MANAGING STRESS AND PREVENTING NURSING BURN-OUT Ms.NirmalaPriyadarshanie B.Sc. Nursing (Hons)
Learning Objectives • Student will be able to : • Define Stress • Identify Types of Stress • Describe Cause of Stress in Nursing • Identify Physical Indicators of Mental Stress • Describe Stress Response Pattern • Describe How does Stress Affect Health • Define Burn-out • Describe Modalities to Cope with Stress
Out Line • What is Stress • Types of Stress • Cause of Stress in Nursing • Physical Indicators of Mental Stress • Signs & Symptoms of Stress • Stress Response Pattern • How does Stress Affect Health • Common Stress Associated Diseases
Out Line Cond.., • Burn-out • Modalities to Cope with Stress • Step 1: Identifying the Stress • Step 2: Analyze the Stress • Step 3: Evaluating the Stress • Step4: Designing Stress Management Strategies • Step 5: Implementing • Step 6: Evaluation
Some Stress Facts • Second biggest occupational health problem • Affects 1 in 3 employees
What Are Your Major Work and Life Stressors? WORK OTHER HEALTH FINANCIAL FAMILY
Job stress & health Individual factors Acute stress Chronic stress Job stressors Personality traits Motivation Talent Training Reactions: Physical Psychological Behavioral Stress- related Illness: Heart disease Depression Infections Job Demands Workload Shift work Limited worker control Technology Client demographics (age, culture) Organizational Factors Role demands Management style Career security Interpersonal relations Change Physical Environment Space, noise, heat, cold, lighting, etc. OR Finances Family Hx trauma Social support Coping skills Hardiness Healthy worker Non-work stressors Buffer factors
What is Stress ? • Stress is the emotional and physical strain caused by our response to pressure from the outside world. • A state of disharmony or a threat to homeostasis • Physiological changes increase alertness, focus, and energy • Perceived demands may exceed the perceived resources • A force which acts on a body, setting up strains within it according to its load-carrying capacity, flexibility and tolerance
Stress An adaptive response (moderated by individual differences) that is a consequence of any action, situation or event which places special demandson a person. MEDIATING FACTORS IMPORTANCE UNCERTAINTY DURATION
PERFORMANCE STRESS *CONTROLABILITY*
Overview of Terminology • Coping:The ability to maintain control, think rationally, and problem solve • Resilience: Resistant quality that permits a person to recovery quickly and thrive in spite of adversity • Eustress • Manageable Stress can lead to growth and enhanced competence
Overview of Terminology Cond.., • Distress • Uncontrollable, prolonged, or overwhelming stress is destructive. • Acute Stress • Immediate response to a threat or challenge • Chronic Stress • Ongoing exposure to stress, may seem unrelenting
TYPES OF STRESS • Eustress: A positive form of stress that helps us to perform, and is usually experienced when we are going through happy events like a graduation, a wedding, the birth of a child, a competitive event, or a vacation. • Distress This is one of the types of stress that the mind and body undergoes when the normal routine is constantly adjusted and altered (acute and chronic stress). • Hypostress : is lack of stress, experience by people who are constantly bore. • Hyperstress: is the type of negative stress that comes when a person is forced to undertake or undergo more than he or she can take (job). POSTIVE STRESS NEGATIVE STRESS
CAUSE OF STRESS IN NURSING SOURCES OF STRESS DESCRIPTION • Job design and workload • Interpersonal relationships at work • Relationships with patients and their families • Work organization and management of work • Technical aspects of nursing • Personal • dealing with death and dying, ambiguity • conflict with other staff • inadequate preparation for dealing with emotional needs of family • lack of staff support (RN shortage) and resources • concern about treatment and client care • Concern about technical knowledge and skills
CAUSE OF STRESS IN NURSING COND.., SOURCES OF STRESS DESCRIPTION • AGE • HOURS WORKED • SHIFT • aged 35 to 54 reporting high work stress, the highest among age groups • Health care providers who worked 35 or more hours per week were much more likely than those working fewer than 35 hours per week to report high stress. • Health care providers whose schedule was other than a regular daytime shift were more likely to report high work stress
Physical Indicators of Mental Stress • Facial tautness • Muscle aches, stiffness, or tension • Profuse sweating or facial flushing • Cold, clammy hands • Facial tics: rapid eye blinking, etc. • Tapping feet or drumming fingers • Headaches • Sleep problems • Dizziness • Back pain • Change in appetite • Palpitations • Fatigue • GI symptoms: nausea, etc. • Skin disorders: rashes, hives, acne
Signs & Symptoms of Stress • Cognitive • Decreased concentration, comprehension, & memory • Behavioral • Irritability, withdrawal, violence • Emotional • Fear, anxiety, depression, fatigue • Physiological • Increased BP, HR, Respirations, etc • Somatic symptoms • Decreased immune response
Development Genetics & Development • Life experiences can affect a person's stress response • Social support • Strong support is protective • Early life stress • Increases stress reactivity as an adult Genetics Genes control the stress response Individuals have different responses to stress There is a genetic component to: fearful behavior anxiety disorders Neurobiological response
Stage 1 Stage 2 Stage 3 Alarm Resistance Exhaustion Response to stressful event Normal level of resistance Stress Response Pattern
Stress Response Pattern Alarm Resistance Exhaustion “Fight or Flight” activation of the autonomic nervous system (e.g., heart rate, blood pressure, cortisol, etc.) Immune suppression reaction, release of endorphins and growth hormone Exhaustion phase contributing towards stress related illness and exacerbation of medical conditions
HOW DOES STRESS AFFECT HEALTH • There appears to be general agreement that the experience of work-related stress generally detracts from the quality of nurses’ working lives, social life, increases minor psychiatric morbidity, and may contribute to some forms of physical illness. • Nurses were among the highest groups who reported significantly raised rates of stress and depression.
Common Stress Associated Diseases • Diminished Immunity • Headache • Fatigue • Weight gain • Dyslipidemia • Hypertension • Heart Disease • Psoriasis/Eczema • Digestive problems • Anxiety • Depression • Alcoholism • Substance abuse • Insomnia • Irritable bowel syndrome • Fibromyalgia • Decreased sex drive
BURN-OUT Unrelieved work stress emotional exhaustion, depersonalisation & feelings of reduced accomplishment. Requires high degree of involvement
BURN-OUT COND.., • High Depersonalization (“hardened, withdrawn”) • High Emotional Exhaustion (“drained”) • Low Personal Accomplishment. (“ineffective”)
BURN-OUT COND.., • Major contributor: Unsupportive work environment. • Gradual, predictable. “Progressive loss of idealism, energy & purpose…as a result of work conditions.” • Relief occurs with vacation or job change.
BURN-OUT COND.., • 6 main components of burn-out • Overload • Lack of control • Too little reward • Unfairness • Value conflict • Lost sense of community at work • Management can work with employees to: • Increase engagement, involvement, effectiveness & hardiness
MODALITES TO COPE WITH STRESS • Identify the stress • Analyzed the stress • Evaluating the risk • Design stress management strategies • Implementing • evaluation
STEP 1: IDENTIFYING THE STRESS • The approach to stress management can only begin once a potential problem has been recognized and accepted. • That nurses may be experiencing stress through work which could potentially present as a threat to their health and social life.
SIGNS OF STRESS • Availability to work, sickness or absence • Accident or incident • Disciplinary action or compliant • Seeking help from fellow employee or counseling • Low attitude and esteem for the job • Frustration, irritability, anger
STEP 2: ANALYZE THE STRESS • Sources of stress (where, when and why) Where is the stress coming from ? When did the stress start ? Why did the stress happen ? • What types of stress it is ?
STEP 3: EVALUATING THE STRESS • Can the stress endanger my ability to work and take care client? • Can the stress be a hazardous to my social life and family? • Is the stress affecting my ability to work, concentrate, or make decisions?
STEP 3: EVALUATING THE STRESS COND.., • Is the stress causing my personality change (depression, labile affect, dull, suicidal, frustration, anger, anxious, anxiety)? • Is the stress changing my usual habits (exercise or diet) ? • Does the stress affect my relationship with my fellow employees ?
STEP4: DESIGNING STRESS MANAGEMENT STRATEGIES In designing stress management strategies, attention should focus on the total work system, which includes the organizational, social and physical environments, the technology in use, the work systems, and the people involved.
STEP4: DESIGN STRESS MANAGEMENT STRATEGIES COND.., • Types of strategy: This would involve what type of stress you are experiencing, what your symptoms are (anger, depression, sad, anxiety), and the level of your stress • Target: Who are what should the intervention be aim at (individual, or organization) • Agency: Who is responsible for caring out the intervention (RN, or the organization) All interventions must have objectives or goals to be achieved!!!! The Total System Matrix
TYPES OF COPING MECHANISMS • Goals setting, self esteem enhancement, active listening • Remedial Action • Practice, preventative maintenance. • Set priorities in your life. • Avoid negative people. • Use time wisely. • Stop saying negative things to yourself. • Develop your sense of humor.
REMEDIAL ACTION: • Change your thinking: (Reframing and Positive thinking) • Change your behavior (be assertive, get organized/time management, ventilation, humor, diversion and distraction) • Change your life style: (diet, exercise drink water, pet therapy, music therapy, sleep, nature walks, guide imagery, leisure, and pacing)
COPING MECHANISM FOR NURSE AT WORK • Reframing: is finding ways to see the problem from a different perspective • Be assertive: standing up for your personal rights and expressing your thoughts, feelings and beliefs directly, honestly and spontaneously in ways that don’t infringe on the rights of others • Ventilation: let your anger out, talk about it, write it down • diversion and distraction: take a vacation or a short walk, it gives you time to catch your breath and think about the problem objectively. • Group therapy or interaction: allows every ones to speak, provide compromise
STEP 5: IMPLEMENTING • Start by understanding your objectives or goals • Start with the more reachable goal and work from there • Prevent further stress
Steps to Master Stress • Claim it: everyone has stress. • Name it: everyone’s stressors are different. • Reframe it: Look at your stress & stressors in a different way. Hardiness, coping. • Tame it: prepare, self-care, share, dare, be aware
STEP 6: EVALUATION • Were the objectives achieved • Was the stress reduced or eliminated • Do you feel like your old self before the stress • Is your quality of life improved (work, social, family, personal) • Was the intervention affected or does it need changes