This document discusses stress, its causes and effects, and strategies for managing stress. It defines stress as the body's nonspecific response to any demand or threat, and identifies three stages of the general adaptation syndrome: alarm, resistance, and exhaustion. Sources of stress for nurses are discussed, including workload, staffing issues, and end-of-life care. Physical and mental health consequences of prolonged stress are outlined. The document recommends various personal and organizational methods for managing stress, such as role redefinition, time management, relaxation techniques, and formal stress management programs.

1. Welcome

2. STRESS
MANAGEMENT

3. Page 3
Definition
• Stress is a nonspecific response of the body to any
demand , whether it is caused by or result is
pleasant or unpleasant conditions
• by Hans seyle
• Stress is mind and body’s response or reaction to a
real or imagined threat, event or change.
• A physical or psychological stimulus that can produce
mental tension or physiological reactions that may
lead to illness."

4. Page 4
LEVELS OF STRESS
• Eustress or positive stress occurs when the level of
stress is high enough to motivate to move into
action to get things accomplished.
• Distress or negative stress occurs when level of
stress is either too high or too low and body and/or
mind begin to respond negatively to the stressors.

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GENERAL
ADAPTATION
SYNDROME : STAGES
OF STRESS

6. ALARM STAGE
When we experience a stressful event
or perceive something to be stressful
psychological changes occur in the body.
This experience or perception disrupts
body’s normal balance and immediately
body begins to respond to the stressor(s)
as effectively as possible.

7. RESISTANCE STAGE
During this stage body tries to cope or adapt
to the stressors by beginning a process of
repairing any damage the stressor has
caused..

8. EXHAUSTION STAGE
During this stage the stressor is not being
managed effectively and the body and
mind are not able to repair the damage.
.

9. For example
• A promotion may be a positive stress but a nurse
may still respond with various emotional ,
cognitive and physical reaction such as anxiety ,
cognitive dissonance , or gastric pain.
• Perceived level vary from person to person
depending upon individual personal factors such
as heredity, habits, personality, past experiences,
illness and previous coping mechanisms.

10. STRESS DIAGRAM BASED ON
SELYE , H(1991)
Stage5: change in stress eliminated or change in person:
coping or no change
Stage 4: physical reaction to stress increased blood
pressure fatigue, sleep alterations
Stage 3: cognitive or intellectual response positive
or negative thinking
Stage 2: emotional reaction: surprise, shock,
anger, happiness
Stage 6: adaptation or burn out
Stage 1: flight or fight response, increased
adrenaline
Perceived stress

11. Stage 1
Alarm Reaction
Stage 2
Resistance
Stage 3
Exhaustion
Normal
Level of
Resistance
General Adaptation Syndrome

12. CAUSES OF STRESS
• At work place
• At Organizational Level
• At Personal Level
• Inter personal factors
• Individual factors

13. Stressors of nurses
• Environment
• Change
• Consumer demands
• Public demands
• Nurses role

14. Workplace stressors of staff nurses
• Workload
• Inadequate staff cover
• Relationship with other clinical staff
• Leadership and management style
• lack of adequate supervisory support
• Coping with emotional needs of patients and their families
• poor patient diagnosis
• Death and dying
• Shift working
• Lack of reward

15. At Organizational Level
• Technical – emergence of new technologies
• Strategic – globalization, privatization, take-
overs,
• Competition
• Increasing urbanization

16. At Personal Level
Life events Entries & exits to the family
Change in job
Daily events Unexciting but tight routine
Struggle of day to day life
Social support Economic, physical & emotional
support from friends, family &
others

17. Inter personal factors
• Interpersonal relationship within the nursing
profession and between other professions
• Shorter stay for patients
• Supervision of assistive personnel
• Interdisciplinary conflict

18. Individual factors
• Marriage
• Pregnancy
• Purchasing a new home

19. ROLE CONFLICT AND ROLE AMBIGUITY
• Role conflict occur when an individual has two competing
roles such as nurse manager both assumes a patient care
assignment and needs to attend a leadership meeting
• Role ambiguity results from unclear expectations for one’s
performance.
• Role under load and under utilization: Being underutilized or
not having much responsibility may be seen as stressful by a
person who is a high achiever or who has high self esteem.

20. PHYSICAL MENTAL
SPIRITUAL
Physical signs of ill
health
Increased flue cold or
accidents
Change in sleeping
habits
fatigue
Dread going to work
everyday
Rigid thinking
being unable to tolerate
any changes
Sense of being a failure
disappointed in work
performance
Anger and resentment
towards clients , colleges
and managers
Chronic signs of
decreased ability to
manage stress
a. Headache
b. Hypertension
c. Gastrointestinal
Being forgetful and
anxious about work to be
done , errors and
incidents more frequent
Lack of positive feeling
toward others

21. Cont..
Use of unhealthy
coping activities
a. Increased use of
drugs and alcholol
b. Increased weight
Returning home
exhausted
Confusion about
duties and roles
Cynicism toward
clients , blaming
them for their
problems
Excessive worry ,
insecurity
Lowered self esteem
Increases family and
friend conflicts

22. CONSEQUENCES OF STRESS
• prolonged anxiety, phobias, or a persistent stateof fear or free
floatinganxietythatseems to have many alternatingcauses
• Depression
• abrupt changesin mood and behavior
• perfectionism
• physical illness like peptic ulcer, arthritis, colitis, hypertension,
MI.
• burn out

23. STRESS MANAGEMENT
STRATEGIES

24. physical
 Acceptance of physical
limitations
 Nutrition ;high carbohydrate
;low sugar
 Exercise; enjoyable activity
three times a week for 30 min
 Make your physical health a
priority
 Sleep quatity and quality
 Relaxation : meditation,
massage,yoga

25. Mental
Learn to say No
Use cognitive restructuring and self talk
Imagery
Develop hobbies
Plan vacations
Learn about the system and how the problems are
handled
Learn communication, conflict resolution and
time management skills
Take continuing education course

26. Spiritual
Use meditation
Seek solace in prayer
Seek professional; counseling
Participate in support groups
Participate in net working
Communicate feelings
Ask for feedback and clarification

27. Page 27
To manage stress
• Personal methods
• Organizational methods

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Personal methods
Recognize the stressors
Caring for yourself physically and
developing effective habits
– Role redefinition
– Improved time management
– Relaxation techniques

29. Page 29
Role redefinition
• Involves clarifying the roles and attempting
to integrate or tie together the various
roles individual play.

30. TIME MANAGEMENT PRINCIPLES
 Goal setting
 Time analysis
 Priority determination
 Daily planning and
scheduling
 Grouping activities and
minimizing routine work
 Implementation
 Interruption control
 Evaluation

31. Time management
techniques
• making daily list of activities to be
accomplished
• Prioritizing the activities by importance and
emergency
• Scheduling activities according to the
priorities set
• Knowing daily cycle and handling the most
alert and productive

32. Relaxation techniques
• listening,
• reading,
• socializing with friends.
• hobbies and recreational activities
• Taking regular vacations

33. Eliminate self-defeating
behaviors
Resist perfectionism
Clean up your act
Flip your negative thinking

34. FIND WAYS TO DISPEL STRESS
Get time away.
Talk it out.
Cultivate allies at work
Find humor in the situation

35. An administrator
1. Is role ambiguity or conflict creating
stress?
2. Is manager using appropriate
leadership style?
3. Would additional training or education
help reduce stress?
4. Is the stress due to low self esteem of
self worth?
5. Are counseling services available in the
organization?

36. ORGANIZATIONAL METHODS
• Supportiveness
• Employee assistance
program
• Formal discussion group
• Rites and rituals

37. • Time management
• Formal stress management programs
• Humor
• Offering small incentives in terms of
money and paid leaves
• Praising employees for performance

38. When stress is job related
ю Proper matching of the job with the applicant during
the selection and hiring process
ю Skill training
ю Developing a programme of job enrichment matched
to the individual goals and desires often increase
autonomy
ю Communication and social support
• POLICIES LIKE
• Reducing the number of hours in night shift, holiday work
assignments
• Providing opportunities for break and meals

39. The effectiveness of current approaches to workplace
stress management in the nursing profession: an
evidence based literature review
• the effectiveness of current approaches to workplace stress
management for nurses was assessed through a systematic
review. Seven randomised controlled trials and three
prospective cohort studies assessing the effectiveness of a
stress management programmes were identified and
reviewed. The quality of research identified was weak. There
is more evidence for the effectiveness of programmes based
on providing personal support than environmental
management to reduce stressors

40. A descriptive study of stress
management in a group of pediatric
oncology nurses
• Pediatric oncology nursing is associated with highly stressful and emotional situations.
• This article describes and discusses major sources of occupational stress among a group of
nurses participating in a stress management group.
• The stress sources for these nurses were preoccupation with death and dying, the
professional image of the oncology nurse, the nurse as fighter in the war against disease and
death, the nurses' perceived isolation from the medical staff, the nurses' perceived inferior
professional status compared with that of physicians, emotional over involvement with
patients and families, suppression of anger, and difficulties in balancing work and home
demands.
• The following factors are suggested as major contributors to the nurses' stress and burnout:
increased tendency for irrational-dysfunctional thinking styles (mainly "demandingness" and
"awfulizing"), diffuse boundaries between nurses and patients, low professional self-efficacy,
and wide prevalence of military metaphors.
•
.

41. BIBLIOGRAPHY
• Sullivan Elanor J , Decker Philip J . Effective
leadership and management in nursing.
Addison Wesley; 1997
• Barret jean. Ward management and teaching .
New Delhi , Konark publishers; 1994
• Ann R L . Basic concepts of psychiatric mental
health nursing. 7th edition. Philadelphia .
Lippincott ;1997

42. • C. Adey: “Stress: Who cares?”, in Nursing
Times, Vol. 28, 1987, pp. 52-53.
• J.T. Bailey, S.M. Steffen and J.W. Grout: “The
stress audit: Identifying the stressors of ICU
• nursing”, in Journal of Nursing Education, Vol.
19, 1980, pp. 15-25
•