and discusses major sources of occupational stress among a group of

nurses participating in a stress management group. • The stress sources for these nurses were preoccupation with death and dying, the

professional image of the oncology nurse, the nurse as fighter in the war against disease and death, the nurses' perceived isolation from the medical staff, the nurses' perceived inferior professional status compared with that of physicians, emotional over involvement with patients and families, suppression of anger, and difficulties in balancing work and home demands.

• The following factors are suggested as major contributors to the nurses' stress and burnout: increased tendency for irrational-dysfunctional thinking styles (mainly "demandingness" and "awfulizing"), diffuse boundaries between nurses and patients, low professional self-efficacy, and wide prevalence of military metaphors.

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BIBLIOGRAPHY

• Sullivan Elanor J , Decker Philip J . Effective leadership and management in nursing. Addison Wesley; 1997

• Barret jean. Ward management and teaching . New Delhi , Konark publishers; 1994

• Ann R L . Basic concepts of psychiatric mental health nursing. 7th edition. Philadelphia . Lippincott ;1997

• C. Adey: “Stress: Who cares?”, in Nursing Times, Vol. 28, 1987, pp. 52-53.

• J.T. Bailey, S.M. Steffen and J.W. Grout: “The stress audit: Identifying the stressors of ICU

• nursing”, in Journal of Nursing Education, Vol. 19, 1980, pp. 15-25

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Stress management

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