Stress Management Management - NSW Health (PDF)

Stress Stress Management Management for Nurses  This booklet was written by Scott Brunero, CNC, Liaison Mental Health Nursing, Prince of Wales Hospital, Sydney; Darrin Cowan, CNC Liaison Mental Health Nursing, Greater Southern Area Health Service; Alan Grochulski, CNC, Mental Health Northern Sydney and Central Coast Health Service; and Angela Garvey, Professional Offi cer, NSW Nurses’ Association. authors We wish to thank the following people for their help and support in the production and editing of this booklet: Marianne Goodwin, Peter Newman, Terry Joyce, Ben Neilson, Salih Ozghul, Patricia McDermott, Beverley Raphael, and the many nurses who shared their stories. Copyright © 2006 New South Wales Nurses’ Association PO Box 40, Camperdown 1450 New South Wales. Australia Telephone: 02 8595 1234 Facsimile: 02 9550 3667 Email: [email protected] Web: http://www.nswnurses.asn.au/ Stress Management for Nurses ISBN: 0-646-45849-3 1. Nurses - Job stress. 2. Stress management. I. Garvey Angela. II. N.S.W Nurses’ Association. 363.11961073 Illustrations by: Scratch! Media, [email protected] Design by: jacstar design, [email protected] Printed by: No Time to Lose, [email protected] This work was funded by the NSW Department of Health under the Mental Health Nursing Enhancement Fund. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior written permission of the copyright owner. acknowledgements  stress management for nurses This booklet is intended to heighten awareness of the mental health needs of nurses and provide useful exercises to assist nurses to manage stress at work (Disclaimer) This book is not designed to be a substitute for professional advice. It should be used in conjunction with specifi c health advice from your health care provider.  4 While your union and others are working hard to achieve improvements in nurses’ employment conditions, it remains a fact of life for nurses that we will frequently encounter situations at work that are physically and emotionally demanding. We also know that chronic exposure to stress can sometimes have very real and signifi cant implications for our health and wellbeing. While there are a number of mechanisms already in place to assist nurses, such as occupational health and safety and employee assistance programs, it is also important that every nurse has the awareness and skills to take care of their own mental health needs. It is hoped that this booklet will be a reminder for nurses about the need to care for ourselves, be mindful of the impact of the stressors and strains they encounter at work, to encourage nurses to seek support and assistance if needed. Brett Holmes forward  Introduction 4 What is Stress? 8 Occupational Health & Safety 11 Employee Assistance Programs 15 Coping Strategies 17 Relaxation Techniques 27 10 Things Every Nurse Should Do 29 Useful Contacts 30 Recommended Reading 32 contents  This booklet has been written by nurses for nurses to help promote awareness and understanding of our own mental health needs. It is widely recognised 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. While there is no doubt that nursing is a wonderful career with many challenges and intensely rewarding experiences, it is also a fact that in their daily work nurses confront emotional and professional demands that are unimaginable to the wider community. Let’s face it: spending your working life taking responsibility for the quality of people’s lives and their deaths is a heavy burden, even for the broadest of shoulders. 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, introduction 4  committed, the list goes on. These expectations are put on us by society, managers, organisations and sometimes ourselves. How do we as nurses react to these demands, what choices do we have and how do we put ourselves fi rst? In the same way as mental health issues have struggled to make it on the broader social agenda, they’re also struggling to make it on the agenda at work. The profession has made a lot of progress in managing many of the physical risks associated with our work: we use safe lifting techniques, we’ve adopted universal precautions and many other practices to ensure our physical safety at work. Unfortunately, we haven’t made the same level of progress where hazards to our mental health are concerned. One of the most signifi cant risks nurses are exposed to in their work is stress. This booklet will highlight some of the signs and symptoms that indicate when stress might be becoming a problem. It offers some skills and strategies to assist you to overcome some of the pressures associated with nursing work. Inevitably nurses fi nd themselves in situations where the source of their stress is diffi cult to eliminate, like fi nding that extra nurse to cover the shift, stopping that extra patient turning up on the ward, or not having enough experienced staff rostered on the shift. Frustrating as it may be, there are some sources of stress that we have limited ability to change, and this can lead to people feeling stressed, anxious, angry and depressed. The coping strategies and relaxation techniques explained in this book have been evaluated and they work. They are simple, effective and helpful in managing anxiety levels, anger and depressed feelings. However, it is critical that we all recognise that individual stress management is only part of the answer to looking after nurses’ mental health. When we consider workplace mental health, we must adopt the same approach that we have adopted for the management of other occupational health and safety concerns. That is, with a risk management approach that focuses on prevention. For this reason, we have included a brief overview of 5  the occupational health and safety laws in NSW and the obligations of both employers and employees to work together to maintain safe and healthy systems of work. It is also important that all nurses are aware of NSW Health’s commitment to the mental health and wellbeing of staff at work in public hospitals. A confi dential employee assistance program (EAP) has been available to all public sector nurses for some time. Many of the nurses who provided personal insights for this project reported a high level of satisfaction with the service provided by local EAPs. It is hoped that nurses who read this book will benefi t, not only from practising the strategies and exercises, but also by developing a better awareness of our own mental health needs and those of our colleagues. Most of all, it is important that we accept that there is no shame in acknowledging that, at times, the demands placed on us at work can become overwhelming and that the best thing we can do for ourselves, our families and our patients is to take care of ourselves and seek help if we need it. introduction 6  7  You would think that defi ning stress would be relatively easy. Yet those who have spent most of their professional lives studying it still have trouble defi ning the term. Despite efforts over the last half-century to defi ne the term, no satisfactory defi nition of stress exists. Defi ning stress is much like defi ning happiness. Everyone knows what it is, but no one can agree on a defi nition. Essentially, stress is the emotional and physical response you experience when you perceive an imbalance between demands placed on you and your resources at a time when coping is important. What this means is that you experience stress whenever you are faced with an event or situation that you perceive as challenging to your ability to cope. If you see the what is stress? 8  event or situation as only mildly challenging, you will probably feel only a little stress; however, if you perceive the situation or event as threatening or overwhelming your coping abilities, you will probably feel a lot of stress. Importantly, your perception of how negative an outcome could be will signifi cantly determine what degree of stress you experience. So, having to wait for a bus when you have all the time in the world triggers only a little stress. Waiting for that same bus when you are running late for an appointment triggers much more stress. The difference between the demands of the situation and your perception of how well you can cope with that situation is what determines how much stress you will feel. What are the signs and symptoms of stress? The signs and symptoms of stress can range from a major physical crisis like a heart attack, to more minor symptoms like tiredness and disrupted sleep patterns. The more serious stress-related problems usually emerge in the context of prolonged periods of exposure to intense stress. It is important therefore to be able to recognise and manage the early signs and symptoms of stress, in order to avoid the more serious effects of stress on your health and well-being. Think about how you have been feeling in the last few months. How many of the physical and psychological signs of stress listed on the following page have you experienced? 9  • tiredness, fatigue, disrupted sleep patterns ____________________ • increased pulse rate and blood pressure ____________________ • shallow, rapid respirations ____________________ • muscular tension ____________________ • loss of appetite, overeating, indigestion ____________________ • constipation, diarrhoea ____________________ • dry mouth ____________________ • excessive perspiration, clamminess ____________________ • nausea ____________________ • decreased libido ____________________ • nail-biting ____________________ • increased use of alcohol or other drugs ____________________ • irritability and impatience ____________________ • frequent worry and anxiety ____________________ • moodiness, feeling sad or upset ____________________ • loss of sense of humour ____________________ • poor concentration, memory lapses ____________________ • ambivalence ____________________ • feeling overwhelmed by even minor problems ____________________ signs and symptons of stress: 1 10  Nurses confront a range of occupational health and safety (OHS) risks in their roles providing care and comfort to the sick and aged. While much has been done to identify and control the physical risks associated with nursing work, such as manual handling, ergonomics, chemical and biological hazards, we have been less successful in recognising the very real psychological risks encountered by nurses. There is a growing recognition among employers and many employees that the effects of the workplace stress that many nurses experience may constitute a mental or psychological disorder due to exposure to risks in the workplace. Recent WorkCover NSW3 statistics indicate that stress is among the most common workplace hazards for nurses, along with manual handling injuries, physical injuries from acts of aggression or violence and the consequences of chemical exposures. occupational health & safety 2 11  While OHS legislation provides a framework for the health, community and aged care industries to develop strategies to minimise the risk of injury to nurses, it takes more than legislation for a safety culture to develop and become the foundation for nursing practice. All nurses, at all levels, need to embrace safety, including psychological safety, and consider it integral to the way work is planned, resourced, performed, monitored and evaluated. The NSW Occupational Health and Safety Act 2000 (OHS Act) is the key legislative instrument that provides for the health, safety and welfare of all people at a workplace including employees, agency nurses, patients, contractors and visitors. Section 8 of the OHS Act places the prime responsibility for occupational health and safety on the employer. Employers are required to: • ensure the health, safety and welfare at work of all employees, and • ensure that people (other than employees) are not exposed to risks to their health and safety arising from the employer’s activities. This means that employers must: • ensure that the work environment is safe • provide and maintain safe systems of work, eg work conditions • ensure that everything used at the workplace is safe when used properly, eg equipment, chemicals • provide information, instruction and training • establish and maintain effective consultation • provide supervision suffi cient to ensure safety • provide adequate facilities for the welfare of employees, eg toilets, facilities for hand washing and meal rooms • provide for the safety of patients, visitors, sub- contractors and others who visit or work in the workplace. occupational health & safety 12  13