Week 13: Rest, Comfort and Mobility (Self-care, Coping and Stress Management for Nurses).
Unit Learning Outcomes
At the end of this chapter, the learner will:
1. Examine personal feelings about self-care to meet the needs of unique and varied patients receiving care.
2. Identify the challenges of workplace safety that nurses face.
3. Discuss the importance of self-care for nurses.
4. Recognize early signs of fatigue in the workplace.
5. Identify various techniques to manage stress in the workplace.
6. Recognize stressful factors in the nursing profession.
7. Discuss various types of stressors that affect health of patients, families and healthcare professionals.
8. Discuss the types of coping mechanisms that patients, families, and healthcare workers can use to manage stress and anxiety.
Overview of this chapter
This chapter will provide information on self-care for nurses, work place safety and early identification of signs of burn out, and fatigue. It is important to include self-care for nurses to provide the best care for the patients. In addition to the emotional burden of providing support for multiple patients and their family members, nurses experience a variety of other stressors inherent to the health care environment itself. This chapter will include various types of stressors and how to manage it.
Introduction
Self-care Means Taking A Break
Self-Care Means Self-Compassion
Make Yourself A Priority
Over the years, nurses have expressed their substantial risk for workplace stress. During the pandemic, 70% of the nurses surveyed by HealthyNurse® said they put the health, safety, and wellness of their patients before their own. Unsurprisingly, during the pandemic, large numbers of nurses reported feeling down, sad, and depressed.
By focusing on self-care for nurses and paying closer attention to their mental health, there’s hope to improve this situation. After all, according to the mission set forth by Healthy Nurse, Healthy Nation (HNHN)—a program of the American Nurses Association (ANA)—the way to improve the nation’s health is ”one nurse at a time.”
1 . Self-Care for Nurses
Self-care is any deliberate activity that we engage in to improve our physical, mental, or spiritual well-being. It is important for workers in every field, but especially for nurses, who spend their working hours caring for others.
According to the World Health Organization (WHO), self-care is defined as “what people do for themselves to establish and maintain health, and to prevent and deal with illness.” Self-care is a skill many nurses neglect. It is a set of practices and activities nurses should engage in regularly to help decrease stress levels and help nurses live longer, healthier lives.
Self-care reduces stress, replenishes a nurse’s capacity to provide compassion and empathy, and helps improve quality of care. It’s also recommended by the ANA in its Code of Ethics. Proper self-care practices for nurses have become especially important in recent years. In one survey of nurses conducted at the peak of COVID-19, 80% reported that they were suffering mental health effects because of the pandemic, and 60% said their physical health was being affected as well. Post-pandemic, nurses’ mental health remains a concern.
Exercises
1. Watch this video: Self-care and wellbeing are more important than ever. That’s why you should join the Healthy Nurse, Healthy Nation™, improving the nation’s health — one nurse at a time.
2. Share three takeaways that you would incorporate to improve self-care.
A. Self-Care Is Mandated by the ANA Code of Ethics
The fifth provision of the American Nurses Association’s Code of Ethics states that the moral respect that nurses extend to all human beings should extend to themselves as well. These duties include the responsibility to:
- Promote health and safety
- Preserve wholeness of character and integrity
- Maintain competence
- Continue personal and professional growth
B. Why Is Self-Care Important for Nurses?
Self-care is a way to reduce the stress that comes with nursing. It’s important for nurses to engage in self-care because as the old adage goes, “You can’t pour from an empty cup”. Nurses have to take care of themselves to do their jobs effectively and be the best caregiver to their patients that they can be. The nursing career is exhausting physically and emotionally. Nurses are experiencing burnout related to caregiving overload. Nurses give so much of their physical and emotional being to their patients and families. When it comes to themselves, self-care is often left behind.
The neglect of self-care can lead to unwanted, unhealthy lifestyles. According to a 2012 survey of 2,500 registered nurses, 71 percent of them experienced musculoskeletal pain and 18 percent experienced depression. This is particularly dangerous, because: “Nurses who aren’t present and caring for themselves have higher patient falls, medication errors, and lower quality of care scores”. This demonstrates how neglected self-care can be detrimental to both the nurse and his/her patients.
Furthermore, stress contributes to chronic disease. The stress hormone cortisol and the hormone adrenaline can build up in the bloodstream and lead to hyperglycemia, hyperinsulinemia, arteriosclerosis, hypertension, and a decrease in the function of the immune system. Ignoring stress can also lead to chronic fatigue or depression. Empathy and compassion are critical components of a nurse’s care. The more taxed a nurse is, the more likely that their capacity to provide these will suffer. You may see strain on the nursing units or a lack of investment in the work. It can actually place patients as well as nurses at risk.
C. Creating a Self-Care Plan for Nurses
Take the following steps to develop a plan for self-care:
Step 1
The first step to crafting a reasonable self-care plan is self-reflection and self-assessment. Where are you currently with self-care? You may wish to assess the following areas of your life:
- Physical
- Mental
- Spiritual
- Personal
- Economic
- Psychological
Step 2
Identify opportunities for growth. Mason asks pointed questions to help hone in on any shortfalls: “Do you have a spiritual or self-care deficit? Are you not attending to your needs? Are you eating too much—or not enough—to fill a void?”
Step 3
Decide which interventions you need to implement. Examples include:
- Physical. Get regular health screenings, eat clean and nutritious meals, maintain a healthy weight, and exercise.
- Mental. Use relaxation and imagery techniques. Focus attention away from fear-based, negative thought patterns and become more open to life-affirming information and patterns of thought. Seek books and groups that promote joy, and pursue counseling if necessary.
- Spiritual. Engage in activities that develop your higher self. This could be accomplished via a religious affiliation, but it doesn’t have to be. Practice meditation or yoga and say positive affirmations.
- Personal. Engage in truthful and caring self-reflection regarding your communication with others. Identify both the cohesiveness and the disharmony in your relationships. Strive to be aware of the effect both have on family and friends. Nurture important relationships.
- Economic. Live within your means. Take the steps necessary to balance your economic health. Sometimes, less is more.
- Psychological. Embrace your creativity and play. Identify what stimulates your mind and invest time into these activities.
Review the Healthy Nurse, Healthy Nation Grand Challenge—the American Nurses Association provides some wonderful recommendations on how nurses can practice self-care and lead a balanced life.
D. How Nurse Managers Can Support Their Team
Nurse managers play a vital role in helping shape their team’s morale and ensuring that everyone is functioning at their best. Modeling self-help behaviors as a leader and implementing effective self-care strategies for nurses can have a significant impact.
Some self-care techniques that managers can incorporate into their own routines for modeling purposes include taking regular breaks, pursuing physical activity, establishing healthy boundaries, and focusing on their general well-being whenever possible. Once these behaviors are commonplace, it helps diminish the stigma often associated with discussing stress and mental health. And by providing easy access to important self-care resources that emphasize staff well-being, nurse leaders open lines of communication that can benefit the nurses on their team. Here are some ways a nurse leader can further enhance nurse self-care:
- Be mindful of hours worked. Studies show that limiting an existing workload or encouraging flexible work hours can have a positive effect on staff. This is a good way to monitor your nurses’ stress levels and prevent burnout.
- Set up workshops with your team. Leaders can take an active role in encouraging healthy practices by supporting mindfulness workshops, balanced sleep, and stress reduction exercises.
- Open communication approach. Set up regular meetings with your team of nurses to listen to their doubts or concerns. By voicing their issues or other pressing worries, this approach can help improve efficiency and overall job performance.
Exercise: Self-Reflection
Throughout your nursing career, there will be times to stop and pay attention to warning signs of fatigue and anxiety that may lead to stress. Here are some questions to consider:
- Has my behavior changed?
- Do I communicate differently with others?
- What destructive habits tempt me?
- Do I project my inner pain onto others?
II. Stress in the Health Care System
Stress within any health care profession occurs as a result of the challenging and dynamic conditions experienced in day-to-day work. See Figure 13.1 for an illustration of stress in a health care environment. Nurses and health care professionals are taxed with supporting clients and families in times of extensive life stress and change. Individuals who seek out care often experience rapid life changes as the result of a new diagnosis, altered body function, death of a family member, or significant mental distress.
Nurses are frontline staff members who help clients and their families navigate these health stressors. It can be difficult to provide frontline support without taking on some of the stress encountered. As clients and families navigate their feelings of fear, frustration, anxiety, and anger, nurses are often the support members who first hear and react to these feelings. It is important to recognize the constant barrage of these emotions can take a toll, and it is challenging to not assume this emotional burden.
In addition to the emotional burden of providing support for multiple clients and their family members, nurses experience a variety of other stressors inherent to the health care environment itself. These stressors include issues such as environmental stress, increased workload, changing practice conditions, lack of resources, communication barriers, unfavorable working conditions, frequency of engagement with a variety of personnel, challenges in care coordination, workplace violence, alarm fatigue, and staff turnover. Research has identified that the variety of stressors experienced by nursing staff result in inherently greater levels of stress than that experienced in the wider working population. Therefore, nurses must acknowledge the variety of stressors they encounter within the profession and identify strategies to mitigate these forces.
Nursing is charged with emotional situations and topics even on days when no other situational stressors have significant impact. One cannot participate in the significant conversations that accompany health care decision-making, provide patient education, and promote individual coping without acknowledging these conversations are more impactful than deciding, “What should we make for dinner?” By acknowledging this inherent job stress, nurses recognize that eliminating stress within the profession is not possible. There will always be a level of stress that accompanies the health care environment, and this underscores the importance of stress identification, mitigation, and incorporation of stress-reduction strategies.
Exercises : Watch video
- Watch this video: Pause and review as time permits. (Link connected to MC library-need M number to access):
Stress and the Nursing Profession—Keeping Your Cool: Stress Management for Nurses: https://montgomerycollege.idm.oclc.org/login?url=https://fod-infobase-com.montgomerycollege.idm.oclc.org/PortalPlaylists.aspx?wID=16705&xtid=116767
2. What are some of the main causes of stress in nursing profession?
- Describe some symptoms of stress
- List some stress reduction techniques and share with your classmates
3. Describe how you are managing stress in nursing school?
III. Mitigating Stress With Self-Care
As previously discussed, the action of providing nursing care can result in significant stress. The stress response is exacerbated when experiencing extreme or repeated stressors, such as client deaths. In some health care settings, nurses do not have time to resolve grief from one loss before another death occurs.
This lack of time to resolve grief has been exacerbated during the COVID-19 pandemic where many units continually filled with clients requiring high levels of skilled nursing care. Additionally, some patients with COVID died without the face-to-face support of friends and family due to visitor restrictions. This resulted in the end-of-life transition supported solely by the health care staff. Many nurses felt additional stress due to supporting both the client and the client’s family during this challenging time.
Compassion fatigue and burnout occur frequently with nurses and other health care professionals who experience cumulative deaths that are not addressed therapeutically. Compassion fatigue is a state of chronic and continuous self-sacrifice and/or prolonged exposure to difficult situations that affect a health care professional’s physical, emotional, and spiritual well-being. This can lead to a person being unable to care for or empathize with someone’s suffering. Additionally, many individuals who experience compassion fatigue may become detached from the emotions associated with the care experience or client needs. These individuals can often appear numb to the severity of the circumstance of the events that are occurring.
Burnout can be manifested physically and psychologically with a loss of motivation. It can be triggered by workplace demands, lack of resources to perform work professionally and safely, interpersonal relationship stressors, or work policies that can lead to diminished caring and cynicism. See Figure 13.4[2] for an image depicting a nurse at home experiencing burnout due to exposure to multiple competing demands of work, school, and family responsibilities.
With the significant dangers of burnout and compassion fatigue within the nursing profession, it is important to acknowledge actions and strategies to facilitate self-care. Self-care can occur in many actions that individuals take to maintain self-health and is critically important for preventing compassion fatigue and burnout.
To facilitate self-care, nurses must recognize the need to take time off, seek out individual healthy coping mechanisms, and voice concerns within their workplace. Prayer, meditation, exercise, art, and music are examples of healthy coping mechanisms that nurses can use for self-care. Nurses should reflect on what actions bring them personal satisfaction and rejuvenation. These strategies should then be purposefully included to help reduce the influence of work-related stressors.
Exercise: Reflection
You are a nurse working in a busy Level 1 trauma center and emergency department. You are nearing the end of your third 12-hour shift and have the following day off. The unit manager approaches you and states that there has been an sick call for tomorrow’s evening shift. You are offered premium pay to come in and work.
Although there is a part of you that is interested in receiving the premium pay, you also take a moment to think about your current situation. You are tired from working three 12-hour shifts the last three days and had plans to go to your child’s baseball game tomorrow evening.
- What decision would you make?
- Could this scenario lead to compassion fatigue or burnout? Explain your answer.
- What steps will you use to create a self-care plan as a nurse?
Additionally, nurses must recognize when outside resources are needed to mitigate stress and facilitate self-care. Many organizations sponsor employee assistance programs that provide counseling services. These programs can be of great value and benefit in allowing individuals to share both individual and employment stressors. For example, employee assistance programs can address employment-related stressors, such as cumulative client deaths, as well as personal challenges impacting one’s work role, such as a family illness. The support of an impartial, trained professional can be very helpful as individuals navigate through stressful stimuli.
There are specific stress stimuli that may require specialized intervention. For example, after a client death resulting from trauma, many organizations hold debriefing sessions to allow individuals who participated in care to come together to verbalize their feelings. These sessions are often held with the support of chaplains to facilitate individual coping and verbalization of feelings. Debriefing sessions can be very helpful as individuals experience collegial support in working through traumatic stress stimuli.
Exercise
IV. Stress Management Strategies
A. Meditation
Meditation can induce feelings of calm and clear-headedness, improving concentration and attention. Research has shown that meditation increases the brain’s gray matter density, which can reduce sensitivity to pain, enhance the immune system, help regulate difficult emotions, and relieve stress. Mindfulness meditation in particular has been proven helpful for people with depression and anxiety, cancer, fibromyalgia, chronic pain, rheumatoid arthritis, type 2 diabetes, chronic fatigue syndrome, and cardiovascular disease. See Figure 13.5 for an image of an individual participating in meditation.
Figure 13.5 Meditation
B. Yoga
Yoga is a centuries-old spiritual practice that creates a sense of union within the practitioner through physical postures, ethical behaviors, and breath expansion. The systematic practice of yoga has been found to reduce inflammation and stress, decrease depression and anxiety, lower blood pressure, and increase feelings of well-being. See Figure 13.6 for an image of an individual participating in yoga.
C. Journaling
Journaling can help a person become more aware of their inner life and feel more connected to experiences. Studies show that writing during difficult times may help a person find meaning in life’s challenges and become more resilient in the face of obstacles. When journaling, it can be helpful to focus on three basic questions: What experiences give me energy? What experiences drain my energy? Were there any experiences today where I felt alive and experienced “flow”? Allow yourself to write freely, without stopping to edit or worry about spelling and grammar.
D. Prayer
Prayer can elicit the relaxation response, along with feelings of hope, gratitude, and compassion, all of which have a positive effect on overall well-being. There are several types of prayer rooted in the belief that there is a higher power that has some level of influence over one’s life. This belief can provide a sense of comfort and support in difficult times. A recent study found that clinically depressed adults who believed their prayers were heard by a concerned presence responded much better to treatment than those who did not believe.
E. Spiritual community
Join a spiritual group, such as a church, synagogue, temple, mosque, meditation center, yoga class, or other local group that meets to discuss spiritual issues. The benefits of social support are well-documented, and having a spiritual community to turn to for fellowship can provide a sense of belonging and support.
F. Nurturing relationships
Relationships with family, significant others, and friends aren’t static – they are living, dynamic aspects of our lives that require attention and care. To benefit from strong connections with others, you should take charge of your relationships and put in the time and energy you would any other aspect of your well-being. It can be helpful to create rituals together. With busy schedules and the presence of online social media that offer the façade of real contact, it’s very easy to drift from friends. Research has found that people who deliberately make time for gatherings or trips enjoy stronger relationships and more positive energy. An easy way to do this is to create a standing ritual that you can share and that doesn’t create more stress, such as talking on the telephone on Fridays or sharing a walk during lunch breaks.
G. Mindfulness
Mindfulness has been defined as, “Awareness that arises through paying attention, on purpose, in the present moment, and nonjudgmentally.” Mindfulness has also been described as, “Non-elaborative, nonjudgmental, present-centered awareness in which each thought, feeling, sensation that arises is acknowledged and accepted as it is.” Mindfulness helps us be present in our lives and gives us some control over our reactions and repetitive thought patterns. It helps us pause, get a clearer picture of a situation, and respond more skillfully.
If practiced regularly, mindfulness helps a person start to see the habitual patterns that lead to automatic negative reactions that create stress. By observing these thoughts and emotions instead of reacting to them, a person can develop a broader perspective and can choose a more effective response.
H. Nature
Spending time in nature is cited by many individuals as a spiritual practice that contributes to their mental health. Spending time in nature can help relieve stress and anxiety, improve your mood, and boost feelings of happiness and wellbeing. Whatever you call it – forest bathing, ecotherapy, mindfulness in nature, green time or the wilderness cure — humans evolved in the great outdoors, and your brain benefits from a journey back to nature.
The modern way we live has changed radically from life in the savanna, but our brains have mostly stayed the same. We still have a deep connection with nature, and research shows that if we don’t nourish that bond despite our technological advancements, we may suffer in many ways. If you’re able to, get back to nature to energize your mind and body.
I. Physical Activity
Regular physical activity, such as brisk walking, can relieve stress and tension. You may notice a “feel good” sensation immediately following your workout, and also see an improvement in overall well-being over time as physical activity becomes a regular part of your life.
Moving more can:
- release stress and calm you
- improve your mood and help you think clearly
- help you lose weight if you’re overweight, or stay at a healthy weight
- give you more energy and stamina
- lower your blood pressure
- improve your quality of sleep
- help you feel better about how you look
Explore additional free resources regarding well-being and resilience:
- American Nurses Association Healthy Nurse Healthy Nation
- University of Minnesota Earl E. Bakken Center for Spirituality and Healing
Review Exercise
Activity: Identifying Stress and Stress Management
| Step 1. Click HERE and watch this short little music clip and think about all of the different things you are told on a day to day basis that may cause you some stress. | |||||||||||||||||||
| Step 2. Take 5 minutes and turn on some music or sit somewhere quiet and make a list of stressors in your life and how you like to manage your stress. | |||||||||||||||||||
| Step 3. List your top 5 stressors here:
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Step 4. Ask 5 different people to share with you the following and fill in the table below:
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V. Reflections in Practice
Key Takeaways
Type your key takeaways here.
Exercises Professionalism and Communication Application
Professionalism in nursing means providing top-quality care to patients, while also upholding the values of accountability, respect, and integrity. (American Nurses Association, Aug. 2017). When nurses exhibit professional behaviors, patients receive better care, team communication is improved, there is increased accountability among all practitioners, and the overall clinical environment is more positive (Nursco, July 13, 2018).
- Identify topics related to communication and professionalism in patient care delivery.
- Describe how to adapt therapeutic communication to special patient care scenarios.
- Conduct patient education using the nursing process
VI. Recommended Resources
Nurse follows a prescription for self-care and promotes caring for the environment: https://engage.healthynursehealthynation.org/blogs/13/4286
Tonight Make Time For Self-care: https://engage.healthynursehealthynation.org/blogs/27/3828
Listening Centering Meditation: https://screenpal.com/watch/cr1vFUV15CW
Forest bathing as a self-care modality for nurses: https://sigma.nursingrepository.org/handle/10755/21789
References
- Chapter 12 Sleep and Rest: https://www.ncbi.nlm.nih.gov/books/NBK591812/#
- “Burnout_At_Work_-_Occupational_Burnout.jpg” by Microbiz Mag is licensed under CC BY 2.0↵
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Miller, E & Hutzel-Dunham, E.(2022). Prioritizing Self-Care of Nurses.
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Pain Management Nursing, Volume 23, Issue 6, 689 – 690,DOI:https://doi.org/10.1016/j.pmn.2022.10.004
- Waddill-Goad, S. (2016). Nurse burnout: Combating stress in nursing. Sigma Theta Tau International. ↵
- Turale, S., & Nantsupawat, A. (2021). Clinician mental health, nursing shortages and the COVID‐19 pandemic: Crises within crises. International Nursing Review, 68(1), 12-14. https://doi.org/10.1111/inr.12674↵
- Maben, J., & Bridges, J. (2020). Covid-19: Supporting nurses’ psychological and mental health. Journal of Clinical Nursing, 29(15-16), 2742-2750. https://doi.org/10.1111/jocn.15307↵
- Horan, K. M., & Dimino, K. (2020). Supporting novice nurses during the COVID-19 pandemic. AJN: American Journal of Nursing, 120(12), 11. https://doi.org/10.1097/01.NAJ.0000724140.27953.d1↵
- “Emergency_medicine_simulation_training_exercise_in_Balad%2C_Iraq.jpg” by Robert Couse-Baker is licensed under CC BY 2.0↵
- American Heart Association. (2021, October 19). Working out to relieve stress. https://www.heart.org/en/healthy-living/healthy-lifestyle/stress-management/working-out-to-relieve-stress↵
- https://med.libretexts.org/Bookshelves/Nursing/Nursing_Management_and_Professional_Concepts_(OpenRN)/12%3A_Burnout_and_Self-Care/12.01%3A_Burnout_and_Self-Care_Introduction
- Sleep Better With Healthy Lifestyle Habits: https://www.heart.org/en/healthy-living/healthy-lifestyle/sleep/sleep-better-with-healthy-lifestyle-habits
- Spend Time in Nature to Reduce Stress and Anxiety: https://www.heart.org/en/healthy-living/healthy-lifestyle/stress-management/spend-time-in-nature-to-reduce-stress-and-anxiety
