Managing Stress

1. 25 Managing Stress

2. Learning Outcomes • Explain why stress is necessary. • Describe the organizational, interpersonal, and individual factors that cause stress. • Explain the consequences that result from stress, including burnout and compassion fatigue.

3. Learning Outcomes • Discuss how individuals can manage stress. • Discuss how managers can help themselves and their staff manage stress. • Explain how organizations can help reduce stress in the workplace.

4. Stress • Results when two or more incompatible demands on the body cause a conflict • Can be positive or negative • Is essential to sustain life • In moderate amounts, stress serves as a stimulus to performance

5. Negative Effects of Stress 1. Physical • Weight gain/loss • Unexpected hair loss • Heart palpitations • High blood pressure 2. Emotional • Mood swings • Anxiety • Can lead to depression • Can also lead to unhealthy coping strategies (i.e. alcohol, drugs, etc)

6. TYPES OF STRESS • Eustress—a positive force adding excitement to provide a sense of well-being • Distress—a negative force caused by unrelieved tension that threatens effectiveness

7. Nature of Stress • Handling stress requires balance • Imbalance occurs when the degree of stress is greater than the available coping mechanism

8. Nature of Stress • Stress greater than a person’s coping mechanisms can lead to physical and psychological problems • Lack of stimulating stress can lead to boredom, apathy, low motivation, and poor performance

9. Organizational Causes of Stress - Job related factors: • Task overload • Conflicting tasks • Inability to do tasks assigned - Physical environment: ICU with alarms, noise, light, odor, color • Manager's behavior • Organizational norms and expectations in conflict with individual's needs • Pressure for efficiency

10. Interpersonal Stress Factors • Strained relationships within the nursing profession and between nurses and other professions • Unrealistic expectations • Interactions not characterized by open communication • Need to fulfill multiple roles • Family versus professional role conflict • Working night shift and shift rotation

11. Individual Stress Factors • Rate of life changes • Marriage, pregnancy, purchasing a new home • Individual’s interpretation of events (stressful or positive) • Role ambiguity: results from unclear expectation for one’s performance • Role conflict: result of incompatibility between the individuals perceptions of the role and its actual requirements.

12. Role Ambiguity • Results from unclear expectations for one's performance • Individuals with high tolerance for ambiguity can deal better with strain from uncertainty and may cope with role ambiguity

13. Role Conflict • Two competing roles • Nurse manager assumes patient care assignment and needs to attend leadership meeting • Conflict between nurses' personal and professional roles • Individual role conflict • Incompatibility between perception of role and actual requirements

14. STRESS RESPONSE • Stressor: Defined as anything an individual perceives as a threat • Three stages of stress response • Alarm reaction • Resistance • Exhaustion

15. Consequences of Stress • Undue, prolonged anxiety, phobias, or persistent state of fear • Depression • Abrupt changes in mood and behavior

16. Consequences of Stress • Perfectionism • Unreasonably high standards • Physical illnesses • Ulcer, arthritis, colitis, hypertension, myocardial infarction, migraine headaches

17. Burnout • Perception that an individual has used up all available energy to perform the job and feels that he or she does not have enough energy to complete the task • Combination of physical fatigue, emotional exhaustion, and cognitive weariness

18. SYMPTOMS OF BURNOUT • Nurse managers demonstrate burnout by: • Being workaholics • Experiencing chronic fatigue • Not wanting to go to work • Increasingly taking sick time • Having a negative attitude • Blaming and criticizing others • Engaging in backbiting • Talking behind others’ backs

19. Compassion Fatigue • Secondary traumatic stress experienced by caregivers • Affects those caring for others suffering from physical/emotional pain, with symptoms similar to burnout

20. Managing Stress • Recognize stressors in the environment • Identify and nurture social supports • Keep life in balance • Clarify roles and integrate or tie together various roles • Manage time • Replenish self and relax • Role identification

21. WAYS TO CONTROL STRESS • Setting of personal and professional goals • Value clarification • Goal setting • Establishment of priorities • Stress avoidance and regulation • Time blocking • Time management • Assertiveness • Feeling pauses

22. WAYS TO CONTROL STRESS (cont.) • Stress avoidance and regulation (cont.) • Inner shouting • Anchoring • Sorting • Thought stopping • Compartmentalizationحصره • فرز • الفكر وقف • التقسيم • Environmental changes

23. WAYS TO CONTROL STRESS (cont.) • Practice of good health habits through: • Humor • Centering • Nutrition • Exercise • Sleep

24. WAYS TO CONTROL STRESS (cont.) • Relaxation techniques • Abdominal breathing • Massage • Progressive relaxation • Biofeedback • Autogenic training: self-hypnosis • Meditation • Visualization and mental imagery • Poetry • Music, Baths

25. WAYS TO CONTROL STRESS (cont.) • Enhancement of self-esteem • Support groups • Protection from workplace violence

26. TIME MANAGEMENT • Personal time management • Start by being proactive and accepting responsibility for one’s actions and attitudes. • Begin with the end in mind. • Put first things first. • Think win-win. • Seek first to understand, then to be understood. • Synergize. • Give priority to a balanced program for self-renewal.

27. MAXIMIZE MANAGERIAL TIME • Inventory activities • Set goals • Plan strategies • Plan schedule • Say “No” • Use transition time • Accelerate learning • Improve reading

28. MAXIMIZE MANAGERIAL TIME (cont.) • Improve memory by: • Verbal techniques (e.g., repeating, clarifying, summarizing) • Physical techniques (e.g., note taking, filing, follow-up memos) • Mental techniques (e.g., focusing, linking, imaging, locating, chunking) • Mnemonics (e.g., rhymes, formulas)

29. MAXIMIZE MANAGERIAL TIME (cont.) • Engage in critical thinking. • Streamline paperwork. • Use computers for time management. • Use telephone calls. • Schedule office visits. • Control visit time. • Use meetings effectively. • Delegate.

30. FIVE RIGHTS OF DELEGATION • Right task • Right circumstance • Right person • Right direction/communication • Right feedback

31. CONDITIONS THAT FACILITATE DELEGATION • Understanding the concept of delegation • Having a positive attitude toward people • Overcoming feelings of loss of prestige through delegation • Developing a positive atmosphere for staff • Clarifying policies, goals, and objectives • Using job descriptions to help determine which assignments can be delegated

32. CONDITIONS THAT FACILITATE DELEGATION (cont.) • Checking on how well the delegated responsibilities were performed • Ensuring that staff know whether or not they are meeting their responsibilities • Assessing the results of delegation

33. RESPONSIBILITY, AUTHORITY, AND ACCOUNTABILITY • Responsibility denotes obligation. • Authority is the power to make final decisions and give commands. • Accountability refers to liability.

34. CULTURAL CONSIDERATIONS FOR DELEGATION • Interpersonal space • Past, present, and future orientations • Context of speech, dialect, kinesics, use of touch, and volume of speech • Social organization • Biopsychosocial differences

35. REASONS FOR UNDERDELEGATING • Leaders and managers think they can do the job more quickly themselves. • Leaders and managers are afraid that the staff will not keep them informed. • Leaders and managers may like to do the work and think they will get the work done better. • Some leaders and managers are afraid of losing power and prestige.

36. REASONS FOR NOT ACCEPTING DELEGATION ASSIGNMENTS • Staff have their reasons for not accepting delegation. • Some depend on the leader or manager and find it easier to ask the boss. • Some lack self-confidence and fear failure or criticism. • Guidelines, standards, and control may be lacking. • Some staff are already overworked. • Some staff may procrastinate.

37. REASONS FOR PROCRASTINATION • Emotional reasons • May fill time with trivia to escape overwhelming task • Can use as an excuse for poor work • Play victim of circumstances to gain sympathy • Nonemotional reasons • Lack of goals • Goals without deadlines • Unrealistic time estimates • Overcommitment to other duties

38. TECHNIQUES TO STOP PROCRASTINATION • Plan • Organize • Staff • Direct • Control

39. Questions Managers Ask • Is stress from role ambiguity or conflict? • Can conflict or ambiguity be reduced? • What is the manager's leadership style? • Do barriers interfere with goal attainment? • Do staff have feelings of low self-worth?

40. Questions Managers Ask • Is additional training or education needed? • Would reinforcing positive behaviors be helpful? • What other sources of support help the individual? • Is an EAP with counseling available?

41. Organizational Stress Reduction • Matching job with applicant • Skills training • Employee assistance programs (EAPs) • Communication and social support • Reducing stress of shift work