music has been understood for many years, and its value in pain control, stress reduction and in reducing anxiety is well known.20 Healthcare professionals can use music both in the work setting on breaks and off duty as a means of stress reduction along with other relaxation strategies.


The power of touch In the 1950s, most student nurses learned that a back rub was part of evening care for patients. In some hospitals, massages are now available from certifi ed massage therapists, many of whom are nurses. Massage elicits a relaxation response not only through human touch and muscle relaxation, but through the chemical changes that occur when this happens. In response to touch, va- sodilation occurs, thus increasing circulation to muscles. Neural messages from the brain become blunted, and muscle tension then decreases. Research on the eff ects of therapeutic massage does demonstrate a calming response on the sympathetic nervous system with lower heart rate. MRI demonstrates responses to therapeutic touch in areas of the brain involved in stress and emotion regulation.21 Interacting with therapy animals has a similar calming eff ect.


While muscle relaxation has not been studied, favorable changes in resting heart rate, blood pressure and mood have been documented with pet therapy.22


Trained pet therapy dogs in acute and long-term


care settings often help reduce stress. Under certain conditions, some hospitals allow family members to bring a patient’s pet to the hospital for visits. Healthcare professionals who have pets at home may notice similar eff ects in dissipating work tensions.


CE424F


1. The fi rst stage in the body’s response to stress is:


a. Awareness b. Alarm c. Adaptation d. Overload


2. The body’s reaction to stress causes: a. Reduced heart rate b. Increased blood pressure c. Decreased sweat production d. Increased immune response


3. Immune modulations caused by psy- chosocial stressors or interventions:


a. Lead directly to health outcomes


b. Are things over which we have no control


c. Have no connection to disease states d. Must be accomplished by a therapist


4. Which statement is TRUE about stress? a. All stress is bad. b. There is nothing we can do about stress.


c. If we accumulate a lot of stress, we work better.


d. We can learn to control stress and adapt to it.


5. Telling patients what to expect will: a. Make them more afraid.


b. Help them maintain self-control. c. Allow them to tell their families. d. Increase their fear.


6. Blood pressure and pulse: a. Increase when a person is stressed. b. Decrease when a person is stressed. c. Undergo no changes with stress. d. Cannot be controlled.


7. The alarm stage can be modulated by: a. Breathing rapidly b. Calming one’s breath c. Thinking about what to do next d. Walking fast


8. Modulation of breathing can help over- come stress by:


a. Allowing the mind to focus on the present


b. Increasing oxygen to the brain, making it more alert


c. Fooling people into thinking you are not afraid


d. Helping you stall for time until you fi gure out the problem


9. Healthcare professionals who remain calm in tense situations:


a. Have moved to the high-anxiety state and are immobile.


b. Will burn out from adrenaline exhaustion.


c. Have learned to adapt and control their stress responses.


d. Do not grasp the signifi cance of the situation.


10. Controlling the musculoskeletal system during stress is done best through:


a. Practicing yoga


b. Allowing the hands and arms to tremble


c. Performing a quick body scan to let go of tension consciously


d. Walking rapidly from place to place


11. The relaxation response: a. Has been used since ancient times. b. Is found in many religious practices. c. Is called by many names. d. All of the above


12. Energy modalities: a. Have no use in lowering stress


b. Have no validity in the research literature


c. Can be used by trained nurses in any setting


d. Require a trained physician 2016 • Visit us at NURSE.com 29


Energy modalities, including ancient and modern forms of


acupuncture and acupressure, can also be used to relieve stress. Therapeutic touch and healing touch treatments are also taking place in healthcare settings to help patients and staff handle stress-related issues.23


Energy-based therapies such as reiki, Jin


Shin Jyutsu, polarity, and refl exology use stimulation of specifi c points or laying on of hands in a pattern.24 Physical exercise, from dancing to Pilates, and mind-body disci-


plines, such as yoga and meditation, are excellent stress reduction techniques outside the hospital.25


The healthcare professional


who is stress-free radiates a calmness to the patient, who then may also become less stressed. Emotions — both positive and negative — are energy; they


aff ect the psychoneuroimmunological system, changing hor- mones, altering white blood cell production, and reducing or increasing a cascade of adaptive hormones. Chronic stress and negative emotions, without counteractive adaptive techniques, may lead to physical illness and burnout. Consider using some of these adaptive ways to control stress for yourself, and your patients will benefi t. •


Connie Vogel, PhD, RN, CNS-BC, CNE, is a psychiatric clinical nurse specialist and a nurse educator. She teaches in MSN programs at Walden University and Capella University.


NOTE: Susan B. Collins, MSN, MEd, RN, FNP-BC, AHN-BC, is the original author of this educational activity, but has not had an opportunity to infl u- ence the content of this current version.


EDITOR’S NOTE: References available online: Nurse.com/CE/CE424.


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42