INTRODUCTION:

This booklet has been written by nurses for nurses to help promote awareness and understanding of our own mental health needs. It is widely recognized that nurses, like many others in the caring professions, have mastered the art of anticipating and attending to the physical and emotional needs of others. Unfortunately, nurses tend to forget how to take care of themselves and each other. Nurses have a habit of putting the needs of our patients ahead of our own. The community regards us as tough, able to cope in all situations, resilient, always caring, loyal to our patients, dedicated, committed, the list goes on. These expectations are put on us by society, managers, organizations and sometimes ourselves [1].

As lucrative and rewarding as it is, being a nurse is filled with a certain level of substantial pressure that can easily cause burnout. While working, you have to stand for hours. You also have longs shifts and the emotional drain on you as you take care of your patients is phenomenal.

In some cases, you are required to work for 12+ hours a day. And research has shown working long hours can lead to burnout and serious health problems. This makes sense since the shifts are demanding, as well as physically and emotionally draining. Moreover, you are always on your feet performing your duties.

Nursing is related to a wide range of emotions that you can experience throughout the day including being overwhelmed, anxiety, and of course, stress. At the same time, you can also feel challenged, stimulated, confident, and rewarded.

Dealing with all these emotions in one day can make you lose your mind, let alone dealing with it on a daily basis. Sometimes you end up with no energy to take care of yourself as you care for others.

As a nurse, keeping a calm head and staying relaxed as possible under stressful conditions is extremely important. In order to help you avoid letting the pressure overwhelm you, here are some great stress management tips for nurses. The major sources of stresses for nurses as contained in literature includes, workload, working hours, work environment, interpersonal relationship. Lack of staff and high turnover, having too much work to do (overload), having to assume unpleasant tasks, discriminations and latent favours, incapacity to close with the job at home, consequences of made mistakes, pursue the career to damage of the familiar life, bringing the work at home, inadequate supervision of the superiors, feeling isolated among others [2].

STRESS SOURCES:

The World Health Organisation (WHO 1948) defined healthy jobs as the one where the work pressure is equivalent to the abilities and inherent capacity of an employee to manage the effect of the pressure and this implies having control of their work and working environment and getting enough support and encouragement from the people they consider important. The people who matter in the context of this research are the employers, the bosses and supervisors, colleagues, the patients as well as the family members of both the nurses and the patients. Though pressure is unavoidably present in everyday working life, the source and form of the pressure could define how different persons perceive it. Work pressure is seen to be positive or acceptable when the worker sees it as a source of motivation rather than a stressor. In this case, the worker is willing to learn and work depending on his inherent characteristics and available resources.

On the other hand, if the pressure is perceived to be excessive or otherwise unmanageable it leads to stress. The World Health Organisation (WHO 1948) defined work stress as, “the response people may have when presented with work demands and pressures that are not matched to their knowledge and abilities and which challenge their ability to cope. According to (WHO 1948) stress is seen in almost every work environment but the negative aspect of it is made prominent when workers consider the support they get from their supervisors and colleagues as inadequate or when they have little or no control over the work process [3].

In research work, “Stress arises when individuals perceive that they cannot adequately cope with the demands being made on them or with threats to their well-being.” When the pressures arising from the demand of the job is overbearing and when it tend to weigh down on the employee either physically, mentally or emotionally, one can say that he is stressed.

“Work-related stress can be caused by poor work organisation which could mean the design of the jobs and work systems, and the way they are managed. According to literature, work related stress could also be as a result of poor institutional management, poor work environment or working condition as well as lack of support from other members of the team. Research findings have shown that the most stressful types of work are those in which the demand of the job does not match the capacity and capabilities of the employee. Stress also occurs where there are too much restrictions and little or no opportunity to make choices and where the amount of external support is low. When these factors are provided for, employees are less likely to experience work related stress [4].

STRESS COPING STRATEGIES:

There are many known and traditional means of managing everyday stress. These could be in form of physical exercise, emotional and psychological therapies, change in work approach, medications among others. The choice of management procedure adopted is usually subjective to the source and nature of the stress and the resources available to the individual under stress. It is believed that the best management practice for stress is learning healthy coping strategies. The first step to effective stress management is to understand one-self better and to appreciate what constitute stress and how one reacts to stressful situations. In the nursing context, to manage the demand arising from the strenuous nature of the job and still render quality health and nursing services to patient could be seen as effective coping. Most literatures that worked on stress and coping tried to link the coping strategies to the type and sources of the stressor.

There is need to establish safe hour work limit for nurses in order to prevent the high rate of fatigue related medical errors and injuries. In other words, to be able to manage the stress arising from long working hours, there is need for management action on limiting the amount of hours done by nurses. The kind of shifts and the duration of shifts can be controlled by a combined effort of the nurse managers and the nurses working in the hospitals. Researchers agreed that stress is associated to the number of hours done by hospital doctors the stress on their performance. Consequently, social support was identified as an effective coping strategy for junior doctors as against senior doctors.

Nurses are believed to have lower level of burnout than surgeons and they agreed that this is as a result of better working practice, the type of responsibilities and the management structure. By this, a better organized management structure and organized individual working practice are seen as effective way of managing or coping with work stress. Other preventive strategies include effective communication strategies during end of life care, prevention of management conflicts and perceived control [5].

QUALITY AND EFFECTIVE CARE:

For care to be effective, it has to meet the World Health Organisation standard of “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO 1948). The quality of care available to patients is a product of the quality of the healthcare professionals offering the healthcare services. This is in support of the popular theory of garbage in garbage out. The quality of the personnel on the other hand is a reflection of the quality of training he received, the tools available to him and the environment in which he is delivering the services. To measure how effective a particular coping strategy is in the management of stressful situation among nurses, the quality of care the patients receive comes to play. Researchers concluded that fatigue arising from stress impairs performance, cause medical errors and injuries. Medication errors has been made by 64.55% of nurses and one major cause of it is the number of patients been cared for by a nurse (work overload). The wrong dosing and other nurses errors are some of the health threatening mistakes that lead to poor patient care with the consequent mortalities, length of hospital stay and the related cost. It therefore implies that coping strategies outlined will be aiming to eliminate stress in Nurses to allow for positive result oriented care [6].

EFFECTS OF UNRESOLVED STRESS:

If it goes unmanaged, stress can easily lead to burnout and that can lead to an overall negative effect on your life. Ongoing stress can manifest itself in several ways, including [7]:

· Physical illness and depression

· Bitterness and anger

· Being demoralized

· Poor turnover and absenteeism

· Substance abuse

· Family negligence

Some researchers have shown that if untreated, stress can lead to immune system impairment in addition to causing an increase in cardiovascular diseases and cancer. Fortunately, you can adopt certain lifestyle changes to help you overcome work burnout.

STRESS MANAGEMENT FOR NURSES:

1. Be Sociable and Humorous

Nurses’ work is demanding and taking breaks from the patients may seem like an impossible thing to do. But it's wise to take breaks when one is working in stressful environments. Taking a break helps one to relax so that when the person comes back, he/she will be better prepared to continue offering care. Nurses should “consider taking care of themselves as one take care of patients”.

One of the best ways to relieve stress for nurses is by opening up to someone one can trust such as a friend or a family member. Your friend might not have a definite solution to what's stressing you. What that friend will be is an assurance of a listening ear and that is all you need in some cases. Talking about your feelings with someone puts them in the right perspective and reduces the heavy burden in your heart and mind.

Additionally, while you are around your loved ones, laugh your heart out at an interesting joke. Laughing acts as a tension reliever lifting your spirits and strengthening the bond between you and your friends. You can also use humor at the appropriate time and during breaks to lighten the mood in your working environment.

2. Fight Compassion Fatigue:

Caring too much for other people lead to stress called secondhand stress. If you listen to patients’ stories of fear, pain, and suffering continuously, you can empathically experience the same emotional pain your patient is going through. This kind of stress does not go away by consuming conventional medication. But you can relieve the stress naturally.

For instance, practicing the ancient Chinese healing technique of Qigong breathing is one way you can relieve empathetic stress.

Similarly, stop feeling guilty about the situation your patients are experiencing. It is not your fault. Letting go of this guilty feeling relieves your stress. Furthermore, consider increasing your social support, participating in community projects, and involving yourself in various charitable events [8].

3. Exercise Regularly and Fix Your Diet:

A healthy diet improves your overall health including helping in stress management. Therefore, ensure you do not skip your meals and keep your body well hydrated.

Fatigue and stress can interfere with your sleep patterns. Unfortunately, the two are very common among nurses. To perform well, you need enough sleep as much as you need a good diet. Ensure you have a sleep schedule that you strictly follow even when you feel like you cannot sleep.

Improving on your physical wellness can have a great impact on your stress levels. Getting started is simple:

· Join a gym.

· Decide to walk more than you drive or take a cab.

· Use the stairs instead of the elevator.

Interestingly, when one part of your body feels good, it can easily affect your other parts including the brain. That's why exercise is such a powerful stress management technique for nurses [9].

4. Mindful Meditation:

Practicing mindful meditation (or mindfulness based stress reduction) helps you be aware of what is happening around you without making any judgments. While meditating, try focusing on one issue at a time until you completely sink in your thoughts and start connecting with your subconscious mind.

It is possible to face distractions when doing this but your mind will gradually rest and start giving you meaningful thoughts. At this point, feelings and emotions such as stress, anxiety, blame, guilt, or anger will become start to fade away. By the time you are done meditating, you will have gotten over those feelings [10].

5. Nurturing Your Spirit:

Your feelings can affect your mind. Setting low standards in your daily schedule can leave you with a lot of free time to think negative things. Make sure that you set reasonable standards and work hard to achieve them.

Accomplishing your daily goals can help a lot in raising your spirits, as you will be happy with your progress. Also, ensure that you avoid the company of negative minded people as they have the power of poisoning your thoughts.

As a nurse, you cannot avoid facing stressful situations each day, some of which are out of your control. However, with a positive mindset, staying healthy, and always associating with trustworthy people, you can manage job-related stress.

With managed stress levels, you become happier and are able to deliver better care to your patients. Being happy and less stressed can also make you more motivated to do your job. You will also have a better relationship with your colleagues and your patients who will enjoy having you taking care of them [11].

CONCLUSION:

A combination of physical factors, administrative and organizational malfunction, psychological factors and interpersonal conflict are the major sources of stress for nurses working in the hospitals. These factors work in isolation and in combination with other factors to cause graded level of stress for nurses. The effect of the stress on the nurses is dependent on the nurses’ individual traits and other environ-mental factors. The combination of personal coping skills, effective organizational plans and social support is the best and effective way of managing and/or coping with stress in nurses.

REFERENCES:

1. Cheragi, M.A., Manoocheri, H., Mohammadnejad, E. and Ehsani, S.R., 2013. Types and causes of medication errors from nurse’s viewpoint. Iranian journal of nursing and midwifery research, 18(3), pp.228–231.

2. Petermann, B.A., Springer, P. and Farnsworth, J., 1995. Analyzing Job Demands and Coping Techniques. Nursing Management, 26(2), p.51.

3. Anbazhagan, A. and Rajan, L.J.S., 2013. A conceptual framework of occupational stress and coping strategies. ZENITH International Journal of Business Economics and Management Research, 3(5), pp.154–172.

4. Hendel, T., Fish, M. and Aboudi, S., 2000. Strategies used by hospital nurses to cope with a national crisis: a manager’s perspective. International nursing review, 47(4), pp.224–231.

5. Edwards, D., Burnad, P., Owen, M., Hannigan, B., Fothergill, A. and Coyle, D., 2003. A Systematic Review of the Effectiveness of Stress-Management Interventions for Mental Health Professionals. Journal of Psychiatric and Mental Health Nursing 10 (2003): 370–371. doi:10.1046/j.1365-2850.2003.00606.x.

6. Stordeur, S., D’Hoore, W. and Vandenberghe, C., 2001. Leadership, organizational stress, and emotional exhaustion among hospital nursing staff. Journal of Advanced Nursing, 35(4), pp.533–542.

7. Healy, C.M. and McKay, M.F., 2000. Nursing stress: the effects of coping strategies and job satisfaction in a sample of Australian nurses. Journal of Advanced Nursing, 31(3), pp.681–688.

8. Burns, V.E., Ring, C., Drayson, M. and Douglas, C., 2002. Cortisol and cardiovascular reactions to mental stress and antibody status following hepatitis B vaccination: a preliminary study. Psychophysiology, 39(3), pp.361–368.

9. Stoica, M. and Buicu, F., 2010. Occupational Stress Management. Management in Health, 14(2).

10. Sharma, A. Sharp, D. M., Walker, L. G. and Monson, J. R. T., 2008. Stress and burnout among colorectal surgeons and colorectal nurse specialists working in the National Health Service. Colorectal disease: the official journal of the Association of Coloproctology of Great Britain and Ireland, 10(4), pp.397–406.

11. Lazarus, R.S. and Cohen, J.B., 1977. Environmental Stress. In Human Behavior and Environment. Boston, MA: Springer US, pp. 89–127.

Received on 22.03.2018 Modified on 29.06.2018

Int. J. Nur. Edu. and Research. 2018; 6(4):431-434.

DOI: 10.5958/2454-2660.2018.00104.7