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 !