This portion of the Nurse residency course addresses stress management.As students begin their practice they face the challenge of transforming to a new roleWith that, comes many challenges, opportunities, and …stress as they move beyond the known to the unknown
This idea is based on Benner’s Novice to Expert theory. The transitional stages, the novice and the advanced beginner, are the one addressed in this residency program As the new graduate transitions from novice to competent practitioner: Improved organizational ability and technical skills Focus on managing the patient condition as opposed to accomplishing “tasks” Moving toward involvement, responsibility and professionalism
This course is not only based on a theoretical framework, but satisfies accreditation requirements set forth by the CCNE: FOUR standards: Program Faculty, Commitment and Resources, Curriculum and Evaluation Three topic areas:Leadership focuses on managing resources, including staff, supplies, and services for quality patient care.Patient outcomes focus on nurse sensitive quality indicators and on the provision of quality care and assurance of patient safety.Professional role focuses on the advancement of nursing knowledge and experience.
The inclusion of this topic may lead one to ask, “what does stress management have to do with it?”The transition to practice is a stressful transformationResearch shows: Turnover rates in the first year are high The consequences of increased stress include poor sleep, weight changes, absenteeism, work errors, burnout and departure from the profession.
The design selected for this lesson plan follows Hunter’s Seven Step MethodLesson Design Anticipatory Set (focus) - A short activity or prompt that focuses the students' attention before the actual lesson begins. Used when students enter the room or in a transition. A hand-out given to students at the door, review question written on the board, "two problems" on the overhead are examples of AS. Purpose (objective) - The purpose of today's lesson, why the students need to learn it, what they will be able to "do", and how they will show learning as a result are set forth by the instructorInput - The concepts the instructor will impart to the students - the "stuff" the students need to know in order to be successful. Modeling (show) - The teacher shows in graphic form or demonstrates what the finished product looks like - a picture worth a thousand words. Guided Practice (follow me) - The instructor leads the students through the steps necessary to perform the skill using the tri-modal approach - hear/see/do. Checking For Understanding (CFU) - The teacher uses a variety of questioning strategies to determine "Got it yet?" and to pace the lesson - move forward?/back up? Independent Practice - Students are provided the opportunity to practice on their own based on #3-#6.
ANTICIPATORY SET (focus) – Involves “setting the stage” - A short activity or prompt that focuses the students' attention before the actual lesson begins. Used when students enter the room or in a transition. For this lesson, the room would be set with low lighting and the word “RELAX: How do you do it?” on the board or on overhead with quiet music playing; selection of relaxation herbal teas Introductory Exercise – Stress release exercise where students sit upright in chairs, hands in laps, eyes closed; focus on breathing, while tensing and releasing muscle groups, allowing disruptive thoughts to leave; breathe deep and release.
PURPOSE (objective) - The purpose of today's lesson, why the students need to learn it, what they will be able to "do", and how they will show learning as a result are set forth by the instructorThe objective will be shown in a power point slide accompanied by a handout containing an outline on which the students may take notes.
INPUT – (the lesson) The concepts the instructor will impart to the students - the "stuff" the students need to know in order to be successful. [DISCUSSION] - small group activity; break into dyads or triads to discuss the following:Causes – Ask: what makes you tense in your daily life? suggest: at home (finances, housekeeping, kids/family, relationships) leisure (friends/network, rec. activities) work (work schedule, peers, duties/responsibilities) In Yourself – Ask: How do you know when you’re feeling anxious? Reconvene group, and share answers
Impact of Stress on Nurses: Stress can impact an individual in a number of ways. Somatic – bodily complaints Agitation Isolation Palpitation Loss of empathy Cravings Weight Gain Loss of concentration GERD Headaches HTN Sleep disturbancesBehavioral difficulty in attaining educational goals. disillusionment with the nursing profession and nursing program practices; increase in clinical errorsDel Prato, D., Bankert, E., Grust, P., & Joseph, J. (2011). Transforming nursing education: a review of stressors and strategies that support students' professional socialization. Advances in Medical Education and Practice, 2, 109-116.Negative Coping – occurs when people lack skills to manage stressIncludes: disputing, profanity or insulting, shouting, self negative speeches, excessive caffeine consumption, alcohol abuse, smoking, drug abuse, suicide thoughts, impatience, speed driving, overeating or eating very small,isolation or getting distance from others, looking forward to bad ending, crying a lot, tossing objects, nail chewing.A person’s adaptation to stress – whether positive or negative – is influenced by anumber of personal factors. The total person is involved in responding and adapting tostress. The stress is even greater for two groups of nurses: new graduates, who mustadjust to an environment different from what they experienced as students, and thenurses who work in settings such as intensive care and emergency care.Laal, M., & Aliramaie, N. (2010). Nursing and coping with stress. International Journal of Calloborative Research on Internal Medicine & Public Health, 2(5), 168-181.
(MODELING) Relaxation Techniques Adequate rest Healthy diet Deep breathing Exercise Yoga Aroma Therapy Humor Meditation Massage TalkingPAUSE: CHECK FOR UNDERSTANDING & discussion (GUIDED PRACTICE) Try Some (this segment will include several “try it” stations to include chair massage, aroma therapy, yoga, etc… where students can “sample” various techniques)
In INDEPENDENT PRACTICE, students will be asked to track their stress for a defined period of time including how they felt, what caused the stress, and how they coped. Keep a food plan for this same period of time, noting what/how they ate to identify trends
Repetition and summary of main points: This lesson has shown the stress related to nursing practice and its effects on the person and those around themIdentify personal stressors Assess self for signs of increasing strainDescribe consequences of stressDemonstrate methods for relaxationQuestions
NurseResidencyLesson PlanNancy Bock, RN, BSNKaplan University
Theoretical Framework Benner’s From Novice To Expert in Clinical Nursing Practice Advanced Novice Competent Proficient Expert BeginnerBrykczynski, K. A. (2006). From novice to expert: Excellence and power in clinical nursing practice. A. M. Tomey &M.A. Alligood (Eds.), Nursing Theorists and Their Work. St. Louis, MO: Mosby Elsevier.
Accreditation: Commission onCollegiate Nursing Education (CCNE)Standard III – Curriculum• III-C.4. Stress Management “The nurse must recognize and deal with personal stress levels in order to effectively manage situational stress. The program is designed to help the resident develop strategies to manage stress that results from a new job, role, or work environment. The resident must also learn to anticipate, assess, and intervene when situational stress occurs in a variety of interactions with different people.”
Stress Management• Transition into practice is stressful to graduate nurses• Turnover rates in the first year of nursing are high, ranging from 20% – 40% (Fink, Krugman, Casey, & Goode, 2008)• Increased stress levels can lead to: • Lack of sleep • Weight fluctuations • Increased absenteeism • Increase in errors • Burnout
Hunter’s Seven Steps for Lesson PlansDr. Madeline Hunter, UCLA • Anticipatory Set - focus • Statement of Objectives – goal of lesson • Instructional Input – the lesson • Modeling - demonstration • Check for Understanding- questions and discussion • Guided Practice– assist in practice of new skills • Independent Practice – autonomous practice
Lesson Plan: Stress ManagementAnticipatory Set• Room: Low lighting, soft music, herbal teas• Focus Question: RELAX: How do you do it?• Stress/Release Exercise
Lesson Plan: Stress ManagementObjectivesUpon completion of this lesson, the resident will be able to: Identify personal stressors Assess self for signs of increasing strain Describe consequences of stress Demonstrate methods for relaxation
Lesson Plan: Stress ManagementInstructional Input – the lesson• Causes – What causes stress for you? • At home • Leisure • Work• Self Recognition – How do you know? * * DISCUSSION * *
Lesson Plan: Stress ManagementInstructional Input – the lesson Impact: What can happen?
Lesson Plan: Stress ManagementInstructional Input – the lesson• Positive Coping Techniques: What can you do?• Demonstration – Let’s try it!
Lesson Plan: Stress Management• Independent Practice • Stress Diary/Coping • Meal plan