STRESS MANAGEMENT

SMITHA R T
M.SC NURSING
4TH SEMESTER
 INTRODUCTION

Modern world is full of hassles, deadlines,

frustrations and demands. For many
people ,stress is so common place that it has
become a way of life. Stress isn’t always bad,
In small doses , it can help you perform
under pressure and motivate you to do your
best.
 DEFINITION

“ A condition or
circumstance(not
always adverse)
which can disturb
the normal
physiological and
psychological
functioning of an
individual.
In medical parlance
‘stress’ is defined as a
perturbation of the
body’s homeostasis.
This demand on mind-
body occurs when it
tries to cope with
incessant changes in
life.
 WORK STRESS:

The CBI defines stress as that which arises when the

pressures placed upon an individual exceed the perceived
capacity of that individual to cope.

According to the TUC, stress occurs where demands made on individuals do not
match the resources available or meet the individual’s needs and motivation.
Stress will arise if the workload is too large for the number of workers and time
available. Equally, a boring or repetitive task which does not use the potential
skills and experience of some individuals will cause them stress.
 WORK STRESS
The Health and Safety Executive (HSE) (1995) defined work stress
as ‘pressure and extreme demands placed on a person beyond his
ability to cope’. In 1999, the Health and Safety Commission (HSC)
stated that ‘stress is the reaction that people have to excessive
pressures or other types of demand placed upon them’.

According to Cox (1993), ‘stress is now understood as a psychological state that results from
people’s perceptions of an imbalance between job demands and their abilities to cope with
those demands’. ‘work stress is a psychological state which can cause an individual to
behave dysfunctional at work and results from people’s response to an imbalance between
job demands and their abilities to cope’.
 WORK STRESS

The Occupational Safety and Health Administration at the national level . The
National Institute for Occupational Safety and Health defines it as the
mismatch between job demand and capabilities, resources, and needs of
employees. The resources are physical, emotional, economic, social or
spiritual
 NATURE OF STRESS
‘stress’ produces a number of features of stress and the stress
response, like disturbance of the natural equilibrium, taxation
of the body’s resources, failure to cope, sustained anxiety, a
non-specific response, pressure and extreme demands and
imbalance between job demands and coping ability.

Fundamentally, a stressor (or source of stress) produces stress which,

in turn, produces a stress response on the part of the individual.

No two people respond to the same stressor in the same way or to the
same extent.
TYPES OF STRESS
GENERAL STRESS
Generally resolves within a day or two
 CUMULATIVE STRESS

Prolonged stress which builds up after time

and can lead to adverse mental and physical
consequences.
 ACUTE TRAUMATIC
STRESS

Critical incident stress.

Produces considerable
Psychological distress. Normal
reaction to abnormal events.
POST TRAUMATIC
Severe stress produced
STRESS
by severe psychological
trauma. Can produce
lasting changes.
LEVELS OF STRESS
 EUSTRESS- positive stress that presents
the opportunity for personal growth and
satisfaction

DISTRESS-negative stress that results in

debilitative stress and strain

OPTIMAL STRESS-a blend of the two

that creates a motivational and healthy
outcome.
 YERKES-DODSON PRINCIPLE

The Yorkes-Dodson According to

law is a relationship this law
between arousal performance When levels of
(stress) and increases with arousal become
performance,
developed by physiological or too
psychologists, Robert mental arousal high ,performan
M Yerkes and John or some stress, ce decreases
Dillingham Dodson in but only up to a
1908. point.
The classic research by Seyle has identified
the physiological responses to the stress:
Local adaptation
syndrome
General adaptation
syndrome
LOCAL ADAPTATION SYNDROME

LAS: Is a response of the body tissue, organ

or part to the stress of trauma, illness or
other physiological change. The body
produces many localized responses to stress.
These include blood clotting, wound healing,
accommodation of eye to light and response
to pressure. The response is localized, it does
not involve entire body systems.
 GENERAL ADAPTATION SYNDROME

• GAS: Is a defense response of the whole body to stress, that involves the autonomic
nervous system and the endocrine system. There are three stages n GAS
• Alarm stage- During the alarm phase , sympathetic flight or fight response is
activated with the release of catecholamine and the onset of ACTH-ADRENAL
CORTICAL response.
• Resistance stage- It is impossible to live in a continuous state of alarm [ death would
ensue] ,the person moves into the second stage.
HORMONE INVOLVED ARE: CRH,GHRH, TRH. The resources of the body
may eventually become so depleted that they cannot sustain the resistance stage and
exhaustion ensue
• Exhaustion Stage-Prolonged exposure of high levels of cortisol and other hormones
involved in the resistance stage causes wasting of muscles, suppression of immune
system, ulceration of GI tract, failure of pancreatic beta cells.
CLASSIFICATION OF THE
CAUSES OF STRESS AT WORK
THE PHYSICAL ENVIRONMENT

Poor working conditions associated with the following can be frequent sources of
stress in the workplace:

● Insufficient space to operate

● Excessive noise levels, comfortably, safely and in the
requiring the individual to raise most efficient manner;
his voice; and
● Inadequate temperature and
humidity control, creating excessive
discomfort; ● Lack of privacy which may be
● Poor levels of illumination to the disconcerting for some people;
extent that tasks cannot be
undertaken safely;
● Open plan office layouts,
● Inhuman workplace resulting in distractions, noise,
layouts requiring excessive constant interruptions and
bending, stretching and difficulty in concentrating on the
manual handling of task in hand;
materials;
 2. THE ORGANIZATION

• The organization, its policies and procedures, its culture and style of operation can be a cause of
stress.
• Culture is defined as ‘a state or set of manners in a particular organization’. All organizations
incorporate one or more cultures, which may be described as, for example, friendly, hostile,
unrewarding or family-style. Stress can be associated with organizational culture and style due to,
for instance:
● Insufficient staff for the size of the workload, resulting in excessive overtime working;
● Too many unfilled posts, with employees having to ‘double up’ at tasks for which they have not
necessarily been trained or instructed;
● Poor co-ordination between departments;
● Insufficient training to do the job well, creating uncertainty and lack of confidence in undertaking
tasks;
● Inadequate information to the extent that people ‘do not know where they stand’;
● No control over the workload, the extent of which may fluctuate on a day-to-day basis;
● Rigid working procedures with no flexibility in approach; and
● No time being given to adjust to change, one of the greatest causes of stress amongst employees.
 3. THE WAY THE ORGANIZATION IS MANAGED

Management styles, philosophies, work systems, approaches and objectives can contribute to the
individual stress on employees, as a result of:
● Inconsistency in style and approach by different managers;
● Emphasis on competitiveness, often at the expense of safe and healthy working procedures;
● Crisis management all the time, due to management’s inability, in many cases, to plan ahead and to
manage sudden demands made by clients;
● Information being seen as power by some people, resulting in intentional withholding of key
information which is relevant to tasks, procedures and systems;
● Procedures always being changed due, in many cases, to a failure by management to do the basic
initial research into projects prior to commencement of same;
● Over-dependence on overtime working, on the presumption that employees are always amenable to
the extra cash benefits to be derived from working overtime;
● The need to operate shift work which can have a detrimental effect on the domestic lives of
employees in some cases.
 4. ROLE IN THE ORGANIZATION

Everyone has a role, function or purpose within the organization. Stress

can be created through:
● Role ambiguity
● Role conflict
● Too little responsibility
● Lack of senior management support, particularly in the case of
disciplinary matters dealt with by junior managers, such as supervisors,
● Responsibility for people and things which some junior managers, in
particular, may not have been adequately trained to deal with.
 5. RELATIONS WITHIN THE ORGANIZATION

How people relate to each other within the organizational framework and structure can be a
significant cause of stress, due to, perhaps:
● Poor relations with the boss which may arise through lack of understanding of each other’s
role and responsibilities, attitudes held, and other human emotions, such as greed, envy and
lack of respect.
● Poor relations with colleagues and subordinates created by a wide range of human emotions.
● Difficulties in delegating responsibility due, perhaps, to lack of management training, the
need ‘to get the job done properly’, lack of confidence in subordinates and no clear dividing
lines as to the individual functions of management and employees.
● Personality conflicts arising from, for example, differences in language, regional accent, race,
sex, temperament, level of education and knowledge.
● No feedback from colleagues or management, creating a feeling of isolation and despair.
 6. CAREER DEVELOPMENT

Stress is directly related to progression or otherwise in a career within the

organization. It may be created by:
● Lack of job security due to continuing changes within the organization’s
structure.
● Over promotion due, perhaps, to incorrect selection or there being no one else
available to fill the post effectively.
● Under promotion, creating a feeling of ‘having been overlooked’
● Thwarted ambition, where the employee’s personal ambitions do not necessarily
tie up with management’s perception of his current and future abilities.
● The job has insufficient status.
● Not being paid as well as others who do similar jobs.
 7. PERSONAL AND SOCIAL RELATIONSHIPS

The relationships which exist between people on a personal and

social basis are frequently a cause of stress through, for instance:
● Insufficient opportunities for social contact while at work due to the
unremitting nature of tasks;
● Sexism and sexual harassment;
● Racism and racial harassment;
● Conflicts with family demands; and
● Divided loyalties between one’s own needs and organizational
demands.
 8. EQUIPMENT

Inadequate, out-of-date, unreliable work equipment is frequently associated with stressful conditions
amongst workers. Such equipment may be:

● Not suitable for the job or environment;

● Old and/or in poor condition;

● Unreliable or not properly maintained on a regular basis, resulting in constant breakdowns and down time;

● Badly sited, resulting in excessive manual handling of components or the need to walk excessive distances between
different parts of a processing operation;

● Of such a design and sited in such a way that it requires the individual to adopt fixed and uncomfortable posture when
operating same

● Adds to noise and heat levels, increasing discomfort and reducing effective verbal communication between employees.
 9. INDIVIDUAL CONCERNS

All people are different in terms of attitudes, personality, motivation and

in their ability to cope with stressors. People may experience a stress
response due to:
● Difficulty in coping with change;
● Lack of confidence in dealing with interpersonal problems, such as
those arising from aggression, bullying and harassment at work;
● Not being assertive enough, allowing other people to dominate in
terms of deciding how to do the work;
SOURCES OF STRESS:

The primary cause of job stress is

employees’ characteristics and
working condition, which can lead
to the risk of injury and illness.
SOURCES OF STRESS: IN
NURSING
 ORGANIZATIONAL FACTORS:

Organizational and management characteristics are the cause of stress. The origin of stress can be due to
physical, psychological, or social factors. The significant predictors of stress are as follows:

 Workload: The excessive workload in terms of actual workload, due to a shortage of staff or time pressure
increasing responsibilities, non-nursing work, can lead to emotional exhaustion.
 Understaffing: The shortage of staff during the morning, evening, and night duties can lead to extra work or
burden among the nurses, and there will be time pressure to complete the task, which can be the cause of
stress and burn out among nurses.
 Job content: If there is hectic, monotonous, or routine work, unpleasant tasks and work of low social value
can lead to frustration among the staff. The nurses working in a hazardous environment have a fear of
getting infections.
 Working hours: Long, unsocial, strict, and inflexible duty hours. The nurses who work for more than 35
hours or more per week are likely to report high risk than the nurses working for fewer hours and in the
regular shift.
 Shift duty pattern: Frequent shift duty pattern of odd hours, especially the night duties, changes the lifestyle and
behavior of the nurses.
 Undefined job: One of the predictor of stress as reported by nurses is unclear job descriptions, unit, and
organization Lack of task autonomy, accountability, and feedback: Accountability without independence at times
becomes the source of stress between nurse administrators and supervisors.
 Lack of career development: Job insecurity, lack of promotional avenues, lack of opportunity for growth, and
advancement can cause stress among nurses
 Physical facilities/environment: Inadequate, unpleasant, or dangerous physical facilities, poor ventilation, lighting,
temperature, crowding, noise, air pollution, or ergonomic the stressors at work place. Lack of adequate
equipment and articles to provide the care and lack of facilities for rest during the long hours of duty can also be
the predictors of low productivity and can also be the predictors of low productivity and can lead to frustration
among nurses.
• Social environment: Lack of support from the nurse administrators; Lack of family- friendly policies; poor
interpersonal relationships with coworker, doctors, nurse administrator and other team members; and lack of
staff support, autocratic behavior of the superiors and conflict with doctors are predictors of psychological stress
among nurses. The problematic relationship with team members also increase stress among them, and they can
develop anxiety and feeling of fear.
• Communication barriers: Ineffective comm cation can lead to stress among staff; for example the team or its
individual member , if not informed ahead of time for the change of duty, may feel frustrated while reporting
PROFESSIONAL SERVICE-RELATED FACTORS:

The nature of nursing is not free

from stress. It is considered as one
of the stressful occupations.
Following are some of the critical
contributory factors of stress among
nurses
Caring for suffering and death and dying patients :The patients suffering from pain, disability,
long term and acutely ill, death, and dying can be the source of stress for nurses. Having daily
contact with suffering patients and nurses can get psychological trauma associated with
witnessing death and dying.

Severe patients and their family members: At times, the nurses are
experiencing critical and demanding patients, and their family members
can be the sources of stress among nurses.

Working with psychiatry patients: Nurses may face emotional exhaustion in

working with aggressive patients, especially with suicidal and violent
incidences of patients.

Exposure to occupational hazards: The nurses are working in the environment susceptible to
exposure to various biological, physical, reproductive, chemical, mechanical, psychological,
and occupational cancers. Working in such a situation will be stressful for them.
 PERSONAL CHARACTERISTICS

 Demographic characteristics: The empirical evidence revealed that age, gender, length of tenure in
the job, and 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. The nurses with state anxiety of personality “A” and have a
problematic relationship; and with uncooperative behavior with coworkers, doctors, and head
nurses usually have psychological stress.
 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 think that they can control
potentially adverse effects in their job.
 Competency: The nurses, if not competent, may be scared and not confident to handle the
situations that will be under stress.
 Lack of preparation: Nurses who are not emotionally mature can have a high level of stress to deal
with the patients.
 OTHER FACTORS

 Death or sickness in the family

 A temporary setback or other personal problem
 A poor support structures
 Instability between work and family or own life
 Lack of self-esteem
 Financial issues.
CONSEQUENCES OF
WORKPLACE STRESS
 GENERAL
CONSEQUENCES

Effects of stress can vary among individuals;

however, the stress can be classified into
cognitive, biological or physiological,
emotional, behavioral, and occupational.
 2.Biological or 5. Occupational:
physiological: Due to 4. Behavioral: Due to stress, Absenteeism; poor
3.Emotional and
stress, the individual the individual can develop interpersonal relations
1. Cognitive: Cognitive psychological: The
suffers from many behavioral symptoms with coworkers, doctors
symptoms relate to the individual can develop
physiological symptoms such as remain isolated, head nurse, and patients
understanding and specific emotional and silent, not taking poor performance;
that are psychosomatic.
knowledge functioning psychological symptoms responsibilities, consuming nursing errors; job
The physiological
of the body. The due to increased stress; alcohol, cigarette smoking, dissatisfaction;
symptoms are
common symptoms are the symptoms vary from or other substance to relax, negativities for the job;
headache, body ache,
related to memory, individual to individual. nail biting, teeth grinding, and decreased
constipation, nausea, excessive exercising or motivation are some
decision-making, These symptoms are a
vomiting, loss of shopping, and unnecessary reasons of occupational
indecisiveness, feeling of loneliness,
appetite or excessive reacting to unexpected stress. The findings of the
concentrate, judgment, agitation, irritability, loss
eating, sleep problems, Rule out a studies revealed a strong
negative thinking, of patience, anxiety, medical or psychological negative association of
disturbance,
thoughts, worrying, etc. feeling tense, and condition if anyone is nurses’ occupational
tachycardia, chest pain,
depression. experiencing stress. stress and job
skin allergy, heartburn,
satisfaction.
etc.
 II: CONSEQUENCES OF LONG-TERM STRESS

1. Physical and physiological

• Cardiovascular disease: The persistent stress resulted in many cardiovascular diseases such as hypertension, chest
pain, and angina.
• Musculoskeletal disorders: The literature also documented that stress is the main contributory factor for many
musculoskeletal disorders such as backache and body ache.
• Gastrointestinal and metabolic disorders: The studies indicated stress is one of the risk factors for many
gastrointestinal diseases such as peptic ulcer, intestinal ulcers, diabetes, and even cancer.

2. Psychological: The literature also documented that many psychological problems among
health workers are due to occupational stress and has reported that almost 75% of patients
seek psychiatric consultation. There is an increase in mental problems such as anxiety,
depression, and feeling of insecurity among nurses. They also indulge in substance use such as
drugs, alcohol, and suicides, which are more common among those who have burned out.
BURN OUT
BURN OUT
The term Burn out was coined by the psychologist, Herbert
Freudenberger in the 1970s, burnout describes a severe stress
condition that leads to severe physical, mental, and emotional
exhaustion.

Burnout is a psychological syndrome emerging as a

prolonged response to chronic interpersonal stressors on
the job.
 SIGNS OF BURN OUT

Exhaustion. Feeling Escape fantasies. Dissatisfied Frequent illnesses. Burnout,

physically and with the never-ending like other long-term stress,
emotionally depleted. demands of their jobs, people can lower your immune
with burnout may fantasize system, making you more
Physical symptoms may
about running away or going susceptible to colds, the flu,
include headaches, on a solo-vacation. In extreme and insomnia. Burnout can
stomachaches, and cases, they may turn to drugs, also lead to mental health
appetite or sleeping alcohol, or food as a way to concerns like depression and
changes. numb their emotional pain. anxiety.

Irritability. Burnout can cause

Isolation. People with people to lose their cool with
burnout tend to feel friends, co-workers, and family
overwhelmed. As a members more easily. Coping
result, they may stop with normal stressors like
preparing for a work meeting,
socializing and confiding driving kids to school, and
in friends, family tending to household tasks also
members, and co- may start to feel
insurmountable, especially when
workers. things don’t go as planned.
 THE 12 STAGES OF BURNOUT
Excessive drive/ambition. Common for
people starting a new job or
undertaking a novel task, too much
ambition can lead to burnout.
Neglecting your own needs. You
begin to sacrifice self-care like
sleep, exercise, and eating well.
No time for non-work-related needs. You
begin to withdraw from family and friends.
Social invitations to parties, movies, and
dinner dates start to feel burdensome,
instead of enjoyable.
Pushing yourself to work
harder. Ambition pushes you to
work harder.
Displacement of conflict. Instead of
acknowledging that you’re pushing
yourself to the max, you blame your
boss, the demands of your job, or
colleagues for your troubles.
Denial. Impatience with those around
you mount. Instead of taking
responsibility for your behaviors, you
blame others, seeing them as
incompetent, lazy, and overbearing.
THE 12 STAGES OF BURNOUT
Withdrawal. You begin to withdraw
Behavioral changes. Those on the
from family and friends. Social
road to burnout may become more
invitations to parties, movies, and
aggressive and snap at loved ones for
dinner dates start to feel
no reason.
burdensome, instead of enjoyable.

Inner emptiness or anxiety. Feeling

Depersonalization. Feeling detached empty or anxious. You may turn to
from your life and your ability to thrill seeking behaviors to cope with
control your life. this emotion, such as substance use,
gambling, or overeating.

Mental or physical collapse. This can

Depression. Life loses its meaning impact your ability to cope. Mental
and you begin to feel hopeless. health or medical attention may be
necessary.
 TREATMENT & PREVENTION

b) c) f)
a) developing
coping skills obtaining e) developing a
changing work better self‐
patterns (e.g., (e.g., social d) promotin
working less, support understandi
cognitive g good
taking more restructurin (both utilizing ng (via
breaks, avoiding
overtime work, g, conflict from relaxation health various self‐
analytic
balancing work resolution, colleagues strategies and techniques,
with the rest of time fitness
one's life) managemen and counseling,
family) or therapy)
t)
THE EFFECTS OF STRESS ON
JOB PERFORMANCE
 Erratic job
performance:
Absenteeism: Alternating
Absenteeism, between low
and high
especially on productivity
Monday due, in some Personal
mornings, or in cases, to Loss of short- appearance:
the taking of changes outside term memory: Becoming
early/extended the control of This leads to abnormally untidy,
meal breaks is a the individual, is arguments perhaps smelling
a common of alcohol, is a
typical symptom of about who said, common
manifestation stress within an did or decided manifestation of a
of stress. organization. what. stressful state.

Accidents: People Loss of Mistakes: Poor staff relations:

suffering stress at concentration: Stress is a People going
work can rapidly Stressful events in classic cause of through a period of
become problem people’s lives errors of stress frequently
become irritable and
drinkers. Such commonly result judgement,
sensitive to criticism.
people have in a lack of the which can This may be
three times the ability to result in accompanied by
average number concentrate, accidents, ‘Jekyll and Hyde’
of accidents; whereby a person wastage, mood changes, all of
many accidents is easily rejects. Such which have a direct
incorporate distracted, or an mistakes are effect on staff
stress-related inability to frequently relationships and
indirect causes. complete one blamed on home life
task at a time. others.
APPROACHES TO STRESS
MANAGEMENT
 INDIVIDUAL COPING STRATEGIES

It includes programs in which the employees learn

about the Causes and consequences of occupational
stress, cognitive coping skills, and time management,
which are intended to change how they can organize
their working Situation. It also includes relaxation and
meditation techniques, which can reduce stress.
1. Time management: The inability to
manage time could be one of the
stressful situations in a job. If the nurses
know how to manage their time and
have a plan for doing it along with the
necessary room to deal with
unexpected crises or emergencies, they
will feel more positive and will have
fewer tensions. Nurses who feel less
stress are better able to take care of
themselves and their patients.
 Prioritize: Use the
80–20 rule stated by
Set goals: Goals the Italian economist
give direction to Vilfredo Pareto who
noted that 80 per
people’s cent of the reward
Allocate time for activities. They comes from 20 per
planning and should be cent of the effort.
Things to do to organizing: Taking specific, realistic Prioritize your time
improve time and achievable. to concentrate on
time to think and that 20 per cent
management: plan ahead is Check to see which produces the
time well spent. whether you best return.
Do it now instead have achieved
of putting it off these goals.
till tomorrow.
 ● Be flexible: Allow time
● Make a list: Some people ● Consider your biological
for interruptions and
keep on top of their time prime time: Consider the
distractions. By virtue of
by a simple daily ‘to do’ list time of day when you are at
the nature of the job, it
which they assemble last your best in terms of
may only be feasible to
thing on the previous day performance. Some people
plan ahead for 50 per cent
or first thing that morning. are morning people, others
or less of one’s time, taking
Sticking to the items on are night people. Knowing
into account potential
the list, avoiding the best time of the day
interruptions from
distraction from it, is assists in planning future
colleagues, telephones and
important. 76 Stress at performance.
the unplanned
Work
‘emergency’.
● Do the right thing right: Peter Drucker, the well-known management guru, says ‘doing the right thing
is more important than doing things right’. Doing the right thing is effectiveness; doing things right is
efficiency. Focus first on effectiveness, then concentrate on efficiency.
● Eliminate the urgent: Urgent tasks have short-term consequences while important tasks are those with
long-term goal-related implications. The objective must be to reduce those tasks classified as urgent to
enable the more important priorities to be dealt with.
● Practice the art of ‘intelligent neglect’: Efforts should be made to eliminate trivial tasks or those tasks
which do not have long-term consequences. It may be possible to delegate some of these more trivial tasks
and work on those tasks which require your specialized attention.
● Avoid being a perfectionist: People who set themselves standards of performance based on perfection
by, for example, paying unnecessary attention to detail, inevitably suffer stress when these standards
cannot be achieved. It may be necessary to reduce your expectations on a range of issues.
● Conquer procrastination: One technique to try is the ‘Swiss cheese ‘method. When you are avoiding
something, break it into smaller tasks or set a timer and work on the larger tasks for just 15 minutes. By
doing a little at a time, eventually you will reach a point where you want to finish.
● Learn to say ‘No’: Too many people suffer from overload due to a simple inability to say ‘No’ to further
demands on their time. Learning to say ‘No’ to trivial, less important demands, assists in reducing the
stress from overload.
● Reward yourself: Setting goals that are measurable and achievable is important. When these goals have
been achieved, indulge in the reward promised
 2. Relaxation/meditation:
Relaxation/meditation
techniques are complementary
methods. Meditation is a way of
focusing on something in a
relaxed state in a quiet
environment.
Physiologically oriented methods: The aim is
to achieve deep muscle relaxation through
contracting and relaxing major muscle groups.
In muscle relaxation technique, a trained
instructor teaches the participants about deep
breathing and deep relaxation exercises and
advices them to practice daily for 15 minutes
by using tape recorder.
Meditation-relaxation technique: In this
technique, instruct the participants to sit quietly
and meditate for 15-20 minutes once or twice a
day. The participants begin each meditation
session by calming and relaxing the body, and
then they spend the remaining time working with
a mantra (meditation sound).
 COGNITIVE-ORIENTED METHOD:
Imagery and meditation have
relaxation effects. It includes three
cognitive processes: focusing, passivity,
and receptivity with an outcome of a
calm mind and relaxed body functions.
 Biofeedback: It is another popular relaxation
technique. It is a separate intervention evaluated by
Murphy but usually employed in combination with
relaxation. During the practice of relaxation
exercises, observe and record some of the internal
processes of the participant by the use of
sophisticated equipment. The equipment measures
temperature, muscular tension, heartbeat, and
blood pressure. Once you are aware that your
internal body responses are in a state of stress, you
can begin to make adjustments by changing the
environment and adopting other stress releasing
methods.
 3. OTHER INDIVIDUAL COPING STRATEGIES

Keeping pet; saying prayers; singing aloud; laughter therapy; having

a good sleep; aerobatics; spending time with children; taking a
walk; making friends; and cultivating interests in gardening,
reading, writing, and cooking, are also helpful in forgetting the
worries and controlling stress.
COGNITIVE
RESTRUCTURING
STRATEGIES
These strategies aim at the reduction of stress
and the Coping skill strategies directed toward
the development of personal strategies aimed at
improving skills and competencies to meet the
job demand. It involves training in positive
Coping self-statements (e.g. I can do this work, or
I can handle the situation) that encourage the
person to assess conditions, prepare to face
stressors, and to cope with stress.
• STRESS INOCULATION TRAINING
The program focuses on activities such as time management, communication
skills, conflict resolution, and problem-solving skills. Most of the studies use a
method of education and discussion.
• EMPLOYEE ASSISTANCE PROGRAMS
In this program, a form of psychotherapy is given to highly stressed
individuals either outside or in a psychological clinic. A brief therapeutic
model is comprising two weekly sessions of therapy, followed by a third
session 3 months later. Two modes of prescriptive treatment are a short
cognitive-behavioral and exploratory treatment and a brief relationship
oriented.
ORGANIZATIONAL COPING
STRATEGIES
Reducing stress at organizational level

Professor Cooper divides the

organizational strategies for the
management of workplace stress
into three groups in order of
importance.
1. Primary: The first strategy is risk assessment or an organizational
stress audit. It is aimed at eliminating or modifying environmental
stressors to reduce their negative impact on individuals. The likely
structural interventions would consist of:
● Job redesign
● Culture change
● Encouraging participative management
● Flexible working
● Work–life balance policies
● Organizational restructuring and
● Improved organizational communications.
2. Secondary: The secondary strategy is stress management training and
health promotion. It focuses on increasing the awareness, resilience and
coping skills of the individual through:
● Stress management education and training so that the symptoms of
stress can be recognized
● Lifestyle information and health promotion activities
● Skills training more generally, e.g. time management, presentation skills
and
● A reward-orientated management style.
3. Tertiary: The third strategy is workplace counselling and employee
assistance programmes. It is concerned with the treatment and rehabilitation of
distressed individuals, e.g. counselling and return to work policies
1. Organizational change: The regulatory change approach is useful to apply to reduce stress in
case of excessive workload. It is in two forms:
a. Organizational-wide program: According to Jones, take the following steps to organize an
organizational-wide schedule to reduce stress among employees:
 Assess stress levels of employees
 Review and modify causative organizational factors of stress
 Work out a series of policies and procedures concerning interdepartmental communication,
organization, and personnel policies to reduce stress
 Inform employees about work out modifications in policy and procedures in small conference
sessions
 Provide a series of video-cassette training modules to all employees to make them understand
personal and occupational stress and methods of reducing stress and improving coping skills
 Set up a comprehensive employee assistance program for employees to discuss their
problems, both work-related and personal issues.
 B. ORGANIZATIONAL DEVELOPMENTAL PROGRAM
• The program is aiming to create a corporate culture and provisions to meet
individual needs and eliminate the causes of stress. This approach involves
the participation of all employees of an organization to diagnose and solve the
problems by taking the following steps:
 Ask all employees to list down three things they consider best in their
department and the three things they think worst and urgently need
modification
 Discuss their responses in a general meeting and report to the head
 Form a group of volunteers among employees to gather additional
information and make recommendations for improvement.
2. STRESS MANAGEMENT TRAINING PROGRAM:

The program should include the

general building awareness about job
stress, securing top management
commitment and support for the
program, and nurses’ input and
involvement in all phases of the
program and to conduct the program.
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NURSES ROLE
• ASSESSMENT
 Identify the actual or potential stressors
 Identify client’s appraisal of stressor
 Assess the available coping resources
 Positive health behaviour: - exercise, avoid high fat, relaxation,
positive lifestyle.
 Maladaptive coping behaviour: -smoking drinking etc………
 Adherence to healthy practices: -nutritional habits, exercise etc…
• INTERVENTIONS
 Teaching healthy activities of daily living :-exercises, rest and sleep ,nutrition
 Encourage the use of support systems
 Encouraging the use of stress management techniques
 Benefits of exercise…
 Reduced feelings of anxiety, depression, frustration, aggression, anger and hostility.
 Alleviation of insomnia.
 An opportunity to develop new friendships.
 Allows for the development of discipline.
 Provides the opportunity to do something enjoyable and constructive that will lead to
better health and total well-being.
NURSE MANAGERS’ ROLE
IN STRESS MANAGEMENT
• The nurse managers can play an essential role in stress management of nurses by
adopting the following approaches:
1. Design jobs to provide stimulation and opportunities for nurses to use their skills
2. Clearly define nurses’ roles and responsibilities
3. Plan orientation programs for the newly joined staff
4. Give nurses opportunities to participate in decisions and actions in inpatient care
5. Improve communications and provide a supportive environment
6. Provide performance counseling to staff to identify the ways to improve the skills and
performance and to understand the work environment as well as his or her strengths
and weaknesses
7. Provide an empathic climate where he or she can discuss his or her tensions, conflicts,
concerns, and problems
8. Organize group meetings to solve the problems.
TIPS FOR REDUCING STRESS
AT WORKPLACE
 Recognize the sign and symptoms of excessive stress: Do not ignore the signs of
stress.
 Take care of yourself: Pay attention to your physical and emotional health. Use
physical stress-relieving strategies. Do exercises; break up the activity into two
or three shorter segments. Get sound sleep.
 Prioritize and organize your responsibilities: Manage your time by creating a
balanced schedule, do not commit yourself, try to leave earlier in the morning,
and plan regular breaks and relax. Also, manage the task by prioritizing tasks,
delegating responsibilities, and be willing to compromise.
 Improve emotional intelligence: Manage your emotions in positive and
constructive ways. Communicate with others in ways that overcome differences,
repair wounded feelings, and defuse tension and stress.
 Improve upon bad habits: Eliminate self-defeating behaviors. Flip your
negative thinking.
 Improve communication: Share information with employees and define
employees’ roles and responsibilities. Make interface friendly and efficient.
 Be role models: Act as positive role models, especially in times of high stress.
 Consult your employees: Give them opportunities to participate in decisions,
value their feelings, praise excellent work performance, both verbally and
officially. Provide opportunities for career development.
 Cultivate a friendly and social climate: Provide opportunities for social
interaction among employees. Establish a zero-tolerance policy for
harassment.
 Keep yourself physically and mentally fit: Follow a healthy lifestyle. Be
positive.
IMPACT THAT THE COVID-19
PANDEMIC COULD HAVE ON
THE PSYCHOLOGICAL HEALTH
OF THE ENTIRE HEALTHCARE
SECTOR
• Eight specific sources of healthcare personnel anxiety related to the COVID-19
epidemic were argued, including :
(1) availability of appropriate personal protective equipment
(2) exposure to COVID-19 at work and bringing the infection home to family
(3) lack of access to testing if physicians develop COVID-19 symptoms and
associated fear of propagating the infection at work
(4) uncertainty that physicians’ organization will take care of physicians personal
needs if they become infected
(5) access to childcare during increased work hours and school closures
(6) lack of support for other personal and family needs as work demands increase
(7) being able to provide competent medical care if deployed to a new area
(8) lack of access to up-to-date information and communication 
Studies on burnout related to COVID-19 have been mainly
conducted on healthcare professionals. A study of healthcare
professionals showed a significant positive relationship
between stress and burnout (Morgantini et al., 2020).
Another study investigating the relationship between
burnout, anxiety, and stress disorders during COVID-19
pandemic indicated that doctors and nurses experienced high
levels of mental health problems including burnout (Sung
et al., 2020). 
 TO DECREASE THE EXTENT OF THE PSYCHOLOGICAL
CONSEQUENCES SOME ACTIONS CAN BE TAKEN:
• Avoid intense exposure to COVID-19 media coverage (a phenomenon widely spread
on an international scale) and maintain a compassionate and positive lifestyle by
providing support to others.
• To deal with the side effects of the pandemic, resilience training programs should be
implemented for healthcare professionals, law enforcement and the general public:
(a) Balance between family life and work;
(b) Clear and rapid information on the disease and its consequences on psychological
well-being;
(c) Education and preparation of societies for pandemics and epidemics in the future;
and
(d) Validation and evaluation of the contribution of frontline healthcare personnel
 
RESEARCH ARTICLE
 Workplace stressors, psychological well-being, resilience, and caring
behaviours of mental health nurses: A descriptive correlational study
• Foster K, Roche M, Giandinoto JA, Furness T. Workplace stressors, psychological
well‐being, resilience, and caring behaviours of mental health nurses: A descriptive
correlational study. International journal of mental health nursing. 2020 Feb;29(1):56-
68.

• ABSTRACT:
• There is widespread recognition that workplace stress can have profound
negative impacts on nurses’ well-being and practice. Resilience is a process
of positive adaptation to stress and adversity.
• This study aimed to describe mental health nurses’ most challenging
workplace stressors, and their psychological well-being, workplace
resilience, and level of caring behaviours, explore the relationships
between these factors, and describe differences in workplace resilience for
sociodemographic characteristics.
•
• In a descriptive correlational study using convenience sampling, data were
collected from N = 498 nurses working in mental health roles or settings in
Victoria Australia via an online cross-sectional survey.
• Key findings included : weak to strong (r = 0.301 to r = 0.750) positive
relationships between workplace resilience with psychological well-being
across all stressor categories (consumer/carer; colleague; organizational
role; and organizational service). Psychological well-being was moderately
high, but lower for nurses indicating consumer/carer-related stressors as
their most stressful challenge. There were weak to moderate (r = 0.306
to r = 0.549) positive relationships between workplace resilience and
psychological well-being, and no relationship between resilience and caring
behaviours. Workplace resilience was lower (P < 0.05) for less experienced
nurses compared with those with >5 years’ experience, and lower for
younger nurses compared with those aged ≥40 years.
• To improve their resilience and prevent psychological distress, there is prime
opportunity to support nursing students with well-being and resilience-
building strategies during their undergraduate education, and to support
new graduates with similar programmes when they enter the workforce.
 SUMMARY & CONCLUSION

• Some managers are not prepared to recognize the problem of stress in the workplace.
However, it was not until people, such as occupational health nurses, started to relate
sickness absence levels to stress that managers eventually began to admit that the
results of their decisions and actions, the environment they provided for operators and
many other features of their organizational activities could be stressful
• If people are to cope with stressful situations, they have to return to the basic
principles, namely:
● identify the sorts of events in their lives which create the stress response
● measure and evaluate the significance of these events and
● learn various forms of coping strategies to enable them to deal with these life events.
People would be much happier if they were to undertake this exercise
BIBLIOGRAPHY:

1. Stranks Jeremy “Stress at Work Management and Prevention”

Elsevier Publication ,2005; page no: 21-22,44-45, 67-80
2. Vati Jogindra “Principle and Practice of Nursing Management &
Administration” Second Edition: Jaypee publication, 2020; page no:
356-361
3. Brar K N, A textbook of advanced nursing practices 1st edition New
Delhi: Jaypee publication ,2015 ;pp-886
•