MANAGING STRESS AND PREVENTING NURSING BURN-
OUT
Ms.Nirmala PriyadarshanieB.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
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
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
Out Line Cond..,
Some Stress Facts Second biggest occupational health problem
Affects 1 in 3 employees
What Are Your Major Work and Life Stressors?
WORK
HEALTH
FAMILYFINANCIAL
OTHER
Job Demands Workload Shift work Limited worker control TechnologyClient demographics(age, culture)
Organizational Factors Role demands Management style Career security Interpersonal relationsChange Physical Environment Space, noise, heat, cold, lighting, etc.
Personality traitsMotivationTalentTraining
Job stressors
FinancesFamilyHx trauma
Non-work stressors
Social supportCoping skillsHardiness
Bufferfactors
Reactions:
Physical
Psychological
Behavioral
Acutestress
Stress-relatedIllness:
Heart diseaseDepressionInfections
Individual factors
Chronicstress
Healthyworker
OR
Job stress & health
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
What is Stress ?
Stress
An adaptive response (moderated by individual differences) that is a consequence of any action, situation or event which places special demands on a person.
MEDIATING FACTORSIMPORTANCEUNCERTAINTY
DURATION
PER
FOR
MA
NC
E
STRESS
*CONTROLABILITY*
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
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
Overview of Terminology Cond..,
TYPES OF STRESS
POSTIVE STRESS NEGATIVE 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).
• Job design and workload
• Interpersonal relationships at work
• Relationships with patients and their families
• Work organization andmanagement 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 technicalknowledge and skills
CAUSE OF STRESS IN NURSINGSOURCES 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 whoseschedule was other than a regular daytime shift weremore likely to report high work stress
CAUSE OF STRESS IN NURSING COND..,
SOURCES OF STRESS DESCRIPTION
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
Fatigue GI symptoms: nausea, etc. Skin disorders: rashes, hives, acne
Back pain Change in appetite Palpitations
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
Genetics & Development
Genetics
Genes control the stress response◦ Individuals have different
responses to stress There is a genetic
component to:◦ fearful behavior◦ anxiety disorders◦ Neurobiological response
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
Stress Response Pattern
Normal level
of resistance
Response to
stressful event
Stage 1
Alarm
Stage 2
Resistance
Stage 3
Exhaustion
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
• 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.
HOW DOES STRESS AFFECT HEALTH
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”)
◦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..,
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
Identify the stress Analyzed the stress Evaluating the risk Design stress management strategies Implementing evaluation
MODALITES TO COPE WITH 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.
STEP 1: IDENTIFYING THE 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
SIGNS OF 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 2: ANALYZE 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
• 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 ?
STEP 3: EVALUATING THE STRESS COND..,
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: DESIGNING STRESS MANAGEMENT STRATEGIES
1. 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
2. Target: Who are what should the intervention be aim at (individual, or organization)
3. Agency: Who is responsible for caring out the intervention (RN, or the organization)
All interventions must have objectives or goals to be achieved!!!!
STEP4: DESIGN STRESS MANAGEMENT STRATEGIES COND..,
The Total System Matrix
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.
TYPES OF COPING MECHANISMS
1. Change your thinking: (Reframing and Positive thinking)
2. Change your behavior (be assertive, get organized/time management, ventilation, humor, diversion and distraction)
3. Change your life style: (diet, exercise drink water, pet therapy, music therapy, sleep, nature walks, guide imagery, leisure, and pacing)
REMEDIAL ACTION:
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
COPING MECHANISM FOR NURSE AT WORK
Start by understanding your objectives or goals
Start with the more reachable goal and work from there
Prevent further stress
STEP 5: IMPLEMENTING
Steps to Master Stress
1. Claim it: everyone has stress.2. Name it: everyone’s stressors are
different. 3. Reframe it: Look at your stress & stressors
in a different way. Hardiness, coping.4. Tame it: prepare, self-care, share, dare, be
aware
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
STEP 6: EVALUATION
Summery……..!
Questions??
Thank You !