1. Stress management Rawhia salah Assistant Prof. of Nursing 2015/2016 Nursing Management and leadership 485

2. Overview of Terminology Types of stressors Sources of Clinical Stress Signs & Symptoms of Stress Effect of stress Stages of the Stress Response Coping strategies for management of stress 2 Outline

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4. Overview of Terminology Stress : is tension or pressure from a situation that requires us to use, adapt, or develop new coping skills It is defined as the pressure experienced by a person in response to life or work demands. These demands are referred to as stressors

5. Overview of Terminology Stressor: is the stimuli precipitating a change or stress ( sources of stress). It may be internal (fear, guilt) or external (trauma, peer pressure).

6. Types of stressors External – They originate outside the individual such as family, work, economics, major life changes, unexpected events, etc. Internal – They originate within a person such as worry, fear, attitudes, unrealistic expectations, etc.

7. Sources of Clinical Stress For patients Doubt Fear Pain Cost Lack of knowledge Risk for harm Unknown resources For nurses Poor patient outcomes Risk of making an error Unfamiliar situations Excessive workload Inadequate resources

8. Signs & Symptoms of Stress Cognitive – Decreased concentration, understanding and memory Behavioral – Irritability, withdrawal, violence Psychological – Fear, anxiety, depression, fatigue, disrupted sleep patterns

9. Signs & Symptoms of Stress Physiological – Increased BP, HR, Respirations – Decreased immune response – loss of appetite, overeating, indigestion – Major crisis like a heart attack – Gastrointestinal Difficulties

10. Signs & Symptoms of Stress Physiological  Muscle Tension  Headaches  Neck and Back Problems

11. Negative v positive effect Negative effects Distress: (Uncontrollable, prolonged, stress is destructive) Cognitive effects Somatic effects Confusion Lack of concentration Irrational thought Increased heart rate Increased blood pressure sweating

12. 12 Negative v positive effect

13. 13 McGrath (1970) suggest that when placed in a stressful situation, a person would respond by progressing through four stages: Stages of the Stress Response

14. Environment Demands Perception of the environmental demands Stress response (physical & psychological) Actual behaviour Eustress or Distress Enhanced or impaired performance Situation Threat or challenge Stages of the Stress Response

15. Stage 4: Outcome Increased performanceReduced performance Stage 3: Increased arousal levels Eustress (increased energy and motivation) Distress (increased worry) Stage 2: Perception of demand by nurse Positive perception (challenge)Negative Perception (threat) Stage 1: Demand E.g. Lack of resources Example of Stages of the Stress Response

16. How do you cope with stress?

17. The nursing literature suggests that there are a range of interventions to help you reduce stress in nursing. A recent review suggests that cognitive behavioral interventions and relaxation/meditation 17 How do you cope with stress?

18. Coping strategies Strategies that are effective in reducing the personal levels of stress. There are 2 type of coping A. Adaptive Coping: Contribute to resolution of the stress response B. Maladaptive Coping: Strategies that cause further problems

19. 19 A. Adaptive coping strategies

20. Relaxation is a skill. With frequent practice you will improve these skills to control your emotions and improve your physical well being. These techniques can be practiced either day or night to assist you to relax and feel in control. It is really important to practice regularly 20 Coping strategies 1. Practice Relaxation techniques

21. Examples: Deep Breathing exercise Progressive relaxation technique Meditation: is a precise technique for resting the mind (clear & relaxed) Distraction technique Coping strategies: relaxation techniques

22. Recognize when you are stressed Coping strategies 2. Be aware

23. Learn to see stressful situations as challenges Worry does not solve anything, try to confront your problems and make plans to solve them Coping strategies 3. Change attitude

24. Coping strategies 4. Laughter is Good Medicine  Stress is tightening up but laughter is lightening up (relieving)  Find ways to add happiness in your life  Have fun with your family and friends, think positive and enjoy new experiences

25. Coping strategies 6. Positive self talking Learn that you can manage a stressful situation by what you say to your self, “ I can handle this one step at a time”

26. Coping strategies 7. Keep things in perspective, prioritize 8. Share your worries with family and friends

27. Coping strategies 9. Set realistic goals 10. Exercise regularly & eat healthy

28. B. Maladaptive Coping strategies  Excessive Drinking/Substance Abuse  Excessive Eating  Excessive Smoking  Avoidance/withdrawing  Violence  Postponing  Negative attitude

29. It is normal to have hindered, they can be overcome 29 Remember