SMART PP

Nakia Thomas
Prof. Sandra Griffin
NUR: 495 Capstone Project
Capstone Facilitator:
Annamarie Broich MSN, RN
November 12, 2014
S.M.A.R.T
Stress Management, Adversity
&
Resiliency Training Program

S.M.A.R.T
Stress Management, Adversity
&
Resiliency Training Program
Honesty Statement
• The student name indicated on this title page signifies that the
author has read and understands the IWU Honesty Policy as
outlined in the Student Handbook and IWU Catalog. Affixing this
statement to the title page certifies that no cheating or dishonest
use of information has occurred in completing this assignment.
The work submitted is original work specific for this course. If
cheating and/or plagiarism are discovered in this paper, it is
acknowledged that the university policy will be followed, and
may result in dismissal of the student from Indiana Wesleyan
University.

Objectives
 Define stress
 Define adversity
 Define burnout
 Psychological and physical manifestations of stress/burnout
 Concept of resiliency
 Concept of self-care
 The importance of now in building resiliency

Stress
What is Stress?
 The brains response to any demand
 Can be positive and/or negative
 Short and /or long-term
 Major and /or minor
 Anxieties can lead to stress
 The body responds to each type of stress similarly
 Different people handle and respond to stress differently
(National Institute of Mental Health, n.d.)

Types of Stress
Routine Stress: You have a full-time job, home, and family
responsibilities to juggle(National Institute of Mental Health, n.d)
Acute: You are almost hit by a bus while crossing the street
Chronic Stress: You are in a stressful relationship, you have
a very sick parent, and you hate your boss
(Sapolsky, 2004; Trauma Talk: JD Sexton, PhD)

Stress Management
Routine stress
 Stress trends are more constant and body changes are more
difficult to notice compared to others types of stress
 Body gets no clear signals to return to normal function
 Stress and continuous strain on the body from this type of
stress can lead to serious health problems such as:
 Diabetes
 Heart Disease
 High B/P
 Depression
 Anxiety Disorders
 Other Illnesses
(
National Institute of Mental Health, n.d.)

Stress Management
Acute stress
 Known as the fight –or-flight response; the body’s immediate reaction to a
perceived threat, challenge or scare
 Immediate and intense and in certain circumstances can be thrilling
 Severe acute stress can cause mental health problems such as:
 Post Traumatic Stress Disorder (PTSD)
 Physical difficulties like a heart attack
(Mayo Foundation for Medical Education and Research, 2014)
Chronic stress
 Is constant and continuous
 Suppresses functions that are needed for immediate survival.
 Immunity is lowered digestive, excretory, and reproductive systems stop
working normally
 Severe viral infections (flu, common cold)
 Vaccines less effective

Stress Management
 Physical responses to stress
 Brain uses more oxygen
 Headaches
 Increased Heart rate
 Increased Respiratory rate
 Muscle tension
 Fatigue / sleeplessness

Stress Management
 Psychological responses to stress
 Depressed mood
 Anger
 Irritability
 Emotional exhaustion /compassion fatigue (Zander & Hutton, 2010)
 Social responses to stress
 Negative interactions with others
 Conflict
 Withdrawal
 Isolation
(Chesak, 2013; Guadalupe & Ayala, 2011; Jackson; Firtko, &
Edenborough, 2007; National Institute of Mental Health, n.d.;
Mealer, et al., 2021; Zander & Hutton, 2010)

Adversity
Adversity is a state of hardship or suffering
associated with:
 Misfortune
 Trauma
 Distress
 Difficulty
 Tragic event
Workplace adversity is viewed as any
negative, stressful, traumatic or difficult situation
or episode of hardship that is encountered in an
occupational setting. (Jackson, Firtko, & Edenborough, 2007; p. 3)

Types of Adversities
 Limited and/ or shortage in resources
 Staffing
 Scheduling
 Supplies
 Workload
 Lack of support
 Difficult, negative and /or challenging relationships
 Intrapersonal and /or intraprofessional relationships
 Difficult and complex patients / families
 Time management /constraints
 Skills and procedures
 Emotional annoyance and exhaustion
)
(Chesak, 2013; Guadalupe & Ayala, 2011; Hodges, Keeley, & Troyan, 2008; Jackson, Firtko,
& Edenborough, 2007; Mealer, et al., 2012 National Institute of Mental Health, n.d.; Pipe, et
al., 2012; Zander & Hutton, 2010

Burnout
Burnout is a state of physical and mental exhaustion, emotional
annoyance and exhaustion combined with personal and professional self-
efficacy doubts.
 Causes of Burnout
 Lack of control
 Unclear job expectation
 Dysfunctional workplace dynamics
 Mismatch in values
 Poor job fit
 Extremes of activities/ monotonous to chaotic
 Fatigue
 Lack of support
 No work life balance
 Trying to be everything to everyone

Burnout Quiz
 You try to be everything to everyone
 You get to the end of a hard day at work, and feel like you
have not made a meaningful difference
 You feel like the work you are doing is not recognized
 You identify so strongly with work that you lack a
reasonable balance between work and your personal life
 Your job varies between monotony and chaos
 You feel you have little or no control over your work
 You work in healthcare

Burnout
 Physical signs and symptoms of burnout
 Unexplained
 Headaches
 Backaches
 Body aches
 Other physical complaints
 Psychological signs and symptoms of burnout
 Depression, Post traumatic stress disorder (PTSD)
 Drag self to work and have trouble getting started
 Lack of energy to be consistently productive
 Irritable or impatient with co-workers, clients, and patients
 Cynical, or critical at work /negative thoughts and mood
 Lack of satisfaction from your achievements
 Changes in sleep habits and appetite
 Using food, drugs or alcohol to feel better, or to simply not feel

Outcomes of Stress,
Adversities, & Burnout
 Work
 Job dissatisfaction
 Patient dissatisfaction
 Work errors and performance decline
 Needle stick injuries
 Decline in quality decision-making
 Pt. safety issues
 Risk for negligence
 Role conflict and ambiguity
 Relationships
 Negative spillover into personal and professional relationship and life
(Chesak, 2013; Guadalupe & Ayala, 2011; Hodges, Keeley, & Troyan, 2008; Jackson, Firtko, &
Edenborough, 2007; Jones, 2013; Lombardo & Eyre, 2011; Mayo Foundation for Medical Education
and Research, 2014; Mayo Foundation for Medical Education and Research, 2014; Mealer, et al.,
2012; National Institute of Mental Health, n.d.; Pipe, et al., 2012; Zander & Hutton, 2010)

Outcomes of Stress,
Adversities, & Burnout
 Excessive stress
 Fatigue
 Headaches and /or Migraines
 Muscle tension
 Insomnia
 Depression
 Post traumatic stress disorder
(PTSD)
 Anxiety
 Heart disease
 High cholesterol
 Type 2 Diabetes Metillus (esp. in
women)
 Stroke
 Obesity
 Alcohol and substance abuse
 Vulnerability to other illness and health
issue
(Chesak, 2013; Guadalupe & Ayala, 2011; Hodges, Keeley, &
Troyan, 2008; Jackson, Firtko, & Edenborough, 2007; Jones, 2013;
Lombardo & Eyre, 2011; Mayo Foundation for Medical Education
and Research, 2014; Mayo Foundation for Medical Education and
Research, 2014; Mealer, et al., 2012; National Institute of Mental
Health, n.d.; Pipe, et al., 2012; Zander & Hutton, 2010)
Push, listen, scratch and sniff

Resiliency
A function of your ability to cope
(person), and the availability of
resources (situation) related to
health and well being.
(Sapolsky, 2004; Trauma Talk: JD Sexton, PhD)

Resiliency
 What is Resiliency?
 The ability of an individual to adjust to adversity
 Maintains equilibrium
 Retain some sense of control over their environment,
and to continue to move on in a positive manner
 Not a trait and can be learned
 The ability to undergo personal change enabling the
person to thrive and survive
 An active process
 Reduces vulnerability to stress and burnout

Resiliency Interventions
 Hardiness
 Transforming critical positive and negative experiences; learning from those
experiences and applying them to nursing practice
 Being committed
 Feeling in control
 Having positive views toward challenges
 Increases sense of personal accomplishment
 Decreases impact of emotional exhaustion
 Assists in overcoming negative emotions
 Thought sharing of stress, vulnerability, adversity, and
resilience
 Story exchange
 Sharing confidence within team
 Emotional expression /seeking assistance if needed
 Problem solving /not dwelling on problems (Chesak, 2013; Guadalupe & Ayala, 2011; Hodges, Keeley, & Troyan, 2008; Jackson, Firtko,
& Edenborough, 2007; Jones, 2013; Lombardo & Eyre, 2011; Mayo Foundation for Medical
Education and Research, 2014; Mayo Foundation for Medical Education and Research,
2014; Mealer, et al., 2012; National Institute of Mental Health, n.d.; Pipe, et al., 2012; Zander
& Hutton, 2010)

 Promoting positivity
 Creating and having supportive, nurturing, and validating relationships
(in and outside of work)
 Doing three good deeds for others (nothing major as simple as opening the door
for others)
 Reflecting on work and situations to overcome negative situation,
thinking, and attitudes
 Searching for greater meaning and /or good
 Expressive /reflective writing /journaling (personal and professional life and
situations)
 Mindfulness /self-awareness
 Awareness of strengths
 Interest, skills, and passion
 Achievements / personal and professional
 Awareness of limitations
 Emotional
 Seek help /assistance when needed

 Self-care
 Scheduling relaxing time and activities
 Healthy activities that are physically, emotionally, and spiritually nurturing
 Relaxation techniques
 Mediation
 Yoga
 Tia chi
 Taking breaks and lunches
 At least 15-30mins uninterrupted
 Eating healthy to meet bodies needs /requirements
 Work life balance
 Personal and professional boundaries
(Chesak, 2013; Guadalupe & Ayala, 2011; Hodges, Keeley, & Troyan, 2008; Jackson,
Firtko, & Edenborough, 2007; Jones, 2013; Lombardo & Eyre, 2011; Mayo Foundation for
Medical Education and Research, 2014; Mayo Foundation for Medical Education and
Research, 2014; Mealer, et al., 2012; National Institute of Mental Health, n.d.; Pipe, et al.,
2012; Zander & Hutton, 2010)

 Self-care cont.
 Managing stressors
 Know what coping strategies will help and when they are needed
 Weigh achievements against emotional exhaustion
 Mindful of posture /body position
 Resources (which people provide the best support)
 Counselor /Resiliency coach (Tiasha Rojas-Parker MBA, MS)
 S.M.A.R.T Champions (unit based)
 Mentor /preceptor
 Co-workers
 BMT Leadership team

Outcomes of Resiliency
 Are able to find meaning and purpose in life in the face of loss
and trauma
 Ability to emerge stronger in ones’ ability to face adversity
 Experience less stress and negative emotions and work related
problems than others
 Lifelong coping skill
 Able to recognize and transform stress from a more balanced perspective
 Optimism /positive outlook
 Having a sense of humor /laughter
 Improved physical, mental, and social health
 Protective against burnout
 Prevents PTSD
 Broaden perspective mindfulness /self-awareness
 When to seek assistance / use resources
(Chesak, 2013; Guadalupe & Ayala, 2011; Hodges, Keeley, & Troyan, 2008; Jackson, Firtko, & Edenborough, 2007;
Jones, 2013; Lombardo & Eyre, 2011; Mayo Foundation for Medical Education and Research, 2014; Mayo Foundation
for Medical Education and Research, 2014; Mealer, et al., 2012; National Institute of Mental Health, n.d.; Pipe, et al.,
2012; Zander & Hutton, 2010)

 Improved immune system
 Lower stress hormone levels
 Reduce inflammation response to stress
 Lower B/P
 Reduce pain
 Better sleep
 Job satisfaction
 Commitment /reduce turnover
 Productive work environment
 Decrease in work errors
 Improved ability in decision-making and information processing
Improved listening
 Quality patient care and outcomes
Empowerment of patients
Improved patient safety
Improved patient satisfaction
Perceived as more caring (Chesak, 2013; Guadalupe & Ayala, 2011; Hodges, Keeley, & Troyan, 2008; Jackson, Firtko, &
Edenborough, 2007; Jones, 2013; Lombardo & Eyre, 2011; Mayo Foundation for Medical
Education and Research, 2014; Mayo Foundation for Medical Education and Research, 2014;
Mealer, et al., 2012; National Institute of Mental Health, n.d.; Pipe, et al., 2012; Zander &
Hutton, 2010)

 Positive intrapersonal and intraprofessional relationships
Improve unit moral
Communication
Teamwork
Mentoring
 Promotes self-care enhancement
Personal and professional
Having a sense of humor /Laughter
Improves ability to want to take on challenges/ desire for learning
Increases use of resources knowledge and resources
 Improve personal and professional self-efficacy
Hope
Control
Competence
Coping
Appropriate regulation of negative emotions
Effective conflict management /problem solving
 Increases thought action inventory in the face of adversity
Promotes personal and professional goals setting and achievement
(Chesak, 2013; Guadalupe & Ayala, 2011; Hodges, Keeley, & Troyan, 2008;
Jackson, Firtko, & Edenborough, 2007; Jones, 2013; Lombardo & Eyre, 2011;
Mayo Foundation for Medical Education and Research, 2014; Mayo Foundation
for Medical Education and Research, 2014; Mealer, et al., 2012; National
Institute of Mental Health, n.d.; Pipe, et al., 2012; Zander & Hutton, 2010)

Summary
 Stress is the brains response to any demand and can be routine, acute,
or chronic. People handle and respond to stress differently, but all stress
effects the body similarly.
 Adversity is a state of hardship or suffering associated with misfortune,
trauma, distress, difficulty, or tragic event.
 Burnout is a state of physical and mental exhaustion, emotional
annoyance and exhaustion combined with personal and professional
self-efficacy doubts.
 Effects of stress, adversity and burnout can be manifested
psychologically and physically.
 Resiliency is a function of your ability to cope (person), and the
availability of resources (situation) related to health and well being
 Self-care involves healthy activities that are physically, emotionally, and
spiritually nurturing.

Resiliency and you, today and
tomorrow and the day after that…

Post Test & Survey
• Thank you for reviewing the resiliency education
• Please click on or copy and paste the following link to complete
the Resiliency Post Test & Survey
• It should take 5-10 minutes to complete

References
• Chesak, S. (2013, December). Integration and impact of stress management and resiliency training (Smart) in a Nurse Residency Program: A
feasibility study. Retrieved October 16, 2014, from University of Wisconsin Milwaukee UWM Digital Commons:
http://dc.uwm.edu/cgi/viewcontent.cgi?article=1352&context=etd
• Google. (n.d.). Stress, resiliency, and adversity. Retrieved November 14, 2014, from Google images:
https://www.google.com/search?q=stress&biw=702&bih=529&source=lnms&tbm=isch&sa=X&ei=0PFrVM39CMOdgwTUnYK4BA&ved=0CAcQ_AU
oAg#imgdii=_
• Guadalupe, G. M., & Ayala, C. J. (2011). Emotional exhaustion of nursing staff: Influence of emotional annoyance and resilien ce. International
Nursing Review, 59(1), 101-107. Retrieved October 18, 2014, from DOI: 10.1111/j.1466-7657.2011.00927.x
• Hodges, H. F., Keeley, A. C., & Troyan, P. J. (2008). Professional resilience in Baccalaureate-prepared acute care nurses: First steps. Nursing
Education Perspectives , 29(2), 80-89. doi:10.1043/1094-2831
• Jackson, D., Firtko, A., & Edenborough, M. (2007, October ). Personal resilience as a strategy for surviving and thriving in the face of workplace
adversity: A literature review. Journal of Advance Nursing, 60(1), 1 -9. doi:10.1111/j.1365-2648.2007.04412.x
• Jones, B. (2013). Compassion Fatigue and the Challenge of Developing Resilience. Retrieved October 17, 2014, from Oncology Nursing News:
http://nursing.onclive.com/publications/oncology-nurse/2013/June-2013/Compassion-Fatigue-and-the-Challenge-of-Developing-Resilience
• Lombardo, B., & Eyre, C. (2011). Compassion Fatigue: A nurse's primer. Online Journal of Issues in Nursing, 16(1). Retrieved October 16, 2014, from
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol -16-2011/No1-Jan-
2011/Compassion-Fatigue-A-Nurses-Primer.html
• Mayo Foundation for Medical Education and Research. (2014). Healthy lifestyle adult health: Job burnout: How to spot it and take action.
Retrieved October 20, 2014, from Mayo Clinic: http://www.mayoclinic.org/healthy-living/adult-health/in-depth/burnout/art-20046642
• Mayo Foundation for Medical Education and Research. (2014). Healthy lifestyle stress management: Know your triggers. Retrieved November 12,
2014, from Mayo Clinic: http://www.mayoclinic.org/healthy-living/stress-management/in-depth/stress-management/art-20044151
• Mealer, M., Jones, J., Newman, J., McFann, K. K., Rothbaum, B., & Moss, M. (2012). The presence of resilience is associated w ith a healthier
psychological profile in ICU nurses: Results of a national survey. International Journal of Nursing Studies , 49(3), 292-299.
doi:10.1016/j.ijnurstu.2011.09.015
• National Institute of Mental Health. (n.d.). Fact Sheet on Stress. Retrieved October 20, 2014, from National Institute of Mental Health:
http://www.nimh.nih.gov/health/publications/stress/index.shtml
• Pipe, T. B., Buchda, V. L., Launder, S., Hudak, B., Hulvey, L., Karns, K. E., & Pendergast, D. (2012). Building personal and professional resources of
resilience and agility in the healthcare workplace. Stress and Health, 28(1), 11-22. doi:10.1002/smi.1396.
• Sexton, B., & Sexton, J. (2013). Enhancing caregiver resilience: Burnout and quality improvement. Duke University Healthcare Systems Patient
Care Center, (pp. 1-42). Durham. Retrieved October 15, 2014
• Zander, M., & Hutton, A. (2010). Coping and resilience factors in Pediatric Oncology Nurses. Journal of Pediatric Oncology Nursing, 27(2), 94-108.
doi:10.1177/1043454209350154

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