This document outlines a training manual for a stress management seminar for healthcare professionals. The seminar aims to help participants assess their stress levels, understand what causes stress, and provide strategies to help them cope and reduce stress. The training covers defining stress and identifying common stressors in healthcare such as workload, relationships, patients, schedules and role conflicts. It then teaches techniques like deep breathing, stretching, humor and social support. Participants are challenged to practice these coping strategies, track their stressors in a log, and apply the "COPE" (Consider, Optimize, Practice, Enjoy) method to manage stress and enjoy their work. The overall goal is to enhance coping mechanisms and reduce stress among healthcare workers.

1. ACKNOWLEDGEMENT
This training manual was developed and finalized by
Valerie Priya, Satish Vijay, Diana Loh,
Amelia Bay AND Sanchez Barry.
We would like to express our sincere gratitude to
Nicole Kashian for giving us her guidance,
insights and input that made
this manual possible.

2. TRAINING SCHEDULE
1. Introduction (45 minutes)
a. Welcome & Agenda
b. Learning Objectives – COPE
c. Expectation from participants by the end of the training
d. Pre-Test – DCL Stress Scale
2. What is Stress? (30 minutes)
a. Defining Stressed
b. Symptoms of Stress –“Are you stressed?”
c. “Why are you stressed?”
*****Break (15 minutes) *****
3. Objective #1 – CONSIDER (30 minutes)
a. Discussion of Commonly Identified Stressors
i. Workload
ii. Working Relationships
iii. Stress from Patients
iv. Pay and Shift Work Schedules
v. Role Conflict
4. Objective #2 – OPTIMIZE (30 minutes)
a. Understand the effects of Stress
b. Optimize all options to adopt a stress-reducing approach
***** Lunch (60 minutes) *****
5. Objective #3 – PRACTICE (40 minutes)
a. How Do You Manage Stress?
i. Rahim & Bonoma Modal (1979)
II. “So what’s the best choice?”
b. Coping Strategies: Individual
i. Problem Focused
ii. Emotion Focused
d. Social Support
i. Emotional Support
ii. Informational Support
iii. Instrumental Support
e. Activity #1: Stress Management Technique – Hospital Havoc
***** Break (15 minutes) *****
6. Stress Reduction Exercise (15 minutes)
i. Soothing Stretches
ii. Deep Breathing
iii. Humor
7. Learning Objective #4 – ENJOY YOUR WORK
8. Our Challenge to You
a. Create a Stress Log and Record Stressful Events
b. Adopt “COPE”
c. Review and Evaluate
9. Wrapping Up
a. Sum up “COPE”
b. Administer post-test (DCL Stress Scale)
c. Thank you and Goodbye

3. TABLE OF CONTENTS
INTRODUCTIONINTRODUCTION
WHAT IS STRESS?WHAT IS STRESS?
OBJECTIVE #1: CONSIDEROBJECTIVE #1: CONSIDER
OBJECTIVE #2: OPTIMIZEOBJECTIVE #2: OPTIMIZE
OBJECTIVE #3: PRACTICEOBJECTIVE #3: PRACTICE
STRESS REDUCTION EXERCISESTRESS REDUCTION EXERCISE
OBJECTIVE #4: ENJOYOBJECTIVE #4: ENJOY
OUR CHALLENGE TO YOUOUR CHALLENGE TO YOU
WRAPPING UPWRAPPING UP
1.
2.
3.
4.
5.
6.
7.
8.
9.
INTRODUCTION
The following manual is created to enhance coping mechanisms
in areas of stress management among healthcare professionals.
The training seminar will consist of 3 sessions, conducted over
the course of two weeks. Healthcare professionals are
required to attend only one session.
At the start of the seminar, participants will be administered
the Devilliers, Carson, and Leary (DCL) Stress Scale to ASSESS
THEIR LEVEL OF STRESS. It then covers the definition of stress,
strategies and techniques to manage stress through our
strategy “COPE” before closing the seminar with a “Question
Answer” portion.
Stress in the health care sector consists of stressors such
as workload, working relationships and stress from patients.
Other stressors include pay and shiftwork, lack of working
experience and role conflicts. This has caused an increase in
dissatisfaction among health care professionals, thus
resulting in an exponential rise in turnover rate. This OUTCOME
has slowed down organizational processes.
This training manual, alongside with the seminar is engineered
to help healthcare workers identify the sources of stress by
introducing different coping strategies. Furthermore,
choosing and applying the right strategies can enable
wellness and lighten the mood at work. By the end of this
training workshop, you will be able to learn how to COPE:

4. OBJECTIVES
onsider the different stressors
ptimize the best way to reduce stress
ractice the strategies
njoy your work
C
o
p
E
WHAT IS STRESS?
DEFINITION:
It is an individual’s PHYSICAL AND
MENTAL response to environmental
factors surrounding them.
taking a closer look:
We consider an individual’s’ perceptions of:
- The demands they face
- Their capability to meet these demands
symptoms of stress
INSOMNIA
HEADACHES
CHEST PAINS &
RAPID HEARTBEATS
UPSET STOMACH

5. OBJECTIVE #1
CONSIDER THE
DIFFERENT STRESSORS
PAY & WORK SCHEDULE
ROLE CONFLICTS
Long and irregular hours are expected to be
exchanged for a reasonable amount of
compensAtion. Since thESe are the nature of the
nursing occupation, staffs are not rewarded for the
time AND effort that are contributed to allow
operations in hospitals to run smoothly. Compensation is
usually the way organizations offer to show the worth
and value of a staff’s worth and when those benefits
are not met, it becomes a contributing factor to stress.
Many nurses play multiple roles- daughter, mother.
These roles have a set of responsibilities they have
to fulfil. They have to ensure their children are
well taken care of, especially when they are still
in their dependent years. Parents are also relying
on them for many issues at home. These roles that a
person has to take up are not easy, especially when
they have to juggle between shiftwork and irregu-
lar hours and fulfilling the needs of every family
member.
WOR
K
RELATIO
NSHIP
STRES
S
FROM P
ATIENTS
PAY&
WORK SC
HEDULE
ro
le conflict
WORKLOAD
why are we stressed?

6. After considering the stressors affecting you, the next course
of action would be to OPTIMIZE the strategies learnt fur-
ther on in this training workshop. The objective of this step
would be to understand the effects of stress, and then plan
out the best coping strategy. The coping strategy should be
planned around one’s life, as it is part of one’s lifestyle. As
it is unique to the individual how one copes with stress, this
step will help the healthcare worker plan his/her own stress
coping plan around his/her lifestyle with different tips.
Understand the Effects of Stress
There are many different effects of stress, ranging from
emotional, psychological, and physiological. The most observed
emotions that stems from stress are anger, frustration, guilt,
anxiety, and apathy. Not only does stress affect by inflicting
emotional distress, it also reduces work engagement and both
of which leads to productivity decrease.
objective #2
OPTIMIZE THE BEST
WAY TO REDUCE STRESS
STRESS FROM PATIENTS
WORK RELATIONSHIPS
WORKLOAD
One of the most common stressor in the healthcare
sector is workload issues, Understaffing, unorganised
and poorrostering from the management, inadequate rest
times contribute and irregular hours leads to extreme
exhaustion. Fatigue from the nursing occupation leads
to a stressed health care provider.
Relationship among co-workers are important to
meet the patient’s needs. Many times working
relationships between doctors and nurses are
strained DUE TO opinion differences. In the
healthcare sector, IT IS IMPORTANT TO MAINTAIN the
well being of nurses Through leader-member
exchange AS the supervisor’s social support HAS DI-
RECT IMPACT ON STRESS LEVELS.
traumatic events SUCH AS DEATH, aggression and
violence from patients are part and parcel of a
nurse’s career. Through research, many less
experienced nurses, mainly younger ones, fiNDS IT
DIFFICULT TO HANDLE AND COPE IN Such scenarios. THEY
ARE OFTEN THE TARGET OF HIGH stress levels.

7. EXTRACTED FROM RAHIM & BONOMA MODEL (1979)
SO WHAT’S THE BEST CHOICE?
RESEARCH HAS SHOWN THAT
HEALTHCARE
PROFESSIONALS TEND TO FAVOR
TACTICS OF
“AVOIDANCE” & “COMPROMISE”
AVOIDANCE COMPROMISE
OKAY...
SO HOW DO I COMPROMISE?
UNDERSTAND1
RESPECT2
OPEN-MIND3
OBJECTIVE #3
PRACTICE THE STRATEGIES
HOW DO YOU MANAGE STRESS?
INTEGRATING
OBLIGING
DOMINATING
AVOIDING
COMPROMISING
HIGH CONCERN FOR OTHERS, HIGH CONCERN FOR SELF
IN RESOLVING DISPUTES, BOTH PARTIES ENGAGE IN EXCHANGING
OF INFORMATION & APPRAISAL
IN COMPLEX CONTROVERSIES, THIS APPROACH IS ESSENTIAL
FOR PICKING OUT THE ‘BEST OF THE BEST’
HIGH CONCERN FOR OTHERS, LOW CONCERN FOR SELF
KNOWN AS THE ‘OBLIGER’: SELF-SACRIFICIAL & COMPLIANT
THIS APPROACH IS APPROPRIATE WHEN 1 SIDE BELIEVES THAT:
- THEY MAY BE IN ERROR
- THE ISSUE IS MORE IMPORTANT TO THE OTHER
MIDDLE WAY
INTERMEDIATE LEVEL OF CONCERN FOR BOTH SIDES
IN THE CASE OF A CONFLICT, A SOLUTION THAT BEST SUITS
THE NEEDS OF BOTH PARTIES, WILL BE SOUGHT OUT
LOW CONCERN FOR OTHERS, HIGH CONCERN FOR SELF
SEEN AS A DOMINEERING/COMPETITIVE
USES COMPULSION/COERCION TO ENSURE THEY WIN
IGNORES THE NEEDS & EXPECTATIONS OF OTHERS
LOW CONCERN FOR OTHERS, LOW CONCERN FOR SELF
KEY CHARACTERISTIC: WITHDRAWAL
DOESN’T CARE ABOUT PERSONAL/OTHERS’ INTERESTS
THIS APPROACH IS USEFUL WHEN CONFLICT IS TRIVIAL

8. PROBLEM EMOTION
An act of directly
reducing or eliminating
the stressor in a
controllable situation:
- Problem solving
- Decision making
- Informational Seeking
FOCUSED COPING
An act to relieve or
regulate the emotional
impact in an
uncontrollable situation:
- Talk / vent TO OTHERS
- Positive reappraisal
- Seek social support
EMOT
IONAL
INFORM
ATIONAL
instr
umental
Letting another person know that
they are loved and cared for
nvolves getting a message
across that would boost
another’s self-esteem
E.g. You can always look
for me when you have
a problem
Provision of facts
and advice to help
another person
cope with stress
E.g. Clarifying job
description
or providing
information on
job-related task.
Tangible support given to help
cope with stress and strain
E.g. Giving a helping hand
to a co-workers to meet
a deadline
COPING STRATEGIES
(individual)
social support

9. ACTIVITY #1
STRESS MANAGEMENT TECHNIQUES
HOSPITAL HAVOC
Aim : The activity will require participants to apply what has been covered in the training
through a make up scenario. In groups of 6, participants will engage in a role-play activity
and they will have to be able to identify the stressor(s) present. The activity also requires
them to apply the appropriate “Stress Reducing Technique” to cope with the situation at hand
to ensure that stress is managed in the most effective way.
Activity Time : 20 minutes
Instructions :
Divide into groups of 6
Determine who will be the staff nurse and who will be the junior nurse
Scenario :
You are a junior-level nurse at ABC Hospital for 1 year. As a result of an inter-department
merger, a new staff nurse (Nancy) has been appointed. On her first day, Sally sent out her
expectations of the new department and the milestones she wished to achieve.
Ever since NANCY has been appointed to oversee your department, the workload has since
tripled. You are constantly rushing to meet inventory deadlines and juggling between shifts.
This causes you to fall ill very often and NANCY has taken notice and she is not too pleased
with your absence at work lately as she believes that you are taking the easy way out by
avoiding your deadlines and work commitments. However, that is not the case as you are feeling
stressed with the amount of work you are given and you are finding it hard to cope with the
strain and unsure of how to deal with it.
Discussion :
In your groups, brainstorm how you will speak up to NANCY and cope with this stressful
situation you are facing. Firstly, identify the sources of stress followed by the response to
it. Next, adopt the appropriate technique to reduce stress. Finally, break into pairs and act
your the given scenarios to the larger group.
Neck Roll:
1. Let your chin hang down to your chest.
2. Slowly roll your head to your left side, so
that your left ear is near your left shoulder.
3. Roll your head backwards and let your head
hang as far back as is comfortable.
4. Slowly roll your head to the right, so that
your right ear is near your right shoulder.
5. Continue rolling your head until your chin is
once again hanging to your chest.
6. Repeat the process in the other direction.
stress reduction exercise
Worry & stress affects the
circulation, the heart,
the glands, the whole
nervous system, & may
affect heart action. Thus,
engaging in some quick & easy
stretches will help you
ease some of the
physical tension caused by
stress. It can also prevent
muscle tension & feelings of
stress. Although these ac-
tivities are not streneous,
it’s always best to check
with a doctor prior, espe-
cially if you have health
problems.
shoulder
shrug:
1. Relax your shoulders.
2. Slowly shrug towards the front of our
body and upwards.
3. Next, shrug your shoulders down towards
the back of your body.
4. Repeat the exercise in the opposite
direction when your shoulders are relaxed
and back in their natural position.
STRETCHES

10. DEEP BREATHINGWhen you breathe deeply, the
air coming in through your
nose fully fills your lungs,
and the lower belly rises.
It is a great relaxation tool
for stressful situations and
it has Several physical
benefits.
HUMORAn excellent stress RELiever. Humor has been scientifically
proven to lower blood pressure, reduce hormones created
by stress, IT giveS the Immune system a boost and createS a
sense of wellBeing and happiness.
HUMOR AT WORK:
1. Take a break BY Reading a funny story or joke is a great way to
make you laugh
2. Share a laugh with a colleague at work.
However, be mindful and sensitive to others and make SURE That
what you’re sharing is appropriate
LAUGHTER PUTS THINGS IN PErspective.
STABLIIZE
BLOOD
PRESSURE
LOWER
HEART
RATE
CLEARING
OF MIND
MUSCLE
RELAX
boosts
endorphins
When OUR stressors are identified, we will be able to use
the strategies and techniques learnt and incorporate
them into stress relieving methods. With that, relaxation
can take place and this will enhance our working
experience, making it an enjoyable one.
Encourage participants to jot
down reasons why they love
their job, this will serve as a
reminder of why they enjoyed
working there in the first place.
get them to pat themselves on
the back for constantly giving
their best in every task they do.
compliment the neighbour on a
job well done. not only will
they feel motivated, so will you!
objective #4
enjoy your work

11. OUR CHALLENGE TO YOU
STRESS LOGBOOK
A stress logbook will help you identify the stressors present in your life. By
identifying the cause of stress, it can help reduce the number and Effect these
stressors pose in your life as well as learning to manage it. When creating your
logbook, consider the following questions:
WHAT HAPPENED?
WHEN DID IT HAPPEN?
WHERE DID IT HAPPEN?
WHY DID IT HAPPEN?
WHAT WAS MY STRESS LEVEL? (1 = NOT STRESSED, 5 = SEVERELY STRESSED)
WHY DID IT CAUSE ME TO BE STRESSED?
WHAT DID I DO ABOUT IT?
HOW CAN I MANAGE THE SITUATION IF IT WERE
TO ARISE AGAIN?
Tip #1: Record All
Events
Record and fill out the
stress log each time you
find yourself feeling
stressed or anxious.
E.g. Writing a journal
entry to summary your day
at work as well as any
stress-related feelings.
Tip #2: Identifying
Sources of Stress &
Developing a Plan
At the end of the week, take
time to revisit the stress-
ors and identify the major
causes of stress. Next, rate
them accordingly from 1 to
5. Once you have identified
them, you can proceed to
apply “COPE” –
“Consider, Optimize,
Practice & Enjoy’.
Tip #3: Review &
Evaluate
After applying ‘COPE’, con-
sider the following ques-
tionS:
1. What is my stress level
now?
2. What has changed since
my first review?
3. Has the stressor been
successfully taken out
of my life?
4. If not, what can I do
differently to fight the
stress?
WRAPPING UP
feeling stressed?
learn to cope.
onsider the different stressors
ptimize the best way to
reduce stress
ractice the
strategies
njoy
your
work
C
o
p
e