1. Stress Less Lara, Belinda, Stephanie, Jacquie, Lauren

2. The effect of exercise on stress reduction amongst nurses Goals: To evaluate the effectiveness of yoga and cardiovascular exercise on stress reduction for nurses aged 20 -30 years over a 6 weeks period. Objectives:  Reduce stress level by participating in 2 x 60 min classes per week of yoga for a 6 week period  Reduce stress level by completing 5 X 30 min runs for a 6 week period  Compare the effectiveness of yoga and cardiovascular on the level of stress reduction using the Nursing Stress Scale, the DASS21& the 5 items Likert Stress rating Scale.

3. Interest in the topic  Relevant to our lifestyle  Sustainable and relatable throughout transitioning into professional practice  Interventions are feasible and interesting for participation  Overall health benefits within a holistic lifestyle

4. Problem  Stress causes:  Workplace, responsibilities, roles, shift work, expectations, time restrictions  Significance:  Correlation between burnout and fair to poor quality of care and increase risk of failure to recognise patient distress  Patient safety issues and effects on functionality of nursing profession  Increased risk of accidents/errors  Impact:  Negative outcomes- feelings of loss of faith/confidence/self- esteem, fighting with spouses, depression/anxiety  Growing resentment of nursing duties  Unhealthy lifestyles/behaviours  Magnitude:  Occupational stress is “ubiquitous in nursing” (Lim et al., 2010)  Increased risk of developing burnout

5. Examples of other approaches to stress reduction  Primary interventions – addressing causes of stress  Workplace modifications – rostering, ratios, leadership, support, appreciation  Secondary interventions – addressing effects of stress  Massage, music, smoking, social events, relaxation training, prayer, psycho- education

6. Intervention - Yoga  Breathing, posture, strengthening and meditation exercises  Benefits mental and physical wellbeing to enhance the mind body and soul (Li & Goldsmith, 2012).  Endorsed by the US (Li & Goldsmith, 2012).  Physiological – lowers BP and HR  Acts on the parasympathetic nervous system rather than HPA (McCafffery et al, 2005)  Psychological – decision making, concentration (Ross & Thomas, 2010)  60-90 minutes 2-3 times per week is required for beneficial effects (Jackson, 2013)  Its suggested yoga assists in altering attitude towards perceived stress (Galbraith & Brown) Our Study – Each participant will complete 2 x 60 min yoga classes per week for 3 weeks

7. Intervention - Cardiovascular exercise  20-30 minutes of aerobic exercise has a calming effect for up to several hours due to hormonal responses (altered dopamine and serotonin level), resulting in altered mood and perceived stress (Robson, 2011)  Provides a release and distraction from stressor  Recommended 150minutes of moderate intensity or 75minutes of vigorous aerobic exercise per week is required for beneficial results (Jackson, 2013)  Non ward based exercise includes riding/walking to work, yoga classes in break (Harpell et al, 2013)  Limitations  Lack of opportunity and resources e.g. Bike rack, yoga classes, quiet rooms  Short term effects only. Participant needs to complete regular exercise to remain an effective measure to reduce stress  Our Study – Each participant will complete 30 min X 5 times per week for 3 weeks

8. Evaluation  Process: collection of data online (monkeysurvey.com), incl. Demographic. Use of validated evaluation tools:  Nursing Stress Scale (Gray-Toft & Anderson, 1981)at 0, +3 &+6 weeks  DASS21(Sinclair et al., 2012) at 0 & weekly  5 items Likert Stress rating Scale (Davey et al., 2007) at 0, before and after every yoga or cardio intervention & at + 6 weeks.  Impact : reduction in stress by week 1on Likert Scale with peak effect at week 6 statistically significant on all tools.  Outcome: 80% of all diseases and illnesses are related to stress: coronary heart disease, cancer, migraine, hypertension and sleep disturbances (Seaward, 1999).  The expected outcome is a positive impact on overall stress levels and nurse wellbeing, job satisfaction and morbidity and mortality showed by a reduced number of sick days taken by nurses.

9. Reference  Seaward, B. (1999). Managing stress: principles and strategies for health and wellbeing. Jones and Bartlett, Sudbury.  Davey, H. M., Barratt, A. L., Butow, P. N., & Deeks, J. J. (2007). A one-item question with a likert or visual analog scale adequately measured current anxiety. Journal of Clinical Epidemiology, 60(4), 356-60.  Galbraith, N., & Brown, K. (2011). Assessing Intervention Effectiveness for Reducing Stress in Student Nurses: Quantitative Systematic Review. Journal of Advanced Nursing, 1, 1-13.  Gray-Toft P. & Anderson, J. (1981). The Nursing Stress Scale: Development of an instrument. Journal of Psychopathology and Behavioral Assessment, 3(1), 11-23.  Harpell, B., Dwyer, T., Reid-Searl, K., Burke, K., Caperchione, C., & Gaskin, C. (2013). Nurses and Stress: Recognising Causes and Seeking Solutions. Journal of Nursing Management, 21, 628-647.  Jackson, E. (2013). Stress Relief: The Role of Exercise in Stress Management. ACSM's Health and Fitness Journal, 17(3), 14-19.  Li, A., & Goldsmith, C. (2012). The Effects of Yoga on Anxiety and Stress. Alternative Medicine Review, 17(1), 21-35.  Robson, R. (2011). A Critical Assessment of the Acute Effects of Yoga and Cardiovascular Exercise of Markers of Mood and Stress. Journal of Yoga and Physical Therapy, 1(4), 1-7.  Sinclair, S. J., Siefert, C. J., Slavin-Mulford, J., Stein, M. B., Renna, M., & Blais, M. A. (2012). Psychometric evaluation and normative data for the depression, anxiety, and stress scales-21 (DASS-21) in a nonclinical sample of U.S. adults. Evaluation & the Health Professions, 35(3), 259. Retrieved from http://ezproxy.library.usyd.edu.au/login?url=http://search.proquest.com/docview/1032943245?acco untid=14757  Lim J., Bogossian F. and Ahern K. (2010). Stress and coping in Australian nurses: a systematic review. International Nursing Review, 57, 22-31  Welker-Hood, K. (2006). Does Workplace Stress Lead to Accident or Error? American Journal of Nursing, 106, 9, 104