Stress management |Types of stress

STRESS
MANAGEMENT
PRESENTED BY :-
MS. NEHA MALIK

Introduction
 Right from the time of birth till the last breath drawn, an individual is invariably
exposed to various stressful situations. The modern world which is said to be a
world of achievement is also a world of stress and has been called the – Age of
Anxiety and Stress.
 Stress has been defined in many different ways over the years. The word stress is
derived from English word. Originally it was used in physics and it meant an
external pressure, tension, load of an object (Newhouse and Treven, 2005). It was
conceived as pressure from the environment, then as strain within the person.

 The term stress was introduced in medicine in 1949 by Canadian
endocrinologist – Hans Selye. To him, stress is described as the body’s
adjustment to a new circumstance, and the body’s stereotypical and non-
specific response to environmental stimuli that disrupt a personal balance,
and described also as a psychosomatic mechanism to regulate and balance
the tensions, which means the perception and preparation of the body to the
specific loads.
 About one-third of workers reports high level of stress and high level of
stress are associated with the substantial increase in health service
utilization.

 Additionally, periods of disability due to job stress tends to
be much longer then disability periods for other
occupational injuries and illness.
 Stress affecting the nurse across the globe has been
convincingly documented in the literature for more than 40
years, (Lazarus RS).
 Nurse’s environment includes an enclosed atmosphere,
time pressure, excessive noises, no second chance,
unpleasant sights and sounds, and long standing hours.

Definition Of Stress: -
According to Selyle (1956), ―Stress is defined
as the pressure experienced by a person in
response to life demands. These demands are
referred to as stressors and include a range of
life events, physical factors (e.g.: cold, hunger,
hemorrhage, pain), environmental conditions
and personal thoughts.

 According to Selye (1976) Stress is a process of adjusting to or
dealing with circumstances that disrupt or threaten to disrupt a
person’s physical or psychological functioning.
 Stress is tension, strain, or pressure from a situation that requires us
to use, adapt, or develop new coping skills.

STRESSOR
Stressor is any person or situation that
produces anxiety response to the body. A
stressor is a chemical or biological agent,
environmental condition, external stimulus or
an event that causes stress to an individual.
Stressor is the stimuli proceeding or
precipitating a change. It may be internal (fear,
guilt) or external (trauma, peer pressure, etc).

Types of stressor
Physiological stressors:
 Chemical agents
 Physical agents Illness, injuries, hormonal fluctuations, inadequate sleep
or nutrition
 Infectious agent
 Nutrition imbalances
 Genetic or immune disorders

Psychological stressor:
 Accidents can cause stress for the victim, the person who caused the
accident and the families of both
 Stressful experiences of family members and friends
 Fear of aggression or mutilation from others such as
murder, rape, terrorist and attacks.
 Events that we see on T.V. such as war, earthquake, violence
 Developmental and life events• Rapid changes in our world, including
economic and political structures and technology

SOURCES OF STRESS
There are many sources of stress, these are broadly classified as:
 Internal stressors: they originate within a person e.g.: cancer, feeling of depression.
 External stressors: it originates outside the individual e.g.: moving to another city,
death in a family.
 Developmental stressors: it occurs at predictable times throughout an individual ‘s
life. e.g.: child- beginning of school.
 Situational stressors: they are unpredictable and occur at any time during life. It may
be positive or negative. e.g.: death of family member, marriage/ divorce.

Organizational factors
 Workload :- due to shortage of staff or time pressure , increasing
responsibilities, non nursing work, can lead to emotional
exhaustion among the nurses .
 Inadequate staffing :- shortage of staff in shift duties leads to
extra work among nurses and there will be time pressure to
complete the work: that can be the cause of stress and burn out
among nurses
 Job content :- unpleasant tasks and works of low social value can
lead to frustration among the staff and also nurses working in the
hazardous environment have the fear being exposed to infections.

Working hours :- long unsocial, strict and
inflexible duty hours.
Shift duty pattern :- Frequent shift duty pattern of
odd hours especially the night duties change the
lifestyle and behavior of the nurses.
Role Ambiguity and Role Conflict :-Lack of
clarity about tasks, unit and organization is also one
of the predictor of stress as reported by the nurses.

Lack of Task Autonomy , Accountability and Feedback:-
Accountability without autonomy at times become the
source of stress among nurse administrators and
supervisors.
Lack of Career Development:- Job insecurity, lack of
promotional avenues, lack of opportunity of growth,
advancement, can cause stress among nurses.
Physical Facilities/Environment:- Inadequate, unpleasant
or dangerous physical facilities, e.g. poor ventilation,
lighting, temperature, crowding , noise, air pollution, or
ergonomic problems are the stressors at the work place.

Social Environment:- Lack of support from the nurse
administrators, lack of family-friendly policies, poor
interpersonal relationship with co-workers, doctors,
nurse administrators and other team members, lack of
staff support, autocratic behavior of the supervisors,
conflict with doctors are the predictors of psychological
stress among nurses.
Ineffective Communication :- Stress can result from a
lack of communication or from a lack of the right kind
of communication at the right time.

The nature of nursing is not free from stress. It is considered
one of the stressful occupations.
Caring for Suffering and Death and Dying Patients:-The
patients suffering with pain, disability, long term and
acutely ill, death and dying can be the source of stress for
nurses.
Difficult Patients and their Family Members :- At times,
the nurses are experiencing difficult and demanding patients
and their family members can be source of stress for nurses.
Nature of Profession

Working with Psychiatry Patients:- Nurses may face
emotional exhaustion in working with aggressive
patients especially with suicidal and violent incidence of
patients.
Exposure to Occupational Hazards:- The nurses are
working in the environment susceptible to expose to
various biological, physical, reproductive, chemical,
mechanical, psychological and occupational cancers.
Working in such an environment will be stressful for
them.

Demographic Characteristic:- The empirical evidences
revealed that age, gender, length of tenure in the job, job area
of individual nurses are associated with their level of stress.
Personality:- Personality and interpersonal behavior of
individual nurses are associated with various dimensions of
stress.
Belief in External Locus of Control:-The nurses who believe
that outside forces are controlling their fate in the job
environment are more stressful than other nurses who believe
that they can control potential adverse forces in their job.
Personal Characteristics

Competency :-The nurses if not competent, may be
scared and not confident to handle the situations will
be under stress.
Lack of Preparation:- One of the greatest sources
for nurses, stress is the their lack of preparation in
handling the emotional needs of patients which
causes anxiety within the nursing staff. Nurses who
are not emotionally mature can have high level of
stress to deal with the patients.

TYPES OF STRESS:
Stress is the ‘wear and tear’ our bodies experiences as we adjust to
our continually changing environment. It has physical and emotional
effects on us and can create positive and negative feelings.
There are actually two types of stress;
 A.Eustress
 B.Distress

A. Eustress:
o Eustress is the positive stress that stimulates a person to function
better. This is called as friendly stress or positive stress.
o It has a good influence on human in terms of physical and mental
ability.
o It acts in a positive for the individual and the organization.
o It also provides the sense of urgency and alertness needed to survival
when confronting threating situation.

B. Distress
o Distress is a negative stress that may cause illness.
o This is also called as harmful stress.
o Negative stress could be also described as a burning out.
o It is a contributory factor in minor condition such as
headaches, insomnia, ulcers, etc

CLASSIFICATION OF
STRESS:
Stress can be classified as;
 Short term (acute) stress
 Long term (chronic) stress

Short term (acute) stress:
 Acute stress is the reaction to an immediate threat, commonly
known as fight or flight response.
 The threat can be any situation that is experienced, even
subconsciously or falsely as a danger.
 Common acute stress includes – noise, crowding, isolation,
hunger, danger, infection, etc.

Long term (chronic) stress:
In day-to-day life persons faces different stressful situations, which are not
short, lived. The stress becomes chronic when an individual tries to
suppress it.
Common chronic stressor includes;
 Ongoing highly pressured work
 long term relationship problems
 Loneliness

EFFECTS OF STRESS:
Short term effects of stress:
1.Physical changes:
 Physical symptoms are usually triggered by arousal of autonomic nervous
system and includes increase in heart rate and blood pressure
2. Psychological changes: -
 It includes lack of concentration, Muscle ache, Headache, and Insomnia,
Loss of memory, iinability to make decision, Forgetfulness, and
Confusion,Faster breathing,

3. Emotional changes: - Emotional response may
include :-Anxiety, Nervousness, Frustration, Anger,
Irritability
4. Behavioral symptoms: Impact of stress also
affects the behavior and present as pacing, Fidgety
movement, Nail biting, - Smoking, Drinking, and
Throwing things

Long term effects of stress:
Behavioral changes: The affected person becomes victim of
serious behavioral disorder like. Fearfulness, Obesity. Alcoholism
,Drugs addiction
Cardiovascular disease :-many studies suggest that
psychologically demanding jobs that allow employees little control
over the work process increasing the risk of cardiovascular disease

Musculoskeletal disorder:- on the basis of research
by NIOSH and many other organizations, it is
widely believed that job stress increase the risk for
development of back and upper extremity
musculoskeletal disorder.
Mental problems :- occupational stress and its
consequences on nurses behaviour can create mental
problems such as anxiety , depression, insomnia and
feeling of inadequacy
Substance abuse and suicide

Emotional changes: Chronic anxiety ,Depression.
 The affected person become victim of serious Emotional
disorder, like Fear and phobia ,Personality changes ,Mental
disorder
Cognitive changes: - The affected person become victim of
serious Cognitive disorder, like Memory problem
,Obsessive thoughts ,Sleep disorder

STAGES OF STRESS
Hans Selye explained stress through GAS (General Adaptation
Syndrome), a way that the body tries to keep balance. The GAS
stages are;
1.The alarm reaction stage.
2.Stage of resistance.
3.Stage of exhaustion.

The alarm reaction stage:
 Alarm is the first stag When the stressor
is identified or realized, the body’s
stress response is a state of alarm.
 During this stage, adrenaline will be
produced in order to bring about the
fight or flight responses.

Stage of resistance
 Resistance is the second stage, If the stressor
persists, it become necessary to attempt some
means of coping with the stress.
 Although the body begins to try to adapt to
the strains or demands of the environment,
the body cannot keep this up indefinitely, so
its resources are gradually depleted.

Stage of exhaustion
 Exhaustion is the third stage and final stage
in the GAS model, at this point, all the
body’s resources are eventually depleted and
body is unable to maintain normal function.
 If stage three is extended, long term damage
may result as the capacity of gland,
especially the adrenal gland.

STRESS MANAGEMENT:
Stress management involves the use of the coping strategies
in response to stressful situations. Coping strategies are
adaptive when they protect the individual from harm or
strengthen the individual’s ability to meet challenging
situation.
To manage job related stress two types of approaches are
there
Individual coping strategies
Organisational coping strategies

Individual coping strategies
 Awareness; - The initial step in managing stress in awareness- to become aware of the factors
that create stress and the feeling associated with a stressful response. As one can becomes aware
of stressors, he or she can omit, avoid, or accept them.
 Got organized; - Coping with stress is all about planning. You can plan to fall or plan to
succussed. Organized time for work, family, hobbies, spiritual time, time with friends and time
alone, time for exercise and time for relaxation
 Visualized the best outcome; Coping with stress knows how to deal with a stressful situation
before it occurs. Rehearse how you are going to handle it. Picture yourself being successful in
coping with stress
 Time management
 Relaxation/meditation

 Don’t postpone action; - One of the best strategies for coping
with stress is not to put off actions until tomorrow if you can do it
today. Coping with stress become more difficult when you defer.
Do your least favorite chores first, followed by rewards.
 Be realistic; - Set realistic goals. Emphasize quality over quantity.
Work at a leisurely pace, taking breaks often.
 Sleep, eat, and exercise; - Coping with stress is all about treating
your body properly. Eat food that nourish you, exercise and get
plenty of sleep.

Organizational coping strategies

UNHEALTHY WAYS OF COPING
WITH STRESS
1. Smoking
2. Drinking too much
3. Over eating or under eating
4. Using pills or drugs to relax
5. Sleeping to much
6. Withdrawing from friends, family, and activities
7. Zoning out for hours in front of the T.V or computer.
8. Taking your stress out on others (lashing out, angry outbursts, physical violence)

NURSE MANAGER’S ROLE IN
STRESS MANAGEMENT:
 Ensure that the workload is in line with nurses’ capabilities and resources.
 Clearly define the nurse’s role and responsibility.
 Planned orientation programmers for the newly joined staff.
 Give nurses the opportunities to participate in decision making and actions in
patients care.
 Improve the communications and provide supportive environment
 Provide opportunities for social interaction among the nurses.
 Organize group meeting to solve the problems.

RESEARCH ARTICLES ON STRESS MANAGEMENT
1. A Study On Stress Management Among The Employees Of Nationalized Banks
- Harish Shukla and Ms. Rachita Garg (12/2013)
ABSTRACT
Banking, like other services, has become one of the highly competitive sectors in India. The banking organizations, since the
beginning of this decade, have been facing greater challenges in terms of technological revolution, service diversification and
global banking. Stress is unavoidable on the part of the employees as the systems, procedures; techniques are getting
complicated with the use of advance technology. Every employee cannot cope with such rapid Changes taking place in the
jobs.
This will lead to arising of stress among employees. An attempt has been made through this research paper to know the
reasons of stress among the bank employees and the ways used by employees to cope with the stress generated at workplace.
It is found that maximum number of employees in banks remains in stress. Majority of the employees try to find solution to
relieve them from stress.
Also, the measures are also suggested in the paper to overcome stress that affects their physical and mental health.

Findings and Conclusion
Most of the employees fear with the fact that lack quality in their work puts stress on them. It is found
that maximum number of employees in banks remains in stress. 50% employees feel that they are
overloaded with work.
44% employees feel tensed due to their non- achievement of their target of work. 38% employees
accepted that they will obey the order of their boss by sacrificing their important domestic function. It
indicates fear and stress among employees. 24% employees feel stress due to their family related
problems.
Half of the employees accepted that there is conflict among the employees. It is a concern for top
management. Only 48% employees feel that strategies used by banks to manage stress of employees
are effective. Majority of the employees try to find solution to relieve them from stress.50% employees
use YOGA or other ways to relieve them from stress. In spite of stress, majority of the employee’s

Stress management |Types of stress

Stress management |Types of stress

Stress management |Types of stress

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