report higher stress in specialty areas, such as psychiatric units, ICUs and EDs; but this finding does not hold true in all settings.8,10 This result leads to an important aspect for nurse leaders to rec- ognize in determining approaches to reduce nurse workplace stress. Management should be alerted to the need to understand the sources of stress specifically among employees in their orga- nization.10


the incident itself.1


Sit in any meeting in which a controversial This information could be gathered a variety of ways,


including computer-based surveys. Additionally, focus groups or shared governance committees could be a source of gaining more specifics on stress-producing concerns experienced by unit nurses. There appear to be two areas that nursing leadership can focus


on to decrease job-related stress and increase work satisfaction for nurses. One of those areas is to create structures that empower staff nurses to participate in unit decision making, and to be in- formed on organizational policies and evidence-based practices changes.9


creating a healthy work environment and workplace culture. Aspects to consider include addressing bullying and unprofes- sional behavior, reorganizing schedules to reduce stress and implementing reward and recognition programs.11


terventions that managers can implement is ensuring that meal and rest breaks are provided, creating a quiet area for staff on breaks, and providing education and training to ensure all staff are informed on changes occurring on the unit. Some nurses combat increased stress through hospital programs


that teach stress reduction. Methods identified to be most effective are cognitive, behavioral and psychological interventions.12


These


programs center on the relaxation response, nutrition and other forms of self-care. Websites such the American Holistic Nurses Association, Mayo Clinic and www.stressgroup.com provide information to help nurses reduce stress. Nurse researchers are searching for find ways to reduce the


stress in the patient care environment. One study looked at the use of mindfulness-based stress-reduction programs and found that they were reported to be effective by participants in developing individual practices to decrease stress in the work setting.13


Another


study examined the methods nurses used when away from work to reduce stress, including exercising, yoga, family relationships and outdoor activities. The same study also identified alcohol, smoking and displacement as ways nurses used to cope with stress. This study concludes that the results emphasize the need for nursing leadership to understand the stresses nurses experience and to initiate organizational strategies to improve nurse’s health status.14


‘Dis-ease’ Healthcare professionals are trained in observing mind-body interactions. For patients, stress can lead to poor outcomes, such as delayed wound healing, worsening symptoms in diabetes, irri- table bowel syndrome, stomach ulcers, asthma and autoimmune disorders. Almost every major illness has been linked to chronic stress.1


Take the word “disease” and change it to “dis-ease” (not at


ease), and the concept of stress as a potential causative disease-state agent becomes clearer. Stress is viewed as a transactional or interactional concept. How a person perceives an incident is often more important than


26 Visit us at NURSE.com • 2016


topic is discussed and note the different responses, including your own. A person experiences stress when a demand exceeds his or her coping abilities, resulting in disturbances of cognition, emotions and behaviors that can affect well-being adversely. The body can use energy for survival or growth; it cannot do both simultaneously. In protection mode, the system closes down to wall itself off from the threat.15


Unit-based shared governance councils are one of the


effective ways to increase the sense of empowerment among staff. The other area of focus for nurse leadership to consider is


The good and the bad Research during the past 30-plus years shows that many types of psychological stressors elicit reactive stress responses. “Alarm-stage” input is with us constantly as the pace of life increases in intensity and uncertainty, and as we receive continuous communication through the media about the turmoil throughout the world. A patient who waits for a diagnostic test often has a dry mouth,


increased heart rate and elevated blood pressure. Some patients ask for tranquilizers to keep them calmer during the test. These patients are responding to anticipatory stress, some with anxiety and others with panic states.1


Other in- Children experience anticipatory


stress by crying, screaming and kicking; for instance, when they anticipate an injection. Stress reactions are not limited to pa- tients; friends and family who visit patients in the hospital can be stressed, as can hospital staff. Stress is not necessarily bad. The arousal mechanism at a


moderate level can help people focus on tasks at hand and put them in a purposeful mode of heightened awareness. However, anxiety — the physical and emotional response to stress — becomes pathological when it creates an inability to think clearly and interferes with the ability to carry out tasks. A driver who goes through a red light while fixating on the events of the day or a nurse who forgets a set of medications for a patient goes beyond the positive aspects of stress into serious debilitating anxiety that can place the person in danger. The more hurried and harried a workplace becomes, the easier it is to become lax or forgetful regarding safety issues, or checks and balances, which leads to errors.8


The Institutes of Medicine report To Err Is Human:


Building a Safer System estimated the number of deaths due to medical errors at 44,000 to 98,000 per year.16 The level of chronic anxiety in the population and its long-


term effects are reported by the media through work violence, or when a patient or family member threatens others with violence at a hospital. Recognizing the anxiety underlying some of these behaviors may help healthcare professionals understand and cope more effectively with upset or angry patients or family members.


Learning to de-stress There are many ways to adapt and keep stress in check. Those who believe they are in control of their stress are far more successful than those who see themselves as victims of the situation or stressful events.15


The principal way to handle stress is to train the


mind. Self-talk, which is the ongoing dialogue in one’s mind and is typically negative or self-critical, is important.13


By becoming


aware of such thoughts and reframing them as positive perceptions or expectations, healthcare professionals can change the way they perceive and handle situations. Those who see themselves as calm and in control of a situation can change the complexion of the


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