Reflective journal-self appraisal 6

Part 1:

The word stress elicits visions of something that is conflicting, uncomfortable, and even perhaps dangerous in the minds of many people. We say and hear things like, “I’m stressed out”, “That was stressful”, “You’re stressing me out” etc. Stress is a word that is thrown around quite frequently without anyone really thinking too much as to what the word means. Indeed, we think more about stress based on how it makes us feel. But..what is stress and stressors and how do these two things relate to the nursing work environment? Most importantly, how do we manage stress?

Stress and Stressors Defined

According to Seaward (2018), stress has a multiplicity of meanings as it applies to culture and the meaning of the human condition. For example, stress for Eastern cultures (India etc.) consider stress the absence of inner peace while Western cultures look at stress as being out of emotional control (Seaward, 2018). In the writer’s opinion, both of these definitions or conceptions regarding stress are synonymous because when you have inner peace you have more emotional control in your responses to your perception of and reactions to situations that may deemed to be stressful.

Seaward (2018) goes on to provide a definition of stress which comes from the Holistic medicine community,, “Stress is the inability to cope with a perceived (real or imagined) threat to one’s mental, physical, emotional, and spiritual well-being, which results in a series of physiological responses and adaptations” (p.5). Stressors are circumstances, situations, and stimulus that are perceived as a threat (Seaward, 2018). it is important to emphasize, that because what may be deemed to be a stressor is based on perception, they will vary from individual to individual. To understand how stressors work, physiology of stress or the stress response must be understood.

On a physiological level, in the body the stress response is mediated by the hypothalamic-adrenal-pituitary axis (HPA-axis). When the body perceives stress, the sympathetic nervous system and HPA-axis activates the “fight or flight” response. The HPA-axis releases the hormone cortisol which suppresses immune function, increases blood glucose levels, and breaks down different body tissues. In addition, sustained periods of the fight or flight response the sympathetic nervous system dominates the parasympathetic nervous system which is responsible for autonomic control, i.e. digestion and results in the lack of ability to return to normal physical and emotional state (Everly, No date). Anxiety, depression, high cholesterol, high blood pressure, fatigue, insulin resistance, impaired memory, delays in wound healing are some of the effects of sustained stress in the physical body due to cortisol secretion (Everly, No date; Newman, 2016).

The stressors which are common in the nursing workplace are multiple, intertwined and therefore complex. According to Glazer and Behur (2005), there are 3 known role related stressors in the nursing profession, role ambiguity, role overload, and role conflict. In a cross cultural study conducted using nurses in Maryland, United States, London, United Kingdom, Lombardia and Liguria regions in Budapest, Hungary and regions of northern Italy, the researchers investigated the roles of these stressors on job attitude and performance using correlational analysis. The results of the study showed a positive correlation between anxiety, intention to leave, and continuance commitment and a negative correlation with affective commitment to these role stressors (Glazer & Behur, 2005). These are all mental of psychological responses to what is deemed stressful.

According to Slavin (2009), the nursing shortage and inadequate staffing levels which lead to work overload and time pressure is one stressor which leads to many other stressors. Sleep deprivation due to doing doubles and in some cases triples is another huge stressor along with safety and health issues which exposes nurses to infectious and hazardous substances, ex. needlestick injuries are other sources of stressors. Work-related violence such as bullying (nurse on nurse), and hostile patients and family members are yet other sources of workplace stressors. Organizational factors such as lack of autonomy, lack of advancement, and role ambiguity are still other examples of stressors inherent in the nursing workplace. Finally, the job of nursing itself is psychologically and physically demanding which are other sources of stressors in the nursing workplace (Slavin, 2009). The findings of these studies are something that the author has experienced personally and with good cause. The lives of patients are literally in the hands of nurses who care for patients 24 hours a day, 7 days a week (Dagget, Molia, & Belachew, 2016). These demands can affect moral and are therefore, can affect the spirit.

Part 2

Stress Management Plan: 5 Recommendation for Dealing with Stressors

Positive Stressors?

As the interest in stress and stressors and there effects have resulted in studies over the years. According to Seaward (2018), although it was previously considered that the process of stress on a physiological level was initiated based on events and thoughts perceived to be good and beneficial or perceptions of events and thoughts perceived to be dangerous or a threat were the same. However, it has been recently learned that there is a difference in neurochemicals secreted in response to what is perceived based on psychoneuroimmunological data . Psychoneuroimmunological data is the information that has been obtained which trace the interconnections between the body’s immune system and the nervous system . It as been learned recently, that oxyocotin is released in response to positive social interactions and counters the stress response which suppresses the immune system and other bodily responses (Newman, 2016). This is something that can be achieved when devising a stress management plan through control of emotions which affect the body, mind and spirit.

Recommendation 1: Role Ambiguity

Based on the author’s experience, role ambiguity develops when a professional finds themselves in a situation where their actually responsibilities and duties are blurred. Reflection on these experiences have stimulated the awareness that due to the constantly changing dynamics in the nursing workplace, a nurse has to be prepared to take on various roles. Nursing shortages due to lack of retention, retiring, emergencies and other occurrences can result in the possibilities of a change in job duties and responsibilities on a regular basis.

According to Seaward (2018), the Buddhist idea of mind is that is that stress or suffering is based on what we think and desire or become strongly attached to. The recommendation therefore to successfully handling role ambiguity is the remind oneself to be fluid or flexible. In other words, adopt an attitude of detachment. This is an example of finding mental balance (Seaward, 2018). Nurses have many roles to perform. Therefore, as long as there is no risk to one’s health, safety, and loss of license, take on the attitude of cooperation and perhaps do the job that the Certified Nursing Assistant should do with a smile if there is a shortage of staff or other legitimate reason. In a nutshell, don’t take things too personally. A change in job duties may not have anything to do with you!

Recommendation 2: Role Overload

According to Raczova (2019), role overload at work and be extenuated by what is termed “dual role overload”. Dual role overload as it applies to women is a composite of the roles women play at work in and outside the work environment. According Racozova (2019), in a study that has the objective to determine the consequences of dual role overload using quota sampling of women in helping professions, negative consequences were correlated with a lack of self-care. However, in women who demonstrated participation in higher levels of self-care activities such as time management, searching for social support, ability to reassess the situation, self-monitoring, reducing excessive burden or participation in stress reduction activities such as physical exercise, relaxation techniques, breathing exercises etc. were better able to handle stress (Raczova, 2019). The author has found Donna Eden’s 5 Minute Energy exercises to be useful and has incorporated them into a weekly routine. They help to increase stamina.

Role Conflict 3: Recommendation

Role conflict may be defined as irreconcilable requests when in comes to job duties and responsibility according to Glazer and Behur (2005). This man translate into having too many chiefs and not enough Indians so to speak. In many cases, the dynamics in the nursing work place is filled with this phenomenon due to the interprofessional staff whom nurses work with such as physicians or within the ranks of nurses itself. You are given an order to do one thing for a patient that is in conflict with another order that is give at the same time. A recommendation at this point is to relax, take a deep breath and kindly communicate the conflict to each party if possible, together at same time (which is unlikely). If there is something that is obvious to you that may cause a patient harm, but all means do not do it and make notation of it if possible in the patient’s record. Have faith in your knowledge and expertise on the matter and if it is not possible to speak with the parties which are causing the role conflict, speak with the nurse manager. This is an example of getting support which is also as self-care activity (Raczova, 2019).

Recommendation 4: Time Pressure

There is a saying, a woman’s work is never done. This has a direct correlation to time pressure. Whether nurses like it or not, there will be many occasions where stress is the response to the perception that duties and responsibilities will not be done on time. Time pressure is another outgrowth of staff shortages which are anticipated and unanticipated. In reality, in most cases you can only do some of what you plan. According to Seaward (2018), feelings of being overwhelmed indicate a need for prioritizing what needs to be done.

Along with prioritizing when feeling pressed for time, it is also advisable to perform some deep breathing exercises. There is scientific evidence for why deep breathing works as a reducer of tress. According to Doucette (2019), deep breathing relieves stress and anxiety due because of its physiological effect on the nervous system and links the nervous system to the endocrine system, which secretes the hormones that regulate all activities throughout the body giving deep breathing a full body physiological effect (Doucette, 2019). The ease and convenience of deep breathing is that it can be done anywhere and any time in order to reduce stress and maintain and improve health and mental balance (Doucette 2019; Seaward, 2019)..

2018).

In summation, mindfulness, acts of self-care (i.e. developing a support system), building self-confidence, being flexible, deep breathing and maintaining a healthy detachment are some tools that can assist one with managing stress.

Part 3

Theorist of Choice: Reflection and Incorporation in Practice

The author’s theorist of choice is Carl Jung. The fascination of Carl Jung was his abilities to unite science with religion of spirituality. The writer never considered human kind just a bundle of instincts or behaviors and as a practicing Christian know that human kind has a spiritual dimension. The writer has always considered that human kind has a spiritual dimension due to religious prophesies, spiritual intuition, and most of all instances where the writer has witnessed a person get better because of prayer.

Carl Jung proposed that the spiritual nature of human kind was in the unconscious mind and was ridiculed for having such thoughts (Seaward, 2018). However, when it is thought about carefully and openly, many times our automatic response to different circumstances may very well come from the unconscious mind or we experience something in waking life that is familiar and realize that it is from a dream. We should also consider, the immateriality of a thought as further evidence of the reality of the unconscious.

According to Seaward (2018), Jung proposed the classification of “..the unconscious mind: the personal unconscious and the collective unconscious” as well as recognized what is considered the two complimentary forces in the world according to the Tao of Yin and Yang. Yin as receptive and Yang as active. This can be conceptualized as Yin the socket and Yang the plug … bingo... the means to conduct electricity. In the continuing role as nurse, carer, teacher, and indeed sometimes healer, the fact that we are also spirit as per the theory of Jung will assist this writer in learning to respect all humanity better by seeking always to understand and not condemn and to always recognize that this writer is on a journey towards self-discovery.

Reference

Dagget, T., Molla, A., & Belachew, T. (2016). Job related stress among Nurses working in Jimma Zone Public Hospitals, South West Ethiopia: A Cross Sectional Study. BMC Nursing, 15, 1–10. doi:10.1186/s12912-016-0158-2.